1220 Exam 2 Card Set - Amber Folder All Combined

Health Disparities

preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations Resulted from: -poverty -environmental threats -inadequate access to healthcare -individual and behavioral factors -educational inequalities

What are the major characteristics of a child with Down syndrome? (Select all that apply) Oblique palpebral fissures Hyperflexibility and muscle weakness Fused sagittal suture Plantar crease between 4th and 5th toes High arched, narrow palate Small nose

small nose, oblique palpebral fissures, hyperflexibility and muscle weakness, high arched, narrow plate

Prenatal Care

the routine examination of the pregnant woman by an obstetrician or advanced practice nurse such as a nurse practitioner or certified nurse midwife

Sandwich generation

when middle adults help aging parents while being responsible for their own children

Millennial Generation

young adults between the ages of 18 and 29 have been referred to as part of the:

social determinants of health

factors that contribute to a persons current state of healthFactors could be: biological, socio-economic, psychosocial, behavioral, or social in nature

For young adults there are several hallmark indicators for emotional health, which assessment indicates a need for further assessment? a. Has a sense of direction b. Has satisfaction with friendships, and no unrealistic fears c. Focuses on disappointments in life or in the past d. Refines self-perception and ability for intimacy

focuses on disappointments in life or in the past

Industry versus inferiority (6 to 11 years)

going to apply themselves to learning socially productive skills & tools. They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or skills are too difficult, they develop a sense of inadequacy and inferiority.

The nurse is completing an assessment on a male patient, age 24. Following the assessment, the nurse notes that his physical and laboratory findings are within normal limits. Because of these findings, nursing interventions are directed toward activities related to:

instructing him in health promotion activities

Braxton Hicks Contractions

irregular, short contractions

Which therapeutic management of attention deficit hyperactivity disorder (ADHD) has been found to be the most effective? Behavioral therapy Pharmacological therapy Environmental manipulation Multimodal treatment

multimodal treatment

structure or locale assessment

name of community or neighborhood, geographical boundaries, emergency services, water and sanitation, housing, economic status, transportation

community health nursing

nursing practice in the community. primary focus is on health care of individuals, families, and groups. similar to public health nursing. requires understanding the needs of a population. a set of skills and knowledge. community assessment, policy development, access to resources. goal is to preserve, protect, promote, or maintain health. provides direct care services to sub populations in a community.

community based nursing

occurs in community settings. involves acute and chronic care. enhances individuals capacity for self care. promotes autonomy in decision making. uses critical thinking skills. reduces cost for the patient by providing care in or near homes. requires knowledge of family theory, communication, group dynamics, and cultural diversity.

What was the goal to achieving health populations and communities?

overall goal of "Healthy People 2020" -->increase life expectancy and quality of life and eliminate health disparities through improved delivery of health care services

graying hair, wrinkling skin, thickening waist, decreasing hearing and visual acuity

physical changes in middle adulthood include

*When Ryan was 3 months old, he had a toy train; when his view of the train was blocked, he did not search for it. Now that he is 9 months old, he looks for it, reflecting the presence of:* A. Object permanence. B. Sensorimotor play. C. Schemata. D. Magical thinking.

*Answer: A* Rationale: He is now in Piaget's later stage of sensorimotor thought and has learned that objects exist even though he cannot see or touch them.

*A school nurse is counseling an obese 10-year-old child. Which factors would be important to consider when planning an intervention to support the child's health? (Select all that apply.)* A. Consider both the child and the family when addressing the issue. B. Consider the use of medications to suppress the appetite. C. First plan for weight loss through dieting and then add activity as tolerated. D. Plan food intake to allow for growth E. Consider consulting a bariatric surgeon if other measures fail.

*Answer: A & D* Rationale: School-age children need to participate in educational programs that enable them to plan, select, and prepare healthy meals and snacks. Children need adequate caloric intake for growth throughout childhood accompanied by activity for continued gross-motor development.

*A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are the major concerns for this patient? (Select all that apply.)* A. The loss of his work role B. The risk of social isolation C. A determination if the wife will need to start working D. How the wife expects household tasks to be divided in the home in retirement E. The age the patient chose to retire

*Answer: A & D* Rationale: The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time nor is the age of the patient.

*In an interview with a pregnant patient, the nurse discussed the three risk factors that have been cited as having a possible effect on prenatal development. They are:* A. Nutrition, stress, and mother's age. B. Prematurity, stress, and mother's age. C. Nutrition, mother's age, and fetal infections. D. Fetal infections, prematurity, and placenta previa.

*Answer: A* Rationale: A woman's diet can have a significant effect on fetal development. Pregnancy also brings physiological, cognitive, and emotional states that can cause stress and anxiety, which can affect fetal development. An older mother's fetus is at risk for chromosomal defects; and adolescent mothers have an increased risk when they expose their fetuses to alcohol, drugs, and tobacco.

*Allison, age 15 years, calls her best friend Laura and is crying. She has a date with John, someone she has been hoping to date for months, but now she has a pimple on her forehead. Laura firmly believes that John and everyone else will notice the blemish right away. This is an example of the:* A. Imaginary audience. B. False-belief syndrome. C. Personal fable. D. Personal absorption syndrome.

*Answer: A* Rationale: Adolescents are quite egocentric and have the belief that everyone is focused on them and sees all of their flaws.

*When nurses are communicating with adolescents, they should:* A. Be alert to clues to their emotional state. B. Ask closed-ended questions to get straight answers. C. Avoid looking for meaning behind adolescents' words or actions. D. Avoid discussing sensitive issues such as sex and drugs.

*Answer: A* Rationale: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and school opens the channels for further discussion. Ask open-ended questions. Look for the meaning behind their words or actions. Be alert to clues to their emotional state.

*The nurse is completing a health history with the daughter of a newly admitted patient who is confused and agitated. The daughter reports that her mother was diagnosed with Alzheimer's disease 1 year ago but became extremely confused last evening and was hallucinating. She was unable to calm her, and her mother thought she was a stranger. On the basis of this history, the nurse suspects that the patient is experiencing:* A. Delirium. B. Depression. C. New-onset dementia. D. Worsening dementia

*Answer: A* Rationale: Hallmark characteristics of delirium are acute confusion, hallucinations, and agitation. It is not a new onset of dementia since she already has a diagnosis of Alzheimer's disease and, as dementia worsens, we see a gradual rather than sudden changes in memory usually not accompanied with hallucinations. Depression does not present with acute confusion and agitation.

*An 8-year-old child is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which of the following will most help her adjust to the hospital?* A. Explain hospital routines such as mealtimes to her. B. Use terms such as "honey" and "dear" to show a caring attitude. C. Explain when her parents can visit and why siblings cannot come to see her. D. Since she is young, orient her parents to her room and hospital facility.

*Answer: A* Rationale: Illness and hospitalization threaten children's control in these areas. Therefore it is important to allow them to participate in care and maintain as much independence as possible. Nurses need to provide for privacy and offer explanations of common procedures

*At a well-child examination, the mother comments that her toddler eats little at mealtime, will only sit briefly at the table, and wants snacks all the time. Which of the following should the nurse recommend?* A. Provide nutritious snacks. B. Offer rewards for eating at mealtimes. C. Avoid snacks so she is hungry at mealtime. D. Explain to her firmly why eating at mealtime is important.

*Answer: A* Rationale: Mealtime has psychosocial and physical significance. If the parents struggle to control toddlers' dietary intake, problem behavior and conflicts can result. Toddlers often develop "food jags," or the desire to eat one food repeatedly. Rather than becoming disturbed by this behavior, encourage parents to offer a variety of nutritious foods at meals and to provide only nutritious snacks between meals.

*You are caring for a recently retired man who appears withdrawn and says he is "bored with life." Applying the work of Havinghurst, you would help this individual find meaning in life by:* A. Encouraging him to explore new roles. Correct B. Encouraging relocation to a new city. C. Explaining the need to simplify life. D. Encouraging him to adopt a new pet.

*Answer: A* Rationale: The activity theory states that continuing an active, involved lifestyle results in greater satisfaction and well-being.

*Which of the following are examples of the conventional reasoning form of cognitive development? (Select all that apply.)* A. A 35-year-old woman is speaking with you about her recent diagnosis of a chronic illness. She is concerned about her treatment options in relation to her ability to continue to care for her family. As she considers the options and alternatives, she incorporates information, her values, and emotions to decide which plan will be the best fit for her. B. A young father is considering whether or not to return to school for a graduate degree. He considers the impact the time commitment may have on the needs of his wife and infant son. C. A teenage girl is encouraged by her peers to engage in shoplifting. She decides not to join her peers in this activity because she is afraid of getting caught in the act. D. A single mother of two children is unhappy with her employer. She has been unable to secure alternate employment but decides to quit her current job.

*Answer: A, B* Rationale: Adults recognize that there are various solutions to problems and that different situations demand different solutions. Decision making includes consideration of the potential impact of a situation on others. Avoiding punishment is a pre-conventional stage of reasoning.

*Which of the following activities are examples of the use of activity theory in older adults? (Select all that apply.)* A. Teaching an older adult how to use e-mail to communicate with a grandchild who lives in another state B. Introducing golf as a new hobby C. Leading a group walk of older adults each morning D. Engaging an older adult in a community project with a short-term goal E. Directing a community play at the local theater

*Answer: A, B, D* Rationale: Activity theory aids cognitive performance by using new approaches. A daily walk would not be a new activity, and the repetitiveness of it would not meet the definition of Activity Theory. Activities that have short-term goals can be engaging for older adults.

*A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable at 130/70. The patient does not exercise regularly and states that he experiences weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.)* A. Impaired vision B. Residence design C. Blood pressure D. Leg weakness E. Exercise history

*Answer: A, D, E* Rationale: Risk factors for falling include sensory changes such as visual loss, musculoskeletal conditions affecting mobility (in this case weakness), and deconditioning (from lack of exercise). The mere presence of a chronic disease is not a risk factor unless it is a condition such as a neurological disorder that alters mobility or cognitive function. The patient's blood pressure is stable, and there is no report of orthostatic hypotension. A one-floor residence should not pose risks.

*During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings place him at risk for an adverse drug event? (Select all that apply.)* A. Taking two medications for hypertension B. Taking a total of eight different medications during the day C. Having one physician who reviews all medications D. Patient's health history of renal disease E. Involvement of the caregiver in helping with medication administration

*Answer: B & D* Rationale: The patient is at risk for an adverse drug event (ADE) because of polypharmacy and his history of renal disease, which affects drug excretion. Taking two medications for hypertension is common. Having one physician review all medications and involving a family caregiver are desirable and are safety factors for preventing ADEs.

*According to Piaget's cognitive theory, a 12-year-old child is most likely to engage in which of the following activities?* A. Using building blocks to determine how houses are constructed B. Writing a story about a clown who wants to leave the circus C. Drawing pictures of a family using stick figures D. Writing an essay about patriotism

*Answer: B* Rationale: As adolescents mature, their thinking moves to abstract and theoretical subjects. They have the capacity to reason with respect to possibilities.

*An 18-month-old child is noted by the parents to be "angry" about any change in routine. This child's temperament is most likely to be described as:* A. Slow to warm up. B. Difficult. C. Hyperactive. D. Easy.

*Answer: B* Rationale: Children described as "difficult" adapt slowly to new routines and express their emotions forcefully; they like consistent structure.

*A nurse conducted an assessment of a new patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing:* A. Dementia. B. Depression. C. Delirium. D. Hypoglycemic reaction.

*Answer: B* Rationale: Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation.

*You are caring for a 4-year-old child who is hospitalized for an infection. He tells you that he is sick because he was "bad." Which is the most correct interpretation of his comment?* A. Indicative of extreme stress B. Representative of his cognitive development C. Suggestive of excessive discipline at home D. Indicative of his developing sense of inferiority

*Answer: B* Rationale: If two events are related in time or space, preschool children link them in a causal fashion. For example, the hospitalized child reasons, "I cried last night, and that's why the nurse gave me the shot."

*A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. She notes that the patient is very thin and unkempt, has a stage 3 pressure ulcer to her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son who accompanied her to the hospital. The nurse's next step is to:* A. Call social services to begin nursing home placement. B. Ask the son to step out of the room so she can complete her assessment. C. Call adult protective services because you suspect elder mistreatment. D. Assess patient's cognitive status.

*Answer: B* Rationale: The assessment leads you to suspect elder mistreatment, but the nurse needs more information directly from the patient before calling social services or the adult protective services. She will best get this information by asking the son to leave so she can ask the patient direct questions privately. If the son refuses to leave, this will be another indication that elder mistreatment may be occurring. Cognitive testing will be important but is not the priority.

*The nurse teaches parents how to have their children learn impulse control and cooperative behaviors. This would be during which of Erikson's stages of development?* A. Trust versus mistrust B. Initiative versus guilt C. Industry versus inferiority D. Autonomy versus sense of shame and doubt

*Answer: B* Rationale: Toddlers are learning that parents and society have expectations about behaviors and that they must learn to control their behavior.

*A nurse is providing information on prevention of sudden infant death syndrome (SIDS) to the mother of a young infant. Which of the following statements indicates that the mother has a good understanding? (Select all that apply.)* A. "I won't use a pacifier to help my baby sleep." B. "I'll be sure that my baby doesn't spend any time on her abdomen." C. "I'll place my baby on her back for sleep." D. "I'll be sure to keep my baby's room cool." E. "I'll keep a crib bumper in the bed to prevent drafts."

*Answer: B, C, D* Rationale: Safeguards that reduce the risk of SIDS include proper positioning on the back; removing stuffed animals, soft bedding, and pillows; and avoiding overheating the infant.

*A nurse is participating in a health and wellness event at the local community center. A woman approaches and relates that she is worried that her widowed father is becoming more functionally impaired and may need to move in with her. The nurse inquires about his ability to complete activities of daily living (ADLs). ADLs include independence with: (Select all that apply.)* A. Driving. B. Toileting. C. Bathing. D. Daily exercise. E. Eating.

*Answer: B, C, E* Rationale: ADLs are self-care tasks that measure function and are markers for the ability to live independently. Although driving and daily exercise are important to quality of life and health maintenance, they would not necessarily impact a person's ability to live independently.

*A patient's family member is considering having her mother placed in a nursing center. The nurse has talked with the family before and knows that this is a difficult decision. Which of the following criteria does the nurse recommend in choosing a nursing center? (Select all that apply.)* A. The center needs to be clean, and rooms should look like a hospital room. B. Adequate staffing is available on all shifts. C. Social activities are available for all residents. D. The center provides three meals daily with a set menu and serving schedule. E. Staff encourage family involvement in care planning and assisting with physical care.

*Answer: B, C, E* Rationale: Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat and when it is served. A nursing center should be clean, but it should look like a person's home rather than a hospital.

*A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read. His family caregiver will be visiting before discharge. What can the nurse do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.)* A. Yell so the patient can hear you. B. Sit facing the patient so he is able to watch your lip movements and facial expressions. C. Present one idea or concept at a time. D. Send a written copy of the instructions home with him and tell him to have the family review them. E. Include the family caregiver in the teaching session.

*Answer: B, C, E* Rationale: Teaching and communication are more effective with older adults when you sit and face the patient and present one idea or concept at a time. This requires planning. Speaking loudly can distort sound. Speak in a normal tone. Sending instructions is helpful but will not directly facilitate the patient's own understanding. Sharing information with a caregiver provides someone to clarify instructions.

*A 4 month old infant has not been feeling well for 2 days. His mother has brought him to the clinic to be seen by his health care provider. Which number indicates the are of the infant's head where the nurse can assess for dehydration?* A. Posterior fontanel B. Coronal suture C. Anterior fontanel D. Sagittal suture E. Occipital bone

*Answer: C*

*What is the expected order of gross-motor development beginning with the earliest skill? 1. Move from prone to sitting unassisted 2. Sit down from standing position 3. Sit upright without support 4. Roll from abdomen to back 5. Can turn from side to back* A. 5, 4, 2, 1, 3 B. 5, 4, 1, 2, 3 C. 5, 4, 3, 1, 2 D. 4, 5, 1, 3, 2

*Answer: C* Rationale: Although the pace of growth and development varies for each individual, it usually follows the same pattern.

*The nurse sees a 76-year-old woman in the outpatient clinic. She states that she recently started noticing a glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. The nurse suspects that the woman may have:* A. Presbyopia. B. Presbycusis C. Cataract(s). D. Depression.

*Answer: C* Rationale: Cataracts normally result in blurred vision, sensitivity to glare, and gradual loss of vision. Presbyopia is a common eye condition resulting in a person having difficulty adjusting to near and far vision. The symptoms are not reflective of depression since her vision affects her ability to interact. She has not chosen to avoid her friends.

*Parents are concerned about their toddler's negativism. To avoid a negative response, which of the following is the best way for a nurse to demonstrate asking the toddler to eat his or her lunch?* A. Would you like to eat your lunch now? B. When would you like to eat your lunch? C. Would you like apple slices or applesauce with your sandwich? D. Would you like to sit at the big table to eat?

*Answer: C* Rationale: Nurses and parents can deal with the negativism by limiting the opportunities for a "no" answer.

*You are working in an adolescent health center when a 15-year-old patient shares with you that she thinks she is pregnant and is worried that she may now have a sexually transmitted infection (STI). Her pregnancy test is negative. What is your next priority of care?* A. Contact her parents to alert them of her need for birth control. B. Refer her to a primary health care provider to obtain a prescription for birth control. C. Counsel her on safe sex practices. D. Ask her to have her partner come to the clinic for sexually transmitted infection testing.

*Answer: C* Rationale: Nurses need to be sensitive to the emotional cues from adolescents before initiating health teaching to know when the teen is ready to discuss concerns. In addition, discussions with adolescents need to be private and confidential. Adolescents define health in much the same way as adults and look for opportunities to reach their physical, mental, and emotional potential.

*The nurse is working with an older adult after an acute hospitalization. The goal is to help this person be more in touch with time, place, and person. Which intervention will likely be most effective?* A. Reminiscence B. Validation therapy C. Reality orientation D. Body image interventions

*Answer: C* Rationale: Reality orientation is a communication technique that can help restore a sense of reality, improve level of awareness, promote socialization, elevate independent functioning, and minimize confusion.

*Nine-year-old Brian has a difficult time making friends at school and being chosen to play on the team. He also has trouble completing his homework and, as a result, receives little positive feedback from his parents or teacher. According to Erikson's theory, failure at this stage of development results in:* A. A sense of guilt. B. A poor sense of self. C. Feelings of inferiority. D. Mistrust.

*Answer: C* Rationale: School-age children need to feel real accomplishment and be accepted by peers to develop a sense of industry.

*A parent has brought her 6-month-old infant in for a well-child check. Which of her statements indicates a need for further teaching?* A. "I can start giving her whole milk at about 12 months." B. "I can continue to breastfeed for another 6 months." C. "I've started giving her plenty of fruit juice as a way to increase her vitamin intake." D. "I can start giving her solid food now."

*Answer: C* Rationale: The use of fruit juices and nonnutritive drinks such as fruit-flavored drinks or soda should be avoided since these do not provide sufficient and appropriate calories during this period.

*What is the proper order by age progression for the stages of Freud's psychosexual development? 1. Phallic 2. Latent 3. Oral 4. Genital 5. Anal* A. 3, 5, 1, 4, 2 B. 3, 5, 2, 1, 4 C. 5, 3, 2, 1, 4 D. 3, 5, 1, 2, 4

*Answer: D*

*Elizabeth, who is having unprotected sex with her boyfriend, comments to her friends, "Did you hear about Kathy? You know, she fools around so much; I heard she was pregnant. That would never happen to me!" This is an example of adolescent:* A. Imaginary audience. B. False-belief syndrome. C. Personal fable. D. Sense of invulnerability.

*Answer: D* Rationale: Adolescents can be risk takers and believe that they are immune to the negative consequences of behaviors; they are just beginning to be future oriented in their thought process and see everything as black or white.

*The type of injury to which a child is most vulnerable at a specific age is most closely related to which of the following?* A. Provision of adult supervision B. Educational level of the parent C. Physical health of the child D. Developmental level of the child

*Answer: D* Rationale: An understanding of the major developmental accomplishments allows for injury-prevention planning.

*Older adults frequently experience a change in sexual activity. Which best explains this change?* A. The need to touch and be touched is decreased. B. The sexual preferences of older adults are not as diverse. C. Physical changes usually do not affect sexual functioning. D. Frequency and opportunities for sexual activity may decline.

*Answer: D* Rationale: As a result of loss of a loved one or a chronic illness in themselves or their partner, opportunities for sexual activity may decline. Aging does not change the need for touch, and older adults are diverse.

*Which approach would be best for a nurse to use with a hospitalized toddler?* A. Always give several choices. B. Set few limits to allow for open expression. C. Use noninvasive methods when possible. D. Establish a supportive relationship with the mother.

*Answer: D* Rationale: Creating an environment that supports parents helps greatly in gaining the cooperation of the toddler. Establishing a trusting relationship with the parents often results in toddler acceptance of treatment.

*Dave reports being happy and satisfied with his life. What do we know about him?* A. He is in one of the later developmental periods, concerned with reviewing his life. B. He is atypical, since most people in any of the developmental stages report significant dissatisfaction with their lives. C. He is in one of the earlier developmental periods, concerned with establishing a career and satisfying long-term relationships. D. It is difficult to determine Dave's developmental stage since most people report overall satisfaction with their lives in all stages

*Answer: D* Rationale: Each of the life stages can be achieved successfully and result in satisfaction, including old age.

*The nurse is completing an admission assessment with an 80-yearold man who experienced a hip fracture following a fall. He is alert, lives alone, and has very poor hygiene. He reports a 20-pound weight loss in the last 6 months following his wife's death, as well as estrangement from his only child. He admits to falls before this most recent fall. What should the nurse suspect?* A. Dementia. B. Elder abuse. C. Delirium. D. Alcohol abuse.

*Answer: D* Rationale: Hallmarks of alcohol abuse include frequent falling, self-neglect, and poor nutrition, which could result in weight loss and may accompany depression and loss.

*When preparing a 4-year-old child for a procedure, which method is developmentally most appropriate for the nurse to use?* A. Allowing the child to watch another child undergoing the same procedure B. Showing the child pictures of what he or she will experience C. Talking to the child in simple terms about what will happen D. Preparing the child through play with a doll and toy medical equipment

*Answer: D* Rationale: Preschoolers are in the preoperational stage of cognitive development and learn more easily when play is used to teach.

*Sexuality is maintained throughout our lives. Which of the following answers best explains sexuality in an older adult?* A. When the sexual partner passes away, the survivor no longer feels sexual. B. A decrease in an older adult's libido occurs. C. Any outward expression of sexuality suggests that the older adult is having a developmental problem. D. All older adults, whether healthy or frail, need to express sexual feelings.

*Answer: D* Rationale: Sexuality is normal throughout the life span, and older adults need to be able to express their sexual feelings.

*A nursing student is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature was 37.1° C (98.8° F). The student reports her recent assessment to the registered nurse (RN): the patient's temperature is 37.2° C (99° F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend first?* A. Tell the student that temporary confusion is normal and simply requires reorientation B. Tell the student to increase the patient's fluid intake since the urine is concentrated C. Tell the student that her assessment findings are normal for an older adult D. Tell the student that he will notify the patient's health care provider of the findings and recommend a urine culture

*Answer: D* Rationale: The patient may have subtle symptoms of a urinary tract infection, as evidenced by a slight increase in body temperature, development of confusion, and the dark-colored urine. Temporary confusion is not a normal condition in older adults. Increasing the fluid intake is acceptable but not a recommendation for the set of symptoms the patient presents. The presenting set of symptoms is not normal.

*Which of the following statements is most descriptive of the psychosocial development of school-age children?* A. Boys and girls play equally with each other. B. Peer influence is not yet an important factor to the child. C. They like to play games with rigid rules. D. Children frequently have "best friends."

*Answer: D* Rationale: The school-age child prefers same-sex to opposite-sex peers. In general, girls and boys view the opposite sex negatively. Peer influence becomes quite diverse during this stage of development. Clubs and peer groups become prominent. School-age children often develop "best friends" with whom they share secrets and with whom they look forward to interacting on a daily basis

*The nurse is aware that preschoolers often display a developmental characteristic that makes them treat dolls or stuffed animals as if they have thoughts and feelings. This is an example of:* A. Logical reasoning. B. Egocentrism. C. Concrete thinking. D. Animism.

*Answer: D* Rationale: This is the belief that inanimate objects have lifelike qualities; it is a component of magical thinking evident in preoperational thought.

*You are working in a clinic that provides services for homeless people. The current local regulations prohibit providing a service that you believe is needed by your patients. You adhere to the regulations but at the same time are involved in influencing authorities to change the regulation. This action represents _______ stage of moral development.*

*Answer: Social contract (post conventional) orientation* Rationale: At this stage the individual recognizes that at times the law must be changed to meet the needs of society and that all people have basic rights, regardless of their social group.

Community Assessment "Population" list

-age distribution -sex distribution -growth trends -density -education level -predominant ethnic groups -predominant religious groups

When would a nurse do an assessment on incident rates?

-identifying/reporting new infections or diseases -determining adolescent pregnancy rates -reporting number of car accidents caused by teenagers

Community Assessment "Structure" list

-name of community/neighborhood -geographical boundaries -emergency services -water & sanitation -housing -economic status (household income, # of residents on public assistance) -transportation

Nursing practice in community health

1) Expert community health nurses: Understand the needs of a population or community Use critical thinking skills to apply knowledge Understand resources 2) Needed skills: Patient advocacy Communicating people's concerns Designing new systems that cooperate with existing systems

What is the earliest age that children begin puberty? 10-year-old girls, 10-year-old boys 12-year-old girls, 10-year-old boys 10-year-old girls, 12-year-old boys 12-year-old girls, 12-year-old boys

10 yo girls 12 yo boys

physical growth in the young adult is completed at this age

20 yrs

Lawrence Kohlberg's theory of moral development

6 stages of moral development under three levels

What is the earliest age that an infant might begin having fear of strangers (stranger anxiety)? 4 mo 6 mo 9 mo 12 mo

9 mo

stress-management technique

A 34-year-old female executive has a job with frequent deadlines. She notes that, when the deadlines appear, she has a tendency to eat high-fat, high-carbohydrate foods. She also explains that she gets frequent headaches and stomach pain during these deadlines. The nurse provides a number of options for the executive, and she chooses yoga. In this scenario yoga is used as a(n):

depression

A 50-year-old male patient is seen in the clinic. He tells the nurse that he has recently lost his job and his wife of 26 years has asked for a divorce. He has a flat affect. Family history reveals that his father committed suicide at the age of 53. The nurse should assess for the following:

health education

A 50-year-old woman has elevated cholesterol profile values that increase her cardiovascular risk factor. One method to control this risk factor is to identify current diet trends and describe dietary changes to reduce the risk. This nursing activity is a form of:

Oppression

A formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs. It occurs at individual and group experiences.

Health Disparity

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Poor health status, disease risk factors, poor health outcomes, and limited access to health care are types of disparities often interrelated and influenced by the conditions and social context in which people live.

Cultural Encounter

A process that encourages health care professionals health care professionals to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. it aims to modify a health care provider's existing belief about a cultural group and to prevent possible stereotyping.

Intersectionality

A research and policy model used to study the complexities of people's lives and experiences. The model looks at how being marginalized affects people's health and access to care. It serves to describe the forces, factors, and power structures that shape and influence life. It is a way of understanding and analyzing our complex world by looking at the human experience.

Core Measures

A set of evidence-based, scientifically researched standards of care. They are key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs. The measures apply to all patients.

1. Which of the following are examples of subjective data? (Select all that apply.) a. Patient describing excitement about discharge b. Patient's wound appearance c. Patient's expression of fear regarding upcoming surgery d. Patient pacing the floor while awaiting test results e. Patient's temperature

ANS: A, C Subjective data include patient's feelings, perceptions, and reported symptoms. Expressing feelings such as excitement or fear is an example of subjective data. Objective data are observations or measurements of a patient's health status. In this question, the appearance of the wound and the patient's temperature are objective data. Pacing is an observable patient behavior and is also considered objective data.

Which statements about culturally congruent care by the student nurse are correct? Select all that apply. One, some, or all responses may be correct. A) "It is the main goal of transcultural nursing." B) It is provided through cultural competence." C) "It is provided in accordance with set criteria." D) "It is bound to the professional health care system." E) "It depends on the patterns and needs of an individual."

A) "It is the main goal of transcultural nursing." B) It is provided through cultural competence." E) "It depends on the patterns and needs of an individual." Rationale: The main goal of transcultural nursing is to provide culturally congruent care. Cultural competence is applied to ensure the delivery of this care. Culturally congruent care is provided in accordance with people's life patterns, values, and beliefs. Culturally congruent care is tailored to the needs of people themselves, not delivered in accordance with predetermined criteria. This care may be different from the values and meanings of the professional health care system.

When preparing a client for a diagnostic procedure, which action would the nurse take if the client is wearing a religious symbol dangling from a necklace? A) Ask the client about the religious symbol and significance of removing it. B) Explain to the client that the religious symbol must be removed immediately. C) Call the radiologist performing the procedure to obtain an order to keep the necklace in place. D) Say nothing to the client, remove the necklace, and give it to a family member for safekeeping.

A) Ask the client about the religious symbol and significance of removing it. Rationale: The nurse would ask the client about the religious symbol and significance related to removing it. If safety of the client is a concern, the nurse would then explain why removal is necessary and help the client identify an acceptable plan. Explaining the religious symbol must be removed immediately is not addressing spiritual or religious significance to the client. Calling the radiologist is inappropriate because the nurse would know if the symbol can be worn without risk of harm to the client. Saying nothing to the client, removing the necklace, and giving it to a family member is taking away the client's autonomy and not acknowledging the client's religious or spiritual needs.

Which points would the nurse keep in mind when caring for a client who belongs to a different culture? Select all that apply. One, some, or all responses may be correct. A) Be aware of his or her own cultural values and behavior patterns. B) Focus on understanding the client's traditions, values, and beliefs. C) Understand that unique cultural perceptions exist regarding health practices. D) Know that every client strictly adheres to his or her cultural beliefs and traditions. E) Understand that a client's cultural background does not influence the nurse-client relationship.

A) Be aware of his or her own cultural values and behavior patterns. B) Focus on understanding the client's traditions, values, and beliefs. C) Understand that unique cultural perceptions exist regarding health practices. Rationale: <p class="rationale__text ng-binding" ng-bind-html="getFeedbackResponse()">Nurses would be aware of their own cultural values and behavior patterns. This awareness enables them to understand a client's values and beliefs. Nurses would focus on understanding the client's traditions, values, and beliefs and the manner in which these aspects influence his or her health, wellness, and illness. When educating clients about their health issues and treatment plans, nurses would understand that unique perceptions exist about the cause of an illness and its treatment. The nurse would never stereotype clients on the basis of their cultural background and assume that they strictly adhere to cultural traditions and practices. The nurse would understand that the cultural background of a client also influences the nurse-client relationship.

Which component of cultural competence is being demonstrated when the nurse motivates the immigrant to accept differences in the way a pregnant women is cared for in her current residence? A) Cultural desire B) Cultural awareness C) Cultural knowledge D) Cultural encounters

A) Cultural desire Rationale: The nurse is using cultural desire as a part of cultural competence. This component is related to motivation and commitment toward the care of an individual. Through this, an immigrant may become open to cultural differences and accept them. Cultural awareness is an in-depth self-examination of backgrounds and recognition of biases and prejudices. Cultural knowledge is a comparative study about the beliefs and care practices of other cultures. A cultural encounter is about transcultural interactions for effective communication and development.

Which is the nurse demonstrating when labeling the African-American client a drug abuser for requesting pain medication? A) Ethnocentrism B) Multiculturalism C) Cultural Encounter D) Cultural Imposition

A) Ethnocentrism Rationale: Ethnocentrism is the tendency of a person to hold his or her own beliefs superior to those of other people. It causes biases and prejudices in regard to people from other groups. This practice is transmitted by cultural groups from one generation to another. In multiculturalism, two cultures coexist and are accepted by the individual. In a cultural encounter, part of cultural competence, the nurse engages in cross-cultural interactions for effective communication. Cultural imposition occurs when the nurse or health care provider ignores the differences between his or her own culture and others, imposing his or her beliefs on people of other cultures.

The nurse provides care for a Chinese client who is experiencing leg pain. The client states, "I don't want to take any medication that I may get addicted to." Which is the correct nursing intervention in this situation? A) Give ibuprofen to the client with hot tea. B) Give morphine to the client with hot tea. C) Give ibuprofen to the client with cold water. D) Postpone medication administration to the client.

A) Give ibuprofen to the client with hot tea. Rationale: People of Chinese descent may prefer to take medication with hot tea because of cultural beliefs that hot (or yang) foods have healing properties. Ibuprofen does not pose an addiction risk, so the client may feel more comfortable taking it rather than morphine. Together hot tea and ibuprofen may be the best way to treat this client. The nurse does not give morphine to the client, even with hot tea, because the client has already stated a desire to avoid addictive medications and the nurse does not want to force the client. The nurse does not offer cold water with the ibuprofen because a person from the Chinese culture may avoid drinking cold water and other cold liquids during an illness. Postponing the medication administration may increase the severity of the pain in the client, so this is not an appropriate intervention.

The nurse is caring for an Asian client who had a laparoscopic cholecystectomy 6 hours ago. When asked whether there is pain, the client smiles and says, "No." Which action would the nurse take? A) Monitor for nonverbal cues of pain B) Check the pressure dressing for bleeding C) Assist the client to ambulate around the room D) Irrigate the client's nasogastric tube with sterile water

A) Monitor for nonverbal cues of pain Rationale: Asian clients may tend to be stoic regarding pain and usually do not acknowledge pain; therefore, the nurse should assess these clients further. This type of surgery would not require pressure dressings. First, the client must be assessed further for pain. If there is pain, the client should ambulate after, not before, receiving pain medication. Postoperatively, nasogastric tubes are irrigated when needed, not routinely.

A nursing student is conducting an assessment of a client who does not speak English. No interpreter is available. Which action by the student nurse is incorrect? A) Using medical terminology B) Proceeding in an unhurried manner C) Speaking in a low and moderate voice D) Pantomiming words and simple actions while verbalizing them

A) Using medical terminology Rationale: Nurses would follow certain guidelines when interpreter is not available while assessing a client who does not understand English. Rather than using medical terminology, the nursing student should use simple, more well-known words, like "pain" instead of "discomfort." The nursing student's other actions are appropriate. Proceeding in an unhurried manner; speaking in a low, moderate voice; and pantomiming words and simple actions while verbalizing them promote effective communication.

When compared with their non-Hispanic white counterparts, which factors contribute to the health disparities among the older adult Hispanic population? Select all that apply. One, some, or all responses may be correct. A) Value differences B) Language barrier C) Lack of health care facility D) Inadequate health insurance E) Poor diet and nutrition

A) Value differences B) Language barrier C) Lack of health care facility D) Inadequate health insurance Rationale: The health of Hispanic older adults lags behind their white counterparts due to a number of factors. Beliefs and values of some older Hispanic clients may conflict with traditional Western health care views. Most nurses are not educated in Spanish, and this language barrier may affect health care delivery. Lack of health care access and inadequate health insurance also contribute to disparities. Although their diets may differ, it does not necessarily mean their nutrition is poor, so this is not a contributing factor.

3. After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest, therapeutic hypothermia is prescribed. Which action will the nurse include in the plan of care? a. Initiate cooling per protocol. b. Avoid the use of sedative drugs. c. Check mental status every 15 minutes. d. Rewarm if temperature is below 91° F (32.8° C).

ANS A: When therapeutic hypothermia is used postresuscitation, external cooling devices or cold normal saline infusions are used to rapidly lower body temperature to 89.6° to 93.2° F (32° to 34° C). Because hypothermia will decrease brain activity, assessing mental status every 15 minutes is not done at this stage. Sedative drugs are given during therapeutic hypothermia.

The teaching plan for a 3-year-old child who is at risk for developmental delay should include which of these instructions for the parents? a. Encourage play as your child is exploring his or her surroundings. b. Insist that your child discuss various points of view, not just his or her own. c. Discuss world events with your child to foster language development. d. Actively encourage your child to read lengthy books to expedite reading and writing abilities.

ANS: A A 3-year-old child is going to use play to learn and discover the surrounding environment. Children at this age are egocentric and often are unable to see the world from any perspective other than their own. Very young children are not able to understand and comment on world events because their thinking has not advanced to abstract reasoning yet. A 3-year-old child is likely unable to read. Asking a child to perform an activity that is beyond his or her developmental abilities will likely result in frustration at not being able to complete the task.

The nurse is teaching a young adult couple about promoting the health of their 8-year-old child. The nurse knows that the parents understand the developmental stage their child is in according to Erikson when they state, "We should a. Provide proper support for learning new skills." b. Encourage devoted relationships with others." c. Limit choices and provide harsh punishment for mistakes." d. Not leave our child at school for longer than 3 hours at a time."

ANS: A An 8-year-child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised for accomplishments such as learning new skills. Developing devoted relationships is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame and doubt. Separation anxiety is usually a part of the trust versus mistrust stage.

The nurse knows that a priority reason for being knowledgeable about biophysical developmental theories is to a. Understand how the physical body grows. b. Predict definite patterns of cognitive development. c. Anticipate how patients' social behaviors develop. d. Describe the process of psychological development.

ANS: A Biophysical development refers to how our physical bodies grow and change. Nurses and other health care providers are able to quantify and compare the changes that occur as a newborn infant grows into adulthood against established norms to detect abnormalities. Biophysical development refers to physical growth, not cognitive development, social behaviors, or psychological development.

What do changing norms and values about family life in the United States reveal? a. Basic shifts in attitudes in our society b. Greater resistance to cohabitation without marriage c. Decreased numbers of infants born to unmarried women d. Greater support and acceptance from the health care system

ANS: A Changing norms and values about family life in the United States reveal basic shifts in attitudes in our society. The trend toward greater acceptance of cohabitation without marriage is a factor in the greater numbers of infants being born to unmarried women. Many times, parents from alternative family structures feel lack of support and even bias from the health care system.

4. A patient who is unconscious after a fall from a ladder is transported to the emergency department by emergency medical personnel. What should the nurse do during the primary survey of the patient? a. Obtain a complete set of vital signs. b. Check a Glasgow Coma Scale score. c. Attach an electrocardiogram monitor. d. Ask about chronic medical conditions.

ANS: B The Glasgow Coma Scale is included when assessing for disability during the primary survey. The other information is part of the secondary survey.

Which scenario best illustrates the use of data validation when making an independent nursing clinical decision? a. The nurse determines that she needs to remove a wound dressing when the patient reveals the time of the last dressing change, and she notices that the present dressing is saturated with fresh and old blood. b. The nurse administers pain medicine due at 1700 at 1600 because the patient complains of increased pain. c. The nurse removes a leg cast when the patient complains of decreased mobility. d. The nurse administers potassium when a patient complains of leg cramps.

ANS: A Changing the wound dressing is the only independent nursing action given. The nurse validates what the patient says with her own observation of the dressing. This option is the only assessment option as well that involves data validation. Administering pain medicine or potassium and removing a leg cast are examples of nursing interventions.

The nurse is assessing a patient with a hearing deficit. Where is the best place to conduct this interview? a. The patient's room with the door closed b. The waiting area with the television turned off c. The patient's room before administration of pain medication d. The patient's room while the occupational therapist is working on leg exercises

ANS: A Distractions should be eliminated as much as possible when interviewing a patient with a hearing deficit. The best place to conduct this interview is in the patient's room with the door closed. The waiting area does not provide privacy. Pain can sometimes inhibit someone's ability to concentrate, so before pain medication is administered is not advisable. It is best for the patient to be as comfortable as possible when conducting an interview. Assessing a patient while another member of the health care team is working would be distracting and is not the best time for assessment to take place.

A patient states that she is pregnant and concerned because she does not know what to expect, and she wants her husband to play an active part in the birthing process. What should the nurse tell the patient? a. Lamaze classes can prepare pregnant women and their partners for what is coming. b. The frequency of sexual intercourse is key to helping the husband feel valued. c. After the birth, the stress of pregnancy will disappear and will be replaced by relief. d. After the baby is born, the wife should accept the extra responsibilities of motherhood.

ANS: A Education such as Lamaze classes can prepare pregnant women, their partners, and other support persons to participate in the birthing process. The psychodynamic aspect of sexual activity is as important as the type or frequency of sexual intercourse to young adults. The stress that many women experience after childbirth has a significant impact on the health of postpartum women. To avoid stress in a two-career family, partners should share all responsibilities.

When utilizing Freud's psychoanalytical/psychosocial theory, the nurse recalls that a. Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality. b. Development occurs throughout the life span and focuses on psychosocial stages. c. The genital stage precedes the phallic stage of development. d. Problems evident in adult life are due to early successes and resolution of earlier developmental stages.

ANS: A Freud believed that adult personality is the result of how an individual resolved conflicts between sources of sexual pleasure and the mandates of reality. Freud had a strong influence on Erik Erikson, but Erikson's theory differed from Freud's in that it focused on psychosocial stages rather than psychosexual stages. Freud's five stages of psychoanalytical development in sequential order include oral, anal, phallic, latency, and genital. The phallic stage precedes the genital stage. In theory, problems in adult life would be due to unresolved conflicts and failures.

A Hispanic patient complains of abdominal cramping caused by empacho. Which action should the nurse take first? a. Ask the patient what treatments are likely to help. b. Massage the patient's abdomen until the pain is gone. c. Administer prescribed medications to decrease the cramping. d. Offer to contact a curandero(a) to make a visit to the patient.

ANS: A Further assessment of the patient's cultural beliefs is appropriate before implementing any interventions for a culture-bound syndrome such as empacho. Although medication, a visit by a curandero(a), or massage may be helpful, more information about the patient's beliefs is needed to determine which intervention(s) will be most helpful.

Jean Piaget's cognitive developmental theory focuses on four stages of development, including a. Formal operations. b. Intimacy versus isolation. c. Latency. d. The postconventional level.

ANS: A Jean Piaget's theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations, and formal operations. Intimacy versus isolation is part of Erik Erikson's psychosocial theory of development. Latency is stage 4 of Freud's five-stage psychosexual theory of development. The postconventional level of reasoning is part of Kohlberg's theory of moral development.

A 25-year-old patient is brought to the hospital by police after crashing his car in a high-speed chase when trying to avoid arrest for spousal abuse. What should the nurse do? a. Question the patient about drug use. b. Offer the patient a cup of coffee to calm his nerves. c. Be aware that substance abuse is usually obvious. d. Deal with the issue at hand, and put off asking about previous illnesses.

ANS: A Reports of arrests because of driving while intoxicated, wife or child abuse, or disorderly conduct are reasons for the nurse to investigate the possibility of drug abuse more carefully. Caffeine is a naturally occurring legal stimulant that stimulates the central nervous system and is not the choice for calming nerves. Substance abuse is not always diagnosable, particularly in its early stages. The nurse may obtain important information by making specific inquiries about past medical problems, changes in food intake or sleep patterns, and problems of emotional lability.

Subjective data include a. A patient's feelings, perceptions, and reported symptoms. b. A description of the patient's behavior. c. Observations of a patient's health status. d. Measurements of a patient's health status.

ANS: A Subjective data include the patient's feelings, perceptions, and reported symptoms. Only patients provide subjective data relevant to their health condition. Data sometimes reflectphysiological changes, which you further explore through objective data collection. Describing the patient's behavior, observations made, and measurements of a patient's healthstatus are all examples of objective data.

To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge of other physical development exemplars such as a. cerebral palsy. b. autism. c. attention deficit hyperactivity disorder (ADHD). d. failure to thrive.

ANS: D Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar of motor/developmental delay. Autism is an exemplar of social/emotional developmental delay. ADHD is an exemplar of a cognitive disorder.

The nurse is caring for a hospitalized young adult male who is uninsured even though he works as a dishwasher at a local restaurant. He states that he would like to get a better job, but he has no education. How can the nurse best assist this patient psychosocially? a. By providing information and referrals b. By telling the patient that he needs to go back to school c. By focusing on the patient's medical diagnoses d. By expecting the patient to be flexible in his decision making

ANS: A Support from the nurse, access to information, and appropriate referrals provide opportunities for achievement of a patient's potential. Many young adults lack the necessary resources or support systems to facilitate further education or development of skills necessary for many positions in the workplace. As a result, some young adults have limited occupational choices. Health is not merely the absence of disease but involves wellness in all human dimensions. Insecure persons tend to be more rigid in making decisions.

When there is evidence that supports a screening for an individual patient but not for the general population, the nurse would expect the United States Preventive Services Task Force Grading to be what? a. No recommendation for or against b. Recommends c. Recommends against d. Strongly recommends

ANS: A The United States Preventive Services Task Force Grading is an example of how evidence is used to make guidelines and determine priority. When there is evidence that supports a screening for an individual patient but not for the general population, there is no recommendation for or against screening the general population. Recommends is the grading when there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is the grading when there is moderate or high certainty that the intervention has no net benefit or that the harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the net benefit is substantial.

The use of critical thinking skills during the assessment phase of the nursing process ensures that the nurse a. Completes a comprehensive database. b. Identifies pertinent nursing diagnoses. c. Intervenes based on patient goals and priorities of care. d. Determines whether outcomes have been achieved.

ANS: A The assessment phase of the nursing process involves data collection to complete a thorough patient database. Identifying nursing diagnoses occurs during the diagnosis phase. The nurse carries out interventions during the implementation phase, and determining whether outcomes have been achieved takes place during the evaluation phase of the nursing process.

12. A patient arrives in the emergency department (ED) several hours after taking "25 to 30" acetaminophen (Tylenol) tablets. Which action will the nurse plan to take? a. Give N-acetylcysteine. b. Discuss the use of chelation therapy. c. Start oxygen using a non-rebreather mask. d. Have the patient drink large amounts of water.

ANS: A N-acetylcysteine is the recommended treatment to prevent liver damage after acetaminophen overdose. The other actions might be used for other types of poisoning, but they will not be appropriate for a patient with acetaminophen poisoning.

9. When requested to plan the response to the potential use of smallpox as a biological weapon, what should the emergency department (ED) nurse manager expect to obtain? a. Vaccine b. Atropine c. Antibiotics d. Whole blood

ANS: A Smallpox infection can be prevented or ameliorated by the administration of vaccine given rapidly after exposure. The other interventions would be helpful for other agents of terrorism but not for smallpox

What are the most common life events that occur during young adulthood? (Select all that apply.) a. Refining self-perception and ability for intimacy b. Achievement and mastery of the surrounding world c. Examination of life goals and relationships d. Rejection of culture-bound definitions of health and illness e. Women surrendering careers to raise families

ANS: A, B, C Between the ages of 23 and 28, the person refines self-perception and ability for intimacy. From 29 to 34, the person directs enormous energy toward achievement and mastery of the surrounding world. The years from 35 to 43 are a time of vigorous examination of life goals and relationships. Often the stresses of this re-examination result in a "midlife crisis." Each person holds culture-bound definitions of health and illness. Knowing too little about the patient's self-perception or beliefs regarding health and illness creates conflict between the nurse and the patient. Women often continue to work during the childrearing years, and many women struggle with the enormity of balancing three careers: wife, mother, and employee.

The nurse is performing an admission assessment for a non-English speaking patient who is from China. Which actions could the nurse take to enhance communication (select all that apply)? a. Use an electronic translation application. b. Use a telephone-based medical interpreter. c. Wait until an agency interpreter is available. d. Ask the patient's teenage daughter to interpret. e. Use exaggerated gestures to convey information.

ANS: A, B, C Electronic translation applications, telephone-based interpreters, and agency interpreters are all appropriate to use to communicate with non-English-speaking patients. When no interpreter is available, family members may be considered, but some information that will be needed in an admission assessment may be misunderstood or not shared if a child is used as the interpreter. Gestures are appropriate to use, but exaggeration of the gestures is not needed.

The nurse is planning playroom activities for a hospitalized 6-year-old patient. Which of the following age appropriate items that the nurse should ensure are available? (Select all that apply.) a. Crayons and paper b. Children's books c. 500-piece puzzle d. Building blocks e. Magazines and newspapers

ANS: A, B, D A school-aged child thrives on feelings of accomplishment. Drawing pictures, looking at children's books, and building blocks are all ways that a child this age could play while developing a sense of accomplishment. A 500-piece puzzle would be too difficult for a 6-year-old child to complete without the possibility of getting frustrated. Magazines and newspapers would be written at too high a reading level for a 6-year-old child. If play items offered to the child are too difficult, the child may become frustrated and may experience a feeling of inferiority.

6. A patient who has experienced blunt abdominal trauma during a motor vehicle collision reports increasing abdominal pain. What topic will the nurse plan to teach the patient? a. Peritoneal lavage b. Abdominal ultrasonography c. Nasogastric (NG) tube placement d. Magnetic resonance imaging (MRI)

ANS: B For patients who are at risk for intraabdominal bleeding, focused abdominal ultrasonography is the preferred method to assess for intraperitoneal bleeding. An MRI would not be used. Peritoneal lavage is an alternative, but it is more invasive. An NG tube would not be helpful in the diagnosis of intraabdominal bleeding.

Nurses need to provide competent care to young and middle adult patients. Why must nurses be knowledgeable about developmental theories to care for this group? (Select all that apply.) a. These theories provide nurses with a basis for understanding the life events and developmental tasks of young and middle adults. b. It is important to understand societal structures and roles because they have not changed in the past 20 or 30 years. c. Patients present challenges to nurses, who themselves are often young or middle adults coping with the demands of their respective developmental period. d. Nurses need to recognize the needs of their patients even if they are not experiencing the same challenges and events.

ANS: A, C, D Developmental theories provide nurses with a basis for understanding the life events and developmental tasks of young and middle adults. Patients present challenges to nurses who themselves are often young or middle adults coping with the demands of their respective developmental period. Nurses need to recognize the needs of their patients even if they are not experiencing the same challenges and events. Faced with a societal structure that differs greatly from the norms of 20 or 30 years ago, both men and women are assuming different roles in today's society.

When providing prenatal care, what information does the nurse expect to provide? (Select all that apply.) a. Protecting against urinary infection b. No longer needing condoms c. Exercise patterns d. Proper diet e. Physical assessments only during the last trimester

ANS: A, C, D Prenatal care includes a thorough physical assessment of the pregnant woman during regularly scheduled intervals (not just the last trimester). Information regarding STIs and other vaginal infections and urinary infections that will adversely affect the fetus and counseling about exercise patterns, diet, and child care are important for a pregnant woman.

According to Piaget's theory of cognitive development, the nurse should allow a hospitalized 4-year-old patient to safely play with a. The pump administering intravenous fluids. b. The blood pressure cuff. c. A baseball bat. d. A book to read alone in a quiet place.

ANS: B A 4-year-old child would be in the preoperational period. Children at this stage are still egocentric. Play is very important to foster cognitive development. Children should be allowed to play with any equipment that is safe and should be allowed to communicate feelings about their health care. The IV pump is not a safe piece of equipment for a 4-year-old child to play with. A baseball bat typically is not found in a hospital setting and is a potentially dangerous toy to play with in the hospital. The blood pressure cuff is a safer option. A 4-year-old child is of preschool age and more than likely is not able to read yet. Also, the book does not allow for any human interaction and communication if read alone.

The parents of a 14-year-old boy express concern over their child's rebellious behavior. The nurse should plan to respond to the parents' concern by informing them that their a. Child should be referred to a juvenile correctional facility. b. Child's behavior is normal because the adolescent is trying to adjust to his emerging identity. c. Child's behavior is a matter of concern because he is likely conflicted about establishing companionship with a partner. d. Child's behavior is expected because he is expressing his need to support future generations.

ANS: B According to Erikson, a 14-year-old adolescent is developing his identity versus role confusion. A teenager is very concerned with self and is often preoccupied with body image. Frequently, teenagers express themselves rebelliously as they struggle to discover their own identities. Rebellious behavior is very common and normal at this stage of development. A juvenile correctional facility usually is not necessary. Establishing companionship occurs in the young adult age group. Feeling the need to support future generations is usually experienced by the middle-aged adult.

The parents of a 15-month-old child express concern to the nurse about their child's thumb-sucking habit. Which of these explanations related to the child's age and developmental level would be most appropriate for the nurse to give the parents? a. Thumb sucking at this age indicates a developmental delay and should be further assessed. b. Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is normal. c. Thumb sucking at this age demonstrates a transition away from egocentric thinking. d. At this age, thumb sucking will enhance language development.

ANS: B Action patterns are used by infants and toddlers to deal with the environment. For example, the infant who learns that sucking achieves a pleasing result generalizes that action to suck fingers, blankets, or clothing. Children remain egocentric into the preoperational period. Thumb sucking does not indicate transition away from egocentric thinking. No statements have supported thumb sucking as enhancing language development.

After setting the agenda during a patient-centered interview, what will the nurse do? a. Begin by introducing himself. b. Conduct a nursing health history. c. Explain that the interview will be over in a few more minutes. d. Tell the patient that he'll be back to administer medications in 1 hour.

ANS: B After setting the agenda, the nurse should conduct the actual interview and proceed with data collection. Setting the stage begins with introductions and takes place before an agenda is set. The termination phase includes telling the patient when the interview is nearing an end. Telling the patient medications will be given later when the nurse returns would typically take place during the termination phase of the interview.

An 18-month-old patient is brought into the clinic for evaluation because the mother is concerned. The 18-month-old child hits her siblings and says only "No" when communicating verbally. According to Piaget's theory, what recommendation should the nurse make a priority? a. Consult the social worker because the child is hitting other children. b. Reassure the mother that the child is developmentally within specified norms. c. Encourage the mother to seek psychological counseling for the child. d. Remove all toys from the child's room until this behavior ceases.

ANS: B At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking, grasping, and kicking as normal schemas to deal with the environment. The social worker does not need to be consulted in this case, nor is psychological counseling warranted, because the child is exhibiting normal behaviors. Play is an important part of all children's development. Removing the toys is not necessary because this child is exhibiting normal behaviors. Removing toys and the opportunity to play with them may actually hinder the child's development.

To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge of other physical development exemplars such as a. cerebral palsy. b. autism. c. attention deficit hyperactivity disorder (ADHD). d. failure to thrive.

ANS: D Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar of motor/developmental delay. Autism is an exemplar of social/emotional developmental delay. ADHD is an exemplar of a cognitive disorder.

The nurse is caring for a Native American patient who has traditional beliefs about health and illness. Which action by nurse is most appropriate? a. Avoid asking questions unless the patient initiates the conversation. b. Ask the patient whether it is important that cultural healers are contacted. c. Explain the usual hospital routines for meal times, care, and family visits. d. Obtain further information about the patient's cultural beliefs from a family member.

ANS: B Because the patient has traditional health care beliefs, it is appropriate for the nurse to ask whether the patient would like a visit by a shaman or other cultural healer. There is no cultural reason for the nurse to avoid asking the patient questions because they are necessary to obtain health information. The patient (rather than the family) should be consulted about personal cultural beliefs. The hospital routines for meals, care, and visits should be adapted to the patient's preferences rather than expecting the patient to adapt to the hospital schedule.

The nurse is obtaining a health history from a new patient. Which data will be the focus of patient teaching? a. Age and gender b. Saturated fat intake c. Hispanic/Latino ethnicity d. Family history of diabetes

ANS: B Behaviors are strongly linked to many health care problems. The patient's saturated fat intake is a behavior that the patient can change. The other information will be useful as the nurse develops an individualized plan for improving the patient's health, but will not be the focus of patient teaching.

A 61-year-old obese patient is diagnosed with type 2 diabetes and high blood pressure. The patient states that he is upset about the diet restrictions imposed by the treatment regimen. What is the nurse's best approach? a. Tell the patient that he must do what the doctor tells him. b. Offer counseling on nutrition and exercise. c. Tell the patient about what happened to other patients who did not change their lifestyle. d. Explain that he needs to accept the care provider's advice without question if he wants to get better.

ANS: B Counseling related to physical activity and nutrition is an important component of the plan of care for overweight and obese patients. To help the patients develop positive health habits, the nurse becomes a teacher and a facilitator, providing information and positive reinforcement. Ultimately, however, the patient decides which behaviors will become habits of daily living. Scare tactics do not usually work. By providing information about how the body works and how patients form and change habits, the nurse raises the patient's level of knowledge regarding the potential impact of behavior on health. The nurse should encourage patients to express their feelings to promote problem solving and recognition of risk factors by patients themselves.

The plan of care for a patient newly diagnosed with diabetes includes health promotion with the tertiary prevention measure of a. avoiding carcinogens. b. foot screening techniques. c. glaucoma screening. d. seat belt use.

ANS: B Foot screening is considered a tertiary prevention measure, one that minimizes the problems with foot ulcers, an effect of diabetic disease and disability. Avoiding carcinogens is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Glaucoma screening is considered secondary screening—measures designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Seat belt use is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity.

At the well-child clinic, the nurse teaching a mother about health promotion activities describes immunizations as a. unique for children. b. primary prevention. c. secondary prevention. d. tertiary prevention.

ANS: B Immunizations/vaccinations are considered primary prevention measures, those strategies aimed at optimizing health and disease prevention in general. Immunizations/vaccinations are primary prevention measures for individuals across the life span, not just children. Secondary prevention measures are those designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Tertiary prevention measures are those that minimize the effects of disease and disability.

The nurse plans care for a hospitalized patient who uses culturally based treatments. Which action by the nurse is best? a. Encourage the use of diagnostic procedures. b. Coordinate the use of folk treatments with ordered medical therapies. c. Ask the patient to discontinue the cultural treatments during hospitalization. d. Teach the patient that folk remedies will interfere with orders by the health care provider.

ANS: B Many culturally based therapies can be accommodated along with the use of Western treatments and medications. The nurse should attempt to use both traditional folk treatments and the ordered Western therapies as much as possible. Some culturally based treatments can be effective in treating "Western" diseases. Not all folk remedies interfere with Western therapies. It may be appropriate for the patient to continue some culturally based treatments while he or she is hospitalized.

The nurse is caring for an Asian patient who is being admitted to the hospital. Which action would be most appropriate for the nurse to take when interviewing this patient? a. Avoid eye contact with the patient. b. Observe the patient's use of eye contact. c. Look directly at the patient when interacting. d. Ask a family member about the patient's cultural beliefs.

ANS: B Observation of the patient's use of eye contact will be most useful in determining the best way to communicate effectively with the patient. Looking directly at the patient or avoiding eye contact may be appropriate, depending on the patient's individual cultural beliefs. The nurse should assess the patient, rather than asking family members about the patient's beliefs.

While interviewing an older female patient of Asian descent, the nurse notices that the patient looks at the ground when answering questions. This nurse should a. Notify the physician to recommend a psychological evaluation. b. Consider cultural differences during this assessment. c. Ask the patient to make eye contact to determine her affect. d. Continue with the interview and document that the patient is depressed.

ANS: B Older women of Asian descent consider it rude to look an authority figure, such as a health care professional, in the eye. This nurse needs to practice culturally competent care and Appreciate the cultural differences. Assuming that the patient is depressed or in need of a psychological evaluation is inappropriate.

When doing an admission assessment for a patient, the nurse notices that the patient pauses before answering questions about the health history. Which action by the nurse is most appropriate? a. Interview a family member instead. b. Wait for the patient to answer the questions. c. Remind the patient that you have other patients who need care. d. Give the patient an assessment form listing the questions and a pen.

ANS: B Patients from some cultures take time to consider a question carefully before answering. The nurse will show respect for the patient and help develop a trusting relationship by allowing the patient time to give a thoughtful answer. Asking the patient why the answers are taking so much time, stopping the assessment, and handing the patient a form indicate that the nurse does not have time for the patient.

While completing an admission database, the nurse is interviewing a patient who states that he is allergic to latex. The most appropriate nursing action is to first a. Leave the room and place the patient in isolation. b. Ask the patient to describe the type of reaction. c. Proceed to the termination phase of the interview. d. Document the latex allergy on the medication administration record.

ANS: B The nurse should further assess and ask the patient to describe the type of reaction. The patient will not need to be placed in isolation; before terminating the interview or documenting the allergy, health care personnel need to be aware of what type of response the patient suffered.

When choosing an appropriate topic for a young adult health fair, the nurse ranks which topic as least relevant? a. Unplanned pregnancies b. Menopause and climacteric factors c. Smoking cessation d. Alcohol and drug use

ANS: B The onset of menopause and the climacteric affect the sexual health of the middle adult, not the young adult. Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes for the mother (young adult), infant, and family. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular diseases in smokers and in individuals who receive secondhand smoke and constitutes a health risk for the young adult. Substance abuse directly or indirectly contributes to mortality and morbidity in young adults.

The nurse is attempting to prompt the patient to elaborate on her complaints of daytime fatigue. Which question should the nurse ask? a. "Is there anything that you are stressed about right now?" b. "What reasons do you think are contributing to your fatigue?" c. "What are your normal work hours?" d. "Are you sleeping 8 hours a night?"

ANS: B The question asking the patient what factors might be contributing to her fatigue will elicit the best open-ended response. Asking whether the patient is stressed and asking if the patient is sleeping 8 hours a night are closed-ended questions eliciting simple yes or no responses. Asking about normal works hours will elicit a matter-of-fact response and does not prompt the patient to elaborate on her complaints of daytime fatigue nor ask about the contributing reasons.

Which strategy should be a priority when the nurse is planning care for a diabetic patient who is uninsured? a. Obtain less expensive medications. b. Follow evidence-based practice guidelines. c. Assist with dietary changes as the first action. d. Teach about the impact of exercise on diabetes.

ANS: B The use of standardized evidence-based guidelines will reduce the incidence of health care disparities among various socioeconomic groups. The other strategies may also be appropriate, but the priority concern should be that the patient receives care that meets the accepted standard.

The nurse plans health care for a community with a large number of recent immigrants from Vietnam. Which intervention is the most important for the nurse to implement? a. Hepatitis testing b. Tuberculosis screening c. Contraceptive teaching d. Colonoscopy information

ANS: B Tuberculosis (TB) is endemic in many parts of Asia, and the incidence of TB is much higher in immigrants from Vietnam than in the general U.S. population. Teaching about contraceptive use, colonoscopy, and testing for hepatitis may also be appropriate for some patients but is not generally indicated for all members of this community.

A nursing student is completing an assessment on an 80-year-old patient who is alert and oriented. The patient's daughter is present in the room. Which of the following actions made by the nursing student requires the nursing professor to intervene? a. The nursing student is making eye contact with the patient. b. The nursing student is speaking only to the patient's daughter. c. The nursing student nods periodically while the patient is speaking. d. The nursing student leans forward while talking with the patient.

ANS: B When assessing an older adult, nurses need to listen carefully and allow the patient to speak. Positive nonverbal communication, such as making eye contact, nodding, and leaning forward, shows interest in the patient. Gathering data from family members is acceptable, but when a patient is able to interact, nurses need to include information from the older adult to complete the assessment.

What should the nurse recognize when comparing the physical changes in young and middle adulthood? a. Fertility issues do not occur in young adulthood. b. Young adults are quite active but are at risk for illness in later years. c. Young adults tend to suffer more from severe illness. d. Exercise is less important in young adulthood than in middle adulthood.

ANS: B Young adults are generally active and have a minimum of major health problems. However, their lifestyles put them at risk for illnesses or disabilities during their middle or older adult years. An estimated 10% to 15% of reproductive couples are infertile, and many are young adults. Exercise in young adulthood is increasingly important to prevent or decrease the development of chronic health conditions such as high blood pressure, obesity, and diabetes that develop later in life.

MULTIPLE CHOICE 1. During the primary assessment of a victim of a motor vehicle collision, the nurse determines that the patient has an unobstructed airway. Which action should the nurse take next? a. Palpate extremities for bilateral pulses. b. Observe the patient's respiratory effort. c. Check the patient's level of consciousness. d. Examine the patient for any external bleeding.

ANS: B Even with a patent airway, patients can have other problems that compromise ventilation, so the next action is to assess the patient's breathing. The other actions are also part of the initial survey, but assessment of breathing should be done immediately after assessing for airway patency.

11. When assessing an older patient admitted to the emergency department (ED) with a broken arm and facial bruises, the nurse observes several additional bruises in various stages of healing. Which statement or question by the nurse should be first? a. "You should not go home." b. "Do you feel safe at home?" c. "Would you like to see a social worker?" d. "I need to report my concerns to the police."

ANS: B The nurse's initial response should be to further assess the patient's situation. Telling the patient not to return home may be an option once further assessment is done. A social worker or police report may be appropriate once further assessment is completed.

When developing a plan of care concerning growth and development for a hospitalized adolescent, what should the nurse do? (Select all that apply.) a. Stick with one developmental theory for consistency. b. Apply developmental theories when making observations of the individual's patterns of growth and development. c. Compare the individual's assessment findings versus established normal findings. d. Recognize his/her own moral developmental level. e. Apply a unidimensional life span perspective.

ANS: B, C, D No one theory successfully describes all the intricacies of human growth and development. Today's nurses need to be knowledgeable about several theoretical perspectives when working with patients. These theories form the basis for meaningful observation of an individual's pattern of growth and development. They provide important guidelines for an understanding of important human processes that allows the nurse to begin to predict human responses, not medical diagnoses, and to recognize deviations from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision-making process. Growth and development, as supported by a life span perspective, is multidimensional.

Which of the following methods of data collection is utilized to establish a patient's nursing database? a. Reviewing the current literature to determine evidence-based nursing actions b. Orders for diagnostic and laboratory tests c. Physical examination d. Anticipated medications to be ordered

ANS: C A nursing database includes a physical examination. Orders are included in the order section of the patient's chart. The nurse reviews the current literature in the implementation phase of the nursing process to determine evidence-based actions, and the health care provider is responsible for ordering medications. Medication orders are usually written after the database is completed.

After reviewing the database, the nurse discovers that the patient's vital signs have not been recorded by the nursing assistant. With this in mind, what clinical decision should the nurse make? a. Administer scheduled medications assuming she would have been informed if the vital signs were abnormal. b. Have the patient transported to the radiology department for a scheduled x-ray, and review vital signs upon return. c. Ask the nursing assistant to record the patient's vital signs before administering medications. d. Omit the vital signs because the patient is presently in no distress.

ANS: C The nurse should ask the nursing assistant to record the vital signs for review before administering medicines or transporting the patient to another department. The nurse should not make assumptions when providing high-quality patient care, and omitting the vital signs is not an appropriate action.

During a routine physical assessment, the nurse obtaining a health history notes that a 50-year-old female patient reports pain and redness in the right breast. What is the nurse's best action in response to this finding? a. Explain to the patient that breast tenderness is normal at her age. b. Tell the patient that redness is not a cause for concern and is quite common. c. Assess the patient as thoroughly as possible. d. Inform her that redness is the precursor to normal unilateral breast enlargement.

ANS: C A comprehensive assessment offers direction for health promotion recommendations, as well as for planning and implementing any acutely needed intervention. Redness or painful breasts are abnormal physical assessment findings in the middle adult. Increased size of one breast is an abnormal physical assessment finding in the middle adult.

A nurse using the problem-oriented approach to data collection will first a. Complete an observational overview. b. Disregard cues and complete the database questions in chronological order. c. Focus on the patient's presenting situation. d. Make accurate interpretations of the data. .

ANS: C A problem-oriented approach focuses on the patient's current problem or presenting situation rather than on an observational overview. The database is not always completed using a chronological approach if focusing on the current problem. Making interpretations of the data is not data collection. Data interpretation occurs while appropriate nursing diagnoses are assigned. The question is asking about data collection.

To gather information about a patient's home and work surroundings, the nurse will need to utilize which method of data collection? a. Carefully review lab results. b. Conduct the physical assessment before collecting subjective information. c. Perform a thorough nursing health history. d. Prolong the termination phase of the interview.

ANS: C A thorough nursing history includes information about the patient's home and work surroundings. Neither lab results nor the physical assessment will reveal much about the home and work surroundings. Collecting data is part of the working phase of the interview.

The nurse performs a cultural assessment with a patient from a different culture. Which action by the nurse should be taken first? a. Request an interpreter before interviewing the patient. b. Wait until a family member is available to help with the assessment. c. Ask the patient about any affiliation with a particular cultural group. d. Tell the patient what the nurse already knows about the patient's culture.

ANS: C An early step in performing a cultural assessment is to determine whether the patient feels an affiliation with any cultural group. The other actions may be appropriate if the patient does identify with a particular culture.

The nurse working in a clinic in a primarily African American community notes a higher incidence of uncontrolled hypertension in the patients. To correct this health disparity, which action should the nurse take first? a. Initiate a regular home-visit program by nurses working at the clinic. b. Schedule teaching sessions about low-salt diets at community events. c. Assess the perceptions of community members about the care at the clinic. d. Obtain low-cost antihypertensive drugs using funding from government grants.

ANS: C Before other actions are taken, additional assessment data are needed to determine the reason for the disparity. The other actions also may be appropriate, but additional assessment is needed before the next action is selected.

When teaching a patient with a family history of hypertension about health promotion, the nurse describes blood pressure screening as _____ prevention. a. illness b. primary c. secondary d. tertiary

ANS: C Blood pressure screening is considered secondary prevention. It is a measure designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Illness prevention is considered primary prevention. Primary prevention measures are those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Tertiary prevention measures are those that minimize the effects of disease and disability.

The nurse is teaching a class to pregnant women about common physiological changes during pregnancy. Which statement by the nurse accurately describes these changes? a. "Pregnancy enhances your ability to cope with stress." b. "Being nauseated and feeling tired will not affect your physical body image." c. "You and your partner may experience feelings of uncertainty about assuming the roles of parents." d. "Returning home after delivery will rejuvenate you and foster independence."

ANS: C Both partners think about and have feelings of uncertainty about impending role changes. Parents need reassurance that childbirth and childrearing are natural and positive experiences but are also stressful. Parents often are unable to cope with particular stressors. Morning sickness and fatigue contribute to poor body image. New mothers often return home from the hospital fatigued and unfamiliar with infant care.

An older Asian American patient tells the nurse that she has lived in the United States for 50 years. The patient speaks English and lives in a predominantly Asian neighborhood. Which action by the nurse is most appropriate? a. Include a shaman when planning the patient's care. b. Avoid direct eye contact with the patient during care. c. Ask the patient about any special cultural beliefs or practices. d. Involve the patient's oldest son to assist with health care decisions.

ANS: C Further assessment of the patient's health care preferences is needed before making further plans for culturally appropriate care. The other responses indicate stereotyping of the patient based on ethnicity and would not be appropriate initial actions.

What information should the nurse collect when assessing the health status of a community? a. Air pollution levels b. Number of health food stores c. Most common causes of death d. Education level of the individuals

ANS: C Health status measures of a community include birth and death rates, life expectancy, access to care, and morbidity and mortality rates related to disease and injury. Although air pollution, access to health food stores, and education level are factors that affect a community's health status, they are not health measures.

A nurse should instruct the parents of a 10-year-old child to keep which of the following theoretical principles in mind when dealing with a behavioral problem at home? a. Strategies that worked well with the first child will be equally as effective for the second child. b. Encourage the child to volunteer some time at a local hospital to instill a sense of fulfillment. c. Bargaining about chores in exchange for privileges may be an effective method of encouraging helpful activities. d. Do not offer praise for accomplishments and punishment for behavioral issues.

ANS: C In the concrete operations period, children begin to cooperate and share new information about the acts they perform. Parents will be able to adjust their approaches to guide the child into helpful activities within the home, such as bargaining about chores in exchange for privileges. With the birth of a second child, most parents find that the strategies that worked well with the first child no longer work at all. After birth, children grow according to their genetic blueprint and gain skills in an orderly fashion, but at each individual's own pace. The need for a sense of fulfillment is usually experienced by middle-aged adults, not children. School-aged children need praise to discourage a sense of inferiority; providing praise is the best choice for encouraging positive behaviors while nurturing growth and development.

According to Piaget's formal operations level, a 13-year-old adolescent will likely a. Hit other students to deal with environmental change. b. Use play to understand her surroundings. c. Question her parents about an upcoming presidential election. d. Question where the ice is hiding when ice has melted in her drink.

ANS: C In the formal operations period, adolescents and young adults begin to think about such subjects as achieving world peace, finding justice, and seeking meaning in life. Asking about a presidential election demonstrates that the adolescent is concerned about political issues that affect others besides her. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to 12 years), children are able to coordinate two concrete perspectives in social and scientific thinking, such as understanding the difference between "hiding" and "melting."

When describing relevant family psychosocial factors in middle adulthood that cause stress, the nurse would not include a. Singlehood and feeling isolated. b. Choices stemming from marital changes. c. Financial security and certainty. d. Planning for the future when children leave home.

ANS: C In the middle adult years, as children depart from the household, the family enters the postparental family stage. Time and financial demands on parents decrease, and the couple faces the task of redefining their own relationship. Psychosocial factors involving the family include the stresses of singlehood, marital changes, transition of the family as children leave home, and the care of aging parents.

The nurse knows that the young adult patient understands the health risks that affect his/her age group when the patient states a. "It's probably safe for me to start smoking. At my age, there's not enough time for cancer to develop." b. "I am sure that I am going to get emphysema. Both my mother and my aunt had it. It's genetic." c. "Controlling the amount of stress in my life may decrease the risk of illness." d. "I don't do drugs. I do drink coffee, but caffeine is not a drug. It is perfectly safe and has no side effects."

ANS: C Lifestyle habits that activate the stress response increase the risk of illness. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular disease in smokers and in individuals who receive secondhand smoke. The presence of certain chronic illnesses in the family increases the family member's risk of developing a disease. Family risk is distinct from hereditary disease. Caffeine is a naturally occurring legal stimulant that is readily available. Caffeine stimulates catecholamine release, which, in turn, stimulates the central nervous system; it also increases gastric acid secretion, heart rate, and basal metabolic rate.

The nurse is caring for a newly admitted patient. Which intervention is the best example of a culturally appropriate nursing intervention? a. Insist family members provide most of the patient's personal care. b. Maintain a personal space of at least 2 feet when assessing the patient. c. Ask permission before touching a patient during the physical assessment. d. Consider the patient's ethnicity as the most important factor in planning care.

ANS: C Many cultures consider it disrespectful to touch a patient without asking permission, so asking a patient for permission is always culturally appropriate. The other actions may be appropriate for some patients but are not appropriate across all cultural groups or for all individual patients. Ethnicity may not be the most important factor in planning care, especially if the patient has urgent physiologic problems.

A female staff nurse is assessing a male patient of Arab descent who is admitted with complaints of severe headaches. It is most important for the charge nurse to intervene if the nurse takes which action? a. The nurse explains the 0 to 10 intensity pain scale. b. The nurse asks the patient when the headaches started. c. The nurse sits down at the bedside and closes the privacy curtain. d. The nurse calls for a male nurse to bring a hospital gown to the room.

ANS: C Many males of Arab ethnicity do not believe it is appropriate to be alone with any female except for their spouse. The other actions are appropriate.

A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so needy and acting like a child. The best response of the nurse is that in the hospital, adolescents a. have separation anxiety. b. rebel against rules. c. regress because of stress. d. want to know everything.

ANS: C Regression to an earlier stage of development is a common response to stress. Separation anxiety is most common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the adolescent understands the rules and would not create childlike behaviors. An adolescent may want to "know everything" with their logical thinking and deductive reasoning, but that would not explain why they would act like a child.

A patient expresses fear of going home and being alone. Her vital signs are stable and her incision is nearly completely healed. The nurse can infer from the subjective data that a. The patient can now perform the dressing changes herself. b. The patient can begin retaking all her previous medications. c. The patient is apprehensive about discharge. d. Surgery was not successful.

ANS: C Subjective data include expressions of fear of going home and being alone. These data indicate that the patient is apprehensive about discharge. Expressing fear is not an appropriate sign that a patient is able to perform dressing changes independently. An order from a health care provider is required before a patient is taught to resume previous medications. The nurse cannot infer that surgery was not successful if the incision is nearly completely healed.

Interrelated concepts to professional nursing a nurse manager would consider when addressing concerns about the quality of health promotion include a. culture. b. development. c. evidence. d. nutrition.

ANS: C The interrelated concepts to professional nursing include evidence, health care economics, health policy, and patient education. Culture is a patient attribute concept. Development is a patient attribute concept. Nutrition is a health and illness concept.

A 55-year-old female presents to the outpatient clinic describing irregular menstrual periods and hot flashes. What should the nurse explain? a. Those symptoms are normal when a woman undergoes the climacteric. b. An assessment is not really needed because these problems are normal for older women. c. The patient's age and symptoms point toward normal menopause. d. The patient should stop regular exercise because that is probably causing her symptoms.

ANS: C The most significant physiological changes during middle age are menopause in women and the climacteric in men. The nurse should continue with the examination because a comprehensive assessment offers direction for health promotion recommendations, as well as for planning and implementing any acutely needed interventions. High self-esteem, a favorable body image, and a positive attitude toward physiological changes occur when adults engage in physical exercise, balanced diets, adequate sleep, and good hygiene practices that promote vigorous, healthy bodies.

A formerly independent and active older adult becomes severely withdrawn upon admission to a nursing home. When approaching this patient, which intervention should the nurse plan first? a. Offer a reward for participation in all events. b. Encourage the patient to attend all social events scheduled for the patients. c. Allow the patient to incorporate personal belongings into her room. d. Advise the patient of the importance of attending mandatory activities.

ANS: C The older adult is in the mature thinking stages of development according to Piaget and Kohlberg. According to Gould, the older adult needs help in realistically appreciating his/her accomplishments and in fostering continued development. Erikson's theory proposes that the older adult faces integrity versus despair. To avoid despair, the nurse should allow the patient to actively participate in an independent activity, such as preparing his/her own room with personal belongings. Offering a reward does not address the need for continued independence. Encouraging participation in social events again does not address independence, and the question is asking for the best first intervention. Advising the patient to attend all mandatory activities as the first intervention does not allow for the patient's independence. Some activities may be mandatory, but by first allowing the patient to decorate her room, the nurse is fostering independence and is helping the patient feel welcome and more at home.

Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a possible developmental delay based on Piaget's theory? a. The child speaks in complete sentences but often talks only about himself. b. The child still plays with a favorite doll that he has had since he was a toddler. c. The child continues to suck his thumb. d. The child describes an event from his own perspective, even though the entire family was present.

ANS: C This is a characteristic of the sensorimotor stage (birth to 2 years), where schemas become self-initiated activities. For example, the infant who learns that sucking achieves a pleasing result generalizes the action to suck fingers, blanket, or clothing. Successful achievement leads to greater exploration. By age 6, the child is in the preoperational stage of development. The child is expected to be egocentric, even though language ability is progressing. Play becomes a primary means by which children foster their cognitive development; therefore playing with a doll is considered normal at this age. Children see objects and persons from only one point of view—their own—at this stage.

Which of these statements would be most appropriate for a nurse to state when assessing an adult patient for growth and developmental delays? a. "How many times per week do you exercise?" b. "Are you able to stand on one foot for 5 seconds?" c. "Would you please describe your usual activities during the day?" d. "How many hours a day do you spend watching television or sitting in front of a computer?"

ANS: C Understanding normal growth and development helps nurses predict, prevent, and detect deviations from patients' own expected patterns. The nurse can then compare expected patterns of activity based on age with the patient's stated activity patterns to determine deviations from the patient's own expected patterns. Asking the patient to describe his/her usual daily activities will provide the nurse with useful information about the patient's own expected patterns. How many hours are spent watching television or in front of a computer and how many times the patient exercises in a week are closed-ended questions. These questions would not provide the nurse with as much information about the patient's expected patterns when his/her stated patterns are compared with expected patterns for the patient's age group to detect delays.

A nurse comparing data validation and data interpretation correctly explains the difference with which statement? a. "Validation involves looking for patterns in professional standards." b. "Data interpretation involves discovering patterns in professional standards." c. "Validation involves comparing data with other sources for accuracy." d. "Data interpretation occurs before data validation."

ANS: C Validation, by definition, involves comparing data with other sources for accuracy. Data interpretation involves identifying abnormal findings, clarifying information, and identifying patient problems. The nurse should validate data before interpreting the data and making inferences. The nurse is interpreting and validating patient data, not professional standards.

14. The emergency department (ED) triage nurse is assessing four victims involved in a motor vehicle collision. Which patient has the highest priority for treatment? a. A patient with no pedal pulses b. A patient with an open femur fracture c. A patient with paradoxical chest motion d. A patient with bleeding facial lacerations

ANS: C Most immediate deaths from trauma occur because of problems with ventilation, so the patient with paradoxical chest movements should be treated first. Face and head fractures can obstruct the airway, but the patient with facial injuries only has lacerations. The other two patients also need rapid intervention but do not have airway or breathing problems.

7. A patient with hypotension and an elevated temperature after working outside on a hot day is treated in the emergency department (ED). Which patient statement indicates to the nurse that discharge teaching has been effective? a. "I'll take salt tablets when I work outdoors in the summer." b. "I should take acetaminophen (Tylenol) if I start to feel too warm." c. "I need to drink extra fluids when working outside in hot weather." d. "I'll move to a cool environment if I notice that I'm feeling confused"

ANS: C Oral fluids and electrolyte replacement solutions such as sports drinks help replace fluid and electrolytes lost when exercising in hot weather. Salt tablets are not recommended because of the risks of gastric irritation and hypernatremia. Antipyretic drugs are not effective in lowering body temperature elevations caused by excessive exposure to heat. A patient who is confused is likely to have more severe hyperthermia and will be unable to remember to take appropriate action.

While the patient's lower extremity, which is in a cast, is assessed, the patient tells the nurse about an inability to rest at night. The nurse disregards this complaint, thinking that nocorrelation has been noted between having a leg cast and developing restless sleep. A more theoretically sound approach would be to first a. Document the sleep patterns and complaint in the patient's chart. b. Tell the patient you are just focused on the leg right now. c. Explain that a more thorough assessment will be needed next shift. d. Ask the patient about his usual sleep patterns and the onset of having difficulty resting.

ANS: D The nurse must use critical thinking skills in this situation to assess first in this situation. The best response is to gather more assessment data by asking the patient about usual sleep patterns and the onset of having difficulty resting. The nurse should assess before documenting and should not ignore the patient's complaints.

When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine the cause of the patient's behavior. From a growth and development perspective, what should the nurse recall? a. Individuals have uniform patterns of growth and development. b. Health is promoted based on how many developmental failures a patient experiences. c. Culture usually has no effect on predictable patterns of growth and development. d. When individuals experience repeated developmental failures, inadequacies sometimes result.

ANS: D "If individuals experience repeated developmental failures, inadequacies sometimes result" is a true statement. Developmental failures could manifest with ineffective coping skills. However, when an individual experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and development.

According to some developmental theorists, intellectual development and moral development differ between men and women. What did Gilligan propose? a. As women progress toward adulthood, concepts, morals, and responsibility remain unchanged. b. Providing and protecting remain the sole responsibilities of men in today's society. c. Women continue to play a minor role in the financial well-being of their families. d. Women struggle with issues of care and responsibility.

ANS: D According to Gilligan, women struggle with issues of care and responsibility, and in turn, their relationships progress toward a maturity of interdependence. As women progress toward adulthood, the moral dilemma changes from how to exercise their rights without interfering with the rights of others to "how to lead a moral life," which includes obligations to themselves and their families and people in general. Traditional masculine roles include providing and protecting. Recently, however, men have been moving into greater disequilibrium. Both men and women are assuming different roles in today's society. Today, many women pursue careers and contribute significantly to their family's income.

Components of a nursing health history include a. Current treatment orders. b. Nurse's concerns. c. Nurse's goals for the patient. d. Patient expectations.

ANS: D Components of a nursing health history include physical examination findings, patient expectations, environmental history, and diagnostic data. Current treatment orders are located under the Orders section in the patient's chart and are not a part of the nursing health history. Patient concerns, not nurse's concerns, are included in the database. Goals that are mutually established, not nurse's goals, are part of the nursing care plan.

While assessing an 18-month-old toddler, the nurse distinguishes normal from abnormal findings by remembering that Gesell's theory of development states a. "The developmental stage of the toddler is affected solely by environmental influence." b. "Developmental patterns are not affected by gene activity." c. "Skill development should be identical to that of other toddlers in the playroom." d. "Environmental influence does not affect the sequence of development."

ANS: D Gesell's theory of development states that environment plays a part in child development, but it does not have any part in the sequence of development. Other factors influencing growth and development include biological, cognitive, and socioemotional processes. Environmental factors support, change, and modify the pattern of development, but they do not generate progressions of development. Each child's pattern of growth and development is unique and is directed by gene activity. Not every child develops certain skills at the same time. Children grow according to their own genetic blueprint.

The nurse works in a clinic located in a community with many Hispanics. Which strategy, if implemented by the nurse, would decrease health care disparities for the Hispanic patients? a. Improve public transportation to the clinic. b. Update equipment and supplies at the clinic. c. Obtain low-cost medications for clinic patients. d. Teach clinic staff about Hispanic health beliefs.

ANS: D Health care disparities are due to stereotyping, biases, and prejudice of health care providers. The nurse can decrease these through staff education. The other strategies also may be addressed by the nurse but will not directly impact health disparities.

During middle adulthood, the 50-year-old patient is likely to adapt favorably to a changing body image if he or she a. Decreases the amount of physical exercise. b. Eats a diet composed of 40% fat. c. Gets less than 5 hours of sleep per night. d. Engages in good hygiene practices.

ANS: D High self-esteem, a favorable body image, and a positive attitude toward physiological changes occur when adults engage in physical exercise, balanced diets, adequate sleep, and good hygiene practices that promote vigorous, healthy bodies.

The nursing instructor will need to provide further instruction to the student who states a. "Intellectual development is affected by cognitive processes." b. "Socioemotional processes can influence an individual's growth and development." c. "Breast development is an example of a change resulting from biological processes." d. "An individual's biological processes determine physical characteristics and do not affect growth and development."

ANS: D Human growth and development is a complex pattern of movement that involves changes in biological, cognitive, and socioemotional processes. Cognitive processes comprise changes in intelligence, use of language, and development of thinking. Socioemotional processes consist of variations in personality, emotions, and relationships with others. Height and weight, development of gross and fine motor skills, and sexual maturation resulting from hormonal changes during puberty are examples of changes resulting from biological processes.

Which of these approaches would be most appropriate for the nurse to use when teaching a 4-year-old patient about a scheduled surgery? a. Give the parents a book to read about the procedure and do not discuss the procedure with the child to decrease anxiety. b. Set boundaries before teaching by telling the child that she can ask only three questions because time is limited. c. Insist that the parents wait outside the room to ensure privacy of the child. d. Allow the child to touch and hold medical equipment such as thermometers and syringes.

ANS: D Nursing interventions during the preoperational period (age 2 to 7 years) should recognize the use of play (such as handling equipment) to help the child understand the events taking place. Giving the parents a book and not involving the child is not the best option, because the nurse should explain all procedures to children and their parents. Children tend to ask a lot of questions; therefore limiting questions may increase anxiety. Parents and the child all should be involved in preoperative teaching because the parents will be the primary caregivers upon discharge.

The primary health care nurse would recommend screening based on known risk factors, because they can a. eliminate the possibility of developing a condition. b. identify appropriate treatment guidelines. c. initiate treatment of a condition or disease. d. make a substantial difference in morbidity and mortality.

ANS: D Screenings are typically indicated and recommended if the effort makes a substantial difference in morbidity and/or mortality of conditions, and they are safe, cost effective, and accurate. Ideally a screening measure will accurately differentiate individuals who have a condition from those who do not have a condition 100% of the time; however, there may be a false-negative result, or the patient may develop a condition after the screening was conducted. A screening does not specify treatment guidelines; the screen provides results, and the health care provider identifies the treatment. The goal of screening is to identify individuals in an early state of a disease so that prompt treatment can be initiated. The screening results are used for this purpose.

A staff nurse expresses frustration that a Native American patient always has several family members at the bedside. Which action by the charge nurse is most appropriate? a. Remind the nurse that family support is important to this family and patient. b. Have the nurse explain to the family that too many visitors will tire the patient. c. Suggest that the nurse ask family members to leave the room during patient care. d. Ask about the nurse's personal beliefs about family support during hospitalization.

ANS: D The first step in providing culturally competent care is to understand one's own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help achieve this step. Reminding the nurse that this cultural practice is important to the family and patient will not decrease the nurse's frustration. The remaining responses (suggest that the nurse ask family members to leave the room, and have the nurse explain to family that too many visitors will tire the patient) are not culturally appropriate for this patient.

5. A 19-yr-old patient is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization, the patient denies having any previous vaccinations. What should the nurse anticipate giving? a. Tetanus immunoglobulin (TIG) only b. TIG and tetanus-diphtheria toxoid (Td) c. Tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap)

ANS: D For an adult with no previous tetanus immunizations, TIG and Tdap are recommended. The other immunizations are not sufficient for this patient.

The nurse begins a shift assessment by examining a surgical dressing that is saturated with serosanguineous drainage on a patient who had open abdominal surgery yesterday (or 1 day ago). The nurse is performing what type of assessment approach in this situation? a. Comprehensive assessment using Gordon's Functional Health Patterns b. General to specific assessment c. Activity-exercise pattern assessment d. Problem-oriented assessment

ANS: D The nurse is not doing a complete, general assessment and then focusing on specific problem areas. Instead, the nurse focuses immediately on the problem at hand and performs a problem-oriented assessment. Utilizing Gordon's Functional Health Patterns is an example of a structured database-type assessment technique. The nurse in this question is performing a specific problem-oriented assessment approach. The nurse is not performing an activity-exercise pattern assessment in this question.

A patient verbalizes a low pain level of 2 out of 10 but exhibits extreme facial grimacing while moving around in bed. What is the nurse's best action in response to her observation? a. Proceed to the next patient's room while making rounds. b. Offer a massage because the patient does not want any more pain medicine. c. Administer the pain medication ordered for moderate to severe pain. d. Ask the patient about the facial grimacing with movement.

ANS: D The nurse needs to clarify what she observes with what the patient states. Proceeding to the next room is ignoring this visual cue. The nurse cannot assume the patient does not want pain medicine just because he rates his pain level at 2 out of 10. The nurse should not administer medication for moderate to severe pain if it is not necessary.

When performing a thorough psychosocial assessment on a young adult, what must the nurse realize? a. Having a job is the best way to relieve stress. b. Although psychologically disturbing, stress does not lead to physical illness. c. Change is inevitable and is not a factor in stress-related illness. d. Psychosocial health is often related to job and family stress.

ANS: D The psychosocial health concerns of the young adult are often related to job and family stressors. If stress is prolonged and the patient is unable to adapt to the stressor, health problems will develop. Job assessment also includes conditions and hours, duration of employment, changes in sleep or eating habits, and evidence of increased irritability or nervousness. When a patient seeks health care and presents stress-related symptoms, the nurse needs to assess for the occurrence of a life change event.

A nursing student is asked to compare major life events of young adult, middle adult, and childbearing families. Which statement by the student demonstrates understanding? a. "Young adults have gained sexual experience and do not need sexual education." b. "Once a woman has her baby, stress levels decrease, as does health risk." c. "The social pressure to get married is greater now than it ever was." d. "When married people both work, income is increased, but so is stress."

ANS: D The two-career family has benefits and liabilities. Stressors result from transfer to a new city; increased expenditures of physical, mental, or emotional energy; child care demands; or household needs. To avoid stress, partners should share all responsibilities. Young adults are at risk for sexually transmitted diseases. Consequently, there is an increased need for education regarding mode of transmission, prevention, and symptom recognition and management for sexually transmitted diseases. The stress that many women experience after childbirth has a significant impact on the health of postpartum women. Social pressure to get married is not as great as it once was, and many young adults do not marry until their late 20s or early 30s, or not at all.

The nurse cares for a patient who speaks a different language. If an interpreter is not available, which action by the nurse is most appropriate? a. Talk slowly so that each word is clearly heard. b. Speak loudly in close proximity to the patient's ears. c. Repeat important words so that the patient recognizes their significance. d. Use simple gestures to demonstrate meaning while talking to the patient.

ANS: D The use of gestures will enable some information to be communicated to the patient. The other actions will not improve communication with the patient.

The nurse in a newly opened community health clinic is developing a program for the individuals considered at greatest risk for poor health outcomes. The group is considered the a. global community. b. sedentary society. c. unmotivated population. d. vulnerable populations.

ANS: D Vulnerable populations refers to groups of individuals who are at greatest risk for poor health outcomes. The entire world is the global community. Sedentary refers to the lifestyles of people worldwide who have epidemic rates of obesity and many other related chronic diseases. Unmotivated population refers to the individuals who have not demonstrated interest in changing.

A nurse discusses the risks of repeated sun exposure with a young adult patient. Which of these patient responses would be most expected from this patient? a. "I'll make an appointment with my doctor right away for a full skin check." b. "I should consider participating in a health fair about safe sun practices." c. "I have a mole that has been bothering me. I'll call my family doctor for an appointment to get it checked." d. "I've had this mole my whole life. So what if it changed color? My skin is fine."

ANS: D Young adults often ignore physical symptoms and often postpone seeking health care. Making an appointment right away with the doctor and participating in health fairs are not typical behaviors of young adults for the same reason.

10. Which finding indicates that the nurse should discontinue active rewarming of a patient admitted with hypothermia? a. The patient begins to shiver. b. The BP decreases to 86/42 mm Hg. c. The patient develops atrial fibrillation. d. The core temperature is 94° F (34.4° C).

ANS: D A core temperature of at least 89.6° to 93.2° F (32° to 34° C) indicates that sufficient rewarming has occurred. Dysrhythmias, hypotension, and shivering may occur during rewarming, and should be treated but are not an indication to stop rewarming the patient.

8. A 22-yr-old patient who experienced a drowning accident in a local pool, but now is awake and breathing spontaneously, is admitted for observation. Which assessment will be most important for the nurse to take during the observation period? a. Auscultate heart sounds. b. Palpate peripheral pulses. c. Check mental orientation. d. Auscultate breath sounds.

ANS: D Because pulmonary edema is a common complication after drowning, the nurse should assess the breath sounds frequently. The other information also will be obtained by the nurse, but it is not as pertinent to the patient's admission diagnosis.

2. During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left pedal and posterior tibial pulses are absent, and the entire leg is swollen. Which action will the nurse take next? a. Send blood to the lab for a complete blood count. b. Assess further for a cause of the decreased circulation. c. Finish the airway, breathing, circulation, disability survey. d. Start normal saline fluid infusion with a large-bore IV line.

ANS: D The assessment data indicate that the patient may have arterial trauma and hemorrhage. When a life-threatening injury is found during the primary survey, the nurse should immediately start interventions before proceeding with the survey. Although a complete blood count is indicated, administration of IV fluids should be started first. Completion of the primary survey and further assessment should be completed after the IV fluids are initiated.

Case manager

Ability to establish an appropriate plan of care based on the assessment of patients and families and to coordinate needed resources and services for patients well being across a continuum of care

Stereotype

An assumed belief regarding a particular group. Avoid these.

Concrete operations 7 to 11 years

Are not able to perform mental operations. Able to describe a process without actually doing it. Able to coordinate to concrete perspectives and social and scientific thinking so that they are able to appreciate the difference between their perspective and that of a friend.

The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs related to: (A) physical development (B) anticipatory guidance (C) sexual development (D) low-risk adolescents

B anticipatory guidance The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-risk, adolescents. Physical development is assessed with anthropometric data. Sexual development is assessed using physical examination.

The school nurse talking with a high school class about the difference between growth and development would best describe growth as: (a) qualitative changes associated with aging (b) quantitative changes in size or weight (c) processes by which early cells specialize (d) psychosocial and cognitive changes

B quantitative changes in size or weight Growth is a quantitative change in which an increase in cell number and size results in an increase in overall size or weight of the body or any of its parts. The processes by which early cells specialize are referred to as differentiation. Psychosocial and cognitive changes are referred to as development. Qualitative changes associated with aging are referred to as maturation.

During a survey, the community nurse meets a client who has not visited a gynecologist after the birth of her second child. The client says that her mother or sister never had annual gynecologic examinations. Which factor is influencing the client's health practice? A) Spiritual belief B) Family practices C) Emotional Factors D) Cultural Background

B) Family practices Rationale: Family practices influence the client's perception of the seriousness of diseases. The client does not feel the need to seek preventive care measures because no family member practices preventive care. The client is not influenced by spiritual beliefs in this instance. An individual's spiritual beliefs and religious practices may restrict the use of certain forms of medical treatment. Emotional factors such as stress, depression, or fear may influence an individual's health practice; however, this client does not show signs of being affected by emotional factors. The client is said to be influenced by cultural background if he or she follows certain beliefs about the causes of illness and uses customary practices to restore health.

Which culturally based behavior would the nurse expect to observe in an Asian client who has symptoms of anxiety and panic? A) Reluctance to take medication B) Minimal eye contact C) Desire to have an Asian nurse D) Offense at being touched

B) Minimal eye contact Rationale: As a show of respect, people in Asian cultures tend to make little eye contact, particularly with people perceived as authority figures. People from Asian cultures are accustomed to taking medication, herbs, and other complementary therapies, so the nurse would assess before administering medication. Health care professionals with the same cultural background may be preferred, but the nurse would assess if language barriers are the chief concern. If a client is highly anxious or having symptoms of a panic attack, the nurse would not use touch, regardless of the cultural background or ethnicity.

What is the term for the toddler's need to maintain sameness and reliability which provides a sense of comfort? Animism Ritualism Negativism Egocentrism

B. Ritualism

Racial Identity

Based on one's self-identification with one or more social groups in which a common heritage with a particular racial group is shared.

Temperament

Behavioral style that affects an individual's emotional interactions with others

Preoperational 2 to 7 years

Learn to think with the use of symbols and mental images. They exhibit egocentrism and that they see objects and persons from only one point of view, their own. They believe that everyone experiences the world exactly as they do. They believe that inadament object have life like thought, wishes, and feelings

During the process of delegation, which process can improve the lines of communication in a health care organization? A) Considering all aspects of client care B) Selecting experienced nursing assistants as delegatees C) Appreciating and valuing each other's cultural perspectives D) Choosing a delegatee having similar strengths as that of the delegator

C) Appreciating and valuing each other's cultural perspectives Rationale: The lines of communication in a health care organization can be improved by appreciating and valuing each other's cultural perspectives, which balances strengths between the delegator and delegatee and improves client care outcomes. Considering all aspects of client care ensures that all of the client care needs are addressed. Selecting experienced nursing assistants as delegatees increases the chance that the delegatee will adapt to changing situations. Selecting a delegatee having similar strengths as that of the delegator may decrease the lines of communication because the delegatee might do the task of the delegator.

Which of these cultural groups adopts a combination of dietary, herbal, and other naturalistic therapies to prevent and treat illness? A) East Asian B) Hispanic C) Asian Indian D) Native American

C) Asian Indian Rationale: Asian Indians rely on a combination of dietary, herbal, and other naturalistic therapies to prevent and treat illness. East Asians use yin treatment (which uses needles to restore balance and flow of qi) and yang treatment (which uses moxibustion or heat with acupuncture to restore the yin/yang balance). Hispanics use a combination of prayers, herbs, and other rituals to treat traditional illnesses. Native Americans rely on a combination of prayers, chanting, and herbs to treat illnesses caused by supernatural, psychological, and physical factors.

A family member of a client who is prescribed a blood transfusion mentions that blood transfusions are not permitted in their faith. Which would the nurse do to handle the situation? A) Wait for the court's order to give blood to the client. B) Proceed with the transfusion to save the client's life. C) Inform the primary health care provider and not give blood to the client. D) Explain to the family member that the client needs this transfusion.

C) Inform the primary health care provider and not give blood to the client. Rationale: The client or the client's family member has the right to refuse treatment and the nurse would value their beliefs and traditions. The nurse would inform the primary health care provider and not perform the blood transfusion. The nurse would not wait for a court's order or try to convince the family member to change his or her mind. The nurse would not proceed with the treatment because this may cause severe legal implications.

The nurse is helping a client who observes the traditional Jewish dietary laws to prepare a dietary menu. Which considerations would the nurse make? A) Eating beef and veal is prohibited B) Consumption of fish with scales is forbidden C) Meat and milk at the same meal is forbidden D) Consuming alcohol, coffee, and tea is prohibited

C) Meat and milk at the same meal is forbidden Rationale: Jewish dietary laws prohibit any combination of milk and meat at the same meal. The Hindu, not Jewish, religion prohibits the ingestion of beef and veal; many Hindus believe that the cow is sacred. Fish that have scales and fins are considered clean and are allowed in the diet. Seventh Day Adventists, Baptists, Mormons, and Muslims prohibit some or all of the beverages alcohol, coffee, and tea.

A new mother says to the nurse, "I would like to care for my baby independently rather than depending on the baby's grandparents." From this information, which culture would the nurse infer that the new mother belongs to? A) Asian Culture B) African Culture C) North American Culture D) Latin American Culture

C) North American Culture Rationale: People who belong to North American and Western European cultures generally possess individualistic characteristics. People who belong to Asian, African, and Latin American cultures generally do not possess individualistic characteristics; instead, they have a collectivistic approach. The new mother who belongs to any of these cultures, other than the North American culture, may depend on elder family members for child-rearing.

When a client is a member of a different ethnic community, which action would the nurse take? A) Ensure that the nurse's biases are understood by the family B) Make plans to counteract the clients misconceptions about therapies C) Offer a therapeutic regimen compatible with the lifestyle of the family D) Recognize that generally all clients just want good nursing care.

C) Offer a therapeutic regimen compatible with the lifestyle of the family Rationale: The client cannot be expected to accept or even respond to a plan that is incompatible with the family's lifestyle. The family should not have to adjust to the nurse's biases; the nurse must self-identify biases and ensure that they do not interfere with nursing care. There is no evidence that misconceptions will occur. All individuals want good nursing care, but the perception and ideas of what constitutes good care may be different.

Which Quality and Safety Education for Nurses (QSEN) competency does the nurse comply with when asking a client from another country about his or her health care traditions? A) Safety B) Informatics C) Patient-centered care D) Teamwork and collaboration

C) Patient-centered care Rationale: The nurse who provides compassionate and coordinated care to clients based on their preferences, values, and needs is providing patient-centered care. Asking about the health care traditions followed in the client's country is an example of patient-centered care. Safety involves minimizing the risk of harm to clients and primary health care providers. Informatics involves using information and technology to communicate, manage knowledge, mitigate errors, and support decision-making. Teamwork and collaboration involves nursing and interprofessional teams working together effectively to achieve quality client care.

Competency in Community-Based Nursing

Caregiver Case manager Change agent Patient advocate Collaborator Counselor Educator Epidemiologist

What are the roles of a community-based nurse?

Caregiver, case manager, change agent, patient advocate, collaborator, counselor, educator, and epidemiologist

Autonomy versus shame and sense of doubt (1-3 years)

Child gains new found independence (because of being able to walk, feed themselves, and toilet) and they begin to develop autonomy by making choices. These choices include activities related to relationships, desires, and play things. There is also an opportunity to learn that parents and society has expectations about these choices. Limiting choices and/or enacting harsh punishment leads to feelings of shame and doubt. The toddler who successfully masters this stage achieves self control and willpower.

Community Assessment "Social System" list

Community Assessment "Social System" list -education system -government -communication system -welfare system -volunteer programs -health system

Principles of development

Continuous process through life, orderly sequence, predictable but unique ranges, systems mature at different rates, more rapid in early periods.

Cultural Respect

Critical to reducing health disparities and improving access to high-quality health care that is respectful and responsive to the needs of the diverse patient.

Which response would the nurse give to a newly delivered client who asks to take the placenta home with her upon discharge? A) "I'll make sure it is kept for you." B) "I'm sorry, but you can't do that." C) "I'll give it to your husband to take home now." D) "I need to check the hospital protocol for our policy on that practice."

D) "I need to check the hospital protocol for our policy on that practice." Rationale: The placenta is a part of the body and contains body fluids. It must first be assessed by the health care provider to be sure that it is not infected and to be sure that all parts of the placenta have been accounted for. The nurse must follow hospital protocol regarding the release of the placenta to the family. All necessary documentation must be signed and the policies must be followed before the release of the placenta to the family.

The nurse leader states, "The people in rural America dress and act differently from those in urban centers." Which concept describes this statement? A) Acculturation B) Ethnocentrism C) Cultural Imposition D) Cultural Marginality

D) Cultural Marginality Rationale: Cultural marginality is defined as situations and feelings of passive betweenness when people exist between two different cultures. Acculturation refers to adapting to a particular culture. It is a process by which a person becomes a competent participant in the dominant culture. Ethnocentrism refers to the belief that one's own ways are the best, most superior, or preferred ways to act, believe, or behave. Cultural Imposition is defined as the tendency of individuals or groups to impose their values, beliefs, and practices on another culture for varied reasons.

The nurse leader is teaching the staff that the health care provider strives to work effectively within the cultural context of a client. Which cultural principle is the nurse leader explaining? A) Cultural diversity B) Cultural sensitivity C) Cultural imposition D) Cultural competence

D) Cultural competence Rationale: Cultural competence is the process in which the health care provider strives to achieve the ability to work effectively within the cultural context of a client, individual, family, or community. Cultural diversity describes a vast range of cultural differences among individuals or groups. Cultural sensitivity describes the affective behaviors in individuals such as the capacity to feel, convey, and react to ideas, habits, and customs or traditions unique to a group of people. Cultural imposition is defined as the tendency of an individual or group to impose their values, beliefs, and practices on another culture for various reasons.

Which action would the nurse therapist take when the father of an autistic child states that the family members wish to share their religious beliefs with the therapist? A) Ask the father if religious beliefs relate to the child's autism. B) Include the mutual discussion of religious beliefs. C) Invite the family's religious leader to a therapy session. D) Encourage discussion of their religion in the sessions.

D) Encourage discussion of their religion in the sessions. Rationale: If religious beliefs are a family concern, the nurse should encourage discussion of their thoughts and feelings; this would include the relationship of religious beliefs to the child's autism if this topic is important to the family. The role of the nurse is to facilitate and listen, not to participate in a mutual discussion about religious beliefs. The religious leader is not part of the family unit and should be invited only if this is requested by the family.

Which consideration is the most important when attempting to incorporate the Latino client's cultural background into the plan of care? A) Socioeconomic considerations regarding hospitalization B) The meaning and attention the client places on the future C) The client's need to control care to ensure desired outcomes D) Inclusion of the family in the plan of care with the client's permission

D) Inclusion of the family in the plan of care with the client's permission Rationale: In Latino cultures, there is usually a strong family bond, and the support of the family is essential during stressful times. Socioeconomic status does not play more than the usual role in decisions regarding appropriate health care options. Latino clients tend to be present, not future, oriented. They often believe in fate and believe that outcomes are influenced by external controls (e.g., divine being, authority figures).

The nurse manager works on a unit where the nursing staff members are uncomfortable taking care of clients from cultures that are different from their own. Which action would the nurse manager take to address this problem? A) Assign articles about various cultures so that the nurses can become more knowledgeable. B) Relocate the nurses to units where they will not have to care for clients from a variety of cultures. C) Rotate the nurses' assignments so they have an equal opportunity to care for clients from other cultures. D) Plan a workshop that offers opportunities to learn about the cultures the nurses might encounter while at work

D) Plan a workshop that offers opportunities to learn about the cultures the nurses might encounter while at work Rationale: A workshop provides an opportunity to discuss cultural diversity; this should include identification of one's own feelings. Also, it provides an opportunity for participants to ask questions. Although articles provide information, they do not promote a discussion about the topic. Relocation is not feasible or desirable; clients from other cultures are found in all settings. Rotating the nurses' assignments probably will increase tension on the unit.

Which is the secondary use of data from the 2000 census classification system to identify disparities in mental health care along racial-ethnic lines? A) To provide culturally relevant care to the required ethnic group B) To identify all racial and ethnic groups in the United States C) To identify why there are disparities in the United States D) To determine when and how the health care needs of the ethnic populations are being met

D) To determine when and how the health care needs of the ethnic populations are being met Rationale: The census classification system categorized individuals according to racial and ethnic descriptions. In addition to identifying health disparities, recording these classifications helps determine when and how the health care needs of ethnic populations are being met. Nurses would practice culturally relevant nursing to meet the needs of culturally diverse clients of a specific ethnic group; the census has nothing to do with this. Because each racial group contains multiple ethnic cultures, the census does not succeed in identifying all of them in the United States, and it doesn't include them all as options. Although the census helps identify health disparities, it does not attempt to examine and determine why they exist.

Psychoanalytical / psychosocial theory

Describe human development from the perspectives of personality, thinking, and behavior. Explains development is primarily unconscious and influenced by emotion. Unconscious drives influence development through universal stages experienced by all individuals

Erik Erikson's theory of psychosocial development

Development occurs throughout the lifespan and is focused on psychosocial stages. Individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one. Each task is framef with opposing conflicts, and tasks once mastered are challenged and tested again during new situations or at times of conflict.

Sensorimotor (birth to 2 years)

During this stage the child learns about himself and his environment through motor and reflex reactions. They learn that they are separate from the environment and aspects of environment continue to exist even though they cannot always be seen. Object permanence

Gesell's theory of development

Each child pattern of growth is unique and this pattern is directed by gene activity. The pattern of maturation follows a fixed developmental sequence in humans. Sequential development is evident in fetuses, in which there is a specified order of organ system development.

Initiative versus guilt (3 to 6 years)

Fantasy an imagination allows them to further explore their environment. In this time they are developing their superego, or conscience. Conflicts often occur between the child's desire to explore and the limits placed on his or her behavior. These conflicts sometimes lead to feelings of frustration and guilt. Successful resolution of the stage results in direction and purpose.

generativity vs. Self-absorption and stagnation (middle age)

Focuses on supporting future generations. The ability to expand one's personal and social involvement is going to go on this stage of development. Achieve success in this stage by contributing to future generations through parenthood, teaching, and community involvement. Inability to play a role in the development of the next generation results in stagnation

What is an example of assessment that is done on communities that can help fulfill the goal of healthy people 2020?

Gathering information on incident rates for identifying and reporting new infections or diseases, determining adolescent pregnancy rates, and reporting the number of motor vehicle accidents by teenage drivers.

What could a comprehensive community assessment lead to in the community?

Health programs such as: adolescent smoking prevention sex education proper nutrition

What does community based care focus on?

Health promotion, disease prevention, and restorative care

Educator

Help patients and families game the skills and knowledge needed to learn how to care for themselves. examples include prenatal care, infant care, child safety, and cancer screening

bio physical development

How are physical bodies grow and change

identity vs role confusion (puberty)

Identity development begins with the goal of achieving some perspective or direction, answers the question, Who am I? Acquiring a sense of identity is essential for making adult decisions such as choice of location or marriage partner. New social demands, opportunities, and conflicts that relate to the emergent identity and separation from family.

Jean Piaget's theory of cognitive development

Includes four periods are related to age and demonstrate specific categories of knowing and understanding. Individuals move from one state to another seeking cognitive equilbrium or state of mental balance

What are the overall goals of healthy people 2020?

Increase life expectancy and quality of life and eliminate health disparities through an improved delivery of health care services. This is done through assesment of healthcare needs of individuals, families, and communities. Development and implementation of public health policies, and improved access to care

This social contract orientation

Individual follows the societal law but recognizes the possibility of changing the law to improve society. Recognizes that different social groups have different values but believes that all rational people would agree on basic rights such as liberty and life. Make more of an independent effort to determine what society should value rather than what the society as a group would value

Examples of vulnerable populations

Individuals: -living in poverty -older adults -homeless -immigrants -in abusive relationships -substance abusers -with severe mental illness

Oral (birth to 12 to 18 months)

Initially sucking and oral satisfaction are not only vital to life but are also extremely pleasurable in their own rights.

Emic World View

Insider perspective.

Cognitive processes

Intelligence, understanding, thinking

alcohol abuse, pregnancy, unemployment, drug use

Intimate partner violence (IPV) is linked to:

Change agent

Involves identifying and implementing new and more effective approaches to problems. Mediator for problems within a patient's community. Identify any number of problems. Empower individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency

Implicit Bias

Is similar to unconscious; however, we are aware of the bias that is present. We are responsible for this and must recognize and acknowledge our actions as they impact our behavior, decisions, and patient-centered care provided.

Integrity vs. Despair (old age)

Many older adults review their lives with a sense of satisfaction, even with their inevitable mistakes. Others see themselves as failures, with their lives Marked by despair and regret. Interpret their lives as a meaningful whole or experience regret because goals not achieved. External struggles are met with internal struggles

Cultural Competence

Means that professional health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community.

Marginalized Groups

More likely to have poor health outcomes and die earlier because of a complex interaction among their individual behaviors, environment of the communities in which they live, the policies and practices of health care and governmental systems, and the clinical care they receive. Examples of these include people who are gay, lesbian, bisexual, or transgender; people of color; people who are physically or mentally challenged; and people who are not college educated. Marginalization places or keeps someone in a powerless or an unimportant position within a society or group.

Counselor

Must know community resources. Have patient identify and clarify health problems and choose appropriate courses of action to solve problems. Help patients reach decisions that are best for them

collaborator

Need to be confident in working not only with individuals and their families but also with other related health care through. Necessary to develop a mutually acceptable time that will achieve common goals.

Patient advocate

Nurse walk patients through the system and identify where to go for services, how to reach individuals with appropriate authority, services to request, and how to follow through with information they receive. Provide information necessary for patients to make informed decisions and choosing and using services appropriately. Also to support and at times defend your patient's decision

Trust vs mistrust (birth to one year)

The infants successful resolution of this days requires a consistent caregiver who was able to meet his needs. From this basic trust and parents, the infant is able to trust in themselves, or in others, and in the world. The formation of trust results in faith and optimism.

Acculturation

Occurs when an individual or group transitions from one culture and develops traits of another culture. In this transition, there will be adaptation to the new cultures, traditions, customs, and language. This can lead to stress when the values of the transitioning culture differ from the accepted traits of another.

Etic World View

Outsider perspective.

What are examples of vulnerable populations?

Patients who are abused immigrant population homelessness older adults patients with mental illnesses patients who abuse substances

Conventional reasoning level 2

Person sees more reasoning based on his or her own personal internalization of societal and others expectations. A person wants to fulfill their expectations of the family, group, or nation and also develop a loyalty to an actively maintain, support, and justify the order . Emphasis now is on social rules and a community centered approach

Socio emotional factors

Personality, emotions, relationships with others

biological process

Physical growth and development

Menopause

Physiological cessation of ovulation and menstruation that typically occurs during middle adulthood in women

Climacteric

Physiological, developmental change that occurs in the male reproductive system between the ages of 45 and 60

Maslow's theory of human needs

Physiological, safety, belonging / love, esteem, and self-actualization

Developmental theories

Proposed ways to account for how and why people grow as they do, provide a framework for examining, describing, and appreciating human development. Helps nurse assess and treat a patient's response to an illness

Public Health Nursing

Public health nursing is understanding the needs of a population or a collection of individuals who have one or more personal environmental characteristics in common Population examples: high-risk infants, older adults, native Americans

Sigmund Freud's psychoanalytical model of personality development

States that individuals go through five stages of psychosexual development and that each stage is characterized by sexual pleasure and parts of the body: the mouth, the anus, and the genitals. Adult personality is the result of how an individual resolve conflicts between these sources of pleasure and the mandates of reality. The components of the human personality develops in stages and regulate behavior. These components are the id, the ego, and the super ego m

Unconscious Bias

Refers to a bias we are unaware of and that happens outside our control, which is influenced by our personal background, cultural environment, and personal experiences. Typically directs one to make quick judgments and assessments of people and situations.

Culture

Refers to the learned and shared beliefs, values, norms, and traditions of a particular group.

When assessing the young adult for risk factors that contribute to mortality and morbidity, which of the following is most likely a leading contributing factor? Dependence on drugs or alcohol Victim of human trafficking Exposure to work-related hazards Repeated exposure to violence

Repeated exposure to violence

Epidemiologist

Responsible for community surveillance for risk factors. Protect the level of health of the community, develop sensitivity to changes in the health status of the community, and help identify the cause of these changes. study of what is upon the people

Where do patients who are Vulnerable typically come from?

Varied Cultures Have Different Beliefs and Values Face language and literacy Barriers Few sources of Social Support

Latency (6-12 years old)

Sexual urges expressed in the earlier oedipal stage are repressed and channeled into productive activities that are socially acceptable. Within the educational and social worlds of the child, there is much to learn and accomplish

Genital (puberty through adulthood)

Sexual urges reawaken and are directed to an individual outside the Family Circle. Unresolved park on sex service during adolescence. Once the individual resolves conflicts, they are than capable of having a mature adult sexual relationship

chlamydia

Sexually transmitted infections (STIs) continue to be a major health problem in young adults. Men ages 20 to 24 years have the highest rate of which STI?

personal hygiene habits

Sharing eating utensils with a person who has a contagious illness increases the risk of illness. This type of health risk arises from:

Punishment and obedience orientation

Stage 1. A child's response to a moral dilemma is in terms of absolute obedience to authority and rules. Avoiding punishment or that I'm questioning deference to authority is a characteristic motivation to behave

Instrumental relativist orientation

Stage 2. Child recognizes that there is more than one right view. The decision to do something morally right is based on satisfying one's own needs and occasionally the needs of others. The child receives punishment not as proof of being wrong but as something that one wants to avoid

Good boy - nice girl orientation

Stage 3. Then dividual wants to win approval and maintain their expectations of one's immediate group. Being good is important and defined as having good motives, showing concern for others, and keeping mutual relationships through trust, loyalty, respect, and gratitude. One earns approval by being nice

Society maintaining orientation

Stage 4. Individuals expand their focus from the relationship with others to societal concerns . Moral decisions taken 2 accounts aside all perspectives. Right behavior is doing one's duty, showing respect for authority, and maintaining the social order

Universal ethical principle orientation

Stage 6. Defines right by the decision of conscience in accord with self chosen ethical principles. These principles are abstract and appeal to logical comprehensiveness, universality, and consistency

What are three components that need to be identified when developing a community assessment?

Structure or Locale the People Social Systems

Cultural Assessment

Systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities.

Community-Based Nursing

Takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or familyInvolves individual/family safety needs and acute & chronic care, enhances capacity for self care, and promotes autonomy in decision making

Linguistic Competence

The ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences.

Cultural Skill

The ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient's presenting problem, as well as accurately conducting a culturally based physical asessment.

Social Determinants of Health

The conditions in which people are born, grow, live, work, and age. This includes conditions within a health care system.

Health Literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions.

Anal (12-18 months -3 years)

The focus is pleasure changes to the anal zone. Children become increasingly aware of the pleasurable sensations of the body region with interest in the products of their efforts. Potty training

Ethnic/Cultural Identity

The frame in which individuals identify consciously or unconsciously with those whom they feel a common bond because of similar traditions, behaviors, values, and beliefs.

Phallic or oedipal (3-6 years)

The genital organs are the focus of pleasure during this stage. The boy becomes interested in the penis, a girl becomes aware of the absence of the penis, known as penis envy. This is a time of exploration and imagination as a child fantasizes about the parent of the opposite sex as his or her first love interest, known as the oedipus or Electra complex. By the end, they now identify with the parent of the same sex

Cultural Desire

The motivation of a health care professional to "want to" (and not "have to") engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters.

Post conventional level 3

The person find balance between basic human rights and obligations and societal rules and regulations. Individuals move away from our decisions based on a thority or conformity to group to define their own moral values and principles

Cultural Knowledge

The process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups. In acquiring this knowledge, health care professionals must focus on the integration of three specific issues: health-related beliefs and cultural values, care practices, and disease incidence and prevalence.

Assimilation

The process in which the individual adapts to the host's cultural value and no longer prefers the components of the origin culture.

Cultural Awareness

The process of conducting a self-examination of one's own biases toward other cultures and the in-depth exploration of one's cultural and professional background. It also involves being aware of the existence of documented racism and other "isms" in health care delivery.

Formal operations 11 years to adulthood

The transition from concrete to formal operational thinking occurs in stages during which there is a prevalence of egocentric thought. They demonstrate feelings and behaviors characterized by self consciousness , I believe that their actions and the parents are constantly being scrutinized. Who believe that hearts and feelings how you need, and that they are invulnerable which leads to risk taking behaviors.

Preconventional reasoning level 1

Thinking is mostly based on mikes in pleasures. Has punishment guide behavior. Consequences will never be a pharmacist punishment or a reward

What's the goal of community health nursing?

To preserve, protect, promote, or maintain health.The emphasis of nursing care is to improve quality health & life within a community.

Culturally Congruent Care

Transcultural care that emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values; therefore, effective communication is a critical skill in this type of care and helps you engage a patient and family in respectful, patient-centered dialogue.

motivation

When determining the amount of information that a patient needs to make decisions about the prescribed course of therapy, many factors affect the patient's compliance with the regimen, including educational level and socioeconomic factors. Which additional factor affects compliance?

How do you (as a nurse) help reduce duplication of health care services?

You collaborate with your patients and their health care providers. Bring together resources that improve patients care

Intimacy vs isolation (young adult)

Young adults, having developed a sense of identity, deepen their capacity to love others and care for them. They search for meaningful friendships and intimate relationship with another person. If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment

community based health care

a model of care to reach all in a community. occurs outside of traditional impatient health care facilities. outside the hospital setting. provides services for acute and chronic conditions. direct patient contact in a community setting.

Puerperium

a period of approximately 6 weeks after delivery. During this time the woman's body reverts to its prepregnant physical status

Infertility

a prolonged time to conceive

Doula

a support person to be present during labor to assist women who have no other source of support

Many toddlers have problems with bedtime resistance. What is the best action to reduce this issue? A. Establishing a regular bedtime routine B. Remove napping during the day time C. placing a gate at the child's doorway D. Placing a night light near the child's bed

establishing a regular bedtime routine

A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to her toys and makes up stories. The mother wants her child to have a psychological evaluation. The nurse's best initial response is to: a. explain that playing make believe is normal at this age b. separate the child from the mother to get more information c. complete a developmental screening using a validated tool. d. refer the child to a psychologist immediately

a. explain that playing make believe is normal at this age By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at this age. A referral to a psychologist would be premature based only on the complaint of the mother. Completing a developmental screening would be very appropriate but not the initial response. The nurse would certainly want to get more information, but separating the child from the mother is not necessary at this time.

Which aspect of cognition develops during adolescence? a. Ability to see things from the point of view of another b. Capability to use a future time perspective c. Ability to place things in a sensible and logical order d. Progress from making judgments based on what they see to what they reason

ability to see things from the point of view of another

Which statement best describes the cognitive ability of school-age children? Able to classify, group, and sort thoughts and ideas Makes judgments based on what they reason Ability to reason abstractly Capable of scientific reasoning

able to classify, group, and sort thoughts and ideas

people assessment

age distribution, sex distribution, growth trends, density, educational level, predominant ethnic groups, predominant religious groups

Which of the following is a description of how a preschooler understands time? Associates time with events Can tell time on a clock Uses terms like "yesterday" appropriately Has no understanding of time

associates time with events

Why is there a growing need to provide health care delivery services?

because patients are often discharged quickly from acute care settings ... people need health care services where they live, work, socialize, and learn

5 determinants of health w/ examples

biology & genetics: sex & age individual behavior: alcohol, injection drug use, unprotected sex, smoking social environment: discrimination, income, gender physical environment: where person lives or crowding location health services: access to quality health care & having insurance

Lactation

breastfeeding

community health nurses:

care for the community as a whole, assess the individual or family within the context of the community

In terms of development, what should the 3-year-old child be expected to do? Copy a circle Jump rope with a friend Tie shoelaces Can tell a story about a past event

copy a circle

The most appropriate response of the nurse when a mother asks what the Denver II does is that it: (a) identifies a need for physical therapy (b) can diagnose developmental disabilities (c) provides a framework for health teaching (d) is a developmental screening tool

d developmental screening tool The Denver II is the most commonly used measure of developmental status used by health care professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires a thorough neurodevelopment history and physical examination. Developmental delay, which is suggested by screening, is a symptom, not a diagnosis. The need for any therapy would be identified with a comprehensive evaluation, not a screening tool. Some providers use the Denver II as a framework for teaching about expected development, but this is not the primary purpose of the tool.

The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the expected stage of development for a preschooler is: (a) formal operational (b) concrete operational (c) sensorimotor (d) preoperational

d preoperational The expected stage of development for a preschooler (3 to 4 years old) is pre-operational. Concrete operational describes the thinking of a school-age child (7 to 11 years old). Formal operational describes the thinking of an individual after about 11 years of age. Sensorimotor describes the earliest pattern of thinking from birth to 2 years old.

social systems assessment

education system, government, communication system, welfare system, volunteer programs, health system