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TEST BANK - Timby's Introductory Medical-Surgical
Nursing, 13th Edition (Donnelly-Moreno),
Verified Chapters 1 - 72, Complete
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Table of Contents
Cbapter O1 Concepts and Trends in Health Care
Chapter02SettingsandModelsforNursingCare
Cbapter 03 The KursingProcess
Chapter 04 Intenievingand Physical Ass.essment
Cbapter 05 legal and Ethical Issues
Cbapter 06 leadership Roles and Manag,ement functions
Chapter 07Nurse-Client Relationships
Cbapter 08 Cultural Care Considerations
Chapter09 IntegrativeMedicine and .'ttemati·eTherapies
Cbapter 10 End-of-Life Care
Cbapter 11 Pain Manag,ement
Chapter 12 Infection
Cbapter 13 lntra«nous Therapy
Chapter 14Perioperati'eCare
Cbapter 15DisasterSituations
Cbapter 16 Caring for Clients With fluid,Electroly1
e, and Acid-Base lmbalances
Chapter 17Caring for Clients in Shock
Cbapter 18Caring for Clients With Cancer
Chapter 1
9lntroduction to !heRespiratory System
Cbapter 20 Caring for Clients With Upper Respiratory Disorders
Cbapter 21 Caring for Clients fith Lover Respiratory Disorders
Chapter 22 lntroduction to !heCardio'ascular System
Cbapter 23 Caring for Clients With Infectious and Inflammatory Disordersof the Heart
and Blood Vessels
Cbapter 24 Caring for Clients With Valvular Disorders ofthe Heart
Cbapter 25 Caring for Clients With Disorders of Coronary and Peripheral Blood Vessels
Chapter 26 Caring for Clients With Cardiac Arrhytlunias
Cbapter 27 Caring for Clients With Hypertension
Chapter 28 Caring for Clients With Heart failure
Cbapter 29 Caring for Clients Undergoing Cardiovascular Surgery
Cbapter 30 lntroduction to !he Hematopoietic and Lymphatic Systerns
Chapter31 CaringforClientsiithDisordersofthe HematopoieticSystem
Cbapter 32 Caring for Clients With Disorders of the lymphatic System
Chapter33 IntroductiontotheImmuneSystem
Cbapter 34 Caring for Clients fith Immune--Mediated Disorders
Cbapter 35 Caring for Clients With HJV AIDS
Chapter 36 lntroduction to !he Nervous System
Cbapter 37 Caring for Clients With Central andPeripheral Nervous System Disorders
Chapter 38 Caring for Clie11ts iithCerebrovascular Disorders
Cbapter 39Caring for Clients With Head and SpinalCord Trauma
Cbapter40CaringforClientsfithKeurologicDe-fícits
13
25
35
46
58
68
80
87
97
108
120
132
142
153
161
172
183
192
204
216
226
234
244
254
265
275
286
297
308
318
328
341
351
362
374
384
393
402
413
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Cbapter41lntroó0<:tiontotheSensorySystem
Chapter42CaringforClie11tsWithEyeDisorders
Chapter43CaringforClie11tsiithEarDisorders
Cbapter44lntroó0<:tiontotheGastrointestinalSysternandAccessoryStructures
Chapter45CaringforClie11tsiithDisordersoftheUpperGastrointestinalTrac.t
Cbapter46CaringforClientsfithDisordersoftheLoverGastrointestinal Tract
Chapter47 Caring forClie11tsiithDisordersoftheLi·er,Gallbladder,orPancreas
Chapter48 CaringforClie11tsiithOstoinies
Cbapter49lntroó0<:tiontotheEndocrineSystern
Chapter50CaringforClie11tsiithDisordersoftheEndoc.rineSyste1n
Cbapter51 Caring for Clientsfith DiabetesMellitus
Chapter52 lntroóuction totheFemaleand MateReproducti eSystems
Chapter53CaringforClie11tsiithDisordersoftheFemaleReproductiveSyste1n
Cbapter54 Caring for Clientsfith BreastDisorders
Chapter55 CaringforClie11tsiithDisordersoftheMateReproducti·eSystem
Cbapter 56Caring for Clients With Sexually Transmitted Infections
Chapter 57 lntroóuction totheUrinary System
Chapter58CaringforClientsiithDisordersoftheKidneysandUreters
Cbapter 59 Caring for Clients With Disordersof the Bladder and Urethra
Chapter60lntroóuction totheMusculoskeletalSystem
Cbapter61CaringforClientsRequiringOrtbopedic Treatment
Chapter62CaringforClientsiithTratunaticMusculoskeletalInjuries
Chapter63CaringforClientsiithOrthopedicandConnectiveTissueDisorders
Cbapter64lntroó0<:tiontotheIntegumentarySystern
Chapter65 Caring for Clientsiith Skin, Hair.andNail Disorders
Cbapter 66Caring for ClientsWith Bums
Chapter67 Interaction ofBodyand Mind
Chapter68CaringforClie11tsWithAlcxietyDisorders
Cbapter69Caring for Clientsfith Mood Disorders
Chapter 70Caring for Clientsiith Eating Disorders
Cbapter 71 CaringforClientsWithSubstanceUseDisorders
Chapter72CaringforClientsiithDementiaandThoughtDisorders
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432
441
451
460
468
476
486
496
506
517
527
538
547
557
568
578
589
598
609
618
630
642
653
663
674
684
693
703
715
724
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◦
Chapter 1 Concepts and Trends in Healthcare
◦ A new nurse is working with a preceptor on an inpatient medical-surgical unit.
The preceptor advises the student that which is the priority when working as a
professional nurse?
◦ Attending to holistic client needs
◦ Ensuring client safety
◦ Not making medication errors
◦ Providing client-
focused care
ANSWER: B
◦ All actions are appropriate for the professional nurse. However,
ensuring client safety is the priority. Up to 98,000 deaths result each year from errors in
hospital care, according to the 2000 Institute of Medicine report. Many more clients have
suffered injuries and less serious outcomes. Every nurse has the responsibility to guard
the clients safety.
◦ DIF: Understanding/Comprehension REF: 2
KEY: Patient safety MSC: Integrated Process: Nursing
Process: Intervention
◦ NOT: Client Needs Category: Safe and Effective Care
Environment: Safety and Infection Control
◦ A nurse is orienting a new client and family to the inpatient unit. What
information does the nurse provide to help the client promote his or her own
safety?
◦ Encourage the client and family to be active partners.
◦ Have the client monitor hand hygiene in caregivers.
◦ Offer the family the opportunity to stay with the client.
◦ Tell the client to always wear his or
her armband.
ANSWER: A
◦ Each action could be important for the client or family to perform.
However, encouraging the client to be active in his or her health care as a partner is
the most critical. The other actions are
◦
◦ very limited in scope and do not provide the broad protection that
being active and involved does.
◦ DIF: Understanding/Comprehension REF: 3
KEY: Patient safety MSC: Integrated Process: Teaching/
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◦ NOT: Client Needs Category: Safe and Effective Care
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Environment: Safety and Infection Control
◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What
action by the nurse is best?
◦ Call the Rapid Response Team.
◦ Document and continue to monitor.
◦ Notify the primary care provider.
◦ Repeat blood pressure measurement
in 15 minutes.
ANSWER: A
◦ The purpose of the Rapid Response Team (RRT) is to intervene when
clients are deteriorating before they suffer either respiratory or cardiac arrest. Since the
client has manifested a significant change, the nurse should call the RRT. Changes in
blood pressure, mental status, heart rate, and pain are particularly significant.
Documentation is vital, but the nurse must do more than document. The primary care
provider should be notified, but this is not the priority over calling the RRT. The
clients blood pressure should be reassessed frequently, but the priority is getting the
rapid care to the client.
◦ DIF: Applying/Application REF: 3
◦ KEY: Rapid Response Team (RRT)|
medical emergencies MSC: Integrated Process:
Communication and Documentation
◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
◦
◦ A nurse wishes to provide client-centered care in all interactions. Which
action by the nurse best demonstrates this concept?
◦ Assesses for cultural influences affecting health care
◦ Ensures that all the clients basic needs are met
◦ Tells the client and family about all upcoming tests
◦ Thoroughly orients the client and
family to the room
ANSWER: A
◦ Competency in client-focused care is demonstrated when the nurse
focuses on communication, culture, respect, compassion, client education, and
empowerment. By assessing the effect of the
◦
◦ clients culture on health care, this nurse is practicing client-focused
care. Providing for basic needs does not demonstrate this competence. Simply telling
the client about all upcoming tests is not providing empowering education. Orienting
the client and family to the room is an important safety measure, but not directly
related to demonstrating client-centered care.
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◦ DIF: Understanding/Comprehension REF: 3
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◦ KEY: Patient-centered care| culture MSC:
Integrated Process: Caring NOT: Client Needs Category:
Psychosocial Integrity
◦ A client is going to be admitted for a scheduled surgical procedure. Which
action does the nurse explain is the most important thing the client can do
to protect against errors?
◦ Bring a list of all medications and what they are for.
◦ Keep the doctors phone number by the telephone.
◦ Make sure all providers wash hands before entering the room.
◦ Write down the name of each caregiver who
comes in the room.
ANSWER: A
◦ Medication errors are the most common type of health care mistake.
The Joint Commissions Speak Up campaign encourages clients to help ensure their
safety. One recommendation is for clients to know all their medications and why they
take them. This will help prevent medication errors.
◦ DIF: Applying/Application REF: 4
◦ KEY: Speak Up campaign| patient safety MSC: Integrated
Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective
Care Environment: Safety and Infection Control
◦ Which action by the nurse working with a client best demonstrates respect for
autonomy?
◦ Asks if the client has questions before signing a consent
◦ Gives the client accurate information when questioned
◦ Keeps the promises made to the client and family
◦ Treats the client fairly
compared to other clients
ANSWER: A
◦ Autonomy is self-determination. The client should make decisions
regarding care. When the nurse obtains a signature on the consent form, assessing if
the client still has questions is vital, because without full information the client cannot
practice autonomy. Giving accurate information is practicing with veracity. Keeping
promises is upholding fidelity. Treating the
◦
◦ client fairly is providing social justice.
◦
◦ DIF: Applying/Application REF: 4
◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
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◦
◦ A student nurse asks the faculty to explain best practices when communicating
with a person from the lesbian, gay, bisexual, transgender, and queer/
questioning (LGBTQ) community. What answer by the faculty is most
accurate?
◦ Avoid embarrassing the client by asking questions.
◦ Dont make assumptions about their health needs.
◦ Most LGBTQ people do not want to share information.
◦ No differences exist in communicating with
this population.
ANSWER: B
◦ Many members of the LGBTQ community have faced discrimination
from health care providers and may be reluctant to seek health care. The nurse should
never make assumptions about the needs of members of this population. Rather,
respectful questions are appropriate. If approached with sensitivity, the client with any
health care need is more likely to answer honestly.
◦ DIF: Understanding/Comprehension REF: 4
KEY: LGBTQ| diversity MSC: Integrated Process:
Teaching/Learning
◦ NOT: Client Needs Category: Psychosocial Integrity
◦
◦ A nurse is calling the on-call physician about a client who had a hysterectomy 2
days ago and has pain that is unrelieved by the prescribed narcotic pain
medication. Which statement is part of the SBAR format for communication?
◦ A: I would like you to order a different pain medication.
◦ B: This client has allergies to morphine and codeine.
◦ R: Dr. Smith doesnt like nonsteroidal anti-inflammatory meds.
◦ S: This client had a vaginal
hysterectomy 2 days ago.
ANSWER: B
◦ SBAR is a recommended form of communication, and the acronym
stands for Situation, Background, Assessment, and Recommendation. Appropriate
background information includes allergies to medications the on-call physician might
order. Situation describes what is happening right now that must be communicated;
the clients surgery 2 days ago would be considered background. Assessment would
include an analysis of the clients problem; asking for a different pain medication is a
recommendation. Recommendation is a statement of what is needed or what
◦
◦ outcome is desired; this information about the surgeons preference
might be better placed in background.
◦ DIF: Applying/
Application REF: 5 KEY:
SBAR| communication
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of Care
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
◦
◦ A nurse working on a cardiac unit delegated taking vital signs to an
experienced unlicensed assistive personnel (UAP). Four hours later, the nurse
notes the clients blood pressure is much higher than previous readings, and
the clients mental status has changed. What action by the nurse would most
likely have prevented this negative outcome?
◦ Determining if the UAP knew how to take blood pressure
◦ Double-checking the UAP by taking another blood pressure
◦ Providing more appropriate supervision of the UAP
◦ Taking the blood pressure instead of
delegating the task
ANSWER: C
◦ Supervision is one of the five rights of delegation and includes
directing, evaluating, and following up on delegated tasks. The nurse should either
have asked the UAP about the vital signs or instructed the UAP to report them right
away. An experienced UAP should know how to take vital signs and the nurse should
not have to assess this at this point. Double-checking the work defeats the purpose of
delegation. Vital signs are within the scope of practice for a UAP and are
permissible to delegate. The only appropriate answer is that the nurse did not provide
adequate instruction to the UAP.
◦ DIF: Applying/Application REF: 6
◦ KEY: Supervision| delegation|
unlicensed assistive personnel MSC: Integrated
Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
◦
◦ A newly graduated nurse in the hospital states that, since she is so new, she
cannot participate in quality improvement (QI) projects. What response by the
precepting nurse is best?
◦ All staff nurses are required to participate in quality improvement here.
◦ Even being new, you can implement activities designed to improve care.
◦ Its easy to identify what indicators should be used to measure quality.
◦ You should ask to be assigned to the research and
quality committee.
ANSWER: B
◦
◦ The preceptor should try to reassure the nurse that implementing QI
measures is not out of line for a newly licensed nurse. Simply stating that all nurses are
required to participate does not help the nurse understand how that is possible and
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is dismissive. Identifying indicators of quality is not an easy, quick process and would
not be the best place to suggest a new nurse to start.
◦ Asking to be assigned to the QI committee does not give the nurse
information about how to implement QI in daily practice.
◦ DIF: Applying/
Application REF: 6 KEY:
Quality improvement
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
◦
◦ A nurse is talking with a client who is moving to a new state and needs to find a
new doctor and hospital there. What advice by the nurse is best?
◦ Ask the hospitals there about standard nurse-client ratios.
◦ Choose the hospital that has the newest technology.
◦ Find a hospital that is accredited by The Joint Commission.
◦ Use a facility affiliated with a medical or
nursing school.
ANSWER: C
◦ Accreditation by The Joint Commission (TJC) or other accrediting
body gives assurance that the facility has a focus on safety. Nurse-client ratios differ by
unit type and change over time. New technology doesnt necessarily mean the
hospital is safe. Affiliation with a health professions school has several advantages, but
safety is most important.
◦ DIF: Understanding/
Comprehension REF: 2 KEY: The Joint
Commission (TJC)| accreditation
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care
Environment: Safety and Infection Control
◦ MULTIPLE RESPONSE
◦
◦ A nurse manager wishes to ensure that the nurses on the unit are
practicing at their highest levels of competency. Which areas should the
manager assess to determine if the nursing staff demonstrate
competency according to the Institute of Medicine (IOM) report Health
Professions Education: A Bridge to Quality? (Select all that apply.)
◦ Collaborating with an interdisciplinary team
◦
◦ Implementing evidence-based care
◦ Providing family-focused care
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◦ Routinely using informatics in practice
◦ Using quality improvement
in client care
ANSWER: A, B, D,E
◦ The IOM report lists five broad core competencies that all health care
providers should practice. These include collaborating with the interdisciplinary team,
implementing evidence-based practice, providing client-focused care, using
informatics in client care, and using quality improvement in client care.
◦ DIF: Remembering/Knowledge REF: 3
◦ KEY: Competencies| Institute
of Medicine (IOM) MSC: Integrated Process:
Nursing Process: Assessment
◦ NOT: Client Needs Category: Safe and Effective Care
Environment: Safety and Infection Control
◦ A nurse is interested in making interdisciplinary work a high priority.
Which actions by the nurse best demonstrate this skill? (Select all that
apply.)
◦ Consults with other disciplines on client care
◦ Coordinates discharge planning for home safety
◦ Participates in comprehensive client rounding
◦ Routinely asks other disciplines about client progress
◦ Shows the nursing care plans to
other disciplines
ANSWER: A, B, C, D
◦ Collaborating with the interdisciplinary team involves planning,
implementing, and evaluating client care as a team with all other disciplines included.
Simply showing other caregivers the nursing care plan is not actively involving them or
collaborating with them.
of Care
◦ DIF: Applying/Application REF: 4
◦ KEY: Collaboration| interdisciplinary team
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
◦
◦ The nurse utilizing evidence-based practice (EBP) considers which
factors when planning care? (Select all that apply.)
◦ Cost-saving measures
◦ Nurses expertise
◦
◦ Client preferences
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◦ Research findings
◦ Values
of the
client
ANS
WER:
B, C,
D, E
◦ EBP consists of utilizing current evidence, the clients values and
preferences, and the nurses expertise when planning care. It does not include cost-
saving measures.
◦ DIF:
Remembering/Knowledge REF:
6 KEY: Evidence-based practice
(EBP)
◦ MSC: Integrated Process: Nursing Process: Planning
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
◦
◦ A nurse manager wants to improve hand-off communication among the
staff. What actions by the manager would best help achieve this goal?
(Select all that apply.)
◦ Attend hand-off rounds to coach and mentor.
◦ Conduct audits of staff using a new template.
◦ Create a template of topics to include in report.
◦ Encourage staff to ask questions during hand-off.
◦ Give raises based on compliance
with reporting.
ANSWER: A, B, C, D
◦ A good tool for standardizing hand-off reports and other critical
communication is the SHARE model. SHARE stands for standardize critical
information, hardwire within your system, allow opportunities to ask questions,
reinforce quality and measurement, and educate and coach.
◦ Attending hand-off report gives the manager opportunities to educate
and coach. Conducting audits is part of reinforcing quality. Creating a template is
hardwiring within the system.
◦ Encouraging staff to ask questions and think critically about the
information is allowing opportunities to ask questions. The manager may need to tie
raises into compliance if the staff is resistive and other measures have failed, but this is
not part of the SHARE model.
◦
◦ Chapter 2 Settings and Models for Nursing Care
MULTIPLE CHOICE
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• The nurse ensures that a clients bedspace is neat and clean with
the call light within easy reach. The nurse is focusing on which
nursing theorist who realized the importance of the environment
for care?
• Florence Nightingale
• Sister Callista Roy
• Dorothea Orem
• Martha Rogers
ANSWER: 1
Florence Nightingales theory focused on the environment for care. Sister
Callista Roys model is based in systems theory and an individuals ability to
adapt. Dorothea Orems model is the self- care deficit theory. Martha
Rogers model is the science of unitary human beings.
PTS:1DIF:Apply
REF:Emergence of Contemporary Nursing in the United States
• The nurse is instructing a client on self-administration of insulin so
that the client will not need a health care provider to do this
activity. The nurse is implementing which of the following aspects of
Virginia Hendersons theory of nursing?
• A caring relationship
• Helping the client achieve independence from the nurses assistance as quickly as
possible
• Integration of objective and subjective data
• Application of critical thinking
ANSWER: 2
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Virginia Hendersons theory of nursing is to help people achieve health or a
peaceful death so that they can be independent from the nurses
assistance as quickly as possible. A caring relationship, integration of
objective and subjective data, and application of critical thinking are
included in the American Nurses Associations essential features of
professional nursing.
PTS:1DIF:Analyze
REF:Emergence of Contemporary Nursing in the United States
3.A client tells the nurse that he has an HMO for his health insurance. The
nurse understands that the purpose of this type of health plan is to:
• ensure payment is made to Medicare for services rendered.
• maximize the utilization of health care resources.
• efficiently manage costs while providing quality care.
• focus on the illness when providing care.
ANSWER: 3
Health maintenance organizations (HMOs) were created to efficiently
manage health care costs while providing quality care. An HMO is a type
of managed care plan with the goal of providing wellness care and not
focusing on the illness during the provision of care. HMOs do not ensure
payment is made to Medicare for services rendered. HMOs also do not
maximize the utilization of health care resources but rather uses financial
incentives to decrease care costs.
PTS: 1 DIF: Understand REF: Cost of Care
• client tells the nurse that he does not have a primary
care physician but rather makes an appointment with a
doctor who specializes in the area in which he is
experiencing a problem. The nurse realizes this client is at
risk for which of the following?
• Fragmented care
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• Overpayment of services
• Inability to sustain health
• Finding an appropriate general practitioner
ANSWER: 1
In the 1980s, the close and trusting relationship between an individual and
the individuals physician waned and was replaced by acquaintances with
specialists based upon particular health care problems. These episodes of
care cause fragmentation of care. The client who utilizes specialists is not at
risk for overpayment of services, the inability to sustain health, or finding
an appropriate general practitioner.
PTS:1DIF:AnalyzeREFroviders of Care
• The nurse is attending a masters degree
program in efforts to be educationally
prepared to serve as a hospital leader. The
nurse realizes that this educational preparation
will:
• hinder the nurses ability to work with physicians.
• be viewed as not supporting the profession of nursing by other
nurses.
• ensure the nurse is biased towards clinicians interests.
prepare the nurse to serve as strong clinical support with the ability to integrate business
and
• caring.
ANSWER: 4
The nurse is attending an educational program to serve as a hospital
leader. This education will prepare the nurse to serve as strong clinical
support with the ability to integrate business and caring. This education
will not hinder the nurses ability to work with physicians. This education
will not be viewed as unsupportive to the profession of nursing. The
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education will ensure that the nurse is not biased towards clinicians
interests.
PTS: 1 DIF: Analyze REF: Clinical Systems Leadership
• client tells the nurse that all hospitals care about is doing
the minimum for a client regardless of the outcome. Which
of the following should the nurse respond to this client?
• It does feel like that sometimes.
• Health insurance companies have caused this problem.
• The doctors will get paid regardless of the clients outcomes.
There are quality programs in place to make sure clients receive the best quality of care
regardless
• of the cost.
ANSWER: 4
In response to concerns about safety and quality of care voiced by clients
and providers, total quality management and continuous quality
improvement programs were initiated. These programs ensure society
that cost management is not compromising safety or quality. This is what
the nurse should respond to the client. The other choices do not address
the clients concerns nor do they explain quality management programs.
PTS: 1 DIF: Apply REF: Quality Measure Shift
• The nurse is providing care at a time that is the most beneficial
to the client. The nurse is implementing which of the following
Joint Commission Dimensions of Quality Performance?
• Safety
• Timeliness
• Efficiency
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• Availability
ANSWER: 2
The dimension of timeliness means the degree in which interventions are
provided at the most beneficial time to the client. Safety means the degree in
which the risk of an intervention and risk to the environment are reduced
for both client and health care provider. Efficiency means the degree in
which care has the desired effect with a minimum of effort, waste, or
expense.
Availability means the degree in which appropriate interventions are
available to meet the clients needs.
PTS:1DIF:Analyze
REF:Box 1-1 Joint Commission Dimensions of Quality Performance
• The nurse is providing care while adhering to safety as a
Joint Commission Dimension of Quality Performance.
Which of the following did the nurse provide to the client?
• Using a needleless device when providing intravenous medications
• Keeping the siderails of the bed in the down position after providing a pain
medication to a client
• Having the client sit in a wheelchair with the wheels in the unlocked position
• Placing cloth towels over a spill in the room of an ambulatory client
ANSWER: 1
The dimension of safety means the degree in which the risk of an
intervention and risk to the environment are reduced for both client and
health care provider. The nurse who uses a needleless device when
providing intravenous medications is adhering to this dimension.
Keeping the siderails in the down position is not a safe practice. Having a
client sit in a wheelchair with the wheels unlocked is not a safe practice.
Placing cloth towels over a spill in the room of an ambulatory client is not
a safe practice.
PTS:1DIF:Analyze
REF:Box 1-1 Joint Commission Dimensions of Quality Performance
• The nurse is planning and providing care while adhering to the
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American Nurses Association definition of professional nursing.
Which of the following does the nurse include when implementing
client care?
• Follows the NANDA nursing diagnoses process
• Integrates objective and subjective data
• Respects cultural diversity of peers
• Acknowledges the experience and training of physicians
ANSWER: 2
The American Nurses Association acknowledges six essential features of
professional nursing. These include: 1) a caring relationship, 2) attention to
the full range of human health and illness experiences, 3) integrates
objective and subjective data, 4) applies scientific knowledge and critical
thinking, 5) advances nursing knowledge through scholarly inquiry, and
6) promotes social justice. The nurse integrating objective and subjective
data is implementing one of the six essential features of professional
nursing. The other choices are not essential features of professional
nursing.
PTS:1DIF:Analyze
• The nurse has shifted her practice from an illness focus to a
health focus. Which of the following has this nurse
implemented?
• Standardized care plans
• Critical pathways
• Instructing a client on relaxation techniques to aid with sleep
• Holding around-the-clock medication when a client is asleep
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ANSWER: 3
The use of client education as a strategy to attain and maintain the
potential for health is an example of the shift of care from an illness
focus to a health focus. The nurse instructing a client on relaxation
techniques to aid with sleep is implementing a health focus of care. The
other choices do not support the shift from an illness focus to a health
focus.
PTS: 1 DIF: Analyze REF: Leadership
• client is admitted with a highly communicable disease.
The nurses do not want to participate in the care of this
client. Which of the following should be done to ensure
the client receives the highest quality of care?
• Adhere to strict standard precautions.
• Plan to have the client transferred to another health care organization.
• Ask the physician if the client can be cared for in the home.
• Suspend the nurses without pay who refuse to care for the client.
ANSWER: 1
When providing care in a highly global environment, the risks of
communicable diseases increases. In the event that a client is admitted
with a highly communicable disease and the nurses are fearing for their
own health and safety, the only safe approach is to ensure all staff adhere
to strict standard precautions. The other choices do not ensure that the
client will receive the highest quality of care. The nurses must learn
emotional intelligence and resolve issues under fire.
• The nurse has been an employee of an organization for 2
years and is considering a job change. Which of the
following does this nurses plan suggest to any future
employers?
• The nurse moves to other jobs too frequently.
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• The nurse is inflexible.
• The nurse is searching for a more challenging environment with career
opportunities.
• The nurse is willing to sacrifice home and personal life for a job.
ANSWER: 3
At one point in time, job changes every 2 or 3 years was considered a red
flag for employers. This does not hold true today. The nurse who
changes jobs every 2 or 3 years is interested in career advancement and
success. Creativity is valued and opportunities are desired. Moving to
another job in 2 to 3 years does not mean the nurse is inflexible. The
new generation of nurses does not want to sacrifice home and personal
life for a job.
PTS: 1 DIF: Analyze REF: Care Delivery Models
• The nurse is experiencing pain and fatigue in both arms
when using the computer to document client care. Which of
the following can the nurse do to reduce these symptoms?
• Refuse to use the computer and document using a pen and paper.
• Stand up when using the computer.
• Adjust the keyboard and chair to reduce the pressure on the wrists and arms.
• Ask another nurse to input the information for client care activities.
ANSWER: 3
Ergonomic hazards are increasing with health care providers and nurses in
particular. Many of these hazards are because of the implementation of
computers for documentation. The nurse should adjust the keyboard and
chair to reduce the pressure on the wrists and arms when documenting
with the computer. The nurse cannot refuse to use the computer. Standing
up may not reduce the nurses symptoms. The nurse cannot legally ask
another nurse to document client care.
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MULTIPLE RESPONSE
• The nurse is planning care for a client and reviewing appropriate
educational materials to use for discharge instructions. Which
domains of nursing is this nurse implementing? (Select all that
apply.)
• Nursing process
• Clinical practice
• Education
• Literature
• Administration
• Research
ANSWER: 2, 3
The four domains of nursing are: 1) clinical practice, 2) education, 3)
administration, and 4) research. When the nurse plans care for a client, the
domain being implemented is clinical practice. When reviewing appropriate
educational materials to use for discharge instructions, the domain being
implemented is education. The nurse is not utilizing the domains of
research or administration. Nursing process and literature are not domains
of nursing.
PTS:1DIF:Apply
REF:Emergence of Contemporary Nursing in the United States
• The nurse suspects that another health care colleague may be
chemically dependent when which of the following is
assessed? (Select all that apply.)
• Prolonged work breaks
• Clinical care omissions
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• Mood stability
• Extraordinary accomplishments
• Heavy use of fragrances
• Inability to recall recent events
ANSWER: 1, 2, 4, 5, 6
Clues of possible chemical dependency include tardiness, late sick calls,
frequent or prolonged work breaks, inability to recall recent events, heavy
use of fragrances, clinical care omissions or errors, patient complaints or
requests for a change in care provider, mood instability, and extraordinary
accomplishments. Mood stability is not a characteristic of a colleague who
is experiencing chemical dependency.
PTS:1DIF:Apply
REF:Box 1-6 Clues to the Possibility of Chemical Dependence
• The nurse is a member of a health care team that includes a
physician and other health care providers. These providers work
together to ensure the client is relieved of suffering, has diseases
cured, and experiences enhanced health and performance.
Which of the following are the levels of care represented by this
team of health care providers? (Select all that apply.)
• Sustain life
• Maintain health
• Regain health
• Minimize injury
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• Maximize cost
• Attain enhanced health
ANSWER: 1, 2, 3, 6
The medical teams mission is to relieve suffering and cure disease. This
involved the three levels of care: 1) sustain life, 2) regain health, and 3)
maintain health. Once the shift toward health care occurred, the fourth
level of attaining enhanced health was added. Minimize injury and
maximize cost is not a level of care.
PTS:1DIF:AnalyzeREFroviders of Care
• client tells the nurse that she is disappointed that her
employer is offering a health maintenance organization
for a health care benefit. Which of the following can the
nurse use as responses to the client as advantages of this
type of health plan? (Select all that apply.)
• Since there is a nursing shortage, clients need to stay out of the hospital.
• This type of plan provides wellness care at a minimal cost to keep people
healthy.
• This type of plan helps clients avoid illnesses with high costs.
• An HMO standardizes diagnostic and treatment decisions across the
nation.
• This type of plan ensures coordinated services from wellness to death.
This type of plan costs as much as the traditional plans, but the insurance companies
get the extra
• money from premiums.
ANSWER: 2, 3, 4, 5
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There are several missions and visions of managed care. The first is to
provide wellness care at a minimal cost to keep people healthy and avoid
providing illness care at a higher cost. Another mission is to standardize
diagnostic and treatment decisions across the nation. Managed care
emphasizes the delivery of coordinated services across the care spectrum
from wellness to death and uses financial incentives to decrease length of
stay and achieve cost efficiency. Managed care was not implemented to
address the nursing shortage. This type of plan does not cost as much as a
traditional health plan nor do the insurance companies receive the extra
money from premiums.
PTS: 1 DIF: Apply REF: Cost of Care
• The nurse has incorporated several criteria that are
essential for being a member of a profession. Which of
the following has this nurse done? (Select all that
apply.)
• Has passed the licensure examination
• Works regularly scheduled shifts
• Completed a bachelors degree in nursing
• Limits absences from work
• Joined the American Nurses Association
• Reads evidenced-based information to incorporate into planning client care
ANSWER: 1, 3, 5, 6
There are seven essential criteria for a profession. The nurse has
incorporated four of these criteria by passing the licensure examination, the
nurse has implemented a code of ethics; by completing a bachelors degree
in nursing, the nurse has been educated in an institution of higher
education; by joining the American Nurses Association and reading
evidenced-based information, the nurse is affiliated with a professional
association that promotes and ensures quality practice. Working regularly
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scheduled shifts and limiting absences from work are not essential criteria
for a profession.
◦ Chapter 4-Chapter 6 Interviewing and Physical Assessment
◦ Chapter 5 Legal and Ethical Issues Chapter 6 Leadership Roles and
Management Functions
• When a nurse becomes involved in a legal action, the first step to
occur is that a document is filed in an appropriate court. What
is this document called?
ANSWER: C
A document called a complaint is filed in an appropriate court as the first step in litigation. A
deposition is when witnesses are required to undergo questioning by the attorneys. An appeal is a
request for a review of a decision by a higher court. A summons is a court order that notifies the
defendant of the legal action.
PTS: 1 DIF: Cognitive Level: Knowledge REF:
Page 23 OBJ: 1 TOP: Legal KEY: Nursing Process
Step: N/A MSC:NCLEX: N/A
• The nurse caring for a patient in the acute care setting
assumes responsibility for a patients care. What is this
legally binding situation?
a. Nurse-patient relationship
b. Accountability
c. Advocacy
d. Standard of care
ANSWER: A
When the nurse assumes responsibility for a patients care, the nurse-patient
relationship is formed. This is a legally binding contract for which the nurse must take
responsibility.
Accountability is being responsible for ones own actions. An advocate is one who
defends or pleads a cause or issue on behalf of another. Standards of care define acts
whose performance is required, permitted, or prohibited.
c. Complaint
d. Summons
a. Deposition
b. Appeal
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PTS: 1 DIF: Cognitive Level: Comprehension REF:
Page 24 OBJ: 3 TOP: Legal KEY: Nursing Process
Step: N/A MSC:NCLEX: N/A
• What are the universal guidelines that define
appropriate measures for all nursing interventions?
a. Scope of practice
b. Advocacy
c. Standard of care
d. Prudent practice
ANSWER: C
Standards of care define actions that are permitted or prohibited in most nursing
interventions. These standards are accepted as legal guidelines for appropriateness of
performance. The laws that formally define and limit the scope of nursing practice are
called nurse practice acts. An advocate is one who defends or pleads a cause or issue on
behalf of another. Prudent is a term that refers to careful and/or wise practice.
PTS: 1 DIF: Cognitive Level: Knowledge REF:
Page 25 OBJ: 4 TOP: Legal KEY: Nursing Process
Step: N/A MSC:NCLEX: N/A
• An LPN/LVN is asked by the RN to administer an IV
chemotherapeutic agent to a patient in the acute care setting.
What law should this nurse refer to before initiating this
intervention?
a. Standards of care
b. Regulation of practice
c. American Nurses Association Code
d. Nurse practice act
ANSWER: D
It is the nurses responsibility to know the nurse practice act in his or her state. Standards of care,
regulation of practice, and the American Nurses code are not laws that the nurse should refer to
before initiating this treatment.
PTS: 1 DIF: Cognitive Level: Application REF: Page
25 OBJ: 5 TOP: Legal KEY: Nursing
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Process Step: N/A MSC:NCLEX: N/A
5.A nurse fails to irrigate a feeding tube as ordered, resulting in harm to the patient.
This nurse could be found guilty of:
a. malpractice.
b. harm to the patient.
c. negligence.
d. failure to follow the nurse practice act.
ANSWER: A
The nurse can be held liable for malpractice for acts of omission. Failure to meet a
legal duty, thus causing harm to another, is malpractice. The nurse practice act has
general guidelines that can support the charge of malpractice.
PTS: 1 DIF: Cognitive Level: Application REF: Pages
22-23 OBJ: 2 TOP: Legal KEY: Nursing Process Step:
N/A MSC:NCLEX: N/A
• Patients have expectations regarding the health care services they receive.
To protect these expectations, which of the following has become law?
a. American Hospital Associations Patients Bill of Rights
b. Self-determination act
c. American Hospital Associations Standards of Care
d. The Joint Commissions rights and responsibilities of patients
ANSWER: A
Patients have expectations regarding the health care services they receive. In 1972, the American
Hospital Association (AHA) developed the Patients Bill of Rights. The Self-determination act,
American Hospital Associations Standards of Care, and The Joint Commissions rights and
responsibilities do not address patients expectations regarding health care.
PTS: 1 DIF: Cognitive Level: Comprehension REF: Page
26 OBJ: 3 | 4 TOP: Legal KEY: Nursing Process Step:
N/A MSC:NCLEX: N/A
• The nurse is preparing the patient for a thoracentesis. What must be
completed before the procedure may be performed?
a. Physical assessment
b. Interview
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c. Informed consent
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d. Surgical checklist
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a. Physical assessment
b. Interview
c. Informed consent
d. Surgical checklist
ANSWER: C
The doctrine of informed consent refers to full disclosure of the facts the patient
needs to make an intelligent (informed) decision before any invasive treatment or
procedure is performed. A physical assessment, interview, and surgical checklist are not
required before this procedure.
PTS: 1 DIF: Cognitive Level: Application REF: Pages
26-27 OBJ: 8 TOP: Legal KEY: Nursing Process Step:
N/A MSC:NCLEX: N/A
• When a nurse protects the information in a patients record what ethical
responsibility is the nurse fulfilling?
b. Disclosure
c. Confidentiality
d. Absolute secrecy
ANSWER: C
The nurse has an ethical and legal duty to protect information about a patient and preserve
confidentiality. Some disclosures are legal and anticipated, and may not be subject to the rules of
confidentiality. None of the information in a chart is considered secret.
PTS: 1 DIF: Cognitive Level: Comprehension REF:
Page 28 OBJ: 9 TOP: Confidentiality KEY: Nursing
Process Step: N/A MSC:NCLEX: N/A
• An older adult is admitted to the hospital with numerous bodily bruises, and the
nurse suspects elder abuse. What is the best nursing action?
a. Cover the bruises with bandages.
b. Take photographs of the bruises.
c. Ask the patient if anyone has hit her.
d. Report the bruises to the charge nurse.
ANSWER: D
The law stipulates that the health care professional is required to report certain
a. Privacy
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information to the appropriate authorities. The report should be given to a supervisor
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or directly to the police, according to agency policy. When acting in good faith to report
mandated information (e.g., certain communicable diseases or gunshot wounds), the
health care professional is protected from liability.
PTS: 1 DIF: Cognitive Level: Application REF: Page
29 OBJ: 9 TOP: Elder abuse KEY: Nursing Process
Step: N/A
MSC:NCLEX: N/A
• What is the best way for a nurse to avoid a lawsuit?
a. Carry malpractice insurance
b. Spend time with the patient
c. Provide compassionate, competent care
d. Answer all call lights quickly
ANSWER: C
The best defense against a lawsuit is to provide compassionate and competent nursing
care. Carrying malpractice insurance is prudent, but it will not avoid a lawsuit.
Spending time with patients and answering call lights quickly will not necessarily help
avoid a lawsuit.
PTS: 1 DIF: Cognitive Level: Comprehension REF:
Pages 29-30 OBJ: 8 TOP: Avoiding a lawsuit KEY:
Nursing Process Step: N/A MSC:NCLEX: N/A
• The nurse is caring for a patient with a do-not-resuscitate (DNR) order.
Although the nurse may disagree with this order, what is his or her legal
obligation?
a. To question the doctor
b. To seek advice from the family
c. To discuss it with the patient
d. To follow the order
ANSWER: D
When a DNR order is written in the chart, the nurse has a duty to follow the order.
Questioning the doctor, seeking advice from the family, and discussing it with the
patient are not legal obligations of the nurse.
• Although the patient denies pain, the nurse observes the patient
breathing rapidly with clenched fists and facial grimacing. What is
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the nurses best response to these observations?
a
.
I am glad you are feeling better and have no
discomfort.
b
.
Where do you hurt?
c
.
What you are saying and what I am observing
dont seem to match.
d
.
It makes me uncomfortable when you are not
honest with me.
ANSWER: C
The nonverbal communication should be clarified to prevent miscommunication. PTS:
1 DIF: Cognitive Level: Application REF: Pages
59-61 OBJ:2 | 3TOP:Communication
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
• The nurse considers the feelings and needs of a patient by stating, I
know you are concerned about your surgery tomorrow. How can I
help you? What type of communication is this?
a. Intrusive
b. Aggressive
c. Closed
d. Assertive
ANSWER: D
Assertive communication takes a patients feelings and needs into account, yet honors the patients
rights as an individual.
PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 61
OBJ:4TOP:Communication
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
• If the nurse aggressively says to a patient, Why couldnt you have
asked me to give you your pain medication when I was in here
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earlier? what feeling is the patient most likely to demonstrate?
a. Anger
b. Satisfaction that his needs are met
c. Humiliation and worthlessness
d. Confidence that his request will be granted
ANSWER: C
Aggressive communication is highly destructive. Although anger may eventually come,
the patient most likely feels humiliated first.
PTS: 1 DIF: Cognitive Level: Application REF: Page 62 OBJ:7TOP:Communication
KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial
Integrity 4.What does therapeutic communication accomplish?
a
.
Facilitates the formation of a positive
nurse-patient relationship
b
.
Manipulates the patient
c
.
Assigns the patient a passive role
d
.
Requires the patient to accept what the
nurse says
ANSWER: A
A positive nurse-patient relationship is facilitated by therapeutic
communication. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 62
OBJ: 10 TOP: Communication KEY: Nursing Process Step:
N/A MSC:NCLEX: N/A
• The nurse is sitting in a chair near the patients bed, leaning forward to hear
what the patient is saying, and does not interrupt. What is the nurse
demonstrating?
b. Caring
c. Active listening
d. Interest
a. Support
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b. Caring
c. Active listening
d. Interest
ANSWER: C
When demonstrating active listening, the nurse must give his or her full attention and
make an effort to understand both the verbal and nonverbal message.
PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 63
OBJ:5TOP:Communication
KEY:Nursing Process Step:
Implementation MSC: NCLEX:
Psychosocial Integrity
• What therapeutic communication technique requires a great deal of skill
and is not used as frequently as other communication techniques?
a. Touch
b. Silence
c. Listening
d. Summarizing
ANSWER: B
Silence is an extremely effective therapeutic communication skill that is frequently underused because
the nurse feels uncomfortable applying it.
PTS: 1 DIF: Cognitive Level: Comprehension REF: Page
63 OBJ: 5 TOP: Communication KEY: Nursing Process
Step: N/A MSC:NCLEX: N/A
7.A patient does not speak English; therefore, the nurse cannot use words to provide
comfort during a painful procedure. What is another intervention that may provide
comfort to this
patient?
a. Silence
b. Listening
c. Touch
d. Restating
ANSWER: C
Holding the hand of a nonEnglish-speaking patient is effective and
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comforting. PTS: 1 DIF: Cognitive Level: Application REF: Page 63
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OBJ:9TOP:Communication
KEY:Nursing Process Step:
Implementation MSC: NCLEX:
Psychosocial Integrity
8.A patient states, I do cocaine when I feel things are out of my control. The nurse responds by
asking, What else does cocaine do for you? What communication skill does this exemplify?
a. Summarization
b. Restating
c. Showing acceptance
d. Stating observations
ANSWER: C
Acceptance is the willingness to listen and respond to what the patient is saying without passing
judgment.
PTS: 1 DIF: Cognitive Level: Application REF: Page 64-65 OBJ:5TOP:Communication
KEY:Nursing Process Step:
Implementation MSC: NCLEX:
Psychosocial Integrity
9.A patient states, Im really strung out about this pregnancy. The nurse responds by asking, What
about this pregnancy worries you? What communication technique is this?
a. Closed inquiry
b. Restating
c. Open-ended question
d. Minimal encouraging
ANSWER: C
Open-ended questions convey interest and do not require a specific
response. PTS: 1 DIF: Cognitive Level: Application REF: Pages 65
OBJ:5TOP:Communication
KEY:Nursing Process Step:
Implementation MSC: NCLEX:
Psychosocial Integrity
10.A grieving young widow cries out, Why was my husband killed? Why wasnt it me?
What is the nurses best response?
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a
.
Stating You need to be strong for your
children.
b
.
Silently placing her hand on the widows
arm.
c
.
Asking if there is anyone the widow needs
to have notified.
d
.
Stating You are feeling overwhelmed
about your husbands death.
ANSWER: B
The ability to listen and assist those who are newly grieving through the use of silence
and a quiet presence is very effective. Stating You need to be strong for your children is
a clich.
Asking if there is anyone the widow needs to have notified and stating You are feeling
overwhelmed about your husbands death are not therapeutic in this immediate
grieving time.
• The nurse is implementing evidence-based practice. Which of the
following is not a component of this process?
1. Patient preference
2. Clinical expertise
3. Research evidence
4. Leader practice
ANSWER: 4
Evidence-based practice is the combination of applying research findings, creating clinical
guidelines, and the individualization of the plan of care to meet the patients needs and
desired. Leader practice is not a component of the evidence-based process.
PTS:1DIF:AnalyzeREF:The Process of EBP
• The nurse is planning the care for a client using an unstructured
approach. Which of the following approaches did the nurse most
likely use?
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1. Research
2. Trial and error
3. Nursing theory
4. Validated order
ANSWER: 2
Examples of unstructured approaches to plan client care include trial and error,
tradition, and authority. The approaches of research, nursing theory, and validated
order all represent a structured approach to planning client care.
PTS: 1 DIF: Analyze REF: Knowledge Bases for Clinical Decisions
• The nurse is participating in an activity that is the first step of
the ACE Star Model of Knowledge Transformation. Which of
the following is the nurse doing?
2. Evaluating outcomes
3. Integrating findings into practice
4. Participating in research
ANSWER: 4
The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge
according to five sequential steps. The first step is primary research. Subsequent steps
are: 2) evidence summary, 3) translation, 4) integration, and 5) evaluation.
PTS:1DIF:AnalyzeREF:EBP in Nursing
4.A committee has been developed to implement knowledge transformation when
providing client care. The members realize that the purpose of knowledge
transformation is to:
1. reduce length of stay.
2. convert research findings to impact health outcomes.
3. reduce the cost of care.
4. increase the number of patients with health insurance.
1. Creating evidence summaries
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ANS: 2
The core concept of the ACE Star Model is knowledge transformation. Knowledge
transformation is the conversion of research findings to have an impact on health
outcomes by way of evidence-based care. Knowledge transformation is not a method
to reduce length of stay, reduce the cost of care, or increase the number of patients
with health insurance.
PTS: 1 DIF: Analyze REF: Definition of Knowledge Transformation
• An advance practice nurse is being consulted to participate during the
translation phase of the ACE Star Model of Knowledge Transformation.
During this phase, which of the following will the nurse create?
2. Critical pathways
3. Clinical practice guidelines
4. Checklists to streamline documentation
ANSWER: 3
In the third step of the ACE Star Model of Knowledge Transformation, experts are
consulted to consider the evidence summaries, fill in gaps, and merge research
knowledge with expertise to produce clinical practice guidelines. The nurse is not
creating standardized care plans, critical pathways, or checklists to streamline
documentation since these items are not a part of the ACE Star Model of Knowledge
Transformation.
PTS: 1 DIF: Apply REF: Star Point 3: Translation
• The nurse leaders of a health care organization are creating plans to change
clinical and organizational practices to support evidence-based practice. Which
phase of the ACE Star Model of Knowledge Transformation are the leaders
implementing?
1. Integration
2. Evaluation
3. Translation
4. Evidence summaries
1. Standardized care plans
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ANS: 1
During the Integration phase of the ACE Star Model of Knowledge Transformation,
implementation plans are put into action to change the individual clinician practices,
organizational practices, and environmental policies. Implementation plans are not a
part of the evidence summaries, translation, or evaluation of the ACE Star Model of
Knowledge Transformation.
PTS: 1 DIF: Apply REF: Star Point 4: Integration
• The advance practice nurse is writing clinical practice guidelines. Prior to writing these
guidelines which of the following will the nurse need?
1. Current client census
2. Evidence summaries
3. Nursing department budget
4. Staffing ratios
ANSWER: 2
The ideal base for writing clinical guidelines are evidence summaries because they
increase the power and validity of the cause-and-effect relationship between
interventions and outcomes.
Current client census, nursing department budgets, and staffing ratios are not used to
write clinical practice guidelines.
PTS:1DIF:ApplyREF:Evidence Summaries
• The nurse is writing a systematic review. After the nurse formulates
questions and locates relevant studies, the nurse thing the nurse will do is:
1. update the reviews.
2. interpret the findings.
3. summarize and synthesize results.
4. select and appraise the studies.
ANSWER: 4
The next step in the systematic review writing process is selecting and appraising the
studies. Afterwards, the nurse will complete, in order, summarize and synthesize
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results, interpret the findings, and regularly update the reviews.
PTS: 1 DIF: Apply REF: Method for Producing Systematic Reviews
• The nurse is using the scale for rating the strength of research evidence for one
research article for potential inclusion in a clinical practice guideline. Which of
the following is considered the
strongest evidence?
1. Individual cohort study
2. Meta-analysis of randomized clinical trials
3. Expert opinion
4. Case studies
ANSWER: 2
When utilizing the Scale for Rating the Strength of Research Evidence, the level with the
strongest evidence is level I, meta-analysis of randomized clinical trials. Level III is
individual cohort studies. Expert opinion is Level VII or the weakest evidence. Case
studies are Level VI.
PTS:1DIF:Analyze
REF:Table 2-1 Scale for Rating the Strength of Research Evidence
• The nurse is considering a research study for inclusion in a clinical practice
guideline that has been identified as being sufficient to determine effects on
health outcomes. This research study would be considered as being:
1. fair.
2. passable.
3. poor.
4. good.
ANSWER: 1
Research studies are rated according to the Scale for Rating the Quality of Research
Evidence. According to this scale, a research study that is sufficient to determine the
effects on health outcomes is considered fair. A good study has consistent results for
well-designed, well- conducted studies that directly assess effects on health outcomes.
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A poor study has insufficient results to assess the affects on health outcomes. Passable is
not a category of this rating scale.
PTS:1DIF:Analyze
REF:Table 2-2 Scale for Rating the Quality of Research Evidence
• The nurse is reviewing evidence-based clinical practice guidelines to use when
planning care for a client. One guideline has been graded by the U.S. Preventive
Services Task Force as being an A. According to this grade, the nurse should
do which of the following?
1
.
Do not use this guideline because the harm
outweighs the benefits.
2
.
Do not use this guideline because the
benefits and harms cannot be determined.
3
.
Use this guideline because the benefit is
substantial.
4
.
Use this guideline but understand that the
net benefit to the client is small.
ANSWER: 3
The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D
plus I. A grade A guideline is recommended for care since there is high certainty that
the benefit to the client is substantial. A grade C guideline has a small net benefit to the
client. A grade D guideline has harms that outweigh the benefits. A grade I guideline
has benefits and harms that cannot be determined.
PTS:1DIF:Apply
REF: Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force
• The nurse identifies errors and hazards in a care environment and implements
basic safety to reduce the likelihood of an adverse event. Which of the following
core competencies is this nurse implementing?
2. Apply quality improvement
3. Employ evidence-based practice
4. Utilize informatics
1. Provide patient-centered care
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2. Apply quality improvement
3. Employ evidence-based practice
4. Utilize informatics
ANSWER: 2
Of the five Core Competencies for Health Professions, the competency that focuses
on the identification of errors and hazards with implementation of basic safety is
apply quality improvement. Provide patient-centered care focuses on direct care
activities. Employ evidence- based practice focuses on the integration of research
with clinical expertise. Utilize informatics to focus on communication and the use of
information technology to support decision making.
PTS: 1 DIF: Apply REF: Box 2-1 Core Competencies for Health Professions
• The nurse is participating on a committee to select evidence-based practice
guidelines.Which of the following statements by the nurse indicate a clear
understanding of the purpose of these guidelines?
1
.
They provide the best evidence to make
decisions about the care of individual
clients.
2
.
They promote changes in client care
according to a research study.
3
.
They ensure cost-effective care to the
client.
4
.
They identify safe staffing ratios for client
care.
ANSWER: 1
Evidence-based practice guidelines provide the best evidence to make decisions about
the care of individual clients. The use of a single research study to make changes in
client care is a concept within research utilization and not evidence-based practice.
Evidence-based practice does impact the costs of client care but their intent is not to
ensure cost-effective care but rather to improve the overall quality of care.
Evidence-based guidelines do not provide staffing ratios for client care.
PTS:1DIF:AnalyzeREF:The Process of EBP
MULTIPLE RESPONSE
• The nurse is determining the best way to ensure adherence to the core
competencies for health professions. Which of the following competencies will
the nurse implement when providing client care? (Select all that apply.)
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1. Work in interdisciplinary teams
2. Utilize informatics
3. Implement basic safety principles
4. Employ evidence-based practice
5. Apply quality improvement
6. Provide patient-centered care
ANSWER: 1, 2, 4, 5, 6
Core competencies for health professions include providing patient-centered care,
working in interdisciplinary teams, employing evidence-based practice, applying quality
improvement, and utilizing informatics. Implementing basic safety principles is only
one part of a quality improvement program.
PTS:1DIF:Apply
REF: Box 2-1 Core Competencies for Health Professions.
• There are impediments that make the practice of evidence-based practice
difficult. Which of the following are impediments to evidence-based practice?
(Select all that apply.)
3. Variety of knowledge forms
4. Number of patient diagnoses
5. Evidence summary
6. Application of quality improvement
ANSWER: 1, 3
Hurdles to evidence-based practice are the increasing complexity of science and
technology and the variety of knowledge forms, many of which are not suitable for
direct practice. Knowledge transformation, number of patient diagnoses, evidence
summary, application of quality improvement are not considered impediments to the
implementation of evidence-based practice.
Chapter 3. Overview of Health Concepts for Medical-Surgical Nursing
MULTIPLE CHOICE
1. Complexity of science and technology
2. Difficulty of nowledge transformation
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• The nurse ensures that a clients bedspace is neat and clean with the call light
within easy reach. The nurse is focusing on which nursing theorist who realized
the importance of the environment for care?
1. Florence Nightingale
2. Sister Callista Roy
3. Dorothea Orem
4. Martha Rogers
ANSWER: 1
Florence Nightingales theory focused on the environment for care. Sister Callista Roys
model is based in systems theory and an individuals ability to adapt. Dorothea Orems
model is the self- care deficit theory. Martha Rogers model is the science of unitary
human beings.
PTS:1DIF:Apply
REF:Emergence of Contemporary Nursing in the United States
• The nurse is instructing a client on self-administration of insulin so that the
client will not need a health care provider to do this activity. The nurse is
implementing which of the following aspects of Virginia Hendersons theory of
nursing?
1
.
A caring relationship
2
.
Helping the client achieve independence
from the nurses assistance as quickly as
possible
3
.
Integration of objective and subjective data
4
.
Application of critical thinking
ANSWER: 2
Virginia Hendersons theory of nursing is to help people achieve health or a peaceful
death so that they can be independent from the nurses assistance as quickly as
possible. A caring relationship, integration of objective and subjective data, and
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application of critical thinking are included in the American Nurses Associations
essential features of professional nursing.
PTS:1DIF:Analyze
REF:Emergence of Contemporary Nursing in the United States
3.A client tells the nurse that he has an HMO for his health insurance. The nurse
understands that the purpose of this type of health plan is to:
1. ensure payment is made to Medicare for services rendered.
2. maximize the utilization of health care resources.
3. efficiently manage costs while providing quality care.
4. focus on the illness when providing care.
ANSWER: 3
Health maintenance organizations (HMOs) were created to efficiently manage health
care costs while providing quality care. An HMO is a type of managed care plan with the
goal of providing wellness care and not focusing on the illness during the provision of
care. HMOs do not ensure payment is made to Medicare for services rendered.
HMOs also do not maximize the utilization of health care resources but rather uses
financial incentives to decrease care costs.
PTS: 1 DIF: Understand REF: Cost of Care
4.A client tells the nurse that he does not have a primary care physician but rather
makes an appointment with a doctor who specializes in the area in which he is
experiencing a problem. The nurse realizes this client is at risk for which of the
following?
1. Fragmented care
2. Overpayment of services
3. Inability to sustain health
4. Finding an appropriate general practitioner
ANSWER: 1
In the 1980s, the close and trusting relationship between an individual and the
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individuals physician waned and was replaced by acquaintances with specialists based
upon particular health care problems. These episodes of care cause fragmentation of care.
The client who utilizes specialists is not at risk for overpayment of services, the inability
to sustain health, or finding an appropriate general practitioner.
PTS:1DIF:AnalyzeREFroviders of Care
5.The nurse is attending a masters degree program in efforts to be educationally
prepared to serve as a hospital leader. The nurse realizes that this educational
preparation will:
2
.
be viewed as not supporting the profession
of nursing by other nurses.
3
.
ensure the nurse is biased towards
clinicians interests.
4
.
prepare the nurse to serve as strong clinical
support with the ability to integrate
business and caring.
ANSWER: 4
The nurse is attending an educational program to serve as a hospital leader. This
education will prepare the nurse to serve as strong clinical support with the ability to
integrate business and caring. This education will not hinder the nurses ability to work
with physicians. This education will not be viewed as unsupportive to the profession of
nursing. The education will ensure that the nurse is not biased towards clinicians
interests.
PTS: 1 DIF: Analyze REF: Clinical Systems Leadership
A. client tells the nurse that all hospitals care about is doing the minimum for a client
regardless of the outcome. Which of the following should the nurse respond to this
client?
1
.
It does feel like that sometimes.
2
.
Health insurance companies have caused
this problem.
1
.
hinder the nurses ability to work with physicians.
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3
.
The doctors will get paid regardless of the
clients outcomes.
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1
.
It does feel like that sometimes.
2
.
Health insurance companies have caused
this problem.
3
.
The doctors will get paid regardless of the
clients outcomes.
4
.
There are quality programs in place to
make sure clients receive the best quality
of care regardless of the cost.
ANSWER: 4
In response to concerns about safety and quality of care voiced by clients and
providers, total quality management and continuous quality improvement programs were
initiated. These programs ensure society that cost management is not compromising
safety or quality. This is
what the nurse should respond to the client. The other choices do not address the clients
concerns nor do they explain quality management programs.
PTS: 1 DIF: Apply REF: Quality Measure Shift
• The nurse is providing care at a time that is the most beneficial to the client.
The nurse is implementing which of the following Joint Commission
Dimensions of Quality Performance?
1. Safety
2. Timeliness
3. Efficiency
4. Availability
ANSWER: 2
The dimension of timeliness means the degree in which interventions are provided at the
most beneficial time to the client. Safety means the degree in which the risk of an
intervention and risk to the environment are reduced for both client and health care
provider. Efficiency means the degree in which care has the desired effect with a
minimum of effort, waste, or expense.
Availability means the degree in which appropriate interventions are available to meet the clients
needs.
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PTS:1DIF:Analyze
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REF:Box 1-1 Joint Commission Dimensions of Quality Performance
• The nurse is providing care while adhering to safety as a Joint Commission
Dimension of Quality Performance. Which of the following did the nurse
provide to the client?
ANSWER: 1
The dimension of safety means the degree in which the risk of an intervention and risk
to the environment are reduced for both client and health care provider. The nurse who
uses a needleless device when providing intravenous medications is adhering to this
dimension.
Keeping the siderails in the down position is not a safe practice. Having a client sit in a
wheelchair with the wheels unlocked is not a safe practice. Placing cloth towels over
a spill in the room of an ambulatory client is not a safe practice.
PTS:1DIF:Analyze
REF:Box 1-1 Joint Commission Dimensions of Quality Performance
• The nurse is planning and providing care while adhering to the American
Nurses Association definition of professional nursing. Which of the following
does the nurse include when implementing client care?
1. Follows the NANDA nursing diagnoses process
2. Integrates objective and subjective data
3. Respects cultural diversity of peers
4. Acknowledges the experience and training of physicians
3 Having the client sit in a wheelchair with the wheels in the unlocked position
.
4 Placing cloth towels over a spill in the room of an ambulatory client
.
1 Using a needleless device when providing intravenous medications
.
2 Keeping the siderails of the bed in the down position after providing a pain
. medication to a client
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ANSWER: 2
The American Nurses Association acknowledges six essential features of professional
nursing. These include: 1) a caring relationship, 2) attention to the full range of human
health and illness experiences, 3) integrates objective and subjective data, 4) applies
scientific knowledge and critical thinking, 5) advances nursing knowledge through
scholarly inquiry, and 6) promotes social justice. The nurse integrating objective and
subjective data is implementing one of the six essential features of professional
nursing. The other choices are not essential features of
professional
nursing.
PTS:1DIF:A
nalyze
REF:Emergence of Contemporary Nursing in the United States
• The nurse has shifted her practice from an illness focus to a health focus.
Which of the following has this nurse implemented?
1. Standardized care plans
2. Critical pathways
3. Instructing a client on relaxation techniques to aid with sleep
4. Holding around-the-clock medication when a client is asleep
ANSWER: 3
The use of client education as a strategy to attain and maintain the potential for health is
an example of the shift of care from an illness focus to a health focus. The nurse
instructing a client on relaxation techniques to aid with sleep is implementing a health
focus of care. The other choices do not support the shift from an illness focus to a
health focus.
PTS: 1 DIF: Analyze REF: Leadership
11.A client is admitted with a highly communicable disease. The nurses do not want to
participate in the care of this client. Which of the following should be done to
ensure the client receives the highest quality of care?
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1
.
Adhere to strict standard precautions.
2
.
Plan to have the client transferred to
another health care organization.
3
.
Ask the physician if the client can be cared
for in the home.
ANSWER: 1
When providing care in a highly global environment, the risks of communicable
diseases increases. In the event that a client is admitted with a highly communicable
disease and the nurses are fearing for their own health and safety, the only safe
approach is to ensure all staff adhere to strict standard precautions. The other choices
do not ensure that the client will receive the highest quality of care. The nurses must
learn emotional intelligence and resolve issues under fire.
PTS:1DIF:AnalyzeREF:Globalization
• The nurse has been an employee of an organization for 2 years and is
considering a job change. Which of the following does this nurses plan
suggest to any future employers?
1
.
The nurse moves to other jobs too
frequently.
2
.
The nurse is inflexible.
3
.
The nurse is searching for a more
challenging environment with career
opportunities.
4
.
The nurse is willing to sacrifice home and
personal life for a job.
ANSWER: 3
At one point in time, job changes every 2 or 3 years was considered a red flag for
employers. This does not hold true today. The nurse who changes jobs every 2 or 3
years is interested in career advancement and success. Creativity is valued and
opportunities are desired. Moving to another job in 2 to 3 years does not mean the
4
.
Suspend the nurses without pay who refuse to care for the client.

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  • 1. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com TEST BANK - Timby's Introductory Medical-Surgical Nursing, 13th Edition (Donnelly-Moreno), Verified Chapters 1 - 72, Complete
  • 2. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com Table of Contents Cbapter O1 Concepts and Trends in Health Care Chapter02SettingsandModelsforNursingCare Cbapter 03 The KursingProcess Chapter 04 Intenievingand Physical Ass.essment Cbapter 05 legal and Ethical Issues Cbapter 06 leadership Roles and Manag,ement functions Chapter 07Nurse-Client Relationships Cbapter 08 Cultural Care Considerations Chapter09 IntegrativeMedicine and .'ttemati·eTherapies Cbapter 10 End-of-Life Care Cbapter 11 Pain Manag,ement Chapter 12 Infection Cbapter 13 lntra«nous Therapy Chapter 14Perioperati'eCare Cbapter 15DisasterSituations Cbapter 16 Caring for Clients With fluid,Electroly1 e, and Acid-Base lmbalances Chapter 17Caring for Clients in Shock Cbapter 18Caring for Clients With Cancer Chapter 1 9lntroduction to !heRespiratory System Cbapter 20 Caring for Clients With Upper Respiratory Disorders Cbapter 21 Caring for Clients fith Lover Respiratory Disorders Chapter 22 lntroduction to !heCardio'ascular System Cbapter 23 Caring for Clients With Infectious and Inflammatory Disordersof the Heart and Blood Vessels Cbapter 24 Caring for Clients With Valvular Disorders ofthe Heart Cbapter 25 Caring for Clients With Disorders of Coronary and Peripheral Blood Vessels Chapter 26 Caring for Clients With Cardiac Arrhytlunias Cbapter 27 Caring for Clients With Hypertension Chapter 28 Caring for Clients With Heart failure Cbapter 29 Caring for Clients Undergoing Cardiovascular Surgery Cbapter 30 lntroduction to !he Hematopoietic and Lymphatic Systerns Chapter31 CaringforClientsiithDisordersofthe HematopoieticSystem Cbapter 32 Caring for Clients With Disorders of the lymphatic System Chapter33 IntroductiontotheImmuneSystem Cbapter 34 Caring for Clients fith Immune--Mediated Disorders Cbapter 35 Caring for Clients With HJV AIDS Chapter 36 lntroduction to !he Nervous System Cbapter 37 Caring for Clients With Central andPeripheral Nervous System Disorders Chapter 38 Caring for Clie11ts iithCerebrovascular Disorders Cbapter 39Caring for Clients With Head and SpinalCord Trauma Cbapter40CaringforClientsfithKeurologicDe-fícits 13 25 35 46 58 68 80 87 97 108 120 132 142 153 161 172 183 192 204 216 226 234 244 254 265 275 286 297 308 318 328 341 351 362 374 384 393 402 413
  • 3. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com Cbapter41lntroó0<:tiontotheSensorySystem Chapter42CaringforClie11tsWithEyeDisorders Chapter43CaringforClie11tsiithEarDisorders Cbapter44lntroó0<:tiontotheGastrointestinalSysternandAccessoryStructures Chapter45CaringforClie11tsiithDisordersoftheUpperGastrointestinalTrac.t Cbapter46CaringforClientsfithDisordersoftheLoverGastrointestinal Tract Chapter47 Caring forClie11tsiithDisordersoftheLi·er,Gallbladder,orPancreas Chapter48 CaringforClie11tsiithOstoinies Cbapter49lntroó0<:tiontotheEndocrineSystern Chapter50CaringforClie11tsiithDisordersoftheEndoc.rineSyste1n Cbapter51 Caring for Clientsfith DiabetesMellitus Chapter52 lntroóuction totheFemaleand MateReproducti eSystems Chapter53CaringforClie11tsiithDisordersoftheFemaleReproductiveSyste1n Cbapter54 Caring for Clientsfith BreastDisorders Chapter55 CaringforClie11tsiithDisordersoftheMateReproducti·eSystem Cbapter 56Caring for Clients With Sexually Transmitted Infections Chapter 57 lntroóuction totheUrinary System Chapter58CaringforClientsiithDisordersoftheKidneysandUreters Cbapter 59 Caring for Clients With Disordersof the Bladder and Urethra Chapter60lntroóuction totheMusculoskeletalSystem Cbapter61CaringforClientsRequiringOrtbopedic Treatment Chapter62CaringforClientsiithTratunaticMusculoskeletalInjuries Chapter63CaringforClientsiithOrthopedicandConnectiveTissueDisorders Cbapter64lntroó0<:tiontotheIntegumentarySystern Chapter65 Caring for Clientsiith Skin, Hair.andNail Disorders Cbapter 66Caring for ClientsWith Bums Chapter67 Interaction ofBodyand Mind Chapter68CaringforClie11tsWithAlcxietyDisorders Cbapter69Caring for Clientsfith Mood Disorders Chapter 70Caring for Clientsiith Eating Disorders Cbapter 71 CaringforClientsWithSubstanceUseDisorders Chapter72CaringforClientsiithDementiaandThoughtDisorders 422 432 441 451 460 468 476 486 496 506 517 527 538 547 557 568 578 589 598 609 618 630 642 653 663 674 684 693 703 715 724
  • 4. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ Chapter 1 Concepts and Trends in Healthcare ◦ A new nurse is working with a preceptor on an inpatient medical-surgical unit. The preceptor advises the student that which is the priority when working as a professional nurse? ◦ Attending to holistic client needs ◦ Ensuring client safety ◦ Not making medication errors ◦ Providing client- focused care ANSWER: B ◦ All actions are appropriate for the professional nurse. However, ensuring client safety is the priority. Up to 98,000 deaths result each year from errors in hospital care, according to the 2000 Institute of Medicine report. Many more clients have suffered injuries and less serious outcomes. Every nurse has the responsibility to guard the clients safety. ◦ DIF: Understanding/Comprehension REF: 2 KEY: Patient safety MSC: Integrated Process: Nursing Process: Intervention ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control ◦ A nurse is orienting a new client and family to the inpatient unit. What information does the nurse provide to help the client promote his or her own safety? ◦ Encourage the client and family to be active partners. ◦ Have the client monitor hand hygiene in caregivers. ◦ Offer the family the opportunity to stay with the client. ◦ Tell the client to always wear his or her armband. ANSWER: A ◦ Each action could be important for the client or family to perform. However, encouraging the client to be active in his or her health care as a partner is the most critical. The other actions are ◦ ◦ very limited in scope and do not provide the broad protection that being active and involved does. ◦ DIF: Understanding/Comprehension REF: 3 KEY: Patient safety MSC: Integrated Process: Teaching/
  • 5. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com Learning
  • 6. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ NOT: Client Needs Category: Safe and Effective Care
  • 7. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com Environment: Safety and Infection Control ◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best? ◦ Call the Rapid Response Team. ◦ Document and continue to monitor. ◦ Notify the primary care provider. ◦ Repeat blood pressure measurement in 15 minutes. ANSWER: A ◦ The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating before they suffer either respiratory or cardiac arrest. Since the client has manifested a significant change, the nurse should call the RRT. Changes in blood pressure, mental status, heart rate, and pain are particularly significant. Documentation is vital, but the nurse must do more than document. The primary care provider should be notified, but this is not the priority over calling the RRT. The clients blood pressure should be reassessed frequently, but the priority is getting the rapid care to the client. ◦ DIF: Applying/Application REF: 3 ◦ KEY: Rapid Response Team (RRT)| medical emergencies MSC: Integrated Process: Communication and Documentation ◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation ◦ ◦ A nurse wishes to provide client-centered care in all interactions. Which action by the nurse best demonstrates this concept? ◦ Assesses for cultural influences affecting health care ◦ Ensures that all the clients basic needs are met ◦ Tells the client and family about all upcoming tests ◦ Thoroughly orients the client and family to the room ANSWER: A ◦ Competency in client-focused care is demonstrated when the nurse focuses on communication, culture, respect, compassion, client education, and empowerment. By assessing the effect of the ◦ ◦ clients culture on health care, this nurse is practicing client-focused care. Providing for basic needs does not demonstrate this competence. Simply telling the client about all upcoming tests is not providing empowering education. Orienting the client and family to the room is an important safety measure, but not directly related to demonstrating client-centered care.
  • 8. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ DIF: Understanding/Comprehension REF: 3
  • 9. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ KEY: Patient-centered care| culture MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity ◦ A client is going to be admitted for a scheduled surgical procedure. Which action does the nurse explain is the most important thing the client can do to protect against errors? ◦ Bring a list of all medications and what they are for. ◦ Keep the doctors phone number by the telephone. ◦ Make sure all providers wash hands before entering the room. ◦ Write down the name of each caregiver who comes in the room. ANSWER: A ◦ Medication errors are the most common type of health care mistake. The Joint Commissions Speak Up campaign encourages clients to help ensure their safety. One recommendation is for clients to know all their medications and why they take them. This will help prevent medication errors. ◦ DIF: Applying/Application REF: 4 ◦ KEY: Speak Up campaign| patient safety MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control ◦ Which action by the nurse working with a client best demonstrates respect for autonomy? ◦ Asks if the client has questions before signing a consent ◦ Gives the client accurate information when questioned ◦ Keeps the promises made to the client and family ◦ Treats the client fairly compared to other clients ANSWER: A ◦ Autonomy is self-determination. The client should make decisions regarding care. When the nurse obtains a signature on the consent form, assessing if the client still has questions is vital, because without full information the client cannot practice autonomy. Giving accurate information is practicing with veracity. Keeping promises is upholding fidelity. Treating the ◦ ◦ client fairly is providing social justice. ◦ ◦ DIF: Applying/Application REF: 4 ◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
  • 10. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ ◦ A student nurse asks the faculty to explain best practices when communicating with a person from the lesbian, gay, bisexual, transgender, and queer/ questioning (LGBTQ) community. What answer by the faculty is most accurate? ◦ Avoid embarrassing the client by asking questions. ◦ Dont make assumptions about their health needs. ◦ Most LGBTQ people do not want to share information. ◦ No differences exist in communicating with this population. ANSWER: B ◦ Many members of the LGBTQ community have faced discrimination from health care providers and may be reluctant to seek health care. The nurse should never make assumptions about the needs of members of this population. Rather, respectful questions are appropriate. If approached with sensitivity, the client with any health care need is more likely to answer honestly. ◦ DIF: Understanding/Comprehension REF: 4 KEY: LGBTQ| diversity MSC: Integrated Process: Teaching/Learning ◦ NOT: Client Needs Category: Psychosocial Integrity ◦ ◦ A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago and has pain that is unrelieved by the prescribed narcotic pain medication. Which statement is part of the SBAR format for communication? ◦ A: I would like you to order a different pain medication. ◦ B: This client has allergies to morphine and codeine. ◦ R: Dr. Smith doesnt like nonsteroidal anti-inflammatory meds. ◦ S: This client had a vaginal hysterectomy 2 days ago. ANSWER: B ◦ SBAR is a recommended form of communication, and the acronym stands for Situation, Background, Assessment, and Recommendation. Appropriate background information includes allergies to medications the on-call physician might order. Situation describes what is happening right now that must be communicated; the clients surgery 2 days ago would be considered background. Assessment would include an analysis of the clients problem; asking for a different pain medication is a recommendation. Recommendation is a statement of what is needed or what ◦ ◦ outcome is desired; this information about the surgeons preference might be better placed in background. ◦ DIF: Applying/ Application REF: 5 KEY: SBAR| communication
  • 11. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com of Care ◦ MSC: Integrated Process: Communication and Documentation ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management ◦ ◦ A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed assistive personnel (UAP). Four hours later, the nurse notes the clients blood pressure is much higher than previous readings, and the clients mental status has changed. What action by the nurse would most likely have prevented this negative outcome? ◦ Determining if the UAP knew how to take blood pressure ◦ Double-checking the UAP by taking another blood pressure ◦ Providing more appropriate supervision of the UAP ◦ Taking the blood pressure instead of delegating the task ANSWER: C ◦ Supervision is one of the five rights of delegation and includes directing, evaluating, and following up on delegated tasks. The nurse should either have asked the UAP about the vital signs or instructed the UAP to report them right away. An experienced UAP should know how to take vital signs and the nurse should not have to assess this at this point. Double-checking the work defeats the purpose of delegation. Vital signs are within the scope of practice for a UAP and are permissible to delegate. The only appropriate answer is that the nurse did not provide adequate instruction to the UAP. ◦ DIF: Applying/Application REF: 6 ◦ KEY: Supervision| delegation| unlicensed assistive personnel MSC: Integrated Process: Communication and Documentation ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care ◦ ◦ A newly graduated nurse in the hospital states that, since she is so new, she cannot participate in quality improvement (QI) projects. What response by the precepting nurse is best? ◦ All staff nurses are required to participate in quality improvement here. ◦ Even being new, you can implement activities designed to improve care. ◦ Its easy to identify what indicators should be used to measure quality. ◦ You should ask to be assigned to the research and quality committee. ANSWER: B ◦ ◦ The preceptor should try to reassure the nurse that implementing QI measures is not out of line for a newly licensed nurse. Simply stating that all nurses are required to participate does not help the nurse understand how that is possible and
  • 12. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com is dismissive. Identifying indicators of quality is not an easy, quick process and would not be the best place to suggest a new nurse to start. ◦ Asking to be assigned to the QI committee does not give the nurse information about how to implement QI in daily practice. ◦ DIF: Applying/ Application REF: 6 KEY: Quality improvement ◦ MSC: Integrated Process: Communication and Documentation ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care ◦ ◦ A nurse is talking with a client who is moving to a new state and needs to find a new doctor and hospital there. What advice by the nurse is best? ◦ Ask the hospitals there about standard nurse-client ratios. ◦ Choose the hospital that has the newest technology. ◦ Find a hospital that is accredited by The Joint Commission. ◦ Use a facility affiliated with a medical or nursing school. ANSWER: C ◦ Accreditation by The Joint Commission (TJC) or other accrediting body gives assurance that the facility has a focus on safety. Nurse-client ratios differ by unit type and change over time. New technology doesnt necessarily mean the hospital is safe. Affiliation with a health professions school has several advantages, but safety is most important. ◦ DIF: Understanding/ Comprehension REF: 2 KEY: The Joint Commission (TJC)| accreditation ◦ MSC: Integrated Process: Communication and Documentation ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control ◦ MULTIPLE RESPONSE ◦ ◦ A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest levels of competency. Which areas should the manager assess to determine if the nursing staff demonstrate competency according to the Institute of Medicine (IOM) report Health Professions Education: A Bridge to Quality? (Select all that apply.) ◦ Collaborating with an interdisciplinary team ◦ ◦ Implementing evidence-based care ◦ Providing family-focused care
  • 13. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ Routinely using informatics in practice ◦ Using quality improvement in client care ANSWER: A, B, D,E ◦ The IOM report lists five broad core competencies that all health care providers should practice. These include collaborating with the interdisciplinary team, implementing evidence-based practice, providing client-focused care, using informatics in client care, and using quality improvement in client care. ◦ DIF: Remembering/Knowledge REF: 3 ◦ KEY: Competencies| Institute of Medicine (IOM) MSC: Integrated Process: Nursing Process: Assessment ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control ◦ A nurse is interested in making interdisciplinary work a high priority. Which actions by the nurse best demonstrate this skill? (Select all that apply.) ◦ Consults with other disciplines on client care ◦ Coordinates discharge planning for home safety ◦ Participates in comprehensive client rounding ◦ Routinely asks other disciplines about client progress ◦ Shows the nursing care plans to other disciplines ANSWER: A, B, C, D ◦ Collaborating with the interdisciplinary team involves planning, implementing, and evaluating client care as a team with all other disciplines included. Simply showing other caregivers the nursing care plan is not actively involving them or collaborating with them. of Care ◦ DIF: Applying/Application REF: 4 ◦ KEY: Collaboration| interdisciplinary team ◦ MSC: Integrated Process: Communication and Documentation ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management ◦ ◦ The nurse utilizing evidence-based practice (EBP) considers which factors when planning care? (Select all that apply.) ◦ Cost-saving measures ◦ Nurses expertise ◦ ◦ Client preferences
  • 14. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ◦ Research findings ◦ Values of the client ANS WER: B, C, D, E ◦ EBP consists of utilizing current evidence, the clients values and preferences, and the nurses expertise when planning care. It does not include cost- saving measures. ◦ DIF: Remembering/Knowledge REF: 6 KEY: Evidence-based practice (EBP) ◦ MSC: Integrated Process: Nursing Process: Planning ◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care ◦ ◦ A nurse manager wants to improve hand-off communication among the staff. What actions by the manager would best help achieve this goal? (Select all that apply.) ◦ Attend hand-off rounds to coach and mentor. ◦ Conduct audits of staff using a new template. ◦ Create a template of topics to include in report. ◦ Encourage staff to ask questions during hand-off. ◦ Give raises based on compliance with reporting. ANSWER: A, B, C, D ◦ A good tool for standardizing hand-off reports and other critical communication is the SHARE model. SHARE stands for standardize critical information, hardwire within your system, allow opportunities to ask questions, reinforce quality and measurement, and educate and coach. ◦ Attending hand-off report gives the manager opportunities to educate and coach. Conducting audits is part of reinforcing quality. Creating a template is hardwiring within the system. ◦ Encouraging staff to ask questions and think critically about the information is allowing opportunities to ask questions. The manager may need to tie raises into compliance if the staff is resistive and other measures have failed, but this is not part of the SHARE model. ◦ ◦ Chapter 2 Settings and Models for Nursing Care MULTIPLE CHOICE
  • 15. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • The nurse ensures that a clients bedspace is neat and clean with the call light within easy reach. The nurse is focusing on which nursing theorist who realized the importance of the environment for care? • Florence Nightingale • Sister Callista Roy • Dorothea Orem • Martha Rogers ANSWER: 1 Florence Nightingales theory focused on the environment for care. Sister Callista Roys model is based in systems theory and an individuals ability to adapt. Dorothea Orems model is the self- care deficit theory. Martha Rogers model is the science of unitary human beings. PTS:1DIF:Apply REF:Emergence of Contemporary Nursing in the United States • The nurse is instructing a client on self-administration of insulin so that the client will not need a health care provider to do this activity. The nurse is implementing which of the following aspects of Virginia Hendersons theory of nursing? • A caring relationship • Helping the client achieve independence from the nurses assistance as quickly as possible • Integration of objective and subjective data • Application of critical thinking ANSWER: 2
  • 16. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com Virginia Hendersons theory of nursing is to help people achieve health or a peaceful death so that they can be independent from the nurses assistance as quickly as possible. A caring relationship, integration of objective and subjective data, and application of critical thinking are included in the American Nurses Associations essential features of professional nursing. PTS:1DIF:Analyze REF:Emergence of Contemporary Nursing in the United States 3.A client tells the nurse that he has an HMO for his health insurance. The nurse understands that the purpose of this type of health plan is to: • ensure payment is made to Medicare for services rendered. • maximize the utilization of health care resources. • efficiently manage costs while providing quality care. • focus on the illness when providing care. ANSWER: 3 Health maintenance organizations (HMOs) were created to efficiently manage health care costs while providing quality care. An HMO is a type of managed care plan with the goal of providing wellness care and not focusing on the illness during the provision of care. HMOs do not ensure payment is made to Medicare for services rendered. HMOs also do not maximize the utilization of health care resources but rather uses financial incentives to decrease care costs. PTS: 1 DIF: Understand REF: Cost of Care • client tells the nurse that he does not have a primary care physician but rather makes an appointment with a doctor who specializes in the area in which he is experiencing a problem. The nurse realizes this client is at risk for which of the following? • Fragmented care
  • 17. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • Overpayment of services • Inability to sustain health • Finding an appropriate general practitioner ANSWER: 1 In the 1980s, the close and trusting relationship between an individual and the individuals physician waned and was replaced by acquaintances with specialists based upon particular health care problems. These episodes of care cause fragmentation of care. The client who utilizes specialists is not at risk for overpayment of services, the inability to sustain health, or finding an appropriate general practitioner. PTS:1DIF:AnalyzeREFroviders of Care • The nurse is attending a masters degree program in efforts to be educationally prepared to serve as a hospital leader. The nurse realizes that this educational preparation will: • hinder the nurses ability to work with physicians. • be viewed as not supporting the profession of nursing by other nurses. • ensure the nurse is biased towards clinicians interests. prepare the nurse to serve as strong clinical support with the ability to integrate business and • caring. ANSWER: 4 The nurse is attending an educational program to serve as a hospital leader. This education will prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. This education will not hinder the nurses ability to work with physicians. This education will not be viewed as unsupportive to the profession of nursing. The
  • 18. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com education will ensure that the nurse is not biased towards clinicians interests. PTS: 1 DIF: Analyze REF: Clinical Systems Leadership • client tells the nurse that all hospitals care about is doing the minimum for a client regardless of the outcome. Which of the following should the nurse respond to this client? • It does feel like that sometimes. • Health insurance companies have caused this problem. • The doctors will get paid regardless of the clients outcomes. There are quality programs in place to make sure clients receive the best quality of care regardless • of the cost. ANSWER: 4 In response to concerns about safety and quality of care voiced by clients and providers, total quality management and continuous quality improvement programs were initiated. These programs ensure society that cost management is not compromising safety or quality. This is what the nurse should respond to the client. The other choices do not address the clients concerns nor do they explain quality management programs. PTS: 1 DIF: Apply REF: Quality Measure Shift • The nurse is providing care at a time that is the most beneficial to the client. The nurse is implementing which of the following Joint Commission Dimensions of Quality Performance? • Safety • Timeliness • Efficiency
  • 19. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • Availability ANSWER: 2 The dimension of timeliness means the degree in which interventions are provided at the most beneficial time to the client. Safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. Efficiency means the degree in which care has the desired effect with a minimum of effort, waste, or expense. Availability means the degree in which appropriate interventions are available to meet the clients needs. PTS:1DIF:Analyze REF:Box 1-1 Joint Commission Dimensions of Quality Performance • The nurse is providing care while adhering to safety as a Joint Commission Dimension of Quality Performance. Which of the following did the nurse provide to the client? • Using a needleless device when providing intravenous medications • Keeping the siderails of the bed in the down position after providing a pain medication to a client • Having the client sit in a wheelchair with the wheels in the unlocked position • Placing cloth towels over a spill in the room of an ambulatory client ANSWER: 1 The dimension of safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. The nurse who uses a needleless device when providing intravenous medications is adhering to this dimension. Keeping the siderails in the down position is not a safe practice. Having a client sit in a wheelchair with the wheels unlocked is not a safe practice. Placing cloth towels over a spill in the room of an ambulatory client is not a safe practice. PTS:1DIF:Analyze REF:Box 1-1 Joint Commission Dimensions of Quality Performance • The nurse is planning and providing care while adhering to the
  • 20. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com American Nurses Association definition of professional nursing. Which of the following does the nurse include when implementing client care? • Follows the NANDA nursing diagnoses process • Integrates objective and subjective data • Respects cultural diversity of peers • Acknowledges the experience and training of physicians ANSWER: 2 The American Nurses Association acknowledges six essential features of professional nursing. These include: 1) a caring relationship, 2) attention to the full range of human health and illness experiences, 3) integrates objective and subjective data, 4) applies scientific knowledge and critical thinking, 5) advances nursing knowledge through scholarly inquiry, and 6) promotes social justice. The nurse integrating objective and subjective data is implementing one of the six essential features of professional nursing. The other choices are not essential features of professional nursing. PTS:1DIF:Analyze • The nurse has shifted her practice from an illness focus to a health focus. Which of the following has this nurse implemented? • Standardized care plans • Critical pathways • Instructing a client on relaxation techniques to aid with sleep • Holding around-the-clock medication when a client is asleep
  • 21. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ANSWER: 3 The use of client education as a strategy to attain and maintain the potential for health is an example of the shift of care from an illness focus to a health focus. The nurse instructing a client on relaxation techniques to aid with sleep is implementing a health focus of care. The other choices do not support the shift from an illness focus to a health focus. PTS: 1 DIF: Analyze REF: Leadership • client is admitted with a highly communicable disease. The nurses do not want to participate in the care of this client. Which of the following should be done to ensure the client receives the highest quality of care? • Adhere to strict standard precautions. • Plan to have the client transferred to another health care organization. • Ask the physician if the client can be cared for in the home. • Suspend the nurses without pay who refuse to care for the client. ANSWER: 1 When providing care in a highly global environment, the risks of communicable diseases increases. In the event that a client is admitted with a highly communicable disease and the nurses are fearing for their own health and safety, the only safe approach is to ensure all staff adhere to strict standard precautions. The other choices do not ensure that the client will receive the highest quality of care. The nurses must learn emotional intelligence and resolve issues under fire. • The nurse has been an employee of an organization for 2 years and is considering a job change. Which of the following does this nurses plan suggest to any future employers? • The nurse moves to other jobs too frequently.
  • 22. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • The nurse is inflexible. • The nurse is searching for a more challenging environment with career opportunities. • The nurse is willing to sacrifice home and personal life for a job. ANSWER: 3 At one point in time, job changes every 2 or 3 years was considered a red flag for employers. This does not hold true today. The nurse who changes jobs every 2 or 3 years is interested in career advancement and success. Creativity is valued and opportunities are desired. Moving to another job in 2 to 3 years does not mean the nurse is inflexible. The new generation of nurses does not want to sacrifice home and personal life for a job. PTS: 1 DIF: Analyze REF: Care Delivery Models • The nurse is experiencing pain and fatigue in both arms when using the computer to document client care. Which of the following can the nurse do to reduce these symptoms? • Refuse to use the computer and document using a pen and paper. • Stand up when using the computer. • Adjust the keyboard and chair to reduce the pressure on the wrists and arms. • Ask another nurse to input the information for client care activities. ANSWER: 3 Ergonomic hazards are increasing with health care providers and nurses in particular. Many of these hazards are because of the implementation of computers for documentation. The nurse should adjust the keyboard and chair to reduce the pressure on the wrists and arms when documenting with the computer. The nurse cannot refuse to use the computer. Standing up may not reduce the nurses symptoms. The nurse cannot legally ask another nurse to document client care.
  • 23. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com MULTIPLE RESPONSE • The nurse is planning care for a client and reviewing appropriate educational materials to use for discharge instructions. Which domains of nursing is this nurse implementing? (Select all that apply.) • Nursing process • Clinical practice • Education • Literature • Administration • Research ANSWER: 2, 3 The four domains of nursing are: 1) clinical practice, 2) education, 3) administration, and 4) research. When the nurse plans care for a client, the domain being implemented is clinical practice. When reviewing appropriate educational materials to use for discharge instructions, the domain being implemented is education. The nurse is not utilizing the domains of research or administration. Nursing process and literature are not domains of nursing. PTS:1DIF:Apply REF:Emergence of Contemporary Nursing in the United States • The nurse suspects that another health care colleague may be chemically dependent when which of the following is assessed? (Select all that apply.) • Prolonged work breaks • Clinical care omissions
  • 24. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • Mood stability • Extraordinary accomplishments • Heavy use of fragrances • Inability to recall recent events ANSWER: 1, 2, 4, 5, 6 Clues of possible chemical dependency include tardiness, late sick calls, frequent or prolonged work breaks, inability to recall recent events, heavy use of fragrances, clinical care omissions or errors, patient complaints or requests for a change in care provider, mood instability, and extraordinary accomplishments. Mood stability is not a characteristic of a colleague who is experiencing chemical dependency. PTS:1DIF:Apply REF:Box 1-6 Clues to the Possibility of Chemical Dependence • The nurse is a member of a health care team that includes a physician and other health care providers. These providers work together to ensure the client is relieved of suffering, has diseases cured, and experiences enhanced health and performance. Which of the following are the levels of care represented by this team of health care providers? (Select all that apply.) • Sustain life • Maintain health • Regain health • Minimize injury
  • 25. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • Maximize cost • Attain enhanced health ANSWER: 1, 2, 3, 6 The medical teams mission is to relieve suffering and cure disease. This involved the three levels of care: 1) sustain life, 2) regain health, and 3) maintain health. Once the shift toward health care occurred, the fourth level of attaining enhanced health was added. Minimize injury and maximize cost is not a level of care. PTS:1DIF:AnalyzeREFroviders of Care • client tells the nurse that she is disappointed that her employer is offering a health maintenance organization for a health care benefit. Which of the following can the nurse use as responses to the client as advantages of this type of health plan? (Select all that apply.) • Since there is a nursing shortage, clients need to stay out of the hospital. • This type of plan provides wellness care at a minimal cost to keep people healthy. • This type of plan helps clients avoid illnesses with high costs. • An HMO standardizes diagnostic and treatment decisions across the nation. • This type of plan ensures coordinated services from wellness to death. This type of plan costs as much as the traditional plans, but the insurance companies get the extra • money from premiums. ANSWER: 2, 3, 4, 5
  • 26. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com There are several missions and visions of managed care. The first is to provide wellness care at a minimal cost to keep people healthy and avoid providing illness care at a higher cost. Another mission is to standardize diagnostic and treatment decisions across the nation. Managed care emphasizes the delivery of coordinated services across the care spectrum from wellness to death and uses financial incentives to decrease length of stay and achieve cost efficiency. Managed care was not implemented to address the nursing shortage. This type of plan does not cost as much as a traditional health plan nor do the insurance companies receive the extra money from premiums. PTS: 1 DIF: Apply REF: Cost of Care • The nurse has incorporated several criteria that are essential for being a member of a profession. Which of the following has this nurse done? (Select all that apply.) • Has passed the licensure examination • Works regularly scheduled shifts • Completed a bachelors degree in nursing • Limits absences from work • Joined the American Nurses Association • Reads evidenced-based information to incorporate into planning client care ANSWER: 1, 3, 5, 6 There are seven essential criteria for a profession. The nurse has incorporated four of these criteria by passing the licensure examination, the nurse has implemented a code of ethics; by completing a bachelors degree in nursing, the nurse has been educated in an institution of higher education; by joining the American Nurses Association and reading evidenced-based information, the nurse is affiliated with a professional association that promotes and ensures quality practice. Working regularly
  • 27. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com scheduled shifts and limiting absences from work are not essential criteria for a profession. ◦ Chapter 4-Chapter 6 Interviewing and Physical Assessment ◦ Chapter 5 Legal and Ethical Issues Chapter 6 Leadership Roles and Management Functions • When a nurse becomes involved in a legal action, the first step to occur is that a document is filed in an appropriate court. What is this document called? ANSWER: C A document called a complaint is filed in an appropriate court as the first step in litigation. A deposition is when witnesses are required to undergo questioning by the attorneys. An appeal is a request for a review of a decision by a higher court. A summons is a court order that notifies the defendant of the legal action. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 23 OBJ: 1 TOP: Legal KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • The nurse caring for a patient in the acute care setting assumes responsibility for a patients care. What is this legally binding situation? a. Nurse-patient relationship b. Accountability c. Advocacy d. Standard of care ANSWER: A When the nurse assumes responsibility for a patients care, the nurse-patient relationship is formed. This is a legally binding contract for which the nurse must take responsibility. Accountability is being responsible for ones own actions. An advocate is one who defends or pleads a cause or issue on behalf of another. Standards of care define acts whose performance is required, permitted, or prohibited. c. Complaint d. Summons a. Deposition b. Appeal
  • 28. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 24 OBJ: 3 TOP: Legal KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • What are the universal guidelines that define appropriate measures for all nursing interventions? a. Scope of practice b. Advocacy c. Standard of care d. Prudent practice ANSWER: C Standards of care define actions that are permitted or prohibited in most nursing interventions. These standards are accepted as legal guidelines for appropriateness of performance. The laws that formally define and limit the scope of nursing practice are called nurse practice acts. An advocate is one who defends or pleads a cause or issue on behalf of another. Prudent is a term that refers to careful and/or wise practice. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 25 OBJ: 4 TOP: Legal KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • An LPN/LVN is asked by the RN to administer an IV chemotherapeutic agent to a patient in the acute care setting. What law should this nurse refer to before initiating this intervention? a. Standards of care b. Regulation of practice c. American Nurses Association Code d. Nurse practice act ANSWER: D It is the nurses responsibility to know the nurse practice act in his or her state. Standards of care, regulation of practice, and the American Nurses code are not laws that the nurse should refer to before initiating this treatment. PTS: 1 DIF: Cognitive Level: Application REF: Page 25 OBJ: 5 TOP: Legal KEY: Nursing
  • 29. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com Process Step: N/A MSC:NCLEX: N/A 5.A nurse fails to irrigate a feeding tube as ordered, resulting in harm to the patient. This nurse could be found guilty of: a. malpractice. b. harm to the patient. c. negligence. d. failure to follow the nurse practice act. ANSWER: A The nurse can be held liable for malpractice for acts of omission. Failure to meet a legal duty, thus causing harm to another, is malpractice. The nurse practice act has general guidelines that can support the charge of malpractice. PTS: 1 DIF: Cognitive Level: Application REF: Pages 22-23 OBJ: 2 TOP: Legal KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • Patients have expectations regarding the health care services they receive. To protect these expectations, which of the following has become law? a. American Hospital Associations Patients Bill of Rights b. Self-determination act c. American Hospital Associations Standards of Care d. The Joint Commissions rights and responsibilities of patients ANSWER: A Patients have expectations regarding the health care services they receive. In 1972, the American Hospital Association (AHA) developed the Patients Bill of Rights. The Self-determination act, American Hospital Associations Standards of Care, and The Joint Commissions rights and responsibilities do not address patients expectations regarding health care. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 26 OBJ: 3 | 4 TOP: Legal KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • The nurse is preparing the patient for a thoracentesis. What must be completed before the procedure may be performed? a. Physical assessment b. Interview
  • 30. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com c. Informed consent
  • 31. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com d. Surgical checklist
  • 32. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com a. Physical assessment b. Interview c. Informed consent d. Surgical checklist ANSWER: C The doctrine of informed consent refers to full disclosure of the facts the patient needs to make an intelligent (informed) decision before any invasive treatment or procedure is performed. A physical assessment, interview, and surgical checklist are not required before this procedure. PTS: 1 DIF: Cognitive Level: Application REF: Pages 26-27 OBJ: 8 TOP: Legal KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • When a nurse protects the information in a patients record what ethical responsibility is the nurse fulfilling? b. Disclosure c. Confidentiality d. Absolute secrecy ANSWER: C The nurse has an ethical and legal duty to protect information about a patient and preserve confidentiality. Some disclosures are legal and anticipated, and may not be subject to the rules of confidentiality. None of the information in a chart is considered secret. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 28 OBJ: 9 TOP: Confidentiality KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • An older adult is admitted to the hospital with numerous bodily bruises, and the nurse suspects elder abuse. What is the best nursing action? a. Cover the bruises with bandages. b. Take photographs of the bruises. c. Ask the patient if anyone has hit her. d. Report the bruises to the charge nurse. ANSWER: D The law stipulates that the health care professional is required to report certain a. Privacy
  • 33. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com information to the appropriate authorities. The report should be given to a supervisor
  • 34. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com or directly to the police, according to agency policy. When acting in good faith to report mandated information (e.g., certain communicable diseases or gunshot wounds), the health care professional is protected from liability. PTS: 1 DIF: Cognitive Level: Application REF: Page 29 OBJ: 9 TOP: Elder abuse KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • What is the best way for a nurse to avoid a lawsuit? a. Carry malpractice insurance b. Spend time with the patient c. Provide compassionate, competent care d. Answer all call lights quickly ANSWER: C The best defense against a lawsuit is to provide compassionate and competent nursing care. Carrying malpractice insurance is prudent, but it will not avoid a lawsuit. Spending time with patients and answering call lights quickly will not necessarily help avoid a lawsuit. PTS: 1 DIF: Cognitive Level: Comprehension REF: Pages 29-30 OBJ: 8 TOP: Avoiding a lawsuit KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • The nurse is caring for a patient with a do-not-resuscitate (DNR) order. Although the nurse may disagree with this order, what is his or her legal obligation? a. To question the doctor b. To seek advice from the family c. To discuss it with the patient d. To follow the order ANSWER: D When a DNR order is written in the chart, the nurse has a duty to follow the order. Questioning the doctor, seeking advice from the family, and discussing it with the patient are not legal obligations of the nurse. • Although the patient denies pain, the nurse observes the patient breathing rapidly with clenched fists and facial grimacing. What is
  • 35. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com the nurses best response to these observations? a . I am glad you are feeling better and have no discomfort. b . Where do you hurt? c . What you are saying and what I am observing dont seem to match. d . It makes me uncomfortable when you are not honest with me. ANSWER: C The nonverbal communication should be clarified to prevent miscommunication. PTS: 1 DIF: Cognitive Level: Application REF: Pages 59-61 OBJ:2 | 3TOP:Communication KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity • The nurse considers the feelings and needs of a patient by stating, I know you are concerned about your surgery tomorrow. How can I help you? What type of communication is this? a. Intrusive b. Aggressive c. Closed d. Assertive ANSWER: D Assertive communication takes a patients feelings and needs into account, yet honors the patients rights as an individual. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 61 OBJ:4TOP:Communication KEY:Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity • If the nurse aggressively says to a patient, Why couldnt you have asked me to give you your pain medication when I was in here
  • 36. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com earlier? what feeling is the patient most likely to demonstrate? a. Anger b. Satisfaction that his needs are met c. Humiliation and worthlessness d. Confidence that his request will be granted ANSWER: C Aggressive communication is highly destructive. Although anger may eventually come, the patient most likely feels humiliated first. PTS: 1 DIF: Cognitive Level: Application REF: Page 62 OBJ:7TOP:Communication KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 4.What does therapeutic communication accomplish? a . Facilitates the formation of a positive nurse-patient relationship b . Manipulates the patient c . Assigns the patient a passive role d . Requires the patient to accept what the nurse says ANSWER: A A positive nurse-patient relationship is facilitated by therapeutic communication. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 62 OBJ: 10 TOP: Communication KEY: Nursing Process Step: N/A MSC:NCLEX: N/A • The nurse is sitting in a chair near the patients bed, leaning forward to hear what the patient is saying, and does not interrupt. What is the nurse demonstrating? b. Caring c. Active listening d. Interest a. Support
  • 37. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com b. Caring c. Active listening d. Interest ANSWER: C When demonstrating active listening, the nurse must give his or her full attention and make an effort to understand both the verbal and nonverbal message. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 63 OBJ:5TOP:Communication KEY:Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity • What therapeutic communication technique requires a great deal of skill and is not used as frequently as other communication techniques? a. Touch b. Silence c. Listening d. Summarizing ANSWER: B Silence is an extremely effective therapeutic communication skill that is frequently underused because the nurse feels uncomfortable applying it. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 63 OBJ: 5 TOP: Communication KEY: Nursing Process Step: N/A MSC:NCLEX: N/A 7.A patient does not speak English; therefore, the nurse cannot use words to provide comfort during a painful procedure. What is another intervention that may provide comfort to this patient? a. Silence b. Listening c. Touch d. Restating ANSWER: C Holding the hand of a nonEnglish-speaking patient is effective and
  • 38. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com comforting. PTS: 1 DIF: Cognitive Level: Application REF: Page 63
  • 39. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com OBJ:9TOP:Communication KEY:Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 8.A patient states, I do cocaine when I feel things are out of my control. The nurse responds by asking, What else does cocaine do for you? What communication skill does this exemplify? a. Summarization b. Restating c. Showing acceptance d. Stating observations ANSWER: C Acceptance is the willingness to listen and respond to what the patient is saying without passing judgment. PTS: 1 DIF: Cognitive Level: Application REF: Page 64-65 OBJ:5TOP:Communication KEY:Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 9.A patient states, Im really strung out about this pregnancy. The nurse responds by asking, What about this pregnancy worries you? What communication technique is this? a. Closed inquiry b. Restating c. Open-ended question d. Minimal encouraging ANSWER: C Open-ended questions convey interest and do not require a specific response. PTS: 1 DIF: Cognitive Level: Application REF: Pages 65 OBJ:5TOP:Communication KEY:Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 10.A grieving young widow cries out, Why was my husband killed? Why wasnt it me? What is the nurses best response?
  • 40. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com a . Stating You need to be strong for your children. b . Silently placing her hand on the widows arm. c . Asking if there is anyone the widow needs to have notified. d . Stating You are feeling overwhelmed about your husbands death. ANSWER: B The ability to listen and assist those who are newly grieving through the use of silence and a quiet presence is very effective. Stating You need to be strong for your children is a clich. Asking if there is anyone the widow needs to have notified and stating You are feeling overwhelmed about your husbands death are not therapeutic in this immediate grieving time. • The nurse is implementing evidence-based practice. Which of the following is not a component of this process? 1. Patient preference 2. Clinical expertise 3. Research evidence 4. Leader practice ANSWER: 4 Evidence-based practice is the combination of applying research findings, creating clinical guidelines, and the individualization of the plan of care to meet the patients needs and desired. Leader practice is not a component of the evidence-based process. PTS:1DIF:AnalyzeREF:The Process of EBP • The nurse is planning the care for a client using an unstructured approach. Which of the following approaches did the nurse most likely use?
  • 41. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com 1. Research 2. Trial and error 3. Nursing theory 4. Validated order ANSWER: 2 Examples of unstructured approaches to plan client care include trial and error, tradition, and authority. The approaches of research, nursing theory, and validated order all represent a structured approach to planning client care. PTS: 1 DIF: Analyze REF: Knowledge Bases for Clinical Decisions • The nurse is participating in an activity that is the first step of the ACE Star Model of Knowledge Transformation. Which of the following is the nurse doing? 2. Evaluating outcomes 3. Integrating findings into practice 4. Participating in research ANSWER: 4 The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge according to five sequential steps. The first step is primary research. Subsequent steps are: 2) evidence summary, 3) translation, 4) integration, and 5) evaluation. PTS:1DIF:AnalyzeREF:EBP in Nursing 4.A committee has been developed to implement knowledge transformation when providing client care. The members realize that the purpose of knowledge transformation is to: 1. reduce length of stay. 2. convert research findings to impact health outcomes. 3. reduce the cost of care. 4. increase the number of patients with health insurance. 1. Creating evidence summaries
  • 42. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ANS: 2 The core concept of the ACE Star Model is knowledge transformation. Knowledge transformation is the conversion of research findings to have an impact on health outcomes by way of evidence-based care. Knowledge transformation is not a method to reduce length of stay, reduce the cost of care, or increase the number of patients with health insurance. PTS: 1 DIF: Analyze REF: Definition of Knowledge Transformation • An advance practice nurse is being consulted to participate during the translation phase of the ACE Star Model of Knowledge Transformation. During this phase, which of the following will the nurse create? 2. Critical pathways 3. Clinical practice guidelines 4. Checklists to streamline documentation ANSWER: 3 In the third step of the ACE Star Model of Knowledge Transformation, experts are consulted to consider the evidence summaries, fill in gaps, and merge research knowledge with expertise to produce clinical practice guidelines. The nurse is not creating standardized care plans, critical pathways, or checklists to streamline documentation since these items are not a part of the ACE Star Model of Knowledge Transformation. PTS: 1 DIF: Apply REF: Star Point 3: Translation • The nurse leaders of a health care organization are creating plans to change clinical and organizational practices to support evidence-based practice. Which phase of the ACE Star Model of Knowledge Transformation are the leaders implementing? 1. Integration 2. Evaluation 3. Translation 4. Evidence summaries 1. Standardized care plans
  • 43. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ANS: 1 During the Integration phase of the ACE Star Model of Knowledge Transformation, implementation plans are put into action to change the individual clinician practices, organizational practices, and environmental policies. Implementation plans are not a part of the evidence summaries, translation, or evaluation of the ACE Star Model of Knowledge Transformation. PTS: 1 DIF: Apply REF: Star Point 4: Integration • The advance practice nurse is writing clinical practice guidelines. Prior to writing these guidelines which of the following will the nurse need? 1. Current client census 2. Evidence summaries 3. Nursing department budget 4. Staffing ratios ANSWER: 2 The ideal base for writing clinical guidelines are evidence summaries because they increase the power and validity of the cause-and-effect relationship between interventions and outcomes. Current client census, nursing department budgets, and staffing ratios are not used to write clinical practice guidelines. PTS:1DIF:ApplyREF:Evidence Summaries • The nurse is writing a systematic review. After the nurse formulates questions and locates relevant studies, the nurse thing the nurse will do is: 1. update the reviews. 2. interpret the findings. 3. summarize and synthesize results. 4. select and appraise the studies. ANSWER: 4 The next step in the systematic review writing process is selecting and appraising the studies. Afterwards, the nurse will complete, in order, summarize and synthesize
  • 44. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com results, interpret the findings, and regularly update the reviews. PTS: 1 DIF: Apply REF: Method for Producing Systematic Reviews • The nurse is using the scale for rating the strength of research evidence for one research article for potential inclusion in a clinical practice guideline. Which of the following is considered the strongest evidence? 1. Individual cohort study 2. Meta-analysis of randomized clinical trials 3. Expert opinion 4. Case studies ANSWER: 2 When utilizing the Scale for Rating the Strength of Research Evidence, the level with the strongest evidence is level I, meta-analysis of randomized clinical trials. Level III is individual cohort studies. Expert opinion is Level VII or the weakest evidence. Case studies are Level VI. PTS:1DIF:Analyze REF:Table 2-1 Scale for Rating the Strength of Research Evidence • The nurse is considering a research study for inclusion in a clinical practice guideline that has been identified as being sufficient to determine effects on health outcomes. This research study would be considered as being: 1. fair. 2. passable. 3. poor. 4. good. ANSWER: 1 Research studies are rated according to the Scale for Rating the Quality of Research Evidence. According to this scale, a research study that is sufficient to determine the effects on health outcomes is considered fair. A good study has consistent results for well-designed, well- conducted studies that directly assess effects on health outcomes.
  • 45. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com A poor study has insufficient results to assess the affects on health outcomes. Passable is not a category of this rating scale. PTS:1DIF:Analyze REF:Table 2-2 Scale for Rating the Quality of Research Evidence • The nurse is reviewing evidence-based clinical practice guidelines to use when planning care for a client. One guideline has been graded by the U.S. Preventive Services Task Force as being an A. According to this grade, the nurse should do which of the following? 1 . Do not use this guideline because the harm outweighs the benefits. 2 . Do not use this guideline because the benefits and harms cannot be determined. 3 . Use this guideline because the benefit is substantial. 4 . Use this guideline but understand that the net benefit to the client is small. ANSWER: 3 The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D plus I. A grade A guideline is recommended for care since there is high certainty that the benefit to the client is substantial. A grade C guideline has a small net benefit to the client. A grade D guideline has harms that outweigh the benefits. A grade I guideline has benefits and harms that cannot be determined. PTS:1DIF:Apply REF: Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force • The nurse identifies errors and hazards in a care environment and implements basic safety to reduce the likelihood of an adverse event. Which of the following core competencies is this nurse implementing? 2. Apply quality improvement 3. Employ evidence-based practice 4. Utilize informatics 1. Provide patient-centered care
  • 46. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com 2. Apply quality improvement 3. Employ evidence-based practice 4. Utilize informatics ANSWER: 2 Of the five Core Competencies for Health Professions, the competency that focuses on the identification of errors and hazards with implementation of basic safety is apply quality improvement. Provide patient-centered care focuses on direct care activities. Employ evidence- based practice focuses on the integration of research with clinical expertise. Utilize informatics to focus on communication and the use of information technology to support decision making. PTS: 1 DIF: Apply REF: Box 2-1 Core Competencies for Health Professions • The nurse is participating on a committee to select evidence-based practice guidelines.Which of the following statements by the nurse indicate a clear understanding of the purpose of these guidelines? 1 . They provide the best evidence to make decisions about the care of individual clients. 2 . They promote changes in client care according to a research study. 3 . They ensure cost-effective care to the client. 4 . They identify safe staffing ratios for client care. ANSWER: 1 Evidence-based practice guidelines provide the best evidence to make decisions about the care of individual clients. The use of a single research study to make changes in client care is a concept within research utilization and not evidence-based practice. Evidence-based practice does impact the costs of client care but their intent is not to ensure cost-effective care but rather to improve the overall quality of care. Evidence-based guidelines do not provide staffing ratios for client care. PTS:1DIF:AnalyzeREF:The Process of EBP MULTIPLE RESPONSE • The nurse is determining the best way to ensure adherence to the core competencies for health professions. Which of the following competencies will the nurse implement when providing client care? (Select all that apply.)
  • 47. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com 1. Work in interdisciplinary teams 2. Utilize informatics 3. Implement basic safety principles 4. Employ evidence-based practice 5. Apply quality improvement 6. Provide patient-centered care ANSWER: 1, 2, 4, 5, 6 Core competencies for health professions include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Implementing basic safety principles is only one part of a quality improvement program. PTS:1DIF:Apply REF: Box 2-1 Core Competencies for Health Professions. • There are impediments that make the practice of evidence-based practice difficult. Which of the following are impediments to evidence-based practice? (Select all that apply.) 3. Variety of knowledge forms 4. Number of patient diagnoses 5. Evidence summary 6. Application of quality improvement ANSWER: 1, 3 Hurdles to evidence-based practice are the increasing complexity of science and technology and the variety of knowledge forms, many of which are not suitable for direct practice. Knowledge transformation, number of patient diagnoses, evidence summary, application of quality improvement are not considered impediments to the implementation of evidence-based practice. Chapter 3. Overview of Health Concepts for Medical-Surgical Nursing MULTIPLE CHOICE 1. Complexity of science and technology 2. Difficulty of nowledge transformation
  • 48. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com • The nurse ensures that a clients bedspace is neat and clean with the call light within easy reach. The nurse is focusing on which nursing theorist who realized the importance of the environment for care? 1. Florence Nightingale 2. Sister Callista Roy 3. Dorothea Orem 4. Martha Rogers ANSWER: 1 Florence Nightingales theory focused on the environment for care. Sister Callista Roys model is based in systems theory and an individuals ability to adapt. Dorothea Orems model is the self- care deficit theory. Martha Rogers model is the science of unitary human beings. PTS:1DIF:Apply REF:Emergence of Contemporary Nursing in the United States • The nurse is instructing a client on self-administration of insulin so that the client will not need a health care provider to do this activity. The nurse is implementing which of the following aspects of Virginia Hendersons theory of nursing? 1 . A caring relationship 2 . Helping the client achieve independence from the nurses assistance as quickly as possible 3 . Integration of objective and subjective data 4 . Application of critical thinking ANSWER: 2 Virginia Hendersons theory of nursing is to help people achieve health or a peaceful death so that they can be independent from the nurses assistance as quickly as possible. A caring relationship, integration of objective and subjective data, and
  • 49. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com application of critical thinking are included in the American Nurses Associations essential features of professional nursing. PTS:1DIF:Analyze REF:Emergence of Contemporary Nursing in the United States 3.A client tells the nurse that he has an HMO for his health insurance. The nurse understands that the purpose of this type of health plan is to: 1. ensure payment is made to Medicare for services rendered. 2. maximize the utilization of health care resources. 3. efficiently manage costs while providing quality care. 4. focus on the illness when providing care. ANSWER: 3 Health maintenance organizations (HMOs) were created to efficiently manage health care costs while providing quality care. An HMO is a type of managed care plan with the goal of providing wellness care and not focusing on the illness during the provision of care. HMOs do not ensure payment is made to Medicare for services rendered. HMOs also do not maximize the utilization of health care resources but rather uses financial incentives to decrease care costs. PTS: 1 DIF: Understand REF: Cost of Care 4.A client tells the nurse that he does not have a primary care physician but rather makes an appointment with a doctor who specializes in the area in which he is experiencing a problem. The nurse realizes this client is at risk for which of the following? 1. Fragmented care 2. Overpayment of services 3. Inability to sustain health 4. Finding an appropriate general practitioner ANSWER: 1 In the 1980s, the close and trusting relationship between an individual and the
  • 50. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com individuals physician waned and was replaced by acquaintances with specialists based upon particular health care problems. These episodes of care cause fragmentation of care. The client who utilizes specialists is not at risk for overpayment of services, the inability to sustain health, or finding an appropriate general practitioner. PTS:1DIF:AnalyzeREFroviders of Care 5.The nurse is attending a masters degree program in efforts to be educationally prepared to serve as a hospital leader. The nurse realizes that this educational preparation will: 2 . be viewed as not supporting the profession of nursing by other nurses. 3 . ensure the nurse is biased towards clinicians interests. 4 . prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. ANSWER: 4 The nurse is attending an educational program to serve as a hospital leader. This education will prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. This education will not hinder the nurses ability to work with physicians. This education will not be viewed as unsupportive to the profession of nursing. The education will ensure that the nurse is not biased towards clinicians interests. PTS: 1 DIF: Analyze REF: Clinical Systems Leadership A. client tells the nurse that all hospitals care about is doing the minimum for a client regardless of the outcome. Which of the following should the nurse respond to this client? 1 . It does feel like that sometimes. 2 . Health insurance companies have caused this problem. 1 . hinder the nurses ability to work with physicians.
  • 51. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com 3 . The doctors will get paid regardless of the clients outcomes.
  • 52. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com 1 . It does feel like that sometimes. 2 . Health insurance companies have caused this problem. 3 . The doctors will get paid regardless of the clients outcomes. 4 . There are quality programs in place to make sure clients receive the best quality of care regardless of the cost. ANSWER: 4 In response to concerns about safety and quality of care voiced by clients and providers, total quality management and continuous quality improvement programs were initiated. These programs ensure society that cost management is not compromising safety or quality. This is what the nurse should respond to the client. The other choices do not address the clients concerns nor do they explain quality management programs. PTS: 1 DIF: Apply REF: Quality Measure Shift • The nurse is providing care at a time that is the most beneficial to the client. The nurse is implementing which of the following Joint Commission Dimensions of Quality Performance? 1. Safety 2. Timeliness 3. Efficiency 4. Availability ANSWER: 2 The dimension of timeliness means the degree in which interventions are provided at the most beneficial time to the client. Safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. Efficiency means the degree in which care has the desired effect with a minimum of effort, waste, or expense. Availability means the degree in which appropriate interventions are available to meet the clients needs.
  • 53. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com PTS:1DIF:Analyze
  • 54. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com REF:Box 1-1 Joint Commission Dimensions of Quality Performance • The nurse is providing care while adhering to safety as a Joint Commission Dimension of Quality Performance. Which of the following did the nurse provide to the client? ANSWER: 1 The dimension of safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. The nurse who uses a needleless device when providing intravenous medications is adhering to this dimension. Keeping the siderails in the down position is not a safe practice. Having a client sit in a wheelchair with the wheels unlocked is not a safe practice. Placing cloth towels over a spill in the room of an ambulatory client is not a safe practice. PTS:1DIF:Analyze REF:Box 1-1 Joint Commission Dimensions of Quality Performance • The nurse is planning and providing care while adhering to the American Nurses Association definition of professional nursing. Which of the following does the nurse include when implementing client care? 1. Follows the NANDA nursing diagnoses process 2. Integrates objective and subjective data 3. Respects cultural diversity of peers 4. Acknowledges the experience and training of physicians 3 Having the client sit in a wheelchair with the wheels in the unlocked position . 4 Placing cloth towels over a spill in the room of an ambulatory client . 1 Using a needleless device when providing intravenous medications . 2 Keeping the siderails of the bed in the down position after providing a pain . medication to a client
  • 55. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com ANSWER: 2 The American Nurses Association acknowledges six essential features of professional nursing. These include: 1) a caring relationship, 2) attention to the full range of human health and illness experiences, 3) integrates objective and subjective data, 4) applies scientific knowledge and critical thinking, 5) advances nursing knowledge through scholarly inquiry, and 6) promotes social justice. The nurse integrating objective and subjective data is implementing one of the six essential features of professional nursing. The other choices are not essential features of professional nursing. PTS:1DIF:A nalyze REF:Emergence of Contemporary Nursing in the United States • The nurse has shifted her practice from an illness focus to a health focus. Which of the following has this nurse implemented? 1. Standardized care plans 2. Critical pathways 3. Instructing a client on relaxation techniques to aid with sleep 4. Holding around-the-clock medication when a client is asleep ANSWER: 3 The use of client education as a strategy to attain and maintain the potential for health is an example of the shift of care from an illness focus to a health focus. The nurse instructing a client on relaxation techniques to aid with sleep is implementing a health focus of care. The other choices do not support the shift from an illness focus to a health focus. PTS: 1 DIF: Analyze REF: Leadership 11.A client is admitted with a highly communicable disease. The nurses do not want to participate in the care of this client. Which of the following should be done to ensure the client receives the highest quality of care?
  • 56. TO GET ALL CHAPTERS EMAIL ME AT>>>>> donc8246@gmail.com 1 . Adhere to strict standard precautions. 2 . Plan to have the client transferred to another health care organization. 3 . Ask the physician if the client can be cared for in the home. ANSWER: 1 When providing care in a highly global environment, the risks of communicable diseases increases. In the event that a client is admitted with a highly communicable disease and the nurses are fearing for their own health and safety, the only safe approach is to ensure all staff adhere to strict standard precautions. The other choices do not ensure that the client will receive the highest quality of care. The nurses must learn emotional intelligence and resolve issues under fire. PTS:1DIF:AnalyzeREF:Globalization • The nurse has been an employee of an organization for 2 years and is considering a job change. Which of the following does this nurses plan suggest to any future employers? 1 . The nurse moves to other jobs too frequently. 2 . The nurse is inflexible. 3 . The nurse is searching for a more challenging environment with career opportunities. 4 . The nurse is willing to sacrifice home and personal life for a job. ANSWER: 3 At one point in time, job changes every 2 or 3 years was considered a red flag for employers. This does not hold true today. The nurse who changes jobs every 2 or 3 years is interested in career advancement and success. Creativity is valued and opportunities are desired. Moving to another job in 2 to 3 years does not mean the 4 . Suspend the nurses without pay who refuse to care for the client.