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Preview Extract
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
1
Table of Contents
Table of Contents
1
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
3
Chapter 02: Community-Based Nursing Practice
22
Chapter 03: Critical Thinking, Ethical Decision Making and the Nursing Process
41
Chapter 04: Health Education and Promotion
64
Chapter 05: Adult Health and Nutritional Assessment
83
Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation
104
Chapter 07: Overview of Transcultural Nursing
124
Chapter 08: Overview of Genetics and Genomics in Nursing
144
Chapter 09: Chronic Illness and Disability
164
Chapter 10: Principles and Practices of Rehabilitation
183
Chapter 11: Health Care of the Older Adult
220
Chapter 12: Pain Management
240
Chapter 13: Fluid and Electrolytes: Balance and Disturbance
260
Chapter 14: Shock and Multiple Organ Dysfunction Syndrome
280
Chapter 15: Management of Patients with Oncologic Disorders
300
Chapter 16: End-of-Life Care
319
Chapter 17: Preoperative Nursing Management
338
Chapter 18: Intraoperative Nursing Management
357
Chapter 19: Postoperative Nursing Management
376
Chapter 20: Assessment of Respiratory Function
396
Chapter 21: Respiratory Care Modalities
415
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders
434
Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders
453
Chapter 24: Management of Patients With Chronic Pulmonary Disease
472
Chapter 25: Assessment of Cardiovascular Function
490
Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems
508
Chapter 27: Management of Patients With Coronary Vascular Disorders
526
Chapter 28: Management of Patients With Structural, Infectious, and Inflammatory Cardiac
Disorders
545
Chapter 29: Management of Patients With Complications from Heart Disease
564
Chapter 30: Assessment and Management of Patients With Vascular Disorders and
Problems of Peripheral Circulation
582
Chapter 31: Assessment and Management of Patients With Hypertension
601
Chapter 32: Assessment of Hematologic Function and Treatment Modalities
620
Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders
638
Chapter 34: Management of Patients With Hematologic Neoplasms
656
Chapter 35: Assessment of Immune Function
674
Chapter 36: Management of Patients With Immune Deficiency Disorders
692
Chapter 37: Assessment and Management of Patients With Allergic Disorders
710
Chapter 38: Assessment and Management of Patients With Rheumatic Disorders
728
Chapter 39: Assessment of Musculoskeletal Function
746
Chapter 40: Musculoskeletal Care Modalities
764
Chapter 41: Management of Patients With Musculoskeletal Disorders
782
Chapter 42: Management of Patients With Musculoskeletal Trauma
800
Chapter 43: Assessment of Digestive and Gastrointestinal Function
819
Chapter 44: Digestive and Gastrointestinal Treatment Modalities
837
Chapter 45: Management of Patients with Oral and Esophageal Disorders
855
Chapter 46: Management of Patients with Gastric and Duodenal Disorders
874
Chapter 47: Management of Patients With Intestinal and Rectal Disorders
893
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
2
Chapter 48: Assessment and Management of Patients with Obesity
911
Chapter 49: Assessment and Management of Patients with Hepatic Disorders
921
Chapter 50: Assessment and Management of Patients with Biliary Disorders
940
Chapter 51: Assessment and Management of Patients with Diabetes
959
Chapter 52: Assessment and Management of Patients with Endocrine Disorders
978
Chapter 53: Assessment of Kidney and Urinary Function
996
Chapter 54: Management of Patients with Kidney Disorders
1015
Chapter 55: Management of Patients with Urinary Disorders
1034
Chapter 56: Assessment and Management of Patients With Female Physiologic Processes
1054
Chapter 57: Management of Patients with Female Reproductive Disorders
1072
Chapter 58: Assessment and Management of Patients with Breast Disorders
1091
Chapter 59: Assessment and Management of Patients With Male Reproductive Disorders
1110
Chapter 60: Assessment of Integumentary Function
1129
Chapter 61: Managements of Patients with Dermatologic Problems
1147
Chapter 62: Managements of Patients with Burn Injury
1165
Chapter 63: Assessment and Management of Patients with Eye and Vision Disorders
1184
Chapter 64: Assessment and Management of Patients with Hearing and Balance Disorders
1203
Chapter 65: Assessment of Neurologic Function
1221
Chapter 66: Management of Patients with Neurologic Dysfunction
1239
Chapter 67: Management of Patients with Cerebrovascular Disorders
1257
Chapter 68: Management of Patients with Neurologic Trauma
1276
Chapter 69: Management of Patients with Neurologic Infections, Autoimmune Disorders,
and Neuropathies
1294
Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders
1312
Chapter 71: Management of Patients With Infectious Diseases
1331
Chapter 72: Emergency Nursing
1349
Chapter 73: Terrorism, Mass Casualty, and Disaster Nursing
1367
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
3
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
1.
The public health nurse is presenting a health promotion class to a group of new mothers. How should
the nurse best define health?
A)
Health is being disease free.
B)
Health is having fulfillment in all domains of life.
C)
Health is having psychological and physiological harmony.
D)
Health is being connected in body, mind, and spirit.
Ans:
D
Feedback:
The World Health Organization (WHO) defines health in the preamble to its constitution as a state of
complete physical, mental, and social well-being and not merely the absence of disease and infirmity.
The other answers are incorrect because they are not congruent with the WHO definition of health.
2.
A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is
one characteristic the nurse would cite as necessary to possess to be an effective nurse?
A)
Sensitivity to cultural differences
B)
Team-focused approach to problem-solving
C)
Strict adherence to routine
D)
Ability to face criticism
Ans:
A
Feedback:
To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be
culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict
adherence to routine are not characteristics needed to be an effective nurse. The ability to handle
criticism is important, but to a lesser degree than cultural competence.
3.
With increases in longevity, people have had to become more knowledgeable about their health and the
professional health care that they receive. One outcome of this phenomenon is the development of
organized self-care education programs. Which of the following do these programs prioritize?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
Adequate prenatal care
B)
Government advocacy and lobbying
C)
Judicious use of online communities
D)
Management of illness
Ans:
D
4
Feedback:
Organized self-care education programs emphasize health promotion, disease prevention, management
of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and
Internet activities are secondary.
4.
The home health nurse is assisting a patient and his family in planning the patients return to work after
surgery and the development of postsurgical complications. The nurse is preparing a plan of care that
addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the
patients need for self-fulfillment relate?
A)
Physiologic
B)
Transcendence
C)
Love and belonging
D)
Self-actualization
Ans:
D
Feedback:
Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to
know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does
not relate directly to them.
5.
The view that health and illness are not static states but that they exist on a continuum is central to
professional health care systems. When planning care, this view aids the nurse in appreciating which of
the following?
A)
Care should focus primarily on the treatment of disease.
B)
A persons state of health is ever-changing.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
A person can transition from health to illness rapidly.
D)
Care should focus on the patients compliance with interventions.
Ans:
B
5
Feedback:
By viewing health and illness on a continuum, it is possible to consider a person as being neither
completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the
potential to range from high-level wellness to extremely poor health and imminent death. The other
answers are incorrect because patient care should not focus just on the treatment of disease. Rapid
declines in health and compliance with treatment are not key to this view of health.
6.
A group of nursing students are participating in a community health clinic. When providing care in this
context, what should the students teach participants about disease prevention?
A)
It is best achieved through attending self-help groups.
B)
It is best achieved by reducing psychological stress.
C)
It is best achieved by being an active participant in the community.
D)
It is best achieved by exhibiting behaviors that promote health.
Ans:
D
Feedback:
Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen
as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach
that disease prevention is best achieved through attending self-help groups, by reducing stress, or by
being an active participant in the community, though each of these activities is consistent with a healthy
lifestyle.
7.
A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee.
When describing quality improvement programs to nursing colleagues and members of other health
disciplines, what characteristic should the nurse cite?
A)
These programs establish consequences for health care professionals actions.
B)
These programs focus on the processes used to provide care.
C)
These programs identify specific incidents related to quality.
D)
These programs seek to justify health care costs and systems.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Ans:
6
B
Feedback:
Numerous models seek to improve the quality of health care delivery. A commonality among them is a
focus on the processes that are used to provide care. Consequences, a focus on incidents, and
justification for health care costs are not universal characteristics of quality improvement efforts.
8.
Nurses in acute care settings must work with other health care team members to maintain quality care
while facing pressures to care for patients who are hospitalized for shorter periods of time than in the
past. To ensure positive health outcomes when patients return to their homes, what action should the
nurse prioritize?
A)
Promotion of health literacy during hospitalization
B)
Close communication with insurers
C)
Thorough and evidence-based discharge planning
D)
Participation in continuing education initiatives
Ans:
C
Feedback:
Following discharges that occur after increasingly short hospital stays, nurses in the community care for
patients who need high-technology acute care services as well as long-term care in the home. This is
dependent on effective discharge planning to a greater degree than continuing education, communication
with insurers, or promotion of health literacy.
9.
You are admitting a patient to your medical unit after the patient has been transferred from the
emergency department. What is your priority nursing action at this time?
A)
Identifying the immediate needs of the patient
B)
Checking the admitting physicians orders
C)
Obtaining a baseline set of vital signs
D)
Allowing the family to be with the patient
Ans:
A
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Among the nurses important functions in health care delivery, identifying the patients immediate needs
and working in concert with the patient to address them is most important. The other nursing functions
are important, but they are not the most important functions.
10. A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing
assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?
A)
Helping the patient to achieve specific outcomes
B)
Balancing risks and benefits of interventions
C)
Documenting the patients response to therapy
D)
Staying accountable to the interdisciplinary team
Ans:
A
Feedback:
Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes.
Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient
achieve outcomes is paramount.
11. Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of
analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice
RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized
patients. How does this demonstrate a role of the APRN?
A)
Involving patients in their care while hospitalized
B)
Contributing to the scientific basis of nursing practice
C)
Critiquing the quality of patient care
D)
Explaining medical studies to patients and RNs
Ans:
B
Feedback:
Research is within the purview of the APRN. The activity described does not exemplify explaining
studies to RNs, critiquing care, or involving patients in their care.
12. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of
practice for the nurse in todays health care environment is home health care. What is the main basis for
7
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
8
the growth in this health care setting?
A)
Chronic nursing shortage
B)
Western focus on treatment of disease
C)
Nurses preferences for day shifts instead of evening or night shifts
D)
Discharge of patients who are more critically ill
Ans:
D
Feedback:
With shorter hospital stays and increased use of outpatient health care services, more nursing care is
provided in the home and community setting. The other answers are incorrect because they are not the
basis for the growth in nursing care delivered in the home setting.
13. Nurses have different educational backgrounds and function under many titles in their practice setting. If
a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by
influencing the patient, the nurse, and the health care system, what would most accurately describe this
nurses title?
A)
Nursing care expert
B)
Clinical nurse specialist
C)
Nurse manager
D)
Staff nurse
Ans:
B
Feedback:
Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care
(e.g., cardiovascular, oncology). They define their roles as having five major components: clinical
practice, education, management, consultation, and research. The other answers are incorrect because
they are not the most accurate titles for this nurse.
14. Nursing continues to recognize and participate in collaboration with other health care disciplines to meet
the complex needs of the patient. Which of the following is the best example of a collaborative practice
model?
A)
The nurse and the physician jointly making clinical decisions.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
B)
The nurse accompanying the physician on rounds.
C)
The nurse making a referral on behalf of the patient.
D)
The nurse attending an appointment with the patient.
Ans:
A
9
Feedback:
The collaborative model, or a variation of it, promotes shared participation, responsibility, and
accountability in a health care environment that is striving to meet the complex health care needs of the
public. The other answers are incorrect because they are not examples of a collaborative practice model.
15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of
needs, what dimension of care should the nurse consider primary in importance when caring for a dying
patient?
A)
Spiritual
B)
Social
C)
Physiologic
D)
Emotional
Ans:
C
Feedback:
Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and
affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know
and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied
to the various nursing models for assessment of a patients strengths, limitations, and need for nursing
interventions. The other answers are incorrect because they are not of primary importance when caring
for a dying patient, though each should certainly be addressed.
16. A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within
this framework of understanding, what would be the nurses first priority?
A)
Allowing the family to see a newly admitted patient
B)
Ambulating the patient in the hallway
C)
Administering pain medication
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
D)
Teaching the patient to self-administer insulin safely
Ans:
C
10
Feedback:
In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such
as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family
addresses a higher level need related to love and belonging. Teaching the patient is also a higher level
need related to the desire to know and understand and is not appropriate at this time, as the basic
physiologic need of pain control must be addressed before the patient can address these higher level
needs.
17. A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse
provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of
the following?
A)
National Council of Nursings guidelines for care
B)
National League for Nursings Code of Conduct
C)
D)
Ans:
American Nurses Associations Social Policy Statement
Department of Health and Human Services White Paper on Nursing
C
Feedback:
Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply
with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for
Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council
of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included
in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN
published a specific code of conduct.
18. Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the
changing health needs of our aging population. What is one factor that has impacted the need for
certified nurse practitioners (CNPs)?
A)
The increased need for primary care providers
B)
The need to improve patient diagnostic services
C)
The push to drive institutional excellence
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
D)
The need to decrease the number of medical errors
Ans:
A
11
Feedback:
CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive
additional focused training in primary care or acute care. CNPs help meet the need for primary care
providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent
with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.
19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the
treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality
improvement?
A)
By liaising with the members of the interdisciplinary care team
B)
By critically appraising the outcomes of care that is provided
C)
By integrating the patients preferences into the plan of care
D)
By documenting care in the electronic health record in a timely fashion
Ans:
B
Feedback:
Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other
listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement
activities.
20. Professional nursing expands and grows because of factors driven by the changing needs of health care
consumers. Which of the following is a factor that nurses should reflect in the planning and provision of
health care?
A)
Decreased access to health care information by individuals
B)
Gradual increases in the cultural unity of the American population
C)
Increasing mean and median age of the American population
D)
Decreasing consumer expectations related to health care outcomes
Ans:
C
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
12
The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer
school-age children and more senior citizens, many of whom are women.
The population has become more culturally diverse as increasing numbers of people from different
national backgrounds enter the country. Access to information and consumer expectations continue to
increase.
21. A public health nurse has been commissioned to draft a health promotion program that meets the health
care needs and expectations of the community. Which of the following focuses is most likely to
influence the nurses choice of interventions?
A)
Management of chronic conditions and disability
B)
Increasing need for self-care among a younger population
C)
A shifting focus to disease management
D)
An increasing focus on acute conditions and rehabilitation
Ans:
A
Feedback:
In response to current priorities, health care must focus more on management of chronic conditions and
disability than in previous times. The other answers are incorrect because the change in focus of health
care is not an increasing need for self-care among our aging population; our focus is shifting away from
disease management, not toward it; and we are moving away from the management of acute conditions
to managing chronic conditions.
22. A community health nurse has witnessed significant shifts in patterns of disease over the course of a
four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of
disease in the United States?
A)
Type 1 diabetes management
B)
Treatment of community-acquired pneumonia
C)
Rehabilitation from traumatic brain injuries
D)
Management of acute Staphylococcus aureus infections
Ans:
A
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
13
Management of chronic diseases such as diabetes is a priority focus of the current health care
environment. This supersedes the treatment of acute infections and rehabilitation needs.
23. The ANA has identified several phenomena toward which the focus of nursing care should be directed,
and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates
these priorities?
A)
Encouraging the patients dependence on caregivers
B)
Fostering the patients ability to make choices
C)
Teaching the patient about nurses roles in the health care system
D)
Assessing the patients adherence to treatment
Ans:
B
Feedback:
The ANA identifies several focuses for nursing care and research, including the ability to make choices.
The other answers are incorrect because they are not phenomena identified by the ANA.
24. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of
health care. Which of the following activities are considered integral to the CNP role? Select all that
apply.
A)
Educating patients and family members
B)
Coordinating care with other disciplines
C)
Using direct provision of interventions
D)
Educating registered nurses and practical nurses
E)
Coordinating payment plans for patients
Ans:
A, B, C
Feedback:
This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in
home care and community nursing. Nurses help patients meet their needs by using direct intervention,
by teaching patients and family members to perform care, and by coordinating and collaborating with
other disciplines to provide needed services. The other answers are incorrect because NPs do not
commonly perform education of nurses and they do not focus on matters related to payment.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
14
25. The ANA has identified central characteristics of nursing practice that are applicable across the wide
variety of contexts in which nurses practice. A nurse can best demonstrate these principles by
performing which of the following actions?
A)
Teaching the public about the role of nursing
B)
Taking action to control the costs of health care
C)
Ensuring that all of his or her actions exemplify caring
D)
Making sure to carry adequate liability insurance
Ans:
C
Feedback:
The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA
does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a
central tenet of nursing practice.
26. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched
within the past decade. In this role, the nurse should prioritize which of the following activities?
A)
Acting as a spokesperson for the nursing profession
B)
Generating and disseminating new nursing knowledge
C)
Diagnosing and treating health problems that have a predictable course
D)
Helping patients to navigate the health care system
Ans:
D
Feedback:
The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical
leadership, educated to help patients navigate through the complex health care system. The other
answers are incorrect because they are not what nursing has identified as the CNL role.
27. Our world is connected by a sophisticated communication system that makes much health information
instantly accessible, no matter where the patient is being treated. This instant access to health
information has impacted health care delivery strategies, including the delivery of nursing care. What is
one way the delivery of health care has been impacted by this phenomenon?
A)
Brisk changes as well as swift obsolescence
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
B)
Rapid change that is nearly permanent
C)
Limitations on the settings where care can be provided
D)
Increased need for social acceptance
Ans:
A
15
Feedback:
The sophisticated communication systems that connect most parts of the world, with the capability of
rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift
obsolescence in health care delivery strategies. The other answers are incorrect because, although we
have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care
itself evolves. Giving nursing care has not become easier, it becomes more complex with every change;
and it does not need to be more socially acceptable; it needs to be more culturally sensitive.
28. With the changing population of health care consumers, it has become necessary for nurses to work
more closely with other nurses, as when acute care nurses collaborate with public health and home
health nurses. What nursing function has increased in importance because of this phenomenon?
A)
Prescribing medication
B)
Performing discharge planning
C)
Promoting family involvement
D)
Forming collegial relationships
Ans:
B
Feedback:
The importance of effective discharge planning and quality improvement cannot be overstated. The
other answers are incorrect because giving medication and family involvement in the patients care have
not grown in importance. Making and maintaining collegial relationships has become a necessity in
working in the health care delivery system. Effective discharge planning aids in getting patients out of
the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting
possible.
29. A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help
the nurse achieve what goal?
A)
Increasing career satisfaction
B)
Obtaining federal grant money
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
16
Ensuring high quality patient care
D)
Enhancing the publics esteem for nursing
Ans:
C
Feedback:
Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money
are not priorities.
30. A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When
defining this new role, which of the following outcomes should be prioritized by the hospitals
leadership?
A)
Decreased need for physician services
B)
Improved patient and family education
C)
Increased adherence to the principles of EBP
D)
Increased coordination of health services
Ans:
D
Feedback:
Case management is a system of coordinating health care services to ensure cost-effectiveness,
accountability, and quality care. The case manager coordinates the care of a caseload of patients through
facilitating communication between nurses, other health care personnel who provide care, and insurance
companies. Reducing the need for physician services is not a central goal. Education and EBP are
consistent with case management, but they are not central to this particular role.
31. A hospitals current quality improvement program has integrated the principles of the Institute for
Healthcare Improvement (IHI) 5 Million Lives Campaign. How can the hospital best achieve the
campaign goals of reducing preventable harm and death?
A)
By adhering to EBP guidelines
B)
By reducing nurse-to-patient ratios and increasing accountability
C)
By having researchers from outside the facility evaluate care
D)
By involving patients and families in their care planning
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Ans:
17
A
Feedback:
The 5 Million Lives Campaign posits that if evidence-based guidelines it advocated were voluntarily
implemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a twoyear period. Nurse-to-patient ratios, family participation, and independent evaluation are not stated
components of the campaign.
32. Over the past several decades, nursing roles have changed and expanded in many ways. Which of the
following factors has provided the strongest impetus for this change?
A)
The need to decrease the cost of health care
B)
The need to improve the quality of nursing education
C)
The need to increase the number of nursing jobs available
D)
The need to increase the public perception of nursing
Ans:
A
Feedback:
The role of the nurse has expanded to improve the distribution of health care services and to decrease the
cost of health care. The other answers are incorrect because the expansion of roles in nursing did not
occur to improve education, increase the number of nursing jobs, or increase public perception.
33. Advanced practice nursing roles have grown in number and in visibility in recent years. What
characteristic sets these nurses apart from the registered nurse?
A)
Collaboration with other health care providers
B)
Education that goes beyond that of the RN
C)
Advanced documentation skills
D)
Ability to provide care in the surgical context
Ans:
B
Feedback:
There is wide variety in APRN roles. However, a commonality is that they require education beyond that
of the professional RN. All nurses collaborate with other health care providers to provide nursing care to
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
18
their patients. Advanced documentation skills are not what sets advanced practice nurses apart from the
staff nurse. RNs have the ability to provide care in the operating room.
34. CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states,
what right do CNPs have that RNs do not possess?
A)
Perform health interventions independently
B)
Make referrals to members of other health disciplines
C)
Prescribe medications
D)
Perform surgery independently
Ans:
C
Feedback:
In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope of
practice and all professional nurses may perform interventions and make certain referrals.
35. A team of community health nurses are planning to draft a proposal for a program that will increase the
communitys alignment with the principles contained in the Healthy People 2020report. Which of the
following activities would best demonstrate the priorities identified in this report?
A)
Addressing determinants of health such as clean environments and safety in the community
B)
Lobbying for increased funding to the county hospital where many residents receive primary care
C)
Collaborating with health professionals in neighboring communities to pool resources and increase
efficiencies
D)
Creating clinical placements where nursing students and members of other health disciplines can
gain experience in a community setting
Ans:
A
Feedback:
Healthy People 2020 addresses social determinants of health such as safety and the state of the
environment. This report does not specifically address matters such as hospital funding, nursing
education, or resource allocation.
36. A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and
self-care. Which of the following activities would best demonstrate the principles of health promotion?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
A discharge planning initiative between acute care and community care nurses
B)
Collaboration between several schools of nursing in an urban area
C)
Creation of a smoking prevention program undertaken in a middle school
D)
Establishment of a website where patients can check emergency department wait-times
Ans:
C
19
Feedback:
Smoking prevention is a clear example of health promotion. Each of the other listed activities has the
potential to be beneficial, but none is considered health promotion.
37. A group of nursing students are learning about recent changes in the pattern of disease in the United
States. Which of the following statements best describes these current changes?
A)
Infectious diseases continue to decrease in incidence and prevalence.
B)
Chronic illnesses are becoming increasingly resistant to treatment.
C)
Most acute, infectious diseases have been eradicated.
D)
Most, but not all, communicable diseases are declining.
Ans:
D
Feedback:
Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibiotic
resistance is a more serious problem in acute, not chronic, illnesses.
38. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a
large, university medical center according to core measures. Evaluators should perform this evaluation
in what way?
A)
By auditing the medical centers electronic health records
B)
By performing focus groups and interviews with care providers from numerous disciplines
C)
By performing statistical analysis of patient satisfaction surveys
D)
By comparing the centers patient outcomes to best practice indicators
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Ans:
20
D
Feedback:
Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seek
treatment for a specific disease or who need a specific treatment as compared to evidence-based
guidelines and standards of care. Benchmark standards of quality are used to compare the care or
treatment patients receive with the best practice standards. Patient satisfaction is considered, but this is
not the only criterion.
39. Leadership of a medical unit have been instructed to integrate the principles of the Quality and Safety
Education for Nurses (QSEN) competency of quality improvement. What action should the units leaders
take?
A)
Provide access to online journals and Web-based clinical resources for nursing staff.
B)
Use flow charts to document the processes of care that are used on the unit.
C)
Enforce continuing education requirements for all care providers.
D)
Reduce the use of chemical and physical restraints on the unit.
Ans:
B
Feedback:
One of the quality improvement skills is to use tools, such as flow charts and cause-effect diagrams, to
make processes of care explicit. Each of the other listed actions has the potential to benefit patients and
care givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency.
40. The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to
the educational programs that teach nurses and members of other health professions. According to this
report, what activity should educational institutions prioritize?
A)
More clearly delineate each professions scope of practice during education
B)
Move toward developing a single health curriculum that can be adapted for any health profession
C)
Include interdisciplinary core competencies into curricula
D)
Elicit input from patients and families into health care curricula
Ans:
C
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
21
Health Professions Education: A Bridge to Quality challenged health professions education programs to
integrate interdisciplinary core competencies into their respective curricula to include patient-centered
care, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement,
safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input,
or a single curriculum.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
22
Chapter 02: Community-Based Nursing Practice
1.
A community health nurse has scheduled a hypertension clinic in a local shopping mall in which
shoppers have the opportunity to have their blood pressure measured and learn about hypertension. This
nursing activity would be an example of which type of prevention activity?
A)
Tertiary prevention
B)
Secondary prevention
C)
Primary prevention
D)
Disease prevention
Ans:
B
Feedback:
Secondary prevention centers on health maintenance aim at early detection and prevention. Disease
prevention is not a form of health care but is a focus on primary prevention.
2.
The nursing instructor is preparing a group of students for their home care rotation. In preparation, the
group discusses the patients that they are most likely to care for in the home. Which of the following
groups are the most common recipients of home care services?
A)
Mentally ill patients
B)
Patients receiving rehabilitation after surgery
C)
Terminally ill and palliative patients
D)
Elderly patients
Ans:
D
Feedback:
The elderly are the most frequent users of home care services. The patient must be acutely ill, home
bound, and in need of skilled nursing services to be eligible for this service. The other answers are
incorrect because it is the elderly who are seen most frequently in the home health setting, though each
of the other listed groups may sometimes receive home care.
3.
A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles in
their homes and the nurses own practices and beliefs. To work therapeutically with the patient, what
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
23
must the nurse do?
A)
Request another assignment if there is dissonance with the patients lifestyle.
B)
Ask the patient to come to the agency to receive treatment, if possible.
C)
Resolve to convey respect for the patients beliefs and choices.
D)
Try to adapt the patients home to the norms of a hospital environment.
Ans:
C
Feedback:
To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respect
for patients beliefs, even if they differ sharply from the nurses. This can be difficult when a patients
lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of
alcohol, drug abuse, or overeating. The nurse should not request another assignment because of a
difference in beliefs, nor do nurses ask for the patient to come to you at the agency to receive treatment.
It is also inappropriate to convert the patients home to a hospital-like environment.
4.
Infection control is a high priority in every setting where nursing care is provided. When performing a
home visit, how should the nurse best implement the principles of infection control?
A)
Perform hand hygiene before and after giving direct patient care.
B)
Remove the patients wound dressings from the home promptly.
C)
Disinfect the patients syringes prior to disposal.
D)
Establish a sterile field in the patients home before providing care.
Ans:
A
Feedback:
Infection control is as important in the home as it is in the hospital, but it can be more challenging in the
home and requires creative approaches. As in any situation, it is important to clean ones hands before
and after giving direct patient care, even in a home that does not have running water. Removing the
wound dressings from the home and disinfecting all work areas in the home are not the best
implementations of infection control in the home. Used syringes are never disinfected and a sterile field
is not always necessary.
5.
An adult patient is ready to be discharged from the hospital after undergoing a transmetatarsal
amputation. When should your patients discharge planning begin?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
The day prior to discharge
B)
The day of estimated discharge
C)
The day that the patient is admitted
D)
Once the nursing care plan has been finalized
Ans:
C
24
Feedback:
Discharge planning begins with the patients admission to the hospital and must consider the possible
need for follow-up home care. Discharge planning should begin prior to the other listed times.
6.
A home health nurse is preparing to make the initial visit to a new patients home. When planning
educational interventions, what information should the nurse provide to the patient and his or her
family?
A)
Available community resources to meet their needs
B)
Information on other patients in the area with similar health care needs
C)
The nurses contact information and credentials
D)
Dates and times of all scheduled home care visits
Ans:
A
Feedback:
The community-based nurse is responsible for informing the patient and family about the community
resources available to meet their needs. During initial and subsequent home visits, the nurse helps the
patient and family identify these community services and encourages them to contact the appropriate
agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect
because it is inappropriate to ever provide information on other patients to a patient. The nurses
credentials are not normally discussed. Giving the patient the dates and times of their scheduled home
visits is appropriate, but may not always be possible. It is more important to provide them with resources
available within the community to meet their needs.
7.
The home health nurse receives a referral from the hospital for a patient who needs a home visit for
wound care. After obtaining the referral, what would be the first action the nurse should take?
A)
Have community services make contact with the patient.
B)
Obtain a physicians order for the visit.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
Call the patient to obtain permission to visit.
D)
Arrange for a home health aide to initially visit the patient.
Ans:
C
25
Feedback:
After receiving a referral, the first step is to call the patient and obtain permission to make the visit. Then
the nurse should schedule the visit and verify the address. A physicians order is not necessary to
schedule a visit with the patient. The nurse may identify community services or the need for a home
health aide after assessing the patient and the home environment during the first visit with the patient.
This would not be delegated to a home health aide.
8.
At the beginning of a day that will involve several home visits, the nurse has ensured that the health care
agency has a copy of her daily schedule. What is the rationale for the nurses action?
A)
It allows the agency to keep track for payment to the nurse.
B)
It supports safety precautions for the nurse when making a home care visit.
C)
It allows for greater flexibility for the nurse and his or her colleagues for changes in assignments.
D)
It allows the patient to cancel appointments with minimal inconvenience.
Ans:
B
Feedback:
Whenever a nurse makes a home visit, the agency should know the nurses schedule and the locations of
the visits. The other answers are incorrect because providing the agency with a copy of the daily
schedule is not for the purpose of correctly paying the nurse or for the ease of the nurse in changing
assignments. It is also not intended for the patients ease in canceling appointments.
9.
There are specific legal guidelines and regulations for the documentation related to home care. When
providing care for a patient who is a Medicaid recipient, what is most important for the nurse to
document?
A)
The medical diagnosis and the supplies needed to care for the patient
B)
A summary of the patients income tax paid during the previous year
C)
The specific quality of nursing care that is needed
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
D)
The patients homebound status and the specific need for skilled nursing care
Ans:
D
26
Feedback:
Medicare, Medicaid, and third-party payers require documentation of the patients homebound status and
the need for skilled professional nursing care. The medical diagnosis and specific detailed information
on the functional limitations of the patient are usually part of the documentation. The other answers are
incorrect because nursing documentation does not include needed supplies, tax information, or the
quality of care needed.
10. Your patient has had a total knee replacement and will need to walk with a two-wheeled walker for 6
weeks. He is being discharged home with a referral for home health care. What will the home care nurse
need to assess during the initial nursing assessment in the home?
A)
Assistance of neighbors
B)
Qualification for Medicare and Medicaid
C)
Costs related to the visits
D)
Characteristics of the home environment
Ans:
D
Feedback:
The initial assessment includes evaluating the patient, the home environment, the patients self-care
abilities or the familys ability to provide care, and the patients need for additional resources. Normally
an assessment is not made of assistance on the part of neighbors or the costs of the visit. Medicare and
Medicaid qualifications would normally be determined beforehand.
11. A nurse who has an advanced degree in primary care for a pediatric population is employed in a health
clinic. In what role is this nurse functioning?
A)
Nurse practitioner
B)
Case coordinator
C)
Clinical nurse specialist
D)
Clinic supervisor
Ans:
A
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
27
Feedback:
Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on
gerontology, pediatrics, family or adult health, or womens health. Case coordinators and clinical
supervisors do not necessarily require an advanced degree, and a clinical nurse specialist is not educated
in primary care. Primary care is the specific focus of CNPs.
12. A nurse is based in an automotive assembly plant and works with the plants employees in the areas of
health promotion and basic primary care. What nursing role is this nurse performing?
A)
Occupational health nurse
B)
Community nurse specialist
C)
Nurse clinician
D)
Public health nurse
Ans:
A
Feedback:
Occupational health nurses may provide direct care to patients who are ill, conduct health education
programs for the industry staff, or set up health programs. The other answers are incorrect because they
are not consistent with a nurses placement in a manufacturing setting.
13. A school nurse has been working closely with a student who has cystic fibrosis. The nurse is aware that
children with health problems are at major risk for what problem?
A)
Mental health disorders
B)
Gradual reduction in intelligence
C)
Psychological stress due to a desire to overachieve
D)
Underachievement in school
Ans:
D
Feedback:
School-aged children and adolescents with health problems are at major risk for underachieving or
failing in school. These students do not necessarily have a high risk of mental health disorders or a
desire to overachieve. Health problems do not normally cause a progressive decline in intelligence.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
28
14. A community health nurse is aware that restoration of health often depends on appropriate interventions
performed early in the course of a disease. Which patient is most likely to seek health care late in the
course of his or her disease process and deteriorate more quickly than other patients?
A)
A patient who has been homeless for an extended period of time
B)
A patient who recently immigrated to the United States
C)
A patient who is 88 years old and who has enjoyed relatively good health
D)
A teenage boy
Ans:
A
Feedback:
Because of numerous barriers, the homeless seek health care late in the course of a disease and
deteriorate more quickly than patients who are not homeless. Many of their health problems are related
in large part to their living situation. The other answers are incorrect because these populations do not as
often seek care late in the course of their disease process and deteriorate quicker than other populations.
15. A recent nursing school graduate has chosen to pursue a community nursing position because of
increasing opportunities for nurses in community settings. What changes in the health care system have
created an increased need for nurses to practice in community-based settings? Select all that apply.
A)
Tighter insurance regulations
B)
Younger population
C)
Increased rural population
D)
Changes in federal legislation
E)
Decreasing hospital revenues
Ans:
A, D, E
Feedback:
Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, and
alternative health care delivery systems have also affected the ways in which health care is delivered.
Our country does not have an increased rural population nor is our population younger.
16. A nursing student has taught a colleague that nursing practice is not limited to hospital settings,
explaining that nurses are now working in ambulatory health clinics, hospice settings, and homeless
shelters and clinics. What factor has most influenced this increased diversity in practice settings for
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
29
nurses?
A)
Population shift to more rural areas
B)
Shift of health care delivery into the community
C)
Advent of primary care clinics
D)
Increased use of rehabilitation hospitals
Ans:
B
Feedback:
As health care delivery shifts into the community, more nurses are working in a variety of communitybased settings. These settings include public health departments, ambulatory health clinics, long-term
care facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics,
nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay
facilities, and patients homes. The other answers are incorrect because our population has not shifted to a
more rural base, and the use of primary care clinics has not influenced an increase in practice settings or
the use of rehabilitation hospitals.
17. A nurse is collaborating with a team of community nurses to identify the vision and mission for
community care. What is the central focus of community-based nursing?
A)
Increased health literacy in the community
B)
Distributing ownership for the health of the community
C)
Promoting and maintaining the health of individuals and families
D)
Identifying links between lifestyle and health
Ans:
C
Feedback:
Community-based nursing practice focuses centrally on promoting and maintaining the health of
individuals and families, preventing and minimizing the progression of disease, and improving quality of
life. Health literacy is not a goal in itself, but rather a means to promoting health. Distributing ownership
and identifying links between lifestyle and health are not the essence of community-based care.
18. You are the community-based nurse who performs the role of case manager for a small town about 60
miles from a major health care center. When planning care in your community, what is the most
important variable in community-based nursing that you should integrate into your planning?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
Eligibility requirements for services
B)
Community resources available to patients
C)
Transportation costs to the medical center
D)
Possible charges for any services provided
Ans:
B
30
Feedback:
A community-based nurse must be knowledgeable about community resources available to patients as
well as services provided by local agencies, eligibility requirements, and any possible charges for the
services. The other answers are incorrect because they are not the most important factors about which a
community-based nurse must be knowledgeable.
19. An urban, community-based nurse is looking for community resources for a patient who has complex
rehabilitation needs coupled with several comorbid, chronic health conditions. Where is the best place
for the nurse to search for appropriate resources?
A)
A hospital directory
B)
The hospital intranet
C)
A community directory
D)
The nurses own personal network
Ans:
C
Feedback:
Most communities have directories of health and social service agencies that the nurse can consult. The
other answers are incorrect because hospital directories and intranets usually only include people
affiliated with the hospital. The nurses personal network of contacts may or may not be of use.
20. You are a community-based care manager in a medium-sized community that does not have an up-todate resource directory available. As a result, you have been given the task of beginning to compile such
a directory. What would be important to include in this directory? Select all that apply.
A)
Links to online health sciences journals
B)
Lists of social service workers in the community
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
Eligibility requirements for services
D)
Lists of the most commonly used resources
E)
Costs associated with services
Ans:
C, D, E
31
Feedback:
If a community does not have a resource booklet, an agency may develop one for its staff. It should
include the commonly used community resources that patients need, as well as the costs of the services
and eligibility requirements. The other answers are incorrect because a community resource booklet
usually would not include links to online professional journals and it would not identify specific social
service workers, only agencies.
21. You are assessing a new patient and his home environment following the patients referral for
community-based care. Which of the following is the most important responsibility that you, as a
community-based nurse, have at this initial visit?
A)
Encourage the patient and his family to become more involved in their community.
B)
Encourage the patient and his family to delegate someone to contact community resources.
C)
Encourage the patient and his family to focus primarily on online supports.
D)
Encourage the patient and his family to connect with appropriate community resources.
Ans:
D
Feedback:
During initial and subsequent home visits, the nurse helps the patient and family identify community
services and encourages them to contact the appropriate agencies. This is preferable to delegating
another person to make contact. When appropriate, nurses may make the initial contact. A home-health
nurse would not normally encourage the patient to become more involved in the community as a means
of promoting health. Online forms of support can be useful, but they are not the sole form of support that
most patients need.
22. A nurse is comparing some of the similarities and differences between the care that is provided in
community- and hospital-based settings. What type of care is provided in both of these settings?
A)
Dieticians
B)
Ambulatory health care
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
Occupational health care
D)
Hospice care
Ans:
B
32
Feedback:
Ambulatory health care is provided for patients in community or hospital-based settings. The types of
agencies that provide such care are medical clinics, ambulatory care units, urgent care centers, cardiac
rehabilitation programs, mental health centers, student health centers, community outreach programs,
and nursing centers. Dieticians are not generally community-based and hospice care is not generally
provided in hospital settings. Occupational health care is situated in workplaces.
23. A community-based case manager is sending a community nurse to perform an initial home assessment
of a newly referred patient. To ensure safety, the case manager must make the nurse aware of which of
the following?
A)
The potential for at-risk working environments
B)
Self-defense strategies
C)
Locations of emergency services in the area
D)
Standard precautions for infection control
Ans:
A
Feedback:
Based on the principle of due diligence, agencies must inform employees of at-risk working
environments. Agencies have policies and procedures concerning the promotion of safety for clinical
staff, and training is provided to facilitate personal safety. The physical location of emergency services is
not important, though methods for contacting emergency services are a priority. Infection control is part
of the nurses own professional responsibility. Self-defense strategies are not always addressed and are
not legally mandated.
24. A home health nurse is making a visit to a new patient who is receiving home care following a
mastectomy. During the visit, the patients husband arrives home in an intoxicated state and speaks to
both you and the patient in an abusive manner. What is your best response?
A)
Ignore the husband and focus on the patient.
B)
Return to your agency and notify your supervisor.
C)
Call the police from your cell phone.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
D)
Remove the patient from the home immediately.
Ans:
B
33
Feedback:
If a dangerous situation is encountered during a visit, the nurse should return to the agency and contact
his or her supervisor or law enforcement officials, or both. Ignoring the husband or calling the police
while in the home or attempting to remove the patient from the home could further endanger you and the
patient.
25. The community-health nurse has received a referral for a new patient who resides in a high-crime area.
What is the most important request that the nurse should make of the agency to best ensure safety?
A)
An early morning or late afternoon appointment
B)
An assigned parking space in the neighborhood
C)
A colleague to accompany the nurse on the visit
D)
Someone to wait in the car while the nurse makes the visit
Ans:
C
Feedback:
When making visits in high-crime areas, visit with another person rather than alone. A person who is
waiting in the car is of little benefit. An early morning or late afternoon appointment would not
necessarily guarantee safety. Similarly, assigned parking would not guarantee the nurses safety while
performing the visit.
26. A home health nurse has been assigned to the care of an 82 year-old woman who has been discharged
home following hip replacement surgery. At what level of care is this nurse most likely practicing?
A)
Preventative care
B)
Primary prevention
C)
Secondary prevention
D)
Tertiary prevention
Ans:
D
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
34
Feedback:
Nurses in community-based practice provide preventive care at three levels: primary, secondary, and
tertiary. Tertiary prevention focuses on minimizing deterioration and improving quality of life, including
rehabilitation to assist patients in achieving their maximum potential by working through their physical
or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although
primary and secondary prevention are also addressed. Preventive care is an umbrella term for all three
levels of care.
27. You are admitting two new patients to your local home health care service. These patients live within
two blocks of each other and both homes are in a high-crime area. What action best protects your
personal safety?
A)
Drive a car that is hard to break into.
B)
Keep your satchel close to you at all times.
C)
Do not leave anything in the car that might be stolen.
D)
Do not wear expensive jewelry.
Ans:
D
Feedback:
Do not drive an expensive car or wear expensive jewelry when making visits. While all of these answers
might be wise precautions to take, the other suggestions address property rather than personal safety.
28. In two days you are scheduled to discharge a patient home after left hip replacement. You have initiated
a home health referral and you have met with a team of people who have been involved with this
patients discharge planning. Knowing that the patient lives alone, who would be appropriate people to be
on the discharge planning team? Select all that apply.
A)
Home health nurse
B)
Physical therapist
C)
Pharmacy technician
D)
Social worker
E)
Meal-on-Wheels provider
Ans:
A, B, D
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
35
The development of a comprehensive discharge plan requires collaboration with professionals at both
the referring agency and the home care agency, as well as other community agencies that provide
specific resources upon discharge. The pharmacy technician does not participate in discharge planning
and there is no indication that Meals-on-Wheels are necessary.
29. A home health nurse is conducting a home visit to a patient who receives wound care twice weekly for a
diabetic foot ulcer. While performing the dressing change, the nurse realizes that she forgot to bring the
adhesive gauze specified in the wound care regimen. What is the nurses best action?
A)
Phone a colleague to bring the required supplies as soon as possible.
B)
Improvise, if possible, using sterile gauze and adhesive tape.
C)
Leave the wound open to air and teach the patient about infection control.
D)
Schedule a return visit for the following day.
Ans:
B
Feedback:
Improvisation is a necessity in many home health situations. It would be logistically difficult to have the
supplies delivered and leaving the wound open to air may be contraindicated. A return visit the next day
does not resolve the immediate problem.
30. Discharge planning is an integral part of community-health nursing and home health. Which of the
following is prioritized in the discharge-planning process?
A)
Identifying the patients specific needs
B)
Making a social services referral
C)
Getting physical therapy involved in care
D)
Notifying the pharmacy of the discharge date
Ans:
A
Feedback:
The discharge planning process involves identifying the patients needs and developing a thorough plan
to meet them. The other options might be appropriate for some patients, but they are not all appropriate
for every patient.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
36
31. Within the public health system there has been an increased demand for medical, nursing, and social
services. The nurse should recognize what phenomenon as the basis for this increased demand?
A)
Increased use of complementary and alternative therapies
B)
The growing number of older adults in the United States
C)
The rise in income disparity in the United States
D)
Increasing profit potential for home health services
Ans:
B
Feedback:
The growing number of older adults in the United States increases the demand for medical, nursing, and
social services within the public health system. Income disparities, profit potential, and increased use of
complementary therapies do not account for this change.
32. Nursing care is provided in an increasingly diverse variety of settings. Despite the variety in settings,
some characteristics of professional nursing practice are required in any and every setting. These
characteristics include which of the following?
A)
Advanced education
B)
Certification in a chosen specialty
C)
Cultural competence
D)
Independent practice
Ans:
C
Feedback:
Cultural competence is necessary in any and every care setting. The other answers are incorrect because
an advanced education, specialty certification, and the ability to practice independently are not
consistencies between every nursing care delivery setting.
33. Medicare is a federal program that finances many Americans home health care expenses. The Medicare
program facilitates what aspect of home health care?
A)
Providing care without the oversight of a physician
B)
Writing necessary medication orders for the patient
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
Ordering physical, occupational, and speech therapy if needed
D)
Managing and evaluating patient care for seriously ill patients
Ans:
D
37
Feedback:
Many home health care expenditures are financed by Medicare, which allows nurses to manage and
evaluate patient care for seriously ill patients who have complex, labile conditions and are at high risk
for rehospitalization. Home health nurses, despite who funds their visits, do not provide care without the
oversight of a physician; they do not normally write medication orders; nor do they order the services of
ancillary specialists such as physical, occupational, or speech therapists.
34. You are a school nurse who will work with an incoming kindergarten student who has a diagnosis of
cerebral palsy. Why would you make a home visit before school starts?
A)
To provide anticipatory guidance to the family
B)
To assess the safety of the childs assistive devices
C)
To arrange for a teaching aide to work with the child
D)
To provide follow-up care after the childs clinic visit
Ans:
A
Feedback:
Public health, parish, and school nurses may make visits to provide anticipatory guidance to high-risk
families and follow-up care to patients with communicable diseases. The other answers are incorrect
because they are not functions of the school nurse.
35. A home health nurse has been working for several months with a male patient who is receiving
rehabilitative services. The nurse is aware that maintaining the patients confidentiality is a priority. How
can the nurse best protect the patients right to confidentiality?
A)
Avoid bringing the patients medical record to the home.
B)
Discuss the patients condition and care only when he is alone in the home.
C)
Keep the patients medical record secured at all times.
D)
Ask the patient to avoid discussing his home care with friends and neighbors.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Ans:
38
C
Feedback:
If the nurse carries a patients medical record into a house, it must be put in a secure place to prevent it
from being picked up by others or from being misplaced. This does not mean, however, that it must
never be brought to the home. It is not normally necessary to limit discussions to times when the patient
is alone. The patient has the right to decide with whom he will discuss his condition and care.
36. A home health nurse has completed a visit to a patient and has immediately begun to document the visit.
Accurate documentation that is correctly formatted is necessary for which of the following reasons?
A)
Accurate documentation guarantees that the nurse will not be legally liable for unexpected
outcomes.
B)
Accurate documentation ensures that the agency is correctly reimbursed for the visit.
C)
Accurate documentation allows the patient to gauge his or her progress over time.
D)
Accurate documentation facilitates safe delegation of care to unlicensed caregivers.
Ans:
B
Feedback:
The patients needs and the nursing care provided must be documented to ensure that the agency qualifies
for payment for the visit. Medicare, Medicaid, and other third-party payors (i.e., organizations that
provide reimbursement for services covered under a health care insurance plan) require documentation
of the patients homebound status and the need for skilled professional nursing care. Documentation does
not guarantee an absence of liability. Documentation is not normally provided to the patient to gauge his
or her progress. Documentation is not primarily used to facilitate delegation to unlicensed caregivers.
37. A home health nurse is collaborating with a hospice nurse in order to transfer the care of a woman who
has a diagnosis of lung cancer. To qualify for hospice care, the patient must meet what criterion?
A)
The patient must be medically inappropriate for hospital care.
B)
The patient must be in the final six months of his or her life.
C)
The patients family must demonstrate that they are unable to provide care.
D)
The patient must have a diagnosis that is associated with high morbidity and mortality.
Ans:
B
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
39
Patients are eligible for hospice care services if they are determined to be within the final 6 months of
life. Eligibility is not determined on the basis of the familys inability to provide care and it is not
determined by whether the patient can or cannot receive care in a hospital setting.
38. A home health nurse has completed a scheduled home visit to a patient with a chronic sacral ulcer. The
nurse is now evaluating and documenting the need for future visits and the frequency of those visits.
What question can the nurse use when attempting to determine this need?
A)
How does the patient describe his coping style?
B)
When was the patient first diagnosed with this wound?
C)
Is the patients family willing to participate in care?
D)
Is the patient willing to create a plan of care?
Ans:
C
Feedback:
Determining the willingness and ability of friends and family to provide care can help determine
appropriate levels of professional home care. The time of initial diagnosis and the patients coping style
are secondary. The nurse, not the patient, is responsible for creating the plan of care.
39. A home health nurse is conducting an assessment of a patient who may qualify for Medicare.
Consequently, the nurse is utilizing the Outcome and Assessment Instrument Set (OASIS). When
performing an assessment using this instrument, the nurse should assess which of the following domains
of the patients current status?
A)
Psychiatric status
B)
Spiritual state
C)
Compliance with care
D)
Functional status
Ans:
D
Feedback:
The Omaha System of care documentation has been required for over a decade to assure that outcomebased care is provided for all care reimbursed by Medicare. This system uses six major domains:
sociodemographic, environment, support system, health status, functional status, and behavioral status
and addresses selected health service utilization. It does not explicitly assess spirituality, psychiatric
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
40
status, or compliance with care.
40. A community health nurse in a large, urban setting is participating in a pilot project that will involve the
establishment of a community hub. On what population should the nurse focus?
A)
Postsurgical patients
B)
Individuals with vulnerable health
C)
Community leaders
D)
Individuals motivated to participate in health education
Ans:
B
Feedback:
Community hubs are a recent concept that addresses the varied health needs of vulnerable and
marginalized populations. Community hubs do not primarily focus on postsurgical patients, community
leaders, or individuals who are proactive with health education.
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41
Chapter 03: Critical Thinking, Ethical Decision Making and the Nursing
Process
1.
A nurse has been offered a position on an obstetric unit and has learned that the unit offers therapeutic
abortions, a procedure which contradicts the nurses personal beliefs. What is the nurses ethical
obligation to these patients?
A)
The nurse should adhere to professional standards of practice and offer service to these patients.
B)
The nurse should make the choice to decline this position and pursue a different nursing role.
C)
The nurse should decline to care for the patients considering abortion.
D)
The nurse should express alternatives to women considering terminating their pregnancy.
Ans:
B
Feedback:
To avoid facing ethical dilemmas, nurses can follow certain strategies. For example, when applying for a
job, a nurse should ask questions regarding the patient population. If a nurse is uncomfortable with a
particular situation, then not accepting the position would be the best option. The nurse is only required
by law (and practice standards) to provide care to the patients the clinic accepts; the nurse may not
discriminate between patients and the nurse expressing his or her own opinion and providing another
option is inappropriate.
2.
A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large dose
of intravenous opioids by continuous infusion. You know that one of the adverse effects of this medicine
is respiratory depression. When you assess your patients respiratory status, you find that the rate has
decreased from 16 breaths per minute to 10 breaths per minute. What action should you take?
A)
Decrease the rate of IV infusion.
B)
Stimulate the patient in order to increase respiratory rate.
C)
Report the decreased respiratory rate to the physician.
D)
Allow the patient to rest comfortably.
Ans:
C
Feedback:
End-of life issues that often involve ethical dilemmas include pain control, do not resuscitate orders, life-
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
42
support measures, and administration of food and fluids. The risk of respiratory depression is not the
intent of the action of pain control. Respiratory depression should not be used as an excuse to withhold
pain medication for a terminally ill patient. The patients respiratory status should be carefully monitored
and any changes should be reported to the physician.
3.
An adult patient has requested a do not resuscitate (DNR) order in light of his recent diagnosis with late
stage pancreatic cancer. The patients son and daughter-in-law are strongly opposed to the patients
request. What is the primary responsibility of the nurse in this situation?
A)
Perform a slow code until a decision is made.
B)
Honor the request of the patient.
C)
Contact a social worker or mediator to intervene.
D)
Temporarily withhold nursing care until the physician talks to the family.
Ans:
B
Feedback:
The nurse must honor the patients wishes and continue to provide required nursing care. Discussing the
matter with the physician may lead to further communication with the family, during which the family
may reconsider their decision. It is not normally appropriate for the nurse to seek the assistance of a
social worker or mediator. A slow code is considered unethical.
4.
An elderly patient is admitted to your unit with a diagnosis of community-acquired pneumonia. During
admission the patient states, I have a living will. What implication of this should the nurse recognize?
A)
This document is always honored, regardless of circumstances.
B)
This document specifies the patients wishes before hospitalization.
C)
This document that is binding for the duration of the patients life.
D)
This document has been drawn up by the patients family to determine DNR status.
Ans:
B
Feedback:
A living will is one type of advance directive. In most situations, living wills are limited to situations in
which the patients medical condition is deemed terminal. The other answers are incorrect because living
wills are not always honored, they are not binding for the duration of the patients life, and they are not
drawn up by the patients family.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
5.
43
A nurse has been providing ethical care for many years and is aware of the need to maintain the ethical
principle of nonmaleficence. Which of the following actions would be considered a contradiction of this
principle?
A)
Discussing a DNR order with a terminally ill patient
B)
Assisting a semi-independent patient with ADLs
C)
Refusing to administer pain medication as ordered
D)
Providing more care for one patient than for another
Ans:
C
Feedback:
The duty not to inflict as well as prevent and remove harm is termed nonmaleficence. Discussing a DNR
order with a terminally ill patient and assisting a patient with ADLs would not be considered
contradictions to the nurses duty of nonmaleficence. Some patients justifiably require more care than
others.
6.
You have just taken report for your shift and you are doing your initial assessment of your patients. One
of your patients asks you if an error has been made in her medication. You know that an incident report
was filed yesterday after a nurse inadvertently missed a scheduled dose of the patients antibiotic. Which
of the following principles would apply if you give an accurate response?
A)
Veracity
B)
Confidentiality
C)
Respect
D)
Justice
Ans:
A
Feedback:
The obligation to tell the truth and not deceive others is termed veracity. The other answers are incorrect
because they are not obligations to tell the truth.
7.
A)
A nurse has begun creating a patients plan of care shortly after the patients admission. It is important that
the wording of the chosen nursing diagnoses falls within the taxonomy of nursing. Which organization is
responsible for developing the taxonomy of a nursing diagnosis?
American Nurses Association (ANA)
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
B)
NANDA
C)
National League for Nursing (NLN)
D)
Joint Commission
Ans:
B
44
Feedback:
NANDA International is the official organization responsible for developing the taxonomy of nursing
diagnoses and formulating nursing diagnoses acceptable for study. The ANA, NLN, and Joint
Commission are not charged with the task of developing the taxonomy of nursing diagnoses.
8.
In response to a patients complaint of pain, the nurse administered a PRN dose of hydromorphone
(Dilaudid). In what phase of the nursing process will the nurse determine whether this medication has
had the desired effect?
A)
Analysis
B)
Evaluation
C)
Assessment
D)
Data collection
Ans:
B
Feedback:
Evaluation, the final step of the nursing process, allows the nurse to determine the patients response to
nursing interventions and the extent to which the objectives have been achieved.
9.
A medical nurse has obtained a new patients health history and completed the admission assessment.
The nurse has followed this by documenting the results and creating a care plan for the patient. Which of
the following is the most important rationale for documenting the patients care?
A)
It provides continuity of care.
B)
It creates a teaching log for the family.
C)
It verifies appropriate staffing levels.
D)
It keeps the patient fully informed.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Ans:
45
A
Feedback:
This record provides a means of communication among members of the health care team and facilitates
coordinated planning and continuity of care. It serves as the legal and business record for a health care
agency and for the professional staff members who are responsible for the patients care. Documentation
is not primarily a teaching log; it does not verify staffing; and it is not intended to provide the patient
with information about treatments.
10. The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequently
combative and confused, despite the administration of benzodiazepines. The patient has a fractured hip
that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate
action for the nurse to take?
A)
Leave the patient and get help.
B)
Obtain a physicians order to restrain the patient.
C)
Read the facilitys policy on restraints.
D)
Order soft restraints from the storeroom.
Ans:
B
Feedback:
It is mandatory in most settings to have a physicians order before restraining a patient. Before restraints
are used, other strategies, such as asking family members to sit with the patient, or utilizing a specially
trained sitter, should be tried. A patient should never be left alone while the nurse summons assistance.
11. A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility.
Following treatment with a heparin infusion, the nurse notes that the patients leg is pain-free, without
redness or edema. Which step of the nursing process does this reflect?
A)
Diagnosis
B)
Analysis
C)
Implementation
D)
Evaluation
Ans:
D
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
46
Feedback:
The nursing actions described constitute evaluation of the expected outcomes. The findings show that
the expected outcomes have been achieved. Analysis consists of considering assessment information to
derive the appropriate nursing diagnosis. Implementation is the phase of the nursing process where the
nurse puts the care plan into action. This nurses actions do not constitute diagnosis.
12. During report, a nurse finds that she has been assigned to care for a patient admitted with an
opportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she is
refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which
legal premise?
A)
Good Samaritan Act
B)
Nursing Interventions Classification (NIC)
C)
Patient Self-Determination Act
D)
ANA Code of Ethics
Ans:
D
Feedback:
The ethical obligation to care for all patients is clearly identified in the first statement of the ANA Code
of Ethics for Nurses. The Good Samaritan Act relates to lay people helping others in need. The NIC is a
standardized classification of nursing treatment that includes independent and collaborative
interventions. The Patient Self-Determination Act encourages people to prepare advance directives in
which they indicate their wishes concerning the degree of supportive care to be provided if they become
incapacitated.
13. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. The
patient is to have a lumbar puncture performed, and the nurse is doing preprocedure teaching with the
child and the mother. The nurses action is an example of which therapeutic communication technique?
A)
Informing
B)
Suggesting
C)
Expectation-setting
D)
Enlightening
Ans:
A
Feedback:
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
47
Informing involves providing information to the patient regarding his or her care. Suggesting is the
presentation of an alternative idea for the patients consideration relative to problem solving. This action
is not characterized as expectation-setting or enlightening.
14. The nurse, in collaboration with the patients family, is determining priorities related to the care of the
patient. The nurse explains that it is important to consider the urgency of specific problems when setting
priorities. What provides the best framework for prioritizing patient problems?
A)
Availability of hospital resources
B)
Family member statements
C)
Maslows hierarchy of needs
D)
The nurses skill set
Ans:
C
Feedback:
Maslows hierarchy of needs provides a useful framework for prioritizing problems, with the first level
given to meeting physical needs of the patient. Availability of hospital resources, family member
statements, and nursing skill do not provide a framework for prioritization of patient problems, though
each may be considered.
15. A medical nurse is caring for a patient who is palliative following metastasis. The nurse is aware of the
need to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle in
the care of this patient?
A)
The nurse tactfully regulates the number and timing of visitors as per the patients wishes.
B)
The nurse stays with the patient during his or her death.
C)
The nurse ensures that all members of the care team are aware of the patients DNR order.
D)
The nurse liaises with members of the care team to ensure continuity of care.
Ans:
B
Feedback:
Beneficence is the duty to do good and the active promotion of benevolent acts. Enacting the patients
wishes around visitors is an example of this. Each of the other nursing actions is consistent with ethical
practice, but none directly exemplifies the principle of beneficence.
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48
16. The care team has deemed the occasional use of restraints necessary in the care of a patient with
Alzheimers disease. What ethical violation is most often posed when using restraints in a long-term care
setting?
A)
It limits the patients personal safety.
B)
It exacerbates the patients disease process.
C)
It threatens the patients autonomy.
D)
It is not normally legal.
Ans:
C
Feedback:
Because safety risks are involved when using restraints on elderly confused patients, this is a common
ethical problem, especially in long-term care settings. By definition, restraints limit the individuals
autonomy. Restraints are not without risks, but they should not normally limit a patients safety.
Restraints will not affect the course of the patients underlying disease process, though they may
exacerbate confusion. The use of restraints is closely legislated, but they are not illegal.
17. While receiving report on a group of patients, the nurse learns that a patient with terminal cancer has
granted power of attorney for health care to her brother. How does this affect the course of the patients
care?
A)
Another individual has been identified to make decisions on behalf of the patient.
B)
There are binding parameters for care even if the patient changes her mind.
C)
The named individual is in charge of the patients finances.
D)
There is a document delegating custody of children to other than her spouse.
Ans:
A
Feedback:
A power of attorney is said to be in effect when a patient has identified another individual to make
decisions on her behalf. The patient has the right to change her mind. A power-of-attorney for health
care does not give anyone the right to make financial decisions for the patient nor does it delegate
custody of minor children.
18. In the process of planning a patients care, the nurse has identified a nursing diagnosis of Ineffective
Health Maintenance related to alcohol use. What must precede the determination of this nursing
diagnosis?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
Establishment of a plan to address the underlying problem
B)
Assigning a positive value to each consequence of the diagnosis
C)
Collecting and analyzing data that corroborates the diagnosis
D)
Evaluating the patients chances of recovery
Ans:
C
49
Feedback:
In the diagnostic phase of the nursing process, the patients nursing problems are defined through analysis
of patient data. Establishing a plan comes after collecting and analyzing data; evaluating a plan is the last
step of the nursing process and assigning a positive value to each consequence is not done.
19. You are following the care plan that was created for a patient newly admitted to your unit. Which of the
following aspects of the care plan would be considered a nursing implementation?
A)
The patient will express an understanding of her diagnosis.
B)
The patient appears diaphoretic.
C)
The patient is at risk for aspiration.
D)
Ambulate the patient twice per day with partial assistance.
Ans:
D
Feedback:
Implementation refers to carrying out the plan of nursing care. The other listed options exemplify goals,
assessment findings, and diagnoses.
20. The physician has recommended an amniocentesis for an 18-year-old primiparous woman. The patient is
34 weeks gestation and does not want this procedure. The physician is insistent the patient have the
procedure. The physician arranges for the amniocentesis to be performed. The nurse should recognize
that the physician is in violation of what ethical principle?
A)
Veracity
B)
Beneficence
C)
Nonmaleficence
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
D)
Autonomy
Ans:
D
50
Feedback:
The principle of autonomy specifies that individuals have the ability to make a choice free from external
constraints. The physicians actions in this case violate this principle. This action may or may not violate
the principle of beneficence. Veracity centers on truth-telling and nonmaleficence is avoiding the
infliction of harm.
21. During discussion with the patient and the patients husband, you discover that the patient has a living
will. How does the presence of a living will influence the patients care?
A)
The patient is legally unable to refuse basic life support.
B)
The physician can override the patients desires for treatment if desires are not evidence-based.
C)
The patient may nullify the living will during her hospitalization if she chooses to do so.
D)
Power-of-attorney may change while the patient is hospitalized.
Ans:
C
Feedback:
Because living wills are often written when the person is in good health, it is not unusual for the patient
to nullify the living will during illness. A living will does not make a patient legally unable to refuse
basic life support. The physician may disagree with the patients wishes, but he or she is ethically bound
to carry out those wishes. A power-of-attorney is not synonymous with a living will.
22. Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving only
modest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When
creating this patients plan of care, which nursing diagnosis would most likely be appropriate?
A)
Self-care deficit related to fatigue and joint stiffness
B)
Ineffective airway clearance related to chronic pain
C)
Risk for hopelessness related to body image disturbance
D)
Anxiety related to chronic joint pain
Ans:
A
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51
Feedback:
Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions.
Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness
are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely.
Ineffective airway clearance is unlikely.
23. You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and you
note decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate
nursing diagnosis for this patient?
A)
Ineffective airway clearance related to tracheobronchial secretions
B)
Pneumonia related to progression of disease process
C)
Poor ventilation related to acute lung infection
D)
Immobility related to fatigue
Ans:
A
Feedback:
Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis for
this patient is ineffective airway clearance related to copious tracheobronchial secretions. Pneumonia
and poor ventilation are not nursing diagnoses. Immobility is likely, but is less directly related to the
patients admitting medical diagnosis and the nurses assessment finding.
24. You are providing care for a patient who has a diagnosis of pneumonia attributed toStreptococcus
pneumonia infection. Which of the following aspects of nursing care would constitute part of the
planning phase of the nursing process?
A)
Achieve SaO2 92% at all times.
B)
Auscultate chest q4h.
C)
Administer oral fluids q1h and PRN.
D)
Avoid overexertion at all times.
Ans:
A
Feedback:
The planning phase entails specifying the immediate, intermediate, and long-term goals of nursing
action, such as maintaining a certain level of oxygen saturation in a patient with pneumonia. Providing
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52
fluids and avoiding overexertion are parts of the implementation phase of the nursing process. Chest
auscultation is an assessment.
25. You are the nurse who is caring for a patient with a newly diagnosed allergy to peanuts. Which of the
following is an immediate goal that is most relevant to a nursing diagnosis of deficient knowledge
related to appropriate use of an EpiPen?
A)
The patient will demonstrate correct injection technique with todays teaching session.
B)
The patient will closely observe the nurse demonstrating the injection.
C)
The nurse will teach the patients family member to administer the injection.
D)
The patient will return to the clinic within 2 weeks to demonstrate the injection.
Ans:
A
Feedback:
Immediate goals are those that can be reached in a short period of time. An appropriate immediate goal
for this patient is that the patient will demonstrate correct administration of the medication today. The
goal should specify that the patient administer the EpiPen. A 2-week time frame is inconsistent with an
immediate goal.
26. A recent nursing graduate is aware of the differences between nursing actions that are independent and
nursing actions that are interdependent. A nurse performs an interdependent nursing intervention when
performing which of the following actions?
A)
Auscultating a patients apical heart rate during an admission assessment
B)
Providing mouth care to a patient who is unconscious following a cerebrovascular accident
C)
Administering an IV bolus of normal saline to a patient with hypotension
D)
Providing discharge teaching to a postsurgical patient about the rationale for a course of oral
antibiotics
Ans:
C
Feedback:
Although many nursing actions are independent, others are interdependent, such as carrying out
prescribed treatments, administering medications and therapies, and collaborating with other health care
team members to accomplish specific, expected outcomes and to monitor and manage potential
complications. Irrigating a wound, administering pain medication, and administering IV fluids are
interdependent nursing actions and require a physicians order. An independent nursing action occurs
when the nurse assesses a patients heart rate, provides discharge education, or provides mouth care.
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53
27. A nurse has been using the nursing process as a framework for planning and providing patient care.
What action would the nurse do during the evaluation phase of the nursing process?
A)
Have a patient provide input on the quality of care received.
B)
Remove a patients surgical staples on the scheduled postoperative day.
C)
Provide information on a follow-up appointment for a postoperative patient.
D)
Document a patients improved air entry with incentive spirometric use.
Ans:
D
Feedback:
During the evaluation phase of the nursing process, the nurse determines the patients response to nursing
interventions. An example of this is when the nurse documents whether the patients spirometry use has
improved his or her condition. A patient does not do the evaluation. Removing staples and providing
information on follow-up appointments are interventions, not evaluations.
28. An audit of a large, university medical center reveals that four patients in the hospital have current
orders for restraints. You know that restraints are an intervention of last resort, and that it is
inappropriate to apply restraints to which of the following patients?
A)
A postlaryngectomy patient who is attempting to pull out his tracheostomy tube
B)
A patient in hypovolemic shock trying to remove the dressing over his central venous catheter
C)
A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode
D)
A patient with depression who has just tried to commit suicide and whose medications are not
achieving adequate symptom control
Ans:
C
Feedback:
Restraints should never be applied for staff convenience. The patient with urosepsis who is frequently
ringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior that
will not result in patient harm. The other described situations could plausibly result in patient harm;
therefore, it is more likely appropriate to apply restraints in these instances.
29. A patient has been diagnosed with small-cell lung cancer. He has met with the oncologist and is now
weighing the relative risks and benefits of chemotherapy and radiotherapy as his treatment. This patient
is demonstrating which ethical principle in making his decision?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
Beneficence
B)
Confidentiality
C)
Autonomy
D)
Justice
Ans:
C
54
Feedback:
Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to
do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy.
Justice states that cases should be treated equitably.
30. A patient with migraines does not know whether she is receiving a placebo for pain management or the
new drug that is undergoing clinical trials. Upon discussing the patients distress, it becomes evident to
the nurse that the patient did not fully understand the informed consent document that she signed. Which
ethical principle is most likely involved in this situation?
A)
Sanctity of life
B)
Confidentiality
C)
Veracity
D)
Fidelity
Ans:
C
Feedback:
Telling the truth (veracity) is one of the basic principles of our culture. Three ethical dilemmas in
clinical practice that can directly conflict with this principle are the use of placebos (nonactive
substances used for treatment), not revealing a diagnosis to a patient, and revealing a diagnosis to
persons other than the patient with the diagnosis. All involve the issue of trust, which is an essential
element in the nursepatient relationship. Sanctity of life is the perspective that life is the highest good.
Confidentiality deals with privacy of the patient. Fidelity is promise-keeping and the duty to be faithful
to ones commitments.
31. The nursing instructor is explaining critical thinking to a class of first-semester nursing students. When
promoting critical thinking skills in these students, the instructor should encourage them to do which of
the following actions?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
A)
Disregard input from people who do not have to make the particular decision.
B)
Set aside all prejudices and personal experiences when making decisions.
C)
Weigh each of the potential negative outcomes in a situation.
D)
Examine and analyze all available information.
Ans:
D
55
Feedback:
Critical thinking involves reasoning and purposeful, systematic, reflective, rational, outcome-directed
thinking based on a body of knowledge, as well as examination and analysis of all available information
and ideas. A full disregard of ones own experiences is not possible. Critical thinking does not denote a
focus on potential negative outcomes. Input from others is a valuable resource that should not be
ignored.
32. A care conference has been organized for a patient with complex medical and psychosocial needs. When
applying the principles of critical thinking to this patients care planning, the nurse should most
exemplify what characteristic?
A)
Willingness to observe behaviors
B)
A desire to utilize the nursing scope of practice fully
C)
An ability to base decisions on what has happened in the past
D)
Openness to various viewpoints
Ans:
D
Feedback:
Willingness and openness to various viewpoints are inherent in critical thinking; these allow the nurse to
reflect on the current situation. An emphasis on the past, willingness to observe behaviors, and a desire
to utilize the nursing scope of practice fully are not central characteristics of critical thinkers.
33. Achieving adequate pain management for a postoperative patient will require sophisticated critical
thinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all that
apply.
A)
Enhancing the nurses clinical decision making
B)
Identifying the patients individual preferences
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
C)
Planning the best nursing actions to assist the patient
D)
Increasing the accuracy of the nurses judgments
E)
Helping identify the patients priority needs
Ans:
A, C, D, E
56
Feedback:
Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize
information within the context in which it is presented. Critical thinking enhances clinical decision
making, helping to identify patient needs and the best nursing actions that will assist patients in meeting
those needs. Critical thinking does not normally focus on identify patient desires; these would be
identified by asking the patient.
34. A nurse is unsure how best to respond to a patients vague complaint of feeling off. The nurse is
attempting to apply the principles of critical thinking, including metacognition. How can the nurse best
foster metacognition?
A)
By eliciting input from a variety of trusted colleagues
B)
By examining the way that she thinks and applies reason
C)
By evaluating her responses to similar situations in the past
D)
By thinking about the way that an ideal nurse would respond in this situation
Ans:
B
Feedback:
Critical thinking includes metacognition, the examination of ones own reasoning or thought processes,
to help refine thinking skills. Metacognition is not characterized by eliciting input from others or
evaluating previous responses.
35. The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse
should describe skills in which of the following domains? Select all that apply.
A)
Self-esteem
B)
Self-regulation
C)
Inference
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
D)
Autonomy
E)
Interpretation
Ans:
B, C, E
57
Feedback:
Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and
self-regulation. Self-esteem and autonomy would not be on the list because they are not skills.
36. The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The
nurses most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking
is determining the significance of data that have been gathered. What characteristic of critical thinking is
used in determining the best response to this assessment finding?
A)
Extrapolation
B)
Inference
C)
Characterization
D)
Interpretation
Ans:
D
Feedback:
Nurses use interpretation to determine the significance of data that are gathered. This specific process is
not described as extrapolation, inference, or characterization.
37. A nurse is admitting a new patient to the medical unit. During the initial nursing assessment, the nurse
has asked many supplementary open-ended questions while gathering information about the new patient.
What is the nurse achieving through this approach?
A)
Interpreting what the patient has said
B)
Evaluating what the patient has said
C)
Assessing what the patient has said
D)
Validating what the patient has said
Ans:
D
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
58
Feedback:
Critical thinkers validate the information presented to make sure that it is accurate (not just supposition
or opinion), that it makes sense, and that it is based on fact and evidence. The nurse is not interpreting,
evaluating, or assessing the information the patient has given.
38. A nurse uses critical thinking every day when going through the nursing process. Which of the following
is an outcome of critical thinking in nursing practice?
A)
A comprehensive plan of care with a high potential for success
B)
Identification of the nurses preferred goals for the patient
C)
A collaborative basis for assigning care
D)
Increased cost efficiency in health care
Ans:
A
Feedback:
Critical thinking in nursing practice results in a comprehensive plan of care with maximized potential for
success. Critical thinking does not identify the nurses goal for the patient or provide a collaborative basis
for assigning care. Critical thinking may or may not lead to increased cost efficiency; the patients
outcomes are paramount.
39. A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status
post knee replacement. What would be the best explanation why their care plans may be different from
each other?
A)
Patients may have different insurers, or one may qualify for Medicare.
B)
Individual patients are seen as unique and dynamic, with individual needs.
C)
Nursing care may be coordinated by members of two different health disciplines.
D)
Patients are viewed as dissimilar according to their attitude toward surgery.
Ans:
B
Feedback:
Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences in
insurance coverage and attitude may be relevant, but these should not fundamentally explain the
differences in their nursing care. Nursing care should be planned by nurses, not by members of other
disciplines.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
59
40. A class of nursing students is in their first semester of nursing school. The instructor explains that one of
the changes they will undergo while in nursing school is learning to think like a nurse. What is the most
current model of this thinking process?
A)
Critical-thinking Model
B)
Nursing Process Model
C)
Clinical Judgment Model
D)
Active Practice Model
Ans:
C
Feedback:
To depict the process of thinking like a nurse, Tanner (2006) developed a model known as the clinical
judgment model.
41. Critical thinking and decision-making skills are essential parts of nursing in all venues. What are
examples of the use of critical thinking in the venue of genetics-related nursing? Select all that apply.
A)
Notifying individuals and family members of the results of genetic testing
B)
Providing a written report on genetic testing to an insurance company
C)
Assessing and analyzing family history data for genetic risk factors
D)
Identifying individuals and families in need of referral for genetic testing
E)
Ensuring privacy and confidentiality of genetic information
Ans:
C, D, E
Feedback:
Nurses use critical thinking and decision-making skills in providing genetics-related nursing care when
they assess and analyze family history data for genetic risk factors, identify those individuals and
families in need of referral for genetic testing or counseling, and ensure the privacy and confidentiality
of genetic information. Nurses who work in the venue of genetics-related nursing do not notify family
members of the results of an individuals genetic testing, and they do not provide written reports to
insurance companies concerning the results of genetic testing.
42. A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDS-
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
60
related pneumonia. The student tells the instructor that she is unwilling to care for this patient. What key
component of critical thinking is most likely missing from this students practice?
A)
Compliance with direction
B)
Respect for authority
C)
Analyzing information and situations
D)
Withholding judgment
Ans:
D
Feedback:
Key components of critical thinking behavior are withholding judgment and being open to options and
explanations from one patient to another in similar circumstances. The other listed options are incorrect
because they are not components of critical thinking.
43. A group of students have been challenged to prioritize ethical practice when working with a
marginalized population. How should the students best understand the concept of ethics?
A)
The formal, systematic study of moral beliefs
B)
The informal study of patterns of ideal behavior
C)
The adherence to culturally rooted, behavioral norms
D)
The adherence to informal personal values
Ans:
A
Feedback:
In essence, ethics is the formal, systematic study of moral beliefs, whereas morality is the adherence to
informal personal values.
44. Your patient has been admitted for a liver biopsy because the physician believes the patient may have
liver cancer. The family has told both you and the physician that if the patient is terminal, the family
does not want the patient to know. The biopsy results are positive for an aggressive form of liver cancer
and the patient asks you repeatedly what the results of the biopsy show. What strategy can you use to
give ethical care to this patient?
A)
Obtain the results of the biopsy and provide them to the patient.
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