Test Bank Brunner & Suddarths Textbook of Medical-Surgical Nursing 13th Edition

Test Bank Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13th Edition Sample Test Chapter 03 1. A nurse has been offered a position on an obstetric unit and has learned that t which contradicts the nurse’s personal beliefs. What is the nurse’s ethical oblig A) The nurse should adhere to professional standards of practice and B) The nurse should make the choice to decline this position and purs C) The nurse should decline to care for the patients considering aborti D) The nurse should express alternatives to women considering termin Ans: B Feedback: To avoid facing ethical dilemmas, nurses can follow certain strategies. For exa questions regarding the patient population. If a nurse is uncomfortable with a p would be the best option. The nurse is only required by law (and practice stan accepts; the nurse may not discriminate between patients and the nurse expre option is inappropriate. A terminally ill patient you are caring for is complaining of pain. The physician 2. continuous infusion. You know that one of the adverse effects of this medicine patient’s respiratory status, you find that the rate has decreased from 16 breat 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 administration of food and fluids. The risk of respiratory depression is not the i depression should not be used as an excuse to withhold pain medication for a should be carefully monitored and any changes should be reported to the phys An adult patient has requested a “do not resuscitate” (DNR) order in light of hi 3. The patient’s son and daughter-in-law are strongly opposed to the patient’s re 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 fa Ans: B Feedback: The nurse must honor the patient’s wishes and continue to provide required nu physician may lead to further communication with the family, during which the normally appropriate for the nurse to seek the assistance of a social worker or 4. An elderly patient is admitted to your unit with a diagnosis of community-acqui 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 patient’s wishes before hospitalization. C) This document that is binding for the duration of the patient’s life. D) This document has been drawn up by the patient’s family to determ Ans: B Feedback: A living will is one type of advance directive. In most situations, living wills are condition is deemed terminal. The other answers are incorrect because living for the duration of the patient’s life, and they are not drawn up by the patient’s 5. A nurse has been providing ethical care for many years and is aware of the ne nonmaleficence. Which of the following actions would be considered a contrad 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 nonmalefi patient and assisting a patient with ADLs would not be considered contradictio patients justifiably require more care than others. You have just taken report for your shift and you are doing your initial assessm 6. if an error has been made in her medication. You know that an incident report missed a scheduled dose of the patient’s antibiotic. Which of the following prin 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 o obligations to tell the truth. A nurse has begun creating a patient’s plan of care shortly after the patient’s a 7. chosen nursing diagnoses falls within the taxonomy of nursing. Which organiz a nursing diagnosis? A) American Nurses Association (ANA) B) NANDA C) National League for Nursing (NLN) D) Joint Commission Ans: B Feedback: NANDA International is the official organization responsible for developing the nursing diagnoses acceptable for study. The ANA, NLN, and Joint Commission taxonomy of nursing diagnoses. 8. In response to a patient’s complaint of pain, the nurse administered a PRN do the nursing process will the nurse determine whether this medication has had 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 extent to which the objectives have been achieved. A medical nurse has obtained a new patient’s health history and completed the 9. this by documenting the results and creating a care plan for the patient. Which documenting the patient’s 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. Ans: A Feedback: This record provides a means of communication among members of the healt and continuity of care. It serves as the legal and business record for a health c who are responsible for the patient’s care. Documentation is not primarily a tea intended to provide the patient with information about treatments. The nurse is caring for a patient who is withdrawing from heavy alcohol use an 10. despite the administration of benzodiazepines. The patient has a fractured hip trying to get out of bed. What is the most appropriate action for the nurse to ta A) Leave the patient and get help. B) Obtain a physician’s order to restrain the patient. C) Read the facility’s policy on restraints. D) Order soft restraints from the storeroom. Ans: B Feedback: It is mandatory in most settings to have a physician’s order before restraining strategies, such as asking family members to sit with the patient, or utilizing a should never be left alone while the nurse summons assistance. A patient admitted with right leg thrombophlebitis is to be discharged from an a 11. heparin infusion, the nurse notes that the patient’s leg is pain-free, without red does this reflect? A) Diagnosis B) Analysis C) Implementation D) Evaluation Ans: D Feedback: The nursing actions described constitute evaluation of the expected outcomes have been achieved. Analysis consists of considering assessment information Implementation is the phase of the nursing process where the nurse puts the c constitute diagnosis. During report, a nurse finds that she has been assigned to care for a patient a 12. AIDS. The nurse informs the clinical nurse leader that she is refusing to care f 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 state Good Samaritan Act relates to lay people helping others in need. The NIC is a includes independent and collaborative interventions. The Patient Self-Determ directives in which they indicate their wishes concerning the degree of support incapacitated. An emergency department nurse is caring for a 7-year-old child suspected of h 13. puncture performed, and the nurse is doing preprocedure teaching with the ch example of which therapeutic communication technique? A) Informing B) Suggesting C) Expectation-setting D) Enlightening Ans: A Feedback: Informing involves providing information to the patient regarding his or her car idea for the patient’s consideration relative to problem solving. This action is n enlightening. The nurse, in collaboration with the patient’s family, is determining priorities rel 14. that it is important to consider the urgency of specific problems when setting p prioritizing patient problems? A) Availability of hospital resources B) Family member statements C) Maslow’s hierarchy of needs D) The nurse’s skill set Ans: C Feedback: Maslow’s hierarchy of needs provides a useful framework for prioritizing proble needs of the patient. Availability of hospital resources, family member stateme prioritization of patient problems, though each may be considered. 15. A medical nurse is caring for a patient who is palliative following metastasis. T principle of beneficence. How can the nurse best exemplify this principle in the A) The nurse tactfully regulates the number and timing of visitors as p 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 D) The nurse liaises with members of the care team to ensure continui Ans: B Feedback: Beneficence is the duty to do good and the active promotion of benevolent act an example of this. Each of the other nursing actions is consistent with ethical of beneficence. 16. The care team has deemed the occasional use of restraints necessary in the c ethical violation is most often posed when using restraints in a long-term care A) It limits the patient’s personal safety. B) It exacerbates the patient’s disease process. C) It threatens the patient’s autonomy. D) It is not normally legal. Ans: C Feedback: Because safety risks are involved when using restraints on elderly confused p in long-term care settings. By definition, restraints limit the individual’s autono not normally limit a patient’s safety. Restraints will not affect the course of the may exacerbate confusion. The use of restraints is closely legislated, but they 17. While receiving report on a group of patients, the nurse learns that a patient wi for health care to her brother. How does this affect the course of the patient’s c A) Another individual has been identified to make decisions on behalf B) There are binding parameters for care even if the patient changes h C) The named individual is in charge of the patient’s finances. D) There is a document delegating custody of children to other than he Ans: A Feedback: A power of attorney is said to be in effect when a patient has identified another patient has the right to change her mind. A power-of-attorney for health care d decisions for the patient nor does it delegate custody of minor children. 18. In the process of planning a patient’s care, the nurse has identified a nursing d to alcohol use. What must precede the determination of this nursing diagnosis 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 patient’s chances of recovery Ans: C Feedback: In the diagnostic phase of the nursing process, the patient’s nursing problems Establishing a plan comes after collecting and analyzing data; evaluating a pla 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 t 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 diagnoses. The physician has recommended an amniocentesis for an 18-year-old primipa 20. and does not want this procedure. The physician is insistent the patient have t amniocentesis to be performed. The nurse should recognize that the physician A) Veracity B) Beneficence C) Nonmaleficence D) Autonomy Ans: D Feedback: The principle of autonomy specifies that individuals have the ability to make a physician’s actions in this case violate this principle. This action may or may n centers on truth-telling and nonmaleficence is avoiding the infliction of harm. 21. During discussion with the patient and the patient’s husband, you discover tha presence of a living will influence the patient’s care? A) The patient is legally unable to refuse basic life support. B) The physician can override the patient’s desires for treatment if des C) The patient may nullify the living will during her hospitalization if she 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 no during illness. A living will does not make a patient legally unable to refuse bas patient’s wishes, but he or she is ethically bound to carry out those wishes. A p will. Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has b 22. with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating 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 Feedback: Nursing diagnoses are actual or potential problems that can be managed by in be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessn such as RA, but challenges with self-care are more likely. Ineffective airway cl 23. You are writing a care plan for an 85-year-old patient who has community-acq sounds to bilateral lung bases on auscultation. What is the most appropriate n 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 approp airway clearance related to copious tracheobronchial secretions.” “Pneumonia Immobility is likely, but is less directly related to the patient’s admitting medical 24. You are providing care for a patient who has a diagnosis of pneumonia attribut the following aspects of nursing care would constitute part of the planning pha A) Achieve SaO2 ³ 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-t certain level of oxygen saturation in a patient with pneumonia. Providing fluids implementation phase of the nursing process. Chest auscultation is an assess 25. You are the nurse who is caring for a patient with a newly diagnosed allergy to goal that is most relevant to a nursing diagnosis of “deficient knowledge relate A) The patient will demonstrate correct injection technique with today’s B) The patient will closely observe the nurse demonstrating the injectio C) The nurse will teach the patient’s family member to administer the i D) The patient will return to the clinic within 2 weeks to demonstrate th Ans: A Feedback: Immediate goals are those that can be reached in a short period of time. An ap patient will demonstrate correct administration of the medication today. The go 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 interdependent. A nurse performs an interdependent nursing intervention whe A) Auscultating a patient’s apical heart rate during an admission asses B) Providing mouth care to a patient who is unconscious following a ce C) Administering an IV bolus of normal saline to a patient with hypoten D) Providing discharge teaching to a postsurgical patient about the rati Ans: C Feedback: Although many nursing actions are independent, others are interdependent, su administering medications and therapies, and collaborating with other health c expected outcomes and to monitor and manage potential complications. Irriga administering IV fluids are interdependent nursing actions and require a physic when the nurse assesses a patient’s heart rate, provides discharge education, 27. A nurse has been using the nursing process as a framework for planning and do during the evaluation phase of the nursing process? A) Have a patient provide input on the quality of care received. B) Remove a patient’s surgical staples on the scheduled postoperative C) Provide information on a follow-up appointment for a postoperative D) Document a patient’s improved air entry with incentive spirometric u Ans: D Feedback: During the evaluation phase of the nursing process, the nurse determines the example of this is when the nurse documents whether the patient’s spirometry does not do the evaluation. Removing staples and providing information on fol evaluations. 28. An audit of a large, university medical center reveals that four patients in the h that restraints are an intervention of last resort, and that it is inappropriate to a A) A postlaryngectomy patient who is attempting to pull out his tracheo B) A patient in hypovolemic shock trying to remove the dressing over h C) A patient with urosepsis who is ringing the call bell incessantly to us D) A patient with depression who has just tried to commit suicide and symptom control Ans: C Feedback: Restraints should never be applied for staff convenience. The patient with uros requesting assistance to the bedside commode; this is appropriate behavior th described situations could plausibly result in patient harm; therefore, it is more instances. A patient has been diagnosed with small-cell lung cancer. He has met with the 29. and benefits of chemotherapy and radiotherapy as his treatment. This patient i his decision? A) Beneficence B) Confidentiality C) Autonomy D) Justice Ans: C Feedback: Autonomy entails the ability to make a choice free from external constraints. B promotion of benevolent acts. Confidentiality relates to the concept of privacy. equitably. A patient with migraines does not know whether she is receiving a placebo for 30. undergoing clinical trials. Upon discussing the patient’s distress, it becomes ev understand the informed consent document that she signed. Which ethical pri 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 et conflict with this principle are the use of placebos (nonactive substances used patient, and revealing a diagnosis to persons other than the patient with the di essential element in the nurse–patient relationship. Sanctity of life is the persp deals with privacy of the patient. Fidelity is promise-keeping and the duty to be 31. The nursing instructor is explaining critical thinking to a class of first-semester skills in these students, the instructor should encourage them to do which of th A) Disregard input from people who do not have to make the particular B) Set aside all prejudices and personal experiences when making de C) Weigh each of the potential negative outcomes in a situation. D) Examine and analyze all available information. Ans: D Feedback: Critical thinking involves reasoning and purposeful, systematic, reflective, ratio knowledge, as well as examination and analysis of all available information an not possible. Critical thinking does not denote a focus on potential negative ou that should not be ignored. 32. A care conference has been organized for a patient with complex medical and of critical thinking to this patient’s care planning, the nurse should most exemp 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 situation. An emphasis on the past, willingness to observe behaviors, and a de not central characteristics of critical thinkers. 33. Achieving adequate pain management for a postoperative patient will require s What are the potential benefits of critical thinking in nursing? Select all that ap A) Enhancing the nurse’s clinical decision making B) Identifying the patient’s individual preferences C) Planning the best nursing actions to assist the patient D) Increasing the accuracy of the nurse’s judgments E) Helping identify the patient’s priority needs Ans: A, C, D, E Feedback: Independent judgments and decisions evolve from a sound knowledge base a context in which it is presented. Critical thinking enhances clinical decision ma nursing actions that will assist patients in meeting those needs. Critical thinkin desires; these would be identified by asking the patient. 34. A nurse is unsure how best to respond to a patient’s vague complaint of “feelin principles of critical thinking, including metacognition. How can the nurse best 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 thi Ans: B Feedback: Critical thinking includes metacognition, the examination of one’s own reasoni skills. Metacognition is not characterized by eliciting input from others or evalu 35. The nursing instructor cites a list of skills that support critical thinking in clinical which of the following domains? Select all that apply. A) Self-esteem B) Self-regulation C) Inference D) Autonomy E) Interpretation Ans: B, C, E Feedback: Skills needed in critical thinking include interpretation, analysis, evaluation, inf esteem and autonomy would not be on the list because they are not skills. The nurse is providing care for a patient with chronic obstructive pulmonary di 36. assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thi have been gathered. What characteristic of critical thinking is used in determin A) Extrapolation B) Inference C) Characterization D) Interpretation Ans: D Feedback: Nurses use interpretation to determine the significance of data that are gather extrapolation, inference, or characterization. A nurse is admitting a new patient to the medical unit. During the initial nursing 37. supplementary open-ended questions while gathering information about the n 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 Feedback: Critical thinkers validate the information presented to make sure that it is accur sense, and that it is based on fact and evidence. The nurse is not interpreting, has given. 38. A nurse uses critical thinking every day when going through the nursing proce thinking in nursing practice? A) A comprehensive plan of care with a high potential for success B) Identification of the nurse’s 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 wit does not identify the nurse’s goal for the patient or provide a collaborative basi not lead to increased cost efficiency; the patient’s outcomes are paramount. 39. A nurse provides care on an orthopedic reconstruction unit and is admitting tw What would be the best explanation why their care plans may be different from A) Patients may have different insurers, or one may qualify for Medica B) Individual patients are seen as unique and dynamic, with individual C) Nursing care may be coordinated by members of two different healt D) Patients are viewed as dissimilar according to their attitude toward Ans: B Feedback: Regardless of the setting, each patient situation is viewed as unique and dyna may be relevant, but these should not fundamentally explain the differences in by nurses, not by members of other disciplines. 40. A class of nursing students is in their first semester of nursing school. The inst undergo while in nursing school is learning to “think like a nurse.” What is the 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 mo 41. Critical thinking and decision-making skills are essential parts of nursing in all thinking in the venue of genetics-related nursing? Select all that apply. A) Notifying individuals and family members of the results of genetic te B) Providing a written report on genetic testing to an insurance compa C) Assessing and analyzing family history data for genetic risk factors D) Identifying individuals and families in need of referral for genetic tes E) Ensuring privacy and confidentiality of genetic information Ans: C, D, E Feedback: Nurses use critical thinking and decision-making skills in providing genetics-rel family history data for genetic risk factors, identify those individuals and familie counseling, and ensure the privacy and confidentiality of genetic information. N nursing do not notify family members of the results of an individual’s genetic te insurance companies concerning the results of genetic testing. A student nurse has been assigned to provide basic care for a 58-year-old ma 42. student tells the instructor that she is unwilling to care for this patient. What ke missing from this student’s 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 bei patient to another in similar circumstances. The other listed options are incorre thinking. 43. A group of students have been challenged to prioritize ethical practice when w 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 mo 44. Your patient has been admitted for a liver biopsy because the physician believ told both you and the physician that if the patient is terminal, the family does n positive for an aggressive form of liver cancer and the patient asks you repeat strategy can you use to give ethical care to this patient? A) Obtain the results of the biopsy and provide them to the patient. B) Tell the patient that only the physician knows the results of the biop C) Promptly communicate the patient’s request for information to the fa D) Tell the patient that the biopsy results are not back yet in order tem Ans: C Feedback: Strategies nurses could consider include the following: not lying to the patient, procedures and diagnoses, and communicating the patient’s requests for infor cannot tell the patient the results of the biopsy and you cannot lie to the patien The nurse admits a patient to an oncology unit that is a site for a study on the 45. patient knows that placebos are going to be used for some participants in the placebo. When is it ethically acceptable to use placebos? A) Whenever the potential benefits of a study are applicable to the larg B) When the patient is unaware of it and it is deemed unlikely that it w C) Whenever the placebo replaces an active drug D) When the patient knows placebos are being used and is involved in Ans: D Feedback: Placebos may be used in experimental research in which a patient is involved placebos are being used in the treatment regimen. Placebos may not ethically when the patient is unaware, or when a placebo replaces an active drug. 46. The nurse caring for a patient who is two days post hip replacement notifies th the edges, warm to the touch, and seeping a white liquid with a foul odor. Wha A) Collaborative problem B) Nursing problem C) Medical problem D) Administrative problem Ans: A Feedback: In addition to nursing diagnoses and their related nursing interventions, nursin interventions that do not fall within the definition of nursing diagnoses. These a complications that are medical in origin and require collaborative interventions care team. The other answers are incorrect because the signs and symptoms interventions by the nurse. 47. While developing the plan of care for a new patient on the unit, the nurse must the new patient. What resource should the nurse prioritize for identifying these A) Community Specific Outcomes Classification (CSO) B) Nursing-Sensitive Outcomes Classification (NOC) C) State Specific Nursing Outcomes Classification (SSNOC) D) Department of Health and Human Services Outcomes Classificatio Ans: B Feedback: Resources for identifying appropriate expected outcomes include the NOC an care agencies for people with specific health problems. The other options are i The nurse has just taken report on a newly admitted patient who is a 15-year-o 48. States. When planning interventions for this patient, the nurse knows the inter that apply. A) Appropriate to the nurse’s preferences B) Appropriate to the patient’s age C) Ethical D) Appropriate to the patient’s culture E) Applicable to others with the same diagnosis Ans: B, C, D Feedback: Planned interventions should be ethical and appropriate to the patient’s culture have to be in alignment with the nurse’s preferences nor do they have to be sh Chapter 4 A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly 1. health problems. Over the past several years Mrs. Griffin has had several adm has often carried out health promotion interventions. Who is ultimately respons health? A) The medical nurse B) The community health nurse who has also worked with Mrs. Griffin C) Mrs. Griffin’s primary care provider D) Mrs. Griffin Ans: D Feedback: American society places a great importance on health and the responsibility th health. Therefore, the other options are incorrect.