@PROFDOCDIGITALLIBRARIES
TEST BANK
Brunner & Suddarth's Textbook of Medical-Surgical Nursing
Janice L. Hinkle & Kerry H. Cheever
13th Edition
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O
FD
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C
,@PROFDOCDIGITALLIBRARIES
Table of Contents
Chapter 01 Health Care Delivery and Evidence-Based Nursing Practice 2
Chapter 02 Community-Based Nursing Practice 13
Chapter 03 Critical Thinking, Ethical Decision Making, and the Nursing Process 24
Chapter 04 Health Education and Health Promotion 37
Chapter 05 Adult Health and Nutritional Assessment 48
Chapter 06 Individual and Family Homeostasis, Stress, and Adaptation 60
Chapter 07 Overview of Transcultural Nursing 72
Chapter 08 Overview of Genetics and Genomics in Nursing 84
Chapter 09 Chronic Ilness and Disability 96
Chapter 10 Principles and Practices of Rehabilitation 108
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Chapter 11 Health Care of the Older Adult 119
Chapter 12 Pain Management 131
Chapter 13 Fluid and Electrolytes-Balance and Disturbance 143
Chapter 14 Shock and Multiple Organ Dysfunction Syndrome 155
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Chapter 15 Oncology Nursing Management in Cancer Care 167
Chapter 16 End-of-Life Care 178
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Chapter 17 Preoperative Nursing Management 189
Chapter 18 Intraoperative Nursing Management 201
Chapter 19 Postoperative Nursing Management 212
Chapter 20 Assessment of Respitory Function 224
Chapter 21 Respiratory Care Modalities 235
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Chapter 22 Management of Patients With Upper Respiratory Tract Disorders 246
Chapter 23 Management of Patients With Chest and Lower Respiratory Tract Disorders 256
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Chapter 24 Management of Patients With Chronic Pulmonary Disease 267
Chapter 25 Assessment of Cardiovascular Function 277
Chapter 26 Management of Patients Dysrhythmias and Conduction Problems 287
Chapter 27 Management of Patients With Coronary Vascular Disorders 297
Chapter 28 Management of Patients With Structural, Infectious, and Inflamatory Cardiac
Disorders 308
Chapter 29 Management of Patients With Complication from Heart Disease 319
Chapter 30 Assessment and Management of Patients With Vascular Disorders and Problems
of Peripheral Circulation 329
Chapter 31 Assessment and Management of Patients With Hypertension 340
Chapter 32 Assessment of Hematologic Function and Treatment Modalities 351
Chapter 33 Management of Patients With Nonmalignant Hermatologic Disorders 361
Chapter 34 Management of Patients With Hematologic Neoplasms 371
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Chapter 35 Assessment of Immune Function 381
Chapter 36 Management of Patients With Immunodeficiency Disorders 391
Chapter 37 Management of Patients With HIV Infection and AIDS 401
Chapter 38 Assessment and Management of Patients With Allergic Disorders 411
Chapter 39 Assessment and Management of Patients With Rheumatic Disorders 421
Chapter 40 Assessment of Musculoskeletal Function 432
Chapter 41 Musculoskeletal Care Modalities 442
Chapter 42 Management of Patients With Musculoskeletal Disorders 452
Chapter 43 Management of Patients With Musculoskeletal Trauma 462
Chapter 44 Assessment of Digestive and Gastrointestinal Function 473
Chapter 45 Digestive and Gastrointestinal Treatment Modalities 483
Chapter 46 Management of Patients With Oral and Esophageal Disorders 493
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Chapter 47 Management of Patients With Gastric and Duodenal Disorders 504
Chapter 48 Management of Patients With Intestinal and Rectal Disorders 515
Chapter 49 Assessment and Management of Patients With Hepatic Disorders 525
Chapter 50 Assessment and Management of Patients With Biliary Disorders 536
Chapter 51 Assessment and Management of Patients With Diabetes 547
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Chapter 52 Assessment and Management of Patients With Endocrine Disorders 558
Chapter 53 Assessment of Kidney and Urinary Function 568
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Chapter 54 Management of Patients With Kidney Disorders 579
Chapter 55 Management of Patients With Urinary Disorders 590
Chapter 56 Assessment and Management of Female Phsyiologic Processes 601
Chapter 57 Management of Patients With Female Reproductive Disorders 611
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Chapter 58 Assesment and Management of Patients With Breast Disorders 622
Chapter 59 Assessment and Management of Problems Related to Male Reproductive
Processes 633
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Chapter 60 Assessment of Integumentary Function 644
Chapter 61 Management of Patients With Dermatologic Problems 654
Chapter 62 Management of Patients With Burn Injury 664
Chapter 63 Assessment and Management of Patients With Eye and Vision Disorders 675
Chapter 64 Assessment and Management of Patients With Hearing and Balance Disorders 686
Chapter 65 Assessment of Neurologic Function 696
Chapter 66 Management of Patients With Neurologic Dysfunction 706
Chapter 67 Management of Patients With Cerebrovascular Disorders 716
Chapter 68 Management of Patients With Neurologic Trauma 727
Chapter 69 Management of Patients With Neurologic Infections, Autoimmune Disorders, and
Neuropathies 737
Chapter 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders 747
,@PROFDOCDIGITALLIBRARIES
Chapter 71 Management of Patients With Infectious Diseases 757
Chapter 72 Emergency Nursing 767
Chapter 73 Terrorism, Mass Casualty, and Disaster Nursing 777
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,@PROFDOCDIGITALLIBRARIES
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition
MULTIPLE CHOICE
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
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
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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
O
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
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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?
A) Adequate prenatal care
O
B) Government advocacy and lobbying
C) Judicious use of online communities
D) Management of illness
C
ANS: D
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 patient's return to work after
surgery and the development of postsurgical complications. The nurse is preparing a plan of care that
addresses the patient's multifaceted needs. To which level of Maslow's hierarchy of basic needs does
the patient's need for self- fulfillment relate?
A) Physiologic
B) Transcendence
C) Love and belonging
D) Self-actualization
ANS: D
,@PROFDOCDIGITALLIBRARIES
Maslow's 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 person's state of health is ever-changing.
C) A person can transition from health to illness rapidly.
D) Care should focus on the patient's compliance with interventions.
ANS: B
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 person's 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
PR
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.
O
ANS: D
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
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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 hospital's quality committee.
When describing quality improvement programs to nursing colleagues and members of other health
disciplines, what characteristic should the nurse cite?
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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.
C
D) These programs seek to justify health care costs and systems.
ANS: B
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
,@PROFDOCDIGITALLIBRARIES
ANS: C
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 physician's orders
C) Obtaining a baseline set of vital signs
D) Allowing the family to be with the patient
ANS: A
Among the nurse's important functions in health care delivery, identifying the patient's 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?
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A) Helping the patient to achieve specific outcomes
B) Balancing risks and benefits of interventions
C) Documenting the patient's response to therapy
D) Staying accountable to the interdisciplinary team
ANS: A
O
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.
FD
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
O
C) Critiquing the quality of patient care
D) Explaining medical studies to patients and RNs
C
ANS: B
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 today's health care environment is home health care. What is the main basis
for 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
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.
,@PROFDOCDIGITALLIBRARIES
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 nurse's title?
A) Nursing care expert
B) Clinical nurse specialist
C) Nurse manager
D) Staff nurse
ANS: B
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.
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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
The collaborative model, or a variation of it, promotes shared participation, responsibility, and
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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.
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15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslow's 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
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D) Emotional
ANS: C
C
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 patient's 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 patient's care with consideration of Maslow's hierarchy of needs. Within
this framework of understanding, what would be the nurse's first priority?
A) Allowing the family to see a newly admitted patient
B) Ambulating the patient in the hallway
C) Administering pain medication
D) Teaching the patient to self-administer insulin safely
ANS: C
,@PROFDOCDIGITALLIBRARIES
In Maslow's hierarchy of needs, pain relief addresses the patient's 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 nurse's compliance with the nurse practice act demonstrates adherence to which of
the following?
A) National Council of Nursing's guidelines for care
B) National League for Nursing's Code of Conduct
C) American Nurses Association's Social Policy Statement
D) Department of Health and Human Service's White Paper on Nursing
ANS: C
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
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nursing is not included in the ANA's 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)?
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A) The increased need for primary care providers
B) The need to improve patient diagnostic services
C) The push to drive institutional excellence
FD
D) The need to decrease the number of medical errors
ANS: A
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
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role for CNPs.
19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for
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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 patient's preferences into the plan of care
D) By documenting care in the electronic health record in a timely fashion
ANS: B
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
, @PROFDOCDIGITALLIBRARIES
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
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 nurse's 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
In response to current priorities, health care must focus more on management of chronic conditions
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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
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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
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C) Rehabilitation from traumatic brain injuries
D) Management of acute Staphylococcus aureus infections
ANS: A
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.
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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 nurse's actions best
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demonstrates these priorities?
A) Encouraging the patient's dependence on caregivers
B) Fostering the patient's ability to make choices
C) Teaching the patient about nurses' roles in the health care system
D) Assessing the patient's adherence to treatment
ANS: B
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 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
TEST BANK
Brunner & Suddarth's Textbook of Medical-Surgical Nursing
Janice L. Hinkle & Kerry H. Cheever
13th Edition
PR
O
FD
O
C
,@PROFDOCDIGITALLIBRARIES
Table of Contents
Chapter 01 Health Care Delivery and Evidence-Based Nursing Practice 2
Chapter 02 Community-Based Nursing Practice 13
Chapter 03 Critical Thinking, Ethical Decision Making, and the Nursing Process 24
Chapter 04 Health Education and Health Promotion 37
Chapter 05 Adult Health and Nutritional Assessment 48
Chapter 06 Individual and Family Homeostasis, Stress, and Adaptation 60
Chapter 07 Overview of Transcultural Nursing 72
Chapter 08 Overview of Genetics and Genomics in Nursing 84
Chapter 09 Chronic Ilness and Disability 96
Chapter 10 Principles and Practices of Rehabilitation 108
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Chapter 11 Health Care of the Older Adult 119
Chapter 12 Pain Management 131
Chapter 13 Fluid and Electrolytes-Balance and Disturbance 143
Chapter 14 Shock and Multiple Organ Dysfunction Syndrome 155
O
Chapter 15 Oncology Nursing Management in Cancer Care 167
Chapter 16 End-of-Life Care 178
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Chapter 17 Preoperative Nursing Management 189
Chapter 18 Intraoperative Nursing Management 201
Chapter 19 Postoperative Nursing Management 212
Chapter 20 Assessment of Respitory Function 224
Chapter 21 Respiratory Care Modalities 235
O
Chapter 22 Management of Patients With Upper Respiratory Tract Disorders 246
Chapter 23 Management of Patients With Chest and Lower Respiratory Tract Disorders 256
C
Chapter 24 Management of Patients With Chronic Pulmonary Disease 267
Chapter 25 Assessment of Cardiovascular Function 277
Chapter 26 Management of Patients Dysrhythmias and Conduction Problems 287
Chapter 27 Management of Patients With Coronary Vascular Disorders 297
Chapter 28 Management of Patients With Structural, Infectious, and Inflamatory Cardiac
Disorders 308
Chapter 29 Management of Patients With Complication from Heart Disease 319
Chapter 30 Assessment and Management of Patients With Vascular Disorders and Problems
of Peripheral Circulation 329
Chapter 31 Assessment and Management of Patients With Hypertension 340
Chapter 32 Assessment of Hematologic Function and Treatment Modalities 351
Chapter 33 Management of Patients With Nonmalignant Hermatologic Disorders 361
Chapter 34 Management of Patients With Hematologic Neoplasms 371
,@PROFDOCDIGITALLIBRARIES
Chapter 35 Assessment of Immune Function 381
Chapter 36 Management of Patients With Immunodeficiency Disorders 391
Chapter 37 Management of Patients With HIV Infection and AIDS 401
Chapter 38 Assessment and Management of Patients With Allergic Disorders 411
Chapter 39 Assessment and Management of Patients With Rheumatic Disorders 421
Chapter 40 Assessment of Musculoskeletal Function 432
Chapter 41 Musculoskeletal Care Modalities 442
Chapter 42 Management of Patients With Musculoskeletal Disorders 452
Chapter 43 Management of Patients With Musculoskeletal Trauma 462
Chapter 44 Assessment of Digestive and Gastrointestinal Function 473
Chapter 45 Digestive and Gastrointestinal Treatment Modalities 483
Chapter 46 Management of Patients With Oral and Esophageal Disorders 493
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Chapter 47 Management of Patients With Gastric and Duodenal Disorders 504
Chapter 48 Management of Patients With Intestinal and Rectal Disorders 515
Chapter 49 Assessment and Management of Patients With Hepatic Disorders 525
Chapter 50 Assessment and Management of Patients With Biliary Disorders 536
Chapter 51 Assessment and Management of Patients With Diabetes 547
O
Chapter 52 Assessment and Management of Patients With Endocrine Disorders 558
Chapter 53 Assessment of Kidney and Urinary Function 568
FD
Chapter 54 Management of Patients With Kidney Disorders 579
Chapter 55 Management of Patients With Urinary Disorders 590
Chapter 56 Assessment and Management of Female Phsyiologic Processes 601
Chapter 57 Management of Patients With Female Reproductive Disorders 611
O
Chapter 58 Assesment and Management of Patients With Breast Disorders 622
Chapter 59 Assessment and Management of Problems Related to Male Reproductive
Processes 633
C
Chapter 60 Assessment of Integumentary Function 644
Chapter 61 Management of Patients With Dermatologic Problems 654
Chapter 62 Management of Patients With Burn Injury 664
Chapter 63 Assessment and Management of Patients With Eye and Vision Disorders 675
Chapter 64 Assessment and Management of Patients With Hearing and Balance Disorders 686
Chapter 65 Assessment of Neurologic Function 696
Chapter 66 Management of Patients With Neurologic Dysfunction 706
Chapter 67 Management of Patients With Cerebrovascular Disorders 716
Chapter 68 Management of Patients With Neurologic Trauma 727
Chapter 69 Management of Patients With Neurologic Infections, Autoimmune Disorders, and
Neuropathies 737
Chapter 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders 747
,@PROFDOCDIGITALLIBRARIES
Chapter 71 Management of Patients With Infectious Diseases 757
Chapter 72 Emergency Nursing 767
Chapter 73 Terrorism, Mass Casualty, and Disaster Nursing 777
PR
O
FD
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,@PROFDOCDIGITALLIBRARIES
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition
MULTIPLE CHOICE
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
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
PR
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
O
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
FD
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?
A) Adequate prenatal care
O
B) Government advocacy and lobbying
C) Judicious use of online communities
D) Management of illness
C
ANS: D
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 patient's return to work after
surgery and the development of postsurgical complications. The nurse is preparing a plan of care that
addresses the patient's multifaceted needs. To which level of Maslow's hierarchy of basic needs does
the patient's need for self- fulfillment relate?
A) Physiologic
B) Transcendence
C) Love and belonging
D) Self-actualization
ANS: D
,@PROFDOCDIGITALLIBRARIES
Maslow's 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 person's state of health is ever-changing.
C) A person can transition from health to illness rapidly.
D) Care should focus on the patient's compliance with interventions.
ANS: B
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 person's 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
PR
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.
O
ANS: D
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
FD
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 hospital's quality committee.
When describing quality improvement programs to nursing colleagues and members of other health
disciplines, what characteristic should the nurse cite?
O
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.
C
D) These programs seek to justify health care costs and systems.
ANS: B
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
,@PROFDOCDIGITALLIBRARIES
ANS: C
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 physician's orders
C) Obtaining a baseline set of vital signs
D) Allowing the family to be with the patient
ANS: A
Among the nurse's important functions in health care delivery, identifying the patient's 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?
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A) Helping the patient to achieve specific outcomes
B) Balancing risks and benefits of interventions
C) Documenting the patient's response to therapy
D) Staying accountable to the interdisciplinary team
ANS: A
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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.
FD
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
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C) Critiquing the quality of patient care
D) Explaining medical studies to patients and RNs
C
ANS: B
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 today's health care environment is home health care. What is the main basis
for 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
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.
,@PROFDOCDIGITALLIBRARIES
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 nurse's title?
A) Nursing care expert
B) Clinical nurse specialist
C) Nurse manager
D) Staff nurse
ANS: B
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.
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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
The collaborative model, or a variation of it, promotes shared participation, responsibility, and
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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.
FD
15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslow's 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
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D) Emotional
ANS: C
C
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 patient's 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 patient's care with consideration of Maslow's hierarchy of needs. Within
this framework of understanding, what would be the nurse's first priority?
A) Allowing the family to see a newly admitted patient
B) Ambulating the patient in the hallway
C) Administering pain medication
D) Teaching the patient to self-administer insulin safely
ANS: C
,@PROFDOCDIGITALLIBRARIES
In Maslow's hierarchy of needs, pain relief addresses the patient's 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 nurse's compliance with the nurse practice act demonstrates adherence to which of
the following?
A) National Council of Nursing's guidelines for care
B) National League for Nursing's Code of Conduct
C) American Nurses Association's Social Policy Statement
D) Department of Health and Human Service's White Paper on Nursing
ANS: C
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
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nursing is not included in the ANA's 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)?
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A) The increased need for primary care providers
B) The need to improve patient diagnostic services
C) The push to drive institutional excellence
FD
D) The need to decrease the number of medical errors
ANS: A
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
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role for CNPs.
19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for
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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 patient's preferences into the plan of care
D) By documenting care in the electronic health record in a timely fashion
ANS: B
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
, @PROFDOCDIGITALLIBRARIES
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
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 nurse's 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
In response to current priorities, health care must focus more on management of chronic conditions
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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
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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
FD
C) Rehabilitation from traumatic brain injuries
D) Management of acute Staphylococcus aureus infections
ANS: A
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.
O
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 nurse's actions best
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demonstrates these priorities?
A) Encouraging the patient's dependence on caregivers
B) Fostering the patient's ability to make choices
C) Teaching the patient about nurses' roles in the health care system
D) Assessing the patient's adherence to treatment
ANS: B
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 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
