TEST BANK FOR PRIMARY CARE ART AND SCIENCE OF ADVANCED PRACTICE NURSING – AN
INTERPROFESSIONAL APPROACH 6TH EDITION DUNPHY ALL CHAPTERS-2023-2024
,CONTENTS
CHAPTER 1. PRIMARY CARE IN THE TWENTY-FIRST CENTURY: A CIRCLE OF CARING ............. 4
CHAPTER 2. CARING AND THE ADVANCED PRACTICE NURSE.............................................. 11
CHAPTER 3. HEALTH PROMOTION .................................................................................... 17
CHAPTER 4. THE ART OF DIAGNOSIS AND TREATMENT ...................................................... 19
CHAPTER 5. EVIDENCE-BASED CARE .................................................................................. 29
CHAPTER 6. COMMON NEUROLOGICAL COMPLAINTS ....................................................... 32
CHAPTER 7. SEIZURE DISORDERS ...................................................................................... 40
CHAPTER 9. CEREBROVASCULAR ACCIDENT (STROKE) ....................................................... 51
CHAPTER 10. INFECTIOUS AND INFLAMMATORY NEUROLOGICAL DISORDERS ................... 61
CHAPTER 11.COMMON SKIN COMPLAINTS ....................................................................... 62
CHAPTER 12. PARASITIC SKIN INFESTATIONS..................................................................... 70
CHAPTER 13. FUNGAL SKIN INFECTIONS............................................................................ 71
CHAPTER 14. BACTERIAL SKIN INFECTIONS........................................................................ 73
CHAPTER 15. VIRAL SKIN INFECTIONS ............................................................................... 75
CHAPTER 16. DERMATITIS ................................................................................................ 76
CHAPTER 17. SKIN LESIONS ............................................................................................... 78
CHAPTER 18. COMMON EYE COMPLAINTS ........................................................................ 81
CHAPTER 19. LID AND CONJUNCTIVAL PATHOLOGY .......................................................... 88
CHAPTER 20. VISUAL DISTURBANCES AND IMPAIRED VISION ........................................... 101
CHAPTER 21. COMMON EAR, NOSE, AND THROAT COMPLAINTS ...................................... 103
CHAPTER 22. HEARING AND BALANCE DISORDERS ........................................................... 110
CHAPTER 23. INFLAMMATORY AND INFECTIOUS DISORDERS OF THE EAR ........................ 117
CHAPTER 24. INFLAMMATORY AND INFECTIOUS DISORDERS OF THE NOSE, SINUSES, MOUTH,
AND THROAT
....................................................................................................................................... 132
CHAPTER 25. EPISTAXIS ................................................................................................... 138
CHAPTER 26. TEMPOROMANDIBULAR DISORDERS ........................................................... 139
CHAPTER 27. DYSPHONIA ................................................................................................ 141
CHAPTER 28. COMMON RESPIRATORY COMPLAINTS ....................................................... 142
CHAPTER 29. SLEEP APNOEA............................................................................................ 150
,CHAPTER 30. INFECTIOUS RESPIRATORY DISORDERS ........................................................ 151
CHAPTER 31. INFLAMMATORY RESPIRATORY DISORDERS ................................................ 158
CHAPTER 32. LUNG CANCER ............................................................................................ 162
CHAPTER 33. SMOKING ADDICTION ................................................................................. 164
CHAPTER 34. COMMON CARDIOVASCULAR COMPLAINTS ................................................ 164
CHAPTER 35. CARDIAC AND ASSOCIATED RISK DISORDERS............................................... 172
CHAPTER 36. DYSRHYTHMIAS AND VALVULAR DISORDERS .............................................. 179
CHAPTER 37. DISORDERS OF THE VASCULAR SYSTEM ....................................................... 186
CHAPTER 38. COMMON ABDOMINAL COMPLAINTS ......................................................... 198
CHAPTER 39. INFECTIOUS GASTROINTESTINAL DISORDERS .............................................. 205
CHAPTER 40. GASTRIC AND INTESTINAL DISORDERS ........................................................ 212
CHAPTER 41. GALLBLADDER AND PANCREATIC DISORDERS .............................................. 219
CHAPTER 42. CIRRHOSIS AND LIVER FAILURE ................................................................... 225
CHAPTER 43. COMMON URINARY COMPLAINTS .............................................................. 230
CHAPTER 44. URINARY TRACT DISORDERS ....................................................................... 235
CHAPTER 45. KIDNEY AND BLADDER DISORDERS.............................................................. 243
CHAPTER 46. COMMON REPRODUCTIVE SYSTEM COMPLAINTS........................................ 250
CHAPTER 47. BREAST DISORDERS .................................................................................... 257
CHAPTER 48. VAGINAL, UTERINE, AND OVARIAN DISORDERS ........................................... 263
CHAPTER 49. PROSTATE DISORDERS ................................................................................ 270
CHAPTER 50. PENILE AND TESTICULAR DISORDERS........................................................... 276
CHAPTER 51. SEXUALLY TRANSMITTED INFECTIONS ......................................................... 283
CHAPTER 52. COMMON MUSCULOSKELETAL COMPLAINTS .............................................. 302
CHAPTER 53. SPINAL DISORDERS ..................................................................................... 311
CHAPTER 54. SOFT-TISSUE DISORDERS ............................................................................. 313
CHAPTER 55. OSTEOARTHRITIS AND OSTEOPOROSIS........................................................ 339
CHAPTER 56.COMMON ENDOCRINE/METABOLIC COMPLAINTS ....................................... 343
CHAPTER 57. GLANDULAR DISORDERS ............................................................................. 351
CHAPTER 58. DIABETES MELLITUS .................................................................................... 357
CHAPTER 59. METABOLIC DISORDERS .............................................................................. 362
CHAPTER 60. COMMON HEMATOLOGIC AND IMMUNOLOGICAL PROBLEMS .................... 373
,CHAPTER 61. HEMATOLOGIC DISORDERS ......................................................................... 381
CHAPTER 62. IMMUNOLOGICAL DISORDERS ................................................................... 396
CHAPTER 63. INFECTIOUS DISORDERS ............................................................................. 406
CHAPTER 64. COMMON PSYCHOSOCIAL COMPLAINTS .................................................... 415
CHAPTER 65. SUBSTANCE USE DISORDERS ...................................................................... 422
CHAPTER 66. SCHIZOPHRENIA SPECTRUM DISORDERS .................................................... 433
CHAPTER 67. MOOD DISORDERS..................................................................................... 444
CHAPTER 68. ANXIETY, STRESS, AND TRAUMA-RELATED DISORDERS ............................... 449
CHAPTER 69. OBSESSIVE-COMPULSIVE DISORDERS ......................................................... 456
CHAPTER 70. BEHAVIOURAL DISORDERS RELATED TO PHYSICAL/PHYSIOLOGICAL
DISTURBANCES............................................................................................................... 459
CHAPTER 71. NEURODEVELOPMENTAL DISORDERS ......................................................... 468
CHAPTER 72. COMMON URGENT CARE COMPLAINTS ...................................................... 480
CHAPTER 73. COMMON INJURIES ................................................................................... 488
CHAPTER 74. TOXIC EXPOSURES ..................................................................................... 496
CHAPTER 75. ENVIRONMENTAL EXPOSURES ................................................................... 500
CHAPTER 76. SPORTS PHYSICALS .................................................................................... 507
CHAPTER 77. PRIMARY CARE OF OLDER ADULTS ............................................................. 519
CHAPTER 78. PALLIATIVE CARE AND PAIN MANAGEMENT............................................... 528
CHAPTER 79. ETHICAL AND LEGAL ISSUES OF A CARING-BASED PRACTICE ....................... 533
CHAPTER 80. THE BUSINESS OF ADVANCED PRACTICE NURSING ..................................... 538
CHAPTER 81. THE 15-MINUTE HOUR: PRACTICAL APPROACHES TO BEHAVIOURAL HEALTH
FOR PRIMARY CARE........................................................................................................ 542
CHAPTER 82. PUTTING CARING INTO PRACTICE: CARING FOR SELF .................................. 546
,CHAPTER 1. PRIMARY CARE IN THE TWENTY-FIRST CENTURY: A CIRCLE OF CARING
1. A NURSE HAS CONDUCTED A LITERATURE REVIEW IN AN EFFORT TO IDENTIFY THE EFFECT OF
HANDWASHING ON THE INCIDENCE OF NOSOCOMIAL (HOSPITAL-ACQUIRED) INFECTIONS IN ACUTE
CARE SETTINGS. AN ARTICLE PRESENTED FINDINGS AT A LEVEL OF SIGNIFICANCE OF <0.01. THIS
INDICATES THAT
A) THE CONTROL GROUP AND THE EXPERIMENTAL GROUP WERE MORE THAN 99% SIMILAR.
B) THE FINDINGS OF THE STUDY HAVE LESS THAN 1% CHANCE OF BEING ATTRIBUTABLE TO CHANCE.
,THE EFFECTS OF THE INTERVENTION WERE NEARLY ZERO.
C) THE CLINICAL SIGNIFICANCE OF THE FINDINGS WAS LESS THAN 1:100.
ANS:B
FEEDBACK: THE LEVEL OF SIGNIFICANCE IS THE LEVEL AT WHICH THE RESEARCHER BELIEVES THAT THE
STUDY RESULTS MOST LIKELY REPRESENT A NONCHANCE EVENT. A LEVEL OF SIGNIFICANCE OF <0.01
INDICATES THAT THERE IS LESS THAN 1% PROBABILITY THAT THE RESULT IS DUE TO CHANCE.
2. A NURSE HAS READ A QUALITATIVE RESEARCH STUDY IN ORDER TO UNDERSTAND THE LIVED
EXPERIENCE OF PARENTS WHO HAVE A NEONATAL LOSS. WHICH OF THE FOLLOWING QUESTIONS
SHOULD THE NURSE PRIORITIZE WHEN APPRAISING THE RESULTS OF THIS STUDY?
A) HOW WELL DID THE AUTHORS CAPTURE THE PERSONAL EXPERIENCES OF THESE PARENTS?
B) HOW WELL DID THE AUTHORS CONTROL FOR CONFOUNDING VARIABLES THAT MAY HAVE AFFECTED THE
FINDINGS?
C) DID THE AUTHORS USE STATISTICAL MEASURES THAT WERE APPROPRIATE TO THE PHENOMENON IN
QUESTION?
D) WERE THE INSTRUMENTS THAT THE RESEARCHERS USED STATISTICALLY VALID AND RELIABLE?
ANS:A
FEEDBACK: QUALITATIVE STUDIES ARE JUDGED ON THE BASIS OF HOW WELL THEY CAPTURE AND
CONVEY THE SUBJECTIVE EXPERIENCES OF INDIVIDUALS. STATISTICAL MEASURES AND VARIABLES ARE
NOT DIMENSIONS OF A QUALITATIVE METHODOLOGY.
3. A NURSE HAS EXPRESSED SKEPTICISM TO A COLLEAGUE ABOUT THE VALUE OF NURSING
RESEARCH, CLAIMING THAT NURSING RESEARCH HAS LITTLE RELEVANCE TO PRACTICE. HOW CAN
THE NURSES COLLEAGUE BEST DEFEND THE IMPORTANCE OF NURSING RESEARCH?
A) THE EXISTENCE OF NURSING RESEARCH MEANS THAT NURSES ARE NOW ABLE TO ACCESS
FEDERAL GRANT MONEY, SOMETHING THAT DIDNT USE TO BE THE CASE.
B) NURSING RESEARCH HAS ALLOWED THE DEVELOPMENT OF MASTERS AND DOCTORAL
PROGRAMS AND HAS GREATLY INCREASED THE CREDIBILITY OF THE PROFESSION.
C) THE GROWTH OF NURSING RESEARCH HAS CAUSED NURSING TO BE VIEWED AS A TRUE
PROFESSION, RATHER THAN SIMPLY AS A TRADE OR A SKILL.
D) THE APPLICATION OF NURSING RESEARCH HAS THE POTENTIAL TO IMPROVE NURSING
PRACTICE AND PATIENT OUTCOMES.
ANS:D
,FEEDBACK: THE GREATEST VALUE OF NURSING RESEARCH LIES IN THE POTENTIAL TO IMPROVE
PRACTICE AND, ULTIMATELY, TO IMPROVE PATIENT OUTCOMES. THIS SUPERSEDES THE
CONTRIBUTIONS OF NURSING RESEARCH TO EDUCATION PROGRAMS, GRANT FUNDING, OR THE
PUBLIC VIEW OF THE PROFESSION.
4. TRACY IS A NURSE WITH A BACCALAUREATE DEGREE WHO WORKS IN THE LABOR AND DELIVERY
UNIT OF A BUSY URBAN HOSPITAL. SHE HAS NOTICED THAT MANY NEW MOTHERS ABANDON
BREAST-FEEDING THEIR BABIES WHEN THEY EXPERIENCE EARLY CHALLENGES AND WONDERS
WHAT COULD BE DONE TO ENCOURAGE MORE WOMEN TO CONTINUE BREAST-FEEDING. WHAT
ROLE IS TRACY MOST LIKELY TO PLAY IN A RESEARCH PROJECT THAT TESTS AN INTERVENTION
AIMED AT PROMOTING BREAST-FEEDING?
A) APPLYING FOR GRANT FUNDING FOR THE RESEARCH PROJECT
B) POSING THE CLINICAL PROBLEM TO ONE OR MORE NURSING RESEARCHERS
C) PLANNING THE METHODOLOGY OF THE RESEARCH PROJECT
D) CARRYING OUT THE INTERVENTION AND SUBMITTING THE RESULTS FOR PUBLICATION
ANS:B
FEEDBACK: A MAJOR ROLE FOR STAFF NURSES IS TO IDENTIFY QUESTIONS OR PROBLEMS FOR
RESEARCH. GRANT APPLICATIONS, METHODOLOGICAL PLANNING, AND PUBLICATION
SUBMISSION ARE NORMALLY CARRIED OUT BY NURSES WHO HAVE ADVANCED DEGREES IN
NURSING.
5. A PATIENT SIGNED THE INFORMED CONSENT FORM FOR A DRUG TRIAL THAT WAS EXPLAINED
TO PATIENT BY A RESEARCH ASSISTANT. LATER, THE PATIENT ADMITTED TO HIS NURSE THAT HE
DID NOT UNDERSTAND THE RESEARCH ASSISTANTS EXPLANATION OR HIS OWN ROLE IN THE
STUDY. HOW SHOULD THIS PATIENTS NURSE RESPOND TO THIS REVELATION?
A) EXPLAIN THE RESEARCH PROCESS TO THE PATIENT IN GREATER DETAIL.
B) DESCRIBE THE DETAILS OF A RANDOMIZED CONTROLLED TRIAL FOR THE PATIENT.
C) INFORM THE RESEARCH ASSISTANT THAT THE PATIENTS CONSENT IS LIKELY INVALID.
D) EXPLAIN TO THE PATIENT THAT HIS WRITTEN CONSENT IS NOW LEGALLY BINDING.
ANS:C
FEEDBACK: JUST AS THE STAFF NURSE IS NOT RESPONSIBLE FOR MEDICAL CONSENT, THE STAFF NURSE IS
NOT RESPONSIBLE FOR RESEARCH CONSENT. IF PATIENTS WHO HAVE AGREED TO PARTICIPATE EXHIBIT
AMBIVALENCE OR UNCERTAINTY ABOUT PARTICIPATING, DO NOT TRY TO CONVINCE THEM TO
PARTICIPATE. ASK THE PERSON FROM THE RESEARCH TEAM WHO IS MANAGING CONSENTS TO SPEAK WITH
CONCERNED PATIENTS ABOUT THE STUDY, EVEN AFTER
,A PATIENT HAS SIGNED THE CONSENT
FORMS. MULTIPLE SELECTION
6. A NURSE LEADER IS ATTEMPTING TO INCREASE THE AWARENESS OF EVIDENCE-BASED PRACTICE
(EBP) AMONG THE NURSES ON A UNIT. A NURSE WHO IS IMPLEMENTING EBP INTEGRATES WHICH
OF THE FOLLOWING? (SELECT ALL THAT APPLY.)
A) INTERDISCIPLINARY CONSENSUS
B) NURSING TRADITION
C) RESEARCH STUDIES
D) PATIENT PREFERENCES AND VALUES
E) CLINICAL EXPERTISE
ANS:C, D, E
FEEDBACK: FINEOUT-OVERHOLT, MELNYK, STILLWELL, AND WILLIAMSON DEFINE EBP AS A PROBLEM-
SOLVING APPROACH TO THE DELIVERY OF HEALTHCARE THAT INTEGRATES THE BEST EVIDENCE FROM
STUDIES AND PATIENT CARE DATA WITH CLINICIAN EXPERTISE AND PATIENT PREFERENCES AND
VALUES.
MULTIPLE CHOICE
7. MRS. MAYES IS A 73-YEAR-OLD WOMAN WHO HAS A DIABETIC FOOT ULCER THAT HAS BEEN
EXTREMELY SLOW TO HEAL AND WHICH NOW POSES A THREAT OF OSTEOMYELITIS. THE WOUND
CARE NURSE WHO HAS BEEN WORKING WITH MRS. MAYES APPLIES EVIDENCE-BASED PRACTICE (EBP)
WHENEVER POSSIBLE AND HAS PROPOSED THE USE OF MAGGOT THERAPY TO DEBRIDE NECROTIC
TISSUE. MRS. MAYES, HOWEVER, FINDS THE SUGGESTION REPUGNANT AND ADAMANTLY OPPOSES
THIS TREATMENT DESPITE THE SIZABLE BODY OF EVIDENCE SUPPORTING IT. HOW SHOULD THE
NURSE RECONCILE MRS. MAYES VIEWS WITH THE PRINCIPLES OF EBP?
A) THE NURSE SHOULD EXPLAIN THAT RELIABLE AND VALID RESEARCH EVIDENCE OVERRIDES THE PATIENTS
OPINION.
B) THE NURSE SHOULD EXPLAIN THE EVIDENCE TO THE PATIENT IN GREATER DETAIL.
C) THE NURSE SHOULD INTEGRATE THE PATIENTS PREFERENCES INTO THE PLAN OF CARE.
D) THE NURSE SHOULD INVOLVE THE PATIENTS FAMILY MEMBERS IN THE DECISION-MAKING PROCESS.
ANS:C
FEEDBACK: PATIENT PREFERENCES SHOULD BE INTEGRATED INTO EBP AND CONSIDERED ALONGSIDE
RESEARCH EVIDENCE AND THE NURSES CLINICAL EXPERTISE; EVIDENCE DOES NOT TRUMP THE PATIENTS
PREFERENCES. THE FAMILY SHOULD BE INVOLVED, BUT THIS IS NOT AN EXPLICIT DIMENSION OF EBP.
SIMILARLY, EXPLAINING THE
, EVIDENCE IN MORE DETAIL IS NOT A DEMONSTRATION OF EBP.
8. THE ADMINISTRATORS OF A LONG-TERM CARE FACILITY ARE CONSIDERED THE USE OF SPECIALIZED,
PRESSUREREDUCING MATTRESSES IN ORDER TO REDUCE THE INCIDENCE OF PRESSURE ULCERS AMONG
RESIDENTS. THEY HAVE
SOUGHT INPUT FROM THE NURSES ON THE UNIT, ALL OF WHOM ARE AWARE OF THE NEED TO
IMPLEMENT THE PRINCIPLES OF EVIDENCE-BASED PRACTICE (EBP) IN THIS DECISION. WHICH OF
THE FOLLOWING EVIDENCE SOURCES SHOULD THE NURSES PRIORITIZE?
A) A QUALITATIVE STUDY THAT EXPLORES THE EXPERIENCE OF LIVING WITH A PRESSURE ULCER
B) A CASE STUDY THAT DESCRIBES THE MEASURES THAT NURSES ON A GERIATRIC UNIT TOOK TO
REDUCE PRESSURE ULCERS AMONG PATIENTS
C) TESTIMONIALS FROM EXPERIENCED CLINICIANS ABOUT THE EFFECTIVENESS OF THE MATTRESS IN
QUESTION
D) A RANDOMIZED CONTROLLED TRIAL THAT COMPARED THE PRESSURE-REDUCING
MATTRESS WITH STANDARD MATTRESSES
ANS:D
FEEDBACK: THE MOST RELIABLE EVIDENCE IS CONSIDERED RCTS. QUALITATIVE STUDIES, CASE
STUDIES, AND EXPERT OPINION ARE LOW ON THE HIERARCHY OF EVIDENCE.
9. HOSPITAL ADMINISTRATORS ARE APPLYING THE PRINCIPLES OF EVIDENCE-BASED PRACTICE (EBP)
IN THEIR ATTEMPT TO ASCERTAIN THE MOST EFFICIENT AND EFFECTIVE WAY TO COMMUNICATE
BETWEEN NURSES WHO ARE ON DIFFERENT UNITS, A PROJECT THAT WILL CONSIDER MANY TYPES OF
EVIDENCE. WHICH OF THE FOLLOWING INFORMATION SOURCES SHOULD THE ADMINISTRATORS
PRIORITIZE?
A) A SYSTEMATIC REVIEW ABOUT COMMUNICATION IN NURSING CONTEXTS
B) NURSES IDEAS ABOUT COMMUNICATION METHODS
C) THE RESULTS OF A CHART REVIEW
D) THE HOSPITALS ACCREDITATION STATUS
ANS:A
FEEDBACK: SYSTEMATIC REVIEWS ARE ASSIGNED A HIGH VALUE IN EBP. REVIEWS WOULD BE
PRIORITIZED OVER NURSES IDEAS OR A CHART REVIEW, THOUGH BOTH ARE POTENTIAL
CONSIDERATIONS. THE HOSPITALS ACCREDITATION STATUS IS NOT A RELEVANT CONSIDERATION.
A NURSE HAS RESOLVED TO APPLY THE EVIDENCE-BASED PRACTICE (EBP) PROCESS TO THE WAY THAT
ADMISSION ASSESSMENTS ARE CONDUCTED AND DOCUMENTED ON A UNIT. HOW SHOULD THE NURSE
BEGIN THE
INTERPROFESSIONAL APPROACH 6TH EDITION DUNPHY ALL CHAPTERS-2023-2024
,CONTENTS
CHAPTER 1. PRIMARY CARE IN THE TWENTY-FIRST CENTURY: A CIRCLE OF CARING ............. 4
CHAPTER 2. CARING AND THE ADVANCED PRACTICE NURSE.............................................. 11
CHAPTER 3. HEALTH PROMOTION .................................................................................... 17
CHAPTER 4. THE ART OF DIAGNOSIS AND TREATMENT ...................................................... 19
CHAPTER 5. EVIDENCE-BASED CARE .................................................................................. 29
CHAPTER 6. COMMON NEUROLOGICAL COMPLAINTS ....................................................... 32
CHAPTER 7. SEIZURE DISORDERS ...................................................................................... 40
CHAPTER 9. CEREBROVASCULAR ACCIDENT (STROKE) ....................................................... 51
CHAPTER 10. INFECTIOUS AND INFLAMMATORY NEUROLOGICAL DISORDERS ................... 61
CHAPTER 11.COMMON SKIN COMPLAINTS ....................................................................... 62
CHAPTER 12. PARASITIC SKIN INFESTATIONS..................................................................... 70
CHAPTER 13. FUNGAL SKIN INFECTIONS............................................................................ 71
CHAPTER 14. BACTERIAL SKIN INFECTIONS........................................................................ 73
CHAPTER 15. VIRAL SKIN INFECTIONS ............................................................................... 75
CHAPTER 16. DERMATITIS ................................................................................................ 76
CHAPTER 17. SKIN LESIONS ............................................................................................... 78
CHAPTER 18. COMMON EYE COMPLAINTS ........................................................................ 81
CHAPTER 19. LID AND CONJUNCTIVAL PATHOLOGY .......................................................... 88
CHAPTER 20. VISUAL DISTURBANCES AND IMPAIRED VISION ........................................... 101
CHAPTER 21. COMMON EAR, NOSE, AND THROAT COMPLAINTS ...................................... 103
CHAPTER 22. HEARING AND BALANCE DISORDERS ........................................................... 110
CHAPTER 23. INFLAMMATORY AND INFECTIOUS DISORDERS OF THE EAR ........................ 117
CHAPTER 24. INFLAMMATORY AND INFECTIOUS DISORDERS OF THE NOSE, SINUSES, MOUTH,
AND THROAT
....................................................................................................................................... 132
CHAPTER 25. EPISTAXIS ................................................................................................... 138
CHAPTER 26. TEMPOROMANDIBULAR DISORDERS ........................................................... 139
CHAPTER 27. DYSPHONIA ................................................................................................ 141
CHAPTER 28. COMMON RESPIRATORY COMPLAINTS ....................................................... 142
CHAPTER 29. SLEEP APNOEA............................................................................................ 150
,CHAPTER 30. INFECTIOUS RESPIRATORY DISORDERS ........................................................ 151
CHAPTER 31. INFLAMMATORY RESPIRATORY DISORDERS ................................................ 158
CHAPTER 32. LUNG CANCER ............................................................................................ 162
CHAPTER 33. SMOKING ADDICTION ................................................................................. 164
CHAPTER 34. COMMON CARDIOVASCULAR COMPLAINTS ................................................ 164
CHAPTER 35. CARDIAC AND ASSOCIATED RISK DISORDERS............................................... 172
CHAPTER 36. DYSRHYTHMIAS AND VALVULAR DISORDERS .............................................. 179
CHAPTER 37. DISORDERS OF THE VASCULAR SYSTEM ....................................................... 186
CHAPTER 38. COMMON ABDOMINAL COMPLAINTS ......................................................... 198
CHAPTER 39. INFECTIOUS GASTROINTESTINAL DISORDERS .............................................. 205
CHAPTER 40. GASTRIC AND INTESTINAL DISORDERS ........................................................ 212
CHAPTER 41. GALLBLADDER AND PANCREATIC DISORDERS .............................................. 219
CHAPTER 42. CIRRHOSIS AND LIVER FAILURE ................................................................... 225
CHAPTER 43. COMMON URINARY COMPLAINTS .............................................................. 230
CHAPTER 44. URINARY TRACT DISORDERS ....................................................................... 235
CHAPTER 45. KIDNEY AND BLADDER DISORDERS.............................................................. 243
CHAPTER 46. COMMON REPRODUCTIVE SYSTEM COMPLAINTS........................................ 250
CHAPTER 47. BREAST DISORDERS .................................................................................... 257
CHAPTER 48. VAGINAL, UTERINE, AND OVARIAN DISORDERS ........................................... 263
CHAPTER 49. PROSTATE DISORDERS ................................................................................ 270
CHAPTER 50. PENILE AND TESTICULAR DISORDERS........................................................... 276
CHAPTER 51. SEXUALLY TRANSMITTED INFECTIONS ......................................................... 283
CHAPTER 52. COMMON MUSCULOSKELETAL COMPLAINTS .............................................. 302
CHAPTER 53. SPINAL DISORDERS ..................................................................................... 311
CHAPTER 54. SOFT-TISSUE DISORDERS ............................................................................. 313
CHAPTER 55. OSTEOARTHRITIS AND OSTEOPOROSIS........................................................ 339
CHAPTER 56.COMMON ENDOCRINE/METABOLIC COMPLAINTS ....................................... 343
CHAPTER 57. GLANDULAR DISORDERS ............................................................................. 351
CHAPTER 58. DIABETES MELLITUS .................................................................................... 357
CHAPTER 59. METABOLIC DISORDERS .............................................................................. 362
CHAPTER 60. COMMON HEMATOLOGIC AND IMMUNOLOGICAL PROBLEMS .................... 373
,CHAPTER 61. HEMATOLOGIC DISORDERS ......................................................................... 381
CHAPTER 62. IMMUNOLOGICAL DISORDERS ................................................................... 396
CHAPTER 63. INFECTIOUS DISORDERS ............................................................................. 406
CHAPTER 64. COMMON PSYCHOSOCIAL COMPLAINTS .................................................... 415
CHAPTER 65. SUBSTANCE USE DISORDERS ...................................................................... 422
CHAPTER 66. SCHIZOPHRENIA SPECTRUM DISORDERS .................................................... 433
CHAPTER 67. MOOD DISORDERS..................................................................................... 444
CHAPTER 68. ANXIETY, STRESS, AND TRAUMA-RELATED DISORDERS ............................... 449
CHAPTER 69. OBSESSIVE-COMPULSIVE DISORDERS ......................................................... 456
CHAPTER 70. BEHAVIOURAL DISORDERS RELATED TO PHYSICAL/PHYSIOLOGICAL
DISTURBANCES............................................................................................................... 459
CHAPTER 71. NEURODEVELOPMENTAL DISORDERS ......................................................... 468
CHAPTER 72. COMMON URGENT CARE COMPLAINTS ...................................................... 480
CHAPTER 73. COMMON INJURIES ................................................................................... 488
CHAPTER 74. TOXIC EXPOSURES ..................................................................................... 496
CHAPTER 75. ENVIRONMENTAL EXPOSURES ................................................................... 500
CHAPTER 76. SPORTS PHYSICALS .................................................................................... 507
CHAPTER 77. PRIMARY CARE OF OLDER ADULTS ............................................................. 519
CHAPTER 78. PALLIATIVE CARE AND PAIN MANAGEMENT............................................... 528
CHAPTER 79. ETHICAL AND LEGAL ISSUES OF A CARING-BASED PRACTICE ....................... 533
CHAPTER 80. THE BUSINESS OF ADVANCED PRACTICE NURSING ..................................... 538
CHAPTER 81. THE 15-MINUTE HOUR: PRACTICAL APPROACHES TO BEHAVIOURAL HEALTH
FOR PRIMARY CARE........................................................................................................ 542
CHAPTER 82. PUTTING CARING INTO PRACTICE: CARING FOR SELF .................................. 546
,CHAPTER 1. PRIMARY CARE IN THE TWENTY-FIRST CENTURY: A CIRCLE OF CARING
1. A NURSE HAS CONDUCTED A LITERATURE REVIEW IN AN EFFORT TO IDENTIFY THE EFFECT OF
HANDWASHING ON THE INCIDENCE OF NOSOCOMIAL (HOSPITAL-ACQUIRED) INFECTIONS IN ACUTE
CARE SETTINGS. AN ARTICLE PRESENTED FINDINGS AT A LEVEL OF SIGNIFICANCE OF <0.01. THIS
INDICATES THAT
A) THE CONTROL GROUP AND THE EXPERIMENTAL GROUP WERE MORE THAN 99% SIMILAR.
B) THE FINDINGS OF THE STUDY HAVE LESS THAN 1% CHANCE OF BEING ATTRIBUTABLE TO CHANCE.
,THE EFFECTS OF THE INTERVENTION WERE NEARLY ZERO.
C) THE CLINICAL SIGNIFICANCE OF THE FINDINGS WAS LESS THAN 1:100.
ANS:B
FEEDBACK: THE LEVEL OF SIGNIFICANCE IS THE LEVEL AT WHICH THE RESEARCHER BELIEVES THAT THE
STUDY RESULTS MOST LIKELY REPRESENT A NONCHANCE EVENT. A LEVEL OF SIGNIFICANCE OF <0.01
INDICATES THAT THERE IS LESS THAN 1% PROBABILITY THAT THE RESULT IS DUE TO CHANCE.
2. A NURSE HAS READ A QUALITATIVE RESEARCH STUDY IN ORDER TO UNDERSTAND THE LIVED
EXPERIENCE OF PARENTS WHO HAVE A NEONATAL LOSS. WHICH OF THE FOLLOWING QUESTIONS
SHOULD THE NURSE PRIORITIZE WHEN APPRAISING THE RESULTS OF THIS STUDY?
A) HOW WELL DID THE AUTHORS CAPTURE THE PERSONAL EXPERIENCES OF THESE PARENTS?
B) HOW WELL DID THE AUTHORS CONTROL FOR CONFOUNDING VARIABLES THAT MAY HAVE AFFECTED THE
FINDINGS?
C) DID THE AUTHORS USE STATISTICAL MEASURES THAT WERE APPROPRIATE TO THE PHENOMENON IN
QUESTION?
D) WERE THE INSTRUMENTS THAT THE RESEARCHERS USED STATISTICALLY VALID AND RELIABLE?
ANS:A
FEEDBACK: QUALITATIVE STUDIES ARE JUDGED ON THE BASIS OF HOW WELL THEY CAPTURE AND
CONVEY THE SUBJECTIVE EXPERIENCES OF INDIVIDUALS. STATISTICAL MEASURES AND VARIABLES ARE
NOT DIMENSIONS OF A QUALITATIVE METHODOLOGY.
3. A NURSE HAS EXPRESSED SKEPTICISM TO A COLLEAGUE ABOUT THE VALUE OF NURSING
RESEARCH, CLAIMING THAT NURSING RESEARCH HAS LITTLE RELEVANCE TO PRACTICE. HOW CAN
THE NURSES COLLEAGUE BEST DEFEND THE IMPORTANCE OF NURSING RESEARCH?
A) THE EXISTENCE OF NURSING RESEARCH MEANS THAT NURSES ARE NOW ABLE TO ACCESS
FEDERAL GRANT MONEY, SOMETHING THAT DIDNT USE TO BE THE CASE.
B) NURSING RESEARCH HAS ALLOWED THE DEVELOPMENT OF MASTERS AND DOCTORAL
PROGRAMS AND HAS GREATLY INCREASED THE CREDIBILITY OF THE PROFESSION.
C) THE GROWTH OF NURSING RESEARCH HAS CAUSED NURSING TO BE VIEWED AS A TRUE
PROFESSION, RATHER THAN SIMPLY AS A TRADE OR A SKILL.
D) THE APPLICATION OF NURSING RESEARCH HAS THE POTENTIAL TO IMPROVE NURSING
PRACTICE AND PATIENT OUTCOMES.
ANS:D
,FEEDBACK: THE GREATEST VALUE OF NURSING RESEARCH LIES IN THE POTENTIAL TO IMPROVE
PRACTICE AND, ULTIMATELY, TO IMPROVE PATIENT OUTCOMES. THIS SUPERSEDES THE
CONTRIBUTIONS OF NURSING RESEARCH TO EDUCATION PROGRAMS, GRANT FUNDING, OR THE
PUBLIC VIEW OF THE PROFESSION.
4. TRACY IS A NURSE WITH A BACCALAUREATE DEGREE WHO WORKS IN THE LABOR AND DELIVERY
UNIT OF A BUSY URBAN HOSPITAL. SHE HAS NOTICED THAT MANY NEW MOTHERS ABANDON
BREAST-FEEDING THEIR BABIES WHEN THEY EXPERIENCE EARLY CHALLENGES AND WONDERS
WHAT COULD BE DONE TO ENCOURAGE MORE WOMEN TO CONTINUE BREAST-FEEDING. WHAT
ROLE IS TRACY MOST LIKELY TO PLAY IN A RESEARCH PROJECT THAT TESTS AN INTERVENTION
AIMED AT PROMOTING BREAST-FEEDING?
A) APPLYING FOR GRANT FUNDING FOR THE RESEARCH PROJECT
B) POSING THE CLINICAL PROBLEM TO ONE OR MORE NURSING RESEARCHERS
C) PLANNING THE METHODOLOGY OF THE RESEARCH PROJECT
D) CARRYING OUT THE INTERVENTION AND SUBMITTING THE RESULTS FOR PUBLICATION
ANS:B
FEEDBACK: A MAJOR ROLE FOR STAFF NURSES IS TO IDENTIFY QUESTIONS OR PROBLEMS FOR
RESEARCH. GRANT APPLICATIONS, METHODOLOGICAL PLANNING, AND PUBLICATION
SUBMISSION ARE NORMALLY CARRIED OUT BY NURSES WHO HAVE ADVANCED DEGREES IN
NURSING.
5. A PATIENT SIGNED THE INFORMED CONSENT FORM FOR A DRUG TRIAL THAT WAS EXPLAINED
TO PATIENT BY A RESEARCH ASSISTANT. LATER, THE PATIENT ADMITTED TO HIS NURSE THAT HE
DID NOT UNDERSTAND THE RESEARCH ASSISTANTS EXPLANATION OR HIS OWN ROLE IN THE
STUDY. HOW SHOULD THIS PATIENTS NURSE RESPOND TO THIS REVELATION?
A) EXPLAIN THE RESEARCH PROCESS TO THE PATIENT IN GREATER DETAIL.
B) DESCRIBE THE DETAILS OF A RANDOMIZED CONTROLLED TRIAL FOR THE PATIENT.
C) INFORM THE RESEARCH ASSISTANT THAT THE PATIENTS CONSENT IS LIKELY INVALID.
D) EXPLAIN TO THE PATIENT THAT HIS WRITTEN CONSENT IS NOW LEGALLY BINDING.
ANS:C
FEEDBACK: JUST AS THE STAFF NURSE IS NOT RESPONSIBLE FOR MEDICAL CONSENT, THE STAFF NURSE IS
NOT RESPONSIBLE FOR RESEARCH CONSENT. IF PATIENTS WHO HAVE AGREED TO PARTICIPATE EXHIBIT
AMBIVALENCE OR UNCERTAINTY ABOUT PARTICIPATING, DO NOT TRY TO CONVINCE THEM TO
PARTICIPATE. ASK THE PERSON FROM THE RESEARCH TEAM WHO IS MANAGING CONSENTS TO SPEAK WITH
CONCERNED PATIENTS ABOUT THE STUDY, EVEN AFTER
,A PATIENT HAS SIGNED THE CONSENT
FORMS. MULTIPLE SELECTION
6. A NURSE LEADER IS ATTEMPTING TO INCREASE THE AWARENESS OF EVIDENCE-BASED PRACTICE
(EBP) AMONG THE NURSES ON A UNIT. A NURSE WHO IS IMPLEMENTING EBP INTEGRATES WHICH
OF THE FOLLOWING? (SELECT ALL THAT APPLY.)
A) INTERDISCIPLINARY CONSENSUS
B) NURSING TRADITION
C) RESEARCH STUDIES
D) PATIENT PREFERENCES AND VALUES
E) CLINICAL EXPERTISE
ANS:C, D, E
FEEDBACK: FINEOUT-OVERHOLT, MELNYK, STILLWELL, AND WILLIAMSON DEFINE EBP AS A PROBLEM-
SOLVING APPROACH TO THE DELIVERY OF HEALTHCARE THAT INTEGRATES THE BEST EVIDENCE FROM
STUDIES AND PATIENT CARE DATA WITH CLINICIAN EXPERTISE AND PATIENT PREFERENCES AND
VALUES.
MULTIPLE CHOICE
7. MRS. MAYES IS A 73-YEAR-OLD WOMAN WHO HAS A DIABETIC FOOT ULCER THAT HAS BEEN
EXTREMELY SLOW TO HEAL AND WHICH NOW POSES A THREAT OF OSTEOMYELITIS. THE WOUND
CARE NURSE WHO HAS BEEN WORKING WITH MRS. MAYES APPLIES EVIDENCE-BASED PRACTICE (EBP)
WHENEVER POSSIBLE AND HAS PROPOSED THE USE OF MAGGOT THERAPY TO DEBRIDE NECROTIC
TISSUE. MRS. MAYES, HOWEVER, FINDS THE SUGGESTION REPUGNANT AND ADAMANTLY OPPOSES
THIS TREATMENT DESPITE THE SIZABLE BODY OF EVIDENCE SUPPORTING IT. HOW SHOULD THE
NURSE RECONCILE MRS. MAYES VIEWS WITH THE PRINCIPLES OF EBP?
A) THE NURSE SHOULD EXPLAIN THAT RELIABLE AND VALID RESEARCH EVIDENCE OVERRIDES THE PATIENTS
OPINION.
B) THE NURSE SHOULD EXPLAIN THE EVIDENCE TO THE PATIENT IN GREATER DETAIL.
C) THE NURSE SHOULD INTEGRATE THE PATIENTS PREFERENCES INTO THE PLAN OF CARE.
D) THE NURSE SHOULD INVOLVE THE PATIENTS FAMILY MEMBERS IN THE DECISION-MAKING PROCESS.
ANS:C
FEEDBACK: PATIENT PREFERENCES SHOULD BE INTEGRATED INTO EBP AND CONSIDERED ALONGSIDE
RESEARCH EVIDENCE AND THE NURSES CLINICAL EXPERTISE; EVIDENCE DOES NOT TRUMP THE PATIENTS
PREFERENCES. THE FAMILY SHOULD BE INVOLVED, BUT THIS IS NOT AN EXPLICIT DIMENSION OF EBP.
SIMILARLY, EXPLAINING THE
, EVIDENCE IN MORE DETAIL IS NOT A DEMONSTRATION OF EBP.
8. THE ADMINISTRATORS OF A LONG-TERM CARE FACILITY ARE CONSIDERED THE USE OF SPECIALIZED,
PRESSUREREDUCING MATTRESSES IN ORDER TO REDUCE THE INCIDENCE OF PRESSURE ULCERS AMONG
RESIDENTS. THEY HAVE
SOUGHT INPUT FROM THE NURSES ON THE UNIT, ALL OF WHOM ARE AWARE OF THE NEED TO
IMPLEMENT THE PRINCIPLES OF EVIDENCE-BASED PRACTICE (EBP) IN THIS DECISION. WHICH OF
THE FOLLOWING EVIDENCE SOURCES SHOULD THE NURSES PRIORITIZE?
A) A QUALITATIVE STUDY THAT EXPLORES THE EXPERIENCE OF LIVING WITH A PRESSURE ULCER
B) A CASE STUDY THAT DESCRIBES THE MEASURES THAT NURSES ON A GERIATRIC UNIT TOOK TO
REDUCE PRESSURE ULCERS AMONG PATIENTS
C) TESTIMONIALS FROM EXPERIENCED CLINICIANS ABOUT THE EFFECTIVENESS OF THE MATTRESS IN
QUESTION
D) A RANDOMIZED CONTROLLED TRIAL THAT COMPARED THE PRESSURE-REDUCING
MATTRESS WITH STANDARD MATTRESSES
ANS:D
FEEDBACK: THE MOST RELIABLE EVIDENCE IS CONSIDERED RCTS. QUALITATIVE STUDIES, CASE
STUDIES, AND EXPERT OPINION ARE LOW ON THE HIERARCHY OF EVIDENCE.
9. HOSPITAL ADMINISTRATORS ARE APPLYING THE PRINCIPLES OF EVIDENCE-BASED PRACTICE (EBP)
IN THEIR ATTEMPT TO ASCERTAIN THE MOST EFFICIENT AND EFFECTIVE WAY TO COMMUNICATE
BETWEEN NURSES WHO ARE ON DIFFERENT UNITS, A PROJECT THAT WILL CONSIDER MANY TYPES OF
EVIDENCE. WHICH OF THE FOLLOWING INFORMATION SOURCES SHOULD THE ADMINISTRATORS
PRIORITIZE?
A) A SYSTEMATIC REVIEW ABOUT COMMUNICATION IN NURSING CONTEXTS
B) NURSES IDEAS ABOUT COMMUNICATION METHODS
C) THE RESULTS OF A CHART REVIEW
D) THE HOSPITALS ACCREDITATION STATUS
ANS:A
FEEDBACK: SYSTEMATIC REVIEWS ARE ASSIGNED A HIGH VALUE IN EBP. REVIEWS WOULD BE
PRIORITIZED OVER NURSES IDEAS OR A CHART REVIEW, THOUGH BOTH ARE POTENTIAL
CONSIDERATIONS. THE HOSPITALS ACCREDITATION STATUS IS NOT A RELEVANT CONSIDERATION.
A NURSE HAS RESOLVED TO APPLY THE EVIDENCE-BASED PRACTICE (EBP) PROCESS TO THE WAY THAT
ADMISSION ASSESSMENTS ARE CONDUCTED AND DOCUMENTED ON A UNIT. HOW SHOULD THE NURSE
BEGIN THE
