Contemporary Medical Surgical Nursing 2nd Edition by Daniels, Rick -Test Bank

Chapter 3--Health Education and Promotion MULTIPLE CHOICE 1. A client is reviewing a videotape without the assistance of the nurse for instruction. The type of teaching strategy this client is using is considered: 1. demonstration. 2. slides. 3. programmed instruction. 4. discussion. ANS: 3 Programmed instruction is often referred to as “canned” presentation and is intended for use without the nurse. Demonstration, slides, and discussion require a nurse to be present. PTS: 1 DIF: Analyze REF: Teaching Strategies: Programmed Instruction 2. The nurse is instructing a client regarding food safety, injury prevention, and occupational health. Which of the following Healthy People 2010 objectives is the nurse instructing the client? 1. Promote healthy behaviors 2. Promote healthy and safe communities 3. Improve systems for personal health and public health 4. Prevent and reduce diseases and disorders ANS: 2 This objective addresses instruction that focuses on the health and safety of communities such as food safety, prevention of injury, and occupational health. Promoting healthy behaviors would include weight reduction and smoking cessation. Improve systems for personal health and public health would include immunization programs. Prevent and reduce diseases and disorders would include instruction on screening programs, physician visits, and routine health maintenance care. PTS: 1 DIF: Analyze REF: Health Promotion on a Global Level 3. A client has inadequate resources and impairment of personal support systems. Which nursing diagnosis would apply to this patient? 1. Noncompliance 2. Deficient knowledge 3. Ineffective health maintenance 4. Health-seeking behavior ANS: 3 Defining characteristics for ineffective health maintenance includes impairment of personal support systems, observed inability to take responsibility for meeting basic health practices, demonstrated lack of knowledge, failure to recognize important symptoms reflective to altered health status, lack of health-seeking behaviors, and inadequate resources. Inadequate resources and impairment of personal support systems would not support the nursing diagnoses of Noncompliance, Deficient Knowledge, or Health-Seeking Behavior. PTS: 1 DIF: Apply REF: Box 3-3 Defining Characteristics for Ineffective Health Maintenance 4. While planning care for a client, the nurse identifies content that would address the client’s diagnosis of Deficient Knowledge. The nurse will ensure time is allocated for client instruction because: 1. the client cannot be discharged without it. 2. it is a legal component of the nursing process. 3. it is a nice thing to do for a client. 4. the physician has written an order for instruction. ANS: 2 Patient education is a legal component of the nursing process that was identified in the Patient’s Bill of Rights. Patient education is a necessary function of nursing care. The client could be discharged without receiving instructions. Education is not done because it is a nice thing to do for a client. Client education does not necessitate a physician’s order. PTS: 1 DIF: Apply REF: Patient Education 5. The nurse is engaged in an information teaching session with a client. Which of the following would be appropriate to instruct during an informal teaching session? 1. Expected effects of a new medication 2. Instruction on leg exercises to be used after surgery 3. How to use an incentive spirometer 4. Diet and medications to manage a new diagnosis of diabetes mellitus ANS: 1 Instruction can be either informal or formal. Informal instruction occurs intermittently and frequently during the course of client care. These instructions are simple, relate to the disease process, and answer client questions. Providing the expected effects of a new medication is a type of information instruction. Formal instructions are deliberate with specific goals and an evaluation process. Instructing on postoperative leg exercises, the use of an incentive spirometer, and diet and medications to manage a new health diagnosis are all examples of formal instruction. PTS: 1 DIF: Apply REF: Formal and Informal Patient Education 6. The nurse is planning a presentation to a group of senior citizens as part of a wellness program. Which of the following topics would be appropriate for the nurse to instruct this client population? 1. Importance of taking medications as prescribed 2. Ways to follow a physician’s treatment plan 3. Ease of changing an abdominal dressing 4. Strategies to reduce salt in the diet and increase activity ANS: 4 Some educational topics can be instructed in a group setting. Strategies to reduce salt intake and increase activity are two topics that would be appropriate for a group instruction. The other choices are appropriate for individual instruction. PTS: 1 DIF: Apply REF: Individual and Group Patient Education 7. A client is considering several changes in personal habits to improve his health. Which of the following critical thinking strategies can the nurse use to help this client? 1. Ask the client to identify his goals to improve his health. 2. Remind the client that the physician has to approve all changes in his health improvement plan. 3. Suggest the client wait until he is discharged before planning to make personal habit changes. 4. Recommend that immediate changes are made to confuse the body’s responses. ANS: 1 Critical thinking is a self-directed, deliberate, self-corrected, results-oriented reasoning process that strives to problem-solve client care issues by combining logic, intuition, and creativity. The goal of critical thinking is to assist clients to use what they already know and work with the client to make changes that they identify through self-discovery. Asking the client to identify goals to improve health is one strategy that the nurse can use when implementing critical thinking with client education. The other choices do not support critical thinking with client education. PTS: 1 DIF: Apply REF: Critical Thinking and Patient Education 8. A client has several identified learning needs. Which of the following should the nurse assess prior to planning instruction for this client? 1. Home address 2. Client’s learning style 3. Living arrangements 4. Financial resources ANS: 2 Areas to include in the assessment of a client’s learning needs include the client’s ability to learn, style of learning, information about a health condition, cultural background, and other information as required. The client’s home address, living arrangements, and financial resources are not a part of a client’s assessment of learning needs. PTS: 1 DIF: Apply REF: Patient Education and the Nursing Process 9. Which of the following teaching strategy would best support a client who needs to learn how to self-administer insulin injections? 1. Discussion 2. Role-playing 3. Demonstration 4. Programmed instruction ANS: 3 Demonstration is a practical strategy used when teaching a new skill such as self-injection of insulin. Discussion is an exchange of information and does not provide an opportunity for the client to learn a new skill. Role playing allows the client to apply knowledge in a simulated environment. This strategy does not support learning a new skill. Programmed instruction is intended for use without the nurse. This strategy does not support learning a new skill. PTS: 1 DIF: Apply REF: Teaching Strategies 10. A client tells the nurse that she uses audio CDs in her vehicle when driving to and from work to keep current with educational requirements for her job. The nurse would assess this client as preferring which type of learning style? 1. Auditory 2. Visual 3. Kinesthetic 4. Anesthetic ANS: 1 The client who learns by hearing prefers an auditory learning style. The client who learns by reading uses a visual learning style. The client who learns by doing or touching is using a kinesthetic learning style. Anesthetic is not a type of learning style but rather a medication used for surgery. PTS: 1 DIF: Analyze REF: Teaching Strategies 11. The nurse is attempting to instruct a client on ways to eliminate smoking. The client tells the nurse that he has no health problems because of smoking and does not understand why he needs to quit. Which of the following is interfering with the nurse’s ability to instruct the client in health promotion behaviors? 1. Motivation 2. Perception 3. Self-image 4. Maintenance ANS: 2 Perception is a client’s sense and understanding of his current health status. If the client does not perceive a problem with current health maintenance activities, the nurse should not intervene at this time. Motivation is the internal drive or external stimulus to perform an action or thought. Maintenance is practicing a new behavior for an extended period of time. The client’s self-image is not interfering with the nurse’s ability to instruct the client in health promotion behaviors. PTS: 1 DIF: Analyze REF: Characteristics of Health Maintenance 12. The nurse is planning instruction to support health promotion behaviors. Which of the following clients would benefit the most from these instructions? 1. 60-year-old client diagnosed with type 2 diabetes mellitus 2. 83-year-old client with hypertension 3. 75-year-old client recovering from a total hip replacement 4. 35-year-old client desiring to begin an exercise program ANS: 4 Health promotion interventions are for healthy individuals and are intended to maximize their health status. The 35-year-old client who wants to begin an exercise program would benefit from health promotion instruction. The other clients are considered to be ill and would not benefit from instruction in health promotion behaviors. PTS: 1 DIF: Analyze REF: Health Promotion 13. The nurse and client have determined that goals established for health maintenance behaviors have not been achieved. In which step of the nursing process are the nurse and client working at this time? 1. Evaluation 2. Assessment 3. Planning 4. Implementation ANS: 1 The nurse and client together measure how well the client has achieved the goals for health maintenance in the plan of care. Goals that have not been achieved are evaluated and adjusted. This is an activity done during the evaluation step of the nursing process. Evaluation of goals is not done during the assessment, planning, or implementation steps of the nursing process. PTS: 1 DIF: Analyze REF: Evaluation of Outcomes MULTIPLE RESPONSE 1. A client is demonstrating behaviors consistent with normal health maintenance. Which of the following has this client demonstrated? (Select all that apply.) 1. Motivation 2. Health encouragement 3. Readiness 4. Maintenance 5. Health activities 6. Perception ANS: 1, 4, 6 The three characteristics of health maintenance are: 1) perception, 2) motivation, and 3) maintenance. Health encouragement, readiness, and health activities are not behaviors consistent with normal health maintenance. PTS: 1 DIF: Analyze REF: Characteristics of Health Maintenance 2. The nurse is planning an instructional session with a client. When planning this session, the nurse should incorporate which teaching/learning principles? (Select all that apply.) 1. Assessment of how the client organizes knowledge 2. Motivation and self-efficacy 3. Setting goals 4. Developmental level of the client 5. Time management 6. Self-engagement ANS: 1, 2, 3, 4, 6 Principles of the teaching/learning process include how knowledge is organized by the learner, self-motivation and self-efficacy, setting measurable goals, developmental level of the learner, and self-engagement. Time management is not a teaching/learning principle. PTS: 1 DIF: Apply REF: Patient Education and Teaching/Learning Principles 3. The nurse is planning client instruction interventions to support critical thinking. Which of the following are characteristics of critical thinking in the client education process? (Select all that apply.) 1. Organized 2. Clearly explained with examples 3. Vague 4. Task-oriented 5. Knowledge-oriented 6. Moral and ethically focused ANS: 1, 2, 5, 6 Characteristics of critical thinking with client education include organized and clearly explained with the use of examples, aimed at positive health outcomes, is knowledge-oriented, and is focused on making moral and ethical decisions. Critical thinking is not vague nor task-oriented. PTS: 1 DIF: Analyze REF: Table 3-1 What is Critical Thinking? 4. The nurse is utilizing the technique of motivational interviewing to instruct a client on ways to limit alcohol intake. Which of the following are techniques used when implementing motivational interviewing? (Select all that apply.) 1. Express empathy 2. Develop discrepancy 3. Avoid arguing 4. Roll with resistance 5. Support self-efficacy 6. Contract for goal achievement ANS: 1, 2, 3, 4, 5 Motivational interviewing has five specific techniques: 1) expressing empathy, 2) developing discrepancy, 3) avoiding argument, 4) rolling with resistance, and 5) supporting self-efficacy. Contracting for goal achievement is not a technique of motivational interviewing. PTS: 1 DIF: Apply REF: Motivational Interviewing 5. Which of the following self-examination techniques is a health maintenance behavior for the nurse to instruct a client? (Select all that apply.) 1. Breast self-examination 2. Capillary blood glucose testing 3. Testicular self-examination 4. Skin examination 5. Application of hydrocortisone cream for a skin disorder 6. Elevating edematous lower extremities ANS: 1, 3, 4 Physical self-examination is a health maintenance behavior that does not require any special equipment but requires proper instruction on the correct procedure. Examples of self-examinations that a nurse can instruct a client include breast self-examination, testicular self-examination, and skin examination. Capillary blood glucose testing needs the use of a glucometer. Application of hydrocortisone cream is a medication used for a diagnosed skin disorder. Elevating edematous lower extremities is an intervention for a peripheral vascular or cardiac disorder. PTS: 1 DIF: Apply REF: Physical Self-Examination Techniques Chapter 7--Palliative Care MULTIPLE CHOICE 1. The nurse believes that a client is eligible as a participant for The National Hospice Reimbursement Act of 1986. This act mandated that: 1. clients with terminal illnesses are reimbursed. 2. a physician must order hospice to be reimbursed. 3. to receive reimbursement that client must be eligible for Medicare. 4. to receive benefits, the physician must certify that the client has a limited life expectancy of 6 months or less. ANS: 4 The Medicare hospice benefit is a reimbursement benefit for those with a prognosis of 6 months or less to live (certified by a physician). The act does not mandate reimbursement to clients with terminal illnesses, physicians do not have to order hospice for reimbursement, nor does a client have to be eligible for Medicare for hospice eligibility. PTS: 1 DIF: Analyze REF: History and Overview of Hospice Care 2. After a Native American client has died, the family begins the practice of purifying the body. The nurse realizes that the deceased client may stay with the family for what period of time? 1. 12 hours 2. 24 hours 3. 36 hours 4. 48 hours ANS: 3 Native Americans believe that the soul departs from the body 36 hours after death. The family may want the body to remain at the place of death for this period. The other choices are incorrect lengths of time according to Native American culture. PTS: 1 DIF: Analyze REF: Table 7-1 Cultural Considerations Related to Dying 3. A client is receiving care for symptoms; however, the treatment will not alter the course of the disease. This client is receiving which type of care? 1. Hospital-based 2. Managed 3. Palliative 4. Therapeutic ANS: 3 Palliative care, or “comfort” care, is directed at providing relief to a terminally ill client through symptom and pain relief. The goal is not curative. Care for symptoms that will not alter the course of the disease does not need to be provided in the hospital. Managed care is guided through the direction of a primary care physician. Therapeutic is a type of care that focuses on a specific treatment for a health problem. PTS: 1 DIF: Analyze REF: Overview of Palliative Care 4. A client diagnosed with a terminal illness is receiving an opioid/acetaminophen combination for pain control. The nurse realizes this client is being managed at which step of the World Health Organization approach to pain management? 1. Step 1 2. Step 2 3. Step 3 4. Step 4 ANS: 2 The World Health Organization approach to pain management involves three steps. Step 1: Clients are treated with around-the-clock doses of nonopioids. Step 2: The use of opioid/acetaminophen combinations are used to treat mild to moderate pain. Step 3: Strong opioids are used. There is no Step 4 in the World Health Organization’s approach to pain management. PTS: 1 DIF: Analyze REF: Figure 7-2 Conceptual Model of Ladder Approach to Pain Management 5. A dying client is surrounded by family and friends at home. The hospice nurse talks with the spouse of the dying client to ensure that everything the family needs during this time is being done. The nurse is providing support to: 1. the client. 2. the bereaved. 3. ensure compliance with the hospice rules and regulations. 4. determine if the spouse understands that the client is dying. ANS: 2 Supporting the family’s rituals and cultural practices gives structure to support the bereaved through this painful process when people are vulnerable and feel off balance. The nurse is not providing support to the client. The nurse is not providing support to ensure compliance with the hospice rules and regulations. The nurse is also not providing support to determine if the spouse understands that the client is dying. PTS: 1 DIF: Analyze REF: Role of the Hospice and Palliative Care Nurse 6. A client of the Hispanic culture is nearing death and the family requests that the client be prepared for discharge. The nurse realizes that the reason the family and client want to return home is because: 1. individuals within this culture do not trust hospital caregivers. 2. the family wants to have a spiritual healer care for the client. 3. it is bad luck to die in the hospital. 4. the spirit may get lost if the client dies in the hospital, and it will not be able to find its way home. ANS: 4 Within the Hispanic culture, the client and family may not want to die in the hospital because the spirit may get lost and will not be able to find its way home. The reason the family and client want to return home is not because of a distrust of hospital caregivers. The family may want to have a spiritual healer conduct a ceremony for the client, but this does not need to be done in the home. Members of the Hispanic culture do not believe that it is bad luck to die in the hospital. PTS: 1 DIF: Analyze REF: Table 7-1 Cultural Considerations Related to Dying 7. During the period of time when a client diagnosed with a terminal illness became comatose, a health care proxy made decisions about the client’s care. When the client regained consciousness a few days later, the nurse consulted whom regarding the client’s ongoing care decisions? 1. The client 2. The health care proxy 3. The client’s family 4. The client’s physician ANS: 1 A health care proxy is in effect whenever the client is unable to communicate and ceases to be in effect as soon as the client regains decision-making capacity. The nurse should consult with the client regarding the client’s ongoing care decisions. The nurse should not consult with the health care proxy, the family, or the physician. PTS: 1 DIF: Apply REF: Ethics in Practice: Legal and Ethical Considerations Related to Dying 8. The nurse is concerned that the spouse of a terminally ill client is experiencing Anticipatory Grieving when which of the following is assessed? 1. Confidence in the ability to care for the ill client at home 2. Expressing anger about the client’s pending death and crying throughout the day 3. Large social support system 4. Knowledge of equipment function ANS: 2 Anticipatory grieving is the intellectual and emotional responses and behaviors by which individuals work through the process of modifying self-concept based on the perception of potential loss. Anger and crying about the client’s pending death are signs of Anticipatory Grieving. The other assessment findings are evidence that the spouse is accepting the caregiver role. PTS: 1 DIF: Analyze REF: Nursing Diagnoses 9. The nurse administers additional intravenous medication to a hospice client with uncontrollable pain. After receiving the additional medication, the client demonstrates apneic periods and bradycardia. Which of the following does this nurse’s actions suggest? 1. Euthanasia 2. Assisted suicide 3. Double effect 4. Malpractice ANS: 3 The principle of double effect means that increasing the dose of medication to achieve pain control, even if death is hastened, is ethically justified. Euthanasia is the administration of medication to purposefully cause another’s death. Assisted suicide is the practice of providing medication to a client with the intent that the client use the medication to voluntarily commit suicide. Malpractice is conducting some aspect of care that causes a client harm. PTS: 1 DIF: Analyze REF: Managing Pain 10. A client with a terminal illness was ingesting morphine sulfate 10 mg by mouth every 6 hours for pain. To ensure that the client receives the same degree of pain control when delivering the same medication through the intravenous route, which of the following should the nurse do? 1. Provide morphine sulfate 10 mg intravenous every 6 hours. 2. Provide morphine sulfate 20 mg intravenous every 4 hours. 3. Provide a different medication since morphine sulfate cannot be given through the intravenous route. 4. Consult a dose equivalent table to determine the dose of morphine sulfate the client will need through the intravenous route. ANS: 4 Dose equivalent tables should be used by the nurse when analgesics or the routes of administration are changed. The nurse should not provide the same dosage of the medication through the intravenous route since this may be too much. Morphine sulfate can be administered through the intravenous route. PTS: 1 DIF: Apply REF: Managing Pain 11. A terminally ill client is experiencing nausea. Which of the following interventions can be used to help the client at this time? 1. Administer diphenhydramine (Benadryl) as prescribed. 2. Provide three regular meals. 3. Limit mouth care. 4. Restrict iced fluids. ANS: 1 Diphenhydramine (Benadryl) acts on the vomiting center in the medulla. This is the intervention that would be the most helpful to the client at this time. The client should be provided with small, frequent meals. Mouth care should be provided when necessary. Iced fluids are helpful for dry mouth. PTS: 1 DIF: Apply REF: Managing Loss of Appetite, Constipation, Nausea, and Vomiting 12. A terminally ill client is more alert and talkative, and she is requesting specific foods to eat. The nurse should caution the family regarding the client’s behavior because this could indicate: 1. total remission of the disease process. 2. final surprising rally before retreating. 3. the client is cured of the terminal illness. 4. the client was misdiagnosed. ANS: 2 Nurses should prepare the family of a terminally ill client for an occasional final surprising rally in which the client becomes temporarily more alert and responsive before retreating. The period of alertness does not indicate total remission of the disease process, the client’s being cured of the terminal illness, or the client’s being misdiagnosed. PTS: 1 DIF: Apply REF: Providing Care in the Active Phase of Dying 13. The nurse is concerned that a hospice client is approaching death when which of the following is assessed? 1. Respiratory rate 16 and regular 2. Blood pressure 110/60 mmHg 3. Restlessness, irritability, and anxiety 4. Periods of wakefulness are greater than periods of sleep ANS: 3 Symptoms of hypoxia include restlessness, irritability, and anxiety. Respirations of 16 and regular is a normal respiratory rate. Blood pressure of 110/60 mmHg is within normal limits. Periods of wakefulness being greater than periods of sleep is also a normal physiological finding. PTS: 1 DIF: Analyze REF: Table 7-2 Physiology of Dying MULTIPLE RESPONSE 1. The nurse is discussing end-of-life wishes with a client and his family. Since the client is not sure of what type of care he wants, the nurse provides the document “Five Wishes” because this document provides which of the following types of information? (Select all that apply.) 1. What the client wants his loved ones to know 2. The level of comfort that the client wants 3. Comments and ideas for health care providers 4. The person designated by the client to make health care decisions 5. The kinds of medical treatment that the client wants or does not want 6. The way in which the client wants to be treated ANS: 1, 2, 4, 5, 6 The “Five Wishes” document helps clients express themselves if they are seriously ill and unable to communicate their wishes for themselves. It looks at all of a client’s needs: medical, personal, emotional, and spiritual. Comments and ideas for health care providers is not a part of the Five Wishes document. PTS: 1 DIF: Apply REF: Role of the Hospice and Palliative Care Nurse 2. The nurse is making a home visit to a client receiving hospice care. Which of the following symptoms will the nurse assess in the client during the visit? (Select all that apply.) 1. Aggression 2. Anxiety 3. Confusion 4. Depression 5. Increased appetite 6. Urinary continence ANS: 2, 3, 4 Common symptoms of the client receiving hospice care include pain, dyspnea, nausea, vomiting, constipation, loss of appetite, urinary urgency and incontinence, insomnia, confusion, delirium, anxiety, and depression. Aggression, increased appetite, and urinary continence are not symptoms typically assessed in a client receiving hospice care. PTS: 1 DIF: Apply REF: Assessment of the Patient Receiving Hospice and Palliative Care 3. The nurse, assessing pain in a client receiving hospice care, uses the ABCDE model to guide pain management. Which of the following is a part of this pain management approach? (Select all that apply.). 1. Ask about the pain regularly. 2. Believe the patient and family in their reports of pain. 3. Confront the patient if you believe pain control was not achieved. 4. Deliver interventions only when requested. 5. Enable the patient to control her course of pain management to the greatest extent possible. 6. Utilize complementary alternative medicine approaches first. ANS: 1, 2, 5 The “ABCDE” model is a guide to pain management. For A, the nurse should regularly ask about pain. For B, the nurse should believe the patient and family in their reports of pain and what relieves it. For C, the nurse should choose pain control options that are appropriate for the patient. The nurse should not confront the patient about pain control since this is not therapeutic. For D, interventions should be delivered in a timely, logical, and coordinated manner and not only when requested. For E, patients and families should be empowered. Complementary alternative medicine approaches should not be used first. PTS: 1 DIF: Apply REF: Box 7-2 ABCDE Guide to Pain Assessment 4. The nurse is providing a terminally ill client with morphine for pain control. In addition to this medication, which of the following can be provided to enhance analgesic effect? (Select all that apply.) 1. Antihypertensive 2. Antidepressant 3. Antibiotic 4. Antiemetic 5. Anticonvulsant 6. Corticosteroid ANS: 2, 5, 6 Adjuvant medications can enhance analgesic effect and include antidepressants, anticonvulsants, and corticosteroids. Antihypertensives, antibiotics, and antiemetics are not considered adjuvant medications for pain control. PTS: 1 DIF: Apply REF: Managing Pain 5. A client with a terminal illness refuses pain medication. The nurse realizes that the client may decline pain medication for which of the following reasons? (Select all that apply.) 1. Fear that the pain means the disease is worse 2. Insufficient health plan benefits to pay for the medication 3. Cultural background prevents the use of pain medication 4. Fear of becoming addicted to pain medication 5. Fear of side effects 6. Concern about being labeled as a “bad” client ANS: 1, 4, 5, 6 Client barriers to sufficient pain management include fear that the disease is worse, fear of becoming addicted to pain medication, fear of side effects, and concern about being labeled as a “bad” client. Insufficient health plan benefits to pay for the medication and cultural background preventing the use of pain medication are not identified client barriers to sufficient pain management. PTS: 1 DIF: Analyze REF: Box 7-4 Barriers to Pain Management