Test Bank for Brunner & Suddarth's Textbook of MedicalSurgical Nursing 14e. 2

Test Bank for Brunner & Suddarth's Textbook of MedicalSurgical Nursing 14e. 2 Table of Contents 1 Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice Chapter 02: Community-Based Nursing Practice Chapter 03: Critical Thinking, Ethical Decision Making and the Nursing Process Chapter 04: Health Education and Promotion Chapter 05: Adult Health and Nutritional Assessment Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation Chapter 07: Overview of Transcultural Nursing Chapter 08: Overview of Genetics and Genomics in Nursing Chapter 09: Chronic Illness and Disability Chapter 10: Principles and Practices of Rehabilitation Chapter 11: Health Care of the Older Adult Chapter 12: Pain Management Chapter 13: Fluid and Electrolytes: Balance and Disturbance Chapter 14: Shock and Multiple Organ Dysfunction Syndrome Chapter 15: Management of Patients with Oncologic Disorders Chapter 16: End-of-Life Care Chapter 17: Preoperative Nursing Management Chapter 18: Intraoperative Nursing Management Chapter 19: Postoperative Nursing Management Chapter 20: Assessment of Respiratory Function Chapter 21: Respiratory Care Modalities Chapter 22: Management of Patients With Upper Respiratory Tract Disorders Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders Chapter 24: Management of Patients With Chronic Pulmonary Disease Chapter 25: Assessment of Cardiovascular Function Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems Chapter 27: Management of Patients With Coronary Vascular Disorders 3 22 41 64 83 104 124 144 164 183 220 240 260 280 300 319 338 357 376 396 415 434 453 472 490 508 526 Chapter 28: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders Chapter 29: Management of Patients With Complications from Heart Disease Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation Chapter 31: Assessment and Management of Patients With Hypertension Chapter 32: Assessment of Hematologic Function and Treatment Modalities Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders Chapter 34: Management of Patients With Hematologic Neoplasms Chapter 35: Assessment of Immune Function Chapter 36: Management of Patients With Immune Deficiency Disorders Chapter 37: Assessment and Management of Patients With Allergic Disorders Chapter 38: Assessment and Management of Patients With Rheumatic Disorders Chapter 39: Assessment of Musculoskeletal Function Chapter 40: Musculoskeletal Care Modalities Chapter 41: Management of Patients With Musculoskeletal Disorders Chapter 42: Management of Patients With Musculoskeletal Trauma Chapter 43: Assessment of Digestive and Gastrointestinal Function Chapter 44: Digestive and Gastrointestinal Treatment Modalities Chapter 45: Management of Patients with Oral and Esophageal Disorders Chapter 46: Management of Patients with Gastric and Duodenal Disorders Chapter 47: Management of Patients With Intestinal and Rectal Disorders 545 564 582 601 620 638 656 674 692 710 728 746 764 782 800 819 837 855 874 893 3 Chapter 48: Assessment and Management of Patients with Obesity Chapter 49: Assessment and Management of Patients with Hepatic Disorders Chapter 50: Assessment and Management of Patients with Biliary Disorders Chapter 51: Assessment and Management of Patients with Diabetes Chapter 52: Assessment and Management of Patients with Endocrine Disorders Chapter 53: Assessment of Kidney and Urinary Function Chapter 54: Management of Patients with Kidney Disorders Chapter 55: Management of Patients with Urinary Disorders 911 921 940 959 978 996 1015 1034 Chapter 56: Assessment and Management of Patients With Female Physiologic Processes 1054 Chapter 57: Management of Patients with Female Reproductive Disorders Chapter 58: Assessment and Management of Patients with Breast Disorders 1072 1091 Chapter 59: Assessment and Management of Patients With Male Reproductive Disorders 1110 Chapter 60: Assessment of Integumentary Function Chapter 61: Managements of Patients with Dermatologic Problems Chapter 62: Managements of Patients with Burn Injury Chapter 63: Assessment and Management of Patients with Eye and Vision Disorders 1129 1147 1165 1184 Chapter 64: Assessment and Management of Patients with Hearing and Balance Disorders 1203 Chapter 65: Assessment of Neurologic Function Chapter 66: Management of Patients with Neurologic Dysfunction Chapter 67: Management of Patients with Cerebrovascular Disorders Chapter 68: Management of Patients with Neurologic Trauma 1221 1239 1257 1276 Chapter 69: Management of Patients with Neurologic Infections, Autoimmune Disorders, and Neuropathies 1294 Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders 1312 Chapter 71: Management of Patients With Infectious Diseases Chapter 72: Emergency Nursing Chapter 73: Terrorism, Mass Casualty, and Disaster Nursing 1331 1349 1367 4 Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice The public health nurse is presenting a health promotion class to a group of new mothers. How shouldthe nurse best define health? Health is being disease free. Health is having fulfillment in all domains of life. Health is having psychological and physiological harmony. Health is being connected in body, mind, and spirit. Ans: D Feedback: The World Health Organization (WHO) defines health in the preamble to its constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. The other answers are incorrect because they are not congruent with the WHO definition of health. A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What isone characteristic the nurse would cite as necessary to possess to be an effective nurse? Sensitivity to cultural differences Team-focused approach to problem-solving Strict adherence to routine Ability to face criticism Ans: A Feedback: To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict adherence to routine are not characteristics needed to be an effective nurse. The ability to handle criticism is important, but to a lesser degree than cultural competence. 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? 5 Adequate prenatal care Government advocacy and lobbying Judicious use of online communities Management of illness Ans: D Feedback: Organized self-care education programs emphasize health promotion, disease prevention, management of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and Internet activities are secondary. The home health nurse is assisting a patient and his family in planning the patients return to work after surgery and the development of postsurgical complications. The nurse is preparing a plan of care that addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the patients need for self-fulfillment relate? Physiologic Transcendence Love and belonging Self-actualization Ans: D Feedback: Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does not relate directly to them. 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? Care should focus primarily on the treatment of disease. A persons state of health is ever-changing. 6 A person can transition from health to illness rapidly. Care should focus on the patients compliance with interventions. Ans: B Feedback: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The other answers are incorrect because patient care should not focus just on the treatment of disease. Rapid declines in health and compliance with treatment are not key to this view of health. A group of nursing students are participating in a community health clinic. When providing care in this context, what should the students teach participants about disease prevention? It is best achieved through attending self-help groups. It is best achieved by reducing psychological stress. It is best achieved by being an active participant in the community. It is best achieved by exhibiting behaviors that promote health. Ans: D Feedback: Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle. A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee. When describing quality improvement programs to nursing colleagues and members of other health disciplines, what characteristic should the nurse cite? These programs establish consequences for health care professionals actions. These programs focus on the processes used to provide care. These programs identify specific incidents related to quality. These programs seek to justify health care costs and systems. 7 Ans: B Feedback: Numerous models seek to improve the quality of health care delivery. A commonality among them is a focus on the processes that are used to provide care. Consequences, a focus on incidents, and justification for health care costs are not universal characteristics of quality improvement efforts. Nursesin acute care settings must work with other health care team members to maintain quality carewhile 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? Promotion of health literacy during hospitalization Close communication with insurers Thorough and evidence-based discharge planning Participation in continuing education initiativesAns: C Feedback: Following discharges that occur after increasingly short hospital stays, nurses in the community care for patients who need high-technology acute care services as well as long-term care in the home. This is dependent on effective discharge planning to a greater degree than continuing education, communication with insurers, or promotion of health literacy. 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? Identifying the immediate needs of the patient Checking the admitting physicians orders Obtaining a baseline set of vital signs Allowing the family to be with the patientAns: A Feedback: 8 Among the nurses important functions in health care delivery, identifying the patients immediate needs and working in concert with the patient to address them is most important. The other nursing functions are important, but they are not the most important functions. 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? Helping the patient to achieve specific outcomes Balancing risks and benefits of interventions Documenting the patients response to therapy Staying accountable to the interdisciplinary teamAns: A Feedback: Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount. 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 practiceRN 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? Involving patients in their care while hospitalized Contributing to the scientific basis of nursing practice Critiquing the quality of patient care Explaining medical studies to patients and RNsAns: B Feedback: Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving patients in their care. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of practice for the nurse in todays health care environment is home health care. What is the main basis for 9 the growth in this health care setting? Chronic nursing shortage Western focus on treatment of disease Nurses preferences for day shifts instead of evening or night shifts Discharge of patients who are more critically illAns: D Feedback: With shorter hospital stays and increased use of outpatient health care services, more nursing care is provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting. Nurses have different educational backgrounds and function under many titles in their practice setting. Ifa nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurses title? Nursing care expert Clinical nurse specialist Nurse manager Staff nurse Ans: B Feedback: Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care (e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse. Nursing continues to recognize and participate in collaboration with other health care disciplines to meetthe complex needs of the patient. Which of the following is the best example of a collaborative practice model? The nurse and the physician jointly making clinical decisions. 10 The nurse accompanying the physician on rounds. The nurse making a referral on behalf of the patient. The nurse attending an appointment with the patient. Ans: A Feedback: The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of needs, what dimension of care should the nurse consider primary in importance when caring for a dying patient? Spiritual Social Physiologic Emotional Ans: C Feedback: Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patients strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for a dying patient, though each should certainly be addressed. A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Withinthis framework of understanding, what would be the nurses first priority? Allowing the family to see a newly admitted patient Ambulating the patient in the hallway Administering pain medication 11 Teaching the patient to self-administer insulin safelyAns: C Feedback: In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family addresses a higher level need related to love and belonging. Teaching the patient is also a higher level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the patient can address these higher level needs. A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of the following? National Council of Nursings guidelines for care National League for Nursings Code of Conduct American Nurses Associations Social Policy Statement Department of Health and Human Services White Paper on NursingAns: C Feedback: Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN published a specific code of conduct. 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)? The increased need for primary care providers The need to improve patient diagnostic services The push to drive institutional excellence 12 The need to decrease the number of medical errorsAns: A Feedback: CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primary care or acute care. CNPs help meet the need for primary care providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement? By liaising with the members of the interdisciplinary care team By critically appraising the outcomes of care that is provided By integrating the patients preferences into the plan of care By documenting care in the electronic health record in a timely fashionAns: B Feedback: Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement activities. 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? Decreased access to health care information by individuals Gradual increases in the cultural unity of the American population Increasing mean and median age of the American population Decreasing consumer expectations related to health care outcomesAns: C Feedback: 13 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. A public health nurse has been commissioned to draft a health promotion program that meets the healthcare needs and expectations of the community. Which of the following focuses is most likely to influence the nurses choice of interventions? Management of chronic conditions and disability Increasing need for self-care among a younger population A shifting focus to disease management An increasing focus on acute conditions and rehabilitationAns: A Feedback: In response to current priorities, health care must focus more on management of chronic conditions and disability than in previous times. The other answers are incorrect because the change in focus of health care is not an increasing need for self-care among our aging population; our focus is shifting away from disease management, not toward it; and we are moving away from the management of acute conditions to managing chronic conditions. A community health nurse has witnessed significant shifts in patterns of disease over the course of a fourdecade career. Which of the following focuses most clearly demonstrates the changing pattern of disease in the United States? Type 1 diabetes management Treatment of community-acquired pneumonia Rehabilitation from traumatic brain injuries Management of acute Staphylococcus aureus infectionsAns: A Feedback: 14 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. The ANA has identified several phenomena toward which the focus of nursing care should be directed, and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstratesthese priorities? Encouraging the patients dependence on caregivers Fostering the patients ability to make choices Teaching the patient about nurses roles in the health care system Assessing the patients adherence to treatmentAns: B Feedback: The ANA identifies several focusesfor nursing care and research, including the ability to make choices. The other answers are incorrect because they are not phenomena identified by the ANA. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of health care. Which of the following activities are considered integral to the CNP role? Select all that apply. Educating patients and family members Coordinating care with other disciplines Using direct provision of interventions Educating registered nurses and practical nurses Coordinating payment plans for patientsAns: A, B, C Feedback: This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in home care and community nursing. Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to perform care, and by coordinating and collaborating with other disciplines to provide needed services. The other answers are incorrect because NPs do not commonly perform education of nurses and they do not focus on matters related to payment. 15 The ANA hasidentified 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? Teaching the public about the role of nursing Taking action to control the costs of health care Ensuring that all of his or her actions exemplify caring Making sure to carry adequate liability insuranceAns: C Feedback: The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a central tenet of nursing practice. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched within the past decade. In this role, the nurse should prioritize which of the following activities? Acting as a spokesperson for the nursing profession Generating and disseminating new nursing knowledge Diagnosing and treating health problems that have a predictable course Helping patients to navigate the health care systemAns: D Feedback: The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical leadership, educated to help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role. Our world is connected by a sophisticated communication system that makes much health information instantly accessible, no matter where the patient is being treated. This instant access to health information has impacted health care delivery strategies, including the delivery of nursing care. What is one way the delivery of health care has been impacted by this phenomenon? Brisk changes as well as swift obsolescence 16 Rapid change that is nearly permanent Limitations on the settings where care can be provided Increased need for social acceptanceAns: A Feedback: The sophisticated communication systems that connect most parts of the world, with the capability of rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift obsolescence in health care delivery strategies. The other answers are incorrect because, although we have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care itself evolves. Giving nursing care has not become easier, it becomes more complex with every change; and it does not need to be more socially acceptable; it needs to be more culturally sensitive. With the changing population of health care consumers, it has become necessary for nurses to workmore closely with other nurses, as when acute care nurses collaborate with public health and home health nurses. What nursing function has increased in importance because of this phenomenon? Prescribing medication Performing discharge planning Promoting family involvement Forming collegial relationships Ans: B Feedback: The importance of effective discharge planning and quality improvement cannot be overstated. The other answers are incorrect because giving medication and family involvement in the patients care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible.