Test Bank Fundamentals of Nursing 2nd Edition Yoost

Test Bank Fundamentals of Nursing 2nd Edition Yoost Chapter 01: Nursing, Theory, and Professional Practice MULTIPLE CHOICE 1. A group of nursing students are discussing the impact of no nursing theories in clinical practice. The students would be correct if they chose which theory to prioritize patient care? a. Erikson’s Psychosocial Theory b. Paul’s Critical-Thinking Theory c. Maslow’s Hierarchy of Needs d. Rosenstock’s Health Belief Model ANS: C Maslow’s hierarchy of needs specifies the psychological and physiologic factors that affect each person’s physical and mental health. The nurse’s understanding of these factors helps with formulating Nursing diagnoses that address the patient’s needs and values to prioritize care. Erikson’s Psychosocial Theory of Development and Socialization is based on individuals’ interacting and learning about their world. Nurses use concepts of developmental theory to critically think in providing care for their patients at various stages of their lives. Rosenstock (1974) developed the psychological Health Belief Model. The model addresses possible reasons for why a patient may not comply with recommended health promotion behaviors. This model is especially useful to nurses as they educate patients. DIF: Remembering OBJ: 1.5 TOP: Planning MSC: NCLEX Client Needs Category: Safe and effective Care Environment: Management of Care NOT: Concepts: Care Coordination 2. A nursing student is preparing study notes from a recent lecture in nursing history. The student would credit Florence Nightingale for which definition of nursing? a. The imbalance between the patient and the environment decreases the capacity for health. b. The nurse needs to focus on interpersonal processes between nurse and patient. c. The nurse assists the patient with essential functions toward independence. d. Human beings are interacting in continuous motion as energy fields. ANS: A Florence Nightingale’s (1860) concept of the environment emphasized prevention and clean air, water, and housing. This theory states that the imbalance between the patient and the environment decreases the capacity for health and does not allow for conservation of energy. Hildegard Peplau (1952) focused on the roles played by the nurse and the interpersonal process between a nurse and a patient. Virginia Henderson described the nurse’s role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person), with the goal of independence for the patient. Martha Rogers (1970) developed the Science of Unitary Human Beings. She stated that human beings and their environments are interacting in continuous motion as infinite energy fields. DIF: Understanding OBJ: 1.4 TOP: Planning MSC: NCLEX Client Needs Category: Health Promotion and Maintenance NOT: Concepts: Health Promotion 3. The nurse identifies which nurse established the American Red Cross during the Civil War? 1a. Dorothea Dix b. Linda Richards c. Lena Higbee d. Clara Barton ANS: D Clara Barton practiced nursing in the Civil War and established the American Red Cross. Dorothea Dix was the head of the U.S. Sanitary Commission, which was a forerunner of the Army Nurse Corps. Linda Richards was America’s first trained nurse, graduating from Boston’s Women’s Hospital in 1873, and Lena Higbee, superintendent of the U.S. Navy Nurse Corps, was awarded the Navy Cross in 1918. DIF: Remembering OBJ: 1.3 TOP: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance NOT: Concepts: Professionalism 4. The nursing instructor is researching the five proficiencies regarded as essential for students and professionals. The nursing instructor identifies which organization would be found to have added safety as a sixth competency? a. Quality and Safety Education for Nurses (QSEN) b. Institute of Medicine (IOM) c. American Association of Colleges of Nursing (AACN) d. National League for Nursing (NLN) ANS: A The Institute of Medicine report, Health Professions Education: A Bridge to Quality (2003), outlines five core competencies. These include patient-centered care, interdisciplinary teamwork, use of evidence-based medicine, quality improvement, and use of information technology. QSEN added safety as a sixth competency. The Essentials of Baccalaureate Education for Professional Nursing Practice are provided and updated by the American Association of Colleges of Nursing (AACN) (2008). The document offers a framework for the education of professional nurses with outcomes for students to meet. The National League for Nursing (NLN) outlines and updates competencies for practical, associate, baccalaureate, and graduate nursing education programs. DIF: Remembering OBJ: 1.1 TOP: Planning MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 5. The nurse manager is interviewing graduate nurses to fill existing staffing vacancies. When hiring graduate nurses, the nurse manager realizes that they will probably not be considered “competent” until they complete which task? a. They graduate and pass NCLEX. b. They have worked 2 to 3 years. c. Their last year of nursing school. d. They are actually hired. ANS: B Benner’s model identifies five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. The student nurse progresses from novice to advanced beginner during nursing school and attains the competent level after approximately 2 to 3 years of work experience after graduation. To obtain the RN credential, a person must graduate from an approved school of nursing and pass a state licensing examination called the National Council Licensure Examination for Registered Nurses (NCLEX-RN) usually taken soon after completion of an approved nursing program. DIF: Remembering OBJ: 1.7 TOP: Planning MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 26. The prospective student is considering options for beginning a career in nursing. Which degree would best match the student’s desire to conduct research at the university level? a. Associate Degree in Nursing (ADN) b. Bachelor of Science in Nursing (BSN) c. Doctor of Nursing Practice (DNP) d. Doctor of Philosophy in Nursing (PhD) ANS: D Doctoral nursing education can result in a Doctor of Philosophy (PhD) degree. This degree prepares nurses for leadership roles in research, teaching, and administration that are essential to advancing nursing as a profession. Associate Degree in Nursing (ADN) programs usually are conducted in a community college setting. The nursing curriculum focuses on adult acute and chronic disease; maternal/child health; pediatrics; and psychiatric/mental health nursing. ADN RNs may return to school to earn a bachelor’s degree or higher in an RN-to-BSN or RN-to-MSN program. Bachelor’s degree programs include community health and management courses beyond those provided in an associate degree program. A newer practice-focused doctoral degree is the Doctor of Nursing practice (DNP), which concentrates on the clinical aspects of nursing. DNP specialties include the four advanced practice roles of NP, CNS, CNM, and CRNA. DIF: Remembering OBJ: 1.9 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 7. During a staff meeting, the nurse manager announces that the hospital will be seeking Magnet status. To explain the requirements for this award, the nurse manager will contact which organization? a. American Nurses Association (ANA) b. American Nurses Credentialing Center (ANCC) c. National League for Nursing (NLN) d. Joint Commission ANS: B The American Nurses Credentialing Center (ANCC) awards Magnet Recognition to hospitals that have shown excellence and innovation in nursing. The ANA is a professional organization that provides standards of nursing practice. The National League for Nursing (NLN) outlines and updates competencies for practical, associate, baccalaureate, and graduate nursing education programs. The Joint Commission is the accrediting organization for health care facilities in the United States. DIF: Remembering OBJ: 1.1 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 8. The nurse is caring for a patient who refuses two units of packed red blood cells. When the nurse notifies the health care provider of the patient’s decision, the nurse is acting in which role? a. Manager b. Change agent c. Advocate d. Educator ANS: C As the patient’s advocate, the nurse interprets information and provides the necessary education. The nurse then accepts and respects the patient’s decisions even if they are different from the nurse’s own beliefs. The nurse supports the patient’s wishes and communicates them to other health care providers. A nurse manages all of the activities and treatments for patients. In the role of change agent, the nurse works with patients to address their health concerns and with staff members to address change in an organization 3or within a community. The nurse ensures that the patient receives sufficient information on which to base consent for care and related treatment. Education becomes a major focus of discharge planning so that patients will be prepared to handle their own needs at home. DIF: Applying OBJ: 1.2 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 9. The nursing student develops a plan of care based on a recently published article describing the effects of bed rest on a patient’s calcium blood levels. When creating the plan of care, the nursing student has the obligation to consider which action? a. Critically appraise the evidence and determine validity. b. Ensure that the plan of care does not alter current practice. c. Change the process even when there is no problem identified. d. Maintain the plan of care regardless of initial outcome. ANS: A Evidence-based practice (EBP) is an integration of the best-available research evidence with clinical judgment about a specific patient situation. The nurse assesses current and past research, clinical guidelines, and other resources to identify relevant literature. The application of EBP includes critically appraising the evidence to assess its validity, designing a change for practice, assessing the need for change and identifying a problem, and integrating and maintaining change while monitoring process and outcomes by reevaluating the application of evidence and assessing areas for improvement. DIF: Applying OBJ: 1.2 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 10. The nurse is delegating frequent blood pressure (BP) measurements for a patient admitted with a gunshot wound to a licensed practical nurse (LPN). When delegating, the nurse understands which fact? a. He/she may assume that the LPN is able to perform this task appropriately. b. The LPN is ultimately responsible for the patient findings and assessment. c. The LPN may perform the tasks assigned without further supervision. d. He/she retains ultimate responsibility for patient care and supervision is needed. ANS: D The RN retains ultimate responsibility for patient care, which requires supervision of those to whom patient care is delegated. In the process of collaboration, the nurse delegates certain activities to other health care personnel. The RN needs to know the scope of practice or capabilities of each health care member for delegation to be effective and safe. DIF: Understanding OBJ: 1.2 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 11. The nurse is preparing to discharge a patient admitted with fever of unknown origin. The patient states, “I never got past the fifth grade in school. Don’t read much. Never saw much sense in it. But I do OK. I can read most stuff. But my doctor explains things good and doesn’t think that my sickness is serious.” Considering this patient response, what action should the nurse carry out? a. Provide discharge medication information from a professional source to provide the most information. b. Expect that the patient may return to the hospital if the discharge process is poorly done. c. Assume that the physician and the patient have a good rapport and that the physician will clarify everything. d. Defer offering the patient the opportunity to sign up for wellness classes due to the 4low literacy rate. ANS: B Low health literacy is associated with increased hospitalization, greater emergency care use, lower use of mammography, and lower receipt of influenza vaccine. A goal of patient education by the nurse is to inform patients and deliver information that is understandable by examining their level of health literacy. The more understandable health information is for patients, the closer the care is coordinated with need. DIF: Applying OBJ: 1.2 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Health Promotion 12. A nurse is caring for a patient who lost a large amount of blood during childbirth. The nurse provides the opportunity for the patient to maintain her activity level while providing adequate periods of rest and encouragement. Which nursing theory would the nurse most likely choose as a framework for addressing the fatigue associated with the low blood count? a. Watson Human Caring Theory b. Parse’s Theory of Human Becoming c. Roy’s Adaptation Model d. Rogers’ Science of Unitary Human Beings ANS: C Roy’s Adaptation Model is based on the human being as an adaptive open system. The person adapts by meeting physiologic-physical needs, developing a positive self-concept–group identity, performing social role functions, and balancing dependence and independence. Stressors result in illness by disrupting the equilibrium. Nursing care is directed at altering stimuli that are stressors to the patient. The nurse helps patients strengthen their abilities to adapt to their illnesses or helps them to develop adaptive behaviors. Watson’s theory is based on caring, with nurses dedicated to health and healing. The nurse functions to preserve the dignity and wholeness of humans in health or while peacefully dying. Parse’s theory is called the Human Becoming School of Thought. Parse formulated the Theory of Human Becoming by combining concepts from Martha Rogers’ Science of Unitary Human Beings with existential-phenomenologic thought. This theory looks at the person as a constantly changing being, and at nursing as a human science. Martha Rogers (1970) developed the Science of Unitary Human Beings. She stated that human beings and their environments are interacting in continuous motion as infinite energy fields. DIF: Applying OBJ: 1.4 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Care Coordination 13. The nurse recognizes which nursing theorist who described the relationship between the nurse and the patient as an interpersonal and therapeutic process? a. Virginia Henderson b. Betty Neuman c. Imogene King d. Hildegard Peplau ANS: D Hildegard Peplau focused on the roles played by the nurse and the interpersonal process between a nurse and a patient. The interpersonal process occurs in overlapping phases: (1) orientation, (2) working, consisting of two subphases: identification and exploitation, and (3) resolution. Betty Neuman’s Systems Model includes a holistic concept and an open-system approach. The model identifies energy resources that provide for basic survival, with lines of resistance that are activated when a stressor invades the system. Virginia Henderson described the nurse’s role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person), with the ultimate goal of independence for the patient. Imogene King developed a general systems framework that incorporates three levels of systems: (1) individual or personal, (2) group or interpersonal, and (3) society or social. 5The theory of goal attainment discusses the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space. In this theory, both the nurse and the patient work together to achieve the goals in the continuous adjustment to stressors. DIF: Remembering OBJ: 1.4 TOP: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation NOT: Concepts: Health Promotion 14. When a nursing class volunteers to serve hot meals at a local homeless shelter on a Saturday afternoon, which term identifies this focus on serving the community? a. Altruism b. Accountability c. Autonomy d. Advocate ANS: A A profession provides services needed by society. Additionally, practitioners’ motivation is public service over personal gain (altruism). Service to the public requires intellectual activities, which include responsibility. This accountability has legal, ethical, and professional implications. Members of a profession have autonomy in decision making and practice and are self-regulating in that they develop their own policies in collaboration with one another. As the patient’s advocate, the nurse interprets information and provides the necessary education. The nurse then accepts and respects the patient’s decisions even if they are different from the nurse’s own beliefs. DIF: Understanding OBJ: 1.6 TOP: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance NOT: Concepts: Health Promotion 15. A patient is being discharged from the hospital with wound care dressing changes. The nurse recommends a referral for home health nursing care. The nurse is using which standard of practice? a. Assessment b. Diagnosis c. Planning d. Implementation ANS: C As a care provider, the nurse follows the nursing process to assess patient data, prioritize Nursing diagnoses, plan the care of the patient, implement the appropriate interventions, and evaluate care in an ongoing cycle. In recommending a referral, the nurse is, in effect, planning care. DIF: Applying OBJ: 1.2 TOP: Planning MSC: NCLEX Client Needs Category: Physiological Integrity: Basic Care and Comfort NOT: Concepts: Care Coordination 16. The nurse administers a medication to the patient and then realizes that the medication had been discontinued. The error is immediately reported to the physician. The nurse recognizes which term that identifies complying with the standards of professional performance? a. Ethics b. Socialization c. Altruism d. Autonomy ANS: A 6Guiding the nurse’s professional practice are ethical behaviors. Ethics is the standards of right and wrong behavior. The main concepts in nursing ethics are accountability, advocacy, autonomy (be independent and self-motivated), beneficence (act in the best interest of the patient), confidentiality, fidelity (keep promises), justice (relate to others with fairness and equality), nonmaleficence (do no harm), responsibility, and veracity (be truthful). Ethical guidelines direct the nurse’s decision making in routine situations and in ethical dilemmas. Socialization to professional nursing is a process that involves learning the theory and skills necessary for the role of nurse. A profession provides services needed by society. Additionally, practitioners’ motivation is public service over personal gain (altruism). Members of a profession have autonomy in decision making and practice and are self-regulating in that they develop their own policies in collaboration with one another. DIF: Applying OBJ: 1.6 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control NOT: Concepts: Ethics 17. A newly licensed registered nurse is curious about the scope of care that he or she has in caring for patients undergoing conscious sedation. Which would be the best source of information for this nurse? a. National Student Nurses Association b. Nurse Practice Act c. ANA Standards of Professional Performance d. National League for Nursing ANS: B Nurse practice acts provide the scope of practice defined by each state or jurisdiction and set forth the legal limits of nursing practice. Nursing organizations enable the nurse to have access to current Information and resources as well as a voice in the profession. Nursing organizations include the ANA, the NLN, the ICN, Sigma Theta Tau International Honor Society of Nursing, and the National Student Nurses Association (NSNA). DIF: Remembering OBJ: 1.7 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Health Care Law 18. The nursing student is writing a paper about the direct patient care role of advanced practice nurses. Which advanced practice role would the student include in the report? a. Nurse Administrator b. Clinical Nurse Leader c. Clinical Nurse Specialist d. Nurse Educator ANS: C There are four specialties in which nurses provide direct patient care in advanced practice roles: certified nurse midwife (CNM), nurse practitioner (NP), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA). Four additional advanced practice roles that do not always involve direct patient care are clinical nurse leader (CNL), nurse educator, nurse researcher, and nurse administrator. DIF: Remembering OBJ: 1.9 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Health Care Law 19. The nurse is determining the patient care assignments for a nursing unit. The nurse knows which responsibility may be delegated to the licensed practical nurse? a. Initiating the nursing care plans b. Formulating Nursing diagnoses 7c. Assessing a newly admitted patient d. Administering oral medications ANS: D LPNs, or LVNs in California and Texas, are not RNs. They complete an educational program consisting of 12 to 18 months of training, and then they must pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN) to practice as an LPN/LVN. They are under the supervision of an RN in most institutions and are able to collect data but cannot perform an assessment requiring decision making, cannot formulate a Nursing diagnosis, and cannot initiate a care plan. They may update care plans and administer medications except for certain IV medications. DIF: Applying OBJ: 1.9 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Health Care Law 20. The nursing student is taking a class in Nursing Research. In class the student has learned which term that identifies the most abstract level of knowledge? a. Metaparadigm b. Philosophy c. Conceptual framework d. Nursing theory ANS: A A metaparadigm, as the most abstract level of knowledge, is defined as a global set of concepts that identify and describe the central phenomena of the discipline and explain the relationship between those concepts. For example, the metaparadigm for nursing focuses on the concepts of person, environment, health, and nursing. The next level of knowledge is a philosophy, which is a statement about the beliefs and values of nursing in relation to a specific phenomenon such as health. The third level of knowledge is a nursing conceptual framework, or model, which is a collection of interrelated concepts that provides direction for nursing practice, research, and education. The fourth level of nursing knowledge is a nursing theory, which represents a group of concepts that can be tested in practice and can be derived from a conceptual model. DIF: Remembering OBJ: 1.4 TOP: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance NOT: Concepts: Professionalism MULTIPLE RESPONSE 1. The nurse recognizes which statements contribute to the understanding that nursing is considered a profession? (Select all that apply.) a. Nursing requires specialized training. b. Nursing has a specialized body of knowledge. c. The ANA regulates nursing practice. d. Nurses make independent decisions within their scope of practice. e. Once licensure is complete, no further education is required. ANS: A, B, D A profession is an occupation that requires at a minimum specialized training and a specialized body of knowledge. Nursing meets these minimum requirements. Thus nursing is considered to be a profession. Members of a profession have autonomy in decision making and practice and are self-regulating in that they develop their own policies in collaboration with one another. Nursing professionals make independent decisions within their scope of practice and are responsible for the results and consequences of those decisions. A profession is committed to competence and has a legally recognized license. Members are accountable for continuing their education. The ANA is a professional organization that provides standards 8(not regulation) of nursing practice. DIF: Remembering OBJ: 1.6 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Professionalism 2. The Institute of Medicine (IOM) Report identified several goals for nursing in the United States. The nurse identifies that the IOM offered which suggestions? (Select all that apply.) a. Nurses should practice to the full extent of their education. b. Nursing education should demonstrate seamless progression. c. Nurses should continue to be subservient to physicians in the hospital setting. d. Policy making requires better data collection and information infrastructure. e. Higher levels of education will not be needed by practicing nurses. ANS: A, B, D The Future of Nursing: Leading Change, Advancing Health (IOM, 2011) identified several goals for nursing in the United States: nurses should practice to the full extent of their education and training; Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States; and Effective workforce planning and policy making require better data collection and an improved information infrastructure. DIF: Remembering OBJ: 1.1 TOP: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance NOT: Concepts: Professionalism 3. The nurse is caring for a patient admitted for the removal of an infected appendix. Which actions by the nurse would indicate an understanding of the 2018 hospital safety goals? (Select all that apply.) a. Places an identification band on the right arm. b. Marks the surgical site with a black-felt pen. c. Checks medications three times before administration. d. Washes hands between patients and/or when soiled. e. Removes allergy bands prior to transfer to surgery. ANS: A, B, C, D The Joint Commission identifies each category and has specific elements of performance that are required for the health care worker to meet the goals. As new problems in patient care emerge, the safety goals are reassessed and revised. The 2018 hospital goals include the following broad categories: improve the accuracy of patient identification, improve the effectiveness of communication among caregivers, improve the safety of using medications, reduce the harm associated with clinical alarm systems, reduce the risk of health care– associated infections. The organization identifies safety risks inherent in its patient population. Improve the accuracy of patient identification. (Placing an ID band on the right are), improve the safety of using medications (check medications three times before administration), reduce the risk of health care–associated infections. (Washing hands), and the organization identifies safety risks inherent in its patient population. (Mark the surgical site with a black-felt pen) are all examples of actions that comply with the 2018 safety goals. Removing allergy bands would prevent identification of that patient’s safety risk. DIF: Applying OBJ: 1.1 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control NOT: Concepts: Care Coordination 4. The nurse is conducting a health assessment on a patient from a foreign country. Which concepts should be addressed by the nurse during the interview? (Select all that apply.) a. Food preferences 9b. Religious practices c. Health beliefs d. Family orientation e. Politics ANS: A, B, C, D Culture is the integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. DIF: Applying OBJ: 1.7 TOP: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Care Coordination 5. The nurse documents that patient laboratory results often take 4 hours to populate into the electronic medical record. The lengthy time frame has contributed to delayed antibiotic administration. From this point, what should the nurse do to produce change using Evidence-Based practice? (Select all that apply.) a. Identify a problem affecting patient care. b. Realize the facility resources may influence the decision. c. Review pertinent journal articles from the literature search. d. Apply the findings to clinical practice considering patient preferences. e. Using the process recommended by the best clinical article. ANS: A, B, C, D The process of using evidence-based practice (EBP) starts with the identification of a problem. The nurse then conducts a literature search to find the best evidence pertaining to the problem. Facility resources may impact the ability to implement the chosen decision. Patient preferences need to be incorporated into the use of evidence from the literature combined with clinical expertise. The nurse would not use just one clinical article to determine a solution to the issue. DIF: Applying OBJ: 1.2 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Evidence 10Chapter 02: Values, Beliefs, and Caring MULTIPLE CHOICE 1. The nurse identifies the concept of enduring ideas about what a person considers desirable or has worth in life is known by which term? a. Values b. First-order belief c. Higher-order belief d. Stereotype ANS: A Values are enduring ideas about what a person considers is the good, the best, and the “right” thing to do and their opposites—the bad, worst, and wrong things to do—and about what is desirable or has worth in life. First-order beliefs serve as the foundation or the basis of an individual’s belief system. Higher-order beliefs are ideas derived from a person’s first-order beliefs through inductive or deductive reasoning. A stereotype is a belief about a person, a group, or an event that is thought to be typical of all others in that category. DIF: Remembering OBJ: 2.1 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Professionalism 2. A group of nursing students are discussing the history of nursing to a staff nurse. When a student states, “Yeah, nurses used to be called doctors’ handmaidens.” the staff nurse recognizes that this comment is identified by which term? a. Prejudice b. Generalization c. Stereotype d. Belief ANS: C A stereotype is a belief about a person, a group, or an event that is thought to be typical of all others in that category. A prejudice is a preformed opinion, usually an unfavorable one, about an entire group of people that is based on insufficient knowledge, irrational feelings, or inaccurate stereotypes. In the process of learning, people form generalizations (general statements or ideas about people or things) to relate new information to what is already known and to categorize the new information, making it easier to remember or understand. A belief is a mental representation of reality or a person’s perceptions about what is right (correct), true, or real, or what the person expects to happen in a given situation. DIF: Understanding OBJ: 2.1 TOP: Evaluation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Professionalism 3. A values system is a set of somewhat consistent values and measures that are organized hierarchically into a belief system on a continuum of relative importance. The nurse knows that a value system is also identified by which concept? a. It is culturally based. b. It is unique to each individual. c. It is a poor basis for making decisions. d. It is rigid and uniform within a culture. ANS: A Anthropologists and social scientists have noted that in every culture, a particular value system prevails and consists of culturally defined moral and ethical principles and rules that are learned in childhood. 11Everyone possesses a relatively small number of values and may share the same values with others, but to different degrees. A value system helps the person choose between alternatives, resolve values conflicts, and make decisions. Within every culture, however, values vary widely among subcultural groups and even between individuals on the basis of the person’s gender, personal experiences, personality, education, and many other variables. DIF: Remembering OBJ: 2.1 TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 4. The nurse is caring for a patient who is under arrest for murder and is attempting to perform nursing care duties while, at the same time, feeling a sense of repugnance toward the patient. The nurse recognizes this situation is identified by which term? a. Value clarification b. Value conflict c. First-order beliefs d. Higher-order beliefs ANS: B A values conflict occurs when a person’s values are inconsistent with his or her behaviors or when the person’s values are not consistent with the choices that are available. Providing care for a convicted murderer may elicit troubling feelings for a nurse, resulting in a values conflict between the nurse’s commitment to care for all people and a personal repugnance for the act of murder. First-order beliefs serve as the foundation or the basis of an individual’s belief system. Higher-order beliefs are ideas derived from a person’s first-order beliefs, inductive, or syllogistic reasoning. DIF: Understanding OBJ: 2.1 TOP: Diagnosis MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 5. While helping patients with values clarification and care decisions, the nurse should complete which action? a. Convince the patient to do what the nurse believes is best. b. Give advice about what the nurse would do. c. Tell the patient what the right thing to do is. d. Provide information so the patient can make informed decisions. ANS: D While helping patients with values clarification and care decisions, nurses must be aware of the potential influence of their professional nursing role on patient decision making. Nurses should be careful to assist patients to clarify their own values in reaching informed decisions. Providing information to patients so that they can make informed decisions is a critical nursing role. Giving advice or telling patients what to do in difficult circumstances is both unethical and ill-advised. DIF: Applying OBJ: 2.2 TOP: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 6. A patient with terminal cancer says to the nurse, “I just don’t know if I should allow CPR in the event I quit breathing. What do you think?” Which statement by the nurse would be most beneficial to the patient? a. “If it were me, I would want to live no matter what.” b. “Don’t worry. You have plenty of time to decide that later on.” c. “It’s totally up to you. Have you discussed this with your family?” d. “Let’s talk about what CPR means to you.” ANS: D The use of the value clarification process is helpful when assisting patients in making health care decisions regarding end-of-life care. Giving advice or telling patients what to do is unethical and not recommended. Ignoring a patient concern or changing the subject is inappropriate. Patients should be given factual 12information in order for them to make their own decisions. DIF: Applying OBJ: 2.2 TOP: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 7. The nurse is observed sitting at the bedside of a patient discussing the nursing care plan for the shift. The nurse identifies which theory or model most accurately reflects this nurse–patient relationship? a. Swanson’s Theory of Caring b. Travelbee’s human-to-human relationship model c. Watson’s Theory of Caring d. Leininger Cultural Care Theory ANS: A Swanson’s five caring processes include being with and enabling. Sitting at the bedside and sharing information are activities that exemplify these behaviors. Travelbee’s model describes steps toward compassionate and empathetic care. Watson’s Theory of Caring impacts both the person and the universe and is built upon 10 caritas processes. Leininger describes patient care and its relationship to cultural diversity. DIF: Understanding OBJ: 2.4 TOP: Diagnosis MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 8. The student nurse is planning care for a patient who believes that Western medicine is effective but not always accurate and recognizes which nursing theory would best explain the patient’s health practices? a. Nursing: Human Science and Human Care b. Theory of Cultural Care Diversity and Universality c. Theory of Nursing as Caring d. Five caring processes ANS: B Leininger describes patient care and its relationship to cultural diversity. Swanson’s five caring processes include maintaining belief, knowing, being with, doing for, and enabling. In the Theory of Nursing as Caring, Boykin & Schoenhofer, note that caring is defined as “the intentional and authentic presence of the nurse with another who is recognized as person living caring and growing in caring.” Watson’s Theory of Human Science and Human Care impacts both the person and the universe and is built upon 10 caritas processes. DIF: Understanding OBJ: 2.4 TOP: Diagnosis MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 9. The nurse identifies which nursing theorist/theorists who describes/describe the nurse– patient relationship as a situation in which the nurse and patient share the lived experience of caring? a. Kristen Swanson b. Jean Watson c. Madeleine Leininger d. Anne Boykin & Savina Schoenhofer ANS: D In the Theory of Nursing as Caring (Boykin & Schoenhofer, 2015), caring is defined as “the intentional and authentic presence of the nurse with another who is recognized as person living caring and growing in caring” (Boykin & Schoenhofer, 2001, p. 13), and “the general intention of nursing as a practiced discipline is nurturing persons living caring and growing in caring” (Boykin & Schoenhofer, 2015, p. 343). One of the major concepts of the theory is the nursing situation in which the nurse and patient share the lived experience of caring. It is in this nursing situation that nursing is created and can best be understood. The model has been 13used in a variety of settings to guide practice, education, and research. Leininger describes patient care and its relationship to cultural diversity. Swanson’s five caring processes include maintaining belief, knowing, being with, doing for, and enabling. Watson’s Theory of Human Science and Human Care impacts both the person and the universe and is built upon 10 caritas processes. DIF: Remembering OBJ: 2.4 TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 10. The nurse on a busy medical–surgical floor contacts a social worker requesting a home care referral prior to a patient’s discharge. This action is best illustrated by which of Swanson’s five caring processes? a. Enabling b. Knowing c. Doing for d. Being with e. Maintaining belief ANS: A Advocating for a patient’s post-hospitalization care is an enabling process. Enabling also includes informing, anticipating, and preparing for the future. Swanson’s five caring processes also include maintaining belief, knowing, being with, and doing for. DIF: Remembering OBJ: 2.4 TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 11. Which action observed by a nurse manager is not indicative of the qualities and behaviors of caring? a. A staff nurse orders extra desserts for a patient diagnosed with morbid obesity. b. A medication nurse administers scheduled pain medication to patients as ordered. c. A respiratory therapist teaches a patient’s spouse how to adjust an oxygen mask. d. A nursing assistant encourages a patient to assist with the morning bath. ANS: A Caring includes demonstrating to the patient and significant others “authentic concern”. Giving extra dessert for a morbidly obese patient, even if the patient is asking for them, does not show authentic concern for the patient, the patient’s conditions, and the possible consequences of the condition. Giving pain medications on time, teaching a spouse how to help provide care, and encouraging self-care all demonstrate this authentic concern. DIF: Evaluating OBJ: 2.6 TOP: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity: Basic Care and Comfort NOT: Concepts: Caregiving 12. The nurse recognizes that when developing a nursing practice, it is important for the nurse to: carry out which action? a. Be exposed to negative as well as positive role models. b. Avoid negative role models as much as possible. c. Understand that caring and compassion are taught in class. d. Consider another profession if he/she is not naturally compassionate. ANS: A Nurses develop caring skills through life experiences, educational activities, observation of both positive and negative role models, and interaction with strong professional mentors. Although there has been disagreement in the past about whether or not it is possible to teach values— specifically caring, recent research suggests that care, compassion, and empathy can be taught. DIF: Applying OBJ: 2.5 TOP: Implementation 14MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Caregiving 13. The nurse is discussing the use of a values clarification tool with a patient. The patient asks, “What is the goal of the values clarification tool?” Which is the best response by the nurse? a. “The tool will help change your value system so that you can make the right decision.” b. “The tool will dispel your current beliefs and formulate brand new ones.” c. “The tool will assist you in prioritizing your value preferences and help you make decisions.” d. “The tool allows you to make decisions without the need of self-awareness.” ANS: C Values clarification is a process used to help people reflect on, clarify, and prioritize personal values to increase self-awareness or to make decisions. Nurses can use values clarification to help patients identify the nature of a conflict and reach a decision based on their values. DIF: Understanding OBJ: 2.2 TOP: Evaluation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Caregiving 14. The nurse knows providing care that is consistent and predictable can make the health care experience less intimidating for the patient. What additional action can the nurse take to enhance this experience? a. Explaining what is going to take place beforehand b. Never making promises to patients c. Assuring the patient that his/her requests will get done eventually d. Protecting the patient from knowing why things are happening ANS: A Care should be delivered in a way that conveys competence. Patients become alarmed when they detect that their nurse is unfamiliar with a procedure. It is best to seek assistance with any procedure or skill that the nurse cannot safely accomplish alone. Every task-oriented procedure should be explained to a patient, followed by feedback indicating patient understanding, before care is initiated. The remaining three actions do not reduce patients’ feelings of intimidation. DIF: Applying OBJ: 2.6 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Caregiving 15. When planning to change a dressing on an anxious patient, the nurse recognizes which to be the best approach? a. Ask another staff member to perform the task. b. Tell the patient the dressing change will take 30 minutes. c. Schedule a time in collaboration with the patient. d. Review the physician’s order prior to the procedure. ANS: C Setting up a schedule to perform tasks helps to relieve patient anxiety and promotes a sense of security. Explaining the procedure and reviewing physician orders should be completed after establishing a schedule. Asking another staff member to change the dressing may increase patient anxiety. DIF: Applying OBJ: 2.6 TOP: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Caregiving 16. Collaborating effectively with patients to find treatment methods that are congruent with the patients’ belief systems and that promote healthy outcomes is an approach that requires the 15nurse to include which activity? a. Focus on patient values only and disregard family desires in setting goals. b. Rely more and more on their scientific background. c. Listen carefully to how the patient’s beliefs impact their health beliefs. d. Understand that the nurse’s beliefs are the most important. ANS: C Nurses must collaborate effectively with patients to find treatment methods that are congruent with the patients’ belief systems and that promote healthy outcomes. This approach requires excellent assessment skills and a willingness to listen carefully to determine how patients’ personal beliefs impact their health beliefs. Failure to consider the patient’s belief systems may result in ineffective implementation of the plan of care. DIF: Applying OBJ: 2.3 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Caregiving 17. The nurse is caring for a patient scheduled for heart surgery. Which statement made by the patient requires further discussion? a. “My friend died on the operating table several months ago.” b. “The surgeon has a great reputation in the community.” c. “I believe that this surgery is going to make me better.” d. “Yesterday I asked my pastor to visit me after the procedure.” ANS: A Personal beliefs are one of the most important factors in determining how a person responds to a health problem and its treatment. The patient has a concern about the possibility of dying during the surgery based on prior experiences. The nurse should further explore the concern and determine the patient’s true meaning of the statement. Failure to consider the patient’s belief systems may result in ineffective implementation of the plan of care. Belief in the surgeon’s reputation, the success of the surgery, and the patient’s ability to visit after the surgery indicates a positive belief. DIF: Analyzing OBJ: 2.3 TOP: Analysis MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Coping 18. The nurse recognizes that a vital aspect of providing effective and appropriate nursing care is being able to actively listen to a patient and then demonstrates this concept when carrying out which activity? a. Pays attention as if in a social conversation with the patient. b. Practices and develops this skill over many years. c. Focuses on what the patient is saying. d. Passively listens with the ears. ANS: B A vital aspect of providing effective and appropriate nursing care is being able to actively listen to a patient in a way that conveys understanding, sensitivity, and compassion. Caring involves interpersonal relationships and communication skills that require paying more attention to the details of communication than would be necessary in a social conversation. This type of listening is a highly developed skill that usually takes a great deal of time and many years of experience to acquire. It can be learned with practice and enhanced with sensitivity and attention to the feedback that is received during each interaction. In a caring nurse–patient relationship, the nurse takes responsibility for establishing trust, making sure that the lines of communication are open and that the nurse accurately understands not only what the patient is saying, but also that the nurse is clearly understood. Active listening means paying careful attention and using all of the senses to listen rather than just passively listening with the ears. It requires energy and concentration and involves hearing the entire message— what the patient means as well as what the patient says. This type of listening focuses solely on the patient and conveys respect and interest. 16DIF: Applying OBJ: 2.6 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Caregiving 19. The nurse is caring for a patient with lung disease. The patient tells the nurse that the most important thing to do during the shift is to walk down to the nurses’ station and back without having shortness of breath. The patient’s request is an example of which nursing theory? a. Leininger’s Cultural Care Theory b. Boykin & Schoenhofer’s Theory of Nursing as Caring c. Swanson’s Theory of Caring d. Watson’s Human Science and Human Care Theory ANS: C Swanson’s Theory of Caring is composed of five interrelated caring processes: having faith in the ability of others to have meaningful lives; striving to understand the meaning of events in other’s lives; being emotionally present to the other person; doing for others what they would do if possible and facilitating or enabling the capacity of others to help themselves and their families. The patient’s goal to walk without breathing problems is an example of the enabling process. Leininger’s Cultural Care Theory centers on cultural practices that influence patient care. Boykin & Schoenhofer’s theory focuses on the intentional and authentic presence of the nurse with another who is recognized as a person living caring and growing in caring. Watson’s theory describes holistic care and focuses on caritas processes such as instilling faith and hope, promoting and accepting positive and negative feelings, and developing a helping-trust relationship. DIF: Remembering OBJ: 2.4 TOP: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation NOT: Concepts: Caregiving 20. When the nurse is dealing with the concept of beliefs and values, the nurse recognizes which type is based in the unconscious? a. Zero-order beliefs b. First-order beliefs c. Higher-order beliefs d. Prejudices ANS: A Three types of beliefs are recognized: zero-order beliefs, most of which are unconscious, such as object permanence; first-order beliefs, which are conscious, typically based on direct experiences; and higher- order beliefs, which are generalizations or ideas that are derived from first-order beliefs and reasoning. A prejudice is a preformed opinion, usually an unfavorable one, about an entire group of people that is based on insufficient knowledge, irrational feelings, or inaccurate stereotypes. DIF: Remembering OBJ: 2.1 TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Cognition MULTIPLE RESPONSE 1. A nurse working in a dermatology clinic observes that a patient of Mexican-American descent typically arrives 10 to 15 minutes late to every appointment. Based on an understanding of first- order beliefs, what characteristics can the nurse associate with this level of beliefs? (Select all that apply.) a. First-order beliefs serve as the basis of a person’s belief system. b. First-order beliefs begin to develop in early adolescence. c. First-order beliefs are completely formed in childhood. d. People seldom question their first-order beliefs. 17e. Challenging a patient’s first-order beliefs may cause cognitive upset. ANS: A, D, E First-order beliefs serve as the foundation or the basis of an individual’s belief system. People begin developing first-order beliefs about what is correct, real, and true in early childhood directly through experiences and indirectly from information shared by authority figures such as parents or teachers. People continue to develop first-order beliefs into adulthood through both direct experiences and the acquisition of knowledge from a vast number of sources with various degrees of expertise and levels of influence. People seldom question their first-order beliefs and rarely replace one, because to do so would require a great deal of rethinking about both that belief and similar or closely associated beliefs. Remember that presenting information to patients that challenges their first-order beliefs may cause a great deal of emotional or cognitive upset. DIF: Remembering OBJ: 2.2 TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 2. When dealing with patient who has a values conflict in which substance abuse or an addiction is involved, the nurse should conduct an assessment interview and use which techniques that will make the interview most effective? (Select all that apply.) a. Listen for subtle signs of denial. b. Directly confront the patient about his drug abuse. c. Use a matter-of-fact approach to inform the patient. d. Provide straightforward information. e. Avoid direct confrontation. ANS: A, C, D, E The most effective approach for dealing with a values conflict in which substance abuse or an addiction is involved is to begin with an assessment interview, during which the nurse should: listen for the subtle signs of denial, avoid direct confrontation, use a matter-of-fact approach to inform the patient of the reality of the consequences of the harmful behavior, and provide straightforward information about the effects of the substance abuse. DIF: Applying OBJ: 2.2 TOP: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Professionalism 3. Caring, according to the American Nurses Association (ANA) Code of Ethics (2015), is having concern or regard for that which affects the welfare of another. The nurse recognizes that as a profession, nursing can trace its earliest beginnings to what types of nurturing activities that demonstrate care? (Select all that apply.) a. Active listening b. Advocating for the vulnerable c. Valuing all individuals d. Separating healing from spirit e. Attempting to relieve pain ANS: A, B, C, E Caring, according to the American Nurses Association (ANA) Code of Ethics, is having concern or regard for that which affects the welfare of another. As a profession, nursing can trace its earliest beginnings to the types of nurturing activities that demonstrate care, such as taking time to be with a suffering person, actively listening, advocating for the vulnerable, valuing and respecting all individuals, attempting to relieve pain, and making the healing process an act of the body, mind, and spirit. DIF: Remembering OBJ: 2.6 TOP: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity: Basic Care and Comfort NOT: Concepts: Caregiving 4. Touch is the intentional physical contact between two or more people and it is deemed to be an essential and universal component of nursing care. The nurse knows that task-oriented 18touch occurs during which activities? (Select all that apply.) a. Holding the patient’s hand during a painful procedure b. Giving the patient an injection to treat discomfort c. Starting an intravenous (IV) line for fluid administration d. Inserting a nasogastric tube to decompress the patient’s stomach e. Shaking the patient’s hand in order to establish rapport ANS: B, C, D Task-oriented touch includes performing nursing interventions such as giving treatments, changing dressings, suctioning an endotracheal tube, giving an injection, starting an IV line, or inserting an NG tube. Task-oriented touch should be done gently, skillfully, and in a way that conveys competence. Patients become alarmed when they detect that their nurse is unfamiliar with a procedure. It is best to seek assistance with any procedure or skill that the nurse cannot safely accomplish alone. Every task-oriented procedure should be explained to a patient, followed by feedback indicating patient understanding, before care is initiated. Caring touch is considered by most people to be a valuable means of nonverbal communication. In today’s highly technical world of nursing, caring touch is an essential aspect of patient-centered care. Caring touch can be used to soothe, comfort, establish rapport, and create a bond between the nurse and the patient. Care may be conveyed by holding the hand of a patient during a painful or frightening procedure or when delivering bad news. This is an important way nurses let patients know that they are not alone and that another human being cares. DIF: Applying OBJ: 2.6 TOP: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Caregiving 5. The nurse recognizes that after several years of work in the emergency room, compassion fatigue has developed. What symptoms associated with this condition would the nurse be experiencing? (Select all that apply.) a. Chronic depression b. Sleeping all the time c. Anorexia d. Poor concentration e. Feeling detached from patients f. Euphoria ANS: A, D, E Compassion fatigue is an extreme state of distress experienced as the progressive and cumulative result of exposure to stress in the therapeutic use of self in caring for others. Compassion fatigue involves the nurse experiencing a feeling of being unable to meet the needs of patients arising from the inability to alleviate suffering. Compassion fatigue may result in feelings of vulnerability, anxiety, depression, and anger. Left unrecognized, compassion fatigue can produce physical and mental exhaustion manifested by difficulty sleeping, poor concentration, and low morale; and it can lead to compulsive behaviors, such as substance abuse. Nurses experiencing compassion fatigue often detach themselves from patients, have a higher risk of making errors, exercise poor judgment, and experience difficulty in maintaining interprofessional relationships. DIF: Understanding OBJ: 2.7 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care NOT: Concepts: Caregiving Chapter 03: Communication MULTIPLE CHOICE 191. The nurse is caring for an adult patient with a recent below-the-knee amputation. During shift report, the nurse reports that the patient has urinated in the bed multiple times since the surgery. The nurse knows which defense mechanism best describes this behavior? a. Compensation b. Denial c. Rationalization d. Regression ANS: D Regression is the return to an earlier developmental stage as a means of avoiding unpleasant or unacceptable thoughts. The adult patient recently lost a limb and reverted to bedwetting as a coping mechanism. Compensation refers to a strategy that uses a personal strength to counterbalance a weakness or a feeling of inadequacy. Refusing to accept a fact or reality as truth is termed denial. Rationalization is the act of suggesting a different explanation for one that is painful, negative, or unacceptable. DIF: Understanding OBJ: 3.8 TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Coping