TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS

TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS (COMPLETE ALL CHAPTERS) Which nursing intervention is considered an independent intervention? 1) Administering 1 L of dextrose 5% in normal saline solution at 100 mL/hour 2) Encouraging the postoperative client to perform coughing and deep breathing exercises 3) Explaining his diet to the client; then communicating the teaching with the dietitian 4) Administering morphine sulfate 2 mg IV to the client with postoperative pain ANS: 2 Chapter number and title: 6, Planning Interventions Chapter learning objective: Compare and contrast independent, dependent, and interdependent (collaborative) nursing interventions. Chapter page reference: p. 94 Heading: What Are Nursing Interventions? Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive level: Application [Applying] TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N Concept: Patient-Centered Care Difficulty: Moderate Feedback 1 Administering IV fluid is a dependent intervention; it requires an order from a physician or advanced practice nurse but is carried out by the nurse. 2 An independent intervention is one that nurses are licensed to prescribe, perform, or delegate based on their skills and knowledge. Encouraging the postoperative client to perform coughing and deep breathing exercises is an independent nursing intervention. 3 Explaining to the client how sodium intake affects his heart failure and then communicating the teaching with the dietitian is an interdependent (collaborative) intervention, one that is carried out in collaboration with other healthcare team members. 4 Administering morphine sulfate is a dependent intervention; it requires an order from a physician or advanced practice nurse but is carried out by the nurse. PTS: 1 CON: Patient-Centered Care 3. The nurse identifies the diagnosis of Acute Pain related to the postoperative abdominal incision and writes a nursing order to reposition the client in a comfortable position using pillows to splint or support the painful areas. What type of nursing intervention did the nurse write? 1) Collaborative 2) Interdependent 3) Dependent 4) Independent ANS: 4 Chapter number and title: 6, Planning Interventions Chapter learning objective: Compare and contrast independent, dependent, and interdependent (collaborative) nursing interventions. Chapter page reference: p. 94 Heading: What Are Nursing Interventions? Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate Feedback 1 A collaborative or interdependent intervention is one that is carried out in collaboration with other health team members, such as providing the client with a sodium-restricted diet. 2 A collaborative or interdependent intervention is one that is carried out in collaboration with other health team members, such as providing the client with a sodium-restricted diet. 3 A dependent intervention is prescribed by a physician or advanced practice nurse, for example, “Administer oxygen at 2 L/min via nasal cannula.” TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N 4 Writing an order to reposition the client in a comfortable position is an example of an independent nursing intervention, one that does not require a physician’s order. The nurse is licensed to prescribe, perform, or delegate the intervention based on her knowledge and skills. PTS: 1 CON: Patient-Centered Care 4. The nurse instructs a client scheduled for surgery on deep breathing and coughing exercises even though the client has no history of respiratory problems. Which type of nursing intervention did the nurse perform? 1) Health promotion 2) Treatment 3) Prevention 4) Assessment ANS: 3 Chapter number and title: 6, Planning Interventions Chapter learning objective: Explain how nursing interventions are determined by problem status (i.e., as actual or potential problems). Chapter page reference: p. 97 Heading: How Does Problem Status Influence Nursing Interventions? Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate Feedback 1 Health-promotion interventions promote a client’s efforts to achieve a higher level of wellness. 2 Treatment interventions treat disorders, relieve symptoms, and carry out medical orders. 3 The nurse teaches the client coughing and deep breathing exercises, which help prevent postoperative pneumonia. Therefore, the nurse is utilizing a prevention intervention. Prevention interventions are used to help prevent complications, such as postoperative pneumonia. 4 Assessment interventions detect changes in the client’s condition and detect potential problems. PTS: 1 CON: Patient-Centered Care 5. Which standardized intervention vocabulary was designed specifically for community health nurses? 1) Omaha System 2) Clinical Care Classification 3) Nursing Interventions Classification 4) International Classification for Nursing Practice ANS: 1 Chapter number and title: 6, Planning Interventions TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N Chapter learning objective: Explain how to use a standardized vocabulary for nursing interventions. Chapter page reference: p. 102 Heading: Standardized Languages for Home Health and Community Care Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive level: Knowledge [Remembering] Concept: Patient-Centered Care Difficulty: Easy Feedback 1 The Omaha System was designed specifically for community health nurses to use in caring for individuals, families, community groups, or entire communities. 2 The Clinical Care Classification was developed for home healthcare. 3 The Nursing Interventions Classification system is applicable in all settings, including home health and community nursing. 4 The International Classification for Nursing Practice system was designed to describe nursing practice of individuals, families, and communities worldwide. PTS: 1 CON: Patient-Centered Care 6. A patient returns to the medical–surgical unit after having a right hemicolectomy (abdominal surgery) for colon cancer. Which statement is an appropriate, correctly written nursing order for this patient? 1) 7/12/13 Encourage use of the incentive spirometer every hour while the client is awake—D. Goodman, RN 2) By 7/12/13, uses incentive spirometer 10 times every hour while awake to 1000 mL 3) Incentive spirometer hourly while awake 4) Offer incentive spirometer to the client—J. Smith, RN ANS: 1 Chapter number and title: 6, Planning Interventions Chapter learning objective: Write complete, detailed nursing orders, in correct format, for patients. Chapter page reference: p. 103 Heading: Components of a Nursing Order Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate Feedback 1 The option beginning with a date and ending with the RN’s signature contains necessary information. It contains the date the order was written along with specific instruction for the nurse that is written in terms of nursing behavior. 2 “Uses incentive spirometer 10 times . . .” is an example of an expected outcome. TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N 3 “Incentive spirometer hourly . . .” is an example of a medical order. Plus, the date and nurse’s signature are missing. 4 “Offer incentive spirometer . . .” does not provide the nurse with enough detailed instruction. Therefore, it is a poorly written nursing order. PTS: 1 CON: Patient-Centered Care 7. A client is admitted for control of diabetes. Which statement is an appropriate direct-care intervention for this client? 1) Consulting the diabetic nurse educator for help with a teaching plan 2) Making arrangements for the client to join a diabetic support group 3) Demonstrating blood glucose monitoring and insulin administration to the client 4) Consulting with the dietician about the client’s dietary concerns ANS: 3 Chapter number and title: 6, Planning Interventions Chapter learning objective: Compare and contrast independent, dependent, and interdependent (collaborative) nursing interventions. Chapter page reference: p. 94 Heading: What Are Nursing Interventions? Integrated Processes: Nursing Process Client Need: Physiological Integrity: Physiological Adaptation Cognitive level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate Feedback 1 Indirect-care activities are performed away from but on behalf of the client and include consulting the diabetic nurse educator. 2 Indirect-care activities are performed away from but on behalf of the client and include making arrangements for the client to join a diabetic support group. 3 Demonstrating blood glucose monitoring and insulin administration is an appropriate direct-care intervention for this client. Direct-care interventions are performed through intervention with the client and include interventions such as physical care, emotional support, and client teaching. 4 Indirect-care activities are performed away from but on behalf of the client and include consulting with the dietician about the client’s dietary concerns. PTS: 1 CON: Patient-Centered Care 8. Which definition best describes a critical pathway? 1) Standardized plan of care for frequently occurring conditions 2) Systematically developed statement to assist practitioners and patients in making decisions 3) Systematic review of clinical evidence for an intervention 4) Set of interrelated concepts that describes or explains something ANS: 1 Chapter number and title: 6, Planning Interventions TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N Chapter learning objective: Explain how theories, research, and evidence-based practice influence the choice of nursing interventions. Chapter page reference: p. 96 Heading: Types of Research-Based Support Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive level: Knowledge [Remembering] Concept: Patient-Centered Care Difficulty: Easy Feedback 1 Critical pathways are standardized plans of care for commonly occurring health conditions (e.g., myocardial infarction) for which similar outcomes and interventions are appropriate for the majority of patients with the condition. 2 Clinical practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate healthcare for a particular disease or procedure. 3 Evidence reports are systematic reviews on clinical topics for the purpose of providing evidence for guidelines, quality improvement, quality measures, and insurance coverage decisions. 4 A theory is a set of interrelated concepts that describe or explain something. PTS: 1 CON: Patient-Centered Care 9. The nurse identifies the diagnosis of Ineffective Breathing Pattern related to inability to maintain adequate rate and depth of respirations for a client with an acute respiratory problem resulting from lung disease. Which nursing intervention should be listed first on the care plan? 1) Determine airway adequacy hourly and as needed. 2) Administer oxygen as needed. 3) Monitor arterial blood gas values. 4) Place the client in a high Fowler’s position. ANS: 1 Chapter number and title: 6, Planning Interventions Chapter learning objective: Explain how nursing interventions are determined by problem status (i.e., as actual or potential problems). Chapter page reference: p. 95 Heading: How Do I Decide Which Interventions to Use? Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive level: Analysis [Analyzing] Concept: Patient-Centered Care Difficulty: Difficult Feedback 1 For any acute respiratory problem, prior to implementing interventions, the nurse would assess breathing status of the patient by checking respiratory rate and depth. 2 When devising a plan of care for the client, nursing interventions should be TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N listed according to priority. Airway always takes precedence, as oxygenation will be ineffective without a patent airway. 3 When devising a plan of care for the client, nursing interventions should be listed according to priority. Airway always takes precedence, as ventilation will be ineffective without a patent airway. 4 When devising a plan of care for the client, nursing interventions should be listed according to priority. Airway always takes precedence, as positioning will be ineffective without a patent airway. PTS: 1 CON: Patient-Centered Care 10. Who is the primary decision maker when caring for healthy adult clients? 1) Physician 2) Family 3) Client 4) Nurse ANS: 3 Chapter number and title: 6, Planning Interventions Chapter learning objective: Give an example of a standardized wellness (health promotion) intervention and one individualized nursing order for performing that intervention. Chapter page reference: p. 102 Heading: Does Standardized Language Interfere With Holistic Care? Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Patient-Centered Care Difficulty: Easy Feedback 1 The physician plays a role in health promotion and screening. 2 The family may give input, but the client is the decision maker. 3 The client is the primary decision maker in the care of healthy clients. 4 The nurse functions as a teacher and health counselor. PTS: 1 CON: Patient-Centered Care 11. The nurse identifies the diagnosis of Ineffective Breathing Pattern related to inability to maintain adequate rate and depth of respirations for a client with an acute episode of chronic obstructive pulmonary (lung) disease. After establishing care goals, what should the nurse do first when selecting nursing interventions? 1) Identify several interventions likely to achieve the desired outcomes. 2) Review the problem and etiology of the nursing diagnosis. 3) Choose the best interventions for the patient. 4) Review the goals she has written. ANS: 2 Chapter number and title: 6, Planning Interventions Chapter learning objective: Explain how nursing interventions are determined by problem status (i.e., as actual or potential problems). TEST BANK FOR BASIC NURSING 2ND EDITION BY TREAS TESTBANKWORLD.ORG N Chapter page reference: p. 97 Heading: What Process Can I Use for Generating and Selecting Interventions? Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive level: Analysis [Analyzing] Concept: Patient-Centered Care Difficulty: Difficult Feedback 1 The process of choosing interventions is to review the nursing diagnosis, review the desired outcomes, identify several interventions or actions, choose the best interventions for the patient, and then individualize standardized interventions to meet the patient’s unique needs. 2 The process of choosing interventions is to review the nursing diagnosis, review the desired outcomes, identify several interventions or actions, choose the best interventions for the patient, and then individualize standardized interventions to meet the patient’s unique needs. 3 The process of choosing interventions is to review the nursing diagnosis, review the desired outcomes, identify several interventions or actions, choose the best interventions for the patient, and then individualize standardized interventions to meet the patient’s unique needs. 4 The process of choosing interventions is to review the nursing diagnosis, review the desired outcomes, identify several interventions or actions, choose the best interventions for the patient, and then individualize standardized interventions to meet the patient’s unique needs. PTS: 1 CON: Patient-Centered Care 12. When using electronic care planning, the nurse enters the nursing diagnoses, chooses desired outcomes, and validates data, diagnosis, and goals. What should the nurse do if the computer generates interventions that are not appropriate for the client’s needs? 1) Reject them all and type in appropriate interventions. 2) Select the interventions from the program that are most suitable. 3) Ask another nurse to assess the patient and give a recommendation. 4) Restart the computer; it is probably a program malfunction.