Test Bank for Canadian Fundamentals of Nursing 6th Edition by Potter

1. You are a nurse re- searcher interviewing se- nior oncology nurses, asking them to describe how they deal with the loss of a patient. The analysis of the interviews yields common themes describing the nurses' grief. This is an example of which type of study? 2. An operating room nurse is talking with colleagues during a meeting. She asks, "I wonder if we would see fewer wound infections if we used chlorhexidine instead of povidone-iodine to clean the skin of our surgical patients? What does the P represent in this exam- ple of a PICOT question? 3. A nurse researcher is de- signing an exercise study that involves 100 pa- tients who attend a well- ness clinic. As the pa- tients come to the clinic, each has a choice as to whether he or she wants to be in the new exercise program or remain in the traditional program. The Qualitative study. (A qualitative study involves inductive reason- ing to develop generalizations or theories from specific observations or interviews. Historical re- search establishes facts and relationships con- cerning past events. Correlational research is exploration of the interrelationships among vari- ables of interest without any intervention by the researcher. An experimental study involves the use of tightly controlled subject groups, variables, and procedures to eliminate bias and ensure that findings can be generalized to similar groups of subjects.) Surgical patients. (Surgical patients are the patient population of interest (P) in the PICOT (patient population, in- tervention, comparison, outcome, time) question. The intervention is the cleaning of the skin, and the comparison of interest is between chlorhex- idine use and povidone-iodine use. Operating room nurses are not an element of the PICOT question.) Sampling method. (Because the patients at the clinic are allowed their choice of the traditional versus the new ex- ercise program, the sampling in this study is not random sampling.) nurse plans to measure the patients' self-report of exercise before and 6 months after the pro- gram begins. What factor might influence the re- sults of this study in an unfavourable way? 4. The foundation of re- search is which of the fol- lowing? 5. A researcher gives a sub- ject full and complete in- formation about the pur- pose of a study. This is an example of which of the following? 6. A new nurse on an or- thopedic unit is assigned to care for a patient un- dergoing skeletal trac- tion. The nurse asks a colleague, "What is the best practice for cleaning Scientific method. (The scientific method is the foundation of re- search and is the most reliable and objective of all methods of obtaining knowledge. Documentation, critical thinking, and evidence are not the founda- tions of research.) Informed consent. (Informed consent implies that the research sub- jects are given full and complete information about the purpose of the study, procedures, data collection, potential harms and benefits, and al- ternative methods of treatment. Confidentiality rules guarantee that any information the subject provides will not be reported to people outside the research team. Bias is any personal opinion or judgement that may be interjected into the results. Anonymity means that the subject's name and identifying information would not be disclosed during the research study.) Knowledge-focused trigger. (A knowledge-focused trigger is a question re- garding new information available on a topic. A problem-focused trigger is one faced while the nurse is caring for a patient or noting a trend. The PICOT (population, intervention, compari- pin sites in skeletal trac- tion?" This question is an example of which of the following? 7. The nurses on a med- ical unit have seen an increase in the num- ber of pressure injuries developing in their pa- tients. The nurses decide to initiate a quality im- provement project with the plan, do, study, act (PDSA) model. Which of the following is an exam- ple of the "do" step of that model? 8. The nurse researcher ob- tains informed consent from participants in a study primarily for which reason? 9. Which of the following is a priority goal for nursing research? son, outcome, time) format is a way to phrase a question to help clarify the question and the parts. A hypothesis is a prediction about the relationship between study variables.) Implement a new skin care protocol on all medical units. (The "do" step consists of selecting an inter- vention on the basis of a data review, imple- menting the change, and studying the results of the change. The "plan" step includes reviewing the available data to understand existing practice conditions or problems to identify the need for change. The results of the change are evaluated in the "study" step. The "act" step is the incorpo- ration of the findings into current practice.) To ensure that the study subjects understand their roles in the study. (The conduct of research must meet ethical stan- dards in which the rights of human subjects are protected. The research participants must be told about the study's purpose and procedure and their roles in the study. The researcher is always legally responsible for his or her actions. Control of variables is related to the study design, not to informed consent. Confidentiality is part of the ethical nature of research but is not the focus of informed consent.) Improving patient care. (Quality patient care is always the primary focus of nursing practice. Cost control would be a ben- efit but is not the primary focus. Research is not about technology; many "old" procedures can be 10. A clinical nurse devel- ops a better way to se- cure an intravenous ac- cess device in a patient and wants to see whether it would benefit other pa- tients. Which of the fol- lowing should be the first step in initiating a study? 11. The nurse researcher who obtains new knowl- edge regarding a proce- dure can most effective- ly share the information with the nursing profes- sion by doing which of the following? 12. Nurses who are new to practice can best con- tribute to nursing re- search by doing which of the following? improved through research. Although research is a professional function of nursing, it is not done to serve the profession.) Review current literature related to the clinical problem. (Review of the literature is the first step in the orderly research process to determine what is already known about the problem. Recruiting pa- tients occurs later in the process, after the nurse identifies the problem, researches the literature, and designs the study. Experimenting with new nursing procedures that have not been tested or approved is a risk to patients. Surveys are designed to obtain information from large study populations and would not be a first step in the research process.) Communicating the research findings in a profes- sional journal. (Publication of research results provides other nurses with the scientific background of the study before they apply its findings in practice. Study subjects and setting should be similar in order to replicate a study. Nurses should not change from accepted to unproven ways of providing care without careful research and collaboration with colleagues. Experimenting with new nursing mea- sures is inappropriate and may place a patient at risk.) Assisting with data collection. (A nurse who is new to practice has not developed the experience required for research but can be- gin at the less complicated level of data collection. An experienced researcher is more qualified to 13. A nurse manager wants to determine how well a new policy is working in the clinical area. Which of the following would be appropriate to use? 14. The nurse involved in sci- entific research effective- ly analyzes the informa- tion collected and deter- mines a course of nurs- ing action by doing which of the following? 15. A nurse manager is re- searching the effects of staff shortages on job satisfaction among new graduates. Which of the identify problems for formal research, although input from all levels of nursing is valuable. Nurs- es with doctoral-level training are typically pre- pared for obtaining financial backing. A Canadian Nurses Association position paper cites a mas- ter's degree as qualification for preparing nurses to implement research-based change in nursing practice.) Evaluation research. (Evaluation research is aimed at finding out how well a program, practice, policy, or procedure is working. A survey is a study of a large group to identify general information, opinions, attitudes, or perceptions. A grounded theory is developed through the collection and analysis of qualita- tive data. Experimental research involves collect- ing information about human subjects who are assigned to a control group and a comparison group.) Using critical thinking. (Critical thinking involves analyzing the data, learning, and problem solving to come up with a course of action. Tradition limits the ability to learn new ways and overlooks what research has to offer. The advice of experienced practitioners may limit research because experience may mean do- ing things the same way they have been done for years. Using personal opinion overlooks the objective data that are available.) By interviewing staff nurses on the unit regarding their perceptions. (A qualitative research study can be carried out effectively, in this case, in order to explore and following would be the most effective way to gather data? 16. Which of the following could be a barrier to nurs- ing research? 17. An advanced-practice nurse in the communi- ty has completed a re- search project showing that follow-up care for women who have expe- rienced gestational dia- betes is not adequate. As a member of an interdis- ciplinary team, the nurse writes a policy guiding follow-up standards for all postpartum women. In effecting change, the nurse would be involving which principle? describe the perceptions of staff nurses about staff shortages and their job satisfaction. Through narrative interviews, the participants' perceptions can be compared, and common characteristics can be discovered. It is difficult to collect data about perceptions or feelings without talking to those involved. Quantitative survey and experi- mental research involves precise measurements and would not be of use in this study of percep- tions. Although obtaining suggestions for possible solutions could be useful, it does not help to iden- tify the problems on this specific unit. The data must be collected first.) Shortage of professional nursing staff. (Shortage of staff could mean less time and per- sonnel to conduct and participate in research. Nursing teams that have teamwork skills can aid research. The desire to change is an incentive for research. Pressure from higher levels in the organization is also an incentive for research.) Social justice. (The concept of social justice is also related to a concern for equitable distribution of resources, like the principle of justice, but goes beyond this, encouraging the nurse to seek ways to effect a change in the larger health care system and societal structure in order to create greater equity for all. In this example, the nurse is moving toward this in the actions of writing a policy. Autonomy is the ability to operate independently. In this case, the nurse is working as part of an interdisciplinary team and not focusing on upholding a patient's autonomy. Ethics of care is a philosophy of care not specifically referred to here.) 18. It may seem redundant that health care providers pledge to "do no harm" to patients. The purpose of this oath is to reassure the public that the health care team will work to heal patients with as lit- tle pain and harm as pos- sible. Which principle un- derlies this pledge? 19. A child's immuniza- tion may cause discom- fort during administra- tion, but the benefits of protection from disease outweigh the temporary discomforts. Which prin- ciple applies to this situ- ation? 20. If the nurse assesses a patient for pain and then offers a plan to manage the pain, which principle encourages the nurse to monitor the patient's re- sponse to the pain man- agement plan? 21. Nurses agree to be ad- Nonmaleficence. (Nonmaleficence means not causing harm. Beneficence means providing the best care pos- sible. Accountability refers to answerability for one's actions. Respect for autonomy means al- lowing patients to choose their own course of care.) Beneficence. (Beneficence means doing or promoting good for others. Commitment to beneficence helps guide difficult decisions. Balancing the risks between the temporary pain of an injection and the extend- ed benefits is an example. Fidelity means being true to one's work. Nonmaleficence means doing no harm. Respect for autonomy means giving allowing patients to choose their own course of care.) Fidelity. (Fidelity means keeping the promises that are made. If the nurse offers to manage pain, then the nurse needs to follow through and ensure that the pain is controlled. Beneficence means taking positive actions to help others. Nonmalefi- cence means doing no harm. Respect for auton- omy means allowing patients to choose their own care.) Assess the patient's point of view, and prepare to vocates for their patients. articulate this point of view. The practice of advocacy (As an advocate, the nurse needs to understand calls for the nurse to do which of the following? 22. When many people share the same values, it may be possible to identify a philosophy of utilitarian- ism. Which of the follow- ing statements is a prin- ciple of utilitarianism? 23. Relational ethics sug- gests that ethical dilem- the patient's point of view and then be prepared to verbalize that point of view to others involved in the patient's care. Understanding the law, seek- ing advice from a manager, and ensuring that prescribers' orders are completed correctly can all help in advocacy, but they are not themselves acts of advocacy.) The value of something is determined by its use- fulness to society; this concept is also known by the guiding principle of "greatest good" for the greatest number of people. (According to a utilitarian system of ethics, the value of something is determined by its useful- ness for the greatest number of people.) Relationships. mas can best be attended (Relational ethics focuses on the role of relational to by focusing on atten- tion to which of the fol- lowing? context or the experience of the relationships in shaping moral decisions.) 24. In most ethical dilemmas, Nurses develop a relationship with the patient that the solution to the dilem- ma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 25. Ethical dilemmas often involve a conflict of opin- ion. Once the nurse has determined that the dilemma is ethical, which of the following would be is unique among all health care providers. (Nurses generally interact with patients over longer intervals of time than do health care providers in other disciplines. Because nurses are often involved in personal care, patients and families reveal information not always shared with physicians or others.) Gather all relevant information regarding the clin- ical, social, and spiritual aspects of the dilemma. (The process of resolving ethical dilemmas is similar to the nursing process. The first step is gathering all relevant information. Then the group a critical first step in ne- gotiating the difference of opinion? 26. Which of the following sets forth ethical prin- ciples for professional nursing practice in a clin- ical setting? 27. Which of the follow- ing statements concern- ing informed consent is correct? 28. Withdrawal of food and hydration at the end of will proceed through assessment, planning, im- plementation, and evaluation.) Code of Ethics for Registered Nurses of the Canadian Nurses Association. (The Code of Ethics is an ethical guide em- bodying professional values and standards es- tablished by nurses and the Canadian Nurses Association to maintain the highest standards for the nurse's conduct in practice. The code gives a broad overview of the appropriate and inap- propriate roles of the registered nurse. Standards of care written by field experts are guidelines that direct the usual pathway of patient manage- ment under certain circumstances. Good Samar- itan laws are laws that prevent an individual from suing another person who tries in "good faith" to assist that individual in an accident.) he goal of informed consent is to protect the pa- tient's right to autonomy. (The patient's right to autonomy is the basis of informed consent. Informed consent applies to all treatments, not just those related to surgical procedures.) It is appropriate to withhold food and fluids only after careful examination of the patient's status life is an ethical issue that because artificial hydration may not be benefiting nurses may face, partic- ularly if a patient is near death or in a vegeta- tive state. Which of the following is an accurate statement that the nurse the patient. (The research literature related to withdrawing food and fluids at the end of life is not conclusive enough to support either withdrawing or not with- drawing food and hydration. Rather, a clinician's decision should be based on the goals of care of could reveal to the pa- tient's family? the patient and family and a careful assessment of the patient's comfort. At the end of life, when the body is shutting down, individuals may lose their desire for food and fluids. Force-feeding can sometimes harm a patient.) 29. The experience of "moral Moral distress occurs when inconsistency exists distress" is captured by which of the following statements? 30. To distinguish an eth- ical problem from oth- er types of problems encountered, the nurse should be aware that which of the following statements about ethical problems is true? 31. After researching the sci- entific literature and con- firming that an issue is an ethical dilemma, which of the following should the nurse do next? 32. Which of the following represents utilitarian al- location of scarce re- sources? 33. hen the nurse describe a patient as "that nasty old man in 354," the nurse is exhibiting which of the following? between a nurse's beliefs and values and how he or she is able to act. The answer is not determined by logical deduc- tion. (The characteristics of an ethical problem include the lack of a logical conclusion, lack of scientific support for either choice or support for both choic- es, differences in valuing by staff and the patient that might result in harm or in options that are less than the best, and an answer that involves several areas of human concern.) Perform a values clarification Distribution of resources to achieve the greater good of the larger group. Gender bias and ageism 34. Values clarification is a process that involves which of the following? 35. Which of the follow- ing are true regarding advance care planning? (Select all that apply.) 36. Advance care planning (ACP) 37. The nurse recognizes which correct interpreta- Appraising one's personal values that arise from careful reflection. A. It includes the expression and comprehension of a patient's beliefs and values. Correct B. It is a multidimensional process that involves health care providers. Correct C. The patient's family is not included in this plan- ning. D. Patients can also identify surrogate decision makers, should they become unable to make their own health care decisions. Correct E. The number of unwanted medical interventions is increased. F. This approach remains underutilized in health care. Correct Advance care planning (ACP) is a multidimen- sional process that involves health care providers in discussion with patients to ensure that they clearly understand their illness, its trajectory, and available treatment options. ACP includes the ex- pression and comprehension of a patient's beliefs and values and the translation of these beliefs and values into medical decisions. During the ACP process, patients can also identify surrogate decision makers who can act if they become un- able to make their own health care decisions. De- spite its benefits, ACP remains an underutilized tool in health care. tion of advance-directive provisions? 38. The nurse notes that the health care unit keeps a list of patients' names at the front desk in clear view so that health care providers can more ef- ficiently locate patients. The nurse knows that this action is a violation of which of the following? 39. Nurses are bound by a variety of laws. Which of the following descrip- tions of types of law is correct? 40. A patient who is con- fused is left alone in bed with the side rails down and the bed in a high position, and the patient falls and breaks a hip. In legal terms, what has oc- curred? A proxy directive allows an appointed person to make health care decisions when the patient is in an incapacitated state. Common law tort relating to invasion of privacy. Statutory law is created by elected legislatures, such as the provincial or territorial legislature that defines the nursing practice act. Negligence 41. Battery defined Battery is the actual unlawful touching of another, whether threat of harm is included or not. 42. Assault defined Assault is the threat to engage in harmful or of- fensive contact. 43. Civil tort A civil tort is a civil wrong committed against a person or property. An example of a tort involving property would be to lose the patient's dentures by misplacing them. 44. When the nurse signs a form as a witness, the nurse's signature shows which of the following re- garding the patient? 45. Most litigation involving hospital care is related to which of the following sit- uations? 46. A patient can be admitted to a mental health facility and treated without his or her consent under which of the following circum- stances? 47. The best way for a nurse to avoid being liable for negligence might be to do which of the follow- ing? (Select all that ap- ply.) The patient has signed that form and the witness saw it being done. (indicates only that the person signing the form was indeed the person whose name was on the form. The witness does not have to know whether the patient was fully informed or not. The wit- nessing agent is indicating no judgement about the level of cognitive function of the patient by signing as a witness. The nurse should assess for coercion, but the signature of the witness is not an acknowledgement of having performed such an assessment. If the witness feels that someone is forcing a patient to sign, however, then the witness may refuse to sign, and the contract is then void (unless a different witness signs).) The nurse follows an order that is incomplete or incorrect. The patient has threatened to harm himself or herself or others. (police officers (or other authorized parties) may bring the patient to a health care facility for exam- ination and treatment without the patient's con- sent. The next of kin cannot override a patient's autonomy. Although a psychotic episode may have potential untoward effects, the patient must be the one to consent to treatment.) - Follow standards of care. - Give safe, competent care in a caring manner. - Document assessments, interventions, and evaluations as soon as possible after performing them. 48. A nurse is sued for failure to monitor a patient ap- propriately. Which state- ments are correct about professional negligence lawsuits? (Select all that apply.) A. The nurse is the plain- tiff. B. The person filing the lawsuit has the burden of proof. C. The defendant must prove injury, damage, or loss. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. 49. The nurse must follow standards of care to avoid potential litigation B. The person filing the lawsuit has the burden of proof. Correct D. The plaintiff must prove that a breach in the pre- vailing standard of care caused an injury. Correct (The plaintiff, the person filing the suit, has the burden of proof and must prove that a breach in the prevailing standards of care caused an injury. The nurse would be a defendant in this case. The plaintiff, not the defendant, must prove injury, damage, or loss.) 1. Failure to question a health care provider about the appropriateness of a patient order. Correct 2. Failure to make a nursing diagnosis. Correct such as negligence suits. 3. Failure to properly use medical equipment or- Which of the follow- ing describe a potential nursing malpractice situ- ation? (Select all that ap- ply.) 50. A nursing student is un- sure about the legal lia- bility of using skills as- sociated with placement as a student. Which of the following is true about le- gal liability for a nursing student? dered for patient monitoring. Correct 4. Failure to follow the "seven rights" of medication administration. Correct 5. Failure to provide discharge instructions. Cor- rect 1. Student nurses, like all other nurses, are ac- countable for their own actions. *Correct* 2. The institution where a student is placed has no responsibility to monitor the actions of a student. 3. It is the nursing instructor's role to inform pa- tients that they are being cared for by a student nurse 4. Usually faculty members are responsible for in- structing and observing students; however, there are some situations in which staff nurses may share these responsibilities. *Correct* 5. Nursing students should never perform tasks they have not been taught; instructors should su- pervise all new skills that are being performed. *Correct*