Complete test bank
Primary care: art and science of advanced practice nursing - an
interprofessional approach 6th edition
By dunphy all chapters 1-82(answer key )
,Table of contents
chapter 1. Primary care in the twenty-first century: a circle of caring.......................................................... 5
chapter 2. Caring and the advanced practice nurse .................................................................................... 14
chapter 3. Health promotion ....................................................................................................................... 23
chapter 4. The art of diagnosis and treatment ............................................................................................ 25
chapter 5. Evidence-based care................................................................................................................... 38
chapter 6. Common neurological complaints.............................................................................................. 42
chapter 7. Seizure disorders ........................................................................................................................ 53
chapter 8. Degenerative disorders .............................................................................................................. 58
chapter 9. Cerebrovascular accident (stroke) ............................................................................................. 63
chapter 10. Infectious and inflammatory neurological disorders................................................................ 75
chapter 11.common skin complaints .......................................................................................................... 75
chapter 12. Parasitic skin infestations ......................................................................................................... 86
chapter 13. Fungal skin infections ............................................................................................................... 87
chapter 14. Bacterial skin infections ........................................................................................................... 88
chapter 15. Viral skin infections .................................................................................................................. 91
chapter 16. Dermatitis................................................................................................................................. 93
chapter 17. Skin lesions ............................................................................................................................... 95
chapter 18. Common eye complaints.......................................................................................................... 99
chapter 19. Lid and conjunctival pathology............................................................................................... 107
chapter 20. Visual disturbances and impaired vision ................................................................................ 119
chapter 21. Common ear, nose, and throat complaints............................................................................ 122
chapter 22. Hearing and balance disorders............................................................................................... 131
chapter 23. Inflammatory and infectious disorders of the ear.................................................................. 139
chapter 24. Inflammatory and infectious disorders of the nose, sinuses, mouth, and throat .................. 152
chapter 25. Epistaxis.................................................................................................................................. 159
chapter 26. Temporomandibular disorders .............................................................................................. 160
chapter 27. Dysphonia............................................................................................................................... 162
chapter 28. Common respiratory complaints............................................................................................ 163
chapter 29. Sleep apnea ............................................................................................................................ 174
,chapter 30. Infectious respiratory disorders ............................................................................................. 175
chapter 31. Inflammatory respiratory disorders ....................................................................................... 183
chapter 32. Lung cancer ............................................................................................................................ 187
chapter 33. Smoking addiction .................................................................................................................. 189
chapter 34. Common cardiovascular complaints ...................................................................................... 189
chapter 35. Cardiac and associated risk disorders .................................................................................... 199
chapter 36. Dysrhythmias and valvular disorders ..................................................................................... 206
chapter 37. Disorders of the vascular system ........................................................................................... 214
chapter 38. Common abdominal complaints ............................................................................................ 226
chapter 39. Infectious gastrointestinal disorders ...................................................................................... 234
chapter 40. Gastric and intestinal disorders.............................................................................................. 242
chapter 41. Gallbladder and pancreatic disorders .................................................................................... 249
chapter 42. Cirrhosis and liver failure ....................................................................................................... 257
chapter 43. Common urinary complaints .................................................................................................. 261
chapter 44. Urinary tract disorders ........................................................................................................... 266
chapter 45. Kidney and bladder disorders ................................................................................................ 274
chapter 46. Common reproductive system complaints ............................................................................ 283
chapter 47. Breast disorders ..................................................................................................................... 291
chapter 48. Vaginal, uterine, and ovarian disorders ................................................................................. 298
chapter 49. Prostate disorders .................................................................................................................. 307
chapter 50. Penile and testicular disorders ............................................................................................... 315
chapter 51. Sexually transmitted infections .............................................................................................. 322
chapter 52. Common musculoskeletal complaints ................................................................................... 339
chapter 53. Spinal disorders ...................................................................................................................... 349
chapter 54. Soft-tissue disorders............................................................................................................... 351
chapter 55. Osteoarthritis and osteoporosis ............................................................................................. 378
chapter 56.common endocrine/metabolic complaints ............................................................................. 382
chapter 57. Glandular disorders ................................................................................................................ 393
chapter 58. Diabetes mellitus .................................................................................................................... 398
,chapter 59. Metabolic disorders ............................................................................................................... 403
chapter 60. Common hematologic and immunological problems ............................................................ 422
chapter 61. Hematologic disorders ........................................................................................................... 433
chapter 62. Immunological disorders ........................................................................................................ 447
chapter 63. Infectious disorders ................................................................................................................ 456
chapter 64. Common psychosocial complaints ......................................................................................... 471
chapter 65. Substance use disorders ......................................................................................................... 480
chapter 66. Schizophrenia spectrum disorders ......................................................................................... 490
chapter 67. Mood disorders ...................................................................................................................... 501
chapter 68. Anxiety, stress, and trauma-related disorders ....................................................................... 506
chapter 69. Obsessive-compulsive disorders ............................................................................................ 513
chapter 70. Behavioral disorders related to physical/physiological disturbances .................................... 516
chapter 71. Neurodevelopmental disorders ............................................................................................. 525
chapter 72. Common urgent care complaints ........................................................................................... 537
chapter 73. Common injuries .................................................................................................................... 547
chapter 74. Toxic exposures ...................................................................................................................... 554
chapter 75. Environmental exposures....................................................................................................... 562
chapter 76. Sports physicals ...................................................................................................................... 569
chapter 77. Primary care of older adults ................................................................................................... 579
chapter 78. Palliative care and pain management .................................................................................... 589
chapter 79. Ethical and legal issues of a caring-based practice ................................................................. 595
chapter 80. The business of advanced practice nursing............................................................................ 601
chapter 81. The 15-minute hour: practical approaches to behavioral health for primary care ................ 606
chapter 82. Putting caring into practice: caring for self ............................................................................ 610
,Chapter 1. Primary care in the twenty-first century: a circle of caring
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on
the incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
findings at a level of significance of <0.01. This indicates that
A) The control group and the experimental group were more than 99% similar.
B) The findings of the study have less than 1% chance of being attributable to chance.
C) The effects of the intervention were nearly zero.
D) The clinical significance of the findings was less than 1:100.
Ans: b
Feedback the level of significance is the level at which the researcher believes that the study
results most likely represent a nonchance event. A level of significance of <0.01 indicates that there is
less than 1% probability that the result is due to chance.
2. A nurse has read a qualitative research study in order to understand the lived experience of
parents who have a neonatal loss. Which of the following questions should the nurse prioritize when
appraising the results of this study?
A) How well did the authors capture the personal experiences of these parents?
B) How well did the authors control for confounding variables that may have affected the
findings?
,C) Did the authors use statistical measures that were appropriate to the phenomenon in
question?
D) Were the instruments that the researchers used statistically valid and reliable?
Ans: a
Feedback qualitative studies are judged on the basis of how well they capture and convey
the subjective experiences of individuals. Statistical measures and variables are not dimensions of a
qualitative methodology.
3. A nurse has expressed skepticism to a colleague about the value of nursing research,
claiming that nursing research has little relevance to practice. How can the nurses colleague best
defend the importance of nursing research?
A) The existence of nursing research means that nurses are now able to access federal grant
money, something that didnt use to be the case.
B) Nursing research has allowed the development of masters and doctoral programs and has
greatly increased the credibility of the profession.
C) The growth of nursing research has caused nursing to be viewed as a true profession, rather
than simply as a trade or a skill.
D) The application of nursing research has the potential to improve nursing practice and patient
outcomes.
Ans: d
,Feedback the greatest value of nursing research lies in the potential to improve practice and,
ultimately, to improve patient outcomes. This supersedes the contributions of nursing research to
education programs, grant funding, or the public view of the profession.
4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy
urban hospital. She has noticed that many new mothers abandon breast-feeding their babies when they
experience early challenges and wonders what could be done to encourage more women to continue
breast-feeding. What role is tracy most likely to play in a research project that tests an intervention
aimed at promoting breast-feeding?
A) Applying for grant funding for the research project
B) Posing the clinical problem to one or more nursing researchers
C) Planning the methodology of the research project
D) Carrying out the intervention and submitting the results for publication
Ans: b
Feedback a major role for staff nurses is to identify questions or problems for research. Grant
applications, methodological planning, and publication submission are normally carried out by nurses
who have advanced degrees in nursing.
5. A patient signed the informed consent form for a drug trial that was explained to patient by a
research assistant. Later, the patient admitted to his nurse that he did not understand the research
assistants explanation or his own role in the study. How should this patients nurse respond to this
revelation?
A) Explain the research process to the patient in greater detail.
B) Describe the details of a randomized controlled trial for the patient.
C) Inform the research assistant that the patients consent is likely invalid.
,D) Explain to the patient that his written consent is now legally binding.
Ans: c
Feedback just as the staff nurse is not responsible for medical consent, the staff nurse is not
responsible for research consent. If patients who have agreed to participate exhibit ambivalence or
uncertainty about participating, do not try to convince them to participate. Ask the person from the
research team who is managing consents to speak with concerned patients about the study, even after
a patient has signed the consent forms.
Multiple selection
6. A nurse leader is attempting to increase the awareness of evidence-based practice (ebp)
among the nurses on a unit. A nurse who is implementing ebp integrates which of the following?
(select all that apply.)
A) Interdisciplinary consensus
B) Nursing tradition
C) Research studies
D) Patient preferences and values
E) Clinical expertise
Ans: c, d, e
Feedback
Fineout-overholt, melnyk, stillwell, and williamson define ebp as a problem-solving approach to the
delivery of healthcare that integrates the best evidence from studies and patient care data with
clinician expertise and patient preferences and values.
,Multiple choice
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow
to heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working
with mrs. Mayes applies evidence-based practice (ebp) whenever possible and has proposed the use of
maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and
adamantly opposes this treatment despite the sizable body of evidence supporting it. How should the
nurse reconcile mrs. Mayes views with the principles of ebp?
A) The nurse should explain that reliable and valid research evidence overrides the patients
opinion.
B) The nurse should explain the evidence to the patient in greater detail.
C) The nurse should integrate the patients preferences into the plan of care.
D) The nurse should involve the patients family members in the decision-making process.
Ans: c
Feedback patient preferences should be integrated into ebp and considered alongside research
evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The
family should be involved, but this is not an explicit dimension of ebp. Similarly, explaining the
evidence in more detail is not a demonstration of ebp.
8. The administrators of a long-term care facility are considered the use of specialized, pressure-
reducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have
sought input from the nurses on the unit, all of whom are aware of the need to implement the
principles of evidence-based practice (ebp) in this decision. Which of the following evidence sources
should the nurses prioritize?
A) A qualitative study that explores the experience of living with a pressure ulcer
, B) A case study that describes the measures that nurses on a geriatric unit took to reduce
pressure ulcers among patients
C) Testimonials from experienced clinicians about the effectiveness of the mattress in question
D) A randomized controlled trial that compared the pressure-reducing mattress with standard
mattresses
Ans: d
Feedback the most reliable evidence is considered rcts. Qualitative studies, case studies, and
expert opinion are low on the hierarchy of evidence.
9. Hospital administrators are applying the principles of evidence-based practice (ebp) in their
attempt to ascertain the most efficient and effective way to communicate between nurses who are on
different units, a project that will consider many types of evidence. Which of the following information
sources should the administrators prioritize?
A) A systematic review about communication in nursing contexts
B) Nurses ideas about communication methods
C) The results of a chart review
D) The hospitals accreditation status ans: a
Feedback systematic reviews are assigned a high value in ebp. Reviews would be prioritized
over nurses ideas or a chart review, though both are potential considerations. The hospitals
accreditation status is not a relevant consideration.
Primary care: art and science of advanced practice nursing - an
interprofessional approach 6th edition
By dunphy all chapters 1-82(answer key )
,Table of contents
chapter 1. Primary care in the twenty-first century: a circle of caring.......................................................... 5
chapter 2. Caring and the advanced practice nurse .................................................................................... 14
chapter 3. Health promotion ....................................................................................................................... 23
chapter 4. The art of diagnosis and treatment ............................................................................................ 25
chapter 5. Evidence-based care................................................................................................................... 38
chapter 6. Common neurological complaints.............................................................................................. 42
chapter 7. Seizure disorders ........................................................................................................................ 53
chapter 8. Degenerative disorders .............................................................................................................. 58
chapter 9. Cerebrovascular accident (stroke) ............................................................................................. 63
chapter 10. Infectious and inflammatory neurological disorders................................................................ 75
chapter 11.common skin complaints .......................................................................................................... 75
chapter 12. Parasitic skin infestations ......................................................................................................... 86
chapter 13. Fungal skin infections ............................................................................................................... 87
chapter 14. Bacterial skin infections ........................................................................................................... 88
chapter 15. Viral skin infections .................................................................................................................. 91
chapter 16. Dermatitis................................................................................................................................. 93
chapter 17. Skin lesions ............................................................................................................................... 95
chapter 18. Common eye complaints.......................................................................................................... 99
chapter 19. Lid and conjunctival pathology............................................................................................... 107
chapter 20. Visual disturbances and impaired vision ................................................................................ 119
chapter 21. Common ear, nose, and throat complaints............................................................................ 122
chapter 22. Hearing and balance disorders............................................................................................... 131
chapter 23. Inflammatory and infectious disorders of the ear.................................................................. 139
chapter 24. Inflammatory and infectious disorders of the nose, sinuses, mouth, and throat .................. 152
chapter 25. Epistaxis.................................................................................................................................. 159
chapter 26. Temporomandibular disorders .............................................................................................. 160
chapter 27. Dysphonia............................................................................................................................... 162
chapter 28. Common respiratory complaints............................................................................................ 163
chapter 29. Sleep apnea ............................................................................................................................ 174
,chapter 30. Infectious respiratory disorders ............................................................................................. 175
chapter 31. Inflammatory respiratory disorders ....................................................................................... 183
chapter 32. Lung cancer ............................................................................................................................ 187
chapter 33. Smoking addiction .................................................................................................................. 189
chapter 34. Common cardiovascular complaints ...................................................................................... 189
chapter 35. Cardiac and associated risk disorders .................................................................................... 199
chapter 36. Dysrhythmias and valvular disorders ..................................................................................... 206
chapter 37. Disorders of the vascular system ........................................................................................... 214
chapter 38. Common abdominal complaints ............................................................................................ 226
chapter 39. Infectious gastrointestinal disorders ...................................................................................... 234
chapter 40. Gastric and intestinal disorders.............................................................................................. 242
chapter 41. Gallbladder and pancreatic disorders .................................................................................... 249
chapter 42. Cirrhosis and liver failure ....................................................................................................... 257
chapter 43. Common urinary complaints .................................................................................................. 261
chapter 44. Urinary tract disorders ........................................................................................................... 266
chapter 45. Kidney and bladder disorders ................................................................................................ 274
chapter 46. Common reproductive system complaints ............................................................................ 283
chapter 47. Breast disorders ..................................................................................................................... 291
chapter 48. Vaginal, uterine, and ovarian disorders ................................................................................. 298
chapter 49. Prostate disorders .................................................................................................................. 307
chapter 50. Penile and testicular disorders ............................................................................................... 315
chapter 51. Sexually transmitted infections .............................................................................................. 322
chapter 52. Common musculoskeletal complaints ................................................................................... 339
chapter 53. Spinal disorders ...................................................................................................................... 349
chapter 54. Soft-tissue disorders............................................................................................................... 351
chapter 55. Osteoarthritis and osteoporosis ............................................................................................. 378
chapter 56.common endocrine/metabolic complaints ............................................................................. 382
chapter 57. Glandular disorders ................................................................................................................ 393
chapter 58. Diabetes mellitus .................................................................................................................... 398
,chapter 59. Metabolic disorders ............................................................................................................... 403
chapter 60. Common hematologic and immunological problems ............................................................ 422
chapter 61. Hematologic disorders ........................................................................................................... 433
chapter 62. Immunological disorders ........................................................................................................ 447
chapter 63. Infectious disorders ................................................................................................................ 456
chapter 64. Common psychosocial complaints ......................................................................................... 471
chapter 65. Substance use disorders ......................................................................................................... 480
chapter 66. Schizophrenia spectrum disorders ......................................................................................... 490
chapter 67. Mood disorders ...................................................................................................................... 501
chapter 68. Anxiety, stress, and trauma-related disorders ....................................................................... 506
chapter 69. Obsessive-compulsive disorders ............................................................................................ 513
chapter 70. Behavioral disorders related to physical/physiological disturbances .................................... 516
chapter 71. Neurodevelopmental disorders ............................................................................................. 525
chapter 72. Common urgent care complaints ........................................................................................... 537
chapter 73. Common injuries .................................................................................................................... 547
chapter 74. Toxic exposures ...................................................................................................................... 554
chapter 75. Environmental exposures....................................................................................................... 562
chapter 76. Sports physicals ...................................................................................................................... 569
chapter 77. Primary care of older adults ................................................................................................... 579
chapter 78. Palliative care and pain management .................................................................................... 589
chapter 79. Ethical and legal issues of a caring-based practice ................................................................. 595
chapter 80. The business of advanced practice nursing............................................................................ 601
chapter 81. The 15-minute hour: practical approaches to behavioral health for primary care ................ 606
chapter 82. Putting caring into practice: caring for self ............................................................................ 610
,Chapter 1. Primary care in the twenty-first century: a circle of caring
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on
the incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
findings at a level of significance of <0.01. This indicates that
A) The control group and the experimental group were more than 99% similar.
B) The findings of the study have less than 1% chance of being attributable to chance.
C) The effects of the intervention were nearly zero.
D) The clinical significance of the findings was less than 1:100.
Ans: b
Feedback the level of significance is the level at which the researcher believes that the study
results most likely represent a nonchance event. A level of significance of <0.01 indicates that there is
less than 1% probability that the result is due to chance.
2. A nurse has read a qualitative research study in order to understand the lived experience of
parents who have a neonatal loss. Which of the following questions should the nurse prioritize when
appraising the results of this study?
A) How well did the authors capture the personal experiences of these parents?
B) How well did the authors control for confounding variables that may have affected the
findings?
,C) Did the authors use statistical measures that were appropriate to the phenomenon in
question?
D) Were the instruments that the researchers used statistically valid and reliable?
Ans: a
Feedback qualitative studies are judged on the basis of how well they capture and convey
the subjective experiences of individuals. Statistical measures and variables are not dimensions of a
qualitative methodology.
3. A nurse has expressed skepticism to a colleague about the value of nursing research,
claiming that nursing research has little relevance to practice. How can the nurses colleague best
defend the importance of nursing research?
A) The existence of nursing research means that nurses are now able to access federal grant
money, something that didnt use to be the case.
B) Nursing research has allowed the development of masters and doctoral programs and has
greatly increased the credibility of the profession.
C) The growth of nursing research has caused nursing to be viewed as a true profession, rather
than simply as a trade or a skill.
D) The application of nursing research has the potential to improve nursing practice and patient
outcomes.
Ans: d
,Feedback the greatest value of nursing research lies in the potential to improve practice and,
ultimately, to improve patient outcomes. This supersedes the contributions of nursing research to
education programs, grant funding, or the public view of the profession.
4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy
urban hospital. She has noticed that many new mothers abandon breast-feeding their babies when they
experience early challenges and wonders what could be done to encourage more women to continue
breast-feeding. What role is tracy most likely to play in a research project that tests an intervention
aimed at promoting breast-feeding?
A) Applying for grant funding for the research project
B) Posing the clinical problem to one or more nursing researchers
C) Planning the methodology of the research project
D) Carrying out the intervention and submitting the results for publication
Ans: b
Feedback a major role for staff nurses is to identify questions or problems for research. Grant
applications, methodological planning, and publication submission are normally carried out by nurses
who have advanced degrees in nursing.
5. A patient signed the informed consent form for a drug trial that was explained to patient by a
research assistant. Later, the patient admitted to his nurse that he did not understand the research
assistants explanation or his own role in the study. How should this patients nurse respond to this
revelation?
A) Explain the research process to the patient in greater detail.
B) Describe the details of a randomized controlled trial for the patient.
C) Inform the research assistant that the patients consent is likely invalid.
,D) Explain to the patient that his written consent is now legally binding.
Ans: c
Feedback just as the staff nurse is not responsible for medical consent, the staff nurse is not
responsible for research consent. If patients who have agreed to participate exhibit ambivalence or
uncertainty about participating, do not try to convince them to participate. Ask the person from the
research team who is managing consents to speak with concerned patients about the study, even after
a patient has signed the consent forms.
Multiple selection
6. A nurse leader is attempting to increase the awareness of evidence-based practice (ebp)
among the nurses on a unit. A nurse who is implementing ebp integrates which of the following?
(select all that apply.)
A) Interdisciplinary consensus
B) Nursing tradition
C) Research studies
D) Patient preferences and values
E) Clinical expertise
Ans: c, d, e
Feedback
Fineout-overholt, melnyk, stillwell, and williamson define ebp as a problem-solving approach to the
delivery of healthcare that integrates the best evidence from studies and patient care data with
clinician expertise and patient preferences and values.
,Multiple choice
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow
to heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working
with mrs. Mayes applies evidence-based practice (ebp) whenever possible and has proposed the use of
maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and
adamantly opposes this treatment despite the sizable body of evidence supporting it. How should the
nurse reconcile mrs. Mayes views with the principles of ebp?
A) The nurse should explain that reliable and valid research evidence overrides the patients
opinion.
B) The nurse should explain the evidence to the patient in greater detail.
C) The nurse should integrate the patients preferences into the plan of care.
D) The nurse should involve the patients family members in the decision-making process.
Ans: c
Feedback patient preferences should be integrated into ebp and considered alongside research
evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The
family should be involved, but this is not an explicit dimension of ebp. Similarly, explaining the
evidence in more detail is not a demonstration of ebp.
8. The administrators of a long-term care facility are considered the use of specialized, pressure-
reducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have
sought input from the nurses on the unit, all of whom are aware of the need to implement the
principles of evidence-based practice (ebp) in this decision. Which of the following evidence sources
should the nurses prioritize?
A) A qualitative study that explores the experience of living with a pressure ulcer
, B) A case study that describes the measures that nurses on a geriatric unit took to reduce
pressure ulcers among patients
C) Testimonials from experienced clinicians about the effectiveness of the mattress in question
D) A randomized controlled trial that compared the pressure-reducing mattress with standard
mattresses
Ans: d
Feedback the most reliable evidence is considered rcts. Qualitative studies, case studies, and
expert opinion are low on the hierarchy of evidence.
9. Hospital administrators are applying the principles of evidence-based practice (ebp) in their
attempt to ascertain the most efficient and effective way to communicate between nurses who are on
different units, a project that will consider many types of evidence. Which of the following information
sources should the administrators prioritize?
A) A systematic review about communication in nursing contexts
B) Nurses ideas about communication methods
C) The results of a chart review
D) The hospitals accreditation status ans: a
Feedback systematic reviews are assigned a high value in ebp. Reviews would be prioritized
over nurses ideas or a chart review, though both are potential considerations. The hospitals
accreditation status is not a relevant consideration.
