BASIC NURSING ESSENTIALS FOR PRACTICE 7TH EDITION BY POTTER

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BASIC NURSING ESSENTIALS FOR PRACTICE 7TH EDITION BY POTTER

Potter: Basic Nursing, 7th Edition

 

Chapter 02: The Health Care Delivery System

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse is teaching the importance of self-breast examination to a group of 20-year-old women. The nurse is promoting _____ care.
A. primary
B. secondary
C. tertiary
D. restorative

 

 

ANS:   A

Secondary and tertiary care is administered after an illness has been diagnosed. Restorative care occurs after a patient is recovering from an acute illness or for those who have chronic illnesses. Primary care is centered on prevention of disease.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    21

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A patient who needs nursing and rehabilitation after a stroke would benefit most by receiving care at a(n):
A. primary care center.
B. restorative care setting.
C. assisted living center.
D. respite center.

 

 

ANS:   B

In primary care centers, health promotion is the major theme. Assisted living centers offer long-term assistance with activities of daily living. Respite centers offer short-term relief to persons who provide full-time care to an older adult. Restorative care settings provide rehabilitation and nursing care.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension       REF:    23

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A patient states that he cannot afford health care insurance. What is the best form of insurance available to him?
A. Medicaid
B. Medicare
C. Private insurance
D. A managed care organization

 

 

ANS:   A

Medicare is a federally funded health insurance program. Private insurance is a fee-for-service plan. A managed care organization (MCO) provides care to a specific group of voluntarily enrolled patients. Medicaid is for those who cannot afford insurance.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    19

OBJ:    Compare the various methods for financing health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A managed care system focuses on:
A. customer service and patient choices.
B. admissions, diagnostic testing, and treatments.
C. control over primary health services of a defined population.
D. comprehensive rather than fragmented approaches to health.

 

 

ANS:   C

Managed care focuses on control over primary services of a defined population. The remaining answers describe levels of health care.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    18

OBJ:    Explain the advantages and disadvantages of managed health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A nurse admits an older adult patient who states that she has no living relatives and only friends of her own age. One of the nurse’s immediate considerations for this patient will be to implement a:
A. critical pathway.
B. discharge plan.
C. patient-focused care model.
D. resource utilization group.

 

 

ANS:   B

A critical pathway is a multidisciplinary treatment plan for the hospitalized patient. A discharge plan begins the moment a patient is admitted to a health care facility. A resource utilization group is used in long-term care settings to manage patient costs.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    22

OBJ:    Explain the advantages and disadvantages of managed health care

TOP:    Nursing Process: Planning

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Technological advances in health care:
A. make a nurse’s job easier.
B. depersonalize bedside patient care.
C. threaten the integrity of the health care industry.
D. do not replace sound personal judgment.

 

 

ANS:   D

Technological advances influence how and where nurses provide patient care; however, technology does not replace a nurse’s critical eye and clinical judgment.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    30, 32

OBJ:    Discuss the implications of issues in the health care system on nursing

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. In 1983 Congress established the Prospective Payment System (PPS) to:
A. establish cost-based reimbursement for health care.
B. provide reimbursement for patient medications.
C. establish reimbursement rates based upon diagnosis-related groups (DRGs).
D. establish quality improvement measures.

 

 

ANS:   C

Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients using Medicare were no longer paid for all costs incurred in delivering care to a patient. Instead, inpatient hospital services for patients using Medicare were combined into 468 diagnosis-related groups (DRGs).

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    18

OBJ:    Compare the various methods for financing health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A 74-year-old man was admitted to the hospital with diabetic ketoacidosis. The hospital where he was admitted will be reimbursed by Medicare according to:
A. his diagnostic-related group.
B. the cost of his care.
C. his length of stay.
D. his clinical outcome.

 

 

ANS:   A

Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients using Medicare were no longer paid for all costs incurred to deliver care to a patient. Instead, inpatient hospital services for patients using Medicare were combined into 468 diagnosis-related groups.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension       REF:    18

OBJ:    Compare the various methods for financing health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Capitation is the payment mechanism in which health care providers receive a fixed amount of money for each patient. What is the purpose of capitation?
A. To balance the quality of care with the cost of providing care
B. To provide the least expensive care for patients
C. To build a payment plan that includes professional standards of care
D. To ensure that all patients receive the same care for the same cost

 

 

ANS:   C

The purpose of capitation is to build a payment plan for select diagnoses or surgical procedures that includes the best standards of care.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    18

OBJ:    Compare the various methods for financing health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A single mother with three children utilizes the public health department services in her county to immunize her children. Which of the following best describes this level of health care?
A. Continuing care
B. Preventative care
C. Secondary acute care
D. Restorative care

 

 

ANS:   B

Preventative care includes services such as immunizations, screenings, poison control information, mental health counseling and crisis prevention, and community legislation.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension       REF:    21

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A registered nurse working as a school nurse for a small poor rural school district has noticed an increase in children arriving at school without having eaten breakfast. She has discussed this issue with the school principle and is working on a proposal to ask the school district to explore a school breakfast program. This is an example of which of the following?
A. Primary care
B. Continuing care
C. Restorative care
D. Tertiary care

 

 

ANS:   A

In the settings that deliver preventive and primary care, such as schools, physicians’ or health care providers’ offices, occupational health clinics, and nursing centers, health promotion is a major theme.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    21

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Planning

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A small business owner has consulted with an occupational health nurse regarding health promotion activities for his employees. The registered nurse explores with him the possibility of providing an area outside the new office complex where employees can walk during their breaks. This an example of which of the following?
A. Continuing care
B. Restorative care
C. Primary care
D. Tertiary care

 

 

ANS:   C

In the settings that deliver preventive and primary care, such as schools, physicians’ or health care providers’ offices, occupational health clinics, and nursing centers, health promotion is a major theme.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    21

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Planning

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A 43-year-old grocery store clerk does not have a family health care provider. She has had a sore throat for the past week and recently began running a fever. Her husband takes her to the local community hospital’s emergency room for treatment. This is an example of what level of care?
A. Continuing care
B. Restorative care
C. Primary care
D. Tertiary care

 

 

ANS:   D

Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units are sites that provide secondary and tertiary levels of care.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    21

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A retired high school teacher has been admitted to the hospital with complications of his diabetes. The hospital where he has been admitted uses a case management model to coordinate care. His discharge planning will be coordinated by which of the following?
A. Physician
B. Insurance company representative
C. Case manager
D. Dietitian

 

 

ANS:   C

In a case management model of care, a case manager, usually a nurse or a social worker, coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care for the patient.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    22

OBJ:    Explain the advantages and disadvantages of managed health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Discharge planning is a centralized, coordinated, multidisciplinary process that ensures that a patient has a plan for continuing care after leaving a health care agency. What is the most appropriate time to begin discharge planning?
A. The day of patient discharge from the health care agency
B. As soon as the insurance provider has been identified
C. When the health care provider writes the discharge order
D. When the patient is admitted to the health care agency

 

 

ANS:   D

Discharge planning begins the moment a patient is admitted to a health care facility.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    22

OBJ:    Explain the advantages and disadvantages of managed health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Which of the following patients is most in need of discharge planning?
A. 29-year-old mother with a healthy newborn
B. 59-year-old patient after appendectomy
C. 43-year-old patient with heart failure
D. 56-year-old patient after hysterectomy

 

 

ANS:   C

Some patients are more in need of discharge planning because of the risks they have. For example, some patients have limited financial resources or limited family support;

others may have long-term disabilities or chronic illnesses. Early discharge teaching is especially important as a way to decrease readmission to the hospital.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    22

OBJ:    Explain the advantages and disadvantages of managed health care

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Which of the following is considered the most expensive place to deliver care?
A. Rehabilitation unit
B. Long-term care facility
C. Intensive care unit
D. Private hospital room

 

 

ANS:   C

An intensive care unit is the most expensive delivery site for medical care because each nurse is usually assigned to care for only one or two patients at a time and because of the types of treatments and procedures the patients in the intensive care unit typically require.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    23

OBJ:    Compare the various methods for financing health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A 23-year-old college student with severe depression was recently admitted to the psychiatric ward of a local hospital. His family is concerned about him finishing his college term. Which of the following is the best information for the nurse to give regarding how long psychiatric patients are typically hospitalized?
A. A relatively short inpatient stay is followed by outpatient treatment.
B. A long inpatient hospitalization is normal.
C. Patients with emotional or behavioral problems generally are not hospitalized.
D. Most are automatically placed in a long-term care facility.

 

 

ANS:   A

Patients who have emotional and behavioral problems, such as depression, violent behavior, and eating disorders, often require special counseling and treatment in psychiatric facilities. Hospitalization involves relatively short stays with the purpose of stabilizing patients before transfer to outpatient treatment centers.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    23

OBJ:    Discuss the types of settings in which professionals provide various levels of health care    TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A 17-year-old girl was seriously injured in a motor vehicle accident and has been transferred from an acute care hospital to a rehabilitation facility. Which of the following options will ensure the best outcome for her?
A. Making sure that she gets enough rest
B. Pushing her beyond her limits
C. Requesting that the family not visit for the first few days
D. Involving her family early in the rehabilitation process

 

 

ANS:   D

In restorative settings, nurses recognize that success is dependent on effective and early partnering with patients and their families.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    25

OBJ:    Discuss the types of settings in which professionals provide various levels of health care    TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A 54-year-old businessman who experienced a stroke four days ago has been discharged from the hospital and will be undergoing outpatient rehabilitation. He should expect which of the following with this level of care?
A. Admission to the rehabilitative unit of the hospital
B. Scheduled appointment times for therapy
C. Home visits from all members of the multidisciplinary team
D. House calls from his primary health care provider

 

 

ANS:   B

When patients receive rehabilitation services in outpatient settings, patients get treatment at specified times during the week but remain at home the rest of the time.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    25

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. The Omnibus Budget Reconciliation Act of 1987 is also referred to as the _____ Act.
A. Medicaid
B. Nursing Home Reform
C. Diagnostic Related Group
D. Universal Healthcare

 

 

ANS:   B

The nursing center industry has become one of the most highly regulated industries in the United States. The Omnibus Budget Reconciliation Act of 1987, also known as the Nursing Home Reform Act, raised the standard of services provided by nursing centers.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension       REF:    25

OBJ:    Compare the various methods for financing health care

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A new registered nurse who recently began working in a nursing center has been asked to complete a Resident Assessment Instrument (RAI) on a newly admitted resident. She knows the purpose of this instrument is to:
A. provide a database to better understand the healthcare needs of this population.
B. provide the nursing staff with an overall physical assessment of the resident.
C. provide statistical evidence to support a universal healthcare policy.
D. determine how many health care resources this population consumes.

 

 

ANS:   A

The facility needs to complete the RAI on all residents. The RAI consists of the Minimum Data Set (MDS) (Box 2-4), Resident Assessment Protocols (RAPs), and utilization guidelines of each state. The RAI ultimately provides a national database for nursing facilities so that policy makers will better understand the health care needs of the long-term care population.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension       REF:    26

OBJ:    Discuss the types of settings in which professionals provide various levels of health care    TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Gladys, an 81-year-old widow with dementia, recently moved in with her daughter Cecilia, a 46-year-old working mother with three children. In considering how to have care for her mother when she is working, what is the most appropriate option?
A. A rehabilitation center
B. A nursing center
C. An adult day care center
D. Respite care

 

 

ANS:   C

Services offered by adult day care centers allow family members to maintain their lifestyles and employment and still provide home care for their relatives.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    27

OBJ:    Discuss the types of settings in which professionals provide various levels of health care    TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A 78-year-old widow needs assistance with her medications, housekeeping, and laundry. She would like to maintain her independence. Of the following, which is the best option for her to consider?
A. Assisted living
B. Respite care
C. Nursing center
D. Rehabilitation center

 

 

ANS:   A

Assisted living provides independence, security, and privacy at the same time. These facilities promote independence and physical and psychosocial health. Services in an assisted living facility include medication management, exercise and educational activities, social activities, laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    26

OBJ:    Discuss the types of settings in which professionals provide various levels of health care    TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Which of the following patients is most suitable for admission into a hospice?
A. 63-year-old man with a fractured femur
B. 45-year-old woman with end-stage renal failure
C. 14-year-old patient with leukemia
D. 78-year-old patient with dementia

 

 

ANS:   B

A patient entering a hospice is at the terminal phase of illness, and the patient, family, and physician agree that no further treatment will reverse the disease process.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    27

OBJ:    Discuss the types of settings in which professionals provide various levels of health care    TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. A registered nurse has been working for an oncology unit for the past year. She has a passion for caring for oncology patients undergoing chemotherapy. Whose responsibility is it for the nurse to become competent in administering chemotherapy?
A. The hospital where she works
B. The charge nurse
C. Her own
D. The oncologist who admits patients to the unit where she works

 

 

ANS:   C

A nurse’s responsibility is to follow policies and procedures and to know the most current practice standards. As a nurse progresses in a career, it becomes his or her responsibility to obtain necessary continued education and to earn certifications when he or she chooses to practice in specialty areas.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    27

OBJ:    Discuss opportunities for nursing within the changing health care delivery system

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

SHORT ANSWER

 

  1. Changes in the health care delivery system are being driven by _____________________.

 

ANS:

increasing health care costs

 

Changes in health care are being driven by increasing health care costs.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    33

OBJ:    Discuss opportunities for nursing within the changing health care delivery system

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. A registered nurse working in a restorative care setting will focus on which of the following? Select all that apply.
A. Providing extensive supportive care
B. Providing one-on-one care to patients
C. Promoting patient self-care
D. Promoting independence

 

 

ANS:   C, D

A secondary care setting provides in-depth diagnosis and treatment of illnesses that require extensive, one-on-one complex treatments.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    23

OBJ:    Describe the six levels of health care

TOP:    Nursing Process: Evaluation

MSC:   Client Needs: Health Promotion and Maintenance

 

Potter: Basic Nursing, 7th Edition

 

Chapter 12: Managing Patient Care

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Brenda is a new nurse who is applying for a job as a registered nurse. One of the hospitals where she is interested in working has a Nursing Practice Council, which comprises nurses who write the nursing policies and procedures for the organization. The Nursing Practice Council is an example of which of the following?
A. Nursing autonomy
B. Nursing theory
C. Nursing code of ethics
D. Nursing service

 

 

ANS:   A

Autonomy means that a person is reasonably independent and self-governing in decision-making and practice. Autonomy is reached through experience, advanced education, and the support of an organization that values the independent role of the nurse.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    211

OBJ:    Describe the elements of decentralized decision making

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A registered nurse has been practicing as an operating room nurse for the past 6 years. She is a member of the Association of Perioperative Registered Nurses (AORN) and attends the national conference annually to keep abreast of the latest research in that field of nursing. This is an example of maintaining which of the following American Nurses Association Standards of Performance?
A. Quality of practice
B. Collegiality
C. Practice evaluation
D. Education

 

 

ANS:   D

The definition of education by the ANA Code of Ethics is that the registered nurse attains knowledge and competency that reflects current nursing practice.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    212

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nurse manager in an outpatient oncology center is responsible for the management of 23 registered nurses, four clerical associates, and three nurse practitioners who work at the center. He requires all staff to review the performance of their peers on an annual basis. This is an example of which of the American Nurses Association Standards of Practice?
A. Quality of practice
B. Collegiality
C. Practice evaluation
D. Education

 

 

ANS:   B

The definition of collegiality by the ANA Code of Ethics is that registered nurses interact with and contribute to the professional development of peers and colleagues.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    212

OBJ:    Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model  TOP:               Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Gwen is a registered nurse who works on a busy orthopedic unit. She is responsible for caring for six patients on her day shift with the help of Mike, a nursing assistive personnel (NAP). Gwen begins her shift by discussing patients with Mike and delegating appropriate tasks that are in Mike’s job description. This is an example of which of the following American Nurses Association Standards of Practice?
A. Research
B. Resource utilization
C. Quality of Practice
D. Education

 

 

ANS:   B

The definition of resource utilization by the ANA Standards of Practice is that the registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    213

OBJ:    Discuss principles to follow in the appropriate delegation of patient care activities

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A registered nurse who works in postanesthesia care is caring for a 54-year-old patient who has just had an appendectomy. The patient has arrived in the postanesthesia care unit with a heart rate of 88, respiratory rate of 14, and blood pressure of 134/78. The nurse notes that the patient’s mucus membranes are dusky, and she retakes the vital signs. This is an example of which of the following American Nurses Association Standards of Practice?
A. Assessment
B. Nursing diagnosis
C. Outcomes identification
D. Implementation

 

 

ANS:   A

The definition of assessment by the ANA Standards of Practice is that the registered nurse collects comprehensive data pertinent to the patient’s health or situation.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    214

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A patient admitted to the intensive care unit was placed on ventilator support. The nurse caring for this patient identified on the plan of care that one of the outcomes was that the patient would not develop ventilator-acquired pneumonia. This is an example of which of the following American Nurses Association Standards of Practice?
A. Assessment
B. Nursing diagnosis
C. Outcomes identification
D. Implementation

 

 

ANS:   C

The definition of outcomes identification by the ANA Standards of Practice is that the registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    214

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. An 83-year-old patient was admitted to the hospital for hip replacement surgery after falling at home and breaking her hip. She has developed pneumonia while in the hospital. The nurse caring for the patient is concerned about her hip healing but is more concerned about her ineffective airway clearance related to pain, increased tracheobronchial secretions, and fatigue. The nurse encourages the patient to breathe deeply and cough during her shift. This is an example of which of the following American Nurses Association Standards of Practice?
A. Assessment
B. Nursing diagnosis
C. Planning
D. Outcomes identification

 

 

ANS:   C

The definition of planning by the ANA Standards of Practice is that the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    214

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Katie is a student nurse completing her final semester of nursing school. This semester she is caring for patients in a wound clinic. One of the patients, Mr. Theim, is a 67-year-old man with a varicose ulcer in his right lower leg. Katie has been caring for Mr. Theim for the past month and is taking off the bandages from the leg to see how it is healing. The ulcer no longer had exudates and appeared to be healing as expected. This is an example of which of the following American Nurses Association Standards of Practice?
A. Planning
B. Evaluation
C. Implementation
D. Nursing diagnosis

 

 

ANS:   B

The definition of evaluation by the ANA Standards of Practice is that the registered nurse evaluates progress toward attainment of outcomes.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    214

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A senior nursing student is applying to several hospitals where she would like to work after she graduates. She would like to work where her clinical performance is valued and in an environment that uses evidence-based practice. Given her goals, she should concentrate on applying to which of the following organizations?
A. Private hospitals
B. Community hospitals
C. Not-for-profit hospitals
D. Magnet-designated hospitals

 

 

ANS:   D

Typically a Magnet hospital has a system to recognize and reward nurses for clinical performance, has research programs, and uses evidence-based practice.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    215

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Margaret is a nurse of 15 years. Her husband is in the army and they have recently relocated to a new city. Margaret has worked in a variety of nursing areas and would like to find a unit within the hospital that mirrors her professional values. The best way for Margaret to find a unit that would be a good fit is for her to examine which of the following documents?
A. Hospital mission statement
B. Unit scope of practice
C. Unit philosophy of care
D. Hospital vision statement

 

 

ANS:   C

A philosophy of care incorporates the professional nursing staff ’s values and concerns for the way that they view and care for patients. For example, a philosophy addresses the nursing unit’s purpose, how staff will work with patients and families, and the standards of care for the work unit. A philosophy is a vision for how to practice nursing.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    215

OBJ:    Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model  TOP:               Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A registered nurse works on a unit with other registered nurses, a licensed practical nurse (LPN), and a nursing assistive technician. He does all the dressing changes, the technician gives all the baths, and the LPN administers medications. This model of care is best described as:
A. team nursing.
B. functional nursing.
C. primary nursing.
D. total patient care.

 

 

ANS:   B

Functional nursing is a model of care that evolved in the 1940s and is task focused, not patient focused. In this model tasks are divided, with one nurse assuming responsibility for specific tasks.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    215

OBJ:    Discuss principles to follow in the appropriate delegation of patient care activities

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nurse works at a community hospital in a rural area. She typically cares for six patients during a day shift and is accountable for all their care. There is a licensed practical nurse who works on the same unit to whom she delegates specific tasks, such as bathing. This model of care is best described as:
A. team nursing.
B. functional nursing.
C. primary nursing
D. total patient care.

 

 

ANS:   D

A registered nurse is responsible for all aspects of care for one or more patients during an assigned shift. The registered nurse delegates aspects of care to a licensed practical nurse or nursing assistive personnel but is accountable for the care of all assigned patients.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    216

OBJ:    Discuss principles to follow in the appropriate delegation of patient care activities

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A registered nurse who works in a women’s hospital assumes care for the same patients from the time they are admitted to when they are discharged home. This model of nursing can best be described as:
A. team nursing.
B. primary care nursing.
C. case management.
D. total care.

 

 

ANS:   B

Primary nursing is a model of care delivery in which a registered nurse assumes responsibility for a caseload of patients over time (e.g., a length of stay in a hospital or a series of home care visits). Typically the registered nurse selects the patients for his or her caseload and cares for the same patients during their hospitalization or stay in the health care setting.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    216

OBJ:    Differentiate among the types of nursing care delivery models

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A registered nurse has a patient assignment of caring for six postoperative patients in the orthopedic unit. He completes the patient assessments, distributes medications, and provides care to the patients as outlined within his job description. What term best describes this behavior?
A. Accountability
B. Responsibility
C. Authority
D. Leadership

 

 

ANS:   B

Responsibility refers to the duties and activities that an individual is employed to perform. A position description outlines a professional nurse’s responsibilities in patient care and in participating as a member of the nursing unit.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    217

OBJ:    Differentiate among the types of nursing care delivery models

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nurse works in a trauma intensive care unit in a busy urban hospital. Once a week, staff from all the disciplines caring for the trauma patients get together to discuss their progress. As the team meets in the patient room, the patient’s family can be included in the discussion if it is approved by the patient. This is best described as which of the following?
A. Nursing practice
B. Staff communication
C. Interdisciplinary collaboration
D. Staff education

 

 

ANS:   C

Interdisciplinary collaboration involves bringing representatives of the various disciplines together in practice projects, in-services, conferences, and staff meetings. This brings in different points of view to understand and solve complex patient problems.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    218

OBJ:    Discuss ways to apply clinical care coordination skills in nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nursing student has just started her first clinical rotation. She is seeing a patient for the first time this morning. Which of the following should she do first?
A. Focused patient assessment
B. Patient health history
C. Pass medications
D. Chart review

 

 

ANS:   A

When beginning a patient assignment, always conduct a focused but complete assessment of the patient’s condition and ask what outcomes the patient expects in his or her care.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    221

OBJ:    Discuss ways to apply clinical care coordination skills in nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A registered nurse is prioritizing his care for four patients on his shift. Which of the patients should he see first?
A. 44-year-old woman 1 day postoperative
B. 64-year-old man who had a stroke 2 days ago
C. 56-year-old woman with acute asthma
D. 67-year-old man with a fractured hip

 

 

ANS:   C

According to Maslow, meet the patient’s physiological needs such as oxygen, food, water, sleep, and elimination first. After meeting the physiological needs, meet the patient’s higher-level needs of safety, security, belonging, esteem, and self-actualization.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    219

OBJ:    Discuss ways to apply clinical care coordination skills in nursing practice

TOP:    Nursing Process: Planning

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A first-year nursing student is learning how to prioritize her time. One of the best ways that this can be accomplished is for her to focus on which of the following?
A. Nursing tasks
B. Patient priorities
C. Medication schedule
D. Ancillary procedures

 

 

ANS:   B

Because nurses have a limited amount of time with patients, it is essential to remain goal oriented and focused on patients’ priorities.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    219-220

OBJ:    Discuss ways to apply clinical care coordination skills in nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Jenny is a staff nurse who works on a busy medical unit in a community hospital. She is caring for six patients on her shift and is working with Nancy, a nursing assistive personnel. Which of the following tasks can she safely delegate to Nancy?
A. Patient assessment
B. Patient discharge teaching
C. Patient bed bath
D. Medication administration

 

 

ANS:   C

The American Nurses Association defines delegation as transferring responsibility for the performance of an activity or task while retaining accountability for the outcome.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    222

OBJ:    Discuss principles to follow in the appropriate delegation of patient care activities

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Joann, a registered nurse, requested that Heather, a student nurse, give Mrs. Harris a bath in the morning because she was going to surgery. As Joann prepared Mrs. Harris for surgery, she noted that she had not yet had her bath, and it was too late to give her one because surgery was calling for the patient. Joann needed to give feedback to Heather. Where would be the most appropriate place for Joann to provide Heather this feedback?
A. In the hallway
B. At the nurse’s station
C. In the patient’s room
D. In the conference room

 

 

ANS:   D

If the staff member’s performance is not satisfactory, give constructive and appropriate feedback. Feedback given should be specific in regard to any mistakes that the staff members make, explaining how to avoid the mistake or a better way to handle the situation. Give feedback in private to preserve the staff member’s dignity. When giving feedback, make sure to focus on things that are changeable, choose only one issue at a time, and give specific details.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    223

OBJ:    Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model  TOP:               Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. As a profession, nursing requires that members possess a significant amount of education. Nurses know that education provides:
A. a consumer-focused and service-based practice.
B. the autonomy necessary for the performance of nursing skills.
C. methods to decentralize medical and nursing care.
D. a foundation for practice responding to changes created by scientific and technological advances.

 

 

ANS:   D

Nursing is a service profession, and it is necessary to maintain a consumer- and service-based focus. Autonomy is essential to professional nursing. Autonomy means a person is reasonably independent and self-governing in decision-making and practice. Methods to decentralize medical and nursing care are a type of nursing care delivery system.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    211

OBJ:    Discuss the importance of education in professional nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Nurses use professional standards of nursing practice while rendering care to patients. These nursing practice standards are essential because they:
A. provide guidelines for active participation in clinical care management.
B. provide a theoretical framework for how to practice.
C. identify nursing competencies and evaluative criteria.
D. offer guidelines for how to perform professionally, exercise care, cure, and coordination.

 

 

ANS:   D

The practice of professional nursing and nursing knowledge have been developed through nursing theory, global views that help to describe, predict, or prescribe activities for the practice of nursing. Competencies and evaluative criteria are established to perform tasks and procedures.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    211

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nurse is working in a health care facility where she assumes responsibility for a caseload of patients over a period of time. The nurse is practicing:
A. team nursing.
B. primary nursing.
C. functional nursing.
D. decentralized management.

 

 

ANS:   B

In team nursing, licensed vocational nurses/licensed practical nurses and assistive personnel work under the direction of the registered nurse. Functional nursing is task focused, not patient focused. Decentralized management includes decision-making, which is moved down to the level of staff, involving all employees at all levels of activities.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    216

OBJ:    Differentiate among the types of nursing care delivery models

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

SHORT ANSWER

 

  1. A nurse is working in a busy university-centered medical center. The nurse works in a system where tasks are divided among the registered nurse, licensed vocational nurse/licensed practical nurse, and assistive personnel. The nurse recognizes this nursing care delivery model as ____________________.

 

ANS:

functional nursing

 

In this model tasks are divided, with one nurse assuming responsibility for specific tasks. For example, one nurse does the hygiene and dressing changes, and another nurse assumes responsibility for medication administration.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    215

OBJ:    Differentiate among the types of nursing care delivery models

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nurse has been promoted to nurse manager. This new nurse manager can foster the decentralized decision-making model by ____________________.

 

ANS:

supporting interdisciplinary collaboration

 

Decentralized management occurs when decision-making is moved to the level of staff. A successful decentralized nursing unit exercises three elements of decision-making on an ongoing basis. Responsibility, authority, and accountability are important.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    217

OBJ:    Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model  TOP:               Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

MULTIPLE RESPONSE

 

  1. A newly graduated nurse has been assigned to a team consisting of her and one assistive personnel staff member. When delegating skills the nurse needs to do which of the following? Select all that apply.
A. Assign only bed-making skills and feeding tasks.
B. Assess the knowledge of assistive personnel.
C. Remind the staff member that she is working under the license of the RN.
D. Allow the staff member to perform only skills that the RN is able to teach assistive personnel to perform.
E. Assign only feeding tasks.
F. Assess skill levels of assistive personnel.

 

 

ANS:   B, F

Delegation of patient care improves efficiency. Even though a nurse is capable of providing basic care to patients, nurses need to coordinate care to a group of patients while conducting assessments, using critical thinking to solve problems, and rendering ordered registered nurse therapies. Assistive personnel perform their duties based on hospital protocols, procedures, and their scope of practice. Although nurses demonstrate leadership via mentoring, assistive personnel are not authorized to perform tasks outside of their scope of practice and certification.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    222-223

OBJ:    Discuss principles to follow in the appropriate delegation of patient care activities

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Nurses working at a progressive health care organization participate in a decentralized decision-making framework where they are actively involved in nursing unit decisions. These nurses know that the key elements of decentralization include which of the following? Select all that apply.
A. Trust
B. Standards
C. Responsibility
D. Authority
E. Accountability

 

 

ANS:   C, D, E

Trust is a skill that is used in all types of nursing care delivery. Professional standards are adhered to when providing patient care. They are state or nationally recognized. Standards include care, cure, and coordination.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    217

OBJ:    Describe the purpose of professional standards of nursing practice

TOP:    Nursing Process: Assessment

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A senior nursing student is assigned to a nurse caring for a group of patients. Leadership skills a student should use when caring for patients include which of the following? Select all that apply.
A. Priority setting
B. Time management
C. Benchmarking
D. Delegation
E. Communication

 

 

ANS:   A, B, D, E

Benchmarking consists of identifying best practices and comparing them to the organization’s practices. This is not considered a leadership skill but an aspect of quality improvement. Priority setting, time management, delegation, and communication are all leadership skills.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    220

OBJ:    Discuss ways to apply clinical care coordination skills in nursing practice

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

Potter: Basic Nursing, 7th Edition

 

Chapter 24: Stress and Coping

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Kelly is a nursing student who has been assigned to care for a 67-year-old postoperative patient who is very demanding. She was late for clinical rounds because she had to change the tire on her car. Kelly is in the process of preparing pain medication for her patient when her nursing instructor asks her to identify the drug classification of the pain medication she is preparing. Kelly finds the she is very frustrated and becomes tearful. Kelly’s reaction to her instructor is most likely due to what ego-defense mechanism?
A. Compensation
B. Conversion
C. Denial
D. Dissociation

 

 

ANS:   B

Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite).

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    640

OBJ:    Describe stress management techniques beneficial for coping with stress

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Michael is a 44-year-old nurse who works in a small clinic with two other nurses and a nurse practitioner. Recently Michael has been staying at work longer than he usually does. Michael’s neighbor, a patient at the clinic, asked one of the other nurses at the clinic how Michael was coping since his wife left him. Michael had not shared this information with his co-workers. The nurse is concerned that Michael may be coping with his loss with which of the following?
A. Compensation
B. Conversion
C. Denial
D. Dissociation

 

 

ANS:   C

Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    640

OBJ:    Describe stress management techniques beneficial for coping with stress

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Monty is a 4-year-old boy who has been admitted to the hospital with pneumonia. He has been in the hospital for 3 days and has suddenly started to become incontinent of urine. This is most likely a result of what ego-defense mechanism?
A. Compensation
B. Conversion
C. Denial
D. Regression

 

 

ANS:   D

Regression is coping with a stressor through actions and behaviors associated with an earlier developmental period.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    640

OBJ:    Describe stress management techniques beneficial for coping with stress

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Daniel is a 48-year-old patient who was involved in a motor vehicle accident. He was driving home from a wedding with his family when he was hit by a drunk driver. Daniel’s 23-year-old daughter and his wife were killed in the accident. Daniel is in the trauma unit with internal injuries. He had to have his left leg amputated above the knee. How is the crisis that Daniel is facing best described?
A. Situational
B. Developmental
C. Existential
D. Ecosystemic

 

 

ANS:   A

A patient with stress so severe that the patient is unable to cope using previous stress reduction strategies often experiences a crisis. A crisis devastates a person and requires use of all resources available. Unlike stress, which ends when the stressor disappears, the effects of a crisis sometimes last for years. Developmental crises often arise during the normal flow of human growth, such as with the birth of a child, graduation from college, or a midlife career change. Situational crises emerge from the occurrence of extraordinary events such as terrorist attacks, car crashes, rapes, or job loss. Existential crises refer to inner conflicts and anxieties arising from concerns about life’s purpose, responsibilities, independence, or commitment. Finally, ecosystemic crises occur following a natural or human-caused disaster, such as a hurricane.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    641

OBJ:    Discuss the process of crisis intervention

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Sally is a registered nurse who works in a mental health clinic. She is admitting 17-year-old Elliott who has been referred to the clinic by his pediatrician. Elliott has recently been doing poorly in school, his girlfriend broke up with him, and his best friend was killed in a motor vehicle accident. Elliott tells Sally that he is missing classes because he does not have any motivation to get up in the morning. This assessment finding is from what psychological domain?
A. Cognitive
B. Emotional
C. Behavior
D. Lifestyle

 

 

ANS:   B

Cognitive assessment findings include forgetfulness/preoccupation, denial, and poor concentration. Emotional assessment findings include the lack of motivation to get up in the morning. Behavioral/lifestyle assessment findings include increased or decreased food intake.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    639

OBJ:    Discuss the integration of stress theory with nursing theories

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Richard is a nursing student who has severe test anxiety. When he receives a test in class, his heart rate increases, he feels more mentally alert and his pupils dilate. According to the general adaptation theory, this is what stage of the body’s reaction to stress?
A. Alarm
B. Resistance
C. Adaptation
D. Exhaustion

 

 

ANS:   A

During the alarm reaction, rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    639

OBJ:    Describe the three stages of the general adaptation syndrome

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. The __________ system mediates emotions and is responsible for the mind-body connection.
A. lymphatic
B. circulatory
C. limbic
D. musculoskeletal

 

 

ANS:   C

The limbic system in the brain mediates emotions and includes the hypothalamus, the pituitary gland, and the amygdala. The limbic system possesses receptors for neuropeptides, such as endorphins, insulin, and angiotensin, and makes the connection with the rest of the body to provide the physiological basis for the emotions.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    640

OBJ:    Describe the three stages of the general adaptation syndrome

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Crystal is a new nurse who is looking for a staff nurse position. She had several instances during clinical rotations in nursing school where she was late because she studied until the early hours of the morning. According to her circadian rhythm she would be best suited for which of the following positions?
A. Full-time 8-hour day/evening rotation on the orthopedic unit
B. Part-time 12-hour day position in the emergency department
C. Full-time 12-hour night position in surgery
D. Part-time 8-hour day/night position on the pediatric unit

 

 

ANS:   C

Coping strategies vary with the individual and the situation. People often ease their coping with shift work by knowing their own circadian rhythms.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    641

OBJ:    Discuss how stress in the workplace affects nurses

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Psychosocial Integrity

 

  1. Kevin is a student nurse who is talking to a 23-year-old patient who was involved in a motor vehicle accident. The patient asked Kevin why he didn’t feel any pain at the time of the accident. What is the best explanation that Kevin can give the patient?
A. “You were probably in shock.”
B. “Endorphins are released during a time of stress, and they act like morphine to reduce pain.”
C. “Hormones are released by your body during a time of stress.”
D. “The stress of the accident caused you to forget the pain that you felt.”

 

 

ANS:   B

Endorphins are hormones that act on the mind like morphine and opiates, and they produce a sense of well-being and reduce pain.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    639

OBJ:    Describe the three stages of the general adaptation syndrome

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. Janet is a nurse who has a lot of stress in her life. Which of the following situational factors would be considered work stress?
A. Speeding ticket she received on her way to work
B. Death of a friend she used to work with
C. Overdrawn checking account
D. Mandatory overtime

 

 

ANS:   D

Work stress for nurses happens with work overload, heavy physical work, shift work, patient concerns (dealing with death and medical treatment), and interpersonal problems with other health care professionals and staff.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    641

OBJ:    Discuss how stress in the workplace affects nurses

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. Florence is a student nurse who has been involved in administering flu vaccines. Kevin, one of the children who is scheduled to receive the vaccine, is afraid of needles and is tearful, and his younger brother is trying to calm him down. Florence knows that Kevin has evaluated this event as significant and is experiencing psychological stress due to which of the following?
A. Primary appraisal
B. Coping
C. Secondary appraisal
D. Dissociation

 

 

ANS:   A

A person experiences stress only if the person evaluates the event or circumstance as personally significant. If primary appraisal results in the person identifying the event or circumstance as a harm, loss, threat, or challenge, the person has stress. After the recognition of stress, secondary appraisal focuses on possible coping strategies. Coping means trying to manage a situation a person appraised as potentially harmful or stressful.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    640

OBJ:    Describe stress management techniques beneficial for coping with stress

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Psychosocial Integrity

 

  1. Jenny has recently been promoted to a new management position in her hospital. She is concerned about her new responsibilities and has found that she is having difficulty sleeping at night. This is an example of what ego-defense mechanism?
A. Compensation
B. Denial
C. Conversion
D. Displacement

 

 

ANS:   C

Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite).

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    640

OBJ:    Discuss the integration of stress theory with nursing theories

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. A patient who was injured in a motor vehicle accident is taken via ambulance to the emergency department. The nurse performing the physical assessment knows that, according to the general adaptation syndrome, the patient should be expected to exhibit:
A. an increased appetite.
B. an increased heart rate.
C. decreased perspiration.
D. a decreased respiratory rate.

 

 

ANS:   B

This fight-or-flight response to stress is an arousal of the sympathetic nervous system. The heart rate increases, blood is diverted from the intestines to the brain and striated muscles, blood pressure increases, respiratory rate increases, blood glucose rises, and sweating increases.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    639

OBJ:    Describe the three stages of the general adaptation syndrome

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. A patient complains of pain. The nursing order calls for pain medication via injection. The patient is afraid of needles. The nurse can assist the patient through this stressful incident by encouraging the patient to think of a relaxing situation. The nurse’s actions can be identified as:
A. restorative care.
B. cognitive therapy.
C. assertiveness training.
D. progressive muscle relaxation.

 

 

ANS:   B

Restorative care occurs when a person recovers from a stressful situation for which stress coping mechanisms were successful. Assertiveness training teaches individuals to communicate effectively regarding their needs and desires. Progressive muscle relaxation is a technique used to achieve a relaxed state through deep breathing along with alternately tightening and relaxing muscle groupings.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    648

OBJ:    Describe stress management techniques beneficial for coping with stress

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Psychosocial Integrity

 

  1. A patient and family attend a counseling session. The patient has become depressed after a job loss. The nurse leading the counseling session informs the patient and his family that this type of crisis is:
A. situational.
B. maturational.
C. sociocultural.
D. posttraumatic.

 

 

ANS:   A

Maturational factors vary with life stages, such as self-esteem for adolescents; changing family structure due to divorce, illness, or death; peer group stress; and major life changes. Sociocultural factors include environmental and social stressors, which often lead to developmental problems. Posttraumatic factors affect people who have experienced accidents, violent events, and natural disasters.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    641

OBJ:    Discuss the process of crisis intervention

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Psychosocial Integrity

 

  1. A patient telephones a crisis intervention hot line. The nurse assigned to this center assesses that the patient is experiencing a crisis. What is the most appropriate action for the nurse to take?
A. Recommending ongoing therapy
B. Focusing on the problem at hand
C. Allowing the patient to work through stress
D. Completing an in-depth evaluation of the situation

 

 

ANS:   B

When assessing a patient’s stress and coping interventions, develop a partnership with the patient. It is necessary to prioritize the patient’s needs during this time of stress. This requires that the nurse focus the patient, learn about the patient’s perception of the event, and making sure the safety of the patient and/or family is at the highest priority.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    641

OBJ:    Discuss the process of crisis intervention

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Psychosocial Integrity

 

  1. A nurse has been working overtime because of high hospital census and a decreased work force. A danger of work-related burnout is:
A. emotional exhaustion.
B. a perception of personal accomplishment.
C. functioning at a more effective level.
D. hurting other’s feelings without concern for their reaction.

 

 

ANS:   A

Burnout occurs as a result of chronic stress related to changing technology, diversity in the workforce, organizational restructuring, changing work systems, difficult work schedules, fear of failure, and inadequate support services. Burnout is a syndrome of emotional exhaustion, depersonalization of others, and perceptions of reduced personal accomplishment, resulting from intense involvement with people in a caregiving environment.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    649

OBJ:    Discuss how stress in the workplace affects nurses

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. An older adult patient in a long-term care facility recently suffered a stroke after experiencing a myocardial infarction. The patient is not speaking or eating. The nurse notices a change in vital signs. When a patient is unable to resist the effects of a stressor, the nurse can identify this stage of the general adaptation system as:
A. alarm reaction.
B. the resistance stage.
C. the exhaustion stage.
D. fight-or-flight response.

 

 

ANS:   C

In the alarm stage, rising hormones result in an increased blood pressure, blood glucose levels, epinephrine and norepinephrine levels, heart rates, blood flow to muscles, oxygen intake, and mental alertness. During the resistance stage, the body stabilizes and responds in an opposite manner to the alarm stage. Changes that occur during the alarm stage prepare the body for the fight-or-flight mechanism.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    640

OBJ:    Describe the three stages of the general adaptation syndrome

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

  1. A busy executive works 80 hours a week. The patient is admitted for angina. The patient is demonstrating physical signs of stress related to the work environment. An appropriate nursing intervention for this patient includes using physiological functions every 2 hours. This type of intervention is best known as:
A. regular exercise.
B. assertive training.
C. cognitive therapy.
D. relaxation technique.

 

 

ANS:   D

Regular exercise improves muscle tone and posture, controls weight, reduces tension, improves circulation, triggers the use of endorphins, and promotes relaxation. Assertive training teaches individuals to communicate effectively regarding their needs and desires and ability to resolve conflict. Cognitive therapy focuses on changing ways of thinking so that the patient feels empowered and in control of his or her own life.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    648

OBJ:    Develop a care plan for patients experiencing stress

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Psychosocial Integrity

 

SHORT ANSWER

 

  1. Because stress plays a central role in vulnerability to disease, nursing interventions are required. Nurses using Neuman Systems Model can relate this model to the general adaptation syndrome because both ____________________.

 

ANS:

focus on concepts of stress and reaction to stress

 

Neuman’s systems approach explains that a stressor at one place in a system affects other parts of a system. Events are multidimensional and not caused or affected by only one thing.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    641

OBJ:    Discuss the integration of stress theory with nursing theories

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Psychosocial Integrity

 

Potter: Basic Nursing, 7th Edition

 

Chapter 38: Surgical Patient

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Richard is a 57-year-old patient who is being admitted for an appendectomy. He is a 2-pack-a-day smoker and has a history of diabetes. In addition to his other risk factors, he is 20 pounds overweight. Which of the following potential postoperative complications should the nurse be most concerned with?
A. Atelectasis
B. Negative nitrogen balance
C. Dehydration
D. Hypothermia

 

 

ANS:   A

There is a significant association between smoking and postoperative pulmonary complications, specifically pneumonia and atelectasis. Chronic smoking increases the amount and thickness of mucous secretions in the lungs. Patients who are obese are more susceptible to developing atelectasis.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1131

OBJ:    List factors to include in the preoperative assessment of a surgical patient

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. Misty is a nurse who works in surgery. She knows that pulmonary embolisms can be a deadly complication of surgery. Which of the following patients is most likely to develop a pulmonary embolism?
A. 45-year-old patient after bariatric surgery
B. 23-year-old patient with head trauma
C. 13-year-old patient after appendectomy
D. 57-year-old patient after cholecystectomy

 

 

ANS:   A

Patients who are obese are more susceptible to developing embolism postoperatively than patients who are not obese.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1132

OBJ:    Identify factors to assess in a patient in postoperative recovery

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. Shawna is a 45-year-old woman with cancerous abdominal tumor. She has been on chemotherapy and is having radiotherapy to shrink the tumor. She will be undergoing surgery to remove the tumor. To best facilitate wound healing, when is the best time for her to undergo surgery?
A. During the radiotherapy treatments
B. Immediately after the radiotherapy treatments
C. 2 to 3 weeks after radiotherapy treatments
D. 4 to 6 weeks after radiotherapy treatments

 

 

ANS:   D

The patient with cancer may have radiotherapy before surgery to reduce the size of a cancerous tumor to remove it surgically. Radiation causes fibrosis and vascular scarring in the radiated area. This causes tissues to become fragile and poorly oxygenated, increasing the risk for wound infection. Ideally surgery takes place 4 to 6 weeks after the completion of radiation treatments to avoid wound-healing problems.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1134

OBJ:    Identify factors to assess in a patient in postoperative recovery

TOP:    Nursing Process: Planning                  MSC:   Client Needs: Physiological Integrity

 

  1. Which of the following patients is most at risk for hypovolemic shock after emergency surgery?
A. 14-year-old adolescent with gastroenteritis
B. 59-year-old patient with pneumonia
C. 12-year-old patient with H1N1 flu
D. 28-year-old patient with renal calculi

 

 

ANS:   A

Patients with preexisting renal, fluid and electrolyte, gastrointestinal, respiratory, or cardiovascular problems are at greatest risk for operative complications. For example, a patient who is dehydrated from vomiting preoperatively is at greater risk for hypovolemic shock.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1134

OBJ:    Identify factors to assess in a patient in postoperative recovery

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. Clara is a perioperative nurse. She is monitoring the blood glucose level of Harold, a 56-year-old patient without diabetes who is undergoing orthopedic surgery. What is the main rationale for monitoring his blood glucose level during surgery?
A. She does not want Harold to develop type 2 diabetes.
B. Research shows a strong relationship between wound infections and hyperglycemia.
C. She knows that normal glucose levels promote good tissue oxygenation.
D. She is monitoring to prevent hypoglycemia.

 

 

ANS:   B

Evidence has shown that there is a relationship between wound and tissue infection and blood glucose levels. Poor control of blood glucose levels (specifically hyperglycemia) during and after surgery increases the risk for wound infection and patient mortality in certain types of surgery.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1134

OBJ:    Describe intraoperative factors that affect a patient’s postoperative course

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. Maria is a perioperative nurse who is admitting a patient for an elective surgery. She asks about a family history of malignant hyperthermia, which is a life-threatening complication. Which of the following is a late sign of malignant hyperthermia?
A. High CO2 levels
B. Tachycardia
C. Elevated temperature
D. Tachypnea

 

 

ANS:   C

Malignant hyperthermia is a life-threatening complication resulting in high CO2, tachypnea, tachycardia, heart rhythm irregularities, and muscular rigidity with elevated temperature in the late stages.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1136

OBJ:    Describe intraoperative factors that affect a patient’s postoperative course

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. Lisa is a 44-year-old patient with breast cancer who is scheduled to undergo a right-side mastectomy. Ideally, when should preoperative teaching begin?
A. As soon as she is diagnosed with breast cancer
B. One week before surgery
C. The day before surgery
D. The day of surgery

 

 

ANS:   B

Preoperative teaching is most useful when started the week before admission and reinforced immediately before surgery. Teaching performed when the patient is less anxious will result in more effective learning. Anxiety and fear are barriers to learning.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1145

OBJ:    Prepare a patient for surgery              TOP:    Nursing Process: Implementation

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Harold is the preoperative nurse who is providing patient teaching to James, a 49-year-old patient who is scheduled to undergo a right-side inguinal surgery repair. Harold tells James that the recommendations of the American Society of Anesthesiologists recommend that patients undergoing surgery with a general anesthesia fast from meat and fried foods for _____ hours before surgery?
A. 2
B. 4
C. 6
D. 8

 

 

ANS:   D

The American Society of Anesthesiologists (ASA) provides recommendations on fluid and food intake before procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia. The ASA recommendations include fasting from intake of clear liquids for 2 or more hours, and a light meal of toast and clear liquids for 6 hours. The patient also cannot have any meat or fried foods 8 hours before surgery, unless explicitly specified by the anesthesiologist or surgeon.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    1146

OBJ:    Design a preoperative teaching plan

TOP:    Nursing Process: Planning

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. A nurse working in an ambulatory care surgery center is preparing to discharge a postoperative patient. The nurse knows that, to be discharged, the ambulatory center surgical patient:
A. will remain in phase 1 recovery before discharge.
B. has to meet established discharge criteria before going home.
C. will be able to ambulate as soon as he or she enters the recovery area.
D. has to be superhydrated to promote metabolism of anesthesia agents.

 

 

ANS:   B

Phase 1 begins immediately after the conclusion of surgery. Vital signs and ongoing assessing occur every 15 minutes. Ambulation will not occur until the patient enters phase 2 or the convalescence stage. The anesthetic agents will metabolize naturally. During phase 2, patients are given light fluids and food before they are discharged home.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1155

OBJ:    Explain the differences in caring for a patient undergoing outpatient surgery versus a patient undergoing inpatient surgery         TOP:    Nursing Process: Evaluation

MSC:   Client Needs: Physiological Integrity

 

  1. The nurse instructs the postoperative patient to perform leg exercises every hour in order to:
A. maintain muscle tone.
B. increase venous return.
C. exercise fatigued muscles.
D. assess range of joint motion.

 

 

ANS:   B

Early measures are directed at preventing venous stasis, which will prevent deep vein thrombosis (DVT).

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1163

OBJ:    Describe the rationale for nursing interventions designed to prevent postoperative complications   TOP:            Nursing Process: Evaluation

MSC:   Client Needs: Physiological Integrity

 

  1. A patient with a ruptured abdominal aortic aneurysm needs to have major surgery. The nurse explains to the family that major surgery:
A. is an excision or removal of a diseased body part.
B. involves extensive surgery to reconstruct body parts.
C. is not necessary but may prevent additional problems.
D. is a surgical exploration that allows the physician or health care provider to confirm a diagnosis.

 

 

ANS:   B

Urgent surgery is necessary for the patient’s health and will possibly prevent additional problems from developing. Elective surgery is performed on a basis of the patient’s choice. It is not always essential, and it is not always necessary for health. Diagnostic surgical exploration allows the physician or health care provider to confirm a diagnosis.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1132

OBJ:    Differentiate among classifications of surgery and types of anesthesia

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. A patient is awaiting surgery. The nurse’s best rationale for assessing vital signs is to:
A. assess the patient’s anxiety level.
B. determine the patient’s basal temperature.
C. establish a baseline for vital signs comparisons.
D. assess for any changes in the blood pressure and pulse.

 

 

ANS:   C

Factors to assess include respiration, circulation, infection control, GI function, and comfort. Baseline vital signs give a basis for comparison.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1136

OBJ:    List factors to include in the preoperative assessment of a surgical patient

TOP:    Nursing Process: Assessment             MSC:   Client Needs: Physiological Integrity

 

  1. The operating room environment is deliberately kept cool. When the nurse assesses the patient in the post anesthesia care unit, the patient is shivering. The nurse needs to understand that shivering may:
A. be a side effect of anesthesia.
B. indicate a problem of the hypothalamus.
C. indicate the beginning of the infectious process.
D. be a normal response to stabilize blood pressure.

 

 

ANS:   A

The operating room environment is cool, and the patient’s depressed level of body function results in a lowering of metabolism and fall in body temperature. When patients begin to awaken, they often complain of feeling cold and uncomfortable. Shivering is not always a sign of hypothermia, but rather a side effect of certain anesthetic agents. If a patient develops a fever, notify the surgeon immediately.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1157

OBJ:    Identify factors to assess in a patient in postoperative recovery

TOP:    Nursing Process: Evaluation              MSC:   Client Needs: Physiological Integrity

 

  1. The assistive personnel asks the nurse to explain what is involved in perioperative nursing. The nurse’s most appropriate response should be that perioperative nursing includes nursing care that is:
A. performed in a variety of settings.
B. rendered before, during, and after surgery.
C. given according to the seriousness of the surgery.
D. classified according to the procedure experienced.

 

 

ANS:   D

The seriousness of the surgery does not preclude preoperative, intraoperative, and postoperative surgical care.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    1131

OBJ:    Explain the concept of perioperative nursing care

TOP:    Nursing Process: Planning                  MSC:   Client Needs: Physiological Integrity

 

  1. All patients undergoing surgery need to have preoperative preparation. When physically preparing the patient, the most appropriate action for the nurse to take is:
A. leaving all of the patient’s jewelry in place.
B. removing the patient’s makeup and nail polish.
C. providing the patient with sips of water for a dry mouth.
D. removing the patient’s hearing aid before transport to the operating room.

 

 

ANS:   B

Jewelry is removed so it can be safeguarded. In addition, swelling may occur postoperatively. Makeup and nail polish are removed so the patient’s skin and mucous membranes can be assessed in order to determine oxygenation, saturation of blood, and application of a pulse oximeter. Patients are to maintain NPO to prevent postoperative GI complications and to prevent aspiration because the gag reflex is suppressed. Although patients need to remove hearing aids, do not have them do this until immediately before surgery; allowing the patient to wear hearing aids will facilitate communication between the patient and health care providers.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1149

OBJ:    Prepare a patient for surgery              TOP:    Nursing Process: Implementation

MSC:   Client Needs: Physiological Integrity

 

  1. Intraoperatively, the circulating nurse observes a member of the surgical team breach aseptic technique. As a result of this incident the patient postoperatively can be at risk for:
A. paralytic ileus.
B. malignant hyperthermia.
C. development of infection.
D. alteration in pulmonary hygiene.

 

 

ANS:   C

Paralytic ileus is a loss of function of the intestine, which causes abdominal distention. Anesthetic agents slow gastrointestinal functioning. Malignant hyperthermia results from administration of certain anesthetic agents. Alteration in pulmonary hygiene occurs when postoperatively the patient does not cough and deep breathe.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1153

OBJ:    Describe intraoperative factors that affect a patient’s postoperative course

TOP:    Nursing Process: Evaluation              MSC:   Client Needs: Physiological Integrity

 

  1. A patient asks a nurse to explain the differences between general anesthesia and regional anesthesia. What is the correct response?
A. “General anesthesia inhibits peripheral nerve conduction.”
B. “Under general anesthesia all sensation and consciousness is lost.”
C. “Under general anesthesia there is a loss of sensation in a specific area of the body.”
D. “General anesthesia is routinely used for procedures that only require a decreased level of consciousness.”

 

 

ANS:   B

Local anesthesia involves loss of sensation at the desired site by inhibiting peripheral nerve conduction. Regional anesthesia results in loss of sensation in an area of the body by anesthetizing sensory pathways. Moderate sedation/analgesia (conscious sedation) is routinely used for diagnostic or therapeutic procedures that do not require complete anesthesia but simply a decreased level of consciousness.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1153

OBJ:    Differentiate among classifications of surgery and types of anesthesia

TOP:    Nursing Process: Evaluation              MSC:   Client Needs: Physiological Integrity

 

  1. The nurse is conducting preoperative teaching with the patient and family. The nurse teaches the patient the proper use of the incentive spirometer. The nurse knows that the patient understands the need for this intervention when the patient states, “I use this device to:
A. help my cough reflex.”
B. expand my lungs after surgery.”
C. increase my lung circulation.”
D. drain excess fluid from my lungs.”

 

 

ANS:   B

To facilitate deep breathing the incentive spirometer encourages forced inspiration to prevent atelectasis.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1146

OBJ:    Describe the rationale for nursing interventions designed to prevent postoperative complications   TOP:            Nursing Process: Evaluation

MSC:   Client Needs: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. When is it appropriate to ask a surgeon to clarify information for a patient who is undergoing surgery? Select all that apply.
A. Before the informed consent has been signed
B. When a patient is confused about the reason for the procedure
C. When a patient understands the risks involved in a procedure
D. If there is confusion about the procedure after the informed consent is signed

 

 

ANS:   A, B, D

Patients need to sign all consent forms before you administer any preoperative medications that alter the patient’s consciousness. The primary responsibility for informing the patient rests with the surgeon and anesthesia care personnel. However, if the patient is confused or uncertain about a procedure, you are ethically obligated to contact the surgeon and/or anesthesia care provider so that further discussion and clarification are provided to meet the patient’s needs. The patient always has the right to refuse surgery or treatment even after giving written consent.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1151

OBJ:    Prepare a patient for surgery              TOP:    Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

  1. Madelyn is a student nurse who is providing preoperative teaching for a patient regarding pain control after surgery. Which of the following statements is/are true regarding the use of postoperative analgesia? Select all that apply.
A. “Analgesics will not provide adequate relief if you wait until the pain becomes excruciating before using them.”
B. “Pain control will help you recover from surgery quicker.”
C. “You shouldn’t be concerned about becoming addicted to your pain medications.”
D. “You will remain pain-free as long as you take your pain medications as prescribed.”

 

 

ANS:   A, B, C

Analgesics will not provide adequate pain relief if the patient waits until the pain becomes excruciating before using or requesting an analgesic. Even though around-the-clock (ATC) analgesia is more effective, most patients still have analgesics ordered prn (as needed). Pain control is essential for a surgical patient to recover quickly. Encourage the patient to use analgesics as needed and not be fearful of any dependence on pain medications after surgery. Explain the schedule for administration of epidural, intramuscular, and oral analgesics. If analgesics are not ordered ATC, encourage the patient to inform nurses as soon as pain becomes a persistent discomfort. The patient also needs to know it takes time for a drug to act and that the drug will rarely eliminate all the discomfort.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    1146

OBJ:    Design a preoperative teaching plan

TOP:    Nursing Process: Planning

MSC:   Client Needs: Health Promotion and Maintenance

 

  1. Malcolm is a student nurse who has been assigned to Mr. LaMar as part of his surgery clinical rotation. Mr. LaMar is a 67-year-old patient who is undergoing thoracic surgery to remove a tumor. As part of the preoperative teaching, Malcolm discusses the importance of coughing. Which of the following statements is true regarding why post-operative coughing is important? Select all that apply.
A. “Coughing assists in removing retained mucus in the airways.”
B. “It won’t hurt to cough with adequate pain control.”
C. “You can splint your incision when coughing to minimize pain.”
D. “Deep breathing and coughing will remove anesthesia gases from your lungs.”

 

 

ANS:   A, C, D

Coughing assists in removing retained mucus in the airways. A deep, productive cough is more beneficial than merely clearing the throat. The patient needs to anticipate postoperative discomfort and understand the importance of coughing, even when it is difficult. Teach the patient to splint an abdominal or thoracic incision to minimize pain during coughing. Pain control is essential for effective deep breathing and coughing; educate the patient to ask for pain medications as needed. Deep breathing also helps to clear any anesthetic gases from the airways.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    1146

OBJ:    Describe the rationale for nursing interventions designed to prevent postoperative complications   TOP:            Nursing Process: Planning

MSC:   Client Needs: Physiological Integrity

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