Nursing A Concept Based Approach to Learning Volume II 2nd Ed-Test Bank

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Nursing A Concept Based Approach to Learning Volume II 2nd Ed-Test Bank

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)

Module 22   Addiction

 

The Concept of Addiction

1) While practicing at an outpatient addiction clinic, the nurse is summarizing a diagram in the orientation handbook for a new associate she is precepting. Which statement most closely aligns with the meaning of this diagram?

 

 

  1. A) Addiction involves an alteration in the amount of available neurotransmitters.
  2. B) Actions at the neurotransmitter level affecting addiction are not genetic.
  3. C) High self-esteem as a basis for pleasure seeking lowers neurotransmitter levels.
  4. D) An addictive personality is identified by differences in the processing of neurotransmitters.

Answer:  A

Explanation:  A) Substances of addiction alter the amount of available neurotransmitters, including dopamine, serotonin, and norepinephrine. Several genes have been identified that seem to influence the risk for alcohol dependence. Low self-esteem increases the risk for addiction. No addictive personality type has been identified.

  1. B) Substances of addiction alter the amount of available neurotransmitters, including dopamine, serotonin, and norepinephrine. Several genes have been identified that seem to influence the risk for alcohol dependence. Low self-esteem increases the risk for addiction. No addictive personality type has been identified.
  2. C) Substances of addiction alter the amount of available neurotransmitters, including dopamine, serotonin, and norepinephrine. Several genes have been identified that seem to influence the risk for alcohol dependence. Low self-esteem increases the risk for addiction. No addictive personality type has been identified.
  3. D) Substances of addiction alter the amount of available neurotransmitters, including dopamine, serotonin, and norepinephrine. Several genes have been identified that seem to influence the risk for alcohol dependence. Low self-esteem increases the risk for addiction. No addictive personality type has been identified.

Page Ref: 1520

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Client Need Sub:  Physiological Adaptation

Nursing Process:  Assessment

Learning Outcome:  1. Summarize the physiological and psychological processes that contribute to addiction.

 

2) During a class for college seniors, a participant admits to frequently using alcohol. What is the priority action of the nurse?

  1. A) Initiate a community assessment of the campus.
  2. B) Contact the campus nurse and refer the student.
  3. C) Notify campus security to watch for driving under the influence.
  4. D) Complete a crisis assessment.

Answer:  D

Explanation:  A) In a trusting relationship, the nurse will complete a crisis assessment to determine the appropriate action. Contacting the campus nurse is not advised without the student’s permission. There is no evidence that the student is driving under the influence.

  1. B) In a trusting relationship, the nurse will complete a crisis assessment to determine the appropriate action. Contacting the campus nurse is not advised without the student’s permission. There is no evidence that the student is driving under the influence.
  2. C) In a trusting relationship, the nurse will complete a crisis assessment to determine the appropriate action. Contacting the campus nurse is not advised without the student’s permission. There is no evidence that the student is driving under the influence.
  3. D) In a trusting relationship, the nurse will complete a crisis assessment to determine the appropriate action. Contacting the campus nurse is not advised without the student’s permission. There is no evidence that the student is driving under the influence.

Page Ref: 1527

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  4. Differentiate assessments of addictions across the life span.

 

3) A nursing instructor is teaching her students about the comprehensive theory of addiction by George Engel. Which statement or statements indicate that the student understands the theory?

Select all that apply.

  1. A) “Addiction occurs due to a lack of emotional attachment.”
  2. B) “There is a biological factor involved in the development of addiction.”
  3. C) “There are social factors that contribute to the development of addiction.”
  4. D) “There is a moral factor involved in the development of addiction.”
  5. E) “There is a psychological factor involved in the development of addiction.”

Answer:  B, C, E

Explanation:  A) The biopsychosocial explanation of addiction is supported by current research and takes a more holistic view of the problem. The biopsychosocial explanation links biological, psychological, and social factors as contributing to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.

  1. B) The biopsychosocial explanation of addiction is supported by current research and takes a more holistic view of the problem. The biopsychosocial explanation links biological, psychological, and social factors as contributing to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.
  2. C) The biopsychosocial explanation of addiction is supported by current research and takes a more holistic view of the problem. The biopsychosocial explanation links biological, psychological, and social factors as contributing to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.
  3. D) The biopsychosocial explanation of addiction is supported by current research and takes a more holistic view of the problem. The biopsychosocial explanation links biological, psychological, and social factors as contributing to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.
  4. E) The biopsychosocial explanation of addiction is supported by current research and takes a more holistic view of the problem. The biopsychosocial explanation links biological, psychological, and social factors as contributing to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.

Page Ref: 1520

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Summarize the physiological and psychological processes that contribute to addiction.

 

4) During visitation on the unit, the nurse is observing the family dynamics of an adolescent client who has an addiction problem and recognizes that the family is experiencing behaviors consistent with codependence. Which problems might the nurse expect this family to manifest on an ongoing basis?

  1. A) Frustration intolerance
  2. B) Enabling
  3. C) Argumentative behaviors
  4. D) Impatience

Answer:  B

Explanation:  A) Codependents often engage in enabling behavior, which is any action an individual takes that consciously or unconsciously facilitates substance dependence. Although impatience, frustration intolerance, and argumentative behaviors may be present in this family, they are generally not related to the cycle of codependence and addiction.

  1. B) Codependents often engage in enabling behavior, which is any action an individual takes that consciously or unconsciously facilitates substance dependence. Although impatience, frustration intolerance, and argumentative behaviors may be present in this family, they are generally not related to the cycle of codependence and addiction.
  2. C) Codependents often engage in enabling behavior, which is any action an individual takes that consciously or unconsciously facilitates substance dependence. Although impatience, frustration intolerance, and argumentative behaviors may be present in this family, they are generally not related to the cycle of codependence and addiction.
  3. D) Codependents often engage in enabling behavior, which is any action an individual takes that consciously or unconsciously facilitates substance dependence. Although impatience, frustration intolerance, and argumentative behaviors may be present in this family, they are generally not related to the cycle of codependence and addiction.

Page Ref: 1526

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  2. Examine the relationship between addiction and other concepts/systems.

 

5) A new nurse orienting to the unit is preparing to assist with obtaining data for a screening tool to determine whether a client is addicted to alcohol. Which tool or tools will be used to assess the client?

Select all that apply.

  1. A) OOWS
  2. B) MAST
  3. C) CAGE questionnaire
  4. D) B-DAST
  5. E) CIWA-ar

Answer:  B, C, E

Explanation:  A) The CAGE questionnaire, MAST (Michigan Alcohol Screening Test), and CIWA-ar (Clinical Institute Withdrawal Assessment of Alcohol Revised) are all used to assess for alcohol-related problems. The B-DAST (Brief Drug Abuse Screening Test) is used to assess for addiction to substances other than alcohol. The OOWS (Objective Opiate Withdrawal Scale) is useful for assessing clients who are experiencing opiate withdrawal.

  1. B) The CAGE questionnaire, MAST (Michigan Alcohol Screening Test), and CIWA-ar (Clinical Institute Withdrawal Assessment of Alcohol Revised) are all used to assess for alcohol-related problems. The B-DAST (Brief Drug Abuse Screening Test) is used to assess for addiction to substances other than alcohol. The OOWS (Objective Opiate Withdrawal Scale) is useful for assessing clients who are experiencing opiate withdrawal.
  2. C) The CAGE questionnaire, MAST (Michigan Alcohol Screening Test), and CIWA-ar (Clinical Institute Withdrawal Assessment of Alcohol Revised) are all used to assess for alcohol-related problems. The B-DAST (Brief Drug Abuse Screening Test) is used to assess for addiction to substances other than alcohol. The OOWS (Objective Opiate Withdrawal Scale) is useful for assessing clients who are experiencing opiate withdrawal.
  3. D) The CAGE questionnaire, MAST (Michigan Alcohol Screening Test), and CIWA-ar (Clinical Institute Withdrawal Assessment of Alcohol Revised) are all used to assess for alcohol-related problems. The B-DAST (Brief Drug Abuse Screening Test) is used to assess for addiction to substances other than alcohol. The OOWS (Objective Opiate Withdrawal Scale) is useful for assessing clients who are experiencing opiate withdrawal.
  4. E) The CAGE questionnaire, MAST (Michigan Alcohol Screening Test), and CIWA-ar (Clinical Institute Withdrawal Assessment of Alcohol Revised) are all used to assess for alcohol-related problems. The B-DAST (Brief Drug Abuse Screening Test) is used to assess for addiction to substances other than alcohol. The OOWS (Objective Opiate Withdrawal Scale) is useful for assessing clients who are experiencing opiate withdrawal.

Page Ref: 1540

Cognitive Level:  Understanding

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals who abuse alcohol.

 

6) The client enters the Emergency Department with signs of drug use. The client reports having ingested Percocet. Which medications will be indicated to manage a potential overdose?

  1. A) Diazepam
  2. B) Haldol
  3. C) Vitamin B12
  4. D) Narcan

Answer:  D

Explanation:  A) Percocet is a type of opiate. Narcan is used to treat an overdose of opiates. Diazepam can be prescribed to manage signs of an overdose. Haldol can be administered to manage an overdose of phencyclidine piperidine (PCP). Vitamin B12 is used to manage the neurologic symptoms that might accompany a nitrate overdose.

  1. B) Percocet is a type of opiate. Narcan is used to treat an overdose of opiates. Diazepam can be prescribed to manage signs of an overdose. Haldol can be administered to manage an overdose of phencyclidine piperidine (PCP). Vitamin B12 is used to manage the neurologic symptoms that might accompany a nitrate overdose.
  2. C) Percocet is a type of opiate. Narcan is used to treat an overdose of opiates. Diazepam can be prescribed to manage signs of an overdose. Haldol can be administered to manage an overdose of phencyclidine piperidine (PCP). Vitamin B12 is used to manage the neurologic symptoms that might accompany a nitrate overdose.
  3. D) Percocet is a type of opiate. Narcan is used to treat an overdose of opiates. Diazepam can be prescribed to manage signs of an overdose. Haldol can be administered to manage an overdose of phencyclidine piperidine (PCP). Vitamin B12 is used to manage the neurologic symptoms that might accompany a nitrate overdose.

Page Ref: 1540

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Explain prevention and management of addictions.

 

7) At a neighborhood clinic, the nurse is planning addiction treatment groups. What knowledge of addictions and related therapies will facilitate implementation of the groups?

  1. A) Relapse is a common feature of substance abuse.
  2. B) Hereditary, as well as complex environmental influences, predisposes one to substance dependence.
  3. C) Clients with a substance dependence cannot be held accountable for their actions.
  4. D) Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are accepted treatment approaches.

Answer:  B

Explanation:  A) Knowing the psychobiology aspects of heritability and predisposition to substance dependence, as well as the complex environmental influences, helps diminish stigma. Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness.

  1. B) Knowing the psychobiology aspects of heritability and predisposition to substance dependence, as well as the complex environmental influences, helps diminish stigma. Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness.
  2. C) Knowing the psychobiology aspects of heritability and predisposition to substance dependence, as well as the complex environmental influences, helps diminish stigma. Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness.
  3. D) Knowing the psychobiology aspects of heritability and predisposition to substance dependence, as well as the complex environmental influences, helps diminish stigma. Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness.

Page Ref: 1521

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  3. Identify commonly occurring addictions and their related therapies.

 

8) The nurse is called to an injury accident of an employee who has a history of addiction and is currently enrolled in a 12-step recovery program. In accordance with company policy, which test will the nurse perform?

  1. A) Liver enzymes
  2. B) Stool guaiac
  3. C) Urine specific gravity
  4. D) Hair testing

Answer:  D

Explanation:  A) Hair testing can detect substance use for up to 90 days. Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. Urine specific gravity is used to detect dilute or concentrated urine.

  1. B) Hair testing can detect substance use for up to 90 days. Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. Urine specific gravity is used to detect dilute or concentrated urine.
  2. C) Hair testing can detect substance use for up to 90 days. Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. Urine specific gravity is used to detect dilute or concentrated urine.
  3. D) Hair testing can detect substance use for up to 90 days. Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. Urine specific gravity is used to detect dilute or concentrated urine.

Page Ref: 1528

Cognitive Level:  Understanding

Client Need:  Health Promotion and Maintenance

Nursing Process:  Assessment

Learning Outcome:  5. Describe diagnostic and laboratory tests to determine an individual’s addiction status.

 

9) An older woman who emigrated from the Middle East lives with her son. She accompanies him to a clinic where he participates in AA. Which independent nursing action will be most helpful for the nurse to implement with this client?

  1. A) Assertiveness training
  2. B) Milieu therapy
  3. C) Family therapy
  4. D) Communication training

Answer:  D

Explanation:  A) Many clients and families with addiction need training in communication skills. Verbal and nonverbal communication training is a vital independent nursing action. Cultural norms must be carefully considered prior to implementing assertiveness training. Milieu therapy and family therapy are interventions involving collaboration with therapists.

  1. B) Many clients and families with addiction need training in communication skills. Verbal and nonverbal communication training is a vital independent nursing action. Cultural norms must be carefully considered prior to implementing assertiveness training. Milieu therapy and family therapy are interventions involving collaboration with therapists.
  2. C) Many clients and families with addiction need training in communication skills. Verbal and nonverbal communication training is a vital independent nursing action. Cultural norms must be carefully considered prior to implementing assertiveness training. Milieu therapy and family therapy are interventions involving collaboration with therapists.
  3. D) Many clients and families with addiction need training in communication skills. Verbal and nonverbal communication training is a vital independent nursing action. Cultural norms must be carefully considered prior to implementing assertiveness training. Milieu therapy and family therapy are interventions involving collaboration with therapists.

Page Ref: 1528

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  7. Demonstrate the nursing process in providing culturally competent and caring interventions across the life span for individuals with addictions.

 

10) The client with a history of alcohol abuse is being discharged. Which intervention is the discharge priority of choice for the multidisciplinary care team in collaboration with the client?

  1. A) Disulfiram
  2. B) AA
  3. C) Contingency contract
  4. D) Varenicline

Answer:  A

Explanation:  A) Disulfiram (Antabuse) causes the client to become immediately and violently ill when consuming alcohol. AA (Alcoholics Anonymous) and a contingency contract are appropriate tools but are not as urgent as Disulfiram. Varenicline is a drug for smoking cessation.

  1. B) Disulfiram (Antabuse) causes the client to become immediately and violently ill when consuming alcohol. AA (Alcoholics Anonymous) and a contingency contract are appropriate tools but are not as urgent as Disulfiram. Varenicline is a drug for smoking cessation.
  2. C) Disulfiram (Antabuse) causes the client to become immediately and violently ill when consuming alcohol. AA (Alcoholics Anonymous) and a contingency contract are appropriate tools but are not as urgent as Disulfiram. Varenicline is a drug for smoking cessation.
  3. D) Disulfiram (Antabuse) causes the client to become immediately and violently ill when consuming alcohol. AA (Alcoholics Anonymous) and a contingency contract are appropriate tools but are not as urgent as Disulfiram. Varenicline is a drug for smoking cessation.

Page Ref: 1533

Cognitive Level:  Understanding

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  8. Compare and contrast common independent and collaborative interventions for addiction.

 

Exemplar 22.1  Alcohol Abuse

 

1) A formerly homeless client has been treated for alcoholism. The client’s physical examination reveals the client has a BMI of 18. Which medications does the nurse expect the physician to prescribe to manage the client’s nutritional status?

  1. A) Sertraline (Zoloft)
  2. B) Methadone
  3. C) Narcan
  4. D) Multivitamin with folic acid

Answer:  D

Explanation:  A) A client with alcohol dependence may suffer from numerous nutritional deficiencies, including deficiencies in thiamine, folic acid, vitamin A, magnesium, and zinc. A multivitamin may be prescribed to help with these deficiencies. Narcan is used to manage an opiate overdose. Methadone is prescribed to manage heroin cravings. Sertraline (Zoloft) is used to reduce anxiety and stabilize mood.

  1. B) A client with alcohol dependence may suffer from numerous nutritional deficiencies, including deficiencies in thiamine, folic acid, vitamin A, magnesium, and zinc. A multivitamin may be prescribed to help with these deficiencies. Narcan is used to manage an opiate overdose. Methadone is prescribed to manage heroin cravings. Sertraline (Zoloft) is used to reduce anxiety and stabilize mood.
  2. C) A client with alcohol dependence may suffer from numerous nutritional deficiencies, including deficiencies in thiamine, folic acid, vitamin A, magnesium, and zinc. A multivitamin may be prescribed to help with these deficiencies. Narcan is used to manage an opiate overdose. Methadone is prescribed to manage heroin cravings. Sertraline (Zoloft) is used to reduce anxiety and stabilize mood.
  3. D) A client with alcohol dependence may suffer from numerous nutritional deficiencies, including deficiencies in thiamine, folic acid, vitamin A, magnesium, and zinc. A multivitamin may be prescribed to help with these deficiencies. Narcan is used to manage an opiate overdose. Methadone is prescribed to manage heroin cravings. Sertraline (Zoloft) is used to reduce anxiety and stabilize mood.

Page Ref: 1566

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual who abuses alcohol.

 

2) A college student attends a seminar on alcohol abuse. Which statement would alert the nurse that the student needs more education?

  1. A) “The children of alcoholics are less likely to become alcoholics.”
  2. B) “Native Americans are more likely to become alcoholics.”
  3. C) “Married college graduates are less likely to become alcoholics.”
  4. D) “Childless people are more likely to become alcoholics than parents.”

Answer:  A

Explanation:  A) A genetic predisposition to alcoholism is established for Native Americans and the children of alcoholics. Married people, college graduates, and parents are less likely to become alcoholics.

  1. B) A genetic predisposition to alcoholism is established for Native Americans and the children of alcoholics. Married people, college graduates, and parents are less likely to become alcoholics.
  2. C) A genetic predisposition to alcoholism is established for Native Americans and the children of alcoholics. Married people, college graduates, and parents are less likely to become alcoholics.
  3. D) A genetic predisposition to alcoholism is established for Native Americans and the children of alcoholics. Married people, college graduates, and parents are less likely to become alcoholics.

Page Ref: 1536

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  2. Identify risk factors associated with alcohol use.

 

3) The nurse has completed her assessment of a client with a history of alcoholism who is hospitalized with anorexia, dysphagia, odynophagia, and chest pressure after eating. Which nursing diagnosis is a priority for this client?

  1. A) Ineffective Coping
  2. B) Imbalanced Nutrition: Less Than Body Requirements
  3. C) Disturbed Sensory Perception
  4. D) Disturbed Thought Processes

Answer:  B

Explanation:  A) An alcoholic client with anorexia is at risk for Imbalanced Nutrition, Less Than Body Requirements. Ineffective Coping is a potential diagnosis used in substance abuse. Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens.

  1. B) An alcoholic client with anorexia is at risk for Imbalanced Nutrition, Less Than Body Requirements. Ineffective Coping is a potential diagnosis used in substance abuse. Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens.
  2. C) An alcoholic client with anorexia is at risk for Imbalanced Nutrition, Less Than Body Requirements. Ineffective Coping is a potential diagnosis used in substance abuse. Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens.
  3. D) An alcoholic client with anorexia is at risk for Imbalanced Nutrition, Less Than Body Requirements. Ineffective Coping is a potential diagnosis used in substance abuse. Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens.

Page Ref: 1541

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  4. Formulate priority nursing diagnoses appropriate for an individual who abuses alcohol.

 

4) A client with alcoholism is receiving court-ordered care in a residential treatment facility. After alcohol is discovered in the client’s room, she denies that it belongs to her. Which statement(s) by the nurse will support the treatment plan made in collaboration with the physician and the addiction therapist?

Select all that apply.

  1. A) “You will lose your day pass privileges for this Sunday.”
  2. B) “We have a video of you accepting the alcohol from your brother.”
  3. C) “What do you think about sharing this at AA tonight?”
  4. D) “You won’t be allowed to go to dinner tonight.”
  5. E) “You have violated our behavior contract.”

Answer:  A, B, C, E

Explanation:  A) Used with care and a calm attitude, confrontation interferes with the client’s ability to use denial or rationalization. Losing privileges is a consequence of violating the behavior contract. Participation in AA will provide peer feedback. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.

  1. B) Used with care and a calm attitude, confrontation interferes with the client’s ability to use denial or rationalization. Losing privileges is a consequence of violating the behavior contract. Participation in AA will provide peer feedback. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.
  2. C) Used with care and a calm attitude, confrontation interferes with the client’s ability to use denial or rationalization. Losing privileges is a consequence of violating the behavior contract. Participation in AA will provide peer feedback. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.
  3. D) Used with care and a calm attitude, confrontation interferes with the client’s ability to use denial or rationalization. Losing privileges is a consequence of the violating the behavior contract. Participation in AA will provide peer feedback. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.
  4. E) Used with care and a calm attitude, confrontation interferes with the client’s ability to use denial or rationalization. Losing privileges is a consequence of violating the behavior contract. Participation in AA will provide peer feedback. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.

Page Ref: 1541

Cognitive Level:  Evaluating

Client Need:  Psychosocial Integrity

Nursing Process:  Caring

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual who abuses alcohol.

 

5) The nurse is evaluating outcome goals written by a student for an alcoholic client being discharged from a detoxification program. Which outcome or outcomes now are appropriate for this client?

Select all that apply.

  1. A) Follow a 2000-calorie high-carbohydrate diet.
  2. B) Sponsor a participant in Alcoholics Anonymous (AA) meetings.
  3. C) Obtain at least 6-8 hours of sleep per night.
  4. D) Acknowledge the blame that family members must take for codependent behavior.
  5. E) Enroll in the Employee Assistance Program (EAP) through his employer.

Answer:  C, E

Explanation:  A) Outcome measures for a client discharging from alcohol detoxification are to obtain at least 6-8 hours of sleep a night and to enroll in the Employee Assistance Program if offered through the client’s employer. The calorie requirement should be individualized and may not be 2000 calories. New or returning members to AA should be sponsored and are not ready to sponsor another person. This client should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.

  1. B) Outcome measures for a client discharging from alcohol detoxification are to obtain at least 6-8 hours of sleep a night and to enroll in the Employee Assistance Program if offered through the client’s employer. The calorie requirement should be individualized and may not be 2000 calories. New or returning members to AA should be sponsored and are not ready to sponsor another person. This client should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.
  2. C) Outcome measures for a client discharging from alcohol detoxification are to obtain at least 6-8 hours of sleep a night and to enroll in the Employee Assistance Program if offered through the client’s employer. The calorie requirement should be individualized and may not be 2000 calories. New or returning members to AA should be sponsored and are not ready to sponsor another person. This client should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.
  3. D) Outcome measures for a client discharging from alcohol detoxification are to obtain at least 6-8 hours of sleep a night and to enroll in the Employee Assistance Program if offered through the client’s employer. The calorie requirement should be individualized and may not be 2000 calories. New or returning members to AA should be sponsored and are not ready to sponsor another person. This client should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.
  4. E) Outcome measures for a client discharging from alcohol detoxification are to obtain at least 6-8 hours of sleep a night and to enroll in the Employee Assistance Program if offered through the client’s employer. The calorie requirement should be individualized and may not be 2000 calories. New or returning members to AA should be sponsored and are not ready to sponsor another person. This client should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.

Page Ref: 1541

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Evaluate expected outcomes for an individual who abuses alcohol.

 

6) A client is admitted for the fourth time in 4 years for alcohol detoxification. Which aspect(s) of the pathophysiology of alcoholism will impact the plan of care?

  1. A) Aging can impact the ability of the body to handle detoxification from alcohol and drugs.
  2. B) The withdrawal may be greater this time.
  3. C) The dependency might have been greater this time.
  4. D) Increased difficulty with alcohol detoxification is likely the result of an addiction to another substance at the same time.

Answer:  B

Explanation:  A) Subsequent episodes of withdrawal tend to get progressively worse due to kindling. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications. Aging does not play a role in the process. There is no evidence to support the suspicion that the client is addicted to additional substances or has an increased degree of dependence.

  1. B) Subsequent episodes of withdrawal tend to get progressively worse due to kindling. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications. Aging does not play a role in the process. There is no evidence to support the suspicion that the client is addicted to additional substances or has an increased degree of dependence.
  2. C) Subsequent episodes of withdrawal tend to get progressively worse due to kindling. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications. Aging does not play a role in the process. There is no evidence to support the suspicion that the client is addicted to additional substances or has an increased degree of dependence.
  3. D) Subsequent episodes of withdrawal tend to get progressively worse due to kindling. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications. Aging does not play a role in the process. There is no evidence to support the suspicion that the client is addicted to additional substances or has an increased degree of dependence.

Page Ref: 1539

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Describe the pathophysiology, psychopathology, etiology, clinical manifestations, and direct and indirect causes of alcohol abuse.

 

7) The nurse is collecting data from a client regarding alcohol use history. What question will provide the greatest amount of information?

  1. A) Are you a heavy drinker?
  2. B) How many alcoholic beverages do you drink each day?
  3. C) Is alcohol use a concern for you?
  4. D) Drinking doesn’t cause any problems for you, does it?

Answer:  B

Explanation:  A) Open-ended questions will elicit the greatest amount of information. Asking closed questions that can be answered with a “yes” or “no” will limit the information obtained.

  1. B) Open-ended questions will elicit the greatest amount of information. Asking closed questions that can be answered with a “yes” or “no,” such as those in the other options, will limit the information obtained.
  2. C) Open-ended questions will elicit the greatest amount of information. Asking closed questions that can be answered with a “yes” or “no” will limit the information obtained.
  3. D) Open-ended questions will elicit the greatest amount of information. Asking closed questions that can be answered with a “yes” or “no” will limit the information obtained.

Page Ref: 1548

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals who abuse alcohol.

 

Exemplar 22.2  Nicotine Addiction

 

1) A client who has smoked 2 packs of cigarettes per day for 34 years has a history of intermittent claudication, chronic bronchitis, and emphysema. After 6 weeks of cessation the client reports yelling at his spouse and “flying off the handle.” Which effect or effects of cigarette smoking are associated with this scenario?

Select all that apply.

  1. A) Nicotine causes destruction of the alveoli.
  2. B) The release of epinephrine causes vasoconstriction.
  3. C) Dopaminergic processes are implicated in withdrawal symptoms.
  4. D) Tar causes the mucus production seen in chronic bronchitis.
  5. E) Tobacco use causes atherosclerosis.

Answer:  B, C, D, E

Explanation:  A) Nicotine causes the release of epinephrine, which triggers vasoconstriction, exacerbating intermittent claudication. Tobacco use causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis.

  1. B) Nicotine causes the release of epinephrine, which triggers vasoconstriction, exacerbating intermittent claudication. Tobacco use causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis.
  2. C) Nicotine causes the release of epinephrine, which triggers vasoconstriction, exacerbating intermittent claudication. Tobacco use causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis.
  3. D) Nicotine causes the release of epinephrine, which triggers vasoconstriction, exacerbating intermittent claudication. Tobacco use causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis.
  4. E) Nicotine causes the release of epinephrine, which triggers vasoconstriction, exacerbating intermittent claudication. Tobacco use causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis.

Page Ref: 1546

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Client Need Sub:  Physiological Adaptation

Nursing Process:  Planning

Learning Outcome:  1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of nicotine addiction.

 

2) The 70-year-old client with heart disease tells the nurse, “I am sick because I sinned by smoking cigarettes.” What is the nurse’s best response to this dying client?

  1. A) “Smoking cigarettes isn’t a sin. There are many worse habits you could have.”
  2. B) “Cigarette smoking was desirable when you began smoking. We didn’t know about the problems it could cause.”
  3. C) “Why don’t we call the hospital chaplain and you can pray about your sins?”
  4. D) “You are correct, but it is too late to do anything about it now.”

Answer:  B

Explanation:  A) This client is in distress and is seeking forgiveness. The nurse should offer this forgiveness and a reason the forgiveness is valid. If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that distress will increase. Suggesting that the hospital chaplain be called for prayer reinforces the idea that smoking cigarettes is a sin. Saying there are worse habits minimizes the client’s concerns and does not offer forgiveness.

  1. B) This client is in distress and is seeking forgiveness. The nurse should offer this forgiveness and a reason the forgiveness is valid. If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that distress will increase. Suggesting that the hospital chaplain be called for prayer reinforces the idea that smoking cigarettes is a sin. Saying there are worse habits minimizes the client’s concerns and does not offer forgiveness.
  2. C) This client is in distress and is seeking forgiveness. The nurse should offer this forgiveness and a reason the forgiveness is valid. If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that distress will increase. Suggesting that the hospital chaplain be called for prayer reinforces the idea that smoking cigarettes is a sin. Saying there are worse habits minimizes the client’s concerns and does not offer forgiveness.
  3. D) This client is in distress and is seeking forgiveness. The nurse should offer this forgiveness and a reason the forgiveness is valid. If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that distress will increase. Suggesting that the hospital chaplain be called for prayer reinforces the idea that smoking cigarettes is a sin. Saying there are worse habits minimizes the client’s concerns and does not offer forgiveness.

Page Ref: 1629

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Caring

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with nicotine addiction.

 

3) The nurse is giving a health promotion class to adolescents. Which point is most important to convey to this audience?

  1. A) Teens are not strongly influenced by tobacco advertising.
  2. B) Smoking causes lung cancer.
  3. C) Cost is no deterrent to smoking.
  4. D) Alcohol use is strongly associated with smoking.

Answer:  B

Explanation:  A) Although alcohol abuse, a sedentary lifestyle, and drug abuse are preventable causes of mortality in the United States, smoking is now the number one cause of preventable death and disease for both men and women.

  1. B) Although alcohol abuse, a sedentary lifestyle, and drug abuse are preventable causes of mortality in the United States, smoking is now the number one cause of preventable death and disease for both men and women.
  2. C) Although alcohol abuse, a sedentary lifestyle, and drug abuse are preventable causes of mortality in the United States, smoking is now the number one cause of preventable death and disease for both men and women.
  3. D) Although alcohol abuse, a sedentary lifestyle, and drug abuse are preventable causes of mortality in the United States, smoking is now the number one cause of preventable death and disease for both men and women.

Page Ref: 1549

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  2. Identify risk factors associated with nicotine addiction.

 

4) The nurse has completed gathering data on a client with esophageal cancer due to years of nicotine abuse. Which nursing diagnosis is a priority for this client?

  1. A) Decisional Conflict
  2. B) Situational Social Isolation
  3. C) Disturbed Body Image
  4. D) Ineffective Airway Clearance

Answer:  D

Explanation:  A) The nurse should anticipate that the client with esophageal cancer may have issues with airway edema and therefore an ineffective airway clearance. This is the priority nursing diagnosis of those listed. There is no evidence that the client has a disturbed body image or experiences decisional conflict or social isolation.

  1. B) The nurse should anticipate that the client with esophageal cancer may have issues with airway edema and therefore an ineffective airway clearance. This is the priority nursing diagnosis of those listed. There is no evidence that the client has a disturbed body image or experiences decisional conflict or social isolation.
  2. C) The nurse should anticipate that the client with esophageal cancer may have issues with airway edema and therefore an ineffective airway clearance. This is the priority nursing diagnosis of those listed. There is no evidence that the client has a disturbed body image or experiences decisional conflict or social isolation.
  3. D) The nurse should anticipate that the client with esophageal cancer may have issues with airway edema and therefore an ineffective airway clearance. This is the priority nursing diagnosis of those listed. There is no evidence that the client has a disturbed body image or experiences decisional conflict or social isolation.

Page Ref: 1549

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  4. Formulate priority nursing diagnoses appropriate for an individual with nicotine addiction.

 

5) A nurse working at a clinic in a community serving a high population of smokers is planning an educational session on “Tips to Quit.” Which topic will be appropriate for the session?

  1. A) Tell this group that smoking is unacceptable.
  2. B) Make sure the group is aware of the increased risk of liver disease and cancer of the esophagus.
  3. C) Review the available pharmacologic adjuncts to cessation.
  4. D) Recommend hypnosis at a local dinner theater.

Answer:  C

Explanation:  A) Available pharmacologic adjuncts for smoking cessation should be discussed in a “Tips to Quit” community talk. Simply telling the group that smoking is unacceptable is not effective in promoting wellness. Discussing esophageal cancer and liver disease is inappropriate for a single educational session; lung cancer and cardiovascular disease are the primary health threats that should be discussed.

  1. B) Available pharmacologic adjuncts for smoking cessation should be discussed in a “Tips to Quit” community talk. Simply telling the group that smoking is unacceptable is not effective in promoting wellness. Discussing esophageal cancer and liver disease is inappropriate for a single educational session; lung cancer and cardiovascular disease are the primary health threats that should be discussed.
  2. C) Available pharmacologic adjuncts for smoking cessation should be discussed in a “Tips to Quit” community talk. Simply telling the group that smoking is unacceptable is not effective in promoting wellness. Discussing esophageal cancer and liver disease is inappropriate for a single educational session; lung cancer and cardiovascular disease are the primary health threats that should be discussed.
  3. D) Available pharmacologic adjuncts for smoking cessation should be discussed in a “Tips to Quit” community talk. Simply telling the group that smoking is unacceptable is not effective in promoting wellness. Discussing esophageal cancer and liver disease is inappropriate for a single educational session; lung cancer and cardiovascular disease are the primary health threats that should be discussed.

Page Ref: 1547

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with nicotine addiction.

 

6) A client has been admitted with chronic obstructive pulmonary disease (COPD) and has asked the nurse for help and information regarding nicotine addiction and ways to quit smoking. The nurse will evaluate the treatment and determine that a goal has been met when the client states:

  1. A) “I will keep a pack of cigarettes in my closet in case I need it.”
  2. B) “I will taper off smoking gradually.”
  3. C) “I will chew sugar-free gum when I want a cigarette.”
  4. D) “I will eat a snack when I am feeling nervous.”

Answer:  C

Explanation:  A) One goal for clients who are attempting to deal with addiction is stating adaptive coping mechanisms to use when stressed. The goal has been met when the client expresses the intention to use a healthy coping mechanism–such as chewing sugar-free gum–when the urge to smoke arises. Tapering off smoking and keeping cigarettes close by are examples of the client who is not wholly committed. Eating when stressed may lead the client to substitute eating for smoking, which is a form of denial.

  1. B) One goal for clients who are attempting to deal with addiction is stating adaptive coping mechanisms to use when stressed. The goal has been met when the client expresses the intention to use a healthy coping mechanism–such as chewing sugar-free gum–when the urge to smoke arises. Tapering off smoking and keeping cigarettes close by are examples of the client who is not wholly committed. Eating when stressed may lead the client to substitute eating for smoking, which is a form of denial.
  2. C) One goal for clients who are attempting to deal with addiction is stating adaptive coping mechanisms to use when stressed. The goal has been met when the client expresses the intention to use a healthy coping mechanism–such as chewing sugar-free gum–when the urge to smoke arises. Tapering off smoking and keeping cigarettes close by are examples of the client who is not wholly committed. Eating when stressed may lead the client to substitute eating for smoking, which is a form of denial.
  3. D) One goal for clients who are attempting to deal with addiction is stating adaptive coping mechanisms to use when stressed. The goal has been met when the client expresses the intention to use a healthy coping mechanism–such as chewing sugar-free gum–when the urge to smoke arises. Tapering off smoking and keeping cigarettes close by are examples of the client who is not wholly committed. Eating when stressed may lead the client to substitute eating for smoking, which is a form of denial.

Page Ref: 1549-1550

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  7. Evaluate expected outcomes for an individual with nicotine addiction.

 

7) The nurse is planning an inservice for the multidisciplinary team on smoking cessation care. Which statements should be included in the class?

Select all that apply.

  1. A) There is no adverse risk if the client chooses to smoke while wearing a nicotine patch.
  2. B) Bupropion (Zyban) is used to suppress the craving for tobacco.
  3. C) A piece of nicotine gum should be chewed for 5 minutes of every waking hour then held in the cheek.
  4. D) Most persons quit smoking several times before they are successful.
  5. E) Alternative therapies should be considered to help reduce the stress that accompanies smoking cessation.

Answer:  B, D, E

Explanation:  A) When teaching clients about smoking cessation, the nurse should emphasize that most persons who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and is a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9 to 12 times daily. The gum should be chewed several times to soften it and then held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, as they may help the client deal with the stress that accompanies smoking cessation.

  1. B) When teaching clients about smoking cessation, the nurse should emphasize that most persons who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and is a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9 to 12 times daily. The gum should be chewed several times to soften it and then held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, as they may help the client deal with the stress that accompanies smoking cessation.
  2. C) When teaching clients about smoking cessation, the nurse should emphasize that most persons who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and is a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9 to 12 times daily. The gum should be chewed several times to soften it and then held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, as they may help the client deal with the stress that accompanies smoking cessation.
  3. D) When teaching clients about smoking cessation, the nurse should emphasize that most persons who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and is a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9 to 12 times daily. The gum should be chewed several times to soften it and then held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, as they may help the client deal with the stress that accompanies smoking cessation.
  4. E) When teaching clients about smoking cessation, the nurse should emphasize that most persons who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and is a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9 to 12 times daily. The gum should be chewed several times to soften it and then held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, as they may help the client deal with the stress that accompanies smoking cessation.

Page Ref: 1533

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Plan evidence-based caring interventions for an individual with nicotine addiction and his or her family in collaboration with other members of the healthcare team.

 

8) A nurse is caring for a client who smokes cigarettes and asks the nurse about nicotine replacement therapy (NRT). Which statement made by the nurse is appropriate?

  1. A) “Over-the-counter (OTC) NRTs include transdermal patches, gums, nicotine inhalers, and nasal sprays.”
  2. B) “NRT helps to relieve the psychological and physiological effects of nicotine withdrawal.”
  3. C) “NRT does not address addictive behavior.”
  4. D) “Combining the use of NRT and a smoking cessation program is no more effective than NRT use alone.”

Answer:  C

Explanation:  A) Nicotine replacement therapy (NRT) does not address addictive behavior. NRT helps to relieve some physiological, not psychological, effects of nicotine withdrawal. Over-the-counter (OTC) NRTs include transdermal patches and gums. Nicotine inhalers and nasal sprays are available by prescription only. Combining the use of NRT and a smoking cessation program is more effective than the use of NRT alone.

  1. B) Nicotine replacement therapy (NRT) does not address addictive behavior. NRT helps to relieve some physiological, not psychological, effects of nicotine withdrawal. Over-the-counter (OTC) NRTs include transdermal patches and gums. Nicotine inhalers and nasal sprays are available by prescription only. Combining the use of NRT and a smoking cessation program is more effective than the use of NRT alone.
  2. C) Nicotine replacement therapy (NRT) does not address addictive behavior. NRT helps to relieve some physiological, not psychological, effects of nicotine withdrawal. Over-the-counter (OTC) NRTs include transdermal patches and gums. Nicotine inhalers and nasal sprays are available by prescription only. Combining the use of NRT and a smoking cessation program is more effective than the use of NRT alone.
  3. D) Nicotine replacement therapy (NRT) does not address addictive behavior. NRT helps to relieve some physiological, not psychological, effects of nicotine withdrawal. Over-the-counter (OTC) NRTs include transdermal patches and gums. Nicotine inhalers and nasal sprays are available by prescription only. Combining the use of NRT and a smoking cessation program is more effective than the use of NRT alone.

Page Ref: 1547

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with nicotine addiction.

 

9) A nurse is caring for a client with congestive heart failure who currently smokes cigarettes and has a 50 pack-year smoking history. When providing smoking cessation education to the client, the nurse will include which statement(s) regarding the pathophysiology of nicotine use?

Select all that apply.

  1. A) “In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine.”
  2. B) “In high doses, nicotine stimulates the parasympathetic system to release epinephrine, causing vasoconstriction.”
  3. C) “Initially, nicotine increases mental alertness and cognitive ability.”
  4. D) “Nicotine is a nonpsychoactive substance found in tobacco.”
  5. E) “Gradual reduction of nicotine appears to be the best method of cessation.”

Answer:  A, C

Explanation:  A) In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco.

  1. B) In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco.
  2. C) In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco.
  3. D) In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco.
  4. E) In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco.

Page Ref: 1546

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with nicotine addiction.

 

10) A nurse working in an outpatient primary care clinic is caring for a client with asthma who has an 80 pack-year smoking history. What statement made by the nurse is most appropriate when assessing the client’s nicotine use?

  1. A) “Have you tried a nicotine patch for quitting smoking?”
  2. B) “Do you smoke cigarettes with filters or without?”
  3. C) “Do you smoke upon waking?”
  4. D) “Tell me about any attempts you’ve made to quit using nicotine.”

Answer:  D

Explanation:  A) Appropriate assessment questions should be open-ended and allow the client to elaborate on the answers. “Tell me about any attempts you’ve made to quit using nicotine” is the only open-ended phrase that is effective in assessing this client.

  1. B) Appropriate assessment questions should be open-ended and allow the client to elaborate on the answers. “Tell me about any attempts you’ve made to quit using nicotine” is the only open-ended phrase that is effective in assessing this client.
  2. C) Appropriate assessment questions should be open-ended and allow the client to elaborate on the answers. “Tell me about any attempts you’ve made to quit using nicotine” is the only open-ended phrase that is effective in assessing this client.
  3. D) Appropriate assessment questions should be open-ended and allow the client to elaborate on the answers. “Tell me about any attempts you’ve made to quit using nicotine” is the only open-ended phrase that is effective in assessing this client.

Page Ref: 1548

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with nicotine addiction.

 

Exemplar 22.3  Prenatal Substance Exposure

1) The nurse is caring for a pregnant woman who admits Ecstasy use on a regular basis. The client states, “Everybody knows that alcohol is bad during pregnancy, but what’s the big deal about Ecstasy?” What should the nurse explain about Ecstasy?

  1. A) “Ecstasy use leads to deficiencies of thiamine and folic acid, which help the baby develop.”
  2. B) “Ecstasy use produces babies with small heads, short bodies, and brain function alterations.”
  3. C) “Ecstasy use results in intrauterine growth restriction and meconium aspiration.”
  4. D) “Ecstasy use has been associated with long-term impaired memory and learning in the child.”

Answer:  D

Explanation:  A) Little is known about the effects of Ecstasy on pregnancy. Preliminary research does suggest that ecstasy is associated with long-term impaired memory and learning in the child. The impact on the timing of Ecstasy use by the pregnant woman during critical brain development may be a critical issue. Alcohol use, not Ecstasy use, by a pregnant woman causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. Cocaine use by a pregnant woman can cause the baby to have a small head and brain alterations. Heroin use by a pregnant woman can cause intrauterine growth restriction and meconium aspiration.

  1. B) Little is known about the effects of Ecstasy on pregnancy. Preliminary research does suggest that ecstasy is associated with long-term impaired memory and learning in the child. The impact on the timing of Ecstasy use by the pregnant woman during critical brain development may be a critical issue. Alcohol use, not Ecstasy use, by a pregnant woman causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. Cocaine use by a pregnant woman can cause the baby to have a small head and brain alterations. Heroin use by a pregnant woman can cause intrauterine growth restriction and meconium aspiration.
  2. C) Little is known about the effects of Ecstasy on pregnancy. Preliminary research does suggest that ecstasy is associated with long-term impaired memory and learning in the child. The impact on the timing of Ecstasy use by the pregnant woman during critical brain development may be a critical issue. Alcohol use, not Ecstasy use, by a pregnant woman causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. Cocaine use by a pregnant woman can cause the baby to have a small head and brain alterations. Heroin use by a pregnant woman can cause intrauterine growth restriction and meconium aspiration.
  3. D) Little is known about the effects of Ecstasy on pregnancy. Preliminary research does suggest that ecstasy is associated with long-term impaired memory and learning in the child. The impact on the timing of Ecstasy use by the pregnant woman during critical brain development may be a critical issue. Alcohol use, not Ecstasy use, by a pregnant woman causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. Cocaine use by a pregnant woman can cause the baby to have a small head and brain alterations. Heroin use by a pregnant woman can cause intrauterine growth restriction and meconium aspiration.

Page Ref: 1554

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect effects of prenatal substance use on both the mother and the fetus.

 

2) A client with admitted use of cocaine during pregnancy has just experienced abruptio placentae. The father of the baby asks the nurse why this has happened to them. What risk factor for this health problem should the nurse explain to the father?

  1. A) Maternal smoking
  2. B) Genetic history
  3. C) Maternal cocaine use
  4. D) The mother having low levels of folic acid

Answer:  C

Explanation:  A) Maternal cocaine consumption during pregnancy puts the woman at risk for abruptio placentae. Cocaine use is also associated with preterm birth, low birth weight, neonatal irritability, neonatal depression, SIDS, and developmental delays. Teratogens are medications known to adversely affect normal cellular development in the embryo or fetus. Folic acid is necessary for normal neural tube development. Genetic history does not affect the risk for spontaneous abortion.

  1. B) Maternal cocaine consumption during pregnancy puts the woman at risk for abruptio placentae. Cocaine use is also associated with preterm birth, low birth weight, neonatal irritability, neonatal depression, SIDS, and developmental delays. Teratogens are medications known to adversely affect normal cellular development in the embryo or fetus. Folic acid is necessary for normal neural tube development. Genetic history does not affect the risk for spontaneous abortion.
  2. C) Maternal cocaine consumption during pregnancy puts the woman at risk for abruptio placentae. Cocaine use is also associated with preterm birth, low birth weight, neonatal irritability, neonatal depression, SIDS, and developmental delays. Teratogens are medications known to adversely affect normal cellular development in the embryo or fetus. Folic acid is necessary for normal neural tube development. Genetic history does not affect the risk for spontaneous abortion.
  3. D) Maternal cocaine consumption during pregnancy puts the woman at risk for abruptio placentae. Cocaine use is also associated with preterm birth, low birth weight, neonatal irritability, neonatal depression, SIDS, and developmental delays. Teratogens are medications known to adversely affect normal cellular development in the embryo or fetus. Folic acid is necessary for normal neural tube development. Genetic history does not affect the risk for spontaneous abortion.

Page Ref: 1553

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  2. Identify risk factors associated with prenatal substance use.

 

3) The nurse is collecting data on prenatal clients at a clinic on a Native American reservation in Arizona. One client has risk factors for substance abuse. What physical sign or signs did the nurse assess that suggest substance abuse in this client?

Select all that apply.

  1. A) Dilated pupils
  2. B) Odor of alcohol on the breath
  3. C) Frequent accidents or falls
  4. D) Underweight
  5. E) Dressed in jeans and a t-shirt

Answer:  A, B, D

Explanation:  A) Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle “track marks” or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing a jeans and t-shirt is not indicative of substance abuse.

  1. B) Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle “track marks” or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing a jeans and t-shirt is not indicative of substance abuse.
  2. C) Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle “track marks” or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing a jeans and t-shirt is not indicative of substance abuse.
  3. D) Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle “track marks” or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing a jeans and t-shirt is not indicative of substance abuse.
  4. E) Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle “track marks” or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing a jeans and t-shirt is not indicative of substance abuse.

Page Ref: 1557

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals who abuse substances during pregnancy.

 

4) A 20-year-old woman is at 28 weeks’ gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. Which potential fetal health problem should the nurse use to select a nursing diagnosis to guide care?

  1. A) Congenital anomalies
  2. B) Abruptio placentae
  3. C) Diabetes mellitus
  4. D) Intrauterine growth restriction (IUGR)

Answer:  D

Explanation:  A) Women who use heroin place the fetus at an increased risk for developing intrauterine growth restriction (IUGR). Congenital anomalies often occur with the use of lithium during pregnancy. Diabetes is an endocrine disorder that is unrelated to drug use and abuse. Abruptio placentae is a condition the mother can experience and is seen more commonly with cocaine and crack use.

  1. B) Women who use heroin place the fetus at an increased risk for developing intrauterine growth restriction (IUGR). Congenital anomalies often occur with the use of lithium during pregnancy. Diabetes is an endocrine disorder that is unrelated to drug use and abuse. Abruptio placentae is a condition the mother can experience and is seen more commonly with cocaine and crack use.
  2. C) Women who use heroin place the fetus at an increased risk for developing intrauterine growth restriction (IUGR). Congenital anomalies often occur with the use of lithium during pregnancy. Diabetes is an endocrine disorder that is unrelated to drug use and abuse. Abruptio placentae is a condition the mother can experience and is seen more commonly with cocaine and crack use.
  3. D) Women who use heroin place the fetus at an increased risk for developing intrauterine growth restriction (IUGR). Congenital anomalies often occur with the use of lithium during pregnancy. Diabetes is an endocrine disorder that is unrelated to drug use and abuse. Abruptio placentae is a condition the mother can experience and is seen more commonly with cocaine and crack use.

Page Ref: 1554

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  4. Formulate priority nursing diagnoses appropriate for an individual who abuses substances during pregnancy and for her newborn.

 

5) The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which client statement indicates that teaching has been effective?

  1. A) “I can continue to drink alcohol throughout my pregnancy.”
  2. B) “A beer once a week will not damage the fetus.”
  3. C) “I don’t need to stop drinking alcohol until my pregnancy is confirmed.”
  4. D) “I can’t drink alcohol while breastfeeding, because it will pass into the breast milk.”

Answer:  D

Explanation:  A) Women should discontinue drinking alcohol when they attempt to become pregnant. It is not known how much alcohol will cause fetal damage; therefore, any amount of alcohol, even one beer, during pregnancy is contraindicated. Alcohol passes readily into breast milk; therefore, it should be avoided, or the milk should be pumped and dumped after alcohol consumption.

  1. B) Women should discontinue drinking alcohol when they attempt to become pregnant. It is not known how much alcohol will cause fetal damage; therefore, any amount of alcohol, even one beer, during pregnancy is contraindicated. Alcohol passes readily into breast milk; therefore, it should be avoided, or the milk should be pumped and dumped after alcohol consumption.
  2. C) Women should discontinue drinking alcohol when they attempt to become pregnant. It is not known how much alcohol will cause fetal damage; therefore, any amount of alcohol, even one beer, during pregnancy is contraindicated. Alcohol passes readily into breast milk; therefore, it should be avoided, or the milk should be pumped and dumped after alcohol consumption.
  3. D) Women should discontinue drinking alcohol when they attempt to become pregnant. It is not known how much alcohol will cause fetal damage; therefore, any amount of alcohol, even one beer, during pregnancy is contraindicated. Alcohol passes readily into breast milk; therefore, it should be avoided, or the milk should be pumped and dumped after alcohol consumption.

Page Ref: 1552-1553

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Evaluation

Learning Outcome:  7. Evaluate expected outcomes for women who abuse substances during pregnancy, their newborns, and their family members.

 

6) A pregnant woman admits to intravenous drug use. She had a negative HIV screening test just after missing her first menstrual period. For which manifestation should the nurse suspect the client needs to be retested for HIV?

  1. A) Hemoglobin of 11 g/dL and a rapid weight gain
  2. B) Elevated blood pressure and ankle edema
  3. C) Unusual fatigue and oral thrush
  4. D) Shortness of breath and frequent urination

Answer:  C

Explanation:  A) The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as oral thrush. The client with HIV would be anemic and anorexic. The client would have a decrease in blood pressure, and no ankle edema. Shortness of breath and frequent urination do not indicate a need to retest for HIV.

  1. B) The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as oral thrush. The client with HIV would be anemic and anorexic. The client would have a decrease in blood pressure, and no ankle edema. Shortness of breath and frequent urination do not indicate a need to retest for HIV.
  2. C) The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as oral thrush. The client with HIV would be anemic and anorexic. The client would have a decrease in blood pressure, and no ankle edema. Shortness of breath and frequent urination do not indicate a need to retest for HIV.
  3. D) The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as oral thrush. The client with HIV would be anemic and anorexic. The client would have a decrease in blood pressure, and no ankle edema. Shortness of breath and frequent urination do not indicate a need to retest for HIV.

Page Ref: 1560

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Planning

Learning Outcome:  6. Plan evidence-based care for women who abuse substances during pregnancy, their newborns, and their family members in collaboration with other members of the healthcare team.

 

7) The nurse provides a wellness program to a group of pregnant adolescents at risk for substance abuse. Which participant statement indicates that teaching has been effective?

  1. A) “Drinking alcohol and smoking marijuana can harm my baby.”
  2. B) “I need to take good care of myself by participating in vigorous exercise.”
  3. C) “My anemia and eating mostly fast food are not important.”
  4. D) “I should seek prenatal care at some point in the pregnancy.”

Answer:  A

Explanation:  A) Pregnant adolescents are at great risk for complications such as pregnancy-induced hypertension, anemia, preterm birth, low-birth-weight infants, and fetal harm from cigarette smoking, alcohol consumption, or the use of street drugs. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus. Pregnant adolescents are at great risk for complications such as anemia. Vigorous exercise would not necessarily promote a healthy pregnancy and does not indicate an understanding of the increased risk for an adolescent who is at risk for substance abuse.

  1. B) Pregnant adolescents are at great risk for complications such as pregnancy-induced hypertension, anemia, preterm birth, low-birth-weight infants, and fetal harm from cigarette smoking, alcohol consumption, or the use of street drugs. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus. Pregnant adolescents are at great risk for complications such as anemia. Vigorous exercise would not necessarily promote a healthy pregnancy and does not indicate an understanding of the increased risk for an adolescent who is at risk for substance abuse.
  2. C) Pregnant adolescents are at great risk for complications such as pregnancy-induced hypertension, anemia, preterm birth, low-birth-weight infants, and fetal harm from cigarette smoking, alcohol consumption, or the use of street drugs. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus. Pregnant adolescents are at great risk for complications such as anemia. Vigorous exercise would not necessarily promote a healthy pregnancy and does not indicate an understanding of the increased risk for an adolescent who is at risk for substance abuse.
  3. D) Pregnant adolescents are at great risk for complications such as pregnancy-induced hypertension, anemia, preterm birth, low-birth-weight infants, and fetal harm from cigarette smoking, alcohol consumption, or the use of street drugs. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus. Pregnant adolescents are at great risk for complications such as anemia. Vigorous exercise would not necessarily promote a healthy pregnancy and does not indicate an understanding of the increased risk for an adolescent who is at risk for substance abuse.

Page Ref: 1552

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Evaluation

Learning Outcome:  7. Evaluate expected outcomes for women who abuse substances during pregnancy, their newborns, and their family members.

 

8) A 19-year-old pregnant client tells the nurse that she and her husband are going to a 50th wedding anniversary party for her grandparents this weekend. The client asks the nurse if it will be okay to have a few glasses of wine at the party. Which should the nurse reply?

  1. A) “Drinking a few glasses of wine will not be a problem.”
  2. B) “Alcohol during pregnancy can cause the baby to be born without limbs.”
  3. C) “Drinking any alcoholic beverages during pregnancy puts your baby at risk for injury.”
  4. D) “Wine is acceptable but not hard liquor.”

Answer:  C

Explanation:  A) Drinking any alcohol, no matter what type and what quantity, during pregnancy increases the risk for accidents and damage to the infant. Mothers are encouraged to drink no alcohol at all during pregnancy. Wine can put the mother and fetus at risk as much as hard liquor.

  1. B) Drinking any alcohol, no matter what type and what quantity, during pregnancy increases the risk for accidents and damage to the infant. Mothers are encouraged to drink no alcohol at all during pregnancy. Wine can put the mother and fetus at risk as much as hard liquor.
  2. C) Drinking any alcohol, no matter what type and what quantity, during pregnancy increases the risk for accidents and damage to the infant. Mothers are encouraged to drink no alcohol at all during pregnancy. Wine can put the mother and fetus at risk as much as hard liquor.
  3. D) Drinking any alcohol, no matter what type and what quantity, during pregnancy increases the risk for accidents and damage to the infant. Mothers are encouraged to drink no alcohol at all during pregnancy. Wine can put the mother and fetus at risk as much as hard liquor.

Page Ref: 1552-1553

Cognitive Level:  Applying

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of women who abuse substances during pregnancy, their newborns, and their family members.

 

9) A nurse is caring for a client who is pregnant and requires IV antibiotic therapy for treatment of pyelonephritis. Prior to administering the medication, the nurse discovers the medication is Category B for pregnancy. This means which of the following?

  1. A) Controlled studies in women have demonstrated no associated fetal risk.
  2. B) There have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk.
  3. C) Animal studies show teratogenic effects, but no controlled studies in women are available.
  4. D) Evidence of human fetal risk exists, but the benefits of the drug in certain situations are thought to outweigh the risks.

Answer:  B

Explanation:  A) To provide information for caregivers and clients, the U.S. Food and Drug Administration (FDA) has developed a classification system for all medications administered during pregnancy. This system can be used to help determine the risk of prenatal substance exposure from use of legal medications whether they are abused or prescribed by a physician. In Category C, there have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk. The other choices are for additional classifications, not Category C.

  1. B) To provide information for caregivers and clients, the U.S. Food and Drug Administration (FDA) has developed a classification system for all medications administered during pregnancy. This system can be used to help determine the risk of prenatal substance exposure from use of legal medications whether they are abused or prescribed by a physician. In Category C, there have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk. The other choices are for additional classifications, not Category C.
  2. C) To provide information for caregivers and clients, the U.S. Food and Drug Administration (FDA) has developed a classification system for all medications administered during pregnancy. This system can be used to help determine the risk of prenatal substance exposure from use of legal medications whether they are abused or prescribed by a physician. In Category C, there have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk. The other choices are for additional classifications, not Category C.
  3. D) To provide information for caregivers and clients, the U.S. Food and Drug Administration (FDA) has developed a classification system for all medications administered during pregnancy. This system can be used to help determine the risk of prenatal substance exposure from use of legal medications whether they are abused or prescribed by a physician. In Category C, there have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk. The other choices are for additional classifications, not Category C.

Page Ref: 1555

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Planning

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals who abuse substances during pregnancy.

 

10) A nurse is caring for a newborn who is being treated in the NICU due to complications from exposure to illicit drugs while in the womb. The newborn has microcephaly and multiple cerebral infarcts and is inconsolable with a high-pitched cry. Which illicit drug is likely to blame for the newborn’s symptoms?

  1. A) Marijuana
  2. B) PCP
  3. C) Cocaine
  4. D) LSD

Answer:  C

Explanation:  A) The newborn is likely showing symptoms of cocaine withdrawal. Although the other choices have been linked to fetal manifestations, they do not match the clinical manifestations that the newborn is displaying.

  1. B) The newborn is likely showing symptoms of cocaine withdrawal. Although the other choices have been linked to fetal manifestations, they do not match the clinical manifestations that the newborn is displaying.
  2. C) The newborn is likely showing symptoms of cocaine withdrawal. Although the other choices have been linked to fetal manifestations, they do not match the clinical manifestations that the newborn is displaying.
  3. D) The newborn is likely showing symptoms of cocaine withdrawal. Although the other choices have been linked to fetal manifestations, they do not match the clinical manifestations that the newborn is displaying.

Page Ref: 1553-1554

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect effects of prenatal substance use on both the mother and the fetus.

 

 

11) A nurse caring for a pregnant client intoxicated with cocaine will notice which clinical manifestations?

Select all that apply.

  1. A) Increased appetite
  2. B) Pinpoint pupils
  3. C) Muscle jerks
  4. D) Hypertension
  5. E) Bradycardia

Answer:  C, D

Explanation:  A) Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.

  1. B) Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.
  2. C) Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.
  3. D) Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.
  4. E) Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.

Page Ref: 1553-1554

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect effects of prenatal substance use on both the mother and the fetus.

 

Exemplar 22.4  Substance Abuse

 

1) The nurse is caring for a client who has been diagnosed with a cocaine addiction. For which additional disorder should the nurse assess this client?

  1. A) Anxiety
  2. B) Diabetes
  3. C) Weight gain
  4. D) Kidney stones

Answer:  A

Explanation:  A) Anxiety and depressive disorders frequently occur with substance abuse. More than 90% of individuals who commit suicide have a depressive or substance abuse disorder. Weight gain, diabetes, and kidney stones are not linked to substance abuse.

  1. B) Anxiety and depressive disorders frequently occur with substance abuse. More than 90% of individuals who commit suicide have a depressive or substance abuse disorder. Weight gain, diabetes, and kidney stones are not linked to substance abuse.
  2. C) Anxiety and depressive disorders frequently occur with substance abuse. More than 90% of individuals who commit suicide have a depressive or substance abuse disorder. Weight gain, diabetes, and kidney stones are not linked to substance abuse.
  3. D) Anxiety and depressive disorders frequently occur with substance abuse. More than 90% of individuals who commit suicide have a depressive or substance abuse disorder. Weight gain, diabetes, and kidney stones are not linked to substance abuse.

Page Ref: 1560

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of substance abuse.

 

2) A nursing instructor is teaching a class about the role of dopamine in substance abuse. Which student statement indicates that the role of dopamine is understood?

  1. A) “The dopamine D(1) and dopamine D(2) receptors are responsible for co-occurring disorders.”
  2. B) “Dopamine increases opioid transmission, and this reinforces the cycle of substance abuse.”
  3. C) “Dopamine causes changes in brain neurotransmission that enhance the cycle of substance abuse.”
  4. D) “The dopamine D(3) receptor is involved in drug-seeking behaviors.”

Answer:  D

Explanation:  A) Although most studies have focused on the role of dopamine D(1) and dopamine D(2) receptors in sustaining the addictive danger of drugs, recent studies also have shown that the dopamine D(3) receptor is involved in drug-seeking behavior. Ethanol, not dopamine, increases opioid transmission and reinforces the cycle of substance abuse. Dopamine does not cause changes in brain neurotransmission that enhance the cycle of substance abuse. D(1) and D(2) receptors are not responsible for co-occurring disorders.

  1. B) Although most studies have focused on the role of dopamine D(1) and dopamine D(2) receptors in sustaining the addictive danger of drugs, recent studies also have shown that the dopamine D(3) receptor is involved in drug-seeking behavior. Ethanol, not dopamine, increases opioid transmission and reinforces the cycle of substance abuse. Dopamine does not cause changes in brain neurotransmission that enhance the cycle of substance abuse. D(1) and D(2) receptors are not responsible for co-occurring disorders.
  2. C) Although most studies have focused on the role of dopamine D(1) and dopamine D(2) receptors in sustaining the addictive danger of drugs, recent studies also have shown that the dopamine D(3) receptor is involved in drug-seeking behavior. Ethanol, not dopamine, increases opioid transmission and reinforces the cycle of substance abuse. Dopamine does not cause changes in brain neurotransmission that enhance the cycle of substance abuse. D(1) and D(2) receptors are not responsible for co-occurring disorders.
  3. D) Although most studies have focused on the role of dopamine D(1) and dopamine D(2) receptors in sustaining the addictive danger of drugs, recent studies also have shown that the dopamine D(3) receptor is involved in drug-seeking behavior. Ethanol, not dopamine, increases opioid transmission and reinforces the cycle of substance abuse. Dopamine does not cause changes in brain neurotransmission that enhance the cycle of substance abuse. D(1) and D(2) receptors are not responsible for co-occurring disorders.

Page Ref: 1560

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Evaluation

Learning Outcome:  1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of substance abuse.

 

3) A male college student is incoherent after taking “downers with beer.” For which health problem should the nurse observe in this client?

  1. A) Hallucinations
  2. B) Respiratory depression
  3. C) Seizure activity
  4. D) Signs of withdrawal

Answer:  B

Explanation:  A) Downers are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The client who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this client as respiratory depression.

  1. B) Downers are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The client who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this client as respiratory depression.
  2. C) Downers are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The client who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this client as respiratory depression.
  3. D) Downers are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The client who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this client as respiratory depression.

Page Ref: 1563

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  2. Identify risk factors associated with substance abuse.

 

4) The nurse is completing a health history with a 16-year-old client and determines the client would benefit from teaching about substance abuse. Which client statement(s) caused the nurse to come to this conclusion?

Select all that apply.

  1. A) “I drink alcohol with my friends on the weekends.”
  2. B) “I smoke cigarettes on a daily basis.”
  3. C) “I use my seat belt every time I ride in a car.”
  4. D) “I became sexually active at the age of 13.”
  5. E) “I get all A’s and B’s in school.”

Answer:  A, B, D

Explanation:  A) Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.

  1. B) Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.
  2. C) Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.
  3. D) Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.
  4. E) Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.

Page Ref: 1567

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Assessment

Learning Outcome:  3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with substance abuse disorders.

 

5) A nurse is concerned about potential substance abuse by a coworker. Which of the coworker’s behaviors would place the clients on the unit at risk for injury?

  1. A) The nurse in question frequently volunteers to give medications to clients.
  2. B) The nurse in question prefers not to be the “medication nurse” on the shift.
  3. C) The nurse in question declines to take scheduled breaks.
  4. D) The nurse in question frequently requests the largest client care assignment for the shift.

Answer:  A

Explanation:  A) Frequently volunteering to give medications or having excessive medication wasting could be a sign that a nurse is using or diverting drugs. The nurse who is unable or unwilling to manage a large client care assignment or who requests to administer medications could be a substance abuser. Taking frequent or lengthy breaks might signal substance abuse.

  1. B) Frequently volunteering to give medications or having excessive medication wasting could be a sign that a nurse is using or diverting drugs. The nurse who is unable or unwilling to manage a large client care assignment or who requests to administer medications could be a substance abuser. Taking frequent or lengthy breaks might signal substance abuse.
  2. C) Frequently volunteering to give medications or having excessive medication wasting could be a sign that a nurse is using or diverting drugs. The nurse who is unable or unwilling to manage a large client care assignment or who requests to administer medications could be a substance abuser. Taking frequent or lengthy breaks might signal substance abuse.
  3. D) Frequently volunteering to give medications or having excessive medication wasting could be a sign that a nurse is using or diverting drugs. The nurse who is unable or unwilling to manage a large client care assignment or who requests to administer medications could be a substance abuser. Taking frequent or lengthy breaks might signal substance abuse.

Page Ref: 1561-1562

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  4. Formulate priority nursing diagnoses appropriate for individuals with a substance abuse disorder.

 

6) A family member of a woman addicted to alcohol and opioids says, “I don’t understand the reason for Naltrexone treatment for my daughter. Won’t she just get high off of that?” What is the best explanation for this family member?

  1. A) “Naltrexone will cause your daughter to become violently ill if she drinks alcohol or abuses drugs.”
  2. B) “Naltrexone is less potent than the street drugs your daughter is currently taking and therefore safer.”
  3. C) “Naltrexone diminishes the cravings your daughter will feel for alcohol and opioids.”
  4. D) “Naltrexone will prevent your daughter from getting drunk when she drinks.”

Answer:  C

Explanation:  A) Naltrexone diminishes the cravings for alcohol and opioids. Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed.

  1. B) Naltrexone diminishes the cravings for alcohol and opioids. Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed.
  2. C) Naltrexone diminishes the cravings for alcohol and opioids. Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed.
  3. D) Naltrexone diminishes the cravings for alcohol and opioids. Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed.

Page Ref: 1566

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Plan evidence-based care for individuals with a substance abuse disorder and their families in collaboration with other members of the healthcare team.

 

7) A client who is attending a Narcotics Anonymous (NA) program asks the nurse what the most important initial goal of attending the meetings is. Which answer is the best response by the nurse?

  1. A) To admit to having a problem
  2. B) To learn problem-solving skills
  3. C) To take a moral inventory of self
  4. D) To make amends to people they have hurt

Answer:  A

Explanation:  A) The initial outcome for clients in substance abuse programs is to admit they have a problem with drugs or alcohol. Clients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. Learning problem-solving skills is a later outcome for a substance abuse program. Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.

  1. B) The initial outcome for clients in substance abuse programs is to admit they have a problem with drugs or alcohol. Clients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. Learning problem-solving skills is a later outcome for a substance abuse program. Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.
  2. C) The initial outcome for clients in substance abuse programs is to admit they have a problem with drugs or alcohol. Clients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. Learning problem-solving skills is a later outcome for a substance abuse program. Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.
  3. D) The initial outcome for clients in substance abuse programs is to admit they have a problem with drugs or alcohol. Clients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. Learning problem-solving skills is a later outcome for a substance abuse program. Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.

Page Ref: 1560

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  7. Evaluate expected outcomes for individuals with a substance abuse disorder.

 

8) A client is admitted to the Emergency Department after snorting phencyclidine piperidine (PCP). The healthcare provider has determined that the client overdosed on the drug. What action(s) does the nurse anticipate will be done to care for this client?

Select all that apply.

  1. A) Obtain materials to assist with lavage.
  2. B) Initiate an IV.
  3. C) Initiate seizure precautions.
  4. D) Induce vomiting.
  5. E) Administer ammonium chloride.

Answer:  B, C, E

Explanation:  A) The client has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or “speed” reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line. The client will need to have seizure precautions such as padded side rails initiated. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose.

  1. B) The client has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or “speed” reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line. The client will need to have seizure precautions such as padded side rails initiated. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose.
  2. C) The client has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or “speed” reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line. The client will need to have seizure precautions such as padded side rails initiated. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose.
  3. D) The client has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or “speed” reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line. The client will need to have seizure precautions such as padded side rails initiated. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose.

 

  1. E) The client has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or “speed” reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line. The client will need to have seizure precautions such as padded side rails initiated. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose.

Page Ref: 1567

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of individuals with a substance abuse disorder.

 

9) After an assessment of a new client, a nursing student expresses a belief that drug addiction is not a real illness, as these clients “did it to themselves.” What should the staff nurse respond to this student’s comment?

  1. A) “Sometimes a client doesn’t show much effort.”
  2. B) “We are legally obligated to provide care.”
  3. C) “It is important to remain nonjudgmental when caring for any client, even a drug addict.”
  4. D) “You are right. I don’t know why we bother.”

Answer:  C

Explanation:  A) Nurses must provide a nonjudgmental attitude with their clients in order to promote trust and respect. Even if a client is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. Although it is true that nurses are legally obligated to provide care, this response is not client-focused and is therefore inappropriate.

  1. B) Nurses must provide a nonjudgmental attitude with their clients in order to promote trust and respect. Even if a client is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. Although it is true that nurses are legally obligated to provide care, this response is not client-focused and is therefore inappropriate.
  2. C) Nurses must provide a nonjudgmental attitude with their clients in order to promote trust and respect. Even if a client is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. Although it is true that nurses are legally obligated to provide care, this response is not client-focused and is therefore inappropriate.
  3. D) Nurses must provide a nonjudgmental attitude with their clients in order to promote trust and respect. Even if a client is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. Although it is true that nurses are legally obligated to provide care, this response is not client-focused and is therefore inappropriate.

Page Ref: 1567

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  6. Plan evidence-based care for individuals with a substance abuse disorder and their families in collaboration with other members of the healthcare team.

 

10) A nurse is caring for a client who displays addiction behavior toward the use of alcohol. The client reveals to the nurse that the client has been jailed twice for driving under the influence. The nurse understands that this type of behavioral therapy is which of the following?

  1. A) Positive reinforcement
  2. B) Negative reinforcement
  3. C) Positive punishment
  4. D) Negative punishment

Answer:  C

Explanation:  A) Consequences that lead to a decrease in undesirable behavior are referred to as punishment. Positive punishment is the addition of a negative consequence if the undesirable behavior occurs; for example, the addict who drives under the influence is jailed or fined. Negative punishment is the removal of a positive reward if the undesirable behavior occurs; for example, the addict who does not show up for work loses his job. Consequences that lead to an increase in a particular behavior are referred to as reinforcement. Positive reinforcement provides a reward for the desired behavior, such as the pleasant sensation, or high, that comes from the use of a substance. Negative reinforcement removes a negative stimulus to increase the chances that the desired behavior will occur. An example of negative reinforcement is when the family of an addict refuses to support the behavior that results from use of the substance.

  1. B) Consequences that lead to a decrease in undesirable behavior are referred to as punishment. Positive punishment is the addition of a negative consequence if the undesirable behavior occurs; for example, the addict who drives under the influence is jailed or fined. Negative punishment is the removal of a positive reward if the undesirable behavior occurs; for example, the addict who does not show up for work loses his job. Consequences that lead to an increase in a particular behavior are referred to as reinforcement. Positive reinforcement provides a reward for the desired behavior, such as the pleasant sensation, or high, that comes from the use of a substance. Negative reinforcement removes a negative stimulus to increase the chances that the desired behavior will occur. An example of negative reinforcement is when the family of an addict refuses to support the behavior that results from use of the substance.
  2. C) Consequences that lead to a decrease in undesirable behavior are referred to as punishment. Positive punishment is the addition of a negative consequence if the undesirable behavior occurs; for example, the addict who drives under the influence is jailed or fined. Negative punishment is the removal of a positive reward if the undesirable behavior occurs; for example, the addict who does not show up for work loses his job. Consequences that lead to an increase in a particular behavior are referred to as reinforcement. Positive reinforcement provides a reward for the desired behavior, such as the pleasant sensation, or high, that comes from the use of a substance. Negative reinforcement removes a negative stimulus to increase the chances that the desired behavior will occur. An example of negative reinforcement is when the family of an addict refuses to support the behavior that results from use of the substance.

 

  1. D) Consequences that lead to a decrease in undesirable behavior are referred to as punishment. Positive punishment is the addition of a negative consequence if the undesirable behavior occurs; for example, the addict who drives under the influence is jailed or fined. Negative punishment is the removal of a positive reward if the undesirable behavior occurs; for example, the addict who does not show up for work loses his job. Consequences that lead to an increase in a particular behavior are referred to as reinforcement. Positive reinforcement provides a reward for the desired behavior, such as the pleasant sensation, or high, that comes from the use of a substance. Negative reinforcement removes a negative stimulus to increase the chances that the desired behavior will occur. An example of negative reinforcement is when the family of an addict refuses to support the behavior that results from use of the substance.

Page Ref: 1529

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of individuals with a substance abuse disorder.

 

11) A nurse manager in the ICU notes a pattern of a staff nurse excessively “wasting” narcotics, and the manager suspects the staff nurse may be impaired. Which clinical situation may have contributed to the staff nurse’s problem?

  1. A) Caring for clients who require IV medications
  2. B) Easy access to prescription drugs
  3. C) Easy access to client care areas
  4. D) Caring for clients who require numerous oral medications

Answer:  B

Explanation:  A) Easy access to prescription drugs presents an at-risk situation for nurses who abuse substances. The other situations are common for all nurses and do not necessary pose an increased risk for substance abuse.

  1. B) Easy access to prescription drugs presents an at-risk situation for nurses who abuse substances. The other situations are common for all nurses and do not necessary pose an increased risk for substance abuse.
  2. C) Easy access to prescription drugs presents an at-risk situation for nurses who abuse substances. The other situations are common for all nurses and do not necessary pose an increased risk for substance abuse.
  3. D) Easy access to prescription drugs presents an at-risk situation for nurses who abuse substances. The other situations are common for all nurses and do not necessary pose an increased risk for substance abuse.

Page Ref: 1561-1562

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  2. Identify risk factors associated with substance abuse.

 

12) A nurse working in the Emergency Department is caring for a client who has overdosed on cocaine. The nurse receives an order from the client’s physician to administer an antipsychotic for treatment of the client’s condition. Which symptom(s) would this medication help to manage?

Select all that apply.

  1. A) Alkaline urine
  2. B) Decreased deep tendon reflexes
  3. C) Hyperpyrexia
  4. D) Respiratory distress
  5. E) CNS depression

Answer:  C, D

Explanation:  A) Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.

  1. B) Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.
  2. C) Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.
  3. D) Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.
  4. E) Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.

Page Ref: 1566

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  5. Summarize therapies used by interdisciplinary teams in the collaborative care of individuals with a substance abuse disorder.

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)

Module 40   Professional Behaviors

 

The Concept of Professional Behaviors

 

1) A toddler who has just been admitted to the pediatric unit is crying and scared. No treatment has been initiated at this point. The nurse needs to start an IV, and the parent asks, “Can I stay with my child and help through the procedure?” In providing care for the family, how does the nurse respond?

  1. A) “I can teach you ways to help your child throughout the procedure if you would like to be involved.”
  2. B) “We do this all the time, so don’t worry. I will come get you when we are done”
  3. C) “Be ready to hold the child down when I tell you to.”
  4. D) “I will be very quick so there is no need for you to stay for the procedure.”

Answer:  A

Explanation:

  1. A) A part of nurse competency is knowing the procedures to follow when performing skills. The nurse who is going to initiate an IV on a pediatric client should always seek assistance from the parent if the parent is willing and capable of offering assistance. Telling the parents that they need to hold the child without giving them a

Choice is not appropriate; many parents do not want to participate in activities that cause pain to their child. The nurse does not know how long the procedure will be, and telling the parent not to worry is pointless.

  1. B) A part of nurse competency is knowing the procedures to follow when performing skills. The nurse who is going to initiate an IV on a pediatric client should always seek assistance from the parent if the parent is willing and capable of offering assistance. Telling the parents that they need to hold the child without giving them a

Choice is not appropriate; many parents do not want to participate in activities that cause pain to their child. The nurse does not know how long the procedure will be, and telling the parent not to worry is pointless.

  1. C) A part of nurse competency is knowing the procedures to follow when performing skills. The nurse who is going to initiate an IV on a pediatric client should always seek assistance from the parent if the parent is willing and capable of offering assistance. Telling the parents that they need to hold the child without giving them a

Choice is not appropriate; many parents do not want to participate in activities that cause pain to their child. The nurse does not know how long the procedure will be, and telling the parent not to worry is pointless.

 

  1. D) A part of nurse competency is knowing the procedures to follow when performing skills. The nurse who is going to initiate an IV on a pediatric client should always seek assistance from the parent if the parent is willing and capable of offering assistance. Telling the parents that they need to hold the child without giving them a

Choice is not appropriate; many parents do not want to participate in activities that cause pain to their child. The nurse does not know how long the procedure will be, and telling the parent not to worry is pointless.

Page Ref: 2482

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  1. Connect professional behaviors to the development of trust in the nurse.

2) A student nurse accidentally left an elderly client’s bed up after giving a bed bath. Luckily, another nurse found that the bed was not left in the lowest position and was able to rectify the matter before something happened. The student responded, “I know better. I should’ve double-checked the bed before I left the room.” Which characteristic is this student demonstrating?

  1. A) Compassion
  2. B) Integrity
  3. C) Fidelity
  4. D) Justice

Answer:  B

Explanation:

  1. A) Integrity means adhering to a strict moral or ethical code. By admitting to not double-checking the position of the bed, the student shows accountability and integrity. Justice has to do with being fair. Fidelity means to be faithful to agreements and promises. Compassion is an awareness of and concern for the suffering of others.
  2. B) Integrity means adhering to a strict moral or ethical code. By admitting to not double-checking the position of the bed, the student shows accountability and integrity. Justice has to do with being fair. Fidelity means to be faithful to agreements and promises. Compassion is an awareness of and concern for the suffering of others.
  3. C) Integrity means adhering to a strict moral or ethical code. By admitting to not double-checking the position of the bed, the student shows accountability and integrity. Justice has to do with being fair. Fidelity means to be faithful to agreements and promises. Compassion is an awareness of and concern for the suffering of others.
  4. D) Integrity means adhering to a strict moral or ethical code. By admitting to not double-checking the position of the bed, the student shows accountability and integrity. Justice has to do with being fair. Fidelity means to be faithful to agreements and promises. Compassion is an awareness of and concern for the suffering of others.

Page Ref: 2483

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  2. Provide examples of how the nurse uses professional behaviors to meet the primary responsibility of nursing.

 

3) The nurse working in a neonatal intensive care unit (ICU) is caring for a critically ill 28-week-old preemie. The parent calls the nurse and asks if it would be possible to bring the client’s 2-year-old sibling to visit because the sibling is having nightmares about the client’s death. Small children are not permitted to visit because of the risk of infection to the infants on the unit. What should the nurse do?

  1. A) Seek permission from unit management and the physician to allow the sibling to visit.
  2. B) Offer to make counseling available to the sibling.
  3. C) Tell the parent that visiting is not permitted and offer to take pictures of the client.
  4. D) Tell the parent to bring the sibling in to visit in the middle of the night.

Answer:  A

Explanation:

  1. A) The nurse realizes that certain rules are in place for the protection of clients. The nurse would be compassionate enough to seek permission to allow the sibling to visit and see that the infant is alive and being cared for. Telling the parent what the rules of the unit are will only increase the family’s frustration when they are looking to the nurse for assistance. Offering counseling may or may not be an effective means of assisting the family. The sibling needs to be reassured that the infant is alive. The nurse would not make the decision without the permission of the management team.
  2. B) The nurse realizes that certain rules are in place for the protection of clients. The nurse would be compassionate enough to seek permission to allow the sibling to visit and see that the infant is alive and being cared for. Telling the parent what the rules of the unit are will only increase the family’s frustration when they are looking to the nurse for assistance. Offering counseling may or may not be an effective means of assisting the family. The sibling needs to be reassured that the infant is alive. The nurse would not make the decision without the permission of the management team.
  3. C) The nurse realizes that certain rules are in place for the protection of clients. The nurse would be compassionate enough to seek permission to allow the sibling to visit and see that the infant is alive and being cared for. Telling the parent what the rules of the unit are will only increase the family’s frustration when they are looking to the nurse for assistance. Offering counseling may or may not be an effective means of assisting the family. The sibling needs to be reassured that the infant is alive. The nurse would not make the decision without the permission of the management team.
  4. D) The nurse realizes that certain rules are in place for the protection of clients. The nurse would be compassionate enough to seek permission to allow the sibling to visit and see that the infant is alive and being cared for. Telling the parent what the rules of the unit are will only increase the family’s frustration when they are looking to the nurse for assistance. Offering counseling may or may not be an effective means of assisting the family. The sibling needs to be reassured that the infant is alive. The nurse would not make the decision without the permission of the management team.

Page Ref: 2483

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  3. Explore nursing behaviors that demonstrate professionalism.

 

4) A nurse is on the elevator preparing to start a 12-hour shift after visiting a sick family member when two other nurses enter. The nurses start talking negatively about a client they are caring for on a medical-surgical unit in the hospital. Although there are no clients on the elevator, how should the nurse handle this situation?

  1. A) Ask the nurses to stop talking in public.
  2. B) Report the nurses to the unit manager.
  3. C) Speak to the nurses in a private place.
  4. D) Report the nurses to the risk manager.

Answer:  C

Explanation:

  1. A) Nursing integrity ensures that patients’ rights are respected in the healthcare setting. If the nurse were to confront the two colleagues on the elevator, it could be overheard by others. The nurse should wait to speak to the other nurses privately about the breach of confidentiality. The nurse could report the incident to the unit manager, but it would be best for the nurse to confront the two colleagues in a professional way. The nurse should confront the two colleagues in a private manner in a professional way. If that cannot be done, then notifying the nurse manager would be the next step. The risk manager is only involved in situations where there is an injury to the staff or a client.
  2. B) Nursing integrity ensures that patients’ rights are respected in the healthcare setting. If the nurse were to confront the two colleagues on the elevator, it could be overheard by others. The nurse should wait to speak to the other nurses privately about the breach of confidentiality. The nurse could report the incident to the unit manager, but it would be best for the nurse to confront the two colleagues in a professional way. The nurse should confront the two colleagues in a private manner in a professional way. If that cannot be done, then notifying the nurse manager would be the next step. The risk manager is only involved in situations where there is an injury to the staff or a client.
  3. C) Nursing integrity ensures that patients’ rights are respected in the healthcare setting. If the nurse were to confront the two colleagues on the elevator, it could be overheard by others. The nurse should wait to speak to the other nurses privately about the breach of confidentiality. The nurse could report the incident to the unit manager, but it would be best for the nurse to confront the two colleagues in a professional way. The nurse should confront the two colleagues in a private manner in a professional way. If that cannot be done, then notifying the nurse manager would be the next step. The risk manager is only involved in situations where there is an injury to the staff or a client.
  4. D) Nursing integrity ensures that patients’ rights are respected in the healthcare setting. If the nurse were to confront the two colleagues on the elevator, it could be overheard by others. The nurse should wait to speak to the other nurses privately about the breach of confidentiality. The nurse could report the incident to the unit manager, but it would be best for the nurse to confront the two colleagues in a professional way. The nurse should confront the two colleagues in a private manner in a professional way. If that cannot be done, then notifying the nurse manager would be the next step. The risk manager is only involved in situations where there is an injury to the staff or a client.

Page Ref: 2483

Cognitive Level:  Evaluating

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  4. Describe professional behaviors based on the ANA Code of Ethics.

5) A nurse supervisor in a hospital that is about to vote on unionizing nurses has been told by the hospital CFO to schedule union organizers during times that have been arranged for union organizational meetings. How might this nurse respond professionally?

Select all that apply.

  1. A) Schedule the organizers during union meeting times.
  2. B) Schedule the organizers according to clinical staffing needs.
  3. C) Reprimand nurses for attempts to unionize.
  4. D) Continue to implement the usual staffing procedures.
  5. E) Discuss the need for professional nursing integrity with the CFO.

Answer:  B, D, E

Explanation:

  1. A) Administrators may serve their careers and no longer the priorities of client-centered care. Nurses in authority who emphasize principles and who focus on client safety can extinguish negative behaviors and encourage nurses at the point of care. Some administrators can be identified by an attitude of arrogance, control, and acceptance of the hierarchical power structure. Nurses should maintain their integrity and that of their profession.
  2. B) Administrators may serve their careers and no longer the priorities of client-centered care. Nurses in authority who emphasize principles and who focus on client safety can extinguish negative behaviors and encourage nurses at the point of care. Some administrators can be identified by an attitude of arrogance, control, and acceptance of the hierarchical power structure. Nurses should maintain their integrity and that of their profession.
  3. C) Administrators may serve their careers and no longer the priorities of client-centered care. Nurses in authority who emphasize principles and who focus on client safety can extinguish negative behaviors and encourage nurses at the point of care. Some administrators can be identified by an attitude of arrogance, control, and acceptance of the hierarchical power structure. Nurses should maintain their integrity and that of their profession.
  4. D) Administrators may serve their careers and no longer the priorities of client-centered care. Nurses in authority who emphasize principles and who focus on client safety can extinguish negative behaviors and encourage nurses at the point of care. Some administrators can be identified by an attitude of arrogance, control, and acceptance of the hierarchical power structure. Nurses should maintain their integrity and that of their profession.
  5. E) Administrators may serve their careers and no longer the priorities of client-centered care. Nurses in authority who emphasize principles and who focus on client safety can extinguish negative behaviors and encourage nurses at the point of care. Some administrators can be identified by an attitude of arrogance, control, and acceptance of the hierarchical power structure. Nurses should maintain their integrity and that of their profession.

Page Ref: 2484

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  5. Compare and contrast organizational commitment and professional commitment.

 

6) A nurse has just received a shift report for a 12-hour shift. As the nurse is preparing to enter a client’s room, the nurse overhears a coworker telling an offensive joke with a sexual undertone to the client. What is the best action for the nurse at this time?

  1. A) Tell the nurse, in private, that such conduct is offensive and not professional.
  2. B) Ignore the coworker and walk away.
  3. C) Report the incident to the nurse manager.
  4. D) Ask to be scheduled opposite this coworker.

Answer:  A

Explanation:

  1. A) Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the coworker to stop, and why, is the first step in putting an end to the situation. Ignoring the situation or asking to be scheduled opposite this individual is not addressing the situation in an assertive manner. Reporting the incident to the nurse manager would be a second step if the behavior doesn’t stop after the nurse’s approach.
  2. B) Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the coworker to stop, and why, is the first step in putting an end to the situation. Ignoring the situation or asking to be scheduled opposite this individual is not addressing the situation in an assertive manner. Reporting the incident to the nurse manager would be a second step if the behavior doesn’t stop after the nurse’s approach.
  3. C) Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the coworker to stop, and why, is the first step in putting an end to the situation. Ignoring the situation or asking to be scheduled opposite this individual is not addressing the situation in an assertive manner. Reporting the incident to the nurse manager would be a second step if the behavior doesn’t stop after the nurse’s approach.
  4. D) Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the coworker to stop, and why, is the first step in putting an end to the situation. Ignoring the situation or asking to be scheduled opposite this individual is not addressing the situation in an assertive manner. Reporting the incident to the nurse manager would be a second step if the behavior doesn’t stop after the nurse’s approach.

Page Ref: 2484

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  5. Provide examples of behaviors that may be interpreted as sexual harassment and strategies to avoid them.

 

Exemplar 40.1  Commitment to Profession

 

1) A new graduate nurse has been hired to work in a busy cardiac intensive care unit at the local hospital. The nurse will spend 12 weeks in orientation to the unit. How does the new nurse demonstrate commitment?

  1. A) Joining the ANA
  2. B) Questioning the preceptor during all procedures
  3. C) Attending every shift on time
  4. D) Exhibiting clinical competence

Answer:  C

Explanation:

  1. A) The new nurse can demonstrate commitment by showing up for all shifts in a timely fashion. It should not be necessary for the new nurse to question every procedure, as the new nurse has some clinical experience. Joining the ANA is a commitment, but is not relevant to this question. Clinical competence develops over time, and the new nurse is not likely to exhibit competence yet; showing up on time is a better predictor of the nurse’s commitment.
  2. B) The new nurse can demonstrate commitment by showing up for all shifts in a timely fashion. It should not be necessary for the new nurse to question every procedure, as the new nurse has some clinical experience. Joining the ANA is a commitment, but is not relevant to this question. Clinical competence develops over time, and the new nurse is not likely to exhibit competence yet; showing up on time is a better predictor of the nurse’s commitment.
  3. C) The new nurse can demonstrate commitment by showing up for all shifts in a timely fashion. It should not be necessary for the new nurse to question every procedure, as the new nurse has some clinical experience. Joining the ANA is a commitment, but is not relevant to this question. Clinical competence develops over time, and the new nurse is not likely to exhibit competence yet; showing up on time is a better predictor of the nurse’s commitment.
  4. D) The new nurse can demonstrate commitment by showing up for all shifts in a timely fashion. It should not be necessary for the new nurse to question every procedure, as the new nurse has some clinical experience. Joining the ANA is a commitment, but is not relevant to this question. Clinical competence develops over time, and the new nurse is not likely to exhibit competence yet; showing up on time is a better predictor of the nurse’s commitment.

Page Ref: 2486

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Discuss concepts of organizational commitment as applied to the profession of nursing.

 

2) A student nurse is caring for an elderly client with dementia who is confused, agitated, and forgetful. The student leaves for a break and forgets to put the call light within reach of the client. When checking on the student’s clients, the instructor discovers the student’s negligence and determines which of the following?

  1. A) The student is appropriately taking care of self.
  2. B) The student’s workload is too difficult.
  3. C) The student is demonstrating inappropriate safety measures for the client.
  4. D) The student is demonstrating appropriate comfort measures for the client.

Answer:  C

Explanation:

  1. A) The student is demonstrating inappropriate safety measures by not leaving the call light within reach of the client. There is no evidence that the student’s load is too difficult. The student has ignored basic safety measures for this client. It is appropriate for nurses and students to take breaks; however, the safety of the client is the first commitment for the nurse.
  2. B) The student is demonstrating inappropriate safety measures by not leaving the call light within reach of the client. There is no evidence that the student’s load is too difficult. The student has ignored basic safety measures for this client. It is appropriate for nurses and students to take breaks; however, the safety of the client is the first commitment for the nurse.
  3. C) The student is demonstrating inappropriate safety measures by not leaving the call light within reach of the client. There is no evidence that the student’s load is too difficult. The student has ignored basic safety measures for this client. It is appropriate for nurses and students to take breaks; however, the safety of the client is the first commitment for the nurse.
  4. D) The student is demonstrating inappropriate safety measures by not leaving the call light within reach of the client. There is no evidence that the student’s load is too difficult. The student has ignored basic safety measures for this client. It is appropriate for nurses and students to take breaks; however, the safety of the client is the first commitment for the nurse.

Page Ref: 2486

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Evaluation

Learning Outcome:  2. Apply factors of professional commitment to the role of nursing student.

 

3) The student nurse is attending a lecture about commitment to the profession of nursing. The instructor is grading the student’s commitment to nursing during this rotation. The instructor knows the student is committed to the nursing profession when the student does which of the following?

  1. A) Calls in sick for clinical to study for a class exam
  2. B) Declines to observe a new procedure to give a necessary bath
  3. C) Misses class to attend a political rally
  4. D) Calls in sick for clinical because of a respiratory infection

Answer:  D

Explanation:

  1. A) Whereas calling in sick for a frivolous reason demonstrates a lack of commitment, calling in sick with a bona fide illness demonstrates protection of the clients who are already compromised. Attending a political rally may be important, but for the student attending class demonstrates the greater commitment. Studying for a class exam is also important, but not more important than learning clinical skills. The student who demonstrates commitment seeks out as many new learning experiences as possible.
  2. B) Whereas calling in sick for a frivolous reason demonstrates a lack of commitment, calling in sick with a bona fide illness demonstrates protection of the clients who are already compromised. Attending a political rally may be important, but for the student attending class demonstrates the greater commitment. Studying for a class exam is also important, but not more important than learning clinical skills. The student who demonstrates commitment seeks out as many new learning experiences as possible.
  3. C) Whereas calling in sick for a frivolous reason demonstrates a lack of commitment, calling in sick with a bona fide illness demonstrates protection of the clients who are already compromised. Attending a political rally may be important, but for the student attending class demonstrates the greater commitment. Studying for a class exam is also important, but not more important than learning clinical skills. The student who demonstrates commitment seeks out as many new learning experiences as possible.
  4. D) Whereas calling in sick for a frivolous reason demonstrates a lack of commitment, calling in sick with a bona fide illness demonstrates protection of the clients who are already compromised. Attending a political rally may be important, but for the student attending class demonstrates the greater commitment. Studying for a class exam is also important, but not more important than learning clinical skills. The student who demonstrates commitment seeks out as many new learning experiences as possible.

Page Ref: 2486

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  3. Analyze your personal level of commitment to the nursing profession.

 

4) The nurse manager on the neurology unit helps the other nurses on the unit become more involved with the local neurological association and providing healthcare in-services to the community. The nurses on the unit know that the nurse manager shows which type of commitment to the nursing profession?

  1. A) Affective commitment
  2. B) Normative commitment
  3. C) Obsessive commitment
  4. D) Continuance commitment

Answer:  A

Explanation:

  1. A) There are three types of commitment: affective, normative, and continuance. Affective commitment is an attachment to a profession and includes identification with and involvement in the profession. Affective commitment develops when involvement in a profession produces a satisfying experience.
  2. B) There are three types of commitment: affective, normative, and continuance. Affective commitment is an attachment to a profession and includes identification with and involvement in the profession. Affective commitment develops when involvement in a profession produces a satisfying experience.
  3. C) There are three types of commitment: affective, normative, and continuance. Affective commitment is an attachment to a profession and includes identification with and involvement in the profession. Affective commitment develops when involvement in a profession produces a satisfying experience.
  4. D) There are three types of commitment: affective, normative, and continuance. Affective commitment is an attachment to a profession and includes identification with and involvement in the profession. Affective commitment develops when involvement in a profession produces a satisfying experience.

Page Ref: 2487

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Discuss concepts of organizational commitment as applied to the profession of nursing.

 

5) The nurse working on the adult psychiatric unit complains of feeling “burnt out.” Which suggestion(s) will help the nurse reduce stress?

Select all that apply.

  1. A) Meditate or take a long soak in a tub.
  2. B) Join a local Zumba class.
  3. C) Participate in a professional organization.
  4. D) Accept an extra shift.
  5. E) Don’t accept failure; try, try, and try again.

Answer:  A, B, C

Explanation:

  1. A) Nurses can prevent burnout by using healthy techniques to manage stress. To do so, they must first recognize their stress and become attuned to responses such as feelings of being overwhelmed, fatigue, angry outbursts, physical illness, and increases in coffee drinking, smoking, or use of alcohol or other mood-enhancing substances. Once attuned to stress and their own personal reactions, nurses must identify which situations produce the most pronounced reactions. Suggestions that help reduce stress include planning daily relaxation activities, establishing a regular exercise program, learn to say no, accepting errors and failures as learning experiences, accepting change and limitations, developing collegial support groups, participating in professional organizations, and seeking counseling if needed.
  2. B) Nurses can prevent burnout by using healthy techniques to manage stress. To do so, they must first recognize their stress and become attuned to responses such as feelings of being overwhelmed, fatigue, angry outbursts, physical illness, and increases in coffee drinking, smoking, or use of alcohol or other mood-enhancing substances. Once attuned to stress and their own personal reactions, nurses must identify which situations produce the most pronounced reactions. Suggestions that help reduce stress include planning daily relaxation activities, establishing a regular exercise program, learn to say no, accepting errors and failures as learning experiences, accepting change and limitations, developing collegial support groups, participating in professional organizations, and seeking counseling if needed.
  3. C) Nurses can prevent burnout by using healthy techniques to manage stress. To do so, they must first recognize their stress and become attuned to responses such as feelings of being overwhelmed, fatigue, angry outbursts, physical illness, and increases in coffee drinking, smoking, or use of alcohol or other mood-enhancing substances. Once attuned to stress and their own personal reactions, nurses must identify which situations produce the most pronounced reactions. Suggestions that help reduce stress include planning daily relaxation activities, establishing a regular exercise program, learn to say no, accepting errors and failures as learning experiences, accepting change and limitations, developing collegial support groups, participating in professional organizations, and seeking counseling if needed.
  4. D) Nurses can prevent burnout by using healthy techniques to manage stress. To do so, they must first recognize their stress and become attuned to responses such as feelings of being overwhelmed, fatigue, angry outbursts, physical illness, and increases in coffee drinking, smoking, or use of alcohol or other mood-enhancing substances. Once attuned to stress and their own personal reactions, nurses must identify which situations produce the most pronounced reactions. Suggestions that help reduce stress include planning daily relaxation activities, establishing a regular exercise program, learn to say no, accepting errors and failures as learning experiences, accepting change and limitations, developing collegial support groups, participating in professional organizations, and seeking counseling if needed.

 

  1. E) Nurses can prevent burnout by using healthy techniques to manage stress. To do so, they must first recognize their stress and become attuned to responses such as feelings of being overwhelmed, fatigue, angry outbursts, physical illness, and increases in coffee drinking, smoking, or use of alcohol or other mood-enhancing substances. Once attuned to stress and their own personal reactions, nurses must identify which situations produce the most pronounced reactions. Suggestions that help reduce stress include planning daily relaxation activities, establishing a regular exercise program, learn to say no, accepting errors and failures as learning experiences, accepting change and limitations, developing collegial support groups, participating in professional organizations, and seeking counseling if needed.

Page Ref: 2488

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  3. Analyze your personal level of commitment to the nursing profession.

6) The nurse observes the student nurse’s behavior on the unit, and notes the student is always on time, neat in appearance, and caring toward clients. Which factor best indicates to the nurse the student level of professional commitment?

  1. A) A pattern of behaviors congruent with the nurses’ professional code of ethics
  2. B) A strong belief in and acceptance of the company’s goals, values, and mores
  3. C) A willingness to be able to exert control over personal behaviors
  4. D) A strong desire to be a part of a group

Answer:  A

Explanation:

  1. A) Factors associated with professional commitment include a strong belief in and acceptance of the profession’s code, role, goals, values, and morals; a willingness to exert considerable personal effort on behalf of the profession; a strong desire to maintain membership in the profession; and a pattern of behaviors congruent with the nurses’ professional code of ethics.
  2. B) Factors associated with professional commitment include a strong belief in and acceptance of the profession’s code, role, goals, values, and mores; a willingness to exert considerable personal effort on behalf of the profession; a strong desire to maintain membership in the profession; and a pattern of behaviors congruent with the nurses’ professional code of ethics.
  3. C) Factors associated with professional commitment include a strong belief in and acceptance of the profession’s code, role, goals, values, and mores; a willingness to exert considerable personal effort on behalf of the profession; a strong desire to maintain membership in the profession; and a pattern of behaviors congruent with the nurses’ professional code of ethics.
  4. D) Factors associated with professional commitment include a strong belief in and acceptance of the profession’s code, role, goals, values, and mores; a willingness to exert considerable personal effort on behalf of the profession; a strong desire to maintain membership in the profession; and a pattern of behaviors congruent with the nurses’ professional code of ethics.

Page Ref: 2486

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Evaluation

Learning Outcome:  2. Apply factors of professional commitment to the role of nursing student.

 

7) When speaking with a nursing student about the nursing profession, the student states, “I’m so nervous about taking the NCLEX, but I’m excited also; your nurse manager asked if I wanted to work here!” The nurse knows that the student is in which stage of commitment development?

  1. A) The integrated stage
  2. B) The testing stage
  3. C) The passionate stage
  4. D) The exploratory stage

Answer:  A

Explanation:

  1. A) The commitment to a profession develops in five stages; exploratory, testing, passionate, quiet and bored, and integrated. The integrated stage is the final stage of commitment. Individuals who reach this stage have integrated both positive and negative elements of the profession into a more flexible, complex, and enduring form of commitment. They act out their commitment as a matter of habit. These students are in the final stages of their nursing program and are beginning to see themselves as nurses, eager to take the NCLEX-RN ® and begin employment.
  2. B) The commitment to a profession develops in five stages; exploratory, testing, passionate, quiet and bored, and integrated. The integrated stage is the final stage of commitment. Individuals who reach this stage have integrated both positive and negative elements of the profession into a more flexible, complex, and enduring form of commitment. They act out their commitment as a matter of habit. These students are in the final stages of their nursing program and are beginning to see themselves as nurses, eager to take the NCLEX-RN ® and begin employment.
  3. C) The commitment to a profession develops in five stages; exploratory, testing, passionate, quiet and bored, and integrated. The integrated stage is the final stage of commitment. Individuals who reach this stage have integrated both positive and negative elements of the profession into a more flexible, complex, and enduring form of commitment. They act out their commitment as a matter of habit. These students are in the final stages of their nursing program and are beginning to see themselves as nurses, eager to take the NCLEX-RN ® and begin employment.
  4. D) The commitment to a profession develops in five stages; exploratory, testing, passionate, quiet and bored, and integrated. The integrated stage is the final stage of commitment. Individuals who reach this stage have integrated both positive and negative elements of the profession into a more flexible, complex, and enduring form of commitment. They act out their commitment as a matter of habit. These students are in the final stages of their nursing program and are beginning to see themselves as nurses, eager to take the NCLEX-RN ® and begin employment.

Page Ref: 2488

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  2. Apply factors of professional commitment to the role of nursing student.

 

Exemplar 40.2  Leadership Principles

 

1) A 52-year-old veteran nurse working on the medical-surgical unit of an urban hospital is frequently consulted by other staff members on clinical issues that she has experience with and new procedures that she assimilates quickly. What characteristic(s) of the informal leader does this nurse demonstrate?

Select all that apply.

  1. A) Seniority
  2. B) Insecurity
  3. C) Special abilities
  4. D) Age
  5. E) Supervisory position

Answer:  A, C, D

Explanation:

  1. A) Informal leaders are recognized by the group as leaders and play an important role in influencing colleagues, coworkers, and other group members to achieve the group’s goals. They often become leaders because of seniority, age, or special abilities. Leaders tend to be informed and confident. An informal leader is not officially appointed.
  2. B) Informal leaders are recognized by the group as leaders and play an important role in influencing colleagues, coworkers, and other group members to achieve the group’s goals. They often become leaders because of seniority, age, or special abilities. Leaders tend to be informed and confident. An informal leader is not officially appointed.
  3. C) Informal leaders are recognized by the group as leaders and play an important role in influencing colleagues, coworkers, and other group members to achieve the group’s goals. They often become leaders because of seniority, age, or special abilities. Leaders tend to be informed and confident. An informal leader is not officially appointed.
  4. D) Informal leaders are recognized by the group as leaders and play an important role in influencing colleagues, coworkers, and other group members to achieve the group’s goals. They often become leaders because of seniority, age, or special abilities. Leaders tend to be informed and confident. An informal leader is not officially appointed.
  5. E) Informal leaders are recognized by the group as leaders and play an important role in influencing colleagues, coworkers, and other group members to achieve the group’s goals. They often become leaders because of seniority, age, or special abilities. Leaders tend to be informed and confident. An informal leader is not officially appointed.

Page Ref: 2489

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Client Need Sub:  Management of Care

Nursing Process:  Teaching and Learning

Learning Outcome:  1. Differentiate between formal and informal leaders.

 

2) The new graduate nurse is interviewing with managers in the hospital. The nurse has decided that working for a manager who demonstrates an autocratic style of leadership would be the best match for the nurse. To determine the manager’s style, what should the nurse asks the manager?

  1. A) “What is your view of nurses working overtime?”
  2. B) “How do you implement orientation?”
  3. C) “What shift will I be working?”
  4. D) “Do you seek input from staff when implementing new policies?”

Answer:  D

Explanation:

  1. A) In order to determine the leadership style of the manager, the nurse would ask the manager how he or she handles new unit policies. If the manager states that policies are determined by leadership who will give orders and directions to the group, then the new graduate knows this manager is autocratic in nature. Asking about the shift will not tell the nurse about leadership style. How the manager implements orientation would not necessarily reveal the manager’s leadership style. Working overtime is a unit or hospital rule, not a leadership style.
  2. B) In order to determine the leadership style of the manager, the nurse would ask the manager how he or she handles new unit policies. If the manager states that policies are determined by leadership who will give orders and directions to the group, then the new graduate knows this manager is autocratic in nature. Asking about the shift will not tell the nurse about leadership style. How the manager implements orientation would not necessarily reveal the manager’s leadership style. Working overtime is a unit or hospital rule, not a leadership style.
  3. C) In order to determine the leadership style of the manager, the nurse would ask the manager how he or she handles new unit policies. If the manager states that policies are determined by leadership who will give orders and directions to the group, then the new graduate knows this manager is autocratic in nature. Asking about the shift will not tell the nurse about leadership style. How the manager implements orientation would not necessarily reveal the manager’s leadership style. Working overtime is a unit or hospital rule, not a leadership style.
  4. D) In order to determine the leadership style of the manager, the nurse would ask the manager how he or she handles new unit policies. If the manager states that policies are determined by leadership who will give orders and directions to the group, then the new graduate knows this manager is autocratic in nature. Asking about the shift will not tell the nurse about leadership style. How the manager implements orientation would not necessarily reveal the manager’s leadership style. Working overtime is a unit or hospital rule, not a leadership style.

Page Ref: 2489-2490

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Assessment

Learning Outcome:  2. Compare and contrast the different leadership styles.

 

3) A nurse manager has had to interact with a particularly difficult physician who is demanding of and demeaning to the nurses on the unit. Through this situation, the nurse manager has learned that which are characteristics of successful communication?

Select all that apply.

  1. A) Accuracy
  2. B) Assertiveness
  3. C) Critical thinking
  4. D) Honesty
  5. E) Networking

Answer:  A, B, D

Explanation:

  1. A) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.
  2. B) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.
  3. C) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.
  4. D) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.
  5. E) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.

Page Ref: 2489

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Assessment

Learning Outcome:  2. Compare and contrast the different leadership styles.

 

4) Which of the following behaviors are fostered by transformational leaders?

Select all that apply.

  1. A) Creativity
  2. B) Risk taking
  3. C) Commitment
  4. D) Obedience
  5. E) Collaboration

Answer:  A, B, C, E

Explanation:

  1. A) The transformational leader empowers the group, facilitating independence, individual growth, and change. The leader enlists others to participate in attaining the goal and share in the organization’s vision but does not expect unreflective obedience.
  2. B) The transformational leader empowers the group, facilitating independence, individual growth, and change. The leader enlists others to participate in attaining the goal and share in the organization’s vision but does not expect unreflective obedience.
  3. C) The transformational leader empowers the group, facilitating independence, individual growth, and change. The leader enlists others to participate in attaining the goal and share in the organization’s vision but does not expect unreflective obedience.
  4. D) The transformational leader empowers the group, facilitating independence, individual growth, and change. The leader enlists others to participate in attaining the goal and share in the organization’s vision but does not expect unreflective obedience.
  5. E) The transformational leader empowers the group, facilitating independence, individual growth, and change. The leader enlists others to participate in attaining the goal and share in the organization’s vision but does not expect unreflective obedience.

Page Ref: 2490

Cognitive Level:  Evaluating

Client Need:  Safe and Effective Care Environment

Nursing Process:  Teaching and Learning

Learning Outcome:  3. List the transformational leadership skills that you possess.

 

5) The charge nurse on first shift was never officially hired for that position, but the nurses on the unit recognize her as the charge nurse because she has been on the unit for 20 years. The nurses know the charge nurse has which type of position?

Select all that apply.

  1. A) Informal leader
  2. B) Nursing leader
  3. C) Mentor
  4. D) Formal leader
  5. E) Official

Answer:  A, B

Explanation:

  1. A) A leader does not require an official position to lead. Leaders are people with the ability to rule, guide, or inspire others to think or act as they recommend. A leader influences others to work together to accomplish a specific goal. Leadership may be formal or informal. The formal leader, or appointed leader, is selected by an organization and given official authority to make decisions and to act. An informal leader is not officially appointed to direct the activities of others but, because of seniority, age, or special abilities, is recognized by the group as a leader and plays an important role in influencing, facilitating, and mentoring colleagues, coworkers, and other group members to achieve the group’s goals.
  2. B) A leader does not require an official position to lead. Leaders are people with the ability to rule, guide, or inspire others to think or act as they recommend. A leader influences others to work together to accomplish a specific goal. Leadership may be formal or informal. The formal leader, or appointed leader, is selected by an organization and given official authority to make decisions and to act. An informal leader is not officially appointed to direct the activities of others but, because of seniority, age, or special abilities, is recognized by the group as a leader and plays an important role in influencing, facilitating, and mentoring colleagues, coworkers, and other group members to achieve the group’s goals.
  3. C) A leader does not require an official position to lead. Leaders are people with the ability to rule, guide, or inspire others to think or act as they recommend. A leader influences others to work together to accomplish a specific goal. Leadership may be formal or informal. The formal leader, or appointed leader, is selected by an organization and given official authority to make decisions and to act. An informal leader is not officially appointed to direct the activities of others but, because of seniority, age, or special abilities, is recognized by the group as a leader and plays an important role in influencing, facilitating, and mentoring colleagues, coworkers, and other group members to achieve the group’s goals.
  4. D) A leader does not require an official position to lead. Leaders are people with the ability to rule, guide, or inspire others to think or act as they recommend. A leader influences others to work together to accomplish a specific goal. Leadership may be formal or informal. The formal leader, or appointed leader, is selected by an organization and given official authority to make decisions and to act. An informal leader is not officially appointed to direct the activities of others but, because of seniority, age, or special abilities, is recognized by the group as a leader and plays an important role in influencing, facilitating, and mentoring colleagues, coworkers, and other group members to achieve the group’s goals.

 

  1. E) A leader does not require an official position to lead. Leaders are people with the ability to rule, guide, or inspire others to think or act as they recommend. A leader influences others to work together to accomplish a specific goal. Leadership may be formal or informal. The formal leader, or appointed leader, is selected by an organization and given official authority to make decisions and to act. An informal leader is not officially appointed to direct the activities of others but, because of seniority, age, or special abilities, is recognized by the group as a leader and plays an important role in influencing, facilitating, and mentoring colleagues, coworkers, and other group members to achieve the group’s goals.

Page Ref: 2489

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Differentiate between formal and informal leaders.

 

6) The nurses on the cardiology unit are unhappy with their nurse manager. The nurses complain that he is “inflexible and impersonal.” The nurses realize that he is which type of leader?

  1. A) Bureaucratic
  2. B) Autocratic
  3. C) Laissez-faire
  4. D) Situational

Answer:  A

Explanation:

  1. A) The bureaucratic leader does not trust anyone to make decisions and instead relies on the organization’s rules, policies, and procedures to direct the group’s work efforts. Group members are usually dissatisfied with the leader’s inflexibility and impersonal relations with them.
  2. B) The bureaucratic leader does not trust anyone to make decisions and instead relies on the organization’s rules, policies, and procedures to direct the group’s work efforts. Group members are usually dissatisfied with the leader’s inflexibility and impersonal relations with them.
  3. C) The bureaucratic leader does not trust anyone to make decisions and instead relies on the organization’s rules, policies, and procedures to direct the group’s work efforts. Group members are usually dissatisfied with the leader’s inflexibility and impersonal relations with them.
  4. D) The bureaucratic leader does not trust anyone to make decisions and instead relies on the organization’s rules, policies, and procedures to direct the group’s work efforts. Group members are usually dissatisfied with the leader’s inflexibility and impersonal relations with them.

Page Ref: 2490

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  2. Compare and contrast the different leadership styles.

 

7) You are a newly hired nurse manager who believes in the theory of shared governance and you direct your unit using that style. As the nurse manager, you know that which skills ensure that you are an effective nurse leader?

Select all that apply.

  1. A) Modeling the way
  2. B) Empowering others
  3. C) Giving feedback
  4. D) Receiving feedback
  5. E) Being political

Answer:  A, B, C, D

Explanation:

  1. A) Nurses are encouraged to design new models of care to improve quality, efficiency, and safety. Effective nurse leaders mentor and direct client care; actively advocate at the point of care; are expert clinicians and apply evidence-based care; model the way; are risk takers and inspire others to create a shared vision; are assertive and challenge the status quo; enable others to act and encourage the heart; empower others to embrace their passions and talents; value point-of-care nurses as equal partners; are trustworthy and model honest communication; are transparent and share information; give and receive feedback; are energetic and committed; collaborate and educate; are responsible and ethical; are creative and flexible; network and build teams; and are politically astute.
  2. B) Nurses are encouraged to design new models of care to improve quality, efficiency, and safety. Effective nurse leaders mentor and direct client care; actively advocate at the point of care; are expert clinicians and apply evidence-based care; model the way; are risk takers and inspire others to create a shared vision; are assertive and challenge the status quo; enable others to act and encourage the heart; empower others to embrace their passions and talents; value point-of-care nurses as equal partners; are trustworthy and model honest communication; are transparent and share information; give and receive feedback; are energetic and committed; collaborate and educate; are responsible and ethical; are creative and flexible; network and build teams; and are politically astute.
  3. C) Nurses are encouraged to design new models of care to improve quality, efficiency, and safety. Effective nurse leaders mentor and direct client care; actively advocate at the point of care; are expert clinicians and apply evidence-based care; model the way; are risk takers and inspire others to create a shared vision; are assertive and challenge the status quo; enable others to act and encourage the heart; empower others to embrace their passions and talents; value point-of-care nurses as equal partners; are trustworthy and model honest communication; are transparent and share information; give and receive feedback; are energetic and committed; collaborate and educate; are responsible and ethical; are creative and flexible; network and build teams; and are politically astute.
  4. D) Nurses are encouraged to design new models of care to improve quality, efficiency, and safety. Effective nurse leaders mentor and direct client care; actively advocate at the point of care; are expert clinicians and apply evidence-based care; model the way; are risk takers and inspire others to create a shared vision; are assertive and challenge the status quo; enable others to act and encourage the heart; empower others to embrace their passions and talents; value point-of-care nurses as equal partners; are trustworthy and model honest communication; are transparent and share information; give and receive feedback; are energetic and committed; collaborate and educate; are responsible and ethical; are creative and flexible; network and build teams; and are politically astute.
  5. E) Nurses are encouraged to design new models of care to improve quality, efficiency, and safety. Effective nurse leaders mentor and direct client care; actively advocate at the point of care; are expert clinicians and apply evidence-based care; model the way; are risk takers and inspire others to create a shared vision; are assertive and challenge the status quo; enable others to act and encourage the heart; empower others to embrace their passions and talents; value point-of-care nurses as equal partners; are trustworthy and model honest communication; are transparent and share information; give and receive feedback; are energetic and committed; collaborate and educate; are responsible and ethical; are creative and flexible; network and build teams; and are politically astute.

Page Ref: 2489

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  3. List the transformational leadership skills that you possess.

 

Exemplar 40.3  Work Ethic

 

1) A nurse mistakenly gave a client who was NPO for surgery a morning breakfast tray. After realizing the mistake, the nurse notified the physician as well as the client; explained the consequences of this mistake, which included a delay in the client’s surgery; and documented the situation in the client’s medical record. This nurse demonstrates which of the following?

  1. A) Social justice
  2. B) Human dignity
  3. C) Reliability
  4. D) Accountability

Answer:  D

Explanation:

  1. A) Accountability is accepting responsibility and the consequences of one’s actions. By taking the responsibility for the mistake, the nurse is accountable with the physician as well as the client and provides accurate documentation of the action. Reliability implies that the nurse is dependable, such as arriving at work in a timely fashion. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the worth and uniqueness of individuals and populations.
  2. B) Accountability is accepting responsibility and the consequences of one’s actions. By taking the responsibility for the mistake, the nurse is accountable with the physician as well as the client and provides accurate documentation of the action. Reliability implies that the nurse is dependable, such as arriving at work in a timely fashion. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the worth and uniqueness of individuals and populations.
  3. C) Accountability is accepting responsibility and the consequences of one’s actions. By taking the responsibility for the mistake, the nurse is accountable with the physician as well as the client and provides accurate documentation of the action. Reliability implies that the nurse is dependable, such as arriving at work in a timely fashion. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the worth and uniqueness of individuals and populations.
  4. D) Accountability is accepting responsibility and the consequences of one’s actions. By taking the responsibility for the mistake, the nurse is accountable with the physician as well as the client and provides accurate documentation of the action. Reliability implies that the nurse is dependable, such as arriving at work in a timely fashion. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the worth and uniqueness of individuals and populations.

Page Ref: 2492

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  1. Apply the concept of work ethic to the behavior of the professional nurse.

 

2) During a staff meeting, the new nurse manager informs the staff that they will be getting an e-mail account that will need to be checked every day for information from the manager. Which response(s) would be expected of a “Generation X” new graduate nurse?

Select all that apply.

  1. A) “Can we access the e-mail from home?”
  2. B) “That sounds like a great idea.”
  3. C) “I would rather get the information directly from you.”
  4. D) “I would rather receive the information in a unit newsletter.”
  5. E) “Can we e-mail one another?”

Answer:  A, B, E

Explanation:

  1. A) Generation X, Generation Y, and Millennial nurses would all support the new policy and would ask if the nurses could e-mail each other and if the e-mails could be accessed from home. Veteran nurses may prefer communication to be personal or not attached to technology.
  2. B) Generation X, Generation Y, and Millennial nurses would all support the new policy and would ask if the nurses could e-mail each other and if the e-mails could be accessed from home. Veteran nurses may prefer communication to be personal or not attached to technology.
  3. C) Generation X, Generation Y, and Millennial nurses would all support the new policy and would ask if the nurses could e-mail each other and if the e-mails could be accessed from home. Veteran nurses may prefer communication to be personal or not attached to technology.
  4. D) Generation X, Generation Y, and Millennial nurses would all support the new policy and would ask if the nurses could e-mail each other and if the e-mails could be accessed from home. Veteran nurses may prefer communication to be personal or not attached to technology.
  5. E) Generation X, Generation Y, and Millennial nurses would all support the new policy and would ask if the nurses could e-mail each other and if the e-mails could be accessed from home. Veteran nurses may prefer communication to be personal or not attached to technology.

Page Ref: 2493-2495

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  2. Differentiate between work ethics commonly seen in four generations of nurses in today’s workplace.

 

3) A charge nurse is making assignments for the shift. The charge nurse notes that a client from a different culture was recently admitted and will require a thorough admission assessment during the upcoming shift. Which generation of nurse is likely to be the most culturally sensitive and to be the best choice for this client assignment?

  1. A) The Millennial nurse
  2. B) The Generation X nurse
  3. C) The veteran nurse
  4. D) The baby boomer nurse

Answer:  A

Explanation:

  1. A) The Millennial generation nurse would most likely provide the most culturally sensitive viewpoints and would be the best choice for this assignment. The Millennial generation nurse received the most education regarding culturally sensitive care and can be a unit resource for the other generations of nurses on the unit.
  2. B) The Millennial generation nurse would most likely provide the most culturally sensitive viewpoints and would be the best choice for this assignment. The Millennial generation nurse received the most education regarding culturally sensitive care and can be a unit resource for the other generations of nurses on the unit.
  3. C) The Millennial generation nurse would most likely provide the most culturally sensitive viewpoints and would be the best choice for this assignment. The Millennial generation nurse received the most education regarding culturally sensitive care and can be a unit resource for the other generations of nurses on the unit.
  4. D) The Millennial generation nurse would most likely provide the most culturally sensitive viewpoints and would be the best choice for this assignment. The Millennial generation nurse received the most education regarding culturally sensitive care and can be a unit resource for the other generations of nurses on the unit.

Page Ref: 2495

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  3. Predict the impact of generational differences in work ethic as it relates to learning to work as a cohesive nursing team.

 

4) The nurse taking care of clients on the medical-surgical unit is habitually late and often leaves work for nurses on the other shift to complete. The nurse knows that in order to keep his job, which action must occur?

  1. A) The nurse must take responsibility and accept any corrective action.
  2. B) The nurse must continue the same behaviors.
  3. C) The nurse must have a positive attitude.
  4. D) The nurse must trade shifts in order to be on time.

Answer:  A

Explanation:

  1. A) Being reliable and being accountable are key factors in professionalism. From a systems perspective, each nurse is responsible for completing the duties of the job appropriately so that others can complete their work, too. Almost everyone must miss work or arrive late on occasion. But when poor attendance or lack of punctuality becomes a habit, it also becomes a performance issue and possible grounds for corrective action (steps taken to overcome a job performance problem) or dismissal (termination of employment).
  2. B) Being reliable and being accountable are key factors in professionalism. From a systems perspective, each nurse is responsible for completing the duties of the job appropriately so that others can complete their work, too. Almost everyone must miss work or arrive late on occasion. But when poor attendance or lack of punctuality becomes a habit, it also becomes a performance issue and possible grounds for corrective action (steps taken to overcome a job performance problem) or dismissal (termination of employment).
  3. C) Being reliable and being accountable are key factors in professionalism. From a systems perspective, each nurse is responsible for completing the duties of the job appropriately so that others can complete their work, too. Almost everyone must miss work or arrive late on occasion. But when poor attendance or lack of punctuality becomes a habit, it also becomes a performance issue and possible grounds for corrective action (steps taken to overcome a job performance problem) or dismissal (termination of employment).
  4. D) Being reliable and being accountable are key factors in professionalism. From a systems perspective, each nurse is responsible for completing the duties of the job appropriately so that others can complete their work, too. Almost everyone must miss work or arrive late on occasion. But when poor attendance or lack of punctuality becomes a habit, it also becomes a performance issue and possible grounds for corrective action (steps taken to overcome a job performance problem) or dismissal (termination of employment).

Page Ref: 2492

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Apply the concept of work ethic to the behavior of the professional nurse.

 

5) The nurse on third shift missed the last chance for the unit competency, stating, “Oh well, it’s not like I don’t know what I’m doing.” The nursing student knows that this is which type of attitude?

  1. A) Arrogance, which keeps the nurse from developing and from accurate assessment of her strengths and weaknesses
  2. B) Pessimism, which endangers the nurse’s professionalism
  3. C) Optimism, which helps the nurse realize that things will turn out for the best
  4. D) Sarcasm, which threatens the nurse’s job performance

Answer:  A

Explanation:

  1. A) Arrogance, or excessive pride and a feeling of superiority, can be an extremely dangerous characteristic in the nurse, as it can lead to a false belief that the nurse is always right and does not need input from others. For example, when the unit begins using a new IV infusion pump, the arrogant nurse does not bother attending the in-service and believes that it is possible to “figure things out” independently. Accurate self-assessment of strengths and weaknesses, as well as acceptance of feedback from others, promote both safety and growth and are therefore abilities essential for the nurse.
  2. B) Arrogance, or excessive pride and a feeling of superiority, can be an extremely dangerous characteristic in the nurse, as it can lead to a false belief that the nurse is always right and does not need input from others. For example, when the unit begins using a new IV infusion pump, the arrogant nurse does not bother attending the in-service and believes that it is possible to “figure things out” independently. Accurate self-assessment of strengths and weaknesses, as well as acceptance of feedback from others, promote both safety and growth and are therefore abilities essential for the nurse.
  3. C) Arrogance, or excessive pride and a feeling of superiority, can be an extremely dangerous characteristic in the nurse, as it can lead to a false belief that the nurse is always right and does not need input from others. For example, when the unit begins using a new IV infusion pump, the arrogant nurse does not bother attending the in-service and believes that it is possible to “figure things out” independently. Accurate self-assessment of strengths and weaknesses, as well as acceptance of feedback from others, promote both safety and growth and are therefore abilities essential for the nurse.
  4. D) Arrogance, or excessive pride and a feeling of superiority, can be an extremely dangerous characteristic in the nurse, as it can lead to a false belief that the nurse is always right and does not need input from others. For example, when the unit begins using a new IV infusion pump, the arrogant nurse does not bother attending the in-service and believes that it is possible to “figure things out” independently. Accurate self-assessment of strengths and weaknesses, as well as acceptance of feedback from others, promote both safety and growth and are therefore abilities essential for the nurse.

Page Ref: 2493

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  1. Apply the concept of work ethic to the behavior of the professional nurse.

 

6) The charge nurse, who is a member of Generation X, is training a new nurse, who happens to belong to the Millennial generation. The student nurse knows that which aspect(s) of the two nurses’ work ethics are in conflict?

Select all that apply.

  1. A) Self-directed versus need for feedback
  2. B) Loyal to profession versus rush of new challenges and opportunities
  3. C) Workaholic versus need for work-life balance
  4. D) Respect authority versus questioning authority
  5. E) Prefer personal form of communication versus personal cell phones

Answer:  A, B

Explanation:

  1. A) Workplace ethics for Generation X include: seek challenges; are self-directed; are comfortable with technology; expect instant access to information; desire employment where they can create balance in work and personal life; prefer managers to be mentors and coaches; have limited motivation to stay with the same employer but are loyal to their profession; desire more control over their own schedule; pragmatic focus on outcomes rather than process.

 

The Millennial generation’s work ethics include: being social, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented; having expectations of daily feedback; high maintenance; having the potential to become the highest-producing workforce in history; thriving on the adrenaline rush of new challenges and new opportunities; having personal cell phones a necessity for daily life and interpersonal communication.

  1. B) Workplace ethics for Generation X include: seek challenges; are self-directed; are comfortable with technology; expect instant access to information; desire employment where they can create balance in work and personal life; prefer managers to be mentors and coaches; have limited motivation to stay with the same employer but are loyal to their profession; desire more control over their own schedule; pragmatic focus on outcomes rather than process.

 

The Millennial generation’s work ethics include: being social, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented; having expectations of daily feedback; high maintenance; having the potential to become the highest-producing workforce in history; thriving on the adrenaline rush of new challenges and new opportunities; having personal cell phones a necessity for daily life and interpersonal communication.

  1. C) Workplace ethics for Generation X include: seek challenges; are self-directed; are comfortable with technology; expect instant access to information; desire employment where they can create balance in work and personal life; prefer managers to be mentors and coaches; have limited motivation to stay with the same employer but are loyal to their profession; desire more control over their own schedule; pragmatic focus on outcomes rather than process.

 

The Millennial generation’s work ethics include: being social, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented; having expectations of daily feedback; high maintenance; having the potential to become the highest-producing workforce in history; thriving on the adrenaline rush of new challenges and new opportunities; having personal cell phones a necessity for daily life and interpersonal communication.

 

  1. D) Workplace ethics for Generation X include: seek challenges; are self-directed; are comfortable with technology; expect instant access to information; desire employment where they can create balance in work and personal life; prefer managers to be mentors and coaches; have limited motivation to stay with the same employer but are loyal to their profession; desire more control over their own schedule; pragmatic focus on outcomes rather than process.

 

The Millennial generation’s work ethics include: being social, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented; having expectations of daily feedback; high maintenance; having the potential to become the highest-producing workforce in history; thriving on the adrenaline rush of new challenges and new opportunities; having personal cell phones a necessity for daily life and interpersonal communication.

  1. E) Workplace ethics for Generation X include: seek challenges; are self-directed; are comfortable with technology; expect instant access to information; desire employment where they can create balance in work and personal life; prefer managers to be mentors and coaches; have limited motivation to stay with the same employer but are loyal to their profession; desire more control over their own schedule; pragmatic focus on outcomes rather than process.

 

The Millennial generation’s work ethics include: being social, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented; having expectations of daily feedback; high maintenance; having the potential to become the highest-producing workforce in history; thriving on the adrenaline rush of new challenges and new opportunities; having personal cell phones a necessity for daily life and interpersonal communication.

Page Ref: 2493-2495

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  2. Differentiate between work ethics commonly seen in four generations of nurses in today’s workplace.

 

7) The nurses in a nursing home have a unique nursing team consisting of all four generational cohorts. The nursing management knows that the best nursing teams utilize which generation’s contributions?

  1. A) The contributions from each generation’s strengths
  2. B) Those of the hardworking, loyal veterans
  3. C) Those of the adaptable, techno-savvy Generation Xers
  4. D) Those of the young, optimistic Millennials

Answer:  A

Explanation:

  1. A) Learning from the unique strengths of each generation can decrease interpersonal tension and facilitate personal growth. Nurses who learn to acknowledge and appreciate their colleagues from different backgrounds, including generational backgrounds, have a distinct advantage. The best teams utilize the contributions of each generation’s skill set and strengths. The hardworking, loyal veterans; the idealist, passionate baby boomers; the technoliterate, adaptable Generation Xers; and the young, optimistic Millennials can come together in a powerful network of nurses with a remarkable ability to support each other and maximize each nurse’s contribution to client care.
  2. B) Learning from the unique strengths of each generation can decrease interpersonal tension and facilitate personal growth. Nurses who learn to acknowledge and appreciate their colleagues from different backgrounds, including generational backgrounds, have a distinct advantage. The best teams utilize the contributions of each generation’s skill set and strengths. The hardworking, loyal veterans; the idealist, passionate baby boomers; the technoliterate, adaptable Generation Xers; and the young, optimistic Millennials can come together in a powerful network of nurses with a remarkable ability to support each other and maximize each nurse’s contribution to client care.
  3. C) Learning from the unique strengths of each generation can decrease interpersonal tension and facilitate personal growth. Nurses who learn to acknowledge and appreciate their colleagues from different backgrounds, including generational backgrounds, have a distinct advantage. The best teams utilize the contributions of each generation’s skill set and strengths. The hardworking, loyal veterans; the idealist, passionate baby boomers; the technoliterate, adaptable Generation Xers; and the young, optimistic Millennials can come together in a powerful network of nurses with a remarkable ability to support each other and maximize each nurse’s contribution to client care.
  4. D) Learning from the unique strengths of each generation can decrease interpersonal tension and facilitate personal growth. Nurses who learn to acknowledge and appreciate their colleagues from different backgrounds, including generational backgrounds, have a distinct advantage. The best teams utilize the contributions of each generation’s skill set and strengths. The hardworking, loyal veterans; the idealist, passionate baby boomers; the technoliterate, adaptable Generation Xers; and the young, optimistic Millennials can come together in a powerful network of nurses with a remarkable ability to support each other and maximize each nurse’s contribution to client care.

Page Ref: 2496

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Assessment

Learning Outcome:  3. Predict the impact of generational differences in work ethic in relation to learning to work as a cohesive nursing team.

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)

Module 50   Quality Improvement

 

The Concept of Quality Improvement

 

1) The nurse on a medical-surgical unit is asked to participate in data collection on skin care for the unit. What purpose will it serve for the nurse to cooperate with this request?

  1. A) Participate in the quality improvement process
  2. B) Advance the nurse’s practice
  3. C) Prevent problems from arising in the unit
  4. D) Fulfill legal requirements

Answer:  A

Explanation:

  1. A) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.
  2. B) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.
  3. C) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.
  4. D) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.

Page Ref: 2683

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  1. Differentiate quality improvement from quality management.

 

2) The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. To which component of care should the quality assurance officer pay particular attention when benchmarking this issue?

  1. A) Structure
  2. B) Process
  3. C) Outcome
  4. D) Competency

Answer:  B

Explanation:

  1. A) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client’s health status as a result of nursing care.
  2. B) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client’s health status as a result of nursing care.
  3. C) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client’s health status as a result of nursing care.
  4. D) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client’s health status as a result of nursing care.

Page Ref: 2686

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  5. Describe the process of benchmarking.

 

3) The nurse manager is planning to implement the Lean Six Sigma system on the care area to improve the quality of care. When following this model, what should the manager implement?

  1. A) Shortening break time
  2. B) Ordering more supplies than needed on the unit to ensure they never run out
  3. C) Replacing a licensed staff member with unlicensed assistive personnel
  4. D) Decreasing staff when the census is low

Answer:  D

Explanation:

  1. A) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.
  2. B) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.
  3. C) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.
  4. D) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.

Page Ref: 2692

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  8. Contrast four quantifiable quality management programs.

 

4) The nurse conducting nursing audits to help increase efficiency and reduce costs wants to suggest a better contribution to quality care. What should the nurse suggest be performed instead?

  1. A) Conduct a wound care study to enhance client outcomes.
  2. B) Install cameras to detect abuse of the clients.
  3. C) Acquire new client care equipment.
  4. D) Decrease staffing on the unit.

Answer:  A

Explanation:

  1. A) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.
  2. B) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.
  3. C) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.
  4. D) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.

Page Ref: 2685

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  2. Describe federal and state initiatives aimed at quality improvement in health care.

 

5) A client who has read several articles about the need to contain healthcare costs asks how a quality improvement program can contain cost of care. What should the nurse respond to this client’s question?

Select all that apply.

  1. A) “Promoting safety increases the cost of care.”
  2. B) “Medication errors decrease the cost of care.”
  3. C) “High nurse-to-client ratios result in decreased length of stay.”
  4. D) “Increased nursing staff has been linked to decreased infection rates.”
  5. E) “Use of computers increases the number of lawsuits.”

Answer:  C, D

Explanation:

  1. A) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.
  2. B) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.
  3. C) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.
  4. D) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

 

  1. E) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

Page Ref: 2683

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  7. Explain common methods used to improve the quality of care.

 

6) The nurse manager is considering increasing the number of RN staff because studies have shown that it decreases infection rates. What purpose will decreasing infection rates serve?

  1. A) An increased use of overtime
  2. B) A decrease in client satisfaction
  3. C) An increase in client care supplies
  4. D) A decreased cost of care

Answer:  D

Explanation:

  1. A) Research has shown that an increase in RN staff decreases a unit’s infection rate. Because infection is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.
  2. B) Research has shown that an increase in RN staff decreases a unit’s infection rate. Because infection is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.
  3. C) Research has shown that an increase in RN staff decreases a unit’s infection rate. Because infection is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.
  4. D) Research has shown that an increase in RN staff decreases a unit’s infection rate. Because infection is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.

Page Ref: 2683

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  7. Explain common methods used to improve the quality of care.

7) The nurse provides medication to a client at the wrong time. No harm came to the client as a result of the nurse’s error and the nurse files a report about the medication error. What should the risk management team do?

  1. A) Discipline the nurse appropriately.
  2. B) Report the nurse to the board of nursing.
  3. C) Monitor all nurses on the unit to ensure this does not occur again.
  4. D) Attempt to implement policy changes to prevent future errors.

Answer:  D

Explanation:

  1. A) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.
  2. B) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.
  3. C) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.
  4. D) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.

Page Ref: 2688

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  6. Provide examples of adverse events and the resulting root cause analysis that would be required.

 

8) While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a “time out” procedure before the surgery begins. What sentinel event should the “time out” procedure prevent?

  1. A) Ineffective control of the client’s pain
  2. B) The lack of healing of the stump
  3. C) The client being mildly over-sedated
  4. D) The removal of the wrong arm

Answer:  D

Explanation:

  1. A) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client’s incorrect arm would be a sentinel event. Mild over-sedation is not a sentinel event as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in a diabetic client. Pain control is individual and is not a sentinel event.
  2. B) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client’s incorrect arm would be a sentinel event. Mild over-sedation is not a sentinel event as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in a diabetic client. Pain control is individual and is not a sentinel event.
  3. C) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client’s incorrect arm would be a sentinel event. Mild over-sedation is not a sentinel event as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in a diabetic client. Pain control is individual and is not a sentinel event.
  4. D) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client’s incorrect arm would be a sentinel event. Mild over-sedation is not a sentinel event as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in a diabetic client. Pain control is individual and is not a sentinel event.

Page Ref: 2686-2687

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  6. Provide examples of adverse events and the resulting root cause analysis that would be required.

 

9) The nurse manager is reviewing a quality improvement study conducted on a client care issue. List the order in which the steps should be evaluated to determine that the study was completed correctly.

  1. Research factors that contribute to better outcomes.
  2. Compare outcomes to benchmarks.
  3. Identify areas for improvement.
  4. Analyzing current protocols of care and associated outcomes.
  5. Implement changes to improve outcomes.
  6. Analyze client outcomes to determine effectiveness of changes.

Answer:  4, 2, 3, 1, 5, 6

Explanation:  Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.

Page Ref: 2685

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Evaluation

Learning Outcome:  3. Identify and explain the steps involved in quality improvement.

 

10) The nurse instructor is preparing a teaching session for staff nurses on intradisciplinary assessments. Which information should the instructor consider when preparing this presentation?

Select all that apply.

  1. A) Utilization reviews
  2. B) Peer review
  3. C) Audits
  4. D) Performance appraisals
  5. E) Outcomes management

Answer:  B, C, E

Explanation:

  1. A) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.
  2. B) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.
  3. C) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.
  4. D) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.
  5. E) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.

Page Ref: 2685

Cognitive Level:  Evaluating

Client Need:  Safe and Effective Care Environment

Nursing Process:  Planning

Learning Outcome:  4. Differentiate between intradisciplinary and interdisciplinary assessments.

 

11) The nurse manager at an acute care facility is educating her staff nurses on the definition of a sentinel event and providing examples. Which would be appropriate for the nurse manager to present to the staff nurses as examples of a sentinel event?

Select all that apply.

  1. A) Delivery of radiation to the wrong body region
  2. B) Invasive surgical procedure at the wrong site
  3. C) Homicide of a staff member while at the facility
  4. D) Homicide of a patient while at the facility
  5. E) Administration of a compatible blood transfusion

Answer:  A, B, C, D

Explanation:

  1. A) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.
  2. B) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.
  3. C) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.
  4. D) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.
  5. E) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.

Page Ref: 2686-2687

Cognitive Level:  Understanding

Client Need:  Safe and Effective Care Environment

Client Need Sub:  Management of Care

Nursing Process:  Teaching and Learning

Learning Outcome:  2. Describe federal and state initiatives aimed at quality improvement in health care.

 

12) A newly licensed nurse is passing medications with a nurse preceptor. Which action taken by the newly licensed nurse would be inappropriate and require the nurse preceptor to intervene?

  1. A) The newly licensed nurse verifies tube placement prior to administering medications.
  2. B) The newly licensed nurse checks for known allergies prior to administering medication.
  3. C) The newly licensed nurse combines medications with the same active ingredient.
  4. D) The newly licensed nurse has a second nurse check the medication order.

Answer:  C

Explanation:

  1. A) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.
  2. B) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.
  3. C) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.
  4. D) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.

Page Ref: 2688

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Client Need Sub:  Pharmacological and Parenteral Therapies

Nursing Process:  Teaching and Learning

Learning Outcome:  7. Explain common methods used to improve the quality of care.

 

13) The nursing instructor is speaking to a group of nursing students about standards of care. Which comment made by the nursing student indicates the need for further education about the standards of care?

  1. A) “Standards of care are based on models of high-quality performance.”
  2. B) “Process standards focus on the steps used to lead to a particular outcome.”
  3. C) “Process standards focus on human resources, and general organizational structure.”
  4. D) “Outcome standards focus on the performance of a process.”

Answer:  C

Explanation:

  1. A) “Process standards focus on human resources and general organizational structure” is incorrect, and indicates that the student needs further education. The rest of the statements are correct.
  2. B) “Process standards focus on human resources and general organizational structure” is incorrect, and indicates that the student needs further education. The rest of the statements are correct.
  3. C) “Process standards focus on human resources and general organizational structure” is incorrect, and indicates that the student needs further education. The rest of the statements are correct.
  4. D) “Process standards focus on human resources and general organizational structure” is incorrect, and indicates that the student needs further education. The rest of the statements are correct.

Page Ref: 2686

Cognitive Level:  Applying

Client Need:  Safe and Effective Care Environment

Client Need Sub:  Management of Care

Nursing Process:  Teaching and Learning

Learning Outcome:  5. Describe the process of benchmarking.

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