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Sample ChaptersChapter 03: Critical Thinking, Ethical Decision Making and the NursingProcess1. A nurse has been offered a position on an obstetric unit and has learned that the unit offers therapeuticabortions, a procedure which contradicts the nurses personal beliefs. What is the nurses ethicalobligation to these patients?A) The nurse should adhere to professional standards of practice and offer service to these patients.B) The nurse should make the choice to decline this position and pursue a different nursing role.C) The nurse should decline to care for the patients considering abortion.D) The nurse should express alternatives to women considering terminating their pregnancy.Ans: BFeedback:To avoid facing ethical dilemmas, nurses can follow certain strategies. For example, when applying for ajob, a nurse should ask questions regarding the patient population. If a nurse is uncomfortable with aparticular situation, then not accepting the position would be the best option. The nurse is only requiredby law (and practice standards) to provide care to the patients the clinic accepts; the nurse may notdiscriminate between patients and the nurse expressing his or her own opinion and providing anotheroption is inappropriate.2. A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large doseof intravenous opioids by continuous infusion. You know that one of the adverse effects of this medicineis respiratory depression. When you assess your patients respiratory status, you find that the rate hasdecreased from 16 breaths per minute to 10 breaths per minute. What action should you take?A) Decrease the rate of IV infusion.B) Stimulate the patient in order to increase respiratory rate.C) Report the decreased respiratory rate to the physician.D) Allow the patient to rest comfortably.Ans: CFeedback:End-of life issues that often involve ethical dilemmas include pain control, do not resuscitate orders, life-support measures, and administration of food and fluids. The risk of respiratory depression is not theintent of the action of pain control. Respiratory depression should not be used as an excuse to withholdpain medication for a terminally ill patient. The patients respiratory status should be carefully monitoredand any changes should be reported to the physician.3. An adult patient has requested a do not resuscitate (DNR) order in light of his recent diagnosis with latestage pancreatic cancer. The patients son and daughter-in-law are strongly opposed to the patientsrequest. What is the primary responsibility of the nurse in this situation?A) Perform a slow code until a decision is made.B) Honor the request of the patient.C) Contact a social worker or mediator to intervene.D) Temporarily withhold nursing care until the physician talks to the family.Ans: BFeedback:The nurse must honor the patients wishes and continue to provide required nursing care. Discussing thematter with the physician may lead to further communication with the family, during which the familymay reconsider their decision. It is not normally appropriate for the nurse to seek the assistance of asocial worker or mediator. A slow code is considered unethical.4. An elderly patient is admitted to your unit with a diagnosis of community-acquired pneumonia. Duringadmission the patient states, I have a living will. What implication of this should the nurse recognize?A) This document is always honored, regardless of circumstances.B) This document specifies the patients wishes before hospitalization.C) This document that is binding for the duration of the patients life.D) This document has been drawn up by the patients family to determine DNR status.Ans: BFeedback:A living will is one type of advance directive. In most situations, living wills are limited to situations inwhich the patients medical condition is deemed terminal. The other answers are incorrect because livingwills are not always honored, they are not binding for the duration of the patients life, and they are notdrawn up by the patients family.5. A nurse has been providing ethical care for many years and is aware of the need to maintain the ethicalprinciple of nonmaleficence. Which of the following actions would be considered a contradiction of thisprinciple?A) Discussing a DNR order with a terminally ill patientB) Assisting a semi-independent patient with ADLsC) Refusing to administer pain medication as orderedD) Providing more care for one patient than for anotherAns: CFeedback:The duty not to inflict as well as prevent and remove harm is termed nonmaleficence. Discussing a DNRorder with a terminally ill patient and assisting a patient with ADLs would not be consideredcontradictions to the nurses duty of nonmaleficence. Some patients justifiably require more care thanothers.6. You have just taken report for your shift and you are doing your initial assessment of your patients. Oneof your patients asks you if an error has been made in her medication. You know that an incident reportwas filed yesterday after a nurse inadvertently missed a scheduled dose of the patients antibiotic. Whichof the following principles would apply if you give an accurate response?A) VeracityB) ConfidentialityC) RespectD) JusticeAns: AFeedback:The obligation to tell the truth and not deceive others is termed veracity. The other answers are incorrectbecause they are not obligations to tell the truth.7. A nurse has begun creating a patients plan of care shortly after the patients admission. It is important thatthe wording of the chosen nursing diagnoses falls within the taxonomy of nursing. Which organization isresponsible for developing the taxonomy of a nursing diagnosis?A) American Nurses Association (ANA)B) NANDAC) National League for Nursing (NLN)D) Joint CommissionAns: BFeedback:NANDA International is the official organization responsible for developing the taxonomy of nursingdiagnoses and formulating nursing diagnoses acceptable for study. The ANA, NLN, and JointCommission are not charged with the task of developing the taxonomy of nursing diagnoses.8. In response to a patients complaint of pain, the nurse administered a PRN dose of hydromorphone(Dilaudid). In what phase of the nursing process will the nurse determine whether this medication hashad the desired effect?A) AnalysisB) EvaluationC) AssessmentD) Data collectionAns: BFeedback:Evaluation, the final step of the nursing process, allows the nurse to determine the patients response tonursing interventions and the extent to which the objectives have been achieved.9. A medical nurse has obtained a new patients health history and completed the admission assessment.The nurse has followed this by documenting the results and creating a care plan for the patient. Which ofthe following is the most important rationale for documenting the patients care?A) It provides continuity of care.B) It creates a teaching log for the family.C) It verifies appropriate staffing levels.D) It keeps the patient fully informed.Ans: AFeedback:This record provides a means of communication among members of the health care team and facilitatescoordinated planning and continuity of care. It serves as the legal and business record for a health careagency and for the professional staff members who are responsible for the patients care. Documentationis not primarily a teaching log; it does not verify staffing; and it is not intended to provide the patientwith information about treatments.10. The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequentlycombative and confused, despite the administration of benzodiazepines. The patient has a fractured hipthat he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriateaction for the nurse to take?A) Leave the patient and get help.B) Obtain a physicians order to restrain the patient.C) Read the facilitys policy on restraints.D) Order soft restraints from the storeroom.Ans: BFeedback:It is mandatory in most settings to have a physicians order before restraining a patient. Before restraintsare used, other strategies, such as asking family members to sit with the patient, or utilizing a speciallytrained sitter, should be tried. A patient should never be left alone while the nurse summons assistance.11. A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility.Following treatment with a heparin infusion, the nurse notes that the patients leg is pain-free, withoutredness or edema. Which step of the nursing process does this reflect?A) DiagnosisB) AnalysisC) ImplementationD) EvaluationAns: DFeedback:The nursing actions described constitute evaluation of the expected outcomes. The findings show thatthe expected outcomes have been achieved. Analysis consists of considering assessment information toderive the appropriate nursing diagnosis. Implementation is the phase of the nursing process where thenurse puts the care plan into action. This nurses actions do not constitute diagnosis.12. During report, a nurse finds that she has been assigned to care for a patient admitted with anopportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she isrefusing to care for him because he has AIDS. The nurse has an obligation to this patient under whichlegal premise?A) Good Samaritan ActB) Nursing Interventions Classification (NIC)C) Patient Self-Determination ActD) ANA Code of EthicsAns: DFeedback:The ethical obligation to care for all patients is clearly identified in the first statement of the ANA Codeof Ethics for Nurses. The Good Samaritan Act relates to lay people helping others in need. The NIC is astandardized classification of nursing treatment that includes independent and collaborativeinterventions. The Patient Self-Determination Act encourages people to prepare advance directives inwhich they indicate their wishes concerning the degree of supportive care to be provided if they becomeincapacitated.13. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. Thepatient is to have a lumbar puncture performed, and the nurse is doing preprocedure teaching with thechild and the mother. The nurses action is an example of which therapeutic communication technique?A) InformingB) SuggestingC) Expectation-settingD) EnlighteningAns: AFeedback:Informing involves providing information to the patient regarding his or her care. Suggesting is thepresentation of an alternative idea for the patients consideration relative to problem solving. This actionis not characterized as expectation-setting or enlightening.14. The nurse, in collaboration with the patients family, is determining priorities related to the care of thepatient. The nurse explains that it is important to consider the urgency of specific problems when settingpriorities. What provides the best framework for prioritizing patient problems?A) Availability of hospital resourcesB) Family member statementsC) Maslows hierarchy of needsD) The nurses skill setAns: CFeedback:Maslows hierarchy of needs provides a useful framework for prioritizing problems, with the first levelgiven to meeting physical needs of the patient. Availability of hospital resources, family memberstatements, and nursing skill do not provide a framework for prioritization of patient problems, thougheach may be considered.15. A medical nurse is caring for a patient who is palliative following metastasis. The nurse is aware of theneed to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle inthe care of this patient?A) The nurse tactfully regulates the number and timing of visitors as per the patients wishes.B) The nurse stays with the patient during his or her death.C) The nurse ensures that all members of the care team are aware of the patients DNR order.D) The nurse liaises with members of the care team to ensure continuity of care.Ans: BFeedback:Beneficence is the duty to do good and the active promotion of benevolent acts. Enacting the patientswishes around visitors is an example of this. Each of the other nursing actions is consistent with ethicalpractice, but none directly exemplifies the principle of beneficence.16. The care team has deemed the occasional use of restraints necessary in the care of a patient withAlzheimers disease. What ethical violation is most often posed when using restraints in a long-term caresetting?A) It limits the patients personal safety.B) It exacerbates the patients disease process.C) It threatens the patients autonomy.D) It is not normally legal.Ans: CFeedback:Because safety risks are involved when using restraints on elderly confused patients, this is a commonethical problem, especially in long-term care settings. By definition, restraints limit the individualsautonomy. Restraints are not without risks, but they should not normally limit a patients safety.Restraints will not affect the course of the patients underlying disease process, though they mayexacerbate confusion. The use of restraints is closely legislated, but they are not illegal.17. While receiving report on a group of patients, the nurse learns that a patient with terminal cancer hasgranted power of attorney for health care to her brother. How does this affect the course of the patientscare?A) Another individual has been identified to make decisions on behalf of the patient.B) There are binding parameters for care even if the patient changes her mind.C) The named individual is in charge of the patients finances.D) There is a document delegating custody of children to other than her spouse.Ans: AFeedback:A power of attorney is said to be in effect when a patient has identified another individual to makedecisions on her behalf. The patient has the right to change her mind. A power-of-attorney for healthcare does not give anyone the right to make financial decisions for the patient nor does it delegatecustody of minor children.18. In the process of planning a patients care, the nurse has identified a nursing diagnosis of IneffectiveHealth Maintenance related to alcohol use. What must precede the determination of this nursingdiagnosis?A) Establishment of a plan to address the underlying problemB) Assigning a positive value to each consequence of the diagnosisC) Collecting and analyzing data that corroborates the diagnosisD) Evaluating the patients chances of recoveryAns: CFeedback:In the diagnostic phase of the nursing process, the patients nursing problems are defined through analysisof patient data. Establishing a plan comes after collecting and analyzing data; evaluating a plan is the laststep of the nursing process and assigning a positive value to each consequence is not done.19. You are following the care plan that was created for a patient newly admitted to your unit. Which of thefollowing aspects of the care plan would be considered a nursing implementation?A) The patient will express an understanding of her diagnosis.B) The patient appears diaphoretic.C) The patient is at risk for aspiration.D) Ambulate the patient twice per day with partial assistance.Ans: DFeedback:Implementation refers to carrying out the plan of nursing care. The other listed options exemplify goals,assessment findings, and diagnoses.20. The physician has recommended an amniocentesis for an 18-year-old primiparous woman. The patient is34 weeks gestation and does not want this procedure. The physician is insistent the patient have theprocedure. The physician arranges for the amniocentesis to be performed. The nurse should recognizethat the physician is in violation of what ethical principle?A) VeracityB) BeneficenceC) NonmaleficenceD) AutonomyAns: DFeedback:The principle of autonomy specifies that individuals have the ability to make a choice free from externalconstraints. The physicians actions in this case violate this principle. This action may or may not violatethe principle of beneficence. Veracity centers on truth-telling and nonmaleficence is avoiding theinfliction of harm.21. During discussion with the patient and the patients husband, you discover that the patient has a livingwill. How does the presence of a living will influence the patients care?A) The patient is legally unable to refuse basic life support.B) The physician can override the patients desires for treatment if desires are not evidence-based.C) The patient may nullify the living will during her hospitalization if she chooses to do so.D) Power-of-attorney may change while the patient is hospitalized.Ans: CFeedback:Because living wills are often written when the person is in good health, it is not unusual for the patientto nullify the living will during illness. A living will does not make a patient legally unable to refusebasic life support. The physician may disagree with the patients wishes, but he or she is ethically boundto carry out those wishes. A power-of-attorney is not synonymous with a living will.22. Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving onlymodest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Whencreating this patients plan of care, which nursing diagnosis would most likely be appropriate?A) Self-care deficit related to fatigue and joint stiffnessB) Ineffective airway clearance related to chronic painC) Risk for hopelessness related to body image disturbanceD) Anxiety related to chronic joint painAns: AFeedback:Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions.Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessnessare plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely.Ineffective airway clearance is unlikely.23. You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and younote decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriatenursing diagnosis for this patient?A) Ineffective airway clearance related to tracheobronchial secretionsB) Pneumonia related to progression of disease processC) Poor ventilation related to acute lung infectionD) Immobility related to fatigueAns: AFeedback:Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis forthis patient is ineffective airway clearance related to copious tracheobronchial secretions. Pneumoniaand poor ventilation are not nursing diagnoses. Immobility is likely, but is less directly related to thepatients admitting medical diagnosis and the nurses assessment finding.24. You are providing care for a patient who has a diagnosis of pneumonia attributed toStreptococcuspneumonia infection. Which of the following aspects of nursing care would constitute part of theplanning phase of the nursing process?A)Achieve SaO2 92% at all times.B) Auscultate chest q4h.C) Administer oral fluids q1h and PRN.D) Avoid overexertion at all times.Ans: AFeedback:The planning phase entails specifying the immediate, intermediate, and long-term goals of nursingaction, such as maintaining a certain level of oxygen saturation in a patient with pneumonia. Providingfluids and avoiding overexertion are parts of the implementation phase of the nursing process. Chestauscultation is an assessment.25. You are the nurse who is caring for a patient with a newly diagnosed allergy to peanuts. Which of thefollowing is an immediate goal that is most relevant to a nursing diagnosis of deficient knowledgerelated to appropriate use of an EpiPen?A) The patient will demonstrate correct injection technique with todays teaching session.B) The patient will closely observe the nurse demonstrating the injection.C) The nurse will teach the patients family member to administer the injection.D) The patient will return to the clinic within 2 weeks to demonstrate the injection.Ans: AFeedback:Immediate goals are those that can be reached in a short period of time. An appropriate immediate goalfor this patient is that the patient will demonstrate correct administration of the medication today. Thegoal should specify that the patient administer the EpiPen. A 2-week time frame is inconsistent with animmediate goal.26. A recent nursing graduate is aware of the differences between nursing actions that are independent andnursing actions that are interdependent. A nurse performs an interdependent nursing intervention whenperforming which of the following actions?A) Auscultating a patients apical heart rate during an admission assessmentB) Providing mouth care to a patient who is unconscious following a cerebrovascular accidentC) Administering an IV bolus of normal saline to a patient with hypotensionD) Providing discharge teaching to a postsurgical patient about the rationale for a course of oralantibioticsAns: CFeedback:Although many nursing actions are independent, others are interdependent, such as carrying outprescribed treatments, administering medications and therapies, and collaborating with other health careteam members to accomplish specific, expected outcomes and to monitor and manage potentialcomplications. Irrigating a wound, administering pain medication, and administering IV fluids areinterdependent nursing actions and require a physicians order. An independent nursing action occurswhen the nurse assesses a patients heart rate, provides discharge education, or provides mouth care.27. A nurse has been using the nursing process as a framework for planning and providing patient care.What action would the nurse do during the evaluation phase of the nursing process?A) Have a patient provide input on the quality of care received.B) Remove a patients surgical staples on the scheduled postoperative day.C) Provide information on a follow-up appointment for a postoperative patient.D) Document a patients improved air entry with incentive spirometric use.Ans: DFeedback:During the evaluation phase of the nursing process, the nurse determines the patients response to nursinginterventions. An example of this is when the nurse documents whether the patients spirometry use hasimproved his or her condition. A patient does not do the evaluation. Removing staples and providinginformation on follow-up appointments are interventions, not evaluations.28. An audit of a large, university medical center reveals that four patients in the hospital have currentorders for restraints. You know that restraints are an intervention of last resort, and that it isinappropriate to apply restraints to which of the following patients?A) A postlaryngectomy patient who is attempting to pull out his tracheostomy tubeB) A patient in hypovolemic shock trying to remove the dressing over his central venous catheterC) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commodeD) A patient with depression who has just tried to commit suicide and whose medications are notachieving adequate symptom controlAns: CFeedback:Restraints should never be applied for staff convenience. The patient with urosepsis who is frequentlyringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior thatwill not result in patient harm. The other described situations could plausibly result in patient harm;therefore, it is more likely appropriate to apply restraints in these instances.29. A patient has been diagnosed with small-cell lung cancer. He has met with the oncologist and is nowweighing the relative risks and benefits of chemotherapy and radiotherapy as his treatment. This patientis demonstrating which ethical principle in making his decision?A) BeneficenceB) ConfidentialityC) AutonomyD) JusticeAns: CFeedback:Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty todo good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy.Justice states that cases should be treated equitably.30. A patient with migraines does not know whether she is receiving a placebo for pain management or thenew drug that is undergoing clinical trials. Upon discussing the patients distress, it becomes evident tothe nurse that the patient did not fully understand the informed consent document that she signed. Whichethical principle is most likely involved in this situation?A) Sanctity of lifeB) ConfidentialityC) VeracityD) FidelityAns: CFeedback:Telling the truth (veracity) is one of the basic principles of our culture. Three ethical dilemmas inclinical practice that can directly conflict with this principle are the use of placebos (nonactivesubstances used for treatment), not revealing a diagnosis to a patient, and revealing a diagnosis topersons other than the patient with the diagnosis. All involve the issue of trust, which is an essentialelement in the nursepatient relationship. Sanctity of life is the perspective that life is the highest good.Confidentiality deals with privacy of the patient. Fidelity is promise-keeping and the duty to be faithfulto ones commitments.31. The nursing instructor is explaining critical thinking to a class of first-semester nursing students. Whenpromoting critical thinking skills in these students, the instructor should encourage them to do which ofthe following actions?A) Disregard input from people who do not have to make the particular decision.B) Set aside all prejudices and personal experiences when making decisions.C) Weigh each of the potential negative outcomes in a situation.D) Examine and analyze all available information.Ans: DFeedback:Critical thinking involves reasoning and purposeful, systematic, reflective, rational, outcome-directedthinking based on a body of knowledge, as well as examination and analysis of all available informationand ideas. A full disregard of ones own experiences is not possible. Critical thinking does not denote afocus on potential negative outcomes. Input from others is a valuable resource that should not beignored.32. A care conference has been organized for a patient with complex medical and psychosocial needs. Whenapplying the principles of critical thinking to this patients care planning, the nurse should mostexemplify what characteristic?A) Willingness to observe behaviorsB) A desire to utilize the nursing scope of practice fullyC) An ability to base decisions on what has happened in the pastD) Openness to various viewpointsAns: DFeedback:Willingness and openness to various viewpoints are inherent in critical thinking; these allow the nurse toreflect on the current situation. An emphasis on the past, willingness to observe behaviors, and a desireto utilize the nursing scope of practice fully are not central characteristics of critical thinkers.33. Achieving adequate pain management for a postoperative patient will require sophisticated criticalthinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all thatapply.A) Enhancing the nurses clinical decision makingB) Identifying the patients individual preferencesC) Planning the best nursing actions to assist the patientD) Increasing the accuracy of the nurses judgmentsE) Helping identify the patients priority needsAns: A, C, D, EFeedback:Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesizeinformation within the context in which it is presented. Critical thinking enhances clinical decisionmaking, helping to identify patient needs and the best nursing actions that will assist patients in meetingthose needs. Critical thinking does not normally focus on identify patient desires; these would beidentified by asking the patient.34. A nurse is unsure how best to respond to a patients vague complaint of feeling off. The nurse isattempting to apply the principles of critical thinking, including metacognition. How can the nurse bestfoster metacognition?A) By eliciting input from a variety of trusted colleaguesB) By examining the way that she thinks and applies reasonC) By evaluating her responses to similar situations in the pastD) By thinking about the way that an ideal nurse would respond in this situationAns: BFeedback:Critical thinking includes metacognition, the examination of ones own reasoning or thought processes,to help refine thinking skills. Metacognition is not characterized by eliciting input from others orevaluating previous responses.35. The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurseshould describe skills in which of the following domains? Select all that apply.A) Self-esteemB) Self-regulationC) InferenceD) AutonomyE) InterpretationAns: B, C, EFeedback:Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, andself-regulation. Self-esteem and autonomy would not be on the list because they are not skills.36. The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). Thenurses most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinkingis determining the significance of data that have been gathered. What characteristic of critical thinking isused in determining the best response to this assessment finding?A) ExtrapolationB) InferenceC) CharacterizationD) InterpretationAns: DFeedback:Nurses use interpretation to determine the significance of data that are gathered. This specific process isnot described as extrapolation, inference, or characterization.37. A nurse is admitting a new patient to the medical unit. During the initial nursing assessment, the nursehas asked many supplementary open-ended questions while gathering information about the new patient.What is the nurse achieving through this approach?A) Interpreting what the patient has saidB) Evaluating what the patient has saidC) Assessing what the patient has saidD) Validating what the patient has saidAns: DFeedback:Critical thinkers validate the information presented to make sure that it is accurate (not just suppositionor opinion), that it makes sense, and that it is based on fact and evidence. The nurse is not interpreting,evaluating, or assessing the information the patient has given.38. A nurse uses critical thinking every day when going through the nursing process. Which of the followingis an outcome of critical thinking in nursing practice?A) A comprehensive plan of care with a high potential for successB) Identification of the nurses preferred goals for the patientC) A collaborative basis for assigning careD) Increased cost efficiency in health careAns: AFeedback:Critical thinking in nursing practice results in a comprehensive plan of care with maximized potential forsuccess. Critical thinking does not identify the nurses goal for the patient or provide a collaborative basisfor assigning care. Critical thinking may or may not lead to increased cost efficiency; the patientsoutcomes are paramount.39. A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both statuspost knee replacement. What would be the best explanation why their care plans may be different fromeach other?A) Patients may have different insurers, or one may qualify for Medicare.B) Individual patients are seen as unique and dynamic, with individual needs.C) Nursing care may be coordinated by members of two different health disciplines.D) Patients are viewed as dissimilar according to their attitude toward surgery.Ans: BFeedback:Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences ininsurance coverage and attitude may be relevant, but these should not fundamentally explain thedifferences in their nursing care. Nursing care should be planned by nurses, not by members of otherdisciplines.40. A class of nursing students is in their first semester of nursing school. The instructor explains that one ofthe changes they will undergo while in nursing school is learning to think like a nurse. What is the mostcurrent model of this thinking process?A) Critical-thinking ModelB) Nursing Process ModelC) Clinical Judgment ModelD) Active Practice ModelAns: CFeedback:To depict the process of thinking like a nurse, Tanner (2006) developed a model known as the clinicaljudgment model.41. Critical thinking and decision-making skills are essential parts of nursing in all venues. What areexamples of the use of critical thinking in the venue of genetics-related nursing? Select all that apply.A) Notifying individuals and family members of the results of genetic testingB) Providing a written report on genetic testing to an insurance companyC) Assessing and analyzing family history data for genetic risk factorsD) Identifying individuals and families in need of referral for genetic testingE) Ensuring privacy and confidentiality of genetic informationAns: C, D, EFeedback:Nurses use critical thinking and decision-making skills in providing genetics-related nursing care whenthey assess and analyze family history data for genetic risk factors, identify those individuals andfamilies in need of referral for genetic testing or counseling, and ensure the privacy and confidentialityof genetic information. Nurses who work in the venue of genetics-related nursing do not notify familymembers of the results of an individuals genetic testing, and they do not provide written reports toinsurance companies concerning the results of genetic testing.42. A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDSTestrelated pneumonia. The student tells the instructor that she is unwilling to care for this patient. What keycomponent of critical thinking is most likely missing from this students practice?A) Compliance with directionB) Respect for authorityC) Analyzing information and situationsD) Withholding judgmentAns: DFeedback:Key components of critical thinking behavior are withholding judgment and being open to options andexplanations from one patient to another in similar circumstances. The other listed options are incorrectbecause they are not components of critical thinking.43. A group of students have been challenged to prioritize ethical practice when working with amarginalized population. How should the students best understand the concept of ethics?A) The formal, systematic study of moral beliefsB) The informal study of patterns of ideal behaviorC) The adherence to culturally rooted, behavioral normsD) The adherence to informal personal valuesAns: AFeedback:In essence, ethics is the formal, systematic study of moral beliefs, whereas morality is the adherence toinformal personal values.44. Your patient has been admitted for a liver biopsy because the physician believes the patient may haveliver cancer. The family has told both you and the physician that if the patient is terminal, the familydoes not want the patient to know. The biopsy results are positive for an aggressive form of liver cancerand the patient asks you repeatedly what the results of the biopsy show. What strategy can you use togive ethical care to this patient?A) Obtain the results of the biopsy and provide them to the patient.B) Tell the patient that only the physician knows the results of the biopsy.C) Promptly communicate the patients request for information to the family and the physician.D) Tell the patient that the biopsy results are not back yet in order temporarily to appease him.Ans: CFeedback:Strategies nurses could consider include the following: not lying to the patient, providing all informationrelated to nursing procedures and diagnoses, and communicating the patients requests for information tothe family and physician. Ethically, you cannot tell the patient the results of the biopsy and you cannotlie to the patient.45. The nurse admits a patient to an oncology unit that is a site for a study on the efficacy of a newchemotherapeutic drug. The patient knows that placebos are going to be used for some participants inthe study but does not know that he is receiving a placebo. When is it ethically acceptable to useplacebos?A) Whenever the potential benefits of a study are applicable to the larger populationB) When the patient is unaware of it and it is deemed unlikely that it would cause harmC) Whenever the placebo replaces an active drugD) When the patient knows placebos are being used and is involved in the decision-making processAns: DFeedback:Placebos may be used in experimental research in which a patient is involved in the decision-makingprocess and is aware that placebos are being used in the treatment regimen. Placebos may not ethicallybe used solely when there is a potential benefit, when the patient is unaware, or when a placebo replacesan active drug.46. The nurse caring for a patient who is two days post hip replacement notifies the physician that thepatients incision is red around the edges, warm to the touch, and seeping a white liquid with a foul odor.What type of problem is the nurse dealing with?A) Collaborative problemB) Nursing problemC) Medical problemD) Administrative problemAns: AFeedback:In addition to nursing diagnoses and their related nursing interventions, nursing practice involves certainsituations and interventions that do not fall within the definition of nursing diagnoses. These activitiespertain to potential problems or complications that are medical in origin and require collaborativeinterventions with the physician and other members of the health care team. The other answers areincorrect because the signs and symptoms of infection are a medical complication that requiresinterventions by the nurse.47. While developing the plan of care for a new patient on the unit, the nurse must identify expectedoutcomes that are appropriate for the new patient. What resource should the nurse prioritize foridentifying these appropriate outcomes?A) Community Specific Outcomes Classification (CSO)B) Nursing-Sensitive Outcomes Classification (NOC)C) State Specific Nursing Outcomes Classification (SSNOC)D) Department of Health and Human Services Outcomes Classification (DHHSOC)Ans: BFeedback:Resources for identifying appropriate expected outcomes include the NOC and standard outcome criteriaestablished by health care agencies for people with specific health problems. The other options areincorrect because they do not exist.48.The nurse has just taken report on a newly admitted patient who is a 15year-old girl who is a recentimmigrant to the United States. When planning interventions for this patient, the nurse knows theinterventions must be which of the following? Select all that apply.A) Appropriate to the nurses preferencesB) Appropriate to the patients ageC) EthicalD) Appropriate to the patients cultureE) Applicable to others with the same diagnosisAns: B, C, DFeedback:Planned interventions should be ethical and appropriate to the patients culture, age, and gender. Plannedinterventions do not have to be in alignment with the nurses preferences nor do they have to be shared byeveryone with the same diagnosis. Chapter 04: Health Education and Promotion1. A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had severaladmissions to the hospital medical unit, and the nurse has often carried out health promotioninterventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health?A) The medical nurseB) The community health nurse who has also worked with Mrs. GriffinC) Mrs. Griffins primary care providerD) Mrs. GriffinAns: DFeedback:American society places a great importance on health and the responsibility that each of us has tomaintain and promote our own health. Therefore, the other options are incorrect.2. An elderly female patient has come to the clinic for a scheduled follow-up appointment. The nurselearns from the patients daughter that the patient is not following the instructions she received upondischarge from the hospital last month. What is the most likely factor causing the patient not to adhere toher therapeutic regimen?A) Ethnic background of health care providerB) Costs of the prescribed regimenC) Presence of a learning disabilityD) Personality of the physicianAns: BFeedback:Variables that appear to influence the degree of adherence to a prescribed therapeutic regimen includegender, race, education, illness, complexity of the regimen, and the cost of treatments. The ethnicbackground of the health care provider and the personality of the physician are not considered variablesthat appear to influence the degree of adherence to a prescribed therapeutic regimen. A learningdisability could greatly affect adherence, but cost is a more likely barrier.3. A gerontologic nurse has observed that patients often fail to adhere to a therapeutic regimen. Whatstrategy should the nurse adopt to best assist an older adult in adhering to a therapeutic regimeninvolving wound care?A) Demonstrate a dressing change and allow the patient to practice.B) Provide a detailed pamphlet on a dressing change.C) Verbally instruct the patient how to change a dressing and check for comprehension.D) Delegate the dressing change to a trusted family member.Ans: AFeedback:The nurse must consider that older adults may have deficits in the ability to draw inferences, applyinformation, or understand major teaching points. Demonstration and practice are essential in meetingtheir learning needs. The other options are incorrect because the elderly may have problems readingand/or understanding a written pamphlet or verbal instructions. Having a family member change thedressing when the patient is capable of doing it impedes self-care and independence.4. A 20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin.When planning the appropriate educational interventions and considering variables that will affect hislearning, the nurse should prioritize which of the following factors?A) Patients expected lifespanB) Patients genderC) Patients occupationD) Patients cultureAns: DFeedback:One of the major variables that influences a patients readiness to learn is the patients culture, because itaffects how a person learns and what information is learned. Other variables include illness states,values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables thatare usually less salient.5. The nurse is planning to teach a 75-year-old patient with coronary artery disease about administering herprescribed antiplatelet medication. How can the nurse best enhance the patients ability to learn?A) Provide links to Web sites that contain evidence-based information.B) Exclude family members from the session to prevent distraction.C) Use color-coded materials that are succinct and engaging.D) Make the information directly relevant to the patients condition.Ans: DFeedback:Studies have shown that older adults can learn and remember if the information is paced appropriately,relevant, and followed by appropriate feedback. Family members should be included in health education.The nurse should not assume that the patients color vision is intact or that the patient possesses adequatecomputer skills.6. A nurse is planning care for an older adult who lives with a number of chronic health problems. Forwhich of the following nursing diagnoses would education of the patient be the nurses highest priority?A) Risk for impaired physical mobility related to joint painB) Functional urinary incontinence related decreased mobilityC) Activity intolerance related to contracturesD) Risk for ineffective health maintenance related to nonadherence to therapeutic regimenAns: DFeedback:For some nursing diagnoses, education is a primary nursing intervention. These diagnoses include riskfor ineffective management of therapeutic regimen, risk for impaired home management, health-seekingbehaviors, and decisional conflict. The other options do not have patient education as the highestpriority, though each necessitates a certain degree of education.7. The nursing instructor has given an assignment to a group of certified nurse practitioner (CNP) students.They are to break into groups of four and complete a health-promotion teaching project and present areport to their fellow students. What project most clearly demonstrates the principles of healthpromotionteaching?A) Demonstrating an injection technique to a patient for anticoagulant therapyB) Explaining the side effects of a medication to an adult patientC) Discussing the importance of preventing sexually transmitted infections (STI) to a group of highschool studentsD) Instructing an adolescent patient about safe and nutritious food preparationAns: CFeedback:Health promotion encourages people to live a healthy lifestyle and to achieve a high level of wellness.Discussing the importance of STI prevention to a group of high school students is the best example of ahealth-promotion teaching project. This proactive intervention is a more precise example of healthpromotion than the other cited examples.8.Health promotion ranks high on the list of health-related concerns of the American public. Based oncurrent knowledge, what factor should the nurse prioritize in an effort to promote health, longevity, andweight control in patients?A) Good nutritionB) Stress reductionC) Use of vitaminsD) Screening for health risksAns: AFeedback:It has been suggested that good nutrition is the single most significant factor in determining health status,longevity, and weight control. A balanced diet that uses few artificial ingredients and is low in fat,caffeine, and sodium constitutes a healthy diet. Stress reduction and screening for health risks are correctanswers, just not the most significant factors. Vitamin use is not normally necessary when an individualeats a healthy diet, except in specific circumstances.9. The nursing profession and nurses as individuals have a responsibility to promote activities that fosterwell-being. What factor has most influenced nurses abilities to play this vital role?A) Nurses are seen as nurturing professionals.B) Nurses possess a baccalaureate degree as the entry to practice.C) Nurses possess an authentic desire to help others.D) Nurses have long-established credibility with the public.Ans: DFeedback:Nurses, by virtue of their expertise in health and health care and their long-established credibility withconsumers, play a vital role in health promotion. The other options are incorrect because they are not themost influential when it comes to health promotion by nursing and nurses.10. The nurse is teaching a local community group about the importance of disease prevention. Why is thenurse justified in emphasizing disease prevention as a component of health promotion?A) Prevention is emphasized as the link between personal behavior and health.B) Most Americans die of preventable causes.C) Health maintenance organizations (HMOs) now emphasize prevention as the main criterion ofhealth care.D) External environment affects the outcome of most disease processes.Ans: AFeedback:Healthy People 2020 defines the current national health-promotion and disease-prevention initiative forthe nation. The overall goals are to (1) increase the quality and years of healthy life for people and (2)eliminate health disparities among various segments of the population. Most deaths are not classified asbeing preventable. HMO priorities do not underlie this emphasis. The external environment affects manydisease processes, but the course of illness is primarily determined by factors intrinsic to the patient.11. The nurse is preparing discharge teaching for a 51-year-old woman diagnosed with urinary retentionsecondary to multiple sclerosis. The nurse will teach the patient to self-catheterize at home upondischarge. What teaching method is most likely to be effective for this patient?A) A list of clear instructions written at a sixth-grade levelB) A short video providing useful information and demonstrationsC) An audio-recorded version of discharge instructions that can be accessed at homeD) A discussion and demonstration between the nurse and the patientAns: DFeedback:Demonstration and practice are essential ingredients of a teaching program, especially when teachingskills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. Whenspecial equipment is involved, such as urinary catheters, it is important to teach with the same equipmentthat will be used in the home setting. A list of instructions, a video, and an audio recording are effectivemethods of reinforcing teaching after the discussion and demonstration have taken place.12. You are the nurse planning to teach tracheostomy care to a patient who will be discharged homefollowing a spinal cord injury. When preparing your teaching, which of the following is the mostimportant component of your teaching plan?A) Citing the evidence that underlies each of your teaching pointsB) Alleviating the patients guilt associated with not knowing appropriate self-careC) Determining the patients readiness to learn new informationD) Including your nursing colleagues in the planning processAns: CFeedback:Assessment in the teachinglearning process is directed toward the systematic collection of data about theperson and familys learning needs and readiness to learn. Patient readiness is critical to accepting andintegrating new information. Unless the patient is ready to accept new information, patient teaching willbe ineffective. Citing the evidence base will not likely enhance learning. Patient guilt cannot bealleviated until the patient understands the intricacies of the condition and his physiologic response tothe disease. Inclusion of colleagues can be beneficial, but this does not determine the success or failureof teaching.13. A public health nurse is preparing to hold a series of health-promotion classes for middle-aged adultsthat will address a variety of topics. Which site would best meet the learning needs of this population?A) A well-respected physicians officeB) A large, local workplaceC) The local hospitalD) An ambulatory clinicAns: BFeedback:The workplace has become a center for health-promotion activity. Health-promotion programs cangenerally be offered almost anywhere in the community, but the workplace is often more convenient forthe adult, working population. This makes this option preferable to a hospital, doctors office, orambulatory clinic.14. A nurse has been studying research that examines the association between stress levels and negativehealth outcomes. Which relationship should underlie the educational interventions that the nurse choosesto teach?A) Stress impairs sleep patterns.B) Stress decreases immune function.C) Stress increases weight.D) Stress decreases concentration.Ans: BFeedback:Studies have shown the negative effects of stress on health and a cause-and-effect relationship betweenstress and infectious diseases, traumatic injuries (e.g., motor vehicle crashes), and some chronicillnesses. It is well known that stress decreases the immune response, thereby making individuals moresusceptible to infectious diseases. The other options can also be correct in certain individuals, but theyare not those that best support stress-reduction initiatives.15. A public health nurse understands that health promotion should continue across the lifespan. Whenplanning health promotion initiatives, when in the lifespan should health promotion begin?A) AdolescenceB) School ageC) PreschoolD) Before birthAns: DFeedback:Health promotion should begin prior to birth because the health practices of a mother prior to the birth ofher child can be influenced positively or negatively. This makes the other options incorrect.16. A nurse is working with a teenage boy who was recently diagnosed with asthma. During the currentsession, the nurse has taught the boy how to administer his bronchodilator by metered-dose inhaler. Howshould the nurse evaluate the teachinglearning process?A) Ask the boy specific questions about his medication.B) Ask the boy whether he now understands how to use his inhaler.C) Directly observe the boy using his inhaler to give himself a dose.D) Assess the boys respiratory health at the next scheduled visit.Ans: CFeedback:Demonstration and practice are essential ingredients of a teaching program, especially when teachingskills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. Byobserving the patient using the inhaler, the nurse may identify what learning needs to be enhanced orreinforced. Asking questions is not as an accurate gauge of learning. Respiratory assessment is arelevant, but indirect, indicator of learning. Delaying the appraisal of the patients technique until a laterclinic visit is inappropriate because health problems could occur in the interval.17. A team of public health nurses are doing strategic planning and are discussing health promotionactivities for the next year. Which of the following initiatives best exemplifies the principles of healthpromotion?A) A blood pressure clinic at a local factoryB) A family planning clinic at a community centerC) An immunization clinic at the largest local mallD) A workplace safety seminarAns: BFeedback:Health promotion may be defined as those activities that assist people in developing resources thatmaintain or enhance well-being and improve their quality of life. A family planning clinic meets thesecriteria most closely. Workplace health and safety would be considered a protection service. A bloodpressure clinic and immunization clinic would fall under the category of preventive services.18. You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of yourpatients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior bestdemonstrates this patients willingness to learn?A) The patient requests a visit from the hospitals diabetic educator.B) The patient sets aside a dessert brought in by a family member.C) The patient wants a family member to meet with the dietician to discuss meals.D) The patient readily allows the nurse to measure his blood glucose level.Ans: AFeedback:Emotional readiness also affects the motivation to learn. A person who has not accepted an existingillness or the threat of illness is not motivated to learn. The patients wiliness to learn is expressedthrough the action of seeking information on his or her own accord. Seeking information shows anemotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn.19. A nurse is planning an educational event for a local group of citizens who live with a variety of physicaland cognitive disabilities. What variable should the nurse prioritize when planning this event?A) Health-promotion needs of the groupB) Relationships between participants and caregiversC) Wellness state of each individualD) Learning needs of caregiversAns: AFeedback:The nurse must be aware of the participants specific health-promotion needs when teaching specificgroups of people with physical and mental disabilities. This is a priority over the relationships betweenparticipants and caregivers, each persons wellness state, or caregivers learning needs.20. A public health nurse is planning educational interventions that are based on Beckers Health BeliefModel. When identifying the variables that affect local residents health promotion behaviors, whatquestion should the nurse seek to answer?A) Do residents believe that they have ready access to health promotion resources?B) Why have previous attempts at health promotion failed?C) How much funding is available for health promotion in the community?D) Who is available to provide health promotion education in the local area?Ans: AFeedback:Barriers, Beckers second variable, are defined as factors leading to unavailability or difficulty in gainingaccess to a specific health promotion alternative. The other listed questions do not directly relate to thefour variables that Becker specified.21. A nursing student is collaborating with a public health nurse on a local health promotion initiative andthey recognize the need for a common understanding of health. How should the student and the nursebest define health?A) Health is an outcome systematically maximizing wellness.B) Health is a state that is characterized by a lack of disease.C) Health is a condition that enables people to function at their optimal potential.D) Health is deliberate attempt to mitigate the effects of disease.Ans: CFeedback:Health is viewed as a dynamic, ever-changing condition that enables people to function at an optimalpotential at any given time. Health does not necessarily denote the absence of disease, an effort tomaximize wellness, or mitigate the effects of disease.22. A parish nurse is describing the relationships between health and physical fitness to a group of olderadults who all attend the same church. What potential benefits of a regular exercise program should thenurse describe? Select all that apply.A) Decreased cholesterol levelsB) Delayed degenerative changesC) Improved sensory functionD) Improved overall muscle strengthE) Increased blood sugar levelsAns: A, B, DFeedback:Clinicians and researchers who have examined the relationship between health and physical fitness havefound that a regular exercise program can promote health in the following ways: by decreasingcholesterol and low-density lipoprotein levels; delaying degenerative changes, such as osteoporosis; andimproving flexibility and overall muscle strength and endurance. Physical fitness does not improve thesenses or increase blood sugar.23. An occupational health nurse is in the planning stages of a new health promotion campaign in theworkplace. When appraising the potential benefits of the program, the nurse should consider that successdepends primarily on what quality in the participants?A) Desire to expand knowledgeB) Self-awarenessC) Adequate time- and task-managementD) Taking responsibility for oneselfAns: DFeedback:Taking responsibility for oneself is the key to successful health promotion, superseding the importanceof desire to learn information, self-awareness, or time-management.24. A public health nurse is assessing the nutritional awareness of a group of women who are participatingin a prenatal health class. What outcome would most clearly demonstrate that the women possessnutritional awareness?A) The women demonstrate an understanding of the importance of a healthy diet.B) The women are able to describe the importance of vitamin supplements during pregnancy.C) The women can list the minerals nutrients that should be consumed daily.D) The women can interpret the nutrition facts listed on food packaging.Ans: AFeedback:Nutritional awareness involves an understanding of the importance of a healthy diet that supplies all ofthe essential nutrients. The other options are incorrect because vitamin supplements are not necessary fora healthy diet, a certain amount of all minerals need to be eaten daily, and understanding whatconstitutes the recommended daily nutrients is not necessary for nutritional awareness.25. A nurse has planned a teachinglearning interaction that is aimed at middle school-aged students. Tofoster successful health education, the nurses planning should prioritize which of the followingcomponents?A) PretestingB) Social and cultural patternsC) Patient awarenessD) Measurable interventionsAns: BFeedback:A patients social and cultural patterns must be appropriately incorporated into the teachinglearninginteraction. Pretesting may or may not be used; patient awareness is a phrase that has many meanings,none of which make the teachinglearning interaction successful. Interventions are not measured; goalsand outcomes are.26. Positive patient outcomes are the ultimate goal of nursepatient interactions, regardless of the particularsetting. Which of the following factors has the most direct influence on positive patient-care outcomes?A) Patients ageB) Patients ethnic heritageC) Health educationD) Outcome evaluationAns: CFeedback:Health education is an influential factor directly related to positive patient-care outcomes. The otheroptions are incorrect because ethnicity, the patients age, and outcome evaluation are less influentialfactors related to positive patient-care outcomes, though each factor should be considered when planningcare.27. A school nurse is facilitating a health screening program among junior high school students. Whatpurpose of health screening should the nurse prioritize when planning this program?A) To teach students about health risks that they can expect as they grow and developB) To evaluate the treatment of students current health problemsC) To identify the presence of infectious diseasesD) To detect health problems at an early age so they can be treated promptlyAns: DFeedback:The goal of health screening in the adolescent population has been to detect health problems at an earlyage so that they can be treated at this time. An additional goal includes efforts to promote positive healthpractices at an early age. The focus is not on anticipatory guidance or evaluation of treatment. Healthscreening includes infectious diseases, but is not limited to these.28. A nurse recognizes that individuals of different ages have specific health promotion needs. Whenplanning to promote health among young adults, what subject is most likely to meet this demographicgroups learning needs?A) Family planningB) Management of risky behaviorsC) Physical fitnessD) Relationship skills trainingAns: AFeedback:Because of the nationwide emphasis on health during the reproductive years, young adults actively seekprograms that address prenatal health, parenting, family planning, and womens health issues. The otheroptions are incorrect because they are not health promotion classes typically sought out by young adults.29. Middle-aged adults are part of an age group that is known to be interested in health and healthpromotion, and the nurse is planning health promotion activities accordingly. To what suggestions domembers of this age group usually respond with enthusiasm? Select all that apply.A) How lifestyle practices can improve healthB) How to eat healthierC) How exercise can improve your lifeD) Strategies for adhering to prescribed therapyE) Exercise for the agingAns: A, B, CFeedback:Young and middle-aged adults represent an age group that not only expresses an interest in health andhealth promotion but also responds enthusiastically to suggestions that show how lifestyle practices canimprove health; these lifestyle practices include nutrition and exercise. Middle-aged adults may notrespond positively to teaching aimed at the aging. Adherence is not noted to be a desired focus in thisage group.30. A community health nurse has been asked to participate in a health fair that is being sponsored by thelocal senior center. The nurse should select educational focuses in the knowledge that older adultsbenefit most from what kind of activities?A) Those that help them eat wellB) Those that help them maintain independenceC) Those that preserve their social interactionsD) Those that promote financial stabilityAns: BFeedback:Although their chronic illnesses and disabilities cannot be eliminated, the elderly can benefit most fromactivities that help them maintain independence and achieve an optimal level of health. For many olderadults, this is a priority over social interaction, finances, or eating well, even though each of thesesubjects is important.31. A recent nursing graduate is aware that the nursing scope of practice goes far beyond what ischaracterized as bedside care. Which of the following is a nurses primary responsibility?A) To promote activities that enhance community cohesionB) To encourage individuals self-awarenessC) To promote activities that foster well-beingD) To influence individuals social interactionsAns: CFeedback:As health care professionals, nurses have a responsibility to promote activities that foster well-being,self-actualization, and personal fulfillment. Nurses often promote activities that enhance the communityand encourage self-awareness; however, they are not a nurses central responsibility. As professionals,nurses do not actively seek to influence social interactions.32. A nurse who provides care at the campus medical clinic of a large university focuses many of her effortson health promotion. What purpose of health promotion should guide the nurses efforts?A) To teach people how to act within the limitations of their healthB) To teach people how to grow in a holistic mannerC) To change the environment in ways that enhance cultural expectationsD) To influence peoples behaviors in ways that reduce risksAns: DFeedback:The purpose of health promotion is to focus on the persons potential for wellness and to encourageappropriate alterations in personal habits, lifestyle, and environment in ways that reduce risks andenhance health and well-being. The other options are incorrect because the purpose of health promotionis not to teach people how to grow in a holistic manner, to accommodate their limitations, or to changethe environment in ways that enhances cultural expectations.33. Health care professionals are involved in the promotion of health as much as in the treatment of disease.Health promotion has evolved as a part of health care for many reasons. Which of the following factorshas most influenced the growing emphasis on health promotion?A) A changing definition of healthB) An awareness that wellness existsC) An expanded definition of chronic illnessD) A belief that disease is preventableAns: AFeedback:The concept of health promotion has evolved because of a changing definition of health and anawareness that wellness exists at many levels of functioning. The other options are incorrect becausehealth promotion has not evolved because we know that wellness exists or a belief that disease ispreventable. No expanded definition of chronic illness has caused the concept of health promotion toevolve.34. A nurse is working with a male patient who has recently received a diagnosis of humanimmunodeficiency virus (HIV). When performing patient education during discharge planning, whatgoal should the nurse emphasize most strongly?A) Encourage the patient to exercise within his limitations.B) Encourage the patient to adhere to his therapeutic regimen.C) Appraise the patients level of nutritional awareness.D) Encourage a disease-free state,Ans: BFeedback:One of the goals of patient education is to encourage people to adhere to their therapeutic regimen. Thisis a very important goal because if patients do not adhere to their therapeutic regimen, they will notattain their optimal level of wellness. In this patients circumstances, this is likely a priority over exerciseor nutrition, though these are important considerations. A disease-free state is not obtainable.35. Research has shown that patient adherence to prescribed regimens is generally low, especially when thepatient will have to follow the regimen for a long time. Which of the following individuals would mostlikely benefit from health education that emphasizes adherence?A) An older adult who is colonized with methicillin-resistant Staphylococcus aureus (MRSA)B) An 80-year-old man who has a small bowel obstructionC) A 52-year-old woman who has a new diagnosis of multiple sclerosisD) A child who fractured her humerus in a playground accidentAns: CFeedback:when the regimens are complex or of long duration (e.g., therapy for tuberculosis, multiple sclerosis, andHIV infection and hemodialysis). This is less likely in a person with MRSA, an arm fracture, or a bowelobstruction.36. You are the clinic nurse providing patient education to a teenage girl who was diagnosed 6 months agowith type 1 diabetes. Her hemoglobin A1C results suggest she has not been adhering to her prescribedtreatment regimen. As the nurse, what variables do you need to assess to help this patient better adhereto her treatment regimen? Select all that apply.A) Variables that affect the patients ability to obtain resourcesB) Variables that affect the patients ability to teach her friends about diabetesC) Variables that affect the patients ability to cure her diseaseD) Variables that affect the patients ability to maintain a healthy social environmentE) Variables that affect the patients ability to adopt specific behaviorsAns: A, D, EFeedback:Nurses success with health education is determined by ongoing assessment of the variables that affect apatients ability to adopt specific behaviors, to obtain resources, and to maintain a healthy socialenvironment. The patients ability to teach her friends about her condition is not a variable that the nursewould likely assess when educating the patient about her treatment regimen. Type 1 diabetes is notcurable.37. Nurses who are providing patient education often use motivators for learning with patients who arestruggling with behavioral changes necessary to adhere to a treatment regimen. When working with a15-year-old boy who has diabetes, which of the following motivators is most likely to be effective?A) A learning contractB) A star chartC) A point systemD) A food-reward systemAns: AFeedback:Using a learning contract or agreement can also be a motivator for learning. Such a contract is based onassessment of patient needs; health care data; and specific, measurable goals. Young adults would notrespond well to the use of star charts, point systems, or food as reward for behavioral change. Thesetypes of motivators would work better with children.38. As the nurse working in a gerontology clinic, you know that some elderly people do not adhere totherapeutic regimens because of chronic illnesses that require long-term treatment by several health careproviders. What is the most important consideration when dealing with this segment of the population?A) Health care professionals must know all the dietary supplements the patient is taking.B) Health care professionals must work together to provide coordinated care.C) Health care professionals may negate the efforts of another health care provider.D) Health care professionals must have a peer witness their interactions with the patient.Ans: BFeedback:Above all, health care professionals must work together to provide continuous, coordinated care;otherwise, the efforts of one health care professional may be negated by those of another. Interactions donot necessarily need to be witnessed. The care team should be aware of the patients use of supplements,but this is not a priority principle that guides overall care.39. An adult patient will be receiving outpatient intravenous antibiotic therapy for the treatment ofendocarditis. The nurse is preparing to perform health education to ensure the patients adherence to thecourse of treatment. Which of the following assessments should be the nurses immediate priority?A) Patients understanding of the teaching planB) Quality of the patients relationshipsC) Patients previous medical historyD) Characteristics of the patients cultureAns: DFeedback:Before beginning health teaching, nurses must conduct an individual cultural assessment instead ofrelying only on generalized assumptions about a particular culture. This is likely a priority over previousmedical history and relationships, though these are relevant variables. The teaching plan would not becreated at this early stage in the teaching process.40. The nurse is working with a male patient who has diagnoses of coronary artery disease and anginapectoris. During a clinic visit, the nurse learns that he has only been taking his prescribed antiplateletmedication when he experiences chest pain and fatigue. What nursing diagnosis is most relevant to thisassessment finding?A) Acute pain related to myocardial ischemiaB) Confusion related to mismanagement of drug regimenC) Ineffective health maintenance related to inappropriate medication useD) Ineffective role performance related to inability to manage medicationsAns: CFeedback:This patients actions suggest that by taking his medications incorrectly he is not adequately maintaininghis health. Role performance is not directly applicable to the patients actions and confusion suggests acognitive deficit. Pain is not central to the essence of the problem.