Test Bank For Medical-Surgical Nursing Making Connections to Practice 3rd Edition Janice J. Hoffman by digitaldownload87

Chapter 1: Foundations for Medical-Surgical Nursing

MULTIPLE CHOICE : 1. Which type of nursing is the root of all other nursing practice areas? A. Pediatric nursing B. Maternal-child nursing C. Medical-surgical nursing D. Mental health–psychiatric nursing ANS: C Chapter number and title: 1, Foundations for Medical-Surgical Nursing Chapter learning objective: 1. Describing the role and competencies of medical-surgical nursing Chapter page reference: p. 2 Heading: Introduction Integrated Processes: N/A Client Need: N/A Cognitive Level: Knowledge [Remembering] Concept: Professionalism Difficulty: Easy Feedback A B C D

PTS:

Pediatric nursing is only focused on the care of younger persons. Maternal-child nursing focuses on the care of pregnant women and families in the childbearing years. Medical-surgical nursing is the root of all nursing practice as care provided here can be implemented in all other areas of nursing practice. Mental health–psychiatric nursing focuses on emotional and behavioral concerns and disorders. 1

CON: Professionalism

2. Which competency did the Nursing Executive Center of the Advisory Board identify as the greatest academic practice gap for new graduate nurses? A. Knowledge of pharmacology B. Interpretation of assessment data C. Knowledge of pathophysiology D. Decision making ANS: C Chapter number and title: 1, Foundations for Medical-Surgical Nursing Chapter learning objective: 1. Describing the role and competencies of medical-surgical nursing Chapter page reference: p. 3 Heading: Competencies in Medical-Surgical Nursing Integrated Processes: N/A Client Need: N/A

Cognitive Level: Knowledge [Remembering] Concept: Professionalism Difficulty: Easy Feedback A B C D

PTS:

28% of nursing executives identified knowledge of pharmacological implications of medications as the largest academic practice gap. 18% of nursing executives identified interpretation of assessment data as the largest academic practice gap. 34% of nursing executives identified knowledge of pathophysiology of patient conditions as the largest academic practice gap. 20% of nursing executives identified decision making based on the nursing process as the largest academic practice gap. 1

CON: Professionalism

3. In the Nursing Executive Center of the Advisory Board report, what recommendations are made to address the academic practice gap for new graduate nurses? A. Mandatory number of clinical hours B. Increased credits in all entry level courses C. Residency programs D. Additional science prerequisite courses ANS: C Chapter number and title: 1, Foundations for Medical-Surgical Nursing Chapter learning objective: 1. Describing the role and competencies of medical-surgical nursing Chapter page reference: p. 3 Heading: Competencies in Medical-Surgical Nursing Integrated Processes: N/A Client Need: N/A Cognitive Level: Comprehension [Understanding] Concept: Healthcare Systems Difficulty: Moderate Feedback A

Clinical hours in nursing programs are not a specific recommendation related to the academic practice gap, and clinical hours are more related to state regulations, academic institutional policies, and accreditation standards. Total credits of nursing programs are not a recommendation to address the academic practice gap. Credits are primarily based on state, university, or higher education regulatory bodies recommendations or requirements. Suggested strategies to better prepare the nurse graduate for the realities of practice include the increased use of simulation in nursing education programs, extended transition-to-practice and residency programs, as well as the establishment of academic service partnerships.

PTS:

Prerequisite courses for nursing programs were not specifically addressed in relation to the academic practice gap. Decisions related to prerequisite courses are typically determined by school and/or university curriculum committees. 1

CON: Healthcare Systems

4. The medical-surgical nurse wants to determine if a policy change is needed for an identified clinical problem. Which is the nurse’s first action? A. Developing a question B. Disseminating the findings C. Conducting a review of the literature D. Evaluating outcomes of practice change ANS: A Chapter number and title: 1, Foundations for Medical-Surgical Nursing Chapter learning objective: 3. Discussing the incorporation of evidence-based practices into medicalsurgical nursing Chapter page reference: p. 4 Heading: Evidence-Based Nursing Care/Box 1.3 Steps of Evidence-Based Practice Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive Level: Comprehension Concept: Evidence-Based Practice Difficulty: Moderate Feedback A B C D

PTS:

The first step of evidence-based practice is to develop a question based on the clinical issue. The last step of evidence-based practice is to disseminate findings. The second step of evidence-based practice is to conduct a review of the literature, or current evidence, available. The fifth step of evidence-based practice is to evaluate the outcomes associated with the practice change. 1

CON: Evidence-Based Practice

5. Which statement regarding the use of the nursing process in clinical practice is accurate? A. “The nursing process is closely related to clinical decision making.” B. “The nursing process is used by all members of the interprofessional team to plan care.” C. “The nursing process has four basic steps: assessment, planning, implementation, and evaluation.” D. “The nursing process is being replaced by the implementation of evidence-based practice.” ANS: A Chapter number and title: 1, Foundations for Medical-Surgical Nursing Chapter learning objective: 1. Describing the role and competencies of medical-surgical nursing

Chapter page reference: pp. 3-4 Heading: Competencies Related to the Nursing Process Integrated Processes: Nursing Process: Diagnosis Client Need: Safe and Effective Care Environment/Management of Care Cognitive Level: Comprehension [Understanding] Concept: Caring Difficulty: Moderate Feedback A

B C D

PTS:

The nursing process is closely related to the nurse’s decision making in the clinical environment because it requires understanding the relationships among physiology, pathophysiology, clinical manifestations, and management of patients. This statement is accurate. The nursing process is not used by all members of the interprofessional team to plan care. The nursing process has five, not four, basic steps: assessment, diagnosis, planning, implementation, and evaluation. The nursing process is not being replaced by the implementation of evidencebased practice. 1

CON: Caring

6. The nurse develops a research question based on observations noted while providing care to patients on the medical-surgical unit. Which step does the nurse implement next during the process of evidence-based practice? A. Search for the best evidence. B. Evaluate the quality of the evidence. C. Integrate the evidence into unit practice. D. Disseminate the evidence to the staff on the unit. ANS: A Chapter number and title: 1, Foundations for Medical-Surgical Nursing Chapter learning objective: 3. Discussing the incorporation of evidence-based practices into medicalsurgical nursing Chapter page reference: p. 4 Heading: Evidence-Based Nursing Care Integrated Processes: N/A Client Need: N/A Cognitive Level: Comprehension [Remembering] Concept: Evidence-Based Practice Difficulty: Easy Feedback A

The first step of evidence-based practice is to develop a research question. Because the nurse has completed this, the next step is to search and collate the best evidence.

7. The nurse is reviewing evidence from a quasi-experimental research study. Which level of evidence should the nurse identify for this research study? 1) Level I 2) Level II 3) Level III 4) Level IV 8. Which level of evidence should the nurse identify when reviewing evidence from a single descriptive research study? 1) Level IV 2) Level V 3) Level VI 4) Level VII 9. Which statement should the nurse make when communicating the “S” in the SBAR approach for effective communication? 1) “The patient presented to the emergency department at 0200 with lower left abdominal pain.” 2) “The patient rated the pain upon admission as a 9 on a 10-point numeric scale.” 3) “The patient has no significant issues in the medical history” 4) “The patient was given a prescribed opioid analgesic at 0300.” 10. The staff nurse is communicating with the change nurse about the change of status of the patient. The nurse would begin her communication with which statement if correctly using the SBAR format? 1) “The patient’s heartrate is 110.” 2) “I think this patient needs to be transferred to the critical care unit.” 3) “The patient is a 68-year-old male patient admitted last night.” 4) “The patient is complaining of chest pain.” 11. Which nursing action exemplifies the Quality and Safety Education for Nursing (QSEN) competency of safety? 1) Advocating for a patient who is experiencing pain 2) Considering the patient’s culture when planning care 3) Evaluating patient learning style prior to implementing discharge instructions 4) Assessing the right drug prior to administering a prescribed patient medication 12. Which type of nursing is the root of all other nursing practice areas? 1) Pediatric nursing 2) Geriatric nursing 3) Medical-surgical nursing 4) Mental health-psychiatric nursing 13. Which did the Nursing Executive Center of The Advisory Board identify as an academic-practice gap for new graduate nurses? 1) Patient advocacy 2) Patient education

3) 4)

Disease pathophysiology Therapeutic communication

14. Which statement regarding the use of the nursing process in clinical practice is accurate? 1) “The nursing process is closely related to clinical decision-making.” 2) “The nursing process is used by all members of the interprofessional team to plan care.” 3) “The nursing process has 4 basic steps: assessment, planning, implementation, evaluation.” 4) “The nursing process is being replaced by the implementation of evidence-based practice.” 15. Which is the basis of nursing care practices and protocols? 1) Assessment 2) Evaluation 3) Diagnosis 4) Research 16. Which is a common theme regarding patient dissatisfaction related to care provided in the hospital setting? 1) Space in hospital rooms 2) Medications received to treat pain 3) Time spent with the health-care team 4) Poor quality food received from dietary 17. The nurse manager is preparing a medical-surgical unit for The Joint Commission (TJC) visit With the nurse manager presenting staff education focusing on TJC benchmarks, which of the following topics would be most appropriate? 1) Implementation of evidence-based practice 2) Implementation of patient-centered care 3) Implementation of medical asepsis practices 4) Implementation of interprofessional care 18. Which aspect of patient-centered care should the nurse manager evaluate prior to The Joint Commission site visit for accreditation? 1) Visitation rights 2) Education level of staff 3) Fall prevention protocol 4) Infection control practices 19. The medical-surgical nurse is providing patient care. Which circumstance would necessitate the nurse verifying the patient’s identification using at least two sources? 1) Prior to delivering a meal tray 2) Prior to passive range of motion 3) Prior to medication administration 4) Prior to documenting in the medical record 20. The nurse is providing care to several patients on a medical-surgical unit. Which situation would necessitate the nurse to use SBAR during the hand-off process?

1) 2) 3) 4)

Wound care Discharge to home Transfer to radiology Medication education

Multiple Response

Identify one or more choices that best complete the statement or answer the question. 21. The staff nurse is teaching a group of student nurses the situations that necessitate hand-off communication. Which student responses indicate the need for further education related to this procedure? Select all that apply. 1) “A hand-off is required prior to administering a medication.” 2) “A hand-off is required during change of shift.” 3) “A hand-off is required for a patient is transferred to the surgical suite.” 4) “A hand-off is required whenever the nurse receives a new patient assignment.” 5) “A hand-off is required prior to family visitation.” 22. Which actions by the nurse enhance patient safety during medication administration? Select all that apply. 1) Answering the call bell while transporting medications for a different patient 2) Identifying the patient using two sources prior to administering the medication 3) Holding a medication if the patient’s diagnosis does not support its use 4) Administering the medication two hours after the scheduled time 5) Having another nurse verify the prescribed dose of insulin the patient is to receive 23. The medical-surgical nurse assumes care for a patient who is receiving continuous cardiopulmonary monitoring. Which actions by the nurse enhance safety for this patient? Select all that apply. 1) Silencing the alarm during family visitation 2) Assessing the alarm parameters at the start of the shift 3) Responding to the alarm in a timely fashion 4) Decreasing the alarm volume to enhance restful sleep 5) Adjusting alarm parameters based on specified practitioner prescription 24. The nurse is planning an interprofessNioUnaRl ScaIreNcGonTfeBre.nCceOfMo r a patient who is approaching discharge from the hospital. Which members of the interprofessional team should the nurse invite to attend? Select all that apply. 1) Physician 2) Pharmacist 3) Unit secretary 4) Social worker 5) Home care aide 25. The nurse manager wants to designate a member of the nursing team as the care coordinator for a patient who will require significant care during the hospitalization. Which skills should this nurse possess in order to assume this role? Select all that apply. 1) Effective clinical reasoning 2) Effective communication skills 3) Effective infection control procedures 4) Effective documentation 5) Effective intravenous skills

Chapter 1: Foundations for Medical-Surgical Nursing Answer Section MULTIPLE CHOICE 1.

ANS: 1 Chapter number and title: 1, Foundations for Medical Surgical Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 003004 Heading: Evidence-Based Nursing Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Comprehension [Understanding] Concept: Evidence-Based Practice Difficulty: Easy 1

2 3 4

Feedback Systematic reviews of randomized control studies (Level I) are the highest level of evidence because they include data from selected studies that randomly assigned participants to control and experimental groups. The lower the numerical rating of the level of evidence indicates the highest level of evidence; therefore, this type of study provides the strongest evidence to support a practice change. Quasi-experimental studies are considered Level III; therefore, this study does not provide the strongest evidenceNtU o R suSp pIoNrt Ga Tp rBac.tiCceOcMhange. Case-control studies are considered Level IV; therefore, this study does not provide the strongest evidence to support a practice change. Cohort studies are considered Level IV; therefore, this study does not provide the strongest evidence to support a practice change.

PTS: 1 CON: Evidence-Based Practice 2. ANS: 4 Chapter number and title: 1, Foundations of Medical-Surgical Practice Chapter learning objective: Explaining the importance of patient-centered care in the management of medical- surgical patients Chapter page reference: 004-005 Heading: Patient-Centered Care in the Medical-Surgical Setting Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Application [Applying]

Concept: Nursing Roles Difficulty: Moderate 1 2

Feedback Evaluation is a step in the nursing process; however, this is not an action that supports the patient-centered care model. Assessment is a step in the nursing process; however, this is not an action that supports the patient-centered care model.

3 4

Diagnosis is a step in the nursing process; however, this is not an action that supports the patient-centered care model. Compassion is a competency closely associated with patient-centered care; therefore, this action supports the patient-centered model of care.

PTS: 1 CON: Nursing Roles 3. ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety Education for Nurses (QSEN) competencies Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate 1 2 3 4

Feedback Safely using alarms is a NPSG identified by TJC. Silencing a cardiorespiratory monitor is not nursing action that supports this NPSG. Patient identification using two separate resources is a NPSG identified by TJC. Identifying a patient using only one source does not support this NPSG. Identification of patient safety risks is a NPSG identified by the TJC. Determining patient safety issues upon admNisUsion R SsIupNpGorTtsBth.isCNOPMSG. Safe use of medication is a NPSG identified by the TJC. Decreasing the amount of pain medication administered does not support this NPSG.

PTS: 1 CON: Safety 4. ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role and competencies of medical-surgical nursing Chapter page reference: 006-007 Heading: Interprofessional Collaboration and Communication Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level:

Comprehension [Understanding] Concept: Nursing Roles Difficulty: Easy 1 2 3 4

Feedback The nurse does not often assume the interprofessional role of social worker when providing patient care in an acute care setting. The nurse does not often assume the interprofessional role of client advocate role when providing patient care in an acute care setting. The nurse often assumes the interprofessional role of care coordinator when providing patient care in an acute care setting. The nurse does not often assume the interprofessional role of massage therapist when providing patient care in an acute care setting.

PTS: 1 CON: Nursing Roles 5. ANS: 1 Chapter number and title: 1, Foundations of Medical-Surgical Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 003 Heading: Box 1.3 Steps of Evidence-Based Practice Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Analysis [Analyzing] Concept: Evidence-Based Practice Difficulty: Difficult 1 2 3 4

Feedback The first step of evidence-based practice is to develop a question based on the clinical issue. The last step of evidence-based practice is to disseminate findings. The second step of evidence-based practice is to conduct a review of the literature, or current evidence, available. The fifth step of evidence-based practice is to evaluate the outcomes associated with the practice change.

PTS: 1 CON: Evidence-Based Practice 6. ANS: 4 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 004 Heading: Box 1.4 Evaluating Levels of Evidence Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Comprehension [Understanding] Concept: Evidence-Based Practice Difficulty: Easy 1

Feedback The lower the numeric value of the evidence the greater the support for a change in practice. Level IV evidence does not carry the lowest level of support

for a practice change. 2

The lower the numeric value of the evidence the greater the support for a change in practice. Level V evidence does not carry the lowest level of support for a practice change. The lower the numeric value of the evidence the greater the support for a change in practice. Level VI evidence does not carry the lowest level of support for a practice change. The lower the numeric value of the evidence the greater the support for a change in practice. Level VII evidence carries the lowest level of support for a practice change.

PTS: 1 CON: Evidence-Based Practice 7. ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 004 Heading: Box 1.4 Evaluating Levels of Evidence Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Evidence-Based Practice Difficulty: Moderate 1 2 3 4

Feedback A systemic review of randomized controlled studies, not a quasiexperimental research study, is identified as Level I. Evidence from at least one study randomized control study, not a quasi-experimental research study, is identified as Level II. A quasi-experimental research study is identified as a Level III. Evidence from case-control or cohort studies, not a quasiexperimental research study, is identified as a Level IV.

PTS: 1 CON: Evidence-Based Practice 8. ANS: 3 Chapter number and title: 1,NURSINGTB.CO Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 004 Heading: Box 1.4 Evaluating Levels of Evidence Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Evidence-Based Practice Difficulty: Moderate 1

Feedback Evidence from case-control or cohort studies, not a single descriptive research study, is identified as a Level IV.

2 3 4

Evidence from systemic reviews of descriptive or qualitative studies, not a single descriptive research study, is identified as Level V. Evidence from a single descriptive research study is identified as Level VI. Evidence from expert individual authorities or committees, not a single descriptive research study, is identified as Level VII.

PTS: 1 CON: Evidence-Based Practice 9. ANS: 1 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role of interprofessional collaboration and teamwork in the provision of safe, quality patient care

Chapter page reference: 005 Heading: Box 1.6 The SBAR Approach for Effective Communication Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate 1

2 3 4

10.

Feedback The “S” reflects the patient’s current situation which is communicated by providing a brief statement of the issue. This statement by the nurse exemplifies the current situation. The “A” reflects the patient’s assessment data. This statement by the nurse exemplifies the patent’s assessment data. The “B” reflects the patient’s medical history. This statement by the nurse exemplifies communicating the patient’s history related to the current problem. The “R” reflects specific actions needed to address the situation. This statement by the nurse exemplifies the actions implemented to address current level of pain.

PTS: 1 CON: Communication ANS: 4 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role of interprofessional collaboration and teamwork in the provision of safe, quality patient care Chapter page reference: 005 Heading: Box 1.6 The SBAR Approach for Effective Communication Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Analysis [Analyzing] Concept: Communication Difficulty: Moderate 1

Feedback This statement is the “A” in the SBAR communication. This is an assessment finding by the staff nurse.

2 3 4

11.

This statement is the “R” in the SBAR communication. This is the recommendation by the staff nurse. This statement is the “B” in the SBAR communication. This is the background information. This statement is the “S” in the SBAR communication. This is the situation information.

PTS: 1 CON: Communication ANS: 4 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety Education for Nurses (QSEN) competencies Chapter page reference: 006 Heading: Box 1.8 Quality and Safety Education for Nursing (QSEN) Competencies

Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate 1 2 3 4

12.

Feedback Advocating for a patient who is in pain exemplifies the QSEN competency of patientcentered care, not safety. Considering the patient’s cultural background exemplifies the QSEN competency of patient-centered care, not safety. Evaluating the patient’s learning style prior to implementing discharge instructions exemplifies the QSEN competency of patientcentered care, not safety. Assessing the right drug prior to administering a prescribed medication exemplifies the QSEN competency of safety.

PTS: 1 CON: Safety ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role and competencies of medical-surgical nursing Chapter page reference: 002 Heading: Introduction Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Knowledge [Remembering] Concept: Nursing Difficulty: Easy Feedback 1 Pediatric nursing is not the root of all nursing practice areas. 2 Geriatric nursing is not the root of all nursing practice areas. 3 Medical-surgical nursing is the root of all nursing practice as care provided here can be implemented in all other areas of nursing practice. 4 Mental health-psychiatric nursing is not the root of all nursing practice areas.

13.

PTS: 1 CON: Nursing ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice

Chapter learning objective: Describing the role and competencies of medical-surgical nursing Chapter page reference: 002-003 Heading: Competencies in MedicalSurgical Nursing Integrated Processes: Teaching and Learning Client Need: Physiological Integrity/Physiological Adaptation Cognitive level: Knowledge [Remembering] Concept: Critical Thinking Difficulty: Easy 1

Feedback Patient advocacy is not identified as an academic-practice gap for new graduate nurses.

2 3 4

14.

PTS: 1 CON: Critical Thinking ANS: 1 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice” Chapter learning objective: Describing the role and competencies of medical-surgical nursing Chapter page reference: 003 Heading: Competencies Related to the Nursing Process Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Comprehension [Understanding] Concept: Critical Thinking Difficulty: Easy 1 2 3 4

15.

Patient education is not identified as an academic-practice gap for new graduate nurses. Knowledge of pathophysiology of patient conditions is identified as an academicpractice gap for new graduate nurses. Therapeutic communication is not identified as an academic-practice gap for new graduate nurses.

Feedback The nursing process is closely related to the nurse’s decision-making in the clinical environment. This statement is accurate. The nursing process is not used by all members of the interprofessional team to plan care. The nursing process has 5, not 4, basic steps: assessment, diagnosis, planning, implementation, and evaluatioNn. The nursing process is not being replaced by the implementation of evidence-based practice.

PTS: 1 CON: Critical Thinking ANS: 4 Chapter number and title: 1, Foundations for Medical-Surgical Nursing Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 003004 Heading: Evidence-Based Nursing Care Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Knowledge [Remembering]

Concept: Evidence-Based Practice Difficulty: Easy 1 2 3

Feedback Assessment is a step in the nursing process; however, this is not the basis for nursing care practices and protocols. Evaluation is a step in the nursing process; however, this is not the basis for nursing care practices and protocols. Diagnosis is a step in the nursing process; however, this is not the basis for nursing care practices and protocols.

16.

PTS: 1 CON: Evidence-Based Practice ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Explaining the importance of patient-centered care in the management of medical- surgical patients Chapter page reference: 004-005 Heading: Patient-Centered Care in the Medical-Surgical Setting Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Knowledge [Remembering] Concept: Communication Difficulty: Easy 1 2 3 4

17.

Evidence that is obtained through research is the basis for nursing care practices and protocols.

Feedback Space in each hospital room is not a common theme of patient dissatisfaction. Medications received for pain management is not a common theme of patient dissatisfaction. A lack of time with members of the health care team is a common theme of patient dissatisfaction. Poor food quality is not a common theme of patient dissatisfaction.

PTS: 1 CON: Communication ANS: 2 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Explaining the importance of patient-centered care in the management of medical- surgical patients Chapter page reference: 004-005 Heading: Patient-Centered Care in the Medical-Surgical Setting Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Quality Improvement Difficulty: Moderate 1

Feedback Implementation of evidence-based practice is not the benchmark in which acute care facilities are evaluated against.

2 3 4

18.

Implementation of patient-centered care is the benchmark in which acute care facilities are evaluated against. Implementation of medical asepsis practices is not the benchmark in which acute care facilities are evaluated against. Implementation of interprofessional care is not the benchmark in which acute care facilities are evaluated against.

PTS: 1 ANS: 1

CON: Quality Improvement

Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Explaining the importance of patient-centered care in the management of medical- surgical patients Chapter page reference: 004-005 Heading: Patient-Centered Care in the Medical-Surgical Setting Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Quality Improvement Difficulty: Moderate 1 2

3 4

19.

Feedback Visitation rights should be evaluated prior to a TJC accreditation site visit as this aspect of patient-centered care is incorporated into the site evaluation. The education level of staff is not evaluated prior to a TJC accreditation visit. This information should be evaluated for a hospital that is attempting to earn Magnet status. While the fall prevention program will be reviewed during a TJC accreditation site visit this is not an aspect of patient-centered care. While infection control practices will be reviewed during a TJC accreditation site visit this is not an aspect of patient-centered care.

PTS: 1 CON: Quality Improvement ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Practice Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety Education for Nurses (QSEN) competencies Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Safety and Infection Control Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate 1

Feedback While the nurse should take care to deliver the meal tray to the correct patient this circumstance does not require verification of patient identity through two sources.

3 4

20.

While the nurse should take care to implement passive range of motion on the correct patient this circumstance does not require verification of patient identity through two sources. The nurse should identify a patient using two sources prior to medication administration. While the nurse should take care to document patient care in the correct medical record this circumstance does not require verification of patient identity through two sources.

PTS: 1 CON: Safety ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice

Chapter learning objective: Describing the role of interprofessional collaboration and teamwork in the provision of safe, quality patient care Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Communication, Safety Difficulty: Moderate 1

2 3

Feedback Effective staff communication is essential to safe patient care, especially during handoffs. Implementation of wound care is not an example of a hand-off situation. Effective staff communication is essential to safe patient care, especially during handoffs. Discharge to home is not an example of a hand-off situation. Effective staff communication is essential to safe patient care, especially during handoffs. Patient transfer to another unit of the hospital necessitate a change in who is responsible for direct patient care; therefore, this situation would necessitate the need for SBAR during the hand-off process. Effective staff communication is essential to safe patient care, especially during handoffs. Medication education is not an example of a hand-off situation.

PTS: 1

CON: Communication | Safety

MULTIPLE RESPONSE 21. ANS: 2, 3, 4 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role of interprofessional collaboration and teamwork in the provision of safe, quality patient care Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Analysis [Analyzing]

Concept: Communication Difficulty: Difficult 1. 2. 3. 4. 5.

Feedback This is incorrect. Hand-off communication is not required prior to the administration of medication. The nurse would, however, verify the patient’s identity using two sources. This is correct. Hand-off communication is required when patient care is transferred from one provider to another, such as during the change of shift. This is correct. Hand-off communication is required when patient care is transferred from one provider to another, such as when a patient is transferred to the surgical suite. This is correct. Hand-off communication is required when patient care is transferred from one provider to another, such as anytime the nurse receives a new patient assignment. This is incorrect. Hand-off communication is not required prior to family visitation.

PTS: 1 CON: Communication 22. ANS: 2, 3, 5 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety Education for Nurses (QSEN) competencies Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Safety and Infection Control Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate

Feedback This is incorrect. Interruptions should be minimized during the medication administration process; therefore, the nurse should not answer the call bell for another patient while transporting medications for administration. This is correct. Verification of the right patient is one of the rights of medication administration; therefore, the nurse would identify the patient using two sources prior to the administration of medication. This is correct. The nurse should ensure that the rationale for all medications are associated with the patient condition; therefore, this action enhances patient safety during medication administration. This is incorrect. One of the rights of medication administration is the right time, which correlates to 30 minutesNbU efR orSe I orN3G0 T mB in.utCesOaMfter the scheduled time. This nursing action would not enhance patient safety during medication administration. This is correct. Verifying the dose of a high-risk medication, such as insulin, enhances patient safety during medication administration.

PTS: 1 CON: Safety 23. ANS: 2, 3, 5 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety Education for Nurses (QSEN) competencies Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Safety and Infection Control Cognitive level: Analysis [Analyzing]

Concept: Safety Difficulty: Difficult

1. 2.

Feedback This is incorrect. Monitor alarms should be audible even during family visitation. Inaudible alarms may impede patient safety. This is correct. The nurse should assess the alarm parameters, comparing to the prescribed settings, at the start of each shift. This action enhanced patient safety.

3. 4. 5.

This is correct. The nurse should respond to all alarms in a timely fashion, which enhances patient safety. This is incorrect. Monitor alarms should be audible at all times, even when the patient is asleep to enhance patient safety. This is correct. The nurse should adjust alarm parameters based on specific practitioner prescriptions. This action enhances safety.

PTS: 1 CON: Safety 24. ANS: 1, 2, 4 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role of interprofessional collaboration and teamwork in the provision of safe, quality patient care Chapter page reference: 006-007 Heading: Interprofessional Collaboration and Communication Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Collaboration Difficulty: Moderate

1. 2. 3. 4. 5.

Feedback This is correct. The physician is a member of the interprofessional team and should be invited to participate in the care conference. This is correct. The pharmacist is a member of the interprofessional team and should be invited to participate in the care R conferen.ce. This is incorrect. The unit secretary is not a member of the interprofssional team; therefore, would not require an invitation to attend the care conference. This is correct. The social worker is a member of the interprofessional team; therefore, should be invited to participate in the care conference. This is incorrect. The home care aide, while a member of the interprofessional team, would not benefit from attending a care conference while the patient is hospitalized.

PTS: 1 CON: Collaboration 25. ANS: 1, 2, 4 Chapter number and title: 1, Foundation of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role of interprofessional collaboration and teamwork in the provision of safe, quality patient care Chapter page reference: 006-007

Heading: Interprofessional Collaboration and Communication Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Analysis [Analyzing] Concept: Collaboration Difficulty: Difficult

Feedback This is correct. Effective clinical reasoning is a skill required for the nurse to assume the role of care coordinator.

2. 3.

4. 5.

PTS: 1

This is correct. Effective communication is a skill required for the nurse to assume the role of care coordinator. This is incorrect. Effective infection control procedures are expected to meet the standard of care; however, this skill is not required for the nurse to assume the role of care coordinator. This is correct. Effective documentation, a form of communication, is a skill required for the nurse to assume the role of care coordinator. This is incorrect. Effective intravenous skills are not required for the nurse to assume the role of care coordinator. CON: Collaboration

Chapter 2: Interprofessional Collaboration and Care Coordination Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The home care nurse is planning care for a diabetic patient requiring an extensive dressing change twice a day, assistance with activities of daily living (ADLs), and comprehensive education. Which role is the nurse assuming by coordinating the care this patient requires? 1) Collaborator NURSINGTB.COM 2) Case manager 3) Health educator 4) Health promoter 2. The nurse is discussing follow-up care with a patient who is being discharged. The patient and family cross their arms and state angrily that the team's suggestions are not acceptable. Which response by the nurse is appropriate? 1) “We only want what's best for you.” 2) “We will leave you alone to discuss your options.” 3) “Perhaps you did not understand the recommendations.” 4) “Let's discuss other options that might work well for you and your family.” 3. The nurse is preparing a patient for discharge who will be requiring physical therapy (PT) to rehabilitate after a total knee replacement. After reading the health-care provider’s order for PT, which would be the nurse's initial action? 1) Teach the family the exercises needed for the patient. NURSINGTB.COM

2) 3) 4)

Call home health and schedule a therapist to visit the home for therapy. Set up appointments according to the order with the hospital PT department. Discuss the various types of settings for therapy and have the patient choose the venue.

4. The nurse is caring for a patient with rheumatoid arthritis who expresses the desire to remain active as long as possible. In order for the patient to meet this goal, what should the nurse prepare to do? 1) Tell the patient there is no hope. 2) Ask the patient the reason for the decision. 3) Teach the patient nutrition and joint exercises. 4) Refer the patient to the appropriate professionals.

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5. A nurse is working as the designated leader of a group of health-care providers in a community clinic setting. The team members are working to decrease the number of adolescent pregnancies in the community. They have defined the problem and are now focusing on objectives and considering various viewpoints presented by the group. The nurse is tasked with helping the team to stay focused in order to address the defined problem. Which competency of collaboration does this describe? 1) Trust 2) Mutual respect 3) Communication 4) Decision making 6. The nurse managers in a community hospital have been charged with reviewing job descriptions of unlicensed assistive personnel (UAPs) and have questions about the delegation of certain patient care activities to UAPs by nurses. To which group, organization, or individual would committee members direct their questions to obtain definitive answers about the parameters of nurse delegation to UAPs? 1) The state board of nursing 2) The American Nurses Association 3) The hospital's Chief Nursing Officer 4) The hospital's Chief Executive Officer

7. Which statement is a primary and historical barrier to effective nursephysician collaboration that has persisted over time? 1) The view among the general population that nurses’ contributions to patients’ care is less important to their health and well-being compared to the contribution of physicians The nurses’ and physicians’ perceptions of inequity in their roles, with nurses assuming a subservient role and physicians assuming leadership and superior role in health-care settings NURSINGTB.COM 3) A general lack of education provided in schools for health professionals about the benefits on health-care quality linked 4) A lack of published evidence about the effectiveness of collaborative efforts among and between nurses and physicians to nurse-physician collaboration 8. A patient with Type 1 diabetes mellitus has developed an open sore on the shin and is having trouble meeting daily goals for exercising. The patient is scheduled for discharge in a couple of days. When planning for this patient’s continued care, who will the nurse notify regarding the patient’s needs after discharge? 1) The pharmacy 2) The case manager 3) The physical therapist 4) The occupational therapist NURSINGTB.COM

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9. A patient who is recovering from coronary bypass surgery is placed on a critical pathway for extended care. Which patient statement indicates appropriate understanding of the plan of care? 1) “I cannot alter the critical pathway plan.” 2) “I must be able to meet goals that are set for me.” 3) “My insurance plan can deny payment if I do not meet goals.” 4) “The chosen critical pathway can be altered to meet my needs.” 10. The case manager interviews an older adult patient hospitalized after hip replacement surgery. The patient requires in-patient rehabilitation prior to being discharged home. The case manager works with the hospital nursing staff, the rehabilitation center, the patient’s family members, and other care providers to assist with a smooth transition. Which is the primary goal of the care management model described here? 1) To provide greater peace of mind for the patient and his or her family members

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2) 3) 4)

To track a patient’s progress to ensure that appropriate care is provided until discharge To manage concerns that are related to the patient’s medical care and treatment regimen only To provide a continuum of clinical services in order to help contain costs and improve patient outcomes

11. The patient’s case manager, diabetes educator, and dietician meet to discuss the patient’s needs in preparation for discharge to home. The patient’s primary healthcare provider arrives and states, “I will be making all decisions regarding the patient’s discharge care.” With the primary health-care provider’s decision to lead the team, the dynamic has shifted between which two types of teams? 1) Intradisciplinary to interdisciplinary team 2) Multidisciplinary to intradisciplinary team 3) Interprofessional to interdisciplinary team 4) Interdisciplinary to multidisciplinary team 12. A school-age patient is admitted to the pediatric intensive care unit (PICU), unconscious and with multiple traumatic injuries, after a skateboard accident that included a closed head injury. Many health professionals are involved in the patient’s care and the scene is chaotic. The parents are extremely anxious and want to know what is happening. The case manager asks for an interdisciplinary team meeting to speak with the patient’s parents. Which is the rationale for this meeting? 1) To allow for each specialty to practice independently 2) To share and evaluate information for care planning and implementation, and prevent priority conflicts, redundancy, and omissions in care 3) To all the primary health-care provider to make all the decision regarding the patient’s care 4) To prevent the parents from trying to change the plan of care NURSINGTB.COM 13. The Chief Nursing Officer and Chief Medical Officer in an urban teaching hospital are leading a series of meetings with nurses, physicians, hospital lawyers, and risk managers to review and update hospital privileging procedures and requirements for advanced practice RNs and physicians new to the hospital. This is an example of which type of collaborative team? 1) Intradisciplinary 2) Interdisciplinary 3) Multidisciplinary 4) Complementary 14. A local hospital formed a neurotrauma (NT) team with the following members: acute care nurses, physicians, other care partners (e.g., physical therapists, social workers, case managers, dieticians), and representatives from the NT outpatient clinic. This team is led by a physician who makes treatment decisions based on the treatment plans developed by individual team members who each communicate with NURSINGTB.COM

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the patients, asking the same or similar questions to obtain data needed for their treatment plan. Which type of communication and action is represented in the scenario described? 1) Parallel communication 2) Parallel functioning 3) Information exchange 4) Coordination and consultation 15. The nurse is caring for a patient who is reporting pain of 8/10 on a 1 to 10 numeric pain scale. The nurse administers the prescribed pain medication. When the nurse reevaluates the patient one hour later, the patient is still reporting pain of 8/10. Which action by the nurse is appropriate at this time? 1) Wait for the health-care provider to make rounds to report the problem.

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2) 3) 4)

Report to the health-care provider by telephone. Increase the dosage of the medication. Include in the nursing report that the medication is ineffective.

16. Handoff communication, the transfer of information during transitions in care such as during change-of-shift report, includes an opportunity to ask questions, clarify, and confirm the information between sender and receiver. Which is the main objective for ensuring effective communication during a patient handoff? 1) To avoid lawsuits 2) To ensure patient safety 3) To facilitate quality improvement 4) To make sure all documentation is done 17. The nurse is providing care to a patient diagnosed with end-stage renal disease. When planning a care plan conference for this patient, who does the nurse invite to participate? 1) The oncologist 2) The psychiatrist 3) The hospital CEO 4) The family members 18. Which should be the focus of an educational session for nurses and other members of the interdisciplinary team when addressing high rates of patient readmission to the health system? 1) Medication errors 2) Coordination of care 3) Adverse clinical events 4) Roles of each member providing care 19. Which patient population should the Nn uUrsReSfoIc N u sGoTn Bto.inCcO r eM a se access to care that is coordinated, safe, and focused on the patient’s unique needs across all care settings? 1) Pediatric patients 2) Older adult patients 3) Young adult patients 4) Acute needs patients 20. Which is a basic principle of the Patient Protection and Affordable Care Act of 2010 that the nurse should include in a teaching session for members of the health-care team? 1) Decreased access 2) Decreased cost of care 3) Decreased quality of care 4) Decreased safety Multiple Response Identify one or more choices that best complete the statement or answer the question. NURSINGTB.COM

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21. The hospital’s nurse case manager has been extensively involved with a shooting victim and members of the patient’s family in coordinating care of providers from many disciplines as the patient progressed from the emergency department (ED) to the intensive care unit (ICU), and then onto the medical-surgical unit. After three weeks of hospitalization, the case manager is helping to prepare the patient for discharge to a rehabilitation center where treatment will continue. Which outcomes have been documented in the literature as benefits of such collaboration? Select all that apply. 1) Improved patient outcomes 2) Decreased duplication of health-care services

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3) 4) 5)

Increased overall cost of health-care services Decreased patient morbidity and mortality Decreased level of job satisfaction

22. The case manager assembles a team of health-care professionals, including the patient’s primary health-care provider, physical therapist, and social worker, for the purpose of collaborative discharge planning and decision making. Which type of team did the case manager assemble? Select all that apply. 1) Management 2) Intradisciplinary 3) Interdisciplinary 4) Interprofessional 5) Primary nursing care 23. The nurse is preparing to document care provided to the patient during the day shift. The nurse documents that the patient experienced an increased pain level while ambulating which required an extra dose of pain medication; took a shower; visited with family; and ate a small lunch. Which information is important to include during the oral end-of-shift reporting? Select all that apply. 1) The last antibiotics given 2) The patient’s taking a shower 3) The patient’s visit with family 4) The extra dose of pain medication 5) The patient’s response to ambulation 24. When the nurse receives a telephone order from the health-care provider's office, which guidelines are used to ensure the order is correct? Select all that apply. 1) Ask the prescriber to speak slowly. 2) Read the order back to the prescN riU b eRr. SINGTB.COM 3) Know agency policy for telephone orders. 4) Sign the prescriber’s name and credentials. 5) Ask the prescriber to repeat or spell out medication. 25. When discussing the importance of interprofessional collaboration, which advantages should the nurse include? Select all that apply. 1) Improved team member satisfaction 2) Increased division among team members 3) Increased safety with medication administration 4) Enhanced communication among team members 5) Increased patient satisfaction with discharge transition process

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Chapter 2: Interprofessional Collaboration and Care Coordination Answer Section MULTIPLE CHOICE 1.

ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Exploring the role of the registered nurse in patient centered transitional care programs Chapter page reference: 017 Heading: Case Manager Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy Feedback 1 Collaboration means a collegial working relationship with other health-care providers to supply patient care. Collaborative practice requires the discussion of diagnoses and management in the delivery of care. 2 Case management involves one or more individuals overseeing the needs and requirements of a particular individual's health. 3 Health promotion activities include disease prevention and healthy lifestyle interventions. Health education would be included in this particular situation, but collaboration is a more inclusiNveUdReS finIitNioGn To fBw.hCatOisMoccurring with these individuals and the care they require. 4 Health promotion activities include disease prevention and healthy lifestyle interventions. Health education would be included in this particular situation, but collaboration is a more inclusive definition of what is occurring with these individuals and the care they require.

PTS: 1 CON: Collaboration 2. ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 010-011 Heading: The Care Transitions Program Integrated Processes: Communication and Documentation Client Need: Psychosocial NURSINGTB.COM

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Integrity Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 Telling the patient that the doctor only wants what is best sends the message that the patient does not know what is best, when, in fact, a well-informed patient does know what is best and should be able to make the correct choice. 2 By leaving the room, the nurse and doctor have turned their backs on the patient.

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3 4

The patient may not understand the recommendations, but pointing that out can be seen as demeaning. The patient is the center of the team, and the goal is to facilitate healing. There are always other options to consider to reach that goal. The nurse would discuss other options with the patient, which will most likely increase cooperation by the patient, who will feel in control as the decision is made.

PTS: 1 CON: Communication 3. ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Exploring the role of the registered nurse in patientcentered transitional care programs Chapter page reference: 011 Heading: The Care Transitions Program Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Collaboration Difficulty: Moderate Feedback 1 The therapy that the patient requires must be performed by a professional physical therapist. To teach the family exercises encroaches upon the expertise of the professional who will be performing the service. 2 Scheduling home PT is leaving the patient out of the decision-making process. 3 The nurse would not refer the patient for outp atient th erapy unless the N UR S I N G T B .C O M patient requests that form of therapy. 4 The nurse best exhibits the characteristic that the patient has a right to self- determination by presenting the methods available for PT and answering the patient's questions about each so the patient can make an informed decision. PTS: 1 CON: Collaboration 4. ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Identifying the roles of health-care professionals coordinating care for patients Chapter page reference: 015-019 Heading: Providers Integrated Processes: Nursing Process NURSINGTB.COM

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Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Analysis [Analyzing] Concept: Collaboration Difficulty: Hard Feedback 1 The patient with a chronic disease should not be told there is no hope but should be helped toward reaching desired goals. 2 Asking the patient the reason for the decision is irrelevant to the situation. 3 The nurse can teach some nutrition and exercise but cannot go into the depth that this patient would need.

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The number of patients with chronic diseases with health-care needs is increasing rapidly, and nurses and primary health-care providers cannot meet all of these patients’ needs. When a patient expresses the desire to live as normally as possible, the nurse should refer the patient to professionals who can help the patient meet that goal.

PTS: 1 CON: Collaboration 5. ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-015 Heading: Interprofessional Collaboration Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy Feedback 1 Trust occurs when an individual is confident in the actions of another individual. Both mutual respect and trust imply mutual process and outcome and may be expressed verbally or nonverbally. 2 Mutual respect occurs when two or more people show or feel honor or esteem toward one another. 3 Communication is necessary in effective collaboration; it occurs only if the involved parties are committed to understanding each other's professional roles and appreciating each other as individuals. 4 Decision making involves shared responsibility for the outcome. The team must follow specific steps of the decision-making process, beginning with a clear definition of the problem. Team decision making must be directed at the objectives of the effort and requires full consideration and respect for various and diverse viewpoints, and often requires guidance and direction from a group leader. PTS: 1 CON: Collaboration 6. ANS: 1 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Identifying the roles of health-care professionals coordinating care for patients Chapter page reference: 014-015 Heading: Interprofessional NURSINGTB.COM

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Education Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Legal Difficulty: Easy Feedback 1 Parameters for the delegation of patient care tasks by nurses to UAPs are established by each state's board of nursing. 2 This organization does not provide definitive answers regarding tasks that nurses can delegate to UAPs. 3 This individual does not provide definitive answers regarding tasks that nurses can delegate to UAPs.

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This individual does not provide definitive answers regarding tasks that nurses can delegate to UAPs.

PTS: 1 CON: Legal 7. ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-015 Heading: Interprofessional Collaboration Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy Feedback 1 Evidence does not suggest that the general population views nurses’ contributions to the care of patients as less important, thus this is not considered a primary barrier to nursephysician collaboration. 2 A primary and historical barrier to effective nurse-physician collaboration has been nurses’ and physicians’ perceptions of inequity in their roles, with nurses assuming a subservient role and medical providers perceiving their role to be superior in the provision of health-care services. 3 Likewise, because health professional students are in fact educated about the benefits of collaborative practice and published evidence has documented the effectiveness of collaboration in improving patient outcomes, these are not barriers to collaboration. 4 In addition, the federal government, as evidenced in particular by the Healthy People initiative, has promoted collaborative efforts among patients, nurses, physicians, other health-care providers, and the larger community to improve the health of the U.S. population. PTS: 1 CON: Collaboration 8. ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Identifying the roles of health-care professionals coordinating care for patients Chapter page reference: 017-018 Heading: Case Manager Integrated Processes: Nursing Process NURSINGTB.COM

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Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Collaboration Difficulty: Moderate Feedback 1 The pharmacy is not needed as part of the team at this time. 2 The patient’s needs and progress have changed. The nurse notifies the case manager to coordinate changes in care needed after discharge. This patient’s exercise program needs to be revamped, and the case manager is the individual to coordinate this change. 3 A physical therapist may be needed, but the nurse would coordinate care best by notifying the case manager.

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The occupational therapist mainly deals with the upper body areas needing rehabilitation.

PTS: 1 CON: Collaboration 9. ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Exploring unique patient situations requiring or enhanced by interprofessional collaboration Chapter page reference: 019-020 Heading: Unique Patient Situations Requiring or Enhanced by Interprofessional Collaboration Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Analysis [Analyzing] Concept: Management Difficulty: Difficult Feedback 1 The patient is included in the discussion of meeting goals. 2 The case manager monitors and works with the patient to alter the pathway as needed during the recovery process. 3 It is possible to have variances in a critical pathway that, if documented properly, should be paid for by insurance. 4 Care maps, or critical pathways, are flexible enough to be adjusted and tailored to the patient's needs and wishes. 10.

PTS: 1 CON: ManageNmUent R SINGTB.COM ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Describing models of transitional care Chapter page reference: 010-012 Heading: Evidence-Based Models of Transitional Care Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehensive [Understanding] Concept: Management Difficulty: Easy Feedback 1 Although the involvement of case managers in care typically provides NURSINGTB.COM

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2 3

11.

greater peace of mind for patients and family members, this is not the primary goal of this service. Toward this end, case managers not only with help to coordinate care and treatment during hospitalization, but also assist with planning for care following discharge. Their focus includes not only medical care, but issues related to health promotion and disease prevention, the cost of health care received, and planning for the efficient use of resources. Case managers coordinate patient care to help ensure that a continuum of clinical services is provided. The goal of case management is to improve patient outcomes and to help contain costs.

PTS: 1 ANS: 4

CON: Management

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Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Describing models of transitional care Chapter page reference: 010011 Heading: The Transitional Care Model Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy 1

3 4

12.

Feedback Intradisciplinary teams include members of the same profession. Interdisciplinary teams include professionals of varied backgrounds who share in decision making. Multidisciplinary teams include members of varied backgrounds, but treatment decisions are made by one member–usually the primary health-care provider. Intradisciplinary teams include members of the same profession. The term interprofessional team is synonymous with interdisciplinary team. Interdisciplinary teams include professionals of varied backgrounds who share in decision making. Multidisciplinary teams include members of varied backgrounds, but treatment decisions are made by one member–usually the primary health-care provider.

PTS: 1 CON: Collaboration ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Exploring unique patient situations requiring or enhanced by interprofessional NURSINGTB.COM collaboration Chapter page reference: 019-020 Heading: Unique Patient Situations Requiring or Enhanced by Interprofessional Collaboration Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration NURSINGTB.COM

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Difficulty: Easy Feedback 1 Interdisciplinary collaboration engages each professional’s contribution to joint care planning, implementation, and accomplishment of patient goals, with possibly less redundancy, more efficiency, and fewer care omissions. The parents of a minor child should be involved in all aspects of care and decision making. 2 Interdisciplinary collaboration engages each professional’s contribution to joint care planning, implementation, and accomplishment of patient goals, with possibly less redundancy, more efficiency, and fewer care omissions. The parents of a minor child should be involved in all aspects of care and decision making. 3 Interdisciplinary collaboration engages each professional’s contribution to joint care planning, implementation, and accomplishment of patient goals, with possibly less redundancy, more efficiency, and fewer care omissions. The parents of a minor child should be involved in all aspects of care and decision making.

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13.

PTS: 1 CON: Collaboration ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Describing models of transitional care Chapter page reference: 010011 Heading: The Transitional Care Model Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy 1 2

3 4

14.

Interdisciplinary collaboration engages each professional’s contribution to joint care planning, implementation, and accomplishment of patient goals, with possibly less redundancy, more efficiency, and fewer care omissions. The parents of a minor child should be involved in all aspects of care and decision making.

Feedback Intradisciplinary teams comprise members of the same profession working to achieve a common goal. A team comprising members from different disciplines that is focused on achieving a common goal is an interdisciplinary team. Their varying professional backgrounds helps to ensure that other perspectives are represented as the issue is considered. Multidisciplinary teams are more commonly teams whose members work more autonomously toward the common goal. Complementary is not a type of team, although team members’ efforts can be complementary and provide a broader perspective of issues.

PTS: 1 CON: Collaboration ANS: 1 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-014 Heading: Interprofessional Communication Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension NURSINGTB.COM

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[Understanding] Concept: Communication Difficulty: Easy Feedback 1 The type of communication and action used by this health-care team is parallel communication. It is at the lowest level along the continuum of communication and collaboration among health team members and is characterized by each professional communicating with the patient independently, asking the same or similar questions needed to develop their plan of care.

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3 4

15.

16.

The next level up on the continuum of communication and collaboration, but not described in this scenario, is parallel functioning. Here, communication is more coordinated, but each professional still develops separate interventions and care plans. In parallel functioning, the exchange of information among team members is more structured and planned, but decision making is unilateral and does not involve much collegiality. While there is an information exchange occurring, this is not the best description of the scenario. The actions of this NT team do not demonstrate coordination and consultation or comanagement and referral, the two highest levels of communication and collaborative action.

PTS: 1 CON: Communication ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-014 Heading: Interprofessional Communication Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 Waiting for the physician to arrive co uld cause th e patient to experience NU RS I N G T B. C O M a great deal of pain in the interim. 2 In this case reporting to the physician by telephone is appropriate. 3 The nurse cannot alter the dose of medication. 4 The nurse would address the patient's distress immediately and later include the event in the end-of-shift report to the oncoming nurse. PTS: 1 CON: Communication ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-014 Heading: Interprofessional Communication Integrated Processes: Communication and Documentation NURSINGTB.COM

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Client Need: Safe and Effective Care Environment – Safety and Infection Control Cognitive level: Comprehension [Understanding] Concept: Communication; Safety Difficulty: Easy Feedback 1 Handoff communication may be scrutinized during a lawsuit, but avoiding litigation is not a primary objective. 2 Ineffective communication is the primary cause of sentinel events, making patient safety the primary objective of the handoff communication process. 3 Analysis of handoff communication may be a quality improvement criterion, not a primary objective.

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17.

18.

Handoff communication may be verbal or written.

PTS: 1 CON: Communication | Safety ANS: 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-014 Heading: Interprofessional Communication Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 The choice of health-care professionals who are invited to attend the conference is based on the needs of the patient. 2 The choice of health-care professionals who are invited to attend the conference is based on the needs of the patient. 3 The choice of health-care professionals who are invited to attend the conference is based on the needs of the patient. 4 The choice of health-care professionals who are invited to attend the conference is based on the needs of the patient. Family members are an important part of the care plan conference, especially for patients who are unable to advocate for themselves. PTS: 1 CON: ManageNmUent R SINGTB.COM ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Discussing the importance of successful transitions for medical-surgical patients Chapter page reference: 009-010 Heading: Overview of Transitional Care Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy Feedback NURSINGTB.COM

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The safety of the patient is at risk during transitions between care settings, particularly following an acute hospitalization. The patient’s needs may go unmet, and there is the risk for medication errors and adverse clinical events; however, these are not the focus of an education session regarding readmission rates. Hospital readmission rates are often attributed to a lack of coordination of care as patients are discharged to rehabilitation facilities, long-term care agencies, or back to their homes; therefore, this should be the focus of the educational session. The safety of the patient is at risk during transitions between care settings, particularly following an acute hospitalization. The patient’s needs may go unmet, and there is the risk for medication errors and adverse clinical events; however, these are not the focus of an education session regarding readmission rates. The role of each member of the interdisciplinary team should not be the focus of an educational session to decrease hospital readmission rates.

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19.

20.

PTS: 1 CON: Management ANS: 2 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Discussing the importance of successful transitions for medical-surgical patient Chapter page reference: 009 Heading: Introduction Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Management Difficulty: Moderate Feedback 1 The pediatric patient population is not identified as a group where access to coordinated, safe, and focused care is lacking across care settings. 2 Access to care that is coordinated, safe, and focused on the patient’s unique needs across all care settings has eluded many patients, particularly the elderly and chronically ill. 3 The young adult patient population is not identified as a group where access to coordinated, safe, and focused care is lacking across care settings. 4 Patients requiring acute care is not identified as a group where access to coordinated, safe, and focused care is lacking across care settings. PTS: 1 CON: Management ANS: 2 NURSINGTB.COM Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Describing changes in the health-care landscape Chapter page reference: 009-010 Heading: Overview of Transitional Care Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Healthcare System Difficulty: Moderate NURSINGTB.COM

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1 2 3 4

Feedback Increased, not decreased, access is a basic principle of the Patient Protection and Affordable Care Act of 2010. Decreased cost of care is a basic principle of the Patient Protection and Affordable Care Act of 2010. Increased, not decreased, quality of care is a basic principle of the Patient Protection and Affordable Care Act of 2010. Increased, not decreased, safety is a basic principle of the Patient Protection and Affordable Care Act of 2010.

PTS: 1

CON: Healthcare System

MULTIPLE RESPONSE

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21. ANS: 1, 2, 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Describing models of transitional care Chapter page reference: 009010 Heading: Overview of Transitional Care Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Management Difficulty: Easy

3. 4.

Feedback This is correct. Research findings suggest that collaboration in health care among patients, family members, caregivers, and communities leads to improved patient outcomes, a reduction in duplicated health-care services, and a decrease in patient morbidity and mortality. This is correct. Research findings suggest that collaboration in health care among patients, family members, caregivers, and communities leads to improved patient outcomes, a reduction in duplicated health-care services, and a decrease in patient morbidity and mortality. This is incorrect. Research findings suggest that collaboration in health care among patients, family members, caregivers, and communities leads to a decreased, not increased, cost of care. This is in correct. Research findings suggest that collaboration in health care among patients, family members, caregivers, and communities leads to improved patient outcomes, a reduction in duplicated health-care services, and a decrease in patient morbidity and mortality. This is incorrect. Collaborative efforts have also been found to contribute to an enhanced sense of autonomy. ThisNiU ncRreSasIe NinGsTenBse.oCf OauMtonomy has been linked to nurses’ greater job satisfaction.

PTS: 1 CON: Management 22. ANS: 3, 4 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Describing models of transitional care Chapter page reference: 010011 Heading: The Transitional Care Model Integrated Processes: Nursing NURSINGTB.COM

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Process Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy

1. 2. 3.

Feedback This is incorrect. Management teams are executive-level teams that run the day-to-day operations of a corporation. This is incorrect. Intradisciplinary teams include members of the same profession. This is correct. Interdisciplinary teams include professionals of varied backgrounds who share decision making. The terms interprofessional team and interdisciplinary team are synonymous.

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4. 5.

This is correct. Interdisciplinary teams include professionals of varied backgrounds who share decision making. The terms interprofessional team and interdisciplinary team are synonymous. This is incorrect. A primary nursing care team includes a primary nurse and associate nurses who will provide care to a patient during a hospital stay.

PTS: 1 CON: Collaboration 23. ANS: 4, 5 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-014 Heading: Interprofessional Communication Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Analysis [Analyzing] Concept: Communication Difficulty: Difficult 1. 2. 3. 4. 5.

Feedback This is incorrect. Antibiotics are reflected on the medication administration record (MAR). This is incorrect. Taking a shower does not need to be reported, only documented. This is incorrect. Visiting with the family need not be mentioned at change of shift but should be documented. This is correct. The nurse would also report any as-needed medications given and when they were last given. NURSINGTB.COM This is correct. In order to provide for the patient’s safety, the nurse would pass on the patient’s response to ambulation so that the oncoming staff can take fall precautions.

PTS: 1 CON: Communication 24. ANS: 1, 2, 3, 5 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Defining interprofessional collaboration in the health-care setting Chapter page reference: 013-014 Heading: Interprofessional Communication Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application NURSINGTB.COM

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[Applying] Concept: Communication Difficulty: Moderate 1.

Feedback This is correct. When receiving a telephone order from a provider, the nurse should ask the prescriber to repeat or spell out the medication, to speak slowly, and read the order back to the prescriber once the prescription is complete. This is correct. When receiving a telephone order from a provider, the nurse should ask the prescriber to repeat or spell out the medication, to speak slowly, and read the order back to the prescriber once the prescription is complete. This is correct. It is also important for the nurse to know the agency’s policy regarding telephone orders.

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4. 5.

This is incorrect. The nurse does not sign the prescriber’s name and credentials; the nurse only transcribed the prescription and the prescriber countersigns it within a time period prescribed by the agency’s policy. This is correct. When receiving a telephone order from a provider, the nurse should ask the prescriber to repeat or spell out the medication, to speak slowly, and read the order back to the prescriber once the prescription is complete.

PTS: 1 CON: Communication 25. ANS: 1, 4, 5 Chapter number and title: 2, Interprofessional Collaboration and Care Coordination Chapter learning objective: Exploring unique patient situations requiring or enhanced by interprofessional collaboration Chapter page reference: 019-020 Heading: Unique Patient Situations Requiring or Enhanced By Interprofessional Collaboration Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Collaboration Difficulty: Moderate 1. 2. 3. 4. 5. PTS: 1

Feedback This is correct. Improved team member satisfaction is an advantage of interprofessional collaboration. This is incorrect. There is a decreased, not increased, division among team members with interprofessional collaboration. CO This is incorrect. There N is UinRcrSeaIsNedGsT afBet. y w ithMthe discharge transition process, not medication administration, with interprofessional collaboration. This is correct. Enhanced communication among team members is an advantage of interprofessional collaboration. This is correct. Increased patient satisfaction with the discharge transition process is an advantage of interprofessional collaboration. CON: Collaboration

Chapter 3: Cultural Considerations Multiple Choice NURSINGTB.COM

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Identify the choice that best completes the statement or answers the question. 1. The nurse is providing care to a Muslim patient who presents to the emergency department (ED) with abdominal pain and vaginal bleeding. The patient’s spouse asks that only a female examines the patient. Which is the most culturally appropriate statement by the nurse in response to this request? 1) “Your spouse will be covered so it will not matter what the gender of the examiner is.” 2) “The male and female providers here both respect privacy.”

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3) 4)

“Your request is unreasonable and cannot be honored at this time.” “Every attempt will be made to honor your request regarding the care of your spouse.”

2. The nurse is caring for a Chinese patient who is one day postoperative for abdominal surgery. The patient’s nonverbal cues indicate pain, but the patient denies the need for pain medication. Which action by the nurse is appropriate? 1) Seeking out a family member to convince the patient to take the medication 2) Consulting the health-care provider about administering medication without the patient’s knowledge 3) Offering the medication again stating that providing comfort is a priority 4) Allowing the patient to suffer in silence 3. The nurse is providing care to an infant who is experiencing colic. The infant’s family immigrated to the United States six months ago. The mother explains that she believes that an herbal remedy, prepared by the village doctor, is the best way to treat the infant’s colic. Which action by the nurse is most appropriate? 1) Ask the mother what the ingredients are in the remedy. 2) Give the mother an alternate remedy for colic. 3) Explain how herbal ingredients may be harmful to the infant. 4) Tell the mother not to use the remedy because there is no way to know what the ingredients’ scientific effect may be. 4. During a sexual history the patient states, “I have always felt like a man trapped in a woman’s body.” Which conclusion about the patient is potentially accurate? 1) Bisexuality 2) Heterosexuality 3) Homosexuality 4) Transgender NURSINGTB.COM 5. The nurse is working with a number of patients at a free clinic. Which population is at the highest risk for low levels of health care? 1) Immigrants 2) Adolescents 3) Older adults 4) Newborns 6. Which treatment program should the nurse include in the plan of care for a homeless client whose Type 1 diabetes mellitus (DM) requires daily insulin injections? 1) Home health care 2) Outpatient clinic 3) Partial hospitalization 4) Inpatient hospital-based care 7. The novice nurse working in an inner-city hospital that serves a diverse patient population states, “I want to NURSINGTB.COM

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learn everything possible about all of the patients.” Which response by the seasoned nurse is appropriate? 1) “I will give you a great book that describes all of the critical factors.” 2) “You should always be nonjudgmental.” 3) “This will come with time as you get to know clients and then encounter problems.” 4) “You need to first understand who you are.” 8. Which acculturation behavior will the nurse observe in a patient who has emigrated from Mexico to the United States? 1) The client buys all needed products from the local store owned by people from Mexico.

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2) 3) 4)

The client lives in a neighborhood that is populated predominantly with people from Mexico. The client speaks Spanish only. The client attends a church service in the neighboring community to meet new people.

9. A male nurse enters the room of a female patient to obtain the patient's vital signs. The patient’s spouse appears uncomfortable with the nurse and moves closer to the patient. Which action by the nurse is most appropriate? 1) Ask a female staff member to obtain the patient’s vital signs. 2) Ask the spouse to leave the patient’s room to obtain the vital signs. 3) Perform the intervention without discussion with the patient or spouse. 4) Explain the procedure to both the patient and the spouse. 10. The nurse is providing care to an adult patient from another country and notices that the patient consults with her mother on all health-care decisions. Which action by the nurse is the most appropriate? 1) Ask the patient why the parent is being consulted for every decision. 2) Accept the behavior of the patient and family member. 3) Ask the patient's mother to leave the room to provide the patient with more privacy. 4) Confront the patient’s mother to state the importance of the patient making her own decisions. 11. When preparing an in-service for staff nurses regarding health disparity, which definition should the nurse include in the presentation? 1) Factors that help explain why some people experience poorer health than others. 2) Describes the health of a person or community along with the many measures that contribute to this health. 3) Achieved when every person haN s tUh R e pIpoNrG tu T n iB ty.toCaOttaMin his or her health potential and no one is disadvantaged. 4) Differences in the incidence, prevalence, mortality rate, and burden of diseases that exist among specific populations. 12. Which of these should the nurse focus on to decrease health disparities among Hispanic patients? 1) Translation services 2) Nutritional education 3) Pediatric immunizations 4) Hypertension prevention 13. Which traditional Chinese medical treatment includes the insertion of needles into precise points along the channel system of flow of the qi? 1) Cupping 2) Moxibustion 3) Acupuncture 4) Skin pinching NURSINGTB.COM

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14. Which traditional Chinese medical treatment involves the use of a heated cup used to treat joint pain? 1) Cupping 2) Moxibustion 3) Acupuncture 4) Skin pinching 15. Which traditional Chinese medical treatment includes the application of heat from different sources to various points which allows medicine to be absorbed through the skin?

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1) 2) 3) 4)

Cupping Moxibustion Acupuncture Skin pinching

16. Which traditional Vietnamese medical treatment is used to treat a headache or sore throat? 1) Cupping 2) Moxibustion 3) Acupuncture 4) Skin pinching 17. A Vietnamese patient with a history of joint and muscle pain presents with large ecchymosis on the hips and legs. Which traditional Vietnamese medical treatment should the nurse inquire about when conducing the assessment? 1) Cao gio 2) Be bao or bar gio 3) Giac 4) Xong 18. Which patient population should the nurse plan care based on individualistic cultural attributes? 1) Canadian 2) Latino 3) Filipino 4) Hindu 19. Which patient population should the nurse plan care based on collectivistic cultural attributes? 1) British NURSINGTB.COM 2) Swedish 3) Norwegi an 4) Vietnam ese 20. When communicating with a patient who is of Vietnamese descent, which action by the nurse is appropriate? 1) Using the patient’s surname with a title 2) Being straightforward with the patient 3) Maintaining direct eye contact with the patient 4) Sharing intimate life details with the patient 21. Which nursing action is appropriate when conducting a cultural assessment for a patient? 1) Stereotyping concepts related to the patient’s culture 2) Evaluating the concepts in isolation from one another 3) Determining how each aspect of the patient’s culture interacts 4) Assuming that the patient believes all aspects of information related to the identified culture NURSINGTB.COM

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Multiple Response Identify one or more choices that best complete the statement or answer the question. 22. Which should the nurse consider when assessing for health disparities within the community? Select all that apply. 1) Age 2) Gender

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3) 4) 5)

Ethnicity Disability Education

23. The nurse is caring for several pediatric patients with numerous cultural backgrounds. Which patients would the nurse anticipate will be encouraged to express themselves? Select all that apply. 1) An Appalachian adolescent 2) A British school-age child 3) An Arab school-age child 4) An Asian-Indian adolescent 5) A Japanese pre-adolescent 24. The nurse is caring for several pediatric patients with numerous cultural backgrounds. Which patients would the nurse anticipate will be discouraged to express themselves? Select all that apply. 1) An Appalachian adolescent 2) A British school-age child 3) An Arab school-age child 4) An Asian-Indian adolescent 5) A Japanese pre-adolescent 25. Which health-care practices are anticipated when providing care to a patient of German descent? Select all that apply. 1) Traditional practices as the first line of defense 2) Self-medicating with over-the-counter drugs 3) Use of liberal pain medication 4) Use of medications ordered from other countries NaUaRn S 5) Mental health issues hold a stigm d aIrN e hGidTdBen.COM 26. Which health-care practices are anticipated when providing care to an Alaskan Native patient? Select all that apply. 1) Traditional practices as the first line of defense 2) Self-medicating with over-the-counter drugs 3) Use of liberal pain medication 4) Use of medications ordered from other countries 5) Mental health issues hold a stigma and are hidden 27. Which questions should the nurse ask when conducting an assessment to determine if the patient has any high-risk cultural behaviors? Select all that apply. 1) “Do you smoke tobacco products?” 2) “How many alcoholic beverages do you drink each day?” 3) “Who makes the health-care decisions within your family?” 4) “Do you use any herbal medications that we should be aware of?” 5) “Are there any foods you would like to include in your diet during hospitalization?”

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Chapter 3: Cultural Considerations Answer Section MULTIPLE CHOICE 1.

ANS: 4 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Distinguishing the cultural attributes of collectivistic and individualistic cultures Chapter page reference: 030-034 Heading: Individualism versus Collectivism Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate 1 2

3 4

Feedback The response of covering the client or stating the request is unreasonable shows insensitivity to the patient’s cultural need. Although both male and female staff have professional and ethical responsibilities to respect a patient’s privacy, the nurse must still make efforts to meet the request of the client. The response of covering the patient or stating the request is unreasonable shows insensitivity to the patient’s cultural need. Many cultures have religious bNeUlieRfsStI h aNt G p rTo hBib.itCeO x aMmination by men of the reproductive areas of a female. To provide culturally appropriate care, the nurse must recognize this as a legitimate request and make every attempt to honor this request.

PTS: 1 CON: Diversity 2. ANS: 3 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Distinguishing the cultural attributes of collectivistic and individualistic cultures Chapter page reference: 030-034 Heading: Individualism versus Collectivism Integrated Processes: Nursing Process – Implementation Client Need: Physiological Integrity - Basic Care and Comfort Cognitive level: Application [Applying] Concept: Comfort; Diversity Difficulty: Moderate Feedback NURSINGTB.COM

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Members of the Chinese culture will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Due to this belief, seeking out a family member to convince the patient to take the medication is inappropriate. It is unethical to administer a medication to a patient without his or her consent.

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Members of the Chinese culture will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Many people of this culture will consider refusal of something offered as a gesture of courtesy. The nurse should take these into account and offer the pain medication to the client. The nurse should make every effort to offer the patient pain medication but respect his or her decision.

PTS: 1 CON: Comfort | Diversity 3. ANS: 1 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Discussing elements of cultural assessment Chapter page reference: 026-028 Heading: Overview of Cultural Domains and Their Concepts Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 To recognize cultural practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is using, and then a m deat nernmeri.nation of the benefit or detriment to the infant can be made in a nonjudgmental NURSINGTB.COM 2 Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse. 3 Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse. 4 Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse. PTS: 1 CON: Diversity 4. ANS: 4 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Discussing elements of NURSINGTB.COM

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cultural assessment Chapter page reference: 026-028 Heading: Overview of Cultural Domains and Their Concepts Integrated Processes: Nursing Process – Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Diversity Difficulty: Easy Feedback 1 A bisexual individual prefers sexual relationships with both men and women.

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2 3 4

A homosexual individual prefers sexual relationships with individuals of the same gender. A heterosexual individual prefer sexual relationships with individuals of the opposite gender. A transgender individual is someone who identifies with a different gender than one assigned.

PTS: 1 CON: Diversity 5. ANS: 1 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Describing how health disparities impact the health and welfare of society Chapter page reference: 023-025 Heading: Health Disparities and the Need for Cultural Competence Integrated Processes: Nursing Process – Assessment Client Need: Health Promotion and Maintenance Cognitive level: Comprehension [Understanding] Concept: Diversity Difficulty: Easy Feedback 1 The term “vulnerable population” refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status. 2 While adolescents are often at risk for low levels of health care, this population isn’t at the greatest risk. 3 While older adults are often at risk fo r low lev e ls o f health care, this N U RS I N GT B . C O M population isn’t at the greatest risk. 4 While newborns are often at risk for low levels of health care, this population isn’t at the greatest risk. PTS: 1 CON: Diversity 6. ANS: 2 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Describing how health disparities impact the health and welfare of society Chapter page reference: 023-025 Heading: Health Disparities and the Need for Cultural Competence Integrated Processes: Nursing Process – Planning Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Health Care NURSINGTB.COM

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System Difficulty: Moderate Feedback 1 Because the patient is homeless, home health care would not be the best option in this situation. 2 The outpatient clinic would provide the care the patient requires in the most costeffective manner. 3 There is no indication for inpatient or partial hospitalization at this time. 4 There is no indication for inpatient or partial hospitalization at this time. PTS: 1

CON: Health Care System

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ANS: 4 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Identifying domains, concepts, and terminology essential to cultural assessment Chapter page reference: 025-026 Heading: Culture and Essential Terminology Integrated Processes: Culture and Spirituality Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. 2 Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. 3 Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory. 4 It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the client populations that are served.

PTS: 1 CON: Diversity 8. ANS: 4 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Identifying domains, concepts, and terminology essential to cultural assessment Chapter page reference: 025-026 NURSINGTB.COM Heading: Culture and Essential Terminology Integrated Processes: Nursing Process – Assessment Client Need: Psychosocial Integrity Cognitive level: Comprehension [Understanding] Concept: Diversity Difficulty: Easy Feedback 1 This behavior is an example of a patient who may feel comfortable only in the Mexican culture. 2 This behavior is an example of a patient who may feel comfortable only in the Mexican culture. NURSINGTB.COM

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3 4

This behavior is an example of a patient who may feel comfortable only in the Mexican culture. Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation.

PTS: 1 CON: Diversity 9. ANS: 4 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Describing the importance of culturally competent skills Chapter page reference: 026-028 Heading: Overview of Cultural Domains and Their Concepts Integrated Processes: Nursing Process – Implementation

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Client Need: Safe and Effective Care Environment – Management of Care Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Asking another staff member to obtain the patient’s vital signs is inappropriate. 2 The patient’s spouse should not be asked to leave the room unless the patient prefers this procedure to be done with privacy. 3 Performing an intervention without first discussing it and asking for permission may be interpreted as assault. 4 The nurse should explain the procedure to both the patient and the spouse prior to touching the patient.

10.

11.

PTS: 1 CON: Diversity ANS: 2 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Describing the importance of culturally competent skills Chapter page reference: 026-028 Heading: Overview of Cultural Domains and Their Concepts Integrated Processes: Nursing Process - Implementation Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate NURSINGTB.COM Feedback 1 This action is inappropriate and do not consider the patient’s cultural or family values. 2 The nurse should accept this behavior as a cultural norm. 3 This action is inappropriate and do not consider the patient’s cultural or family values. 4 This action is inappropriate and do not consider the patient’s cultural or family values. PTS: 1 CON: Diversity ANS: 4 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Describing how health disparities impact the health and welfare of society Chapter page reference: 023-025 Heading: Health Disparities and the Need for Cultural Competence Integrated Processes: Teaching and NURSINGTB.COM

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Learning Client Need: Health Promotion and Maintenance Cognitive level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Determinants of health is defined as factors that help explain why some people experience poorer health than others. 2 Health status is described the health of a person or community along with the many measures that contribute to this health. 3 Health equity is achieved when every person has the opportunity to attain his or her health potential and no one is disadvantaged.

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12.

PTS: 1 CON: Diversity ANS: 1 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Describing how health disparities impact the health and welfare of society Chapter page reference: 023-025 Heading: Health Disparities and the Need for Cultural Competence Integrated Processes: Nursing Process – Planning Client Need: Psychosocial Integrity Cognitive level: Analysis [Analyzing] Concept: Diversity Difficulty: Difficult 1

13.

Health disparity is defined as the differences in the incidence, prevalence, mortality rate, and burden of disease that exist among specific populations.

Feedback Health-care providers and policymakers need to target vulnerable subgroups of Hispanic seniors and identify areas of linguistic isolation to minimize these disparities; therefore, the nurse should focus on translation services to decrease noted health disparities for Hispanic patients. Nutritional education, pediatric immunizations, and hypertension prevention may all be appropriate; however, this is not the nurse’s focus to decrease health disparities for this population. Nutritional education, pediatric immunizations, and hypertension prevention may all be appropriate; however, this is nNotUthReSnIurNseG’sTfoc B .u sC tOo Mdecrease health disparities for this population. Nutritional education, pediatric immunizations, and hypertension prevention may all be appropriate; however, this is not the nurse’s focus to decrease health disparities for this population.

PTS: 1 CON: Diversity ANS: 3 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Distinguishing the cultural attributes of collectivistic and individualistic cultures Chapter page reference: 030-034 Heading: Individualism versus Collectivism Integrated Processes: Culture and Spirituality Client Need: Psychosocial Integrity NURSINGTB.COM

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Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Cupping is a traditional Chinese medical treatment where a heated cup or glass jar is put on the skin creating a vacuum, which causes the skin to be drawn into the cup. The heat that is generated is used to treat joint pain. 2 Moxibustion is the application of heat from different sources to various points. The localized erythema occurs with the heat from the burning substance and the medicine is absorbed through the skin.

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3 4

14.

15.

Acupuncture includes the insertion of needles into precise points along the channel system of flow of the qi. Skin pinching is traditional Vietnamese, not Chinese, medicine.

PTS: 1 CON: Diversity ANS: 1 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Distinguishing the cultural attributes of collectivistic and individualistic cultures Chapter page reference: 030-034 Heading: Individualism versus Collectivism Integrated Processes: Culture and Spirituality Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Cupping is a traditional Chinese medical treatment where a heated cup or glass jar is put on the skin creating a vacuum, which causes the skin to be drawn into the cup. The heat that is generated is used to treat joint pain. 2 Moxibustion is the application of heat from different sources to various points. The localized erythema occurs with the heat from the burning substance and the medicine is absorbed through the skin. 3 Acupuncture includes the insertion of needles into precise points along the channel system of flow of the qi. 4 Skin pinching is traditional Vietna m ese, not Chines e, medicine. NU R SI N GT B.C O M PTS: 1 CON: Diversity ANS: 2 Chapter number and title: 3, Cultural Considerations Chapter learning objective: Distinguishing the cultural attributes of collectivistic and individualistic cultures Chapter page reference: 030-034 Heading: Individualism versus Collectivism Integrated Processes: Culture and Spirituality Client Need: Psychosocial Integrity Cognitive level: Knowledge [Remembering] Concept: Diversity Difficulty: Easy Feedback 1 Cupping is a traditional Chinese medical treatment where a heated cup or glass jar is put on the skin creating a vacuum, which causes the skin to be drawn into the cup. The heat that is generated is used to treat joint pain. NURSINGTB.COM

TEST BANK FOR MEDICAL SURGICAL NURSING 2ND EDITION BY HOFFMAN

3 4

Moxibustion is the application of heat from different sources to various points. The localized erythema occurs with the heat from the burning substance and the medicine is absorbed through the skin. Acupuncture includes the insertion of needles into precise points along the channel system of flow of the qi. Skin pinching is traditional Vietnamese, not Chinese, medicine.

PTS: 1

CON: Diversity

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