Advanced Practice Nursing; Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
Chapter1 Introduction to the Role of Advanced Practices Nursing Multiple Choice
1. In which year did the American Association of College of Nursing (AACN) introduced the Doctorate of Nursing Practice (DNP)? a. b. c. d.
2006 2004 2000 2002
T AhNeSA ; ABCN introduced the DNP degree in 2004 to prepare advanced practice nurses (APRNs) to meet challenges and standardize practice beyond master’s degree programs.
2. Which of the following is the best explanation for the creation of the Doctorate of Nursing Practice (DNP) degree? a. b. c. d.
To compete against master’s degree programs To ensure standardized curriculum ensuring independent practice To validate APRN’s for financial reimbursement To address increasing curriculum requirements of master’s degree programs
ANS; D Although all answers are influenced by the DNP core competencies, the DNP program creation in 2004 by the AACN was designed to address curriculum requirements of master’s degree programs.
3. Which of the following was the first recognized area of advanced practice nursing? a. b. c. d.
Clinical Nurse Specialist Family nurse practitioner Pediatric nurse practitioner Certified Registered Nurse Anesthetist
ANS; D In 1931, the National Association of Nurse Anesthetists (NANA), renamed in 1939 to the American Association of Nurse Anesthetists (AANA) was the first recognized group promoting advanced nursing practice. Agatha Hodgins founded the AANM at Lakeside Hospital in Cleveland, Ohio.
4. Which factor is broadly perceived to solidify and standardize the role of the APNs over the last 25 years? a. b. c. d.
Lack of access to health care providers Standardized curriculum development Payment for services Societal forces
ANS; B As the evolution of Advanced Practice Nursing advances specific specialties and needs are identified. Through the evolution of organization and standardization these roles have solidified the APN’s role in today’s health care environment.
5. During the formation of early APN roles in anesthesia, which of the following increased demand for access to health care? a. b. c. d.
Poverty War Rural access to care Availability of training
ANS; B Earliest demand for nursing-provided anesthesia spiked during periods of war when numbers of physicians were inadequate. The earliest records date back to the American Civil War with the administration of chloroform. During World War I in 1917 more than 1000 nurses, some trained anesthetists, traveled into battle. Other factors such as need for rural health care came later in the validation and need for APNs. 6. In 1889, Dr. William Worrall Mayo built and opened St. Mary’s hospital in Rochester, NY. He is known for some of the earliest recruitment and specialized training of nurses in which of the following roles? a. b. c. d. e.
Pediatrics Anesthesia Obstetrics Research and statistics Family nursing
ANS; B In 1889, Dr. William Worrall Mayo began formally training and recognizing nurse anesthetists. This has been regarded as the earliest training in nurse-provided anesthesia.
7. In 1893, Lillian Wald established the Henry Street Settlement (HSS) House for which purpose? a. b. c. d.
Access to health care of rural areas Create inner-city nursing awareness Provide the disadvantaged access to care Establish guidelines for advanced nursing roles
ANS; C The HHS was established to provide nursing services to immigrants and low-income patients and their families in Manhattan. As resistance to nurse-provided care grew, standing orders were drafted from a group of Lower East Side physicians thereby circumventing then-existing legal ramifications.
8. The Frontier Nursing Service (FNS) founded in Kentucky in 1925 by Mary Breckenridge initially provided Appalachia with nursing resources and which type of advanced nursing care? a. b. c. d.
Pediatric care Anesthesia Midwifery Surgical services
ANS; C The original FNS provided nursing services and obstetric services to Appalachian residents. Later working from standard orders developed from their medical advisory committee nurses treated patients, made diagnoses, and dispensed medications. 9. Which organization founded in 1941 under Mary Breckenridge’s leadership merged with the American College of Nurse-Midwives (ACNM) in 1969? a. b. c. d.
American Association of Nurse-Midwives (AANM) American Nurses Association (ANA) Association for National Nurse-Midwifery (ANNM) Council of Nursing Midwifery (ANM)
ANS; A The American College of Nurse-Midwives (ACNM) formed under the leadership of Mary Breckenridge in 1941 to provide nurse-midwife development and collaboration for midwife
development. In 1955, the American College of Nurse-Midwives was formed and the two organizations merged in 1969 after the death of Mary Breckenridge.
10. In a landmark ruling by the Supreme Court as a result of Chalmers-Frances v. Nelson, 1936, what legal precedent was established? a. b. c. d.
Nurse anesthesia was allowed under the nurse practice act Nurse anesthesia scope of practice included anesthesia Nurse anesthesia was legal, if under guidance of a supervising physician Only trained nursing professionals could administer anesthesia independently
ANS; C The landmark decision from the Chalmers-Frances v. Nelson case set national precedent for the advanced nursing practice role. It proved to be the basis for other cases over the following few decades and established that trained nurses could legally provide anesthesia care under supervision of a physician.
11. The first known establishment of the nurse practitioner role occurred in 1965 at theUniversity of Colorado. In which area of training did this role specialize? a. b. c. d.
Pediatrics Geriatrics Midwifery Anesthesia
ANS; A The establishment of the first pediatric nurse practitioner program was in 1965 at the University of Colorado. Loretta Ford, RN and Henry Silver, MD provided a 4-month course to certified registered nurses to provide education on managing childhood health problems.
12. The DNP program curriculum outlined which of the following clinical requirements in an effort to standardize training? a. b. c. d.
1000 supervised clinical hours and 200 unsupervised clinical hours 1000 supervised clinical hours 900 supervised clinical hours 800 supervised clinical hours and 200 unsupervised clinical hours
ANS; B In 2004, the AACN outlined the DNP curriculum in an effort to standardize and relieve challenges of master’s degree programs. This includes a standardized curriculum requiring 1000 supervised clinical hours.
13. Which state became the first to recognize diagnosis and treatment as part of the scope of practice of specialty nurses? a. b. c. d.
Idaho Oklahoma South Dakota Maryland
ANS; A Idaho Governor Cecil Andrus signed HB 46 and HB 207 into law on February 11, 1971. This amended the states’ nurse practice act making it the first state to officially recognize diagnosis and treatment of specialty nurses. The recognition of the ability to diagnose and treat overcame an initial hurdle toward independent nursing practice.
14. The American Nursing Association (ANA) defines which requirement for the designation of a clinical nurse specialist in any specialty? a. b. c. d. e.
Specialty training certificate Successful completion of certification examination Masters or doctoral degree 1000 hours relevant supervised training Two or more years of clinically relevant experience
ANS; C In 1980, the ANA specifically outlined criteria for the acknowledgment of clinical nurse specialist training programs. At that time they required graduate level training to become an expert in a relevant specialty area of nursing. Additionally, they must meet any requirements set forth by the specific professional society. Chapter2 The Nurse Practitioner; Historical Perspective on the Art and Science of Nurse Practitionering 1. Which of the following is the primary mission of the National Organization of Nurse Practitioner Faculties (NONPF)? a. b. c. d.
Provide leadership in promoting quality NP education NP Faculty training program assistance Provide financial assistance to NP students Lobbying legislature on behalf of NPs
ANS; A The NONPF’s primary mission is to provide leadership in promoting quality NP education. The organization has published domains and core competencies for primary care and these serve as a framework for NP education and practice.
2. A model of competencies that are encompassed around three spheres of influence known as patient, nurses and nursing practice, and organization and influence is known as? a. b. c. d.
NACNS Model of clinical nurse specialist competencies Fenton’s and Brykczynski’s Expert Practice Calkin’s model of Advanced Nursing Practice Shuler’s Model of NP Practice
ANS; A The NACNS’s initial 2008 statement was revised in 2004. The statement outlined competencies that aligned to each of the three spheres of influence; patient, nurses and nursing practice, and organization and influence. 3. Building upon Benner’s seven domains of expert nursing practice, which conceptual model adds an additional domain “The consulting role of the nurse”? a. b. c. d. e.
Calkin’s model of Advanced Nursing Practice Fenton’s and Brykczynski’s Expert Practice Strong Memorial Hospital’s Model of Advanced Nursing Practice Shuler’s Model of NP Practice NACNS Clinical Nurse Specialists Model
ANS; B Fenton’s and Brykczynski’s Expert Practice Domains of the CNS and NP expanded on Benner’s seven domains adding consultation provided by CNS’s to other nurses and management of health and illness in ambulatory care settings.
4. Which model of conceptual practice was the first to explicitly distinguish the experience level of advanced practitioners? a. b. c. d. e.
Calkin’s model of Advanced Nursing Practice Shuler’s Model of NP Practice NACNS Clinical Nurse Specialists Model Strong Memorial Hospital’s Model of Advanced Nursing Practice Fenton’s and Brykczynski’s Expert Practice
ANS; A
Calkins model of Advanced Nursing Practice was the first to explicitly distinguish experience levels of advanced practitioners for nurse administrators to differentiate advanced practice nursing from other levels of clinical practice.
5. The circular and continuous threads of direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the five domains of which advanced nursing conceptual model? a. b. c. d. e.
Strong Memorial Hospital’s Model of Advanced Nursing Practice Calkin’s model of Advanced Nursing Practice NACNS Clinical Nurse Specialists Model Fenton’s and Brykczynski’s Expert Practice Shuler’s Model of NP Practice
ANS; A Direct and indirect activities across five domains including; direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the Strong Memorial Hospital’s Model of Advanced Practice Nursing. 6. Texas Children’s Hospital Transformational Advanced Professional Practice (TAPP) APRN Model added what unifying conceptual strand? a. b. c. d.
Ethics Culture Informatics Education
ANS; A The TAPP model added two additional domains; quality and safety, and credentialing and regulatory practice, to the Strong model. It additionally added professional ethics as a unifying conceptual strand.
7. Poghosyan, Boyd, and Clarke (2016) proposed a comprehensive conceptual model including three factors; scope of practice regulations, institutional policies, and practice environments. What was their primary purpose? a. b. c. d.
To discourage role ambiguity among CNS providers To enhance patient education provided by the APRN To maximize NP Contributions to primary care To provide educational practice guidelines to enhance NP education
ANS; C
The 2016 model provided a comprehensive review of literature and described potential factors that affect NP care and patient outcomes. This included scope of practice regulations that often cause barriers for NP provided primary care.
8. Which model of practice intended to impact the NP domain at four levels; theoretical, clinical, educational, and research in 1993? a. b. c. d.
Hamric’s model Calkin’s model of Advanced Nursing Practice Strong Memorial Hospital’s Model of Advanced Nursing Practice Shuler’s Model of NP Practice
ANS; D Shuler’s Model of NP Practice is a holistic and wellness oriented model that was designed to impact the NP domain at four levels; theoretical, clinical, educational, and research. It is designed to elaborate the NP’s expanded knowledge and skills into medicine including a template for conducting a visit.
9. Which model for APRN practice addresses all four APRN roles; CNS, CRNA, CNM, and NP? a. b. c. d.
Calkin’s model of Advanced Nursing Practice Hamric’s model Strong Memorial Hospital’s Model of Advanced Nursing Practice Donabedian Model
ANS; B Many models highlight core competencies among specific APRN roles, while others emphasize competencies for hiring managers. At the time of this writing, only the Hamric’s model encompasses all four APRN roles.
10. Which of the following is one of the eight published essentials included in the Essentials of Doctoral Education for Advanced Nursing Practice developed by the AACN in 2006? a. b. c. d.
Algorithms for advanced patient care Informatics and health care technologies Scientific underpinnings of practice Liberal education for general nursing practice
ANS; C The AACN publishes their national consensus to provide the core elements for nursing curriculum creation. Currently published are Baccalaureate Essentials, Master’s Essentials, DNP Essentials, and Clinical Resources Essentials. Although they are similar in their core approach to education, listed first in DNP essentials is the scientific underpinnings of practice.
11. Which model of conceptualization identifies that health care needs are not met in a system dominated by medical language as a basis for reimbursement? a. b. c. d.
Donabedian Model Dunphy and Winland-Brown’s Circle of Caring model Shuler’s Model of NP Practice Calkin’s model of Advanced Nursing Practice
ANS; B Dunphy and Winland-Brown’s transformative model (Dunphy, Winland-Brown, Porter, Thomas, and Gallagher, 2011; Fig. 2.12) proposed a circle of caring to encourage medical collaboration and enhance the nursing presence in the health care system. Their model incorporates both strengths of medicine and nursing with process of assessment, planning, intervention, and evaluation, with a feedback loop.
12. Without additional application of conceptual models which model would be best chosen to model the skill level of beginning nurses, experienced nurses, or advanced nurse practitioners with the appropriate level of patient care? a. b. c. d.
Dunphy and Winland-Brown’s Circle of Caring model Strong Memorial Hospital’s Model of Advanced Nursing Practice Donabedian Model Calkin’s model of Advanced Nursing Practice
ANS; D Calkin’s model of Advanced Nursing Practice outlines skills and knowledge of beginning nurses, experienced nurses, and advance practice nurses as they relate the patient responses for health care problems.
13. The 2005 Donabedian model has been used to evaluate the quality of APRN care using which conceptual outline? a. b. c. d.
Assessment, diagnosis, planning, intervention, and evaluation Structure, process, and outcome Diagnosis and outcome Diagnosis, morbidity, and mortality
ANS; D The Donabedian model encompasses structure (health care systems and facilities), process (diagnosis, treatment, education), and outcomes.
14. Which of the following are the functions of a conceptualization ofadvanced practice nursing? (Select all that apply.) a. b. c. d. e.
Basis for furthermore development of knowledge Articulate professional role identity and function Identify specific procedures to provide Deliver holistic and collaborative care Provide guidelines on billing
ANS; A, B, D Conceptual models allow for articulation of professional role identity, provide a basis for furthermore development of knowledge and assist in clinical practice for the delivery of holistic, comprehensive, and collaborative care. Models may assist but in general do not provide assistance with clinical decision making or billing. Test Bank Multiple Choice
15. A registered nurse completes an informal education and training course at his or her place of work authorizing him or her to use ultrasound guided imagery when placing intravenous lines. How is this best classified? a. b. c. d.
Advanced practice nursing Nursing Skill Advancement Advanced Licensure Advanced Certification
ANS; B The addition or advancement of individual skills to the nursing practice is common and encouraged but does not meet the requirements set forth for advanced practice nursing. Licensure and certification were not obtained or expressed.
16. The core foundations of all APN education curricula contain advanced courses covering which of the following? a. b. c. d.
Human anatomy, health and physical assessment, and pharmacology Pathophysiology, research, and pharmacology Health and physical assessment, pathophysiology, and obstetrics and gynecology Pathophysiology, health and physical assessment, and pharmacology
DIF; Cognitive Level; Comprehension REF; p. 99 OBJ; Theory #1 TOP; Verbal Communication Feedback KEY; Nursing Process Step; Assessment MSC; NCLEX; Physiological Integrity; basic care and comfort 3. The nurse recognizes the patient who demonstrates communication congruency when the patient; a. smiles and laughs while speaking of feeling lonely and depressed. b.
wrings her hands and paces around the room while denying that she is upset.
c.
is tearful and slow in speech when talking about her husbands death.
d. states she is comfortable while she frowns and her teeth are clenched. ANS; C Congruent communication is the agreement of verbal and nonverbal messages. DIF; Cognitive Level; Comprehension REF; p. 99 OBJ; Theory #1 TOP; Congruence KEY; Nursing Process Step; Assessment MSC; NCLEX; Physiological Integrity; basic care and comfort 4. A Hispanic patient approaches the Asian nurse and, standing very close, touches the nurses shoulder during their conversation. The nurse begins to step back to 18 to 24 inches, while smiling and nodding to the patient. This situation is most likely an example of; a. the nurses need to maintain a professional role rather than a social role. b.
a patients attempt to keep the nurses attention.
c.
a nurses need to establish a more appropriate location for conversation.
d. a difference in culturally learned personal space of the nurse and the patient. ANS; D Personal space between people is a culturally learned behavior; Asians, North American natives, and Northern European people generally prefer more personal space than people of Hispanic, Southern European, or Middle Eastern cultures. DIF; Cognitive Level; Comprehension REF; p. 100 OBJ; Theory #2 TOP; Cultural Differences KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 5. A nurse says to a patient, I am going to take your TPR, and then Ill check to see whether you can have a PRN analgesic. In considering factors that affect communication, the nurse has; a. used terminology to clearly inform the patient of what she is doing. b.
given information that is unnecessary for the patient to know.
c.
used medical jargon, which might not be understood by the patient.
d. taken into consideration the patients need to know what is happening. ANS; C Medical jargon such as abbreviations or medical terminology is often misunderstood, even by well-educated people. DIF; Cognitive Level; Comprehension REF; p. 101 OBJ; Theory #3 TOP; Blocks to Communication KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 6. A nurse using active listening techniques would;
a.
use nonverbal cues such as leaning forward, focusing on the speakers face, and slightly nodding to i message has been heard.
b.
avoid the use of eye contact to allow the patient to express herself without feeling stared at or deme
c.
anticipate what the speaker is trying to say and help the patient express herself when she has difficu sentence.
d. ask probing questions to direct the conversation and obtain the information needed as efficiently as ANS; A Eye contact is a culturally learned behavior and in some cases may not be appropriate. Probing questions or finishing the patients sentence is not part of active listening and is detrimental to an interview. DIF; Cognitive Level; Comprehension REF; p. 101 OBJ; Theory #3 TOP; Active Listening KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 7. When the patient says, I dont want to go home, the nurses best therapeutic verbal response would be; a. Im sure everything will be fine once you get home. b.
You dont want to go home?
c.
Doesnt your family want you to come home?
d. I felt like that when I had surgery last year. ANS; B The use of reflecting encourages the patient to expand on his or her feelings or thoughts. DIF; Cognitive Level; Application REF; p. 103, Table 8-1 OBJ; Theory #3 TOP; Communication Techniques KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 8. To begin talking with a newly admitted patient about pain management, the nurse would most appropriately state; a. You look pretty comfortable. Are you having any pain? b.
Tell me about the pain youve been having.
c.
Is this pain the same as the pain you had yesterday?
d. Dont worry; this pain wont last forever. ANS; B An open-ended question allows the patient to express his or her feelings or needs. DIF; Cognitive Level; Application REF; p. 103, Table 8-1 OBJ; Theory #3 TOP; Communication Techniques KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 9. When a patient begins crying during a conversation with the nurse about the patients upcoming surgery for possible malignancy, the nurses most therapeutic response would be; a. Your surgeon is excellent, and I know hell do a great job. b.
Oh, dear, your gown is way too big, let me get you another one.
c.
Dont cry; think about something else and youll feel better.
d. Here is a tissue. Id like to sit here for a while if you want to talk. ANS; D Offering self, or presence, and accepting a patients need to cry is supportive. DIF; Cognitive Level; Application REF; p. 103, Table 8-1 OBJ; Theory #3 TOP; Therapeutic Techniques KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 10. To enhance the establishment of rapport with a patient, the nurse should; a. identify himself by name and title each time he introduces himself. b.
share his own personal experiences so that the patient gets to know him as a friend.
c.
act in a trustworthy and reliable manner; respect the individuality of the patient.
d. share information with the patient about other patients and why they are hospitalized. ANS; C Trust and reliability, as well as conveying respect for the individual, all promote rapport. Identifying oneself is important but in itself does not promote rapport. Sharing personal experiences or divulging the confidential nature of other patients conditions is not appropriate in the nursepatient relationship. DIF; Cognitive Level; Comprehension REF; p. 107 OBJ; Clinical Practice #2 TOP; Rapport KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 11. The nurse explains that the therapeutic nursepatient relationship differs from the social relationship because; a. a social relationship does not have goals or needs to be met. b.
the nursepatient relationship ends when the patient is discharged.
c.
the focus is mainly on the nurse in the nursepatient relationship.
d. a social relationship does not require trust or sharing of life experiences. ANS; B The nursepatient relationship is limited to the patients stay in the facility and is focused on the patient. A social relationship may have goals or needs and does require trust and sharing of life experiences. DIF; Cognitive Level; Comprehension REF; pp. 106-107 OBJ; Theory #4 TOP; Relationships KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 12. The nurse has selected an outcome for the patient to eat all of the food on the breakfast tray each day. Assessing that the patient has eaten all of the breakfast, the nurse would give positive feedback by saying; a. Wow! That breakfast must have been pretty good. b.
I like pancakes too. Everyone on the hall seemed to enjoy them.
c.
I hope you can keep all that breakfast down.
d.
Hurray! You finished your whole meal! What would you like for tomorrow?
ANS; D Giving positive feedback increases the likelihood of the desired behavior to be repeated. Commenting on the tastiness of the food or the fact that others liked it is not responding directly to the patients having eaten the whole meal. DIF; Cognitive Level; Application REF; p. 100 OBJ; Theory #9 TOP; Positive Feedback KEY; Nursing Process Step; Implementation MSC; NCLEX; Physiological Integrity; basic care and comfort 13. A 67-year-old woman had major abdominal surgery yesterday. She has IV lines, a urinary catheter, and an abdominal wound dressing, and she is receiving PRN pain medication. The endof-shift report that best conveys the patient status is; a. Doing great, was up in the chair most of the day. No complaints of pain or discomfort. Voiding ade b.
Abdominal surgery yesterday, dressing is dry and intact, her IVs are on time and shes had pain med stable.
c.
Abdominal dressing dry, IVs800 mL left in #6; NS running at 125 mL/hr; urine output 800 mL this 15 mg for pain at 8;00 AM and at 1;30 PM. Shes comfortable now. Vital signs are stable, no fever.
Unchanged since this morning. She wanted to know how soon she can have something to eat, so ma d. check with her doctor this evening. Her husband has been visiting all day and will let you know if s ANS; C This brief clear report addresses the major concerns of the abdominal dressing, the status of the IV fluids, vital signs, and analgesia needs. DIF; Cognitive Level; Application REF; pp. 109-110 OBJ; Clinical Practice #4 TOP; Shift Report KEY; Nursing Process Step; Implementation MSC; NCLEX; Safe Effective Care Environment; coordinated care 14. An aspect of computer use in patient care in which the LPN may need to be proficient includes; a. input of data such as requests for radiographs or laboratory services. b.
programming the computer to record data from physicians and other health care workers.
c.
teaching patients how to use hospital computers to access information such as discharge instruction relative to specific medications.
d. scheduling admissions, discharges, and nurse staffing to keep the unit at the best occupancy and uti ANS; A Many facilities use computers for data entry relative to requesting radiograph or lab services and physical assessment and medication administration. Programming such computers is not a nursing task, and patients need to have individualized information about discharge and medications. DIF; Cognitive Level; Knowledge REF; pp. 110-111 OBJ; Theory #8 TOP; Computer Use KEY; Nursing Process Step; N/A MSC; NCLEX; N/A 15. A patient with a nursing diagnosis of Sensory perception, disturbed auditory, would most appropriately require the nurse to; a. obtain a sign language interpreter when a family member is unavailable. b.
speak slowly and distinctly, but not shout.
c.
provide bright lighting without glare and orient frequently.
d. reorient frequently to time, place, staff, and events. ANS; B A patient with disturbed auditory perception cannot hear well (or at all); therefore, speaking slowly and distinctly without shouting increases patient comprehension. DIF; Cognitive Level; Application REF; pp. 107-108 OBJ; Clinical Practice #3 TOP; Hearing-Impaired Patient Communication KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 16. When an office nurse asks the patient to repeat information that he has just given to the patient over the telephone, the nurse is; a. testing the patients intelligence and memory. b.
acting in a cautious way to avoid charges of negligence.
c.
verifying that the patient understands the information.
d. saving the extra time it would take to mail the information. ANS; C Obtaining feedback from a patient to ascertain that the patient understands instructions is an important part of the communication process, especially over the phone, when the nurse does not have nonverbal cues. DIF; Cognitive Level; Comprehension REF; pp. 100-101 OBJ; Theory #3 TOP; Telephonic Communication KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 17. A 36-year-old woman who is in traction for a fractured femur that she received in an auto accident is found crying quietly. The nurse can best address this situation by saying; a. Whats the matter? Why are you crying? Are you in pain? b.
Stop crying and tell me what your problem is.
c.
This could have been much worse. Youre lucky no one was killed.
d. You are upset. Can you tell me whats wrong? ANS; D The nurse offers a general lead as to what is causing the distress. The other options are judgmental or clichs or offer no opportunity for the patient to express feelings. DIF; Cognitive Level; Application REF; p. 103, Table 8-1 OBJ; Theory #3 TOP; Reflecting Observations KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 18. When the nurse is giving direction to a nursing assistant who is being delegated part of the patient care, the nurses most effective direction would be; a. Do the morning care first on the patients in 205 and 206 who cant get out of bed. b.
You take care of all the patients in 205 and 206. Let me know how youre doing and whether you ne
c.
Give the patient in 204A a shower after breakfast, and call me to check her feet before you get her d
d.
Take the vital signs on all the patients in the lounge and tell me whether there are problems.
ANS; C The clarity and brevity of the direction makes the delegated task clear and leaves the responsibility of assessment to the nurse. DIF; Cognitive Level; Application REF; p. 110 OBJ; Theory #7 TOP; Delegation KEY; Nursing Process Step; Planning MSC; NCLEX; Safe Effective Care Environment; coordinated care 19. When the patient says, I get so anxious just lying here in this hospital bed. I have a million things I should be doing at home, the most empathetic response would be; a. Id feel the same way you do. I know just what youre going through. b.
It sounds like youre having a tough time dealing with this situation.
c.
Its always darkest before the dawn. Hang in there; it will get better.
d. You sound pretty sorry for yourself. Why dont you look at the positives? ANS; B Empathy recognizes a patients situation and encourages expression of feelings. DIF; Cognitive Level; Application REF; p. 107 OBJ; Theory #3 TOP; Empathy KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 20. A patient asks the nurse, What would you do if you had cancer and had to choose between surgery and chemotherapy? The reply that can best help the patient is; a. If I were you, I would choose surgery and then consider chemo afterward. b.
What solutions have you considered?
c.
I would talk it over with my friends first.
d. I dont know. Im glad it isnt my decision. ANS; B Nurses can help by reminding patients of alternatives open to them and should refrain from giving advice but can encourage the patient to consider options. The nurse may be glad not to face a decision a patient must, but it is not helpful to the patient to say this. DIF; Cognitive Level; Application REF; p. 103, Table 8-1 OBJ; Theory #3 TOP; Offering Alternatives KEY; Nursing Process Step; Implementation MSC; NCLEX; Psychosocial Integrity; coping and adaptation 21. The nurse chooses to use touch in the nursepatient relationship because touch; a. can convey caring and support when words are difficult. b.
should be avoided because of problems of cultural misinterpretation.
c.
is appropriate only in special circumstances, such as with young children.
d. is a nursing intervention of choice in almost all situations. ANS; A Touch is a powerful and supportive nonverbal communication in many situations. It is appropriate for all ages, but not in some situations. Careful assessment of the patients situation and cultural values should determine its use, but it should not be avoided because of stereotypes. DIF; Cognitive Level; Comprehension REF; p. 103 OBJ; Theory #4 TOP; Caring Touch KEY; Nursing Process Step; Implementation