(Test Bank) Contemporary Medical-Surgical Nursing

Rick, Nicoll, Leslie, 2

Nursing

Test Bank

2nd Edition

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Test Bank for Contemporary Medical-Surgical Nursing, The downloadable file consists of 382 pages, and the total size of the file is 4.78 MB. Purchase now only for highly discounted price.

Author(s): Rick, Nicoll, Leslie

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Study Note Preview

Chapter 1--The Health Care System and Contemporary Nursing MULTIPLE CHOICE 1.The nurse ensures that a client’s bedspace is neat and clean with the call light within easy reach. The nurse is focusing on which nursing theorist who realized the importance of the environment for care? 1.Florence Nightingale 2.Sister Callista Roy 3.Dorothea Orem 4.Martha Rogers ANS:1 Florence Nightingale’s theory focused on the environment for care. Sister Callista Roy’s model is based in systems theory and an individual’s ability to adapt. Dorothea Orem’s model is the self-care deficit theory. Martha Roger’s model is the science of unitary human beings. PTS:1DIF:Apply REF:Emergence of Contemporary Nursing in the United States 2.The nurse is instructing a client on self-administration of insulin so that the client will not need a health care provider to do this activity. The nurse is implementing which of the following aspects of Virginia Henderson’s theory of nursing? 1.A caring relationship 2.Helping the client achieve independence from the nurse’s assistance as quickly as possible 3.Integration of objective and subjective data 4.Application of critical thinking ANS:2 Virginia Henderson’s theory of nursing is to help people achieve health or a peaceful death so that they can be independent from the nurse’s assistance as quickly as possible. A caring relationship, integration of objective and subjective data, and application of critical thinking are included in the American Nurses Association’s essential features of professional nursing. PTS:1DIF:Analyze REF:Emergence of Contemporary Nursing in the United States 3.A client tells the nurse that he has an HMO for his health insurance. The nurse understands that the purpose of this type of health plan is to: 1.ensure payment is made to Medicare for services rendered. 2.maximize the utilization of health care resources. 3.efficiently manage costs while providing quality care. 4.focus on the illness when providing care. ANS:3 Health maintenance organizations (HMOs) were created to efficiently manage health care costs while providing quality care. An HMO is a type of managed care plan with the goal of providing wellness care and not focusing on the illness during the provision of care. HMOs do not ensure payment is made to Medicare for services rendered. HMOs also do not maximize the utilization of health care resources but rather uses financial incentives to decrease care costs. PTS:1DIF:UnderstandREF:Cost of Care4.A client tells the nurse that he does not have a primary care physician but rather makes an appointment with a doctor who specializes in the area in which he is experiencing a problem. The nurse realizes this client is at risk for which of the following? 1.Fragmented care 2.Overpayment of services 3.Inability to sustain health 4.Finding an appropriate general practitioner ANS:1 In the 1980s, the close and trusting relationship between an individual and the individual’s physician waned and was replaced by acquaintances with specialists based upon particular health care problems. These episodes of care cause fragmentation of care. The client who utilizes specialists is not at risk for overpayment of services, the inability to sustain health, or finding an appropriate general practitioner. PTS:1DIF:AnalyzeREF:Providers of Care 5.The nurse is attending a master’s degree program in efforts to be educationally prepared to serve as a hospital leader. The nurse realizes that this educational preparation will: 1.hinder the nurse’s ability to work with physicians. 2.be viewed as not supporting the profession of nursing by other nurses. 3.ensure the nurse is biased towards clinicians’ interests. 4.prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. ANS:4 The nurse is attending an educational program to serve as a hospital leader. This education will prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. This education will not hinder the nurse’s ability to work with physicians. This education will not be viewed as unsupportive to the profession of nursing. The education will ensure that the nurse is not biased towards clinicians’ interests. PTS:1DIF:AnalyzeREF:Clinical Systems Leadership 6.A client tells the nurse that all hospitals care about is doing the minimum for a client regardless of the outcome. Which of the following should the nurse respond to this client? 1.“It does feel like that sometimes.” 2.“Health insurance companies have caused this problem.” 3.“The doctors will get paid regardless of the clients’ outcomes.” 4.“There are quality programs in place to make sure clients receive the best quality of care regardless of the cost.” ANS:4 In response to concerns about safety and quality of care voiced by clients and providers, total quality management and continuous quality improvement programs were initiated. These programs ensure society that cost management is not compromising safety or quality. This is what the nurse should respond to the client. The other choices do not address the client’s concerns nor do they explain quality management programs. PTS:1DIF:ApplyREF:Quality Measure Shift 7.The nurse is providing care at a time that is the most beneficial to the client. The nurse is implementing which of the following Joint Commission Dimensions of Quality Performance? 1.Safety 2.Timeliness 3.Efficiency4.Availability ANS:2 The dimension of timeliness means the degree in which interventions are provided at the most beneficial time to the client. Safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. Efficiency means the degree in which care has the desired effect with a minimum of effort, waste, or expense. Availability means the degree in which appropriate interventions are available to meet the client’s needs. PTS:1DIF:Analyze REF:Box 1-1 Joint Commission Dimensions of Quality Performance 8.The nurse is providing care while adhering to safety as a Joint Commission Dimension of Quality Performance. Which of the following did the nurse provide to the client? 1.Using a needleless device when providing intravenous medications 2.Keeping the siderails of the bed in the down position after providing a pain medication to a client 3.Having the client sit in a wheelchair with the wheels in the unlocked position 4.Placing cloth towels over a spill in the room of an ambulatory client ANS:1 The dimension of safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. The nurse who uses a needleless device when providing intravenous medications is adhering to this dimension. Keeping the siderails in the down position is not a safe practice. Having a client sit in a wheelchair with the wheels unlocked is not a safe practice. Placing cloth towels over a spill in the room of an ambulatory client is not a safe practice. PTS:1DIF:Analyze REF:Box 1-1 Joint Commission Dimensions of Quality Performance 9.The nurse is planning and providing care while adhering to the American Nurses Association definition of professional nursing. Which of the following does the nurse include when implementing client care? 1.Follows the NANDA nursing diagnoses process 2.Integrates objective and subjective data 3.Respects cultural diversity of peers 4.Acknowledges the experience and training of physicians ANS:2 The American Nurses Association acknowledges six essential features of professional nursing. These include: 1) a caring relationship, 2) attention to the full range of human health and illness experiences, 3) integrates objective and subjective data, 4) applies scientific knowledge and critical thinking, 5) advances nursing knowledge through scholarly inquiry, and 6) promotes social justice. The nurse integrating objective and subjective data is implementing one of the six essential features of professional nursing. The other choices are not essential features of professional nursing. PTS:1DIF:Analyze REF:Emergence of Contemporary Nursing in the United States 10.The nurse has shifted her practice from an illness focus to a health focus. Which of the following has this nurse implemented? 1.Standardized care plans 2.Critical pathways 3.Instructing a client on relaxation techniques to aid with sleep4.Holding around-the-clock medication when a client is asleep ANS:3 The use of client education as a strategy to attain and maintain the potential for health is an example of the shift of care from an illness focus to a health focus. The nurse instructing a client on relaxation techniques to aid with sleep is implementing a health focus of care. The other choices do not support the shift from an illness focus to a health focus. PTS:1DIF:AnalyzeREF:Leadership 11.A client is admitted with a highly communicable disease. The nurses do not want to participate in the care of this client. Which of the following should be done to ensure the client receives the highest quality of care? 1.Adhere to strict standard precautions. 2.Plan to have the client transferred to another health care organization. 3.Ask the physician if the client can be cared for in the home. 4.Suspend the nurses without pay who refuse to care for the client. ANS:1 When providing care in a highly global environment, the risks of communicable diseases increases. In the event that a client is admitted with a highly communicable disease and the nurses are fearing for their own health and safety, the only safe approach is to ensure all staff adhere to strict standard precautions. The other choices do not ensure that the client will receive the highest quality of care. The nurses must learn emotional intelligence and resolve issues under fire. PTS:1DIF:AnalyzeREF:Globalization 12.The nurse has been an employee of an organization for 2 years and is considering a job change. Which of the following does this nurse’s plan suggest to any future employers? 1.The nurse moves to other jobs too frequently. 2.The nurse is inflexible. 3.The nurse is searching for a more challenging environment with career opportunities. 4.The nurse is willing to sacrifice home and personal life for a job. ANS:3 At one point in time, job changes every 2 or 3 years was considered a red flag for employers. This does not hold true today. The nurse who changes jobs every 2 or 3 years is interested in career advancement and success. Creativity is valued and opportunities are desired. Moving to another job in 2 to 3 years does not mean the nurse is inflexible. The new generation of nurses does not want to sacrifice home and personal life for a job. PTS:1DIF:AnalyzeREF:Care Delivery Models 13.The nurse is experiencing pain and fatigue in both arms when using the computer to document client care. Which of the following can the nurse do to reduce these symptoms? 1.Refuse to use the computer and document using a pen and paper. 2.Stand up when using the computer. 3.Adjust the keyboard and chair to reduce the pressure on the wrists and arms. 4.Ask another nurse to input the information for client care activities. ANS:3Ergonomic hazards are increasing with health care providers and nurses in particular. Many of these hazards are because of the implementation of computers for documentation. The nurse should adjust the keyboard and chair to reduce the pressure on the wrists and arms when documenting with the computer. The nurse cannot refuse to use the computer. Standing up may not reduce the nurse’s symptoms. The nurse cannot legally ask another nurse to document client care. PTS:1DIF:ApplyREF:Ergonomic Hazards MULTIPLE RESPONSE 1.The nurse is planning care for a client and reviewing appropriate educational materials to use for discharge instructions. Which domains of nursing is this nurse implementing? (Select all that apply.) 1.Nursing process 2.Clinical practice 3.Education 4.Literature 5.Administration 6.Research ANS:2, 3 The four domains of nursing are: 1) clinical practice, 2) education, 3) administration, and 4) research. When the nurse plans care for a client, the domain being implemented is clinical practice. When reviewing appropriate educational materials to use for discharge instructions, the domain being implemented is education. The nurse is not utilizing the domains of research or administration. Nursing process and literature are not domains of nursing. PTS:1DIF:Apply REF:Emergence of Contemporary Nursing in the United States 2.The nurse suspects that another health care colleague may be chemically dependent when which of the following is assessed? (Select all that apply.) 1.Prolonged work “breaks” 2.Clinical care omissions 3.Mood stability 4.Extraordinary accomplishments 5.Heavy use of fragrances 6.Inability to recall recent events ANS:1, 2, 4, 5, 6 Clues of possible chemical dependency include tardiness, late sick calls, frequent or prolonged work “breaks,” inability to recall recent events, heavy use of fragrances, clinical care omissions or errors, patient complaints or requests for a change in care provider, mood instability, and extraordinary accomplishments. Mood stability is not a characteristic of a colleague who is experiencing chemical dependency. PTS:1DIF:Apply REF:Box 1-6 Clues to the Possibility of Chemical Dependence 3.The nurse is a member of a health care team that includes a physician and other health care providers. These providers work together to ensure the client is relieved of suffering, has diseases cured, and experiences enhanced health and performance. Which of the following are the levels of care represented by this team of health care providers? (Select all that apply.) 1.Sustain life 2.Maintain health3.Regain health 4.Minimize injury 5.Maximize cost 6.Attain enhanced health ANS:1, 2, 3, 6 The medical team’s mission is to relieve suffering and cure disease. This involved the three levels of care: 1) sustain life, 2) regain health, and 3) maintain health. Once the shift toward health care occurred, the fourth level of attaining enhanced health was added. Minimize injury and maximize cost is not a level of care. PTS:1DIF:AnalyzeREF:Providers of Care 4.A client tells the nurse that she is disappointed that her employer is offering a health maintenance organization for a health care benefit. Which of the following can the nurse use as responses to the client as advantages of this type of health plan? (Select all that apply.) 1.“Since there is a nursing shortage, clients need to stay out of the hospital.” 2.“This type of plan provides wellness care at a minimal cost to keep people healthy.” 3.“This type of plan helps clients avoid illnesses with high costs.” 4.“An HMO standardizes diagnostic and treatment decisions across the nation.” 5.“This type of plan ensures coordinated services from wellness to death.” 6.“This type of plan costs as much as the traditional plans, but the insurance companies get the extra money from premiums.” ANS:2, 3, 4, 5 There are several missions and visions of managed care. The first is to provide wellness care at a minimal cost to keep people healthy and avoid providing illness care at a higher cost. Another mission is to standardize diagnostic and treatment decisions across the nation. Managed care emphasizes the delivery of coordinated services across the care spectrum from wellness to death and uses financial incentives to decrease length of stay and achieve cost efficiency. Managed care was not implemented to address the nursing shortage. This type of plan does not cost as much as a traditional health plan nor do the insurance companies receive the extra money from premiums. PTS:1DIF:ApplyREF:Cost of Care 5.The nurse has incorporated several criteria that are essential for being a member of a profession. Which of the following has this nurse done? (Select all that apply.) 1.Has passed the licensure examination 2.Works regularly scheduled shifts 3.Completed a bachelor’s degree in nursing 4.Limits absences from work 5.Joined the American Nurses Association 6.Reads evidenced-based information to incorporate into planning client care ANS:1, 3, 5, 6 There are seven essential criteria for a profession. The nurse has incorporated four of these criteria by passing the licensure examination, the nurse has implemented a code of ethics; by completing a bachelor’s degree in nursing, the nurse has been educated in an institution of higher education; by joining the American Nurses Association and reading evidenced-based information, the nurse is affiliated with a professional association that promotes and ensures quality practice. Working regularly scheduled shifts and limiting absences from work are not essential criteria for a profession. PTS:1DIF:AnalyzeREF:Box 1-3 Essential Criteria for a ProfessionChapter 2--Clinical Decision Making and Evidence-Based Practice MULTIPLE CHOICE 1.The nurse is implementing evidence-based practice. Which of the following is not a component of this process? 1.Patient preference 2.Clinical expertise 3.Research evidence 4.Leader practice ANS:4 Evidence-based practice is the combination of applying research findings, creating clinical guidelines, and the individualization of the plan of care to meet the patient’s needs and desired. Leader practice is not a component of the evidence-based process. PTS:1DIF:AnalyzeREF:The Process of EBP 2.The nurse is planning the care for a client using an unstructured approach. Which of the following approaches did the nurse most likely use? 1.Research 2.Trial and error 3.Nursing theory 4.Validated order ANS:2 Examples of unstructured approaches to plan client care include trial and error, tradition, and authority. The approaches of research, nursing theory, and validated order all represent a structured approach to planning client care. PTS:1DIF:AnalyzeREF:Knowledge Bases for Clinical Decisions 3.The nurse is participating in an activity that is the first step of the ACE Star Model of Knowledge Transformation. Which of the following is the nurse doing? 1.Creating evidence summaries 2.Evaluating outcomes 3.Integrating findings into practice 4.Participating in research ANS:4 The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge according to five sequential steps. The first step is primary research. Subsequent steps are: 2) evidence summary, 3) translation, 4) integration, and 5) evaluation. PTS:1DIF:AnalyzeREF:EBP in Nursing 4.A committee has been developed to implement knowledge transformation when providing client care. The members realize that the purpose of knowledge transformation is to: 1.reduce length of stay. 2.convert research findings to impact health outcomes. 3.reduce the cost of care. 4.increase the number of patients with health insurance. ANS:2The core concept of the ACE Star Model is knowledge transformation. Knowledge transformation is the conversion of research findings to have an impact on health outcomes by way of evidence-based care. Knowledge transformation is not a method to reduce length of stay, reduce the cost of care, or increase the number of patients with health insurance. PTS:1DIF:AnalyzeREF:Definition of Knowledge Transformation 5.An advance practice nurse is being consulted to participate during the translation phase of the ACE Star Model of Knowledge Transformation. During this phase, which of the following will the nurse create? 1.Standardized care plans 2.Critical pathways 3.Clinical practice guidelines 4.Checklists to streamline documentation ANS:3 In the third step of the ACE Star Model of Knowledge Transformation, experts are consulted to consider the evidence summaries, fill in gaps, and merge research knowledge with expertise to produce clinical practice guidelines. The nurse is not creating standardized care plans, critical pathways, or checklists to streamline documentation since these items are not a part of the ACE Star Model of Knowledge Transformation. PTS:1DIF:ApplyREF:Star Point 3: Translation 6.The nurse leaders of a health care organization are creating plans to change clinical and organizational practices to support evidence-based practice. Which phase of the ACE Star Model of Knowledge Transformation are the leaders implementing? 1.Integration 2.Evaluation 3.Translation 4.Evidence summaries ANS:1 During the Integration phase of the ACE Star Model of Knowledge Transformation, implementation plans are put into action to change the individual clinician practices, organizational practices, and environmental policies. Implementation plans are not a part of the evidence summaries, translation, or evaluation of the ACE Star Model of Knowledge Transformation. PTS:1DIF:ApplyREF:Star Point 4: Integration 7.The advance practice nurse is writing clinical practice guidelines. Prior to writing these guidelines which of the following will the nurse need? 1.Current client census 2.Evidence summaries 3.Nursing department budget 4.Staffing ratios ANS:2 The ideal base for writing clinical guidelines are evidence summaries because they increase the power and validity of the cause-and-effect relationship between interventions and outcomes. Current client census, nursing department budgets, and staffing ratios are not used to write clinical practice guidelines. PTS:1DIF:ApplyREF:Evidence Summaries8.The nurse is writing a systematic review. After the nurse formulates questions and locates relevant studies, the nurse thing the nurse will do is: 1.update the reviews. 2.interpret the findings. 3.summarize and synthesize results. 4.select and appraise the studies. ANS:4 The next step in the systematic review writing process is selecting and appraising the studies. Afterwards, the nurse will complete, in order, summarize and synthesize results, interpret the findings, and regularly update the reviews. PTS:1DIF:ApplyREF:Method for Producing Systematic Reviews 9.The nurse is using the scale for rating the strength of research evidence for one research article for potential inclusion in a clinical practice guideline. Which of the following is considered the strongest evidence? 1.Individual cohort study 2.Meta-analysis of randomized clinical trials 3.Expert opinion 4.Case studies ANS:2 When utilizing the Scale for Rating the Strength of Research Evidence, the level with the strongest evidence is level I, meta-analysis of randomized clinical trials. Level III is individual cohort studies. Expert opinion is Level VII or the weakest evidence. Case studies are Level VI. PTS:1DIF:Analyze REF:Table 2-1 Scale for Rating the Strength of Research Evidence 10.The nurse is considering a research study for inclusion in a clinical practice guideline that has been identified as being sufficient to determine effects on health outcomes. This research study would be considered as being: 1.fair. 2.passable. 3.poor. 4.good. ANS:1 Research studies are rated according to the Scale for Rating the Quality of Research Evidence. According to this scale, a research study that is sufficient to determine the effects on health outcomes is considered fair. A good study has consistent results for well-designed, well-conducted studies that directly assess effects on health outcomes. A poor study has insufficient results to assess the affects on health outcomes. Passable is not a category of this rating scale. PTS:1DIF:Analyze REF:Table 2-2 Scale for Rating the Quality of Research Evidence 11.The nurse is reviewing evidence-based clinical practice guidelines to use when planning care for a client. One guideline has been graded by the U.S. Preventive Services Task Force as being an A. According to this grade, the nurse should do which of the following? 1.Do not use this guideline because the harm outweighs the benefits. 2.Do not use this guideline because the benefits and harms cannot be determined. 3.Use this guideline because the benefit is substantial. 4.Use this guideline but understand that the net benefit to the client is small.ANS:3 The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D plus I. A grade A guideline is recommended for care since there is high certainty that the benefit to the client is substantial. A grade C guideline has a small net benefit to the client. A grade D guideline has harms that outweigh the benefits. A grade I guideline has benefits and harms that cannot be determined. PTS:1DIF:Apply REF:Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force 12.The nurse identifies errors and hazards in a care environment and implements basic safety to reduce the likelihood of an adverse event. Which of the following core competencies is this nurse implementing? 1.Provide patient-centered care 2.Apply quality improvement 3.Employ evidence-based practice 4.Utilize informatics ANS:2 Of the five Core Competencies for Health Professions, the competency that focuses on the identification of errors and hazards with implementation of basic safety is apply quality improvement. Provide patient-centered care focuses on direct care activities. Employ evidence-based practice focuses on the integration of research with clinical expertise. Utilize informatics to focus on communication and the use of information technology to support decision making. PTS:1DIF:Apply REF:Box 2-1 Core Competencies for Health Professions 13.The nurse is participating on a committee to select evidence-based practice guidelines.Which of the following statements by the nurse indicate a clear understanding of the purpose of these guidelines? 1.“They provide the best evidence to make decisions about the care of individual clients.” 2.“They promote changes in client care according to a research study. 3.“They ensure cost-effective care to the client.” 4.“They identify safe staffing ratios for client care.” ANS:1 Evidence-based practice guidelines provide the best evidence to make decisions about the care of individual clients. The use of a single research study to make changes in client care is a concept within research utilization and not evidence-based practice. Evidence-based practice does impact the costs of client care but their intent is not to ensure cost-effective care but rather to improve the overall quality of care. Evidence-based guidelines do not provide staffing ratios for client care. PTS:1DIF:AnalyzeREF:The Process of EBP MULTIPLE RESPONSE 1.The nurse is determining the best way to ensure adherence to the core competencies for health professions. Which of the following competencies will the nurse implement when providing client care? (Select all that apply.) 1.Work in interdisciplinary teams 2.Utilize informatics 3.Implement basic safety principles 4.Employ evidence-based practice 5.Apply quality improvement6.Provide patient-centered care ANS:1, 2, 4, 5, 6 Core competencies for health professions include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Implementing basic safety principles is only one part of a quality improvement program. PTS:1DIF:Apply REF:Box 2-1 Core Competencies for Health Professions. 2.There are impediments that make the practice of evidence-based practice difficult. Which of the following are impediments to evidence-based practice? (Select all that apply.) 1.Complexity of science and technology 2.Difficulty of nowledge transformation 3.Variety of knowledge forms 4.Number of patient diagnoses 5.Evidence summary 6.Application of quality improvement ANS:1, 3 Hurdles to evidence-based practice are the increasing complexity of science and technology and the variety of knowledge forms, many of which are not suitable for direct practice. Knowledge transformation, number of patient diagnoses, evidence summary, application of quality improvement are not considered impediments to the implementation of evidence-based practice. PTS:1DIF:ApplyREF:Applying Evidence-Based Concept 3.The nurse identifyies evidence summaries for evidence-based practice. Which of the following are references to types of evidence summaries? (Select all that apply.) 1.Review of literature 2.Evidence synthesis 3.Authentication review 4.Systematic reviews 5.Integrative reviews 6.Substantiation evidence ANS:1, 2, 4, 5 Evidence summaries are also referred to as being review of literature, evidence synthesis, systematic reviews, and integrative reviews. These summaries are not referred to as being authentication review or substantiation evidence. PTS:1DIF:ApplyREF:Star Point 2: Evidence Summary 4.A health care organization is determining which clinical practice guidelines to adopt when providing client care. The organization is using the AGREE Instrument for Assessing Guidelines because this checklist helps the organization determine which of the following? (Select all that apply.) 1.Scope and purpose 2.Stakeholder involvement 3.Rigor of development 4.Clarity and presentation 5.Author credentials 6.Application ANS:1, 2, 3, 4, 6The AGREE Instrument for Assessing Guidelines outlines the primary facets of the clinical practice guideline being appraised for adoption. It includes the following criteria: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application, and editorial independence. Author credentials is not a criteria of this checklist. PTS:1DIF:AnalyzeREF:Clinical Practice Guidelines 5.The nurse is participating in a committee to address the Institute of Medicine’s priority areas for quality improvement. Which of the following are considered priority areas? (Select all that apply.) 1.Diabetes 2.End-of-life organ failures 3.Motor vehicle accidents 4.Scoliosis 5.Tobacco dependence 6.Major depression ANS:1, 2, 5, 6 The Institute of Medicine has identified 20 priority areas for quality improvement which include diabetes, end-of-life organ failures, tobacco dependence, and major depression. Motor vehicle accidents and scoliosis are not priority areas identified by the Institute of Medicine. PTS:1DIF:AnalyzeREF:Box 2-7 IOM-Priority Areas for National ActionChapter 3--Health Education and Promotion MULTIPLE CHOICE 1.A client is reviewing a videotape without the assistance of the nurse for instruction. The type of teaching strategy this client is using is considered: 1.demonstration. 2.slides. 3.programmed instruction. 4.discussion. ANS:3 Programmed instruction is often referred to as “canned” presentation and is intended for use without the nurse. Demonstration, slides, and discussion require a nurse to be present. PTS:1DIF:AnalyzeREF:Teaching Strategies: Programmed Instruction 2.The nurse is instructing a client regarding food safety, injury prevention, and occupational health. Which of the following Healthy People 2010 objectives is the nurse instructing the client? 1.Promote healthy behaviors 2.Promote healthy and safe communities 3.Improve systems for personal health and public health 4.Prevent and reduce diseases and disorders ANS:2 This objective addresses instruction that focuses on the health and safety of communities such as food safety, prevention of injury, and occupational health. Promoting healthy behaviors would include weight reduction and smoking cessation. Improve systems for personal health and public health would include immunization programs. Prevent and reduce diseases and disorders would include instruction on screening programs, physician visits, and routine health maintenance care. PTS:1DIF:AnalyzeREF:Health Promotion on a Global Level 3.A client has inadequate resources and impairment of personal support systems. Which nursing diagnosis would apply to this patient? 1.Noncompliance 2.Deficient knowledge 3.Ineffective health maintenance 4.Health-seeking behavior ANS:3 Defining characteristics for ineffective health maintenance includes impairment of personal support systems, observed inability to take responsibility for meeting basic health practices, demonstrated lack of knowledge, failure to recognize important symptoms reflective to altered health status, lack of health-seeking behaviors, and inadequate resources. Inadequate resources and impairment of personal support systems would not support the nursing diagnoses of Noncompliance, Deficient Knowledge, or Health-Seeking Behavior. PTS:1DIF:Apply REF:Box 3-3 Defining Characteristics for Ineffective Health Maintenance 4.While planning care for a client, the nurse identifies content that would address the client’s diagnosis of Deficient Knowledge. The nurse will ensure time is allocated for client instruction because: 1.the client cannot be discharged without it. 2.it is a legal component of the nursing process. 3.it is a nice thing to do for a client. 4.the physician has written an order for instruction. ANS:2 Patient education is a legal component of the nursing process that was identified in the Patient’s Bill of Rights. Patient education is a necessary function of nursing care. The client could be discharged without receiving instructions. Education is not done because it is a nice thing to do for a client. Client education does not necessitate a physician’s order. PTS:1DIF:ApplyREF:Patient Education 5.The nurse is engaged in an information teaching session with a client. Which of the following would be appropriate to instruct during an informal teaching session? 1.Expected effects of a new medication 2.Instruction on leg exercises to be used after surgery 3.How to use an incentive spirometer 4.Diet and medications to manage a new diagnosis of diabetes mellitus ANS:1 Instruction can be either informal or formal. Informal instruction occurs intermittently and frequently during the course of client care. These instructions are simple, relate to the disease process, and answer client questions. Providing the expected effects of a new medication is a type of information instruction. Formal instructions are deliberate with specific goals and an evaluation process. Instructing on postoperative leg exercises, the use of an incentive spirometer, and diet and medications to manage a new health diagnosis are all examples of formal instruction. PTS:1DIF:ApplyREF:Formal and Informal Patient Education 6.The nurse is planning a presentation to a group of senior citizens as part of a wellness program. Which of the following topics would be appropriate for the nurse to instruct this client population? 1.Importance of taking medications as prescribed 2.Ways to follow a physician’s treatment plan 3.Ease of changing an abdominal dressing 4.Strategies to reduce salt in the diet and increase activity ANS:4 Some educational topics can be instructed in a group setting. Strategies to reduce salt intake and increase activity are two topics that would be appropriate for a group instruction. The other choices are appropriate for individual instruction. PTS:1DIF:ApplyREF:Individual and Group Patient Education 7.A client is considering several changes in personal habits to improve his health. Which of the following critical thinking strategies can the nurse use to help this client? 1.Ask the client to identify his goals to improve his health. 2.Remind the client that the physician has to approve all changes in his health improvement plan. 3.Suggest the client wait until he is discharged before planning to make personal habit changes. 4.Recommend that immediate changes are made to confuse the body’s responses. ANS:1Critical thinking is a self-directed, deliberate, self-corrected, results-oriented reasoning process that strives to problem-solve client care issues by combining logic, intuition, and creativity. The goal of critical thinking is to assist clients to use what they already know and work with the client to make changes that they identify through self-discovery. Asking the client to identify goals to improve health is one strategy that the nurse can use when implementing critical thinking with client education. The other choices do not support critical thinking with client education. PTS:1DIF:ApplyREF:Critical Thinking and Patient Education 8.A client has several identified learning needs. Which of the following should the nurse assess prior to planning instruction for this client? 1.Home address 2.Client’s learning style 3.Living arrangements 4.Financial resources ANS:2 Areas to include in the assessment of a client’s learning needs include the client’s ability to learn, style of learning, information about a health condition, cultural background, and other information as required. The client’s home address, living arrangements, and financial resources are not a part of a client’s assessment of learning needs. PTS:1DIF:ApplyREF:Patient Education and the Nursing Process 9.Which of the following teaching strategy would best support a client who needs to learn how to self- administer insulin injections? 1.Discussion 2.Role-playing 3.Demonstration 4.Programmed instruction ANS:3 Demonstration is a practical strategy used when teaching a new skill such as self-injection of insulin. Discussion is an exchange of information and does not provide an opportunity for the client to learn a new skill. Role playing allows the client to apply knowledge in a simulated environment. This strategy does not support learning a new skill. Programmed instruction is intended for use without the nurse. This strategy does not support learning a new skill. PTS:1DIF:ApplyREF:Teaching Strategies 10.A client tells the nurse that she uses audio CDs in her vehicle when driving to and from work to keep current with educational requirements for her job. The nurse would assess this client as preferring which type of learning style? 1.Auditory 2.Visual 3.Kinesthetic 4.Anesthetic ANS:1 The client who learns by hearing prefers an auditory learning style. The client who learns by reading uses a visual learning style. The client who learns by doing or touching is using a kinesthetic learning style. Anesthetic is not a type of learning style but rather a medication used for surgery. PTS:1DIF:AnalyzeREF:Teaching Strategies