(Test Bank) Lewis’s Medical Surgical Nursing Australian Edition

Brown, 5

Nursing

Test Bank

5th Edition

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Test Bank for Lewis’s Medical Surgical Nursing Australian Edition, The downloadable file consists of 558 pages, and the total size of the file is 9.45 MB. Purchase now only for highly discounted price.

Author(s): Brown

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N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. Chapter 01: The importance of nursing Brown: Lewis's Medical -Surgical Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse completes an admission database and explains that the plan of ca re and discharge goals will be developed with the patient’s input. The patient states, “How is this different from what the doctor does?” Which response would be most appropriate for the nurse to make? a. “The role of the nurse is to administer medications and other treatments prescribed by your doctor.” b. “The nurse’ s job is to help the doctor by collecting information and communicating any problems that occur.” c. “Nurses perform many of the same procedures as the doctor, but nurses are with the patients for a longer time than the doctor.” d. “In addition to caring for you while you are sick, the nurses will assist you to develop an individualized plan to maintain your health.” ANS: D This response is consistent with the American Nurses Association (ANA) definition of nursing, which describes the role of nurses in promoting health. The other responses describe some of the dependent and collaborative functions of the nursing role but do not accurately describe the nurse’s role in the health care system. 2. The nurse describes to a student nurse how to use evidence -based practice guidelines when caring for patients. Which statement, if made by the nurse, would be the most accurate? a. “Inferences from clinical research studies are used as a guide.” b. “Patient care is based on clinical judgment, experience, and traditions.” c. “Data are evaluated to show that the patient outcomes are consistently met.” d. “Recommendations are based on research, clinical expertise, and patient preferences.” ANS: D Evidence -based practice (EBP) is the use of the best research -based evidence combined with clinician expertise. Clinical judgment based on the nurse’s clinical e xperience is part of EBP, but clinical decision making should also incorporate current research and research -based guidelines. Evaluation of patient outcomes is important, but interventions should be based on research from randomized control studies with a large number of subjects. 3. The nurse teaches a student nurse about how to apply the nursing process when providing patient care. Which statement, if made by the student nurse, indicates that teaching was successful? a. “The nursing process is a scientific -based method of diagnosing the patient’s health care problems.” b. “The nursing process is a problem -solving tool used to identify and treat patients’ health care needs.” c. “The nursing process is used primarily to ex plain nursing interventions to other health care professionals.” d. “The nursing process is based on nursing theory that incorporates the TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. biopsychosocial nature of humans.” ANS: B The nursing process is a problem -solving approach to the identification and treatment of patients’ problems. Diagnosis is only one phase of the nursing process. The primary use of the nursing process is in patient care, not to establish nursing theory or e xplain nursing interventions to other health care professionals. 4. A patient has been admitted to the hospital for surgery and tells the nurse, “I do not feel comfortable leaving my children with my parents.” Which action should the nurse take next? a. Reassure the patient that these feelings are common for parents. b. Have the patient call the children to ensure that they are doing well. c. Gather more data about the patient’ s feelings about the child -care arrangements. d. Call the patient’s parents to determine whether adequate child care is being provided. ANS: C Because a complete assessment is necessary in order to identify a problem and choose an appropriate intervention, the nurse’s first action should be to obtain more information. The other actions may be appropriate, but more assessment is needed before the best intervention can be chosen. 5. A patient who is paralyzed on the left side of the body after a stroke develops a pressure ulcer on the left hip. Which nursing diagnosis is most appropriate? a. Impaired physical mobility related to left -sided paralysis b. Risk for impaired tissue integr ity related to left -sided weakness c. Impaired skin integrity related to altered circulation and pressure d. Ineffective tissue perfusion related to inability to move independently ANS: C The patient’ s major problem is the impaired skin integrity as demonstrated by the presence of a pressure ulcer. The nurse is able to treat the cause of altered circulation and pressure by frequently repositioning the patient. Although left -sided weakness is a problem for the patient, the nurse cannot treat the weakness. The “risk for” diagnosis is not appropriate for this patient, who already has impaired tissue integrity. The patient does have ineffective tissue perfusion, but the impaired skin integrity diagnosis ind icates more clearly what the health problem is. 6. A patient with a bacterial infection has a nursing diagnosis of deficient fluid volume related to excessive diaphoresis. Which outcome would the nurse recognize as appropriate for this patient? a. Patient has a balanced intake and output. b. Patient’s bedding is changed when it becomes damp. c. Patient understands the need for increased fluid intake. d. Patient’s skin remains cool and dry throughout hospitalization. ANS: A This statement gives measurable data showing resolution of the problem of deficient fluid volume that was identified in the nursing diagnosis statement. The other statements would not indicate that the problem of deficient fluid volume was resolved. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 7. A nurse asks the patient if pain was relieved after receiving medication. What is the purpose of the evaluation phase of the nursing process? a. To determine if interventions have been effective in meeting patient outcomes b. To document the nursing care p lan in the progress notes of the medical record c. To decide whether the patient’s health problems have been completely resolved d. To establish if the patient a grees that the nursing care provided was satisfactory ANS: A Evaluation consists of determining whether the desired patient outcomes have been met and whether the nursing interventions were appropriate. The other responses do not describe the evaluation phase. 8. The nurse interviews a patient while completing the health history and physical examination. What is the purpose of the assessment phase of the nursing process? a. To teach interventions that relieve health problems b. To use patient data to evaluate patient care outcomes c. To obtain data with which to diagnose patient problems d. To help the patient identify realistic outcomes for health problems ANS: C During the assessment phase, the nurse gathers information about the patient to diagnose patient problems. The other responses are examples of the planning, intervention, and evaluation phases of the nursing process. 9. Which nursing diagnosis statement is written correctly? a. Altered tissue perfusion related to heart failure b. Risk for impaired tissue integrity related to sacral redness c. Ineffective coping related to response to biopsy test results d. Altered urinary elimination related to urinary tract infection ANS: C This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes a patient’s response to a health problem that can be treated by nursing. The use of a medical diagnosis as an etiology (as in the responses beginning “Altered tissue perfusion” and “Altered urinary elimination”) is not appropriate. The response beginning “Risk for impaired tissue i ntegrity” uses the defining characteristic as the etiology. 10. The nurse admits a patient to the hospital and develops a plan of care. W hat components should the nurse include in the nursing diagnosis statement? a. The problem and the suggested patient goals or outcomes b. The problem with possible causes and the planned interventions c. The problem, its cause, and objective data that su pport the problem d. The problem with an etiology and the signs and symptoms of the problem ANS: D When writing nursing diagnoses, this format should be used: problem, etiology, and signs and symptoms. The subjective, as well as objective, data should be included in the defining characteristics. Interventions and outcomes are not included in the nursing diagnosis statement. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 11. A nurse is caring for a patient with heart failure. Which task is appropriate for the nurse to delegate to experienced unlicensed assistive personnel (UAP)? a. Monitor for shortness of breath or fatigue after ambulation. b. Instruct the patient about the need to alternate activity and rest. c. Obtain the patient’s blood pressure and pulse rate after ambulation. d. Determine whether the patient is ready to incr ease the activity level. ANS: C UAP education includes accurate vital sign measurement. Assessment and patient teaching require registe red nurse education and scope of practice and cannot be delegated. 12. A nurse is caring for a group of patients on the medical -surgical unit with the help of one float registered nurse (RN), one unlicensed assistive personnel (UAP), and one licensed practical/vocational nurse (LPN/LVN). Which assignment, if delegated by the nurse, would be inappropriate? a. Measurement of a patient’s urine output by UAP b. Administration of oral medications by LPN/LVN c. Check for the presence of bowel sounds and flatu lence by UAP d. Care of a patient with diabetes by RN who usually works on the pediatric unit ANS: C Assessment requires RN education and scope of practice a nd cannot be delegated to an LPN/LVN or UAP. The other assignments made by the RN are appropriate. 13. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Complete the initial admission assessment and plan of care. b. Document teaching completed before a diagnostic procedure. c. Instruct a patient about low -fat, reduced sodium dietary restrictions. d. Obtain bedside blood glucose on a patient before insulin administration. ANS: D The education and scope of practice of the LPN/LVN include activities such as obtaining glucose testing using a finger stick. Patient teaching and the initial assessment and development of the plan of care are nursing actions that require registered nurse education and scope of practice. 14. A nurse is assigned as a case manager for a hospitalized patient with a spinal cord injury. The patient can expect the nurse functioning in this role to perform which activity? a. Care for the patient during hospitali zation for the injuries. b. Assist the patient with home care activities during recovery. c. Determine what medical care the patient needs for optimal rehabilitation. d. Coordinate the services that the patient receives in the hospital and at home. ANS: D The role of the case manager is to coordinate the patient’s care through multiple settings and levels of care to allow the maximal patient benefit at the least cost. T he case manager does not provide direct care in either the acute or home setting. The case manager coordinates and advocates for care but does not determine what medical care is needed; that would be completed by the health care provider or other provider. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 15. The nurse is caring for an older adult patient who had surgery to repair a fractured hip. The patient needs continued nursing care and physical therapy to improve mobility before returning home. The nurse will help to arrange for transfer of this pa tient to which facility? a. A skilled care facility c. A transitional care facility b. A residential care facility d. An intermediate care facility ANS: C Transitional care settings are appropriate for patients who need continued rehabilitation before discharge to home or to long -term care settings. The patient is no longer in need of the more continuous assessment and care given in acute care settings. Ther e is no indication that the patient will need the permanent and ongoing medical and nursing services available in intermediate or skilled care. The patient is not yet independent enough to transfer to a residential care facility. 16. A home care nurse i s planning care for a patient who has just been diagnosed with type 2 diabetes mellitus. Which task is appropriate for the nurse to delegate to the home health aide? a. Assist the patient to choose appropriate foods. b. Help the patient with a daily bath and oral care. c. Check the patient’s feet for signs of breakdown. d. Teach the patient how to monitor blood glucose. ANS: B Assisting with patient hygiene is included in home health -aide education and scope of practice. Assessment of the patient and instructing the patient in new skills, such as diet and blood glucose monitoring, are complex skills that are included in registered nurse education and scope of practice. 17. The nurse is providing education to nursing staff on quality care initiatives. Which statement is an accurate description of the impact of health care financing on quality care? a. “If a patient develops a catheter -related infection, the hospital receives additional funding.” b. “Payment for patient care is primarily based on clinical outcomes and patient satisfaction.” c. “Hospitals are reimbursed for all costs incurred if care is documented electronically.” d. “Because hospitals are accountable for overall care, it is not nursing’s responsibility to monitor care delivered by others.” ANS: B Payment for health care services pro grams reimburses hospitals for their performance on overall quality -of-care measures. These measures include clinical outcomes and patient satisfaction. Nurses are responsible for coordinating complex aspects of patient care, including the care delivered b y others, and identifying issues that are associated with poor quality care. Payment for care can be withheld if something happens to the patient that is considered preventable (e.g., acquiring a catheter -related urinary tract infection). TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 18. The nurse d ocumenting the patient’s progress in the care plan in the electronic health record before an interprofessional discharge conference is demonstrating competency in which QSEN category? a. Patient -centered care c. Evidence -based practice b. Quali ty improvement d. Informatics and technology ANS: D The nurse is displaying competency in the QSEN area of informatics and technology. Using a computerized information system to document patient needs and progress and communicate vital information regar ding the patient with the interprofessional care team members provides evidence that nursing practice standards related to the nursing process have been maintained during the care of the patient. MULTIPLE RESPONSE 1. Which information will the nurse consider when deciding what nursing actions to delegate to a licensed practical/vocational nurse (LPN/LVN) who is working on a medical -surgical unit (select all that apply)? a. Institutional policies b. Stability of the pa tient c. State nurse practice act d. LPN/LVN teaching abilities e. Experience of the LPN/LVN ANS: A, B, C, E The nurse should assess the experience of LPN/LVNs when delegating. In addition, state nurse practice acts and institutional policies must be considered. In general, whereas the LPN/LVN scope of practice includes caring for patients who are stable, registe red nurses should provide most of the care for unstable patients. Because the LPN/LVN scope of practice does not include patient education, this will not be part of the delegation process. 2. The nurse is administering medications to a patient. Which act ions by the nurse during this process are consistent with promoting safe delivery of care ( select all that apply )? a. Throws away a medication that is not labeled b. Uses a hand sanitizer before preparing a medication c. Identifies the patient by the room number on the door d. Checks laboratory test results before administering a diuretic e. Gives the patient a list of current medications upon discharge ANS: A, B, D, E National Patient Safety Goals have been established to promote safe delivery of care. The nurse should use at least two reliable ways to identify the patient such as asking the patient’s full name and date of birth before medication administrati on. Other actions that improve patient safety include performing hand hygiene, disposing of unlabeled medications, completing appropriate assessments before administering medications, and giving a list of the current medicines to the patient and caregiver before discharge. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. OTHER 1. The nurse uses the Situation -Background -Assessment -Recommendation (SBAR) format to communicate a change in patient status to a health care provider. In which order should the nurse make the following statements? (Put a comma and a space between each answer choice [A, B, C, D].) a. “The patient needs to be evaluated immediately and may need intubation and mechanical ventilation.” b. “The patient was admitted yesterday with heart failure and has been receiving furosemide (Lasix) for diuresis, but urine output has been low.” c. “The patient has crackles audible throughout the posterior chest, and the most recent oxygen saturation is 89%. Her condition is very unstable.” d. “This is the nurse on the surgical unit. After assessing t he patient, I am very concerned about increased shortness of breath over the past hour.” ANS: D, B, C, A The order of the nurse’s statements follows the SBAR format. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. Chapter 0 3: Stress and Stress Management Brown: Lewis's Medical -Surgical Nursing, 5th Edition MULTIPLE CHOICE 1. An adult patient who arrived at the triage desk in the emergency department (ED) with minor facial lacerations after a motor vehicle accident has a blood pressure (BP) of 182/94. Which action by the nurse is appropriate? a. Start an IV line to administer a ntihypertensive medications. b. Recheck the blood pressure after the patient has been assessed. c. Discuss the need for hospital admission to control blood pressure. d. Teach the patient about the stroke risk associated with uncontrolled hypertension. ANS: B When a patient experiences an acute stressor, the BP increases. The nurse should plan to recheck the BP after the patient has stabilized and received treatment. This will provide a more accurate indication of the patient’s usual blood pressure. El evated BP that occurs in response to acute stress does not increase the risk for health problems such as stroke, indicate a need for hospitalization, or indicate a need for IV antihypertensive medications. 2. A female patient who initially came to the cl inic with incontinence was recently diagnosed with endometrial cancer. She is usually well organized and calm, but the nurse who is giving her preoperative instructions observes that the patient is irritable, has difficulty concentrating, and yells at her husband. Which action should the nurse take? a. Ask the health care provider for a psychiatric referral. b. Focus teaching on preventing postoperative complications. c. Try to calm the patient before repeating any information about the surgery. d. Encourage the patient to combine the hysterectomy with surgery for bladder repair. ANS: C Because behavioral responses to stress include temporary changes such as irritabili ty, changes in memory, and poor concentration, patient teaching will need to be repeated. It is also important to try to calm the patient by listening to her concerns and fears. Psychiatric referral will not necessarily be needed for her but that can bette r be evaluated after surgery. Focusing on postoperative care does not address the need for preoperative instruction such as the procedure, NPO instructions before surgery, date and time of surgery, medications to be taken or discontinued before surgery, an d so on. The issue of incontinence is not immediately relevant in the discussion of preoperative teaching for her hysterectomy. 3. An adult patient who is hospitalized after a motorcycle crash tells the nurse, “I didn’t sleep last night because I worried about missing work at my new job and losing my insurance coverage.” Which nursing diagnosis is appropriate to include in the plan of care? a. Anxiety c. Ineffective denial b. Defensive coping d. Risk prone health behavior ANS: A The information abo ut the patient indicates that anxiety is an appropriate nursing diagnosis. The patient data do not support defensive coping, ineffective denial, or risk prone health behavior as problems for this patient. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 4. A patient is extremely anxious about having a biopsy on a femoral lymph node. Which relaxation technique would be the best choice for the nurse to facilitate during the procedure? a. Yoga stretching c. Relaxation breathing b. Guided imagery d. Mindfulness meditation ANS: C Relaxation breathing is an easy relaxation technique to teach and use. The patient should remain still during the biopsy and not move or stretch any of his extremities. Meditation and guided imagery require more time to practice and learn. 5. A patient who has frequent migraines tells the nurse, “My life feels chaotic and out of my control. I could not manage if anything else happens.” Which response should the nurse make initially ? a. “Regular exercise may get y our mind off the pain.” b. “Guided imagery can be helpful in regaining control.” c. “Tell me more about how your life has been recently.” d. “Your previous coping resources can be helpful to you now.” ANS: C The nurse’ s initial strategy should be further assessment of the stressors in the patient’s life. Exercise, guided imagery, or understanding how to use coping strategies that worked in the past may be of assistance to the patient, but more assessment is needed befor e the nurse can determine this. 6. A nurse prepares an adult patient with a severe burn injury for a dressing change. The nurse knows that this is a painful procedure and wants to try providing music to help the patient relax. Which action is best for th e nurse to take? a. Use music composed by Mozart. b. Play music that does not have words. c. Ask the patient about music preferences. d. Select music that has 60 to 80 beats/minute. ANS: C Although music with 60 to 80 beats/min, music without words, and music composed by Mozart are frequently recommended to reduce stress, each patient responds individually to music and personal preferences are important. 7. The nurse teaches a patient who is experiencing stress at work how to use imagery as a relaxation technique. Which statement by the nurse would be appropriate? a. “Think of a place where you feel peaceful and comfortable.” b. “Place the stress in your lif e into an image that you can destroy.” c. “Repeatedly visualize yourself experiencing the distress in your workplace.” d. “Bring what you hear and sense in your work environment into your image.” ANS: A Imagery is the use of one’s mind to generate images that have a calming effect on the body. When using imagery for relaxation, the patient should visualize a comfortable and peaceful place. The goal is to offer a relaxing retreat from the actual work envir onment. Imagery that is not intended for relaxation purposes can target a disease, problem, or stressor. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 8. An obese female patient who had enjoyed active outdoor activities is stressed because osteoarthritis in her hips now limits her activity. Which ac tion by the nurse will best assist the patient to cope with this situation? a. Have the patient practice frequent relaxation breathing. b. Ask the patient what outdoor activities she misses the most. c. Teach the patient to use imagery for reducing pain and stress. d. Encourage the patient to consider weight loss to improve symptoms. ANS: D For problems that can be changed or controlled, problem -focused coping strategies, such as encouraging the patie nt to lose weight, are most helpful. The other strategies also may assist the patient in coping with her problem, but they will not be as helpful as a problem -focused strategy. 9. A hospitalized pa tient with diabetes tells the nurse, “I don’t understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up. This is so frustrating.” Which response by the nurse is accurate? a. “The liver is not able to metabolize glucose as well during stressful times.” b. “Your diet at the hospital is the most likely cause of the increased glucose.” c. “The stress of illness causes release of hormones that increase blood glucose.” d. “It is p robably coincidental that your blood glucose is higher when you are ill.” ANS: C The release o f cortisol, epinephrine, and norepinephrine increase blood glucose levels. The increase in blood glucose is not coincidental. The liver does not control blood glucose. A patient with diabetes who is hospitalized will be on an appropriate diet to help contr ol blood glucose. 10. A middle -aged male patient with usually well -controlled hypertension and diabetes visits the clinic. Today he has a blood pressure of 174/94 mm Hg and a blood glucose level of 190 mg/dL. What patient information may indicate that ad ditional intervention by the nurse is needed? a. The patient states that he takes his prescribed antihypertensive medications daily. b. The patient states that both of his parents have high blood pressure and diabetes. c. The patient indicates that he does blood glucose monitoring several times each day. d. The patient reports that he and his wife are disputing custody of their 8 -yr-old son. ANS: D The increase in blood pressure and glucose levels possibly suggests that stress caused by his divorce and custody battle may be adversely affecting his health. The nurse should assess this further and develop an appropriate plan to assist the patient in decreasing his stress. Although he has been very compliant with his treatm ent plan in the past, the nurse should assess whether the stress in his life is interfering with his management of his health problems. The family history will not necessarily explain why he has had changes in his blood pressure and glucose levels. 11. A patient who is taking antiretroviral medication to control human immunodeficiency virus (HIV) infection tells the nurse about feeling mildly depressed and anxious. Which additional information about the patient is most important to communicate to the health care provider? a. The patient takes vitamin supplements and St. John’s wort. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. b. The patient recently experienced the death of a close friend. c. The patient’s blood pressure has increased to 152/88 mm Hg. d. The patient expresses anxiety about w hether the drugs are effective. ANS: A St. John’ s wort interferes with metabolism of medications that use the cytochrome P450 enzyme system, including many HIV medications. The health care provider will need to check for toxicity caused by the drug interactions. Teaching is needed about drug interaction s. The other information will also be reported but does not have immediate serious implications for the patient’s health. MULTIPLE RESPONSE 1. A patient who is hospitalized with a pelvic fracture after a motor vehicle accident just received news that th e driver of the car died from multiple injuries. What actions should the nurse take based on knowledge of the physiologic stress reactions that may occur in this patient (select all that apply) ? a. Assess for bradycardia. b. Observe for decreased appetite. c. Ask about epigastric discomfort. d. Monitor for decreased respiratory rate. e. Check for elevated blood glucose levels. ANS: B, C, E The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and increase blood glucose levels. In addition, stress causes an increase in respiratory and heart rates. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. Chapter 0 4: Health disparities and cultural care Brown: Lewis's Me dical -Surgical Nursing, 5th Edition MULTIPLE CHOICE 1. The nurse is obtaining a health history from a new patient. Which data will be the focus of patient teaching? a. Age and gender c. Hispanic/Latino ethnicity b. Saturated fat intake d. Family history of diabetes ANS: B Behaviors are strongly linked to many health care problems. The patient’s saturated fat intake is a behavior that the patient can change. The other information will be useful as the nurse develops an individualized plan for improving the patient’s health, but will not be the focus of patient teaching. 2. The nurse works in a clinic located in a community with many Hispanics. Which strategy, if implemented by the nurse, would decrease health care disparities for the Hispanic patients? a. Improve public tra nsportation to the clinic. b. Update equipment and supplies at the clinic. c. Obtain low -cost medications for clinic patients. d. Teach clinic staff about Hispanic health beliefs. ANS: D Health care disparities are caused by stereotyping, biases, and prejudice of health care providers. The nurse can decrease these through staff education. The other strategies may also be addressed by the nurse but will not directly impact health disparitie s. 3. What information should the nurse collect when assessing the health status of a community? a. Air pollution levels c. Most common causes of death b. Number of health food stores d. Education level of the individuals ANS: C Health status measures of a community include birth and death rates, life expectancy, access to care, and morbidity and mortality rates related to disease and injury. Although air pollution, access to health foo d stores, and education level are factors that affect a community’s health status, they are not health measures. 4. The nurse is caring for a Native American patient who has traditional beliefs about health and illness. Which action by nurse is most appropriate? a. Avoid asking questions unless the patient initiates the conversation. b. Ask the patient whether it is important that cultural healers are contacted. c. Explain the usual hospital routines for meal times, care, and family visits. d. Obtain further information about the patient’s cultural beliefs from a family member. ANS: B TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. Because the patient has traditional health care beliefs, it is appropriate for the nurse to ask whether the patient would like a visit by a shaman or other cultural healer. There is no cultural reason for the nurse to avoid asking the patient questions bec ause these questions are necessary to obtain health information. The patient (rather than the family) should be consulted about personal cultural beliefs. The hospital routines for meals, care, and visits should be adapted to the patient’s preferences rath er than expecting the patient to adapt to the hospital schedule. 5. The nurse is caring for an Asian patient who is being admitted to the hospital. Which action would be most appropriate for the nurse to take when interviewing this patient? a. Avoid eye contact with the patient. b. Observe the patient’s use of eye contact. c. Look directly at the patient when interacting. d. Ask a family member about the patient’s cultural beliefs. ANS: B Observation of the patient’ s use of eye contact will be most useful in determining the best way to communicate effectively with the patient. Looking directly at the patient or avoiding eye contact may be appropriate, depending on the patient’s individual cultural beliefs. The nurse should assess the patient, rather than asking family members about the patient’s beliefs. 6. A female staff nurse is assessing a male patient of Arab descent who is admitted with complaints of severe headaches. It is most important for the charge nurse t o intervene if the nurse takes which action? a. The nurse explains the 0 to 10 intensity pain scale. b. The nurse asks the patient when the headaches started. c. The nurse sits down at the bedside and closes the privacy curtain. d. The nurse calls for a male nurse to bring a hospital gown to the room. ANS: C Many men of Arab ethnicity do not believe it is appropriate to be alone with any female except for their spouse. The other actions are appropriate. 7. The nurse is caring for a patient who speaks a different language. If an interpreter is not available, which action by the nurse is most appropriate? a. Talk slowly so that each word is clearly heard. b. Speak loudly in close proximity to the patient’s ears. c. Repeat important words so that the patient recognizes their significance. d. Use simple gestures to demonstrate meaning while talking to the patient. ANS: D The use of gestures will enable some information to be communicated to the patient. The other actions will not improve communication with the patient. 8. The nurse plans c are for a hospitalized patient who uses culturally based treatments. Which action by the nurse is best? a. Encourage the use of diagnostic procedures. b. Coordinate the use of folk treatments with ordered medical therapies. c. Ask the patient to discontinue the cultural treatments during hospitalization. d. Teach the patient that folk remedies will interfere with orders by the health care provider. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. ANS: B Many culturally based therapies can be accommodated along with the use of Western treatments and medications. The nurse should attempt to use both traditional folk treatments and the ordered Western therapies as much as possible. Some culturally bas ed treatments can be effective in treating “Western” diseases. Not all folk remedies interfere with Western therapies. It may be appropriate for the patient to continue some culturally based treatments while he or she is hospitalized. 9. The nurse is car ing for a newly admitted patient. Which intervention is the best example of a culturally appropriate nursing intervention? a. Insist family members provide most of the patient’s personal care. b. Maintain a personal space of at least 2 feet when assessing the patient. c. Ask permission before touching a patient during the physical assessment. d. Consider the patient’s ethnicity as the most important factor in planning care. ANS: C Many cultures consider it disrespectful to touch a patient without asking permission, so asking a patient for permission is always culturally appropriate. The other actions may be appropriate for some patients but are not appropriate across all cultural gr oups or for all individual patients. Ethnicity may not be the most important factor in planning care, especially if the patient has urgent physiologic problems. 10. A staff nurse expresses frustration that a Native American patient always has several fam ily members at the bedside. Which action by the charge nurse is most appropriate? a. Remind the nurse that family support is important to this family and patient. b. Have the nurse explain to the family that too many visitors will tire the patient. c. Suggest that the nurse ask family members to leave the room during patient care. d. Ask about the nurse’s personal beliefs about family support during hospitalization. ANS: D The first step in providing culturally competent care is to understand one’s own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help achieve this step. Reminding the nurse that this cultural practice is important to the family and patient will not decrease the nurse’s frustration. The remaining responses (suggest that the nurse ask family members to leave the room and have the nurse explain to family that too many visitors will tire the patient) are not culturally appropriate for this patient. 11. An older Asian American patient tells the nurse that she has lived in the United States for 50 years. The patient speaks English and lives in a predominantly Asian neighborhood. Which action by the nurse is most appropriate? a. Include a shaman when planni ng the patient’s care. b. Avoid direct eye contact with the patient during care. c. Ask the patient about any special cultural beliefs or practices. d. Involve the patient’ s oldest son to assist with health care decisions. ANS: C Further assessment of the patient’s health care preferences is needed before making further plans for culturally appropriate care. The other responses indicate stereotyping of the patient based o n ethnicity and would not be appropriate initial actions. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM N U R S I N G T B . C O M Copyright © 2020 Elsevier Australia. All rights reserved. 12. The nurse plans health care for a community with a large number of recent immigrants from Vietnam. Which intervention is the most important for the nurse to implement? a. Hepatitis testing c. Contraceptive teaching b. Tuberculosis screening d. Colonoscopy information ANS: B Tuberculosis (TB) is endemic in many parts of Asia, and the incidence of TB is much higher in immigrants from Vietnam than in the general U.S. population. Teaching about contraceptive use, colonoscopy, and testing for hepatitis may also be appropriate for some patients but is not generally indicated for all members of this community. 13. When doing an admission assessment for a patient, the nurse notices that the patient pauses before answering questions about the health history. Which action by the nurse is most appropriate? a. Interview a family member instead. b. Wait for the patient to answer the questions. c. Remind the patient that you have other patients who need care. d. Give the patien t an assessment form listing the questions and a pen. ANS: B Patients from some cultures take time to consider a question carefully before answering. The nurse will show respect for the patient and help develop a trusting relationship by allowing the patient time to give a thoughtful answer. Asking the patient why the answers are taking so much time, st opping the assessment, and handing the patient a form indicate that the nurse does not have time for the patient. 14. Which strategy should be a priority when the nurse is planning care for a diabetic patient who is uninsured? a. Obtain less expensive me dications. b. Follow evidence -based practice guidelines. c. Assist with dietary changes as the first action. d. Teach about the impact of exercise on diabetes. ANS: B The use of standardized evidence -based guidelines will reduce the incidence of health care disparities among various socioeconomic groups. The other strategies may also be appropriate, but the priority concern should be that the patient receives care that meets the accepted standard. 15. A Hispanic patient complains of abdominal cramping caused by empacho. Which action should the nurse take first? a. Ask the patient what treatments are likely to help. b. Massage the patient’ s abdomen until the pain is gone. c. Administer prescribed medications to decrease the cramping. d. Offer to contact a curandero(a) to make a visit to the patient. ANS: A Further assessment of the patient’ s cultural beliefs is appropriate before implementing any interventions for a culture -bound syndrome such as empacho. Although medication, a visit by a curandero(a), or massage may be helpful, more information about the patient’s beliefs is needed to deter mine which intervention(s) will be most helpful. TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING 5TH EDITION BY BROWN NURSINGTB.COM