(Test Bank) Primary Care: Art And Science Of Advanced Practice Nursing - An Interprofessional Approach

Dunphy, 5

Nursing

Test Bank

5th Edition

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Test Bank for Primary Care: Art And Science Of Advanced Practice Nursing - An Interprofessional Approach, The downloadable file consists of 826 pages, and the total size of the file is 6.67 MB. Purchase now only for highly discounted price.

Author(s): Dunphy

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Study Note Preview

Primary Care: Art and Science of Advanced Practice Nursing - An Interprofessional Approach 5th edition Dunphy Test Bank Chapter 1. Primary Care in the Twenty -First Century: A Circle of Caring • A nurse has conducted a literature review in an effort to identify the effect of handwashing on the incidence of nosocomial (hospital -acquired) infections in acute care settings. An article presented findings at a level of significance of <0.01. This indicates that • the control group and the experimental group were more than 99% similar. • the findings of the study have less than 1% chance of being attributable to chance. • the effects of the intervention were nearly zero. • the clinical significance of the findings was less than 1:100. Ans: B Feedback: The level of significance is the level at which the researcher believes that the study results most likely represent a nonchance event. A level of significance of <0.01 indicates that there is less than 1% probability that the result is due to chance. • A nurse has read a qualitative research study in order to understand the lived experience of parents who have a neonatal loss. Which of the following questions should the nurse prioritize when appraising the results of this study? • How well did the authors capture the personal experiences of these parents? • How well did the authors control for confounding variables that may have affected the findings? • Did the authors use statistical measures that were appropriate to the phenomenon in question? • Were the instruments that the researchers used statistically valid and reliable? Ans: A Feedback: Qualitative studies are judged on the basis of how well they capture and convey the subjective experiences of individuals. Statistical measures and variables are not dimensions of a qualitative methodology. • A nurse has expressed skepticism to a colleague about the value of nursing research, claiming that nursing research has little relevance to practice. How can the nurses colleague best defend the importance of nursing research? • The existence of nursing research means that nurses are now able to access federal grant money, something that didnt use to be the case. • Nursing research has allowed the development of masters and doctoral programs and has greatly increased the credibility of the profession. • The growth of nursing research has caused nursing to be viewed as a true profession, rather than simply as a trade or a skill. • The application of nursing research has the potential to improve nursing practice and patient outcomes. Ans: D Feedback: The greatest value of nursing research lies in the potential to improve practice and, ultimately, to improve patient outcomes. This supersedes the contributions of nursing research to education programs, grant funding, or the public view of the profession. • Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy urban hospital. She has noticed that many new mothers abandon breast -feeding their babies when they experience early challenges and wonders what could be done to encourage more women to continue breast -feeding. What role is Tracy most likely to play in a research project that tests an intervention aimed at promoting breast - feeding? • Applying for grant funding for the research project • Posing the clinical problem to one or more nursing researchers • Planning the methodology of the research project • Carrying out the intervention and submitting the results for publication Ans: B Feedback: A major role for staff nurses is to identify questions or problems for research. Grant applications, methodological planning, and publication submission are normally carried out by nurses who have advanced degrees in nursing. • A patient signed the informed consent form for a drug trial that was explained to patient by a research assistant. Later, the patient admitted to his nurse that he did not understand the research assistants explanation or his own role in the study. How should this patients nurse respond to this revelation? • Explain the research process to the patient in greater detail. • Describe the details of a randomized controlled trial for the patient. • Inform the research assistant that the patients consent is likely invalid. • Explain to the patient that his written consent is now legally binding. Ans: C Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible for research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty about participating, do not try to convince them to participate. Ask the person from the research team who is managing consents to speak with concerned patients about the study, even after a patient has signed the consent forms. Multiple Selection • A nurse leader is attempting to increase the awareness of evidence -based practice (EBP) among the nurses on a unit. A nurse who is implementing EBP integrates which of the following? (Select all that apply.) • Interdisciplinary consensus • Nursing tradition • Research studies • Patient preferences and values • , D , E Feedback: Fineout -Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem -solving approach to the delivery of healthcare that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. Multiple Choice • Mrs. Mayes is a 73 -year-old woman who has a diabetic foot ulcer that has been extremely slow to heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working with Mrs. Mayes applies evidence -based practice (EBP) whenever possible and has proposed the use of maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly opposes this treatment despite the sizable body of evidence supporting it. How should the nurse reconcile Mrs. Mayes views with the principles of EBP? • The nurse should explain that reliable and valid research evidence overrides the patients opinion. • The nurse should explain the evidence to the patient in greater detail. • The nurse should integrate the patients preferences into the plan of care. • The nurse should involve the patients family members in the decision -making process. Ans: C Feedback: Patient preferences should be integrated into EBP and considered alongside research evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The family should be involved, but this is not an explicit dimension of EBP. Similarly, explaining the evidence in more detail is not a demonstration of EBP. • The administrators of a long -term care facility are considered the use of specialized, pressure - reducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have sought input from the nurses on the unit, all of whom are aware of the need to implement the principles of evidence -based practice (EBP) in this decision. Which of the following evidence sources should the nurses prioritize? • A qualitative study that explores the experience of living with a pressure ulcer • A case study that describes the measures that nurses on a geriatric unit took to reduce pressure ulcers among patients • Testimonials from experienced clinicians about the effectiveness of the mattress in question • A randomized controlled trial that compared the pressure - reducing mattress with standard mattresses Ans: D Feedback: The most reliable evidence is considered RCTs. Qualitative studies, case studies, and expert opinion are low on the hierarchy of evidence. • Hospital administrators are applying the principles of evidence -based practice (EBP) in their attempt to ascertain the most efficient and effective way to communicate between nurses who are on different units, a project that will consider many types of evidence. Which of the following information sources should the administrators prioritize? • A systematic review about communication in nursing contexts • Nurses ideas about communication methods • The results of a chart review • The hospitals accreditation status Ans: A Feedback: Systematic reviews are assigned a high value in EBP. Reviews would be prioritized over nurses ideas or a chart review, though both are potential considerations. The hospitals accreditation status is not a relevant consideration. • A nurse has resolved to apply the evidence -based practice (EBP) process to the way that admission assessments are conducted and documented on a unit. How should the nurse begin the process of establishing EBP? • Gather evidence showing the shortcomings of current practices • Formulate a clear and concise question to be addressed • Elicit support from the nurses who are most often responsible for admissions • Search the literature for evidence that is potentially relevant to the practice need Ans: B Feedback: The first step in applying EBP is to ask a clear, focused question. This should precede a search of the literature or the recruitment of participants. An assessment of the shortcomings of the current system is not an explicit component of the EBP process. • Which of the following questions best exemplifies the PICOT format for asking evidence -based questions? • What affect does parents alcohol use have on the alcohol use of their teenage children? • Among postsurgical patients, what role does meditation rather than benzodiazepines have on anxiety levels during the 48 hours following surgery? • Among high school students, what is the effectiveness of a sexual health campaign undertaken during the first 4 weeks of the fall semester as measured by incidence of new sexually transmitted infections? • In children aged 68, is the effectiveness of a descriptive pain scale superior to a numeric rating scale in the emergency room context? Feedback: The correct answer includes a population (postsurgical patients), intervention (meditation), comparison (benzodiazepines), outcome (anxiety levels), and a time frame (48 hours). No other option contains each of the five elements of a PICOT question. • A nurse has made plans to implement the University of North Carolina (UNC) model of 5 As during the process of applying evidence - based practice (EBP) to a practice problem. What is the final step that the nurse will take in applying this model? • Analyze the results of the EBP process • Advocate for others to embrace the identified change • Adopt the changes identified in the review process • Assess the outcomes of the new practice Ans: D Feedback: The final step in the UNC rubric is to Assess the change using the quality improvement process in place in the institution. • A nurse has been asked to make a presentation to a group of high school students on the subject of sexual health. However, the nurse does not have a background in this practice area and requires rapid access to evidence -based guidelines. Which of the following strategies is most likely to provide the nurse with valid and reliable evidence in a time-efficient manner? • Search the Cochrane Library of Systematic Reviews • Google search terms such as sexual health teens and sexual education • Search Medline using PubMed and order relevant articles • Scan the most recent issues of nursing journals that address this area of practice Feedback: For some problems, a systematic review may be available from a source such as the Cochrane Library. Often this review is done by an expert panel providing excellent information on which to base decisions. This approach is more likely to produce valid and reliable results than a Google search and is more efficient than searching journal manually or ordering articles through PubMed. • The nurses at a university hospital have been informed that a computerized record system will be implemented over the next 12 months. The nurses should be aware that such as system presents particular challenges in the area of • vulnerability to errors in charting and the inability to make changes. • patient privacy and confidentiality of records. • enforcing compliance with the system on the part of nurses. • ensuring compatibility with different computer operating systems. Ans: B Feedback: Concerns about privacy become magnified when information is available to many people in many sites far removed from where the patient is located, a situation that exists when computerized records are used. This is usually considered a more important concern than issues of compliance, compatibility, or vulnerability to errors. • A nurse is nervous about the impeding introduction of computerized nursing care records at the hospital because he does not consider himself to be technologically adept. How should this nurse best respond to this situation? • Take courses in advanced practice nursing to build his knowledge. • Explore employment opportunities in settings that use written documentation systems. • Advocate for a delay in the introduction of the proposed system. • Seek out opportunities to learn the relevant knowledge and practice the necessary skills. Ans: D Feedback: A nurse who lacks technological knowledge or skills should seek out opportunities to expand these. This is preferable to finding a job elsewhere, studying advanced practice nursing, or attempting to delay the change. Chapter 2. Caring and the Advanced Practice Nurse Multiple Choice • A goal of community nursing is to provide primary prevention from disease. Which of the following nursing actions reflect this goal? • A nurse creates a pamphlet discussing heart -healthy foods and distributes it in the neighborhood community center. • A nurse starts an intravenous line on a dehydrated baby who has been brought to the emergency department. • A nurse performs range -of-motion exercises for a patient in traction. • A nurse repositions an elderly patient confined to a wheelchair to avoid the formation of pressure ulcers. Ans: A Feedback: Primary prevention involves the efforts to prevent disease from ever occurring. Primary prevention can be aimed at stopping the cause of disease. Generalized efforts to educate people regarding healthy diets are aimed at this type of primary prevention. Tertiary prevention focuses on preventing long-term disability and restoring functional capacity, as exemplified by repositioning an immobile patient, rehydrating a patient, or assisting with exercises. • A nurse decides to pursue a career in community -based nursing. Which of the following statements represents the environment in which the nurse will be working? • Community -based nursing is limited to work in public clinics, schools, and industry. • The key to community -based settings is that the nurse is in charge. • The nurse serves as an educator, guide, and resource person and determines the action taken by the client. • Care in the community is cost-effective. Ans: D Feedback: Care in the community is cost-effective and often more acceptable to the client because it causes less disruption in life. It takes place in a wide variety of settings and involves the nurse entering into a collaborative relationship with clients. • The movement of a client from acute care to a long-term nursing care facility involves planning to provide continuity of care. What is the term for this type of planning? • Discharge planning • Comprehensive planning • Ongoing planning • T r a ns i t i o n p l a n n i n g A n s : D Feedback: Transitions are the movement of the patient from one care environment to another. Transition planning refers to the planning process that takes place to assure that the patients well - being is maintained throughout the time of transition. Organizing this transition from one care setting to another is not termed discharge planning, comprehensive planning, or ongoing planning. • A nurse is called into work to perform triage in the aftermath of an earthquake. Which of the following are the expected responsibilities of this nurse? • Set up and monitor IV lines. • Prepare the emergency room for multiple victims. • Screen victims to prioritize treatment. • Check available blood products and assist with transfusions. Ans: C Feedback: Triage involves the initial screening of victims for the purpose of prioritizing treatment and making the most effective and efficient use of both human and material resources. The other noted tasks are within the scope of disaster nursing but are not triage activities. • A client asks a nurse for help in obtaining an alternative healthcare provider. Which of the following is an accurate fact regarding alternative care that the nurse should share with this client? • Most alternative healthcare practitioners do not have education -based credentials to practice their medicine. • Alternative providers are not usually included in the federal HIPAA legislation that mandates confidentiality in conventional healthcare settings. • The cost of alternative therapy is never covered by insurance carriers or healthcare plans. • It is easy to find accurate safety and efficacy data for alternative medicine on the Internet. Ans: B Feedback: Alternative providers are not normally included in the federal Health Insurance Portability and Accountability Act of 1996 legislation that mandates confidentiality in conventional healthcare settings. Alternative practitioners do not necessarily lack credentials. Accurate online information can be difficult to find and costs for treatment may be covered by some insurance plans. • There is an increasing trend for nursing care to move from the hospital setting into the community. Nurses who are to provide excellent care in a community setting should prioritize which of the following? • Integrating culture and family into the planning and delivery of care • Becoming more assertive in client education and the planning of client care • Encouraging clients to limit their interactions with physicians • Teaching clients to replace biomedical interventions with complementary therapies Ans: A Feedback: The move to community care heightens the importance of family - centered, culturally - competent nursing. Community nursing does not necessarily require that a nurse become more assertive with client. It would be simplistic, and in most cases inappropriate, to guide clients to replace biomedical interventions or avoid doctors. • In spite of the important role that hospitals play in American healthcare, there is growing importance of community -based healthcare and community -based nursing. Which of the following statements best conveys a central aspect of the philosophy of community care? • The client is in charge of his or her health and healthcare in the community. • Nurses maximize their scope of practice in noninstitutional settings. • Community settings allow for the greatest number and variety of treatment options. • The nurse becomes the key member of the healthcare team in a community setting. Ans: A Feedback: A central premise of community healthcare is the fact that patients/clients are in charge. The move toward community care is not motivated by an increased role for nurses. There are a greater number of treatment options in hospitals than in the community, but this fact does not negate the importance of community care. • Mr. Hammond is a 70 -year-old man with a diagnosis of type 1 diabetes who developed a diabetic foot ulcer earlier this year. He has recently been discharged from the hospital and now requires regular wound care. Karen is a community health nurse who provides wound care for Mr. Hammond twice weekly. Which of Karens actions is most likely to empower Mr. Hammond? • Encourage Mr. Hammond to acknowledge his contribution to the development of his wound. • Provide information to Mr. Hammond that matches his expressed needs. • Encourage Mr. Hammond to involve members of his family in his care. • Delegate wound care to Mr. Hammond and reduce the frequency of her visits. Ans: B Feedback: Client empowerment is often fostered by assessing and meeting a clients need for information. Encouraging an acknowledgement of the clients contribution to his or her current health state is beneficial in many circumstances, but it less likely to make the client feel empowered. Similarly, family involvement can be beneficial but does not directly foster empowerment. Empowerment does not necessarily mean that the nurse does less and the client performs his or her own care; delegation may not be appropriate. • An elderly female client who resides in the community tends to defer decisions regarding her care to her eldest son. How should the community health nurse respond to the clients reluctance to make independent decisions? • Discuss this observation with the client and her son in an open manner and explore alternatives. • Organize care so that it takes place at times when the son is not present in the home. • Accommodate this aspect of the clients family dynamics when planning and carrying out care. • Teach the client assertiveness skills that she can apply in her interactions with her son.