Brunner And Suddarth Medical Surgical Nursing 12e by Suzanne C. Smeltzer Test Bank

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Brunner And Suddarth Medical Surgical Nursing 12e by Suzanne C. Smeltzer Test Bank

Description

WITH ANSWERS
Brunner And Suddarths Medical Surgical Nursing 12e by Suzanne C. Smeltzer Test Bank

Import Settings:

Base Settings: Brownstone Default

Information Field: Chapter

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: E

Multiple Keywords in Same Paragraph: No

 

 

 

 

 

Chapter: Chapter 02: Community-Based Nursing Practice

 

 

 

 

Multiple Choice

 

 

 

 

  1. A community health nurse has scheduled a hypertension clinic. This service would be an example of which type of health care?
  2. A) Tertiary prevention
  3. B) Secondary prevention
  4. C) Primary prevention
  5. D) Disease prevention

 

Ans:  B

Chapter:  2

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  15, Community-Based Care

 

Feedback:  Secondary prevention centers on health maintenance are aimed at early detection and prevention. Disease prevention is not a form of health care but is a focus with primary prevention.

 

 

 

 

  1. The nursing instructor is preparing her students for their home-care rotation. She discusses the patients that they are likely to care for in the home. Which of the following are the most frequent users of home care services?
  2. A) Disabled patients
  3. B) Chronically ill patients
  4. C) Terminally ill patients
  5. D) Elderly patients

 

Ans:  D

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  5

Page and Header:  16, Home Health Care

 

Feedback:  The elderly are the most frequent users of home care services. The patient must be acutely ill, home bound, and in need of skilled nursing services to be eligible for this service. The other answers are incorrect because it is the elderly who are seen most frequently in the home health setting.

 

 

 

 

  1. Patients lifestyles in the home may vary greatly from the nurses own beliefs. To work successfully with the patient, what must the nurse do?
  2. A) Ask for another assignment if there is a conflict of interest
  3. B) Ask the patient to come to the agency to receive treatment
  4. C) Convey respect for the patients beliefs
  5. D) Adapt the patients home to a hospital-like environment

 

Ans:  C

Chapter:  2

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  5

Page and Header:  16, Home Health Care

 

Feedback:  To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respect for patients beliefs, even if they differ sharply from the nurses. This can be difficult when a patients lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of alcohol, drug abuse, or overeating. The other answers are incorrect because you do not request another assignment because of a difference in beliefs, nor do you ask for the patient to come to you if you are a home health nurse. It is also inappropriate to convert the patients home to a hospital-like environment.

 

 

 

 

  1. Infection control is important in every setting where nursing care is provided. In the home setting, how will the nurse best implement infection control?
  2. A) Cleanse the hands before and after giving direct patient care
  3. B) Remove the patients wound dressings from the home
  4. C) Dispose of patients syringes in the patients garbage
  5. D) Disinfect all work areas in the patients home

 

Ans:  A

Chapter:  2

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  17, Home Health Care

 

Feedback:  Infection control is as important in the home as it is in the hospital, but it can be more challenging in the home and requires creative approaches. As in any situation, it is important to clean ones hands before and after giving direct patient care, even in a home that does not have running water. The other answers are incorrect because removing the wound dressings from the home and disinfecting all work areas in the home are not the best implementation of infection control in the home. Disposing of syringes in the patients garbage is never done.

 

 

 

 

  1. Your patient is ready to be discharged from the hospital. When should your patients discharge planning begin?
  2. A) The day prior to discharge
  3. B) The day of estimated discharge
  4. C) The day the patient is admitted
  5. D) Once the nurse determines care needs

 

Ans:  C

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  17, Home Health Care

 

Feedback:  Discharge planning begins with the patients admission to the hospital and must consider the possible need for follow-up home care. The other answers are incorrect because they are not when discharge planning begins.

 

 

 

 

  1. During the initial visit to a patients home, what information is it important to provide to the patient and family?
  2. A) Available community resources to meet their needs
  3. B) Information on other patients in the area with similar health care needs
  4. C) The nurses home address and phone number
  5. D) Dates and times of all scheduled home care visits

 

Ans:  A

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  17, Home Health Care

 

Feedback:  The community-based nurse is responsible for informing the patient and family about the community resources available to meet their needs. During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because it is inappropriate to ever provide information on other patients to a patient; it is equally inappropriate for a nurse to give her patients her home address or phone number. Giving the patient the dates and times of their scheduled home visits is appropriate, but it is more important to provide them with resources available within the community to meet their needs.

 

 

 

 

  1. The home health nurse receives a referral from the hospital for a patient who needs a home visit. After reading the referral, what would be the first action the nurse should take?
  2. A) Identify community services to initiate for the patient
  3. B) Obtain a physicians order for the visit
  4. C) Call the patient to obtain permission to visit
  5. D) Schedule a home health aide to visit the patient

 

Ans:  C

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  17, Home Health Care

 

Feedback:  After receiving a referral, the first step is to call the patient and obtain permission to make the visit. Then the nurse should schedule the visit and verify the address. A physicians order is not necessary to schedule a visit with the patient. The nurse may identify community services or the need for a home health aide after she assesses the patient and the home environment during the first visit with the patient.

 

 

 

 

  1. Why is it important for the nurse to inform the health care agency of her daily schedule?
  2. A) Allows the agency to keep track for payment of the nurse
  3. B) Supports suggested safety precautions for the nurse when making a home care visit
  4. C) Allows easy accessibility of the nurse for changes in assignments
  5. D) Allows the patient to cancel appointments with minimal inconvenience

 

Ans:  B

Chapter:  2

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  17, Home Health Care

 

Feedback:  Whenever a nurse makes a home visit, the agency should know the nurses schedule and the locations of the visits. The other answers are incorrect because providing the agency with a copy of the daily schedule is not for the purpose of correctly paying the nurse or for the ease of the nurse in changing assignments or for the patients ease in canceling appointments.

 

 

 

 

  1. There are specific guidelines and regulations for documentation related to home care that the nurse must consider and follow. For those patients with Medicaid, what is most important for the nurse to document to assure reimbursement for services?
  2. A) The medical diagnosis and supplies needed to care for the patient
  3. B) Directions to the patients home
  4. C) Quality of nursing care needed
  5. D) The patients homebound status and the need for skilled professional nursing care

 

Ans:  D

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  5

Page and Header:  18, Home Health Care

 

Feedback:  Medicare, Medicaid, and third-party payers require documentation of the patients homebound status and the need for skilled professional nursing care. The medical diagnosis and specific detailed information on the functional limitations of the patient are usually part of the documentation. The other answers are incorrect because nursing documentation does not include needed supplies, directions to the patients home, or the quality of care needed.

 

 

 

 

  1. Your patient has had a total knee replacement and will need to walk with crutches for 6 weeks. He is being discharged home with a referral for home health care. What will the home care nurse need to assess during her initial assessment?
  2. A) Assistance of neighbors
  3. B) Previous health status
  4. C) Costs of the visits
  5. D) Home environment

 

Ans:  D

Chapter:  2

Client Needs:  D-3

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  18, Home Health Care

 

Feedback:  The initial assessment includes evaluating the patient, the home environment, the patients self-care abilities or the familys ability to provide care, and the patients need for additional resources. There is no assessment made of assistance on the part of neighbors, the previous health status, or the costs of the visit.

 

 

 

 

  1. A nurse who has an advanced degree in primary care for a pediatric population is employed in a health clinic. In what role is this nurse functioning?
  2. A) Nurse practitioner
  3. B) Case cocoordinator
  4. C) Clinical nurse specialist
  5. D) Clinic supervisor

 

Ans:  A

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  7

Page and Header:  19, Other Community-Based Health Care Settings

 

Feedback:  Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on gerontology, pediatrics, family or adult health, or womens health. Case cocoordinators and clinic supervisors do not require an advanced degree, and a clinical nurse specialist is not educated in primary care.

 

 

 

 

  1. A nurse working in a large meat-packaging plant sees patients for work-related issues. What is the role of the nurse?
  2. A) Occupational health nurse
  3. B) Staff nurse
  4. C) Nurse clinician
  5. D) Nurse educator

 

Ans:  A

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  7

Page and Header:  20, Other Community-Based Health Care Settings

 

Feedback:  Occupational health nurses may provide direct care to patients who are ill, conduct health education programs for the industry staff, or set up health programs. The other answers are incorrect because they are not consistent with a nurses placement in a manufacturing setting.

 

 

 

 

  1. A school nurse is concerned about a fourth grade student with cystic fibrosis. The nurse is aware that children with health problems are at major risk for what?
  2. A) Sports injuries
  3. B) Attention disorders
  4. C) Experiencing school-related stress due to a desire to overachieve
  5. D) Underachieving or failing in school

 

Ans:  D

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  7

Page and Header:  20, Other Community-Based Health Care Settings

 

Feedback:  School-aged children and adolescents with health problems are at major risk for underachieving or failing in school. The other answers are incorrect because they are not at major risk for sports injuries, attention disorders, or a desire to overachieve.

 

 

 

 

  1. Which patients seek health care late in the course of their disease process and deteriorate more quickly than other patients?
  2. A) Homeless
  3. B) Immigrants
  4. C) Elderly
  5. D) Adolescents

 

Ans:  A

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  20, Other Community-Based Health Care Settings

 

Feedback:  Because of numerous barriers, the homeless seek health care late in the course of a disease and deteriorate more quickly than patients who are not homeless. Many of their health problems are related in large part to their living situation. The other answers are incorrect because these populations do not seek care late in the course of their disease process and deteriorate quicker than other populations.

 

 

 

 

Multiple Selection

 

 

 

 

  1. What changes in the health care system have created an increased need for nurses to practice in community-based settings? (Mark all that apply.)
  2. A) Tighter insurance regulations
  3. B) Younger population
  4. C) Increased rural population
  5. D) Changes in federal legislation
  6. E) Decreasing hospital revenues

 

Ans:  A, D, E

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  1

Page and Header:  15, Introduction

Feedback:  Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, and alternative health care delivery systems have also affected the ways in which health care is delivered. Our country does not have an increased rural population nor is our population younger so these answers are incorrect.

 

 

 

 

Multiple Choice

 

 

 

 

  1. Nurses are now working in ambulatory health clinics, hospice settings, and homeless shelters and clinics. What has influenced this increase in practice settings for nurses?
  2. A) Population shift to more rural areas
  3. B) Shift of health care delivery into the community
  4. C) Advent of primary care clinics
  5. D) Increased use of rehabilitation hospitals

 

Ans:  B

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  1

Page and Header:  15, Introduction

 

Feedback:  As health care delivery shifts into the community, more nurses are working in a variety of community-based settings. These settings include public health departments, ambulatory health clinics, long-term care facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics, nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay facilities, and patients homes. The other answers are incorrect because our population has not shifted to more rural area, and the use of primary care clinics has not influenced an increase in practice settings or the use of rehabilitation hospitals.

 

 

 

 

  1. What is the focus of community-based nursing?
  2. A) Community health
  3. B) Maintaining and improving the health of the community
  4. C) Promoting and maintaining the health of individuals and families
  5. D) Family health

 

Ans:  C

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Caring

Objective:  7

Page and Header:  15, Community-Based Care

 

Feedback:  This nursing practice focuses on promoting and maintaining the health of individuals and families, preventing and minimizing the progression of disease, and improving quality of life. Its focus is not really community health, maintaining or improving the health of a community, or family health per se.

 

 

 

 

  1. You are the community-based nurse who acts as case-manager for a small town about 60 miles from a major health care center. What is the most important factor of community-based nursing you should be knowledgeable about?
  2. A) Eligibility requirements for services
  3. B) Community resources available to patients
  4. C) Transportation costs to the medical center
  5. D) Possible charges for any services provided

 

Ans:  B

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  4

Page and Header:  17, Home Health Care

 

Feedback:  A community-based nurse must be knowledgeable about community resources available to patients as well as services provided by local agencies, eligibility requirements, and any possible charges for the services. The other answers are incorrect because they are not the most important factor for a community-based nurse to be knowledgeable about.

 

 

 

 

  1. A new community-based nurse is looking for community resources for one of her clients. Where would be the best place to look?
  2. A) Hospital directories
  3. B) Telephone book
  4. C) Community directories
  5. D) Church directories

 

Ans:  C

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  4

Page and Header:  17, Home Health Care

 

Feedback:  Most communities have directories of health and social service agencies that the nurse can consult. The other answers are incorrect because hospital directories usually only include people affiliated with the hospital, and neither telephone books nor church directories are meant to be directories of community resources.

 

 

 

 

Multiple Selection

 

 

 

 

  1. You are a community-based care manager in a community that does not have a resource directory available. One of your goals is to compile such a directory. What would be important to include in this directory? (Mark all that apply.)
  2. A) Nearby medical facilities
  3. B) List of social service workers in the community
  4. C) Eligibility requirements for services
  5. D) Commonly used resources
  6. E) Costs of services

 

Ans:  C, D, E

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  4

Page and Header:  17, Home Health Care

Feedback:  If a community does not have a resource booklet, an agency may develop one for its staff. It should include the commonly used community resources that patients need, as well as the costs of the services and eligibility requirements. The other answers are incorrect because a community resource booklet would not always include nearby medical facilities, and it would not identify specific social service workers, only agencies.

 

 

 

 

Multiple Choice

 

 

 

 

  1. You are assessing a new patient and his home environment. What is a responsibility that you, as a community-based nurse, have at this initial visit?
  2. A) Encourage the patient and his family to use local stores to support their community.
  3. B) Encourage the patient and his family to contact their church as a resource.
  4. C) Encourage the patient and his family to use the Internet to find local resources.
  5. D) Encourage the patient and his family to contact appropriate community resources.

 

Ans:  D

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  4

Page and Header:  17, Home Health Care

 

Feedback:  During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because a home-health nurse would not encourage the patient to support the community, nor would she necessarily encourage the patient to use the church as a resource or to use the Internet to find his own local resources. The nurse would provide the patient with the applicable local resources.

 

 

 

 

  1. What type of health care is most likely to be available in both community and hospital-based settings?
  2. A) Dieticians
  3. B) Ambulatory health care
  4. C) Physical therapy
  5. D) Hospice care

 

Ans:  B

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Caring

Objective:  2

Page and Header:  19, Other Community-Based Health Care Settings

 

Feedback:  Ambulatory health care is provided for patients in community or hospital-based settings. The types of agencies that provide such care are medical clinics, ambulatory care units, urgent care centers, cardiac rehabilitation programs, mental health centers, student health centers, community outreach programs, and nursing centers. Dieticians are not generally community based, physical therapy is usually agency based, and hospice care is not generally provided in hospital settings.

 

 

 

 

  1. Every home health agency, based on the principle of due diligence, must inform its employees of what?
  2. A) At-risk working environments
  3. B) OSHA requirements
  4. C) Available training for personal safety
  5. D) Policies and procedures about clinical safety

 

Ans:  A

Chapter:  2

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Page and Header:  17, Home Health Care

 

Feedback:  Based on the principle of due diligence, agencies must inform employees of at-risk working environments. Agencies have policies and procedures concerning the promotion of safety for clinical staff, and training is provided to facilitate personal safety. Home health agencies are not required to inform their staff of OSHA requirements, available training, or the policies and procedures regarding personal safety. They are required to inform someone before she is sent into a risky working environment.

 

 

 

 

  1. A home health nurse is making a visit to a new patient. During the visit, the patients husband arrives home in an intoxicated condition. He speaks to both you and the patient in an abusive and threatening manner. What should you do?
  2. A) Ignore the husband and focus on the patient
  3. B) Return to your agency and notify your supervisor
  4. C) Call the police from your cell phone
  5. D) Remove the patient from the home

 

Ans:  B

Chapter:  2

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  6

Page and Header:  18, Home Health Care

 

Feedback:  If a dangerous situation is encountered during the visit, the nurse should return to the agency and contact his or her supervisor or law enforcement officials, or both. The other answers are incorrect. Ignoring the husband or calling the police while in the home or attempting to remove the patient from the home could further endanger you and the patient.

 

 

 

 

  1. You have been notified by your agency of a new patient in your community. The agency tells you that this patient resides in a high-crime area. What is the most important request you should make of the agency?
  2. A) A cell phone
  3. B) Directions to the home
  4. C) Someone to accompany you on the visit
  5. D) Someone to wait in the car while you make your visit

 

Ans:  C

Chapter:  2

Client Needs:  A-2

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Caring

Objective:  6

Page and Header:  18, Home Health Care

 

Feedback:  When making visits in high-crime areas, visit with another person rather than alone. Answer D is incorrect because that possibly endangers both you and the person waiting in the car. Answers A and B are incorrect because they are not the most important request to the agency.

 

 

 

 

  1. What level of care do home health nurses often focus on?
  2. A) Preventative care
  3. B) Primary prevention
  4. C) Secondary prevention
  5. D) Tertiary prevention

 

Ans:  D

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  6

Page and Header:  20, Other Community-Based Health Care Settings

 

Feedback:  Nurses in community-based practice provide preventive care at three levels primary, secondary, and tertiary. Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although primary and secondary prevention are also addressed.  Answers B and C are incorrect because, while addressed, they are not usually the focus of home care nurses, and preventive care is an umbrella for all three levels of care.

 

 

 

 

  1. You are admitting two new patients to your home health care service. These patients live within two blocks of each other, and both homes are in a high-crime area. What is recommended for your personal safety?
  2. A) Drive a car that is hard to break into.
  3. B) Keep your purse close to you at all times.
  4. C) Dont leave anything in the car that might be stolen.
  5. D) Do not wear expensive jewelry.

 

Ans:  D

Chapter:  2

Client Needs:  A-2

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  6

Page and Header:  18, Home Health Care

 

Feedback:  Do not drive an expensive car or wear expensive jewelry when making visits. While all of these answers might be wise precautions to take, the only recommendation for your personal safety is answer D.

 

 

 

 

Multiple Selection

 

 

 

 

  1. In two days you are scheduled to discharge a patient home status post left hip replacement. You have initiated a home health referral and you have met with a team of people who have been involved with this patients discharge planning. Who would be appropriate people to be on the discharge planning team? (Mark all that apply.)
  2. A) Home health nurse
  3. B) Physical therapist
  4. C) Patients pastor
  5. D) Social service worker
  6. E) Meal-on-Wheels provider

 

Ans:  A, B, D

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  17, Home Health Care

Feedback:  The development of a comprehensive discharge plan requires collaboration with professionals at both the referring agency and the home care agency, as well as other community agencies that provide specific resources upon discharge. The patients pastor and the Meals-on-Wheels provider are not appropriate people to be part of a discharge-planning team.

 

 

 

 

  1. Which type of agencies provides documented home health care services? (Mark all that apply.)
  2. A) Unofficial neighborhood groups
  3. B) Private businesses
  4. C) Proprietary chains
  5. D) Off-duty neighborhood nurses
  6. E) Hospital-based agencies

 

Ans:  B, C, E

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  2

Page and Header:  15, Home Health Care

Feedback:  Home health care services are provided by official, publicly funded agencies; nonprofit agencies; private businesses; proprietary chains; and hospital-based agencies. Unofficial neighborhood groups and off-duty neighborhood nurses are not agencies that provide documented home health services.

 

 

 

 

Multiple Choice

 

 

 

 

  1. Discharge planning begins with the patients admission to the hospital. What is involved in the discharge-planning process?
  2. A) Identifying the patients needs
  3. B) Making a social services referral
  4. C) Getting physical therapy involved
  5. D) Notifying the speech therapist of the discharge date

 

Ans:  A

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  3

Page and Header:  17, Home Health Care

 

Feedback:  The process involves identifying the patients needs and developing a thorough plan to meet them. Answers B, C and D might be appropriate for some patients, but they are not all appropriate for every patient; therefore, these answers are wrong.

 

 

 

 

  1. Within the public health system there has been an increased demand for medical, nursing, and social services. What is the basis for this increased demand?
  2. A) A shift from hospital to community-based health care
  3. B) The growing number of older adults in the United States
  4. C) The rise in poverty in the United States
  5. D) The decreasing revenues in health care

 

Ans:  B

Chapter:  2

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  1

Page and Header:  15, Introduction

 

Feedback:  The growing number of older adults in the United States increases the demand for medical, nursing, and social services within the public health system. While there has been a shift from hospital-based to community-based health care, it is not the main reason for the increased need for public health services. Answers C and D are incorrect because they are not used as the basis for the increased demand for professionals within the public health system.

 

 

 

 

  1. Nursing care, no matter where it is delivered, has many consistencies. One of these consistencies is the need for what?
  2. A) Advanced education
  3. B) Certification in a specialty
  4. C) Cultural competence
  5. D) Independent practice

 

Ans:  C

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Caring

Objective:  2

Page and Header:  15, Introduction

 

Feedback:  Nurses in community settings must be culturally competent, as culture plays a role in the delivery of care. Culture can be structured within the context of care through the utilization of a theoretical framework involving cultural competence. The other answers are incorrect because an advanced education, specialty certification, and the ability to practice independently are not consistencies between nursing care delivery settings.

 

 

 

 

  1. Medicare finances many home health care expenses. What does this allow nurses to do?
  2. A) Provide care without the oversight of a physician
  3. B) Write necessary medication orders for the patient
  4. C) Order physical, occupational, and speech therapy if needed
  5. D) Manage and evaluate patient care for seriously ill patients

 

Ans:  D

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  7

Page and Header:  16, Home Health Care

 

Feedback:  Many home health care expenditures are financed by Medicare, which allows nurses to manage and evaluate patient care for seriously ill patients who have complex, labile conditions and are at high risk for rehospitalization. Home health nurses, despite who funds their visits, do not provide care without the oversight of a physician; they do not write medication orders; nor do they order the services of ancillary specialists such as physical, occupational, or speech therapists.

 

 

 

 

  1. You are a school nurse who is concerned about an incoming kindergartner with muscular dystrophy. Why would you make a home visit before school starts?
  2. A) To provide anticipatory guidance to the family
  3. B) To measure the childs wheelchair to make sure it fits through the school doors
  4. C) To set up home teachers for the child
  5. D) To provide follow-up care after the childs clinic visit

 

Ans:  A

Chapter:  2

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  7

Page and Header:  20, Other Community-Based Health Care Settings

 

Feedback:  Public health, parish, and school nurses may make visits to provide anticipatory guidance to high-risk families and follow-up care to patients with communicable diseases. The other answers are incorrect because they are not functions of the school nurse.

 

 

 

Import Settings:

Base Settings: Brownstone Default

Information Field: Chapter

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: E

Multiple Keywords in Same Paragraph: No

 

 

 

 

 

Chapter: Chapter 20: Postoperative Nursing Management

 

 

 

 

Multiple Choice

 

 

 

 

  1. You are the recovery room nurse who is admitting a patient from the OR. What is the first assessment you would make on a newly admitted patient?
  2. A) Heart rate
  3. B) Nail perfusion
  4. C) Core temperature
  5. D) Patency of the airway

 

Ans:  D

Chapter:  20

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  462, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  The primary objective in the immediate postoperative period is to maintain ventilation and, thus, prevent hypoxemia (reduced oxygen in the blood) and hypercapnia (excess carbon dioxide in the blood). Both can occur if the airway is obstructed and ventilation is reduced (hypoventilation). This assessment is followed by cardiovascular status and the condition of the surgical site. Nail perfusion is part of the cardiovascular status. The core temperature would be assessed after the airway, cardiovascular status, and wound.

 

 

 

 

  1. Your patient is in the recovery room following chest surgery. The patient complains of severe nausea. What would you do next?
  2. A) Administer an analgesic
  3. B) Apply a cool cloth to the patients forehead
  4. C) Offer the patient a small amount of ice chips
  5. D) Turn the patient completely to one side

 

Ans:  D

Chapter:  20

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  465, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  Turning the patient completely to one side allows collected fluid to escape from the side of the mouth if the patient vomits. After turning the patient to the side, the nurse can offer a cool cloth to the patients forehead. Ice chips can increase feelings of nausea. An analgesic is not administered for nausea and vomiting.

 

 

 

 

  1. You are discharging your patient home from day surgery after a general anesthetic. What instruction would you give the patient prior to the patient leaving the hospital?
  2. A) The patient is not to drive a vehicle
  3. B) The patient should have a glass of brandy the first night home to help him or her sleep
  4. C) Eat a large meal at home
  5. D) Do not sign important papers for the first 12 hours after surgery

 

Ans:  A

Chapter:  20

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  468, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  Although recovery time varies depending on the type and extent of surgery and the patients overall condition, instructions usually advise limited activity for 24 to 48 hours. During this time, the patient should not drive a vehicle, drink alcoholic beverages, or perform tasks that require energy or skill. Eat only as tolerated.

 

 

 

 

  1. Your patient is a 78-year-old male who has had outpatient surgery. You are getting him up for his first walk postoperatively. To decrease the potential for orthostatic hypotension, what should you plan to have the patient do?
  2. A) Sit in a chair for 10 minutes prior to ambulating
  3. B) Drink plenty of fluids to increase circulating blood volume
  4. C) Stand upright for 2 to 3 minutes prior to ambulating
  5. D) Sit upright on the side of the bed for 15 minutes prior to ambulating

 

Ans:  C

Chapter:  20

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  473, Care of the Hospitalized Postoperative Patient

 

Feedback:  Older adults are at an increased risk for orthostatic hypotension secondary to age-related changes in vascular tone. The patient should sit up and then stand for 2 to 3 minutes before ambulating to alleviate orthostatic hypotension. Therefore options A, B, and D are incorrect.

 

 

 

 

  1. You admit a patient to the PACU who has undergone a surgical procedure that required the use of general anesthesia. What is the patient most at risk for following general anesthesia?
  2. A) Atelectasis
  3. B) Anemia
  4. C) Dehydration
  5. D) Peripheral edema

 

Ans:  A

Chapter:  20

Client Needs:  D-3

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  470, Care of the Hospitalized Postoperative Patient

 

Feedback:  Atelectasis occurs when the postoperative patient fails to move, cough, and breathe deeply. With good nursing care, this is an avoidable complication. Anemia occurs rarely and usually in situations where the patient loses a significant amount of blood or if he continues bleeding postoperatively. Fluid shifts postoperatively may result in dehydration and peripheral edema, but the patient is most at risk for atelectasis.

 

 

 

 

  1. You are caring for a postoperative patient on the medical-surgical unit. During each patient assessment, you evaluate your patient for infection. Which sign or symptom would be most indicative of infection?
  2. A) Presence of an indwelling urinary catheter
  3. B) Rectal temperature of 100F (37.8C)
  4. C) Red, warm, tender incision
  5. D) White blood cell (WBC) count of 8,000/mL

 

Ans:  C

Chapter:  20

Client Needs:  A-2

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  480, Care of the Hospitalized Postoperative Patient

 

Feedback:  Redness, warmth, and tenderness in the incision area should lead the nurse to suspect a postoperative infection. The presence of any invasive device predisposes a patient to infection but by itself doesnt indicate infection. A rectal temperature of 100F would be a normal expectation in a postoperative patient because of the inflammatory process. A normal white blood cell count ranges from 4,000 to 10,000/mL.

 

 

 

 

  1. The nursing instructor is with a student nurse who is going to be changing an abdominal dressing. The first step is to provide the patient with information regarding the procedure. Which of the following is the best statement for completing this task?
  2. A) The dressing change is often painful, and we will be giving you pain medication prior to the procedure so you do not have to worry.
  3. B) During the dressing change, I will provide privacy at a time of your choosing, it should not be painful, and you can look at the incision and help with the procedure if you want to.
  4. C) The dressing change should not be painful, but you can never be sure, and infection is always a concern.
  5. D) The best time for doing a dressing change is during lunch so we are not interrupted. I will provide privacy, and it should not be painful.

 

Ans:  B

Chapter:  20

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Page and Header:  474, Care of the Hospitalized Postoperative Patient

 

Feedback:  When having dressings changed, the patient needs to be informed that the dressing change is a simple procedure with little discomfort, privacy will be provided, and the patient is free to look at the incision or even assist in the dressing change itself. If the patient decides to look at the incision, assurance is given that the incision will shrink as it heals and that the redness will likely fade. Option A is incorrect; dressing changes should not be painful, but giving pain medication prior to the procedure is always good preventive measure. Option C is incorrect; telling the patient that the dressing change should not be painful, but you can never be sure, and infection is always a concern does not offer the patient any real information or options and serves only to create fear. Option D is incorrect; the best time for dressing changes is when it is most convenient for the patient; nutrition is important so interrupting lunch is probably a poor choice.

 

 

 

 

  1. Your patient is 2 hours postoperative with a Foley catheter in situ. The last hourly urine output you recorded for this patient was 10 mL. The tubing of the Foley is patent. What should you do?
  2. A) Irrigate the Foley with 30 mL normal saline
  3. B) Notify the physician, and continue to closely monitor the hourly urine output
  4. C) Decrease the IV fluid rate
  5. D) Have the patient sit in high-Fowlers position

 

Ans:  B

Chapter:  20

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  472, Care of the Hospitalized Postoperative Patient

 

Feedback:  If the patient has an indwelling urinary catheter, hourly outputs are monitored and rates of less than 30 mL/h are reported. The urine output should continue to be monitored hourly by the nurse.

 

 

 

 

  1. You are caring for a 79-year-old man who has returned to the medical-surgical unit following abdominal surgery. Your patient is unable to ambulate and is now refusing to wear an external pneumatic compression stocking. You explain that refusing to wear external pneumatic compression stockings places him at significant risk for what?
  2. A) Sepsis
  3. B) Infection
  4. C) Pulmonary embolism
  5. D) Hematoma

 

Ans:  C

Chapter:  20

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  1

Page and Header:  478, Care of the Hospitalized Postoperative Patient

 

Feedback:  Patients who have surgery that limit mobility are at an increased risk for pulmonary embolism secondary to deep vein thrombosis. The use of an external pneumatic compression stocking significantly reduces the risk by increasing venous return to the heart and limiting blood stasis. Options A and B are incorrect; the risk of infection or sepsis would not be affected by an external pneumatic compression stocking. Option D is incorrect; a hematoma or bruise would not be affected by the external pneumatic compression stocking unless the stockings were placed directly over the hematoma.

 

 

 

 

  1. You admit a patient to the postanesthesia care unit with a blood pressure of 130/90 and a pulse of 68 beats per minute. After 30 minutes, the patients blood pressure is 120/65, and the pulse is 100. You document the patients skin as cold, moist, and pale. What is the patient showing signs of?
  2. A) Hypothermia
  3. B) Hypovolemic shock
  4. C) Neurogenic shock
  5. D) Malignant hypothermia

 

Ans:  B

Chapter:  20

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  464, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  The patient is exhibiting symptoms of hypovolemic shock; therefore, the nurse should notify the patients physician and anticipate orders for fluid and/or blood product replacement.

 

 

 

 

  1. You are a nurse in the PACU caring for a 56-year-old male patient who had a hernia repair. The patients blood pressure is now 164/92, he has no history of hypertension prior to surgery, and his preoperative blood pressure was 112/68. You know that hypertension following surgery is often related to what?
  2. A) Dysrhythmias, blood loss, and hyperthermia
  3. B) Electrolyte imbalances and neurologic changes
  4. C) A parasympathetic reaction and low blood volumes
  5. D) Pain, hypoxia, or bladder distention, which all cause sympathetic stimulation

 

Ans:  D

Chapter:  20

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  465, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  Hypertension is common in the immediate postoperative period secondary to sympathetic nervous system stimulation from pain, hypoxia, or bladder distention. Options A and B are incorrect; dysrhythmias, blood loss, hyperthermia, electrolytes imbalances, and neurologic changes are not common postoperative reasons for hypertension. Option D is incorrect; a parasympathetic reaction and low blood volumes would cause hypotension.

 

 

 

 

  1. You are the nurse caring for a patient after abdominal surgery in the postanesthesia care unit. The patients blood pressure has increased and the patient is restless. The patients oxygen saturation is 97%. You know that the change in your patient is most likely caused by what?
  2. A) The patients temperature is low.
  3. B) The patient is in shock.
  4. C) The patient is in pain.
  5. D) The patient is nauseated.

 

Ans:  C

Chapter:  20

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  470, Care of the Hospitalized Postoperative Patient

 

Feedback:  An increase in blood pressure and restlessness are symptoms of pain. The patients oxygen saturation is 97%, so hypothermia and shock are not likely causes of the patients restlessness.

 

 

 

 

  1. You are the nurse in the emergency department (ED). You are caring for a man who has returned to the ED after receiving ten stitches for a knife wound while cleaning fish. The wound is now infected, the stitches were removed, and the wound is cleaned and packed with gauze. The ED doctor plans to have the man return tomorrow to remove the packing and resuture the wound. You are aware that the wound will now heal by what?
  2. A) Late intention
  3. B) Second intention
  4. C) Third intention
  5. D) First intention

 

Ans:  C

Chapter:  20

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  474, Care of the Hospitalized Postoperative Patient

 

Feedback:  Third-intention healing or secondary suture is used for deep wounds that either had not been sutured early or that had the suture break down and are resutured later, which is what happened in this case. Secondary suture brings the two opposing granulation surfaces back together; however, this usually results in a deeper and wider scar. These wounds are also packed postoperatively with moist gauze and covered with a dry sterile dressing. Option A is incorrect; late intention is a term that sounds good but is used simply to distract the unsure test-taker. Option B is incorrect; second intention is when the wound is left open and the wound is filled will granular tissue. Option D is incorrect; first intention wounds are wounds made aseptically with a minimum of tissue destruction.

 

 

 

 

  1. You are the nurse caring for 82-year-old women in the PACU. The woman begins to awaken and responds to her name but is confused, restless, and agitated. What are you aware of?
  2. A) Postoperative confusion is an indication of an oxygen problem or possibly a stroke during surgery.
  3. B) Confusion, restlessness, and agitation are normal postoperative findings and will diminish in time.
  4. C) Postoperative confusion is common in the elderly, but it could also indicate a significant blood loss.
  5. D) Confusion, restlessness, and agitation indicate inadequate pain management, and analgesics will help.

 

Ans:  C

Chapter:  20

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  466, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  Postoperative confusion is common in the elderly, but it could also indicate blood loss and the potential for hypovolemic shock and is a critical symptom for the nurse to identify. Option A is a good answer; postoperative confusion is an indication of an oxygen problem or possibly a stroke during surgery, but blood loss is more likely. Option B is incorrect; restlessness and agitation are never normal postoperative findings. Option D is incorrect; confusion, restlessness, and agitation may indicate inadequate pain management, but pain could be assessed by report of pain, splinting of the affected area, and vital signs.

 

 

 

 

  1. A 38-year-old patient has just been admitted to the PACU following abdominal surgery. As the patient begins to awaken, he is restless and asking for a drink of water. The nurse checks his skin and it is cold, moist, and pale. What is the nurse concerned the patient may be at risk for?
  2. A) Hemorrhage and shock
  3. B) Loss of airway and hypotension
  4. C) Pain and anxiety
  5. D) Hypertension and dysrhythmias

 

Ans:  A

Chapter:  20

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  464, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  Hemorrhage is a complication of surgery that can result in death; when blood loss is extreme, the patient usually presents apprehensive, restless, and thirsty; and the skin is cold, moist, and pale. Option B is incorrect; the patient is asking for a drink of water so loss of airway is unlikely, and there is no evidence provided in the question that is related to hypotension such as blood pressure. Options C and D are incorrect; there is no evidence based on the information provided in the question that the patient is in pain or having anxiety, hypertension, or dysrhythmias.

 

 

 

 

  1. The nursing instructor is discussing postoperative care with the junior nursing students. A student nurse asks, Why does the patient go to the PACU prior to the medical-surgical unit? What is the nursing instructors best response?
  2. A) The PACU allows the patient to recover from anesthesia in a stimulating environment to facilitate awakening and reorientation.
  3. B) The PACU allows the patient to recover from the effects of anesthesia, and the patient stays in PACU until he or she is oriented, has stable vital signs, and is without complications.
  4. C) Frequently, patients are recovered in the medical-surgical unit, but hospitals are usually short of beds, and the PACU is an excellent place to triage patients.
  5. D) The medical-surgical unit is frequently very busy and unable accept the patient from surgery, so the patients are observed and monitored in PACU until a bed is available.

 

Ans:  B

Chapter:  20

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  2

Page and Header:  462, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  The PACU provides care for the patient while he or she recovers from the effects of anesthesia. The patient must be oriented, have stable vital signs, and show no evidence of hemorrhage or other complications. Patients will sometimes recover in the intensive care unit, but this is considered an extension of the PACU. Option A is incorrect; the PACU does allow the patient to recover from anesthesia, but the environment is calm and quiet as patients are initially disoriented and confused as they begin to awaken and reorient. Option C is incorrect; patients are not usually recovered in the medical-surgical unit, and although hospitals are occasionally short of beds, the PACU is should not used for patient triage. Option D is incorrect; in an emergency, the medical-surgical unit may be unable to accept a patient from surgery, and so the patients are observed and monitored in PACU until a bed is available, but this is the exception to the rule.

 

 

 

 

  1. The PACU nurse is caring for a patient who has arrived from the operating room who is still unconscious. During the initial assessment, the nurse notices that the patients skin is blue and dusky. She looks, listens, and feels for breathing, and determines the patient is not breathing. The priority intervention is to
  2. A) check an oxygen saturation rate, continue to monitor for apnea, and perform a focused assessment.
  3. B) treat the possible airway obstruction by tilting the head back and pushing forward on the angle of the lower jaw.
  4. C) check the arterial pulses, and place the patient in the Trendelenburg position.
  5. D) call a code blue, and then get an rapid intubation kit and prepare to reintubate.

 

Ans:  B

Chapter:  20

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  463, Care of the Patient in the Postanesthesia Care Unit

 

Feedback:  When a nurse finds a patient who is not breathing, the priority intervention is to open the airway and treat the possible hypopharyngeal obstruction. To treat the possible airw

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