Fundamentals Of Nursing 3rd ed by Wilkinson Treas Smith

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Fundamentals Of Nursing 3rd ed by Wilkinson Treas Smith

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WITH ANSWERS
Fundamentals Of Nursing 3rd ed by Wilkinson Treas Smith

Chapter 2. Critical Thinking & Nursing Process

 

MULTIPLE CHOICE

 

  1. Which of the following characteristics do the various definitions of critical thinking have in common? Critical thinking:
a) Requires reasoned thought
b) Asks the questions why or how
c) Is a hierarchical process
d) Demands specialized thinking skills

 

 

ANS:  A

The definitions listed in the text as well as definitions contained in Box 2-1 state that critical thinking requires reasoning or reasoned thinking. Critical thinking is neither linear nor hierarchical. The steps involved in critical thinking are not necessarily sequential, wherein mastery of one step is necessary to proceed to the next. Critical thinking is a purposeful, dynamic, analytical process that contributes to reasoned decisions and sound contextual judgments.

 

(High-level question, answer not stated verbatim)

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Analysis

Difficulty: Moderate

 

PTS:   1

 

  1. A few nurses on a unit have proposed to the nurse manager that the process for documenting care on the unit be changed. They have described a completely new system. Why is it important for the nurse manager to have a critical attitude? It will help the manager to:
a) Consider all the possible advantages and disadvantages
b) Maintain an open mind about the proposed change
c) Apply the Nursing Process to the situation
d) Make a decision based on past experience with documentation

 

 

ANS:  B

A critical attitude enables the person to think fairly and keep an open mind.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Comprehension

Difficulty: Moderate

 

PTS:   1

 

  1. The nurse has just been assigned to the clinical care of a newly admitted patient. To know how best to care for the patient, the nurse uses the Nursing Process. Which step would the nurse probably undertake first?
a) Make an assessment
b) Make a diagnosis
c) Plan outcomes
d) Plan interventions

 

 

ANS:  A

Assessment is the first step of the Nursing Process. The nursing diagnosis is derived from the data gathered during assessment, outcomes from the diagnosis, and interventions from the outcomes.

 

Nursing Process: Assessment

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Easy

 

PTS:   1

 

  1. Which of the following is an example of practical knowledge? Assume all are true.
a) The tricuspid valve is located between the right atrium and ventricle of the heart.
b) The pancreas does not produce enough insulin in type 1 diabetes.
c) When assessing the abdomen, you should auscultate before palpating.
d) Research shows pain medication given intravenously acts faster than medication given by other routes.

 

 

ANS:  C

Practical knowledge is knowing what to do and how to do it, such as how to make an assessment. The others are examples of theoretical knowledge, anatomy (tricuspid valve), facts (type 1 diabetes), and research (intravenous pain medication).

 

(High-level question, answer not stated verbatim)

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. Which of the following is an example of self-knowledge? The nurse thinks, I know that I:
a) Should take the clients apical pulse for 1 full minute before giving digoxin
b) Should follow the clients wishes even though it is not what I would want
c) Have religious beliefs that may make it difficult to take care of some clients
d) Need to honor the clients request not to discuss his health concern with the family

 

 

ANS:  C

Self-knowledge is being aware of your religious and cultural beliefs and values. Taking the pulse is an example of practical knowledge. Following client wishes and honoring client requests are examples of ethical knowledge.

 

(High-level question, answer not stated verbatim)

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Difficult

 

PTS:   1

 

  1. Which of the following is the most important reason for nurses to be critical thinkers?
a) Nurses need to follow policies and procedures.
b) Nurses work with other healthcare team members.
c) Nurses care for clients who have multiple health problems.
d) Nurses have to be flexible and work variable schedules.

 

 

ANS:  C

Critical thinking is essential for client care, particularly when the care is complex, involving numerous health issues. Following policies and procedures does not necessarily require critical thinking; working with others or being flexible and working different schedules do not necessarily require critical thinking.

 

(High level question, answer not stated verbatim)

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. The nurse administering pain medication every 4 hours is an example of which aspect of patient care?
a) Assessment data
b) Nursing diagnosis
c) Patient outcome
d) Nursing intervention

 

 

ANS:  D

Interventions are activities that will help the patient achieve a goal, such as administering pain-relieving medication. An example of assessment data might be: Patient reports pain is a 5 on a 1 to 10 scale. The nursing diagnosis would be pain. The nurse might define the patient outcome in this scenario as, The patient will state the level of pain is less than 4.

 

(High-level question, answer not stated verbatim)

Nursing Process: Interventions

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. How does a nursing diagnosis differ from a medical diagnosis? A nursing diagnosis is:
a) Terminology for the clients disease or injury
b) A part of the clients medical diagnosis
c) The clients presenting signs and symptoms
d) A clients response to a health problem

 

 

ANS:  D

A nursing diagnosis is the clients response to actual or potential health problems.

 

Nursing Process: Diagnosis

Client Need: Safe and Effective Care

Cognitive Level: Knowledge

Difficulty: Easy

 

PTS:   1

 

  1. What do critical thinking and the Nursing Process have in common?
a) They are both linear processes used to guide ones thinking.
b) They are both thinking methods used to solve a problem.
c) They both use specific steps to solve a problem.
d) They both use similar steps to solve a problem.

 

 

ANS:  B

Critical thinking and the Nursing Process are ways of thinking that can be used in problem-solving (although critical thinking can be used for other than problem-solving applications). Neither method of thinking is linear. The Nursing Process has specific steps; critical thinking does not.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Analysis

Difficulty: Difficult

 

PTS:   1

 

  1. A nurse admits a patient to the unit after completing a comprehensive interview and physical examination. To develop a nursing diagnosis, the nurse must now:
a) Analyze the assessment data
b) Consult standards of care
c) Decide which interventions are appropriate
d) Ask for the clients perceptions of her health problem

 

 

ANS:  A

The basis of the nursing diagnosis is the assessment data. Standards of care are referred to when establishing nursing interventions. Customizing interventions personalizes nursing care. Asking the patient about her perceptions is a method to validate whether the nurse has chosen the correct nursing diagnosis and would probably have been done during the comprehensive assessment.

 

Nursing Process: Diagnosis

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. The nurse developed a care plan for a patient to help prevent Impaired Skin Integrity. She has made sure that nursing assistive personnel change the patients position every 2 hours. In the evaluation phase of the Nursing Process, which of the following would the nurse do first?
a) Determine whether she has gathered enough assessment data
b) Judge whether the interventions achieved the stated outcomes
c) Follow up to verify that care for the nursing diagnosis was given
d) Decide whether the nursing diagnosis was accurate for the patients condition

 

 

ANS:  B

The evaluation phase judges whether the interventions were effective in achieving the desired outcomes and helped to alleviate the nursing diagnosis. This must be done before examining the Nursing Process steps and revising the care plan.

 

Nursing Process: Evaluation

Client Need: Safe and Effective Care

Cognitive Level: Analysis

Difficulty: Moderate

 

PTS:   1

 

  1. In caring for a patient with both diabetes and Impaired Skin Integrity (comorbidity), the nurse draws on her knowledge of diabetes and skin integrity. In a spirit of inquiry, she looks up the latest guidelines for providing skin care and includes them in the plan of care. The nurse provides skin care according to the procedural guidelines and begins regular monitoring to evaluate the effectiveness of the interventions. The nurse has demonstrated:
a) Full-spectrum nursing
b) Critical thinking
c) Nursing Process
d) Nursing knowledge

 

 

ANS:  A

Full-spectrum nursing involves the use of critical thinking, nursing knowledge, Nursing Process, and patient situation. Although the other answers are important for planning and delivering nursing care, they do not reflect all the nurse has demonstrated.

 

(High level question, answers not stated verbatim)

Nursing Process: Not applicable

Client Need: PHSI

Cognitive Level: Analysis

Difficulty: Difficult

 

PTS:   1

 

  1. It is important for nurses to be critical thinkers because:
a) All clients are unique and have individual needs and differences
b) All nursing actions are based on theoretical knowledge
c) Nurses choose their actions primarily by following professional guidelines
d) Nurses provide care based on individual client preferences

 

 

ANS:  A

All clients are unique and have individual differences. Nursing actions are not solely based on theoretical knowledge. Actions are based on theoretical knowledge, practical knowledge, and self-knowledge. Following guidelines does not usually require critical thinking, and guidelines often do not offer adequate help in managing complex situations. Client preferences are certainly included in the plan of care but they do not cover the broad spectrum of being a critical thinkerit does not require critical thinking merely to do what the client prefers.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Comprehension

Difficulty: Moderate

 

PTS:   1

 

  1. A full-spectrum nurse uses a critical-thinking model to organize her thinking when caring for a patient. The nurse realizes she lacks some facts about the patients pathophysiology, so she makes sure to use a credible source for the information. She considers the alternatives for action, then again looks up some information. Before deciding what to do, she thinks about the patients family situation. What aspect of a critical-thinking model does this best illustrate? The nurse is:
a) Following model guidelines for specific interventions
b) Using linear processes to think critically
c) Moving back and forth between steps, and not thinking sequentially
d) Using self-knowledge in the decision-making process

 

 

ANS:  C

Critical thinking is not sequential, and critical-thinking models are not applied sequentially. Critical-thinking models do not proceed from top to bottom, nor are they linear. Nurses may jump back and forth between the various steps. Critical-thinking models do not prescribe guidelines for specific interventions. Although self-knowledge may be used as part of a decision-making process, this is not the best answer to complete the statement. The only way self-knowledge is involved in this scenario is that the nurse recognizes that she is lacking some information/knowledge.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Difficult

 

PTS:   1

 

  1. Which is the best example of a critical-thinking attitude? The nurse:
a) Has extensive knowledge of principles and theories
b) Has a lively curiosity and enjoys discovering new ways of doing things
c) Applies the problem-solving process he was taught in nursing school
d) Responds to patients mainly on the basis of what is socially approved

 

 

ANS:  B

Attitudes are more akin to feelings and traits than to intellectual skills. Therefore, extensive knowledge is not a good example of an attitude. Attitudes are addressed in nursing school but it is unlikely that one can teach attitudes. A problem-solving process does necessarily require critical thinking; moreover, applying a process simply because one learns it in school would mean the person is not demonstrating an attitude of intellectual independence. Society and culture do help to form attitudes, but that is not the same as basing actions on what is socially approved. Again, that would not demonstrate independent thinking or any of the other critical-thinking attitudes.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Difficult

 

PTS:   1

 

  1. What is the best description of the Nursing Process? The Nursing Process is:
a) A way to create nursing knowledge for use in practice
b) A systematic view of a specific phenomenon in nursing
c) A linear process for providing nursing care
d) A systematic process for the delivery of nursing care

 

 

ANS:  D

The Nursing Process is central to nursing care. It is a systematic problem-solving process that guides all nursing actions. The process does not create knowledge. Knowledge is created through theoretical and practical research. The Nursing Process is not a view of a specific phenomenon. Finally, the Nursing Process is not linear; the steps are reflexive and overlapping.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Comprehension

Difficulty: Easy

 

PTS:   1

 

  1. The nurse is caring for a client with heart failure. She begins to obtain the clients history and vital signs and then listens to breath sounds. The nurse is practicing which aspect of the Nursing Process?
a) Assessment
b) Planning interventions
c) Planning outcomes
d) Evaluation

 

 

ANS:  A

Obtaining the history, auscultating breath sounds, and obtaining vital signs are part of the assessment process. In the assessment step, the nurse gathers patient data and information. In the planning interventions step, the nurse chooses nursing activities aimed at meeting patient goals (and thus relieving the patients problem). In the planning outcomes phase, the nurse and patient identify goals for the patients healthexpected or desired outcomes of the care. After performing nursing activities, in the evaluation stage the nurse reassesses the patient to determine whether goals have been met.

 

Nursing Process: Assessment

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. The nurse is caring for a client with skin breakdown of the coccyx area. The physician has ordered a medication to be applied to the area. In applying the medication, the nurse is practicing which aspect of the Nursing Process?
a) Assessment
b) Planning interventions
c) Implementation
d) Evaluation

 

 

ANS:  C

Application of a medication to the coccyx area is an action. The nurse both plans and carries out the intervention. The nurse carries out (and records) interventions in the implementation phase. Evaluation is done after the plan (or nursing action) is implemented.

 

Nursing Process: Implementation

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. The nurse documents in the client plan of care that the wound treatment to the clients left foot has resulted in wound healing. She removed the Skin Integrity diagnosis from the plan of care. The nurse is using which aspect of the Nursing Process?
a) Assessment
b) Evaluation
c) Planning outcomes
d) Planning interventions

 

 

ANS:  B

Documenting nursing interventions and a patients immediate responses (e.g., expressed pain, became restless) is done in the implementation stage. However, in this scenario the nurse also documented that the wound was healing and she removed the nursing diagnosis from the care plan. This demonstrates evaluation.

 

Nursing Process: Evaluation

Client Need: Safe and Effective Care

Cognitive Level: Analysis

Difficulty: Difficult

 

PTS:   1

 

  1. The nurse enters a room to find the client sitting up in the chair, crying. The nurse best displays a critical-thinking attitude, as well as a caring attitude, by:
a) Telling the client that shell be back to chat after she sees her other clients
b) Calling the family to come and sit with the client
c) Trying to determine the reasons for the clients crying
d) Placing a do not disturb sign on the door to protect the clients privacy

 

 

ANS:  C

The nurse should try to find out why the client is crying so that she may intervene appropriately and correctly. Postponing talking with the client does not assist the client nor does it enable the nurse to make an appropriate intervention. Telling the client shell be back may cause the client to feel that her needs are less important. Calling the family may be helpful to the client once the nurse identifies why the client is crying. However, depending on the reason, the family may not be at all helpful. A do not disturb sign, without obtaining more information, may isolate the client. Upon further exploration, the nurse may discover that the client is already feeling alone and that she does not want or need privacy right now.

 

Nursing Process: Implementation

Client Need: PSI

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

  1. Select the answer that best completes the following statement: The primary purpose of employing the full-spectrum nursing model is to:
a) Assist nurses in testing psychomotor skills
b) Have a positive effect on a clients health outcomes
c) Adequately use all aspects of the Nursing Process
d) Assist nurses in completing their work on time

 

 

ANS:  B

The question is asking for the best answer to complete the statement. The best answer is to have a positive effect on a clients health outcomes, which is also a goal of nursing in general. The full-spectrum model may assist nurses in performing psychomotor skills and even in completing their work on timeespecially when something unexpected occurs. However, that is not the focus of the model. Full-spectrum nursing would likely improve the nurses problem-solving ability (as in the Nursing Process); however, that is not the end purpose of full-spectrum nursing. It is merely a means to achieving the purpose of positively affecting health outcomes.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Comprehension

Difficulty: Moderate

 

PTS:   1

 

  1. The nurse has gathered her assessment data and notes several significant changes in the clients health status. The clients weight has increased by 5 lb over the past 24 hours, he is short of breath, and crackles are auscultated at both lung bases. To which step of the Nursing Process should the nurse proceed after organizing these data?
a) Diagnosis
b) Planning
c) Implementation
d) Evaluation

 

 

ANS:  A

After gathering and analyzing the assessment data, the nurse should next formulate a nursing diagnosis. The other options are not done until after the problem has been diagnosed. The problem is used to plan goals, which are then used to plan interventions. After implementing the intervention(s), evaluation is done to identify change in health status and determine whether goals have been met.

 

Nursing Process: Diagnosis

Client Need: Safe and Effective Care

Cognitive Level: Application

Difficulty: Moderate

 

PTS:   1

 

MULTIPLE RESPONSE

 

  1. Which aspects of healthcare are affected by a clients culture? Select all that apply.
a) How the client views healthcare
b) How the client views illness
c) Whether insurance will pay for healthcare services
d) The types of treatments the client will accept
e) When the client will seek healthcare services
f) The environment in which the healthcare services are provided
g) The ease of accessibility of healthcare services

 

 

ANS:  A, B, D, E

Culture impacts clients views of health and healthcare. It influences how they will define illness, when they will seek healthcare, and what treatments are acceptable in their culture. How services are paid for is related to social environment and economic status. Regardless of culture, anyone can be affected by previous healthcare experiences, the environment in which healthcare is provided, and accessibility of services.

 

Nursing Process: Not applicable

Client Need: Safe and Effective Care

Cognitive Level: Knowledge

Difficulty: Moderate

 

PTS:   1

 

  1. Caring is a central concept in nursing that involves which of the following? Select all that apply.
a) Treating all clients with a similar disease in exactly the same way
b) Responding compassionately to client needs
c) Acting in ways to preserve human dignity
d) Connecting with others to give and receive help
e) Using active listening

 

 

ANS:  B, C, D, E

Treating all clients in exactly the same way just because they share similar disease processes does not consider their uniqueness nor honor their personhoodand thus does not reflect caring. The other options are all aspects of caring.

 

Nursing Process: Not applicable

Client Need: PSI

Cognitive Level: Analysis

Difficulty: Moderate

 

PTS:   1

 

Chapter 14. The Family

 

MULTIPLE CHOICE

 

  1. The graduate nurse tells her preceptor that the newly admitted patient has a strange living arrangement, because she lives in a household that consists of two aunts, a grandparent, a niece, a nephew, and her best friend. What is the preceptors best response?
a) You are correct. That is a different type of household.
b) That is an example of a family as defined by a different type of culture.
c) This is considered an extended family and is not unusual.
d) This is a type of blended family and statistics show an increase in these types of living arrangements.

 

 

ANS:  C

The description fits the definition for an extended family, which can consist of various biological relatives and also nonrelatives who live together or in close proximity. A blended family consists of two single parents who marry and raise their children together. Although extended family arrangements may occur in some cultures, this is not the best response to the nurses interpretation of the family living arrangement.

 

Difficulty: Moderate

Client Need: PSPI

Cognitive Level: Application

 

PTS:   1

 

  1. A 65-year-old patient is admitted to the hospital with heart failure. The patients best friend accompanies her on admission. They have been sharing a home since they each were widowed 3 years ago. Both women have grown children who live out of state. Using the family nursing approach, how can the nurse best intervene?
a) Involve the friend and children in the patients care, discharge planning, and home care.
b) Encourage the friend to wait until discharge to provide care for the patient at home.
c) Explain to the friend that for confidentiality reasons she cannot be involved in the patients care.
d) Encourage liberal visiting hours by the friend and the patients children.

 

 

ANS:  A

The nurse can best intervene by involving the friend and the patients children in the patients care, discharge planning, and home care. The friend may or may not be able to care for the patient at home. But if planning to provide home care, the patients friend should be informed of the patients needs while in the hospital and have an opportunity to participate prior to discharge. The nurse can involve the friend with the patients consent without infringing on the patients privacy. Her name needs to be listed on the patient privacy (HIPPA) form. The nurse should also encourage liberal visiting hours by the friend and the patients children if it is beneficial for the patients recovery; however, comprehensive involvement in care is more inclusive than simply liberalizing visiting hours and, therefore, is the best answer.

 

Difficulty: Moderate

Nursing Process: Interventions

Client Need: Safe and Effective Care

Cognitive Level: Application

 

PTS:   1

 

  1. A patient and his wife are 2 years from retirement when he is diagnosed with lung cancer. Although with delayed childbearing, developmental stages can vary among families, which typical stage of family development is this couple likely experiencing?
a) Family launching young adults
b) Postparental family
c) Family with frail elderly
d) Family with teenagers and young adults

 

 

ANS:  B

This couple is most likely experiencing the postparental stage of family development. During this stage, the parents prepare for retirement and adjust to their children moving into phases of adulthood. In the stage of family launching young adults, the parents maintain support of young adults as they leave the security of family and the parents rediscover marriage. During the stage of family with teenagers and young adults, open communication is maintained among family members, ethical and moral values are reinforced, and there is a balance established between rules and independence among teens.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. A nurse is caring for a patient who was newly diagnosed with type 1 diabetes. The patients wife states, We are a family of diabetics. The nurse advises the couple to attend the free nutrition, cooking, and exercise classes at the health center near their neighborhood. She also gives them the name of the public health nurse for their area. Which perspective of family nursing is the nurse practicing?
a) Family as a unit of care
b) Family as a system
c) Family as the context of care
d) Family as a resource and stressor

 

 

ANS:  B

The nurse is viewing the family as a system because the nurse is providing information based on the wifes response that will benefit the entire family. The family is a part of a community and thus should interact or incorporate community resources into their health care plan. A system approach looks beyond the immediate family and views the community and its resources as a part of the suprasystem.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The parents of three children, aged 3, 6, and 8 years, comment that although the children are close in age, they each seem to have different needs. The nurse teaches the parents what tasks the children should accomplish based on the different age groups and provide strategies to help meet the childrens needs. Which theory best explains the nurses teaching plan?
a) General systems theory
b) Family interactional theory
c) Family as a context theory
d) Developmental theory

 

 

ANS:  D

Developmental theories focus on the stage of development of each family member, usually based on age or growth stage. These theories have developmental tasks that should be accomplished at each stage of development to successfully progress and master the next stage. These stages begin at birth and continue through old age. Thus, each child will have different developmental tasks based on his or her age and stage of development; because tasks are different, so are each childs needs.

 

Difficulty: Moderate

Nursing Process: Interventions

Client Need: Safe and Effective Care

Cognitive Level: Application

 

PTS:   1

 

  1. Which situation below best depicts a mid-life crisis?
a) A 22-year-old college graduate moves in with her parents because she cannot find employment.
b) The parents enroll their two toddlers in day care because two incomes are needed to meet the households financial demands.
c) After the couples daughter leaves for college, the husband quits his job and decides to see the world.
d) A 70-year-old widower rejects the childrens advice to move into an assisted living facility.

 

 

ANS:  C

The middle-aged years occur after the demands of raising children are over. This can be a time of personal fulfillment, career success, and social expansion. It can also be a time of intense questioning about the meaning of live, longing for ones youth, and seeking direction in life (mid-life crisis). It is not uncommon for couples who have been married for many years to get a divorce, or for one spouse to engage in atypical behaviors. Although a college graduate moving in with her parents may involve middle-aged adults, it does not necessarily precipitate a mid-life crisis for the parents.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: Safe and Effective Care

Cognitive Level: Application

 

PTS:   1

 

  1. To prevent a reduction in herd immunity, what should the nurse teach a class of pregnant women?
a) You should increase your intake of milk to meet your growing calcium needs.
b) It is important to take your prenatal vitamins daily to provide the essential vitamins and minerals your body needs.
c) You should ensure your child gets his or her immunizations at the recommended scheduled times.
d) You should limit the time your child is in crowded environments for the first 6 months of his or her life.

 

 

ANS:  C

A reduction in herd immunity occurs when families do not follow the immunization schedule. Old diseases, once thought eradicated, begin to reappear and cause illness and even death in persons who are not adequately protected through immunizations. Such diseases include pertussis (whooping cough), polio, mumps, and small pox.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. For which patient in the emergency room is it most important that the nurse conduct a thorough assessment for abuse and neglect?
a) 6-year-old African American male with complaints of abdominal pain
b) 2-year-old Caucasian male with injuries from a fall
c) 7-year-old Caucasian female with a broken arm from a motor vehicle accident
d) 4-year-old Hispanic female who complains of an earache.

 

 

ANS:  B

The younger the child, the more vulnerable he or she is to abuse owing to their dependency, small size, and inability to defend themselves. Statistics indicate that Caucasian children are at a high risk for abuse. The 2-year-old child is the youngest and of the high-risk race, and injuries are from a fall. The nurse should assess all children and adults for signs of violence and neglect; however, the 2-year-old has priority. Many children suffer from otitis media (ear infection) manifested with an earache.

 

Difficulty: Difficult

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The nursing student is caring for a patient with diabetes on a medical-surgical unit. During a teaching session with the patient and family, she asks them questions regarding care at home, ability to perform blood glucose testing, and administering insulin. The student is providing family care using which perspective of family nursing?
a) Family as context for care
b) Family as unit of care
c) Family as a system
d) A blend of all of the above

 

 

ANS:  A

The student is using family as the context for care. In this approach, the focus is on the ill individual and family is viewed as either a resource or stressor to the patient. Unit of care is more complex, as wellness of each member is critical to promoting family health. The family is viewed as the sum of all individual members and assessment and care are provided for all family members. Family as a system focuses on the family as a whole and as an interactional system. This approach sees the family as embedded in and interacting with a larger community.

 

Difficulty: Moderate

Nursing Process: Intervention

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The nurse is participating in a family conference regarding one of the patients on the geriatric unit. During the conference, each family member is asked about his role in the family, communication style, coping strategies, and relationship with other family members. This type of family conference best illustrates the use of which theory related to family care?
a) General systems theory
b) Structural-functional theory
c) Family interactional theory
d) Developmental theory

 

 

ANS:  C

Family interactional theory views the family as a unit of interacting personalities. The major emphasis is on family roles. This approach to understanding families de-emphasizes the influence of the external world on what occurs within the family. Focus is on interaction, communication roles and power, family coping, and relationships. Developmental theories focus on the stage of family development, typically eight stages in the family life cycle. Structural-functional theories include the concepts of family roles and interaction; however, the focus is on outcome rather than process. This theory is best used to assess family function, both internally among family members and externally with outside systems.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The son of an 80-year-old patient tells the nurse, Im starting to worry about my fathers eating habits. He lives alone and has been able to cook, but now he doesnt want to cook and says he is too tired to go to the store. What is the most appropriate response by the nurse?
a) We may need to contact the physician for a nutritional assessment.
b) Your family members will need to get together and bring him meals.
c) It may be time for you to think about nursing home placement.
d) What are your feelings on using some community resources such as Meals on Wheels?

 

 

ANS:  D

Maintaining good nutrition and hydration becomes more difficult as a person ages. Nutrition in older adults may be compromised for a multitude of reasons, such as forgetting to eat, inadequate transportation to shop, lack of money, loss of appetite, and physical changes. It is easy to understand how one of the above problems can affect another. In this item, we have no indication that the patient has any deficits, so the best and initial response by the nurse is to offer/educate the family on outside community resources such as Meals on Wheels. A nutritional assessment may be needed at some point if a lack of eating or weight loss continues. Instructing family members to bring meals over is inappropriate, as the nurse has not assessed family circumstances and availability.

 

Difficulty: Moderate

Nursing Process: Interventions

Client Need: PHSI

Cognitive Level: Application

 

PTS:   1

 

  1. The Americans With Disabilities Act (ADA) defines a disability as a physical or mental impairment that substantially interferes with a persons ability to engage in major life activities. Among the various disabilities in the United States, which of the following is the most prevalent?
a) Vision
b) Hearing
c) Ambulation
d) Learning

 

 

ANS:  C

The ADA defines one component of disability as a physical or mental impairment that substantially interferes with a persons ability to engage in major life activities. Among the various types of disabilities, 10.2 million are people with ambulatory disabilities, whereas 3.5 million have a vision disability.

 

Difficulty: Easy

Nursing Process: NA

Client Need: PHSI

Cognitive Level: Recall

 

PTS:   1

 

  1. According to Maslows Hierarchy of Needs, the nurses primary focus in caring for a homeless family is:
a) Food and shelter
b) Access to healthcare
c) Strengthening family relationships
d) Decreasing social isolation

 

 

ANS:  A

Homelessness is a growing problem in many U.S. cities, not only for individuals but also for families. Homelessness threatens family relationship and emotional and physical health. The primary focus is on meeting basic needs of food and shelter, which according to Maslow must be met before the family can grow and address other areas.

 

Difficulty: Easy

Nursing Process: Intervention

Client Need: SECE

Cognitive Level: Application

 

PTS:   1

 

  1. The nurse is developing a teaching plan on coping strategies for an extended family of a severely disabled 11-year-old child. What step should the nurse take first in developing this plan?
a) Assess the current coping patterns.
b) Establish each members role.
c) Assign specific tasks and deadlines for each member.
d) Assess which family member has the most ineffective coping patterns.

 

 

ANS:  A

V1, p. 29

Family members who are not coping effectively may cause the patient to become stressed, anxious, or have problems sleeping. Assessing family coping is the first step to helping the family develop more effective coping patterns. Once this is identified, it becomes the platform to assess and address member roles, interaction between members, and role expectations.

 

Difficulty: Moderate

Nursing Process: Planning

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The nurse has scheduled a meeting with a family to assess and assist with improving the familys communication patterns. What is of primary importance for the nurse to focus on during the assessment?
a) Identifying how family decisions are made
b) Documenting the number of family members attending the meeting
c) Assessing for the most frequently used means of communication between family members
d) Making careful observations of body language and nonverbal expressions during the meeting

 

 

ANS:  D

Do not rely solely on the information provided by the family members during the interview process. Families usually want to put on the best face for healthcare providers, so they may be careful to give socially desirable responses. Carefully observe the words people use and other cues involved in communication, such as body language, direct eye contact, and other nonverbal expressions particularly among family members. It is important to uncover other information such as how decisions are made within the family, what means of communication are used (telephone calls, texting, visiting), and to how much participation are family committed. These are all relevant observations for the nurse to make during a meeting, but a primary focus is on careful observation of nonverbal cues.

 

Difficulty: Difficult

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The nursing student is caring for a seriously ill child on the pediatric unit. There are many family members present, including parents, aunts, and uncles. The student tells the primary nurse, Every time I go into the room, everyone is shouting at each other, they shout at me, and they ask me the same questions over and over. What is the most appropriate response by the nurse?
a) This is unacceptable and disruptive behavior. Let them know that if this behavior continues, we may need to call security.
b) Families experience a range of emotions when caring for an ill member. Sometimes these are normal reactions, so you need not take it personally.
c) There may be too many people in the room. You might consider limiting their visiting time.
d) I believe this family is of Italian descent. Dont worry about it; it may just be their culture.

 

 

ANS:  B

When a family member is ill or hospitalized, the other family members experience a range of emotionsespecially when the illness is severe or of sudden onset. Family members may display signs of stress in a variety of ways, for example, by arguing with each other or with healthcare providers, in insisting on immediate care for their loved one, by being critical of the care provided, or by frequently asking that information be repeated. These are normal reactions; do not take them personally. Limiting visiting hours is not always beneficial, especially when dealing with children. There are times to call security if the behavior escalates and begins to affect other patients and families. In this instance, citing a cultural connection is inappropriate as it reflects stereotyping and is judgmental.

 

Difficulty: Moderate

Nursing Process: Evaluation

Client Need: PSI

Cognitive Level: Application

 

PTS:   1

 

  1. The nurse is working with a wife who is caring for her chronically ill husband who requires around-the-clock care. The nurse notices that the wife often speaks to her husband sharply. The bed linens are soiled with food and the patient has a strong body odor. Both the house and the wife are unkempt. When encouraged to talk, the wife says, I just drag around. I cant make myself do anything. Im so tired of it all. What nursing diagnosis best fits these defining characteristics?
a) Dysfunctional Family Processes
b) Caregiver Role Strain
c) Defensive coping
d) Impaired Verbal Communication

 

 

ANS:  B

The defining characteristics best fit a nursing diagnosis of Caregiver Role Strain. The caregiver exhibits dysfunctional communication (speaking sharply), is not performing well in the caregiver role (soiled bed linens, patients body odor), and is experiencing and expressing depressive symptoms. Dysfunctional Family Processes usually include denial of problems, resistance to change, and a series of crises; depression is not a symptom. Defensive coping is more about a falsely positive self-evaluation; this woman does not seem defensive, but admits she is having difficulty. Although the wifes communication may sound angry, her verbal communication is not really impaired. Impaired Verbal Communication is characterized by difficulty in receiving, processing, and/or using words to communicate. Furthermore, a diagnosis of Impaired Verbal Communication would not address the wifes depression and inability to provide satisfactory care.

 

Difficulty: Difficult

Nursing Process: Analysis/Diagnosis

Client Need: PSI

Cognitive Level: Analysis

 

PTS:   1

 

MULTIPLE RESPONSE

 

  1. Which family function(s) is/are outlined in the structural-functional family theory? Select all that apply.
a) Meeting the emotional needs of family members
b) Reinforcing ethical and moral values
c) Promoting joint decision making among parents and children
d) Being productive members of society

 

 

ANS:  A, D

Family functions outlined in the structural-functional family theory include being productive members of society, caring for elderly members, meeting physical and emotional needs of family members, and providing socialization of children. This model is more focused on the outcomes of family function than the process by which action occurs. Maintaining support for young adults as they leave the security of the family, reinforcing ethical and moral values, and promoting joint decision making among parents and children are examples of tasks outlined in family development theories.

 

Difficulty: Moderate

Client Need: PSI

Cognitive Level: Knowledge

 

PTS:   1

 

  1. Which of the following suggest that a family health problem may exist? Select all that apply.
a) Family members respect each others need for privacy.
b) Family members enact decisions made by the most powerful member.
c) Family members do not consider that a conflict has been resolved until everyone agrees.
d) Family members set boundaries between family members.

 

 

ANS:  B, C

Respect for privacy and clear boundaries between family members are characteristics of a healthy family. Boundaries define the responsibilities of adults that are clear and separate from responsibilities of growing children. In healthy families, there is typically egalitarian distribution of power. In healthy families, it is not always necessary for all members to agree; instead, they have the ability to compromise and members feel free to disagree.

 

Difficulty: Moderate

Nursing Process: Analysis/Nursing Diagnosis

Client Need: PSI

Cognitive Level: Analysis

 

PTS:   1

 

  1. A family assessment should include which areas? Select all that apply.
a) Coping patterns
b) Health beliefs
c) Medical history
d) Physical examination

 

 

ANS:  A, B

Conducting a family assessment includes identifying data; family composition; family history and developmental stage; environmental data; family structure; family function; health beliefs, values, and behaviors; family stressors and coping; and abuse and violence within the family. The medical history and physical examination of individuals are only relevant to the family assessment if it affects an individual family members.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: PSI

Cognitive Level: Comprehension

 

PTS:   1

 

  1. Homelessness is a growing problem in the United States. What are the primary causes of homelessness?

Select all that apply.

a) Lack of job skills
b) Lack of social skills
c) Underlying mental illness
d) Substance abuse

 

 

ANS:  A, B, C, D

The problem of homelessness might be explained by a number of factors, such as financial crises, socially dysfunctional relationships, unemployment, lack of job skills, substance abuse, inability or lack of desire to live within the socially accepted norms of society, underlying mental illness, disability, or misfortune.

 

Difficulty: Difficult

Nursing process: Assessment

Client Need: SECE

Cognitive Level: Application

 

PTS:   1

 

  1. The study of genomics and the use of a genogram are playing a larger role in personalizing a patients plan of care. How are genomics and the use of a genogram helpful in personalizing a patient plan of care?

Select all that apply.

a) Assists in identifying at-risk individuals for certain conditions enabling better preventative care
b) Helps to more accurately detect illness, even before symptoms appear
c) Provides understanding of how people may respond differently to certain drugs and treatments
d) Increases the trust a patient and family have in the healthcare professionals

 

 

ANS:  A, B, C

Genomics can be used to personalize a patients plan of care by identifying at-risk individuals for certain conditions so more effective preventive care can be provided, more accurately detecting illness, even before symptoms appear, tailoring healthcare to the individual while reducing a trial-and-error approach, evaluating a persons response to the care, and helping to understand how people respond differently to particular drugs and medical treatments. There is no evidence to support that the use of genomics and genograms has any effect on trust. Many individuals and families have an intense skepticism or mistrust of medical care and hospitals based on their own health belief systems or on past experiences with medical care and hospitals.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: PHSI

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