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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Document preview page 1

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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition

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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 1 preview imageTEXTBOOK OF PHYSICALDIAGNOSIS HISTORY AND EXAMINATION 7THEDITION SWARTZ TESTBANKChapter 1 The Interviewer’s QuestionsMULTIPLECHOICE1.Thenurseisconductinganinterviewwithawomanwhohasrecentlylearnedthatsheispregnantandwhohascometotheclinictodaytobeginprenatalcare.Thewomanstatesthatsheandherhusbandareexcitedaboutthepregnancybuthaveafewquestions.Shelooksnervouslyatherhandsduringtheinterviewandsighsloudly.Consideringtheconceptofcommunication,whichstatementdoesthenurseknowtobemostaccurate?Thewomanis:a.Excitedaboutherpregnancybutnervousaboutthelabor.b.Exhibitingverbalandnonverbalbehaviorsthatdonotmatch.c.Excitedaboutherpregnancy,butherhusbandisnotandthisisupsettingtoher.d.Notexcitedaboutherpregnancybutbelievesthenursewillnegativelyrespondtoherifshestatesthis.ANS:BCommunicationisallbehaviors,consciousandunconscious,verbalandnonverbal.Allbehaviorshavemeaning.Herbehaviordoesnotimplythatsheisnervousaboutlabor,upsetbyherhusband,orworriedaboutthenursesresponse.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 28MSC: Client Needs: Psychosocial Integrity2. Receiving is a part of the communication process. Which receiver is most likely tomisinterpret a message sent by a health care professional?a.Well-adjusted adolescent who came in for a sports physicalb.Recovering alcoholic who came in for a basic physical examinationc.Man whose wife has just been diagnosed with lung cancerd.Man with a hearing impairment who uses sign language to communicate and whohas an interpreter with himANS: CThe receiver attaches meaning determined by his or her experiences, culture, self-concept, andcurrent physical and emotional states. The man whose wife has just been diagnosed with lungcancer may be experiencing emotions that affect his receiving.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 28MSC: Client Needs: Psychosocial Integrity3. The nurse makes which adjustment in the physical environment to promote the success of aninterview?a.Reduces noise by turning off televisions and radiosb.Reduces the distance between the interviewer and the patient to 2 feet or lessc.Provides a dim light that makes the room cozy and helps the patient relaxd.Arranges seating across a desk or table to allow the patient some personal space
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 2 preview image
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 3 preview imageANS:AThenurseshouldreducenoisebyturningoffthetelevision,radio,andotherunnecessaryequipment,becausemultiplestimuliareconfusing.Theinterviewerandpatientshouldbeapproximately4to5feetapart;theroomshouldbewell-lit,enablingtheinterviewerandpatienttoseeeachotherclearly.Havingatableordeskinbetweenthetwopeoplecreatestheideaofabarrier;equal-statusseating,ateyelevel,isbetter.DIF: Cognitive Level: Applying (Application) REF:dm. 29MSC: Client Needs: Psychosocial Integrity4. In an interview, the nurse may find it necessary to take notes to aid his or her memory later.Which statement istrueregarding note-taking?a.Note-taking may impede the nurses observation of the patients nonverbal behaviors.b.Note-taking allows the patient to continue at his or her own pace as the nurse recordswhat is said.c.Note-taking allows the nurse to shift attention away from the patient, resulting in anincreased comfort level.d.Note-taking allows the nurse to break eye contact with the patient, which may increasehis or her level of comfort.ANS: AThe use of history forms and note-taking may be unavoidable. However, the nurse must be awarethat note-taking during the interview has disadvantages. It breaks eye contact too often and shiftsthe attention away from the patient, which diminishes his or her sense of importance. Note-taking may also interrupt the patients narrative flow, and it impedes the observation of thepatients nonverbal behavior.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 30MSC: Client Needs: Psychosocial Integrity5. The nurse asks, I would like to ask you some questions about your health and your usual dailyactivities so that we can better plan your stay here. This question is found at the __________phase of the interview process.a.Summaryb.Closingc.Bodyd.Opening or introductionANS: DWhen gathering a complete history, the nurse should give the reason for the interview during theopening or introduction phase of the interview, not during or at the end of the interview.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 31MSC: Client Needs: Psychosocial Integrity6. A woman has just entered the emergency department after being battered by her husband. Thenurse needs to get some information from her to begin treatment. What is the best choice for anopening phase of the interview with this patient?a.Hello, Nancy, my name is Mrs. C.b.Hello, Mrs. H., my name is Mrs. C. It sure is cold today!
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 4 preview imagec.Mrs.H.,mynameisMrs.C.Howareyou?d.Mrs.H.,mynameisMrs.C.Illneedtoaskyouafewquestionsaboutwhathappened.ANS:DAddressthepersonbyusinghisorhersurname.Thenurseshouldintroducehimorherselfandgivethereasonfortheinterview.Friendlysmalltalkisnotneededtobuildrapport.DIF: Cognitive Level: Applying (Application) REF:dm. 31MSC: Client Needs: Psychosocial Integrity7. During an interview, the nurse states, You mentioned having shortness of breath. Tell memore about that. Which verbal skill is used with this statement?a.Reflectionb.Facilitationc.Direct questiond.Open-ended questionANS: DThe open-ended question asks for narrative information. It states the topic to be discussed butonly in general terms. The nurse should use it to begin the interview, to introduce a new sectionof questions, and whenever the person introduces a new topic.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 31MSC: Client Needs: Psychosocial Integrity8. A patient has finished giving the nurse information about the reason he is seeking care. Whenreviewing the data, the nurse finds that some information about past hospitalizations is missing.At this point, which statement by the nurse would be most appropriate to gather these data?a.Mr. Y., at your age, surely you have been hospitalized before!b.Mr. Y., I just need permission to get your medical records from County Medical.c.Mr. Y., you mentioned that you have been hospitalized on several occasions.Would you tell me more about that?d.Mr. Y., I just need to get some additional information about your past hospitalizations.When was the last time you were admitted for chest pain?ANS: DThe nurse should use direct questions after the persons opening narrative to fill in any details heor she left out. The nurse also should use direct questions when specific facts are needed, such aswhen asking about past health problems or during the review of systems.DIF: Cognitive Level: Applying (Application) REF:dm. 31MSC: Client Needs: Psychosocial Integrity9. In using verbal responses to assist the patients narrative, some responses focus on the patientsframe of reference and some focus on the health care providers perspective. An example of averbal response that focuses on the health care providers perspective would be:a.Empathy.b.Reflection.c.Facilitation.d.Confrontation.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 5 preview imageANS:DWhenthehealthcareproviderusestheresponseofconfrontation,theframeofreferenceshiftsfromthepatientsperspectivetotheperspectiveofthehealthcareprovider,andthehealthcareproviderstartstoexpresshisorherownthoughtsandfeelings.Empathy,reflection,andfacilitationresponsesfocusonthepatientsframeofreference.DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 32MSC: Client Needs: Psychosocial Integrity10. When taking a history from a newly admitted patient, the nurse notices that he often pausesand expectantly looks at the nurse. What would be the nurses best response to this behavior?a.Be silent, and allow him to continue when he is ready.b.Smile at him and say, Dont worry about all of this. Im sure we can find out why yourehaving these pains.c.Lean back in the chair and ask, You are looking at me kind of funny; there isnt anythingwrong, is there?d.Stand up and say, I can see that this interview is uncomfortable for you. We can continueit another time.ANS: ASilent attentiveness communicates that the person has time to think and to organize what he orshe wishes to say without an interruption from the nurse. Health professionals most ofteninterrupt thisthinkingsilence. The other responses are not conducive to ideal communication.DIF: Cognitive Level: Applying (Application) REF:dm. 33MSC: Client Needs: Psychosocial Integrity11. A woman is discussing the problems she is having with her 2-year-old son. She says, Hewont go to sleep at night, and during the day he has several fits. I get so upset when that happens.The nurses best verbal response would be:a.Go on, Im listening.b.Fits? Tell me what you mean by this.c.Yes, it can be upsetting when a child has a fit.d.Dont be upset when he has a fit; every 2 year old has fits.ANS: BThe nurse should use clarification when the persons word choice is ambiguous or confusing(e.g., Tell me what you mean byfits.). Clarification is also used to summarize the persons wordsor to simplify the words to make them clearer; the nurse should then ask if he or she is on theright track.DIF: Cognitive Level: Applying (Application) REF:dm. 33MSC: Client Needs: Psychosocial Integrity12. A 17-year-old single mother is describing how difficult it is to raise a 3-year-old child byherself. During the course of the interview she states, I cant believe my boyfriend left me to dothis by myself! What a terrible thing to do to me! Which of these responses by the nurse usesempathy?a.You feel alone.b.You cant believe he left you alone?
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 6 preview imagec.Itmustbesohardtofacethisallalone.d.Iwouldbeangry,too;raisingachildaloneisnopicnic.ANS:CAnempatheticresponserecognizesthefeelingandputsitintowords.Itnamesthefeeling,allowsitsexpression,andstrengthensrapport.Otherempatheticresponsesare,Thismustbeveryhardforyou,Iunderstand,orsimplyplacingyourhandonthepersonsarm.Simplyreflectingthepersonswordsoragreeingwiththepersonisnotanempatheticresponse.DIF: Cognitive Level: Applying (Application) REF:dm. 28MSC: Client Needs: Psychosocial Integrity13. A man has been admitted to the observation unit for observation after being treated for alarge cut on his forehead. As the nurse works through the interview, one of the standardquestions has to do with alcohol, tobacco, and drug use. When the nurse asks him about tobaccouse, he states, I quit smoking after my wife died 7 years ago. However, the nurse notices an openpack of cigarettes in his shirt pocket. Using confrontation, the nurse could say:a.Mr. K., I know that you are lying.b.Mr. K., come on, tell me how much you smoke.c.Mr. K., I didnt realize your wife had died. It must be difficult for you at this time. Please tell me mod.Mr. K., you have said that you dont smoke, but I see that you have an open pack of cigarettes in youANS: DIn the case of confrontation, a certain action, feeling, or statement has been observed, and thenurse now focuses the patients attention on it. The nurse should give honest feedback about whatis seen or felt. Confrontation may focus on a discrepancy, or the nurse may confront the patientwhen parts of the story are inconsistent. The other statements are not appropriate.DIF: Cognitive Level: Applying (Application) REF:dm. 33MSC: Client Needs: Psychosocial Integrity14. The nurse has used interpretation regarding a patients statement or actions. After using thistechnique, it would be best for the nurse to:a.Apologize, because using interpretation can be demeaning for the patient.b.Allow time for the patient to confirm or correct the inference.c.Continue with the interview as though nothing has happened.d.Immediately restate the nurses conclusion on the basis of the patients nonverbal response.ANS: BInterpretation is not based on direct observation as is confrontation, but it is based on onesinference or conclusion. The nurse risks making the wrong inference. If this is the case, then thepatient will correct it. However, even if the inference is correct, interpretation helps promptfurther discussion of the topic.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 33MSC: Client Needs: Psychosocial Integrity15. During an interview, a woman says, I have decided that I can no longer allow my children tolive with their fathers violence, but I just cant seem to leave him. Using interpretation, the nursesbest response would be:a.You are going to leave him?
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 7 preview imageb.Ifyouareafraidforyourchildren,thenwhycantyouleave?c.Itsoundsasifyoumightbeafraidofhowyourhusbandwillrespond.d.Itsoundsasthoughyouhavemadeyourdecision.Ithinkitisagoodone.ANS:CThisstatementisnotbasedononesinferenceorconclusion.Itlinksevents,makesassociations,orimpliescause.Interpretationalsoascribesfeelingsandhelpsthepersonunderstandhisorherownfeelingsinrelationtotheverbalmessage.Theotherstatementsdonotreflectinterpretation.DIF: Cognitive Level: Applying (Application) REF:dm. 33MSC: Client Needs: Psychosocial Integrity16. A pregnant woman states, I just know labor will be so painful that I wont be able to stand it. Iknow it sounds awful, but I really dread going into labor. The nurse responds by stating, Oh,dont worry about labor so much. I have been through it, and although it is painful, many goodmedications are available to decrease the pain. Which statement istrueregarding this response?The nurses reply was a:a.Therapeutic response. By sharing something personal, the nurse gives hope to this woman.b.Nontherapeutic response. By providing false reassurance, the nurse actually cut off further discussiofears.c.Therapeutic response. By providing information about the medications available, the nurse is givingwoman.d.Nontherapeutic response. The nurse is essentially giving the message to the woman that labor cannowithout medication.ANS: BBy providing false assurance or reassurance, thiscouragebuilderrelieves the womans anxietyand gives the nurse the false sense of having provided comfort. However, for the woman,providing false assurance or reassurance actually closes off communication, trivializes heranxiety, and effectively denies any further talk of it.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 32MSC: Client Needs: Psychosocial Integrity17. During a visit to the clinic, a patient states, The doctor just told me he thought I ought to stopsmoking. He doesnt understand how hard Ive tried. I just dont know the best way to do it. Whatshould I do? The nurses most appropriate response in this case would be:a.Id quit if I were you. The doctor really knows what he is talking about.b.Would you like some information about the different ways a person can quit smoking?c.Stopping your dependence on cigarettes can be very difficult. I understand how you feel.d.Why are you confused? Didnt the doctor give you the information about the smoking cessation progANS: BClarification should be used when the persons word choice is ambiguous or confusing.Clarification is also used to summarize the persons words or to simplify the words to make themclearer; the nurse should then ask if he or she is on the right track. The other responses giveunwanted advice or do not offer a helpful response.DIF: Cognitive Level: Applying (Application) REF:dm. 33MSC: Client Needs: Psychosocial Integrity
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 8 preview image18.Asthenurseentersapatientsroom,thenursefindshercrying.Thepatientstatesthatshehasjustfoundoutthatthelumpinherbreastiscancerandsays,Imsoafraidof,um,youknow.Thenursesmosttherapeuticresponsewouldbetosayinagentlemanner:a.Youreafraidyoumightloseyourbreast?b.No,Imnotsurewhatyouaretalkingabout.c.Illwaithereuntilyougetyourselfundercontrol,andthenwecantalk.d.Icanseethatyouareveryupset.Perhapsweshoulddiscussthislater.ANS:AReflectionechoesthepatientswords,repeatingpartofwhatthepersonhasjustsaid.Reflectioncanalsohelpexpressthefeelingsbehindapersonswords.DIF: Cognitive Level: Applying (Application) REF:dm. 33MSC: Client Needs: Psychosocial Integrity19. A nurse is taking complete health histories on all of the patients attending a wellnessworkshop. On the history form, one of the written questions asks, You dont smoke, drink, or takedrugs, do you? This question is an example of:a.Talking too much.b.Using confrontation.c.Using biased or leading questions.d.Using blunt language to deal with distasteful topics.ANS: CThis question is an example of using leading or biased questions. Asking, You dont smoke, doyou? implies that one answer isbetterthan another. If the person wants to please someone, thenhe or she is either forced to answer in a way that corresponds to his or her implied values or ismade to feel guilty when admitting the other answer.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 34MSC: Client Needs: Psychosocial Integrity20. When observing a patients verbal and nonverbal communication, the nurse notices adiscrepancy. Which statement istrueregarding this situation? The nurse should:a.Ask someone who knows the patient well to help interpret this discrepancy.b.Focus on the patients verbal message, and try to ignore the nonverbal behaviors.c.Try to integrate the verbal and nonverbal messages and then interpret them as an average.d.Focus on the patients nonverbal behaviors, because these are often more reflective of a patients trueANS: DWhen nonverbal and verbal messages are congruent, the verbal message is reinforced. Whenthey are incongruent, the nonverbal message tends to be the true one because it is under lessconscious control. Thus studying the nonverbal messages of the patients and examiners andunderstanding their meanings are important. The other statements are not true.DIF: Cognitive Level: Applying (Application) REF:dm. 28MSC: Client Needs: Psychosocial Integrity21. During an interview, a parent of a hospitalized child is sitting in an open position. As theinterviewer begins to discuss his sons treatment, however, he suddenly crosses his arms againsthis chest and crosses his legs. This changed posture would suggest that the parent is:
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 9 preview imagea.Simplychangingpositions.b.Morecomfortableinthisposition.c.Tiredandneedsabreakfromtheinterview.d.Uncomfortabletalkingabouthissonstreatment.ANS:DThepersonspositionisnoted.Anopenpositionwiththeextensionoflargemusclegroupsshowsrelaxation,physicalcomfort,andawillingnesstoshareinformation.Aclosedpositionwiththearmsandlegscrossedtendstolookdefensiveandanxious.Anychangeinpostureshouldbenoted.Ifapersoninarelaxedpositionsuddenlytenses,thenthischangeinposturesuggestspossiblediscomfortwiththenewtopic.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 35MSC: Client Needs: Psychosocial Integrity22. A mother brings her 28-month-old daughter into the clinic for a well-child visit. At thebeginning of the visit, the nurse focuses attention away from the toddler, but as the interviewprogresses, the toddler begins to warm up and is smiling shyly at the nurse. The nurse will bemost successful in interacting with the toddler if which is done next?a.Tickle the toddler, and get her to laugh.b.Stoop down to her level, and ask her about the toy she is holding.c.Continue to ignore her until it is time for the physical examination.d.Ask the mother to leave during the examination of the toddler, because toddlers often fuss less if theview.ANS: BAlthough most of the communication is with the parent, the nurse should not completely ignorethe child. Making contact will help ease the toddler later during the physical examination. Thenurse should begin by asking about the toys the child is playing with or about a special doll orteddy bear brought from home. Does your doll have a name? or What can your truck do? Stoopdown to meet the child at his or her eye level.DIF: Cognitive Level: Applying (Application) REF:dm. 37MSC: Client Needs: Psychosocial Integrity23. During an examination of a 3-year-old child, the nurse will need to take her blood pressure.What might the nurse do to try to gain the childs full cooperation?a.Tell the child that the blood pressure cuff is going to give her arm a big hug.b.Tell the child that the blood pressure cuff is asleep and cannot wake up.c.Give the blood pressure cuff a name and refer to it by this name during the assessment.d.Tell the child that by using the blood pressure cuff, we can see how strong her muscles are.ANS: DTake the time to give a short, simple explanation with a concrete explanation for any unfamiliarequipment that will be used on the child. Preschoolers are animistic; they imagine inanimateobjects can come alive and have human characteristics. Thus a blood pressure cuff can wake upand bite or pinch.DIF: Cognitive Level: Applying (Application) REF: pp. 38-39MSC: Client Needs: Psychosocial Integrity
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 10 preview image24.A16-year-oldboyhasjustbeenadmittedtotheunitforovernightobservationafterbeinginanautomobileaccident.Whatisthenursesbestapproachtocommunicatingwithhim?a.Useperiodsofsilencetocommunicaterespectforhim.b.Betotallyhonestwithhim,eveniftheinformationisunpleasant.c.Tellhimthateverythingthatisdiscussedwillbekepttotallyconfidential.d.Useslanglanguagewhenpossibletohelphimopenup.ANS:BSuccessfulcommunicationwithanadolescentispossibleandcanberewarding.Theguidelinesaresimple.Thefirstconsiderationisonesattitude,whichmustbeoneofrespect.Second,communicationmustbetotallyhonest.Anadolescentsintuitionishighlytunedandcandetectphoninessorthewithholdingofinformation.Alwaystellhimorherthetruth.DIF: Cognitive Level: Applying (Application) REF:dm. 39MSC: Client Needs: Psychosocial Integrity25. A 75-year-old woman is at the office for a preoperative interview. The nurse is aware that theinterview may take longer than interviews with younger persons. What is the reason for this?a.An aged person has a longer story to tell.b.An aged person is usually lonely and likes to have someone with whom to talk.c.Aged persons lose much of their mental abilities and require longer time to complete an interview.d.As a person ages, he or she is unable to hear; thus the interviewer usually needs to repeat much of wANS: AThe interview usually takes longer with older adults because they have a longer story to tell. It isnot necessarily true that all older adults are lonely, have lost mental abilities, or are hard ofhearing.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 40MSC: Client Needs: Psychosocial Integrity26. The nurse is interviewing a male patient who has a hearing impairment. What techniqueswould be most beneficial in communicating with this patient?a.Determine the communication method he prefers.b.Avoid using facial and hand gestures because most hearing-impaired people find this degrading.c.Request a sign language interpreter before meeting with him to help facilitate the communication.d.Speak loudly and with exaggerated facial movement when talking with him because doing so will hANS: AThe nurse should ask the deaf person the preferred way to communicateby signing, lip reading,or writing. If the person prefers lip reading, then the nurse should be sure to face him squarelyand have good lighting on the nurses face. The nurse should not exaggerate lip movementsbecause this distorts words. Similarly, shouting distorts the reception of a hearing aid the personmay wear. The nurse should speak slowly and supplement his or her voice with appropriate handgestures or pantomime.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 41MSC: Client Needs: Psychosocial Integrity
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 11 preview image27.Duringaprenatalcheck,apatientbeginstocryasthenurseasksheraboutpreviouspregnancies.Shestatesthatsheisrememberingherlastpregnancy,whichendedinmiscarriage.Thenursesbestresponsetohercryingwouldbe:a.Imsosorryformakingyoucry!b.Icanseethatyouaresadrememberingthis.Itisallrighttocry.c.WhydontIstepoutforafewminutesuntilyourefeelingbetter?d.Icanseethatyoufeelsadaboutthis;whydontwetalkaboutsomethingelse?ANS:BAbeginningexaminerusuallyfeelshorrifiedwhenthepatientstartscrying.Whenthenursesayssomethingthatmakesthepersoncry,thenurseshouldnotthinkheorshehashurttheperson.Thenursehassimplyhitonanimportanttopic;therefore,movingontoanewtopicisessential.Thenurseshouldallowthepersontocryandtoexpresshisorherfeelingsfully.Thenursecanofferatissueandwaituntilthecryingsubsidestotalk.DIF: Cognitive Level: Applying (Application) REF:dm. 42MSC: Client Needs: Psychosocial Integrity28. A female nurse is interviewing a man who has recently immigrated. During the course of theinterview, he leans forward and then finally moves his chair close enough that his knees arenearly touching the nurses knees. The nurse begins to feel uncomfortable with his proximity.Which statement most closely reflects what the nurse should do next?a.The nurse should try to relax; these behaviors are culturally appropriate for this person.b.The nurse should discreetly move his or her chair back until the distance is more comfortable, and ththe interview.c.These behaviors are indicative of sexual aggression, and the nurse should confront this person aboutd.The nurse should laugh but tell him that he or she is uncomfortable with his proximity and ask him tANS: ABoth the patients and the nurses sense of spatial distance are significant throughout the interviewand physical examination, with culturally appropriate distance zones varying widely. Somecultural groups value close physical proximity and may perceive a health care provider who isdistancing him or herself as being aloof and unfriendly.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 29MSC: Client Needs: Psychosocial Integrity29. A female American Indian has come to the clinic for follow-up diabetic teaching. During theinterview, the nurse notices that she never makes eye contact and speaks mostly to the floor.Which statement istrueregarding this situation?a.The woman is nervous and embarrassed.b.She has something to hide and is ashamed.c.The woman is showing inconsistent verbal and nonverbal behaviors.d.She is showing that she is carefully listening to what the nurse is saying.ANS: DEye contact is perhaps among the most culturally variable nonverbal behaviors. Asian, AmericanIndian, Indochinese, Arabian, and Appalachian people may consider direct eye contact impoliteor aggressive, and they may avert their eyes during the interview. American Indians often stare at
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 12 preview imagethefloorduringtheinterview,whichisaculturallyappropriatebehavior,indicatingthatthelistenerispayingcloseattentiontothespeaker.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 36MSC: Client Needs: Psychosocial Integrity30. The nurse is performing a health interview on a patient who has a language barrier, and nointerpreter is available. Which is the best example of an appropriate question for the nurse to askin this situation?a.Do you take medicine?b.Do you sterilize the bottles?c.Do you have nausea and vomiting?d.You have been taking your medicine, havent you?ANS: AIn a situation during which a language barrier exists and no interpreter is available, simple wordsshould be used, avoiding medical jargon. The use of contractions and pronouns should also beavoided. Nouns should be repeatedly used, and one topic at a time should be discussed.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 46MSC: Client Needs: Psychosocial Integrity31. A man arrives at the clinic for his annual wellness physical. He is experiencing no acutehealth problems. Which question or statement by the nurse is most appropriate when beginningthe interview?a.How is your family?b.How is your job?c.Tell me about your hypertension.d.How has your health been since your last visit?ANS: DOpen-ended questions are used for gathering narrative information. This type of questioningshould be used to begin the interview, to introduce a new section of questions, and whenever theperson introduces a new topic.DIF: Cognitive Level: Applying (Application) REF:dm. 31MSC: Client Needs: Psychosocial Integrity32. The nurse makes this comment to a patient, I know it may be hard, but you should do whatthe doctor ordered because she is the expert in this field. Which statement is correct about thenurses comment?a.This comment is inappropriate because it shows the nurses bias.b.This comment is appropriate because members of the health care team are experts in their area of pac.This type of comment promotes dependency and inferiority on the part of the patient and is best avosituation.d.Using authority statements when dealing with patients, especially when they are undecided about anat times.ANS: C
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 13 preview imageUsingauthorityresponsespromotesdependencyandinferiority.Avoidingtheuseofauthorityisbest.Althoughthehealthcareproviderandpatientdonothaveequalprofessionalknowledge,bothhaveequallyworthyrolesinthehealthprocess.Theotherstatementsarenotcorrect.DIF: Cognitive Level: Applying (Application) REF:dm. 34MSC: Client Needs: Psychosocial Integrity33. A female patient does not speak English well, and the nurse needs to choose an interpreter.Which of the following would be the most appropriate choice?a.Trained interpreterb.Male family memberc.Female family memberd.Volunteer college student from the foreign language studies departmentANS: AWhenever possible, the nurse should use a trained interpreter, preferably one who knows medicalterminology. In general, an older, more mature interpreter is preferred to a younger, lessexperienced one, and the same gender is preferred when possible.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 44MSC: Client Needs: Psychosocial Integrity34. During a follow-up visit, the nurse discovers that a patient has not been taking his insulin ona regular basis. The nurse asks, Why havent you taken your insulin? Which statement is anappropriate evaluation of this question?a.This question may place the patient on the defensive.b.This question is an innocent search for information.c.Discussing his behavior with his wife would have been better.d.A direct question is the best way to discover the reasons for his behavior.ANS: AThe adults use of why questions usually implies blame and condemnation and places the personon the defensive. The other statements are not correct.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 34MSC: Client Needs: Psychosocial Integrity35. The nurse is nearing the end of an interview. Which statement is appropriate at this time?a.Did we forget something?b.Is there anything else you would like to mention?c.I need to go on to the next patient. Ill be back.d.While Im here, lets talk about your upcoming surgery.ANS: BThis question offers the person a final opportunity for self-expression. No new topic should beintroduced. The other questions are not appropriate.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 36MSC: Client Needs: Psychosocial Integrity36. During the interview portion of data collection, the nurse collects __________ data.a.Physical
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 14 preview imageb.Historicalc.Objectived.SubjectiveANS:DTheinterviewisthefirst,andreallythemostimportant,partofdatacollection.Duringtheinterview,thenursecollectssubjectivedata;thatis,whatthepersonsaysabouthimorherself.DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 27MSC: Client Needs: Psychosocial Integrity37. During an interview, the nurse would expect that most of the interview will take place atwhat distance?a.Intimate zoneb.Personal distancec.Social distanced.Public distanceANS: CSocial distance, 4 to 12 feet, is usually the distance category for most of the interview. Publicdistance, over 12 feet, is too much distance; the intimate zone is inappropriate, and the personaldistance will be used for the physical assessment.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 29MSC: Client Needs: Psychosocial Integrity38. A female nurse is interviewing a male patient who is near the same age as the nurse. Duringthe interview, the patient makes an overtly sexual comment. The nurses best reaction would be:a.Stop that immediately!b.Oh, you are too funny. Lets keep going with the interview.c.Do you really think I would be interested?d.It makes me uncomfortable when you talk that way. Please stop.ANS: DThe nurses response must make it clear that she is a health professional who can best care for theperson by maintaining a professional relationship. At the same time, the nurse shouldcommunicate that he or she accepts the person and understands the persons need to be self-assertive but that sexual advances cannot be tolerated.Chapter 2 The Patient’s ResponsesMULTIPLE CHOICE1. After completing an initial assessment of a patient, the nurse has charted that his respirationsare eupneic and his pulse is 58 beats per minute. These types of data would be:a.Objective.b.Reflective.c.Subjective.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 15 preview imaged.Introspective.ANS:AObjectivedataarewhatthehealthprofessionalobservesbyinspecting,percussing,palpating,andauscultatingduringthephysicalexamination.Subjectivedataiswhatthepersonsaysabouthimorherselfduringhistorytaking.Thetermsreflectiveandintrospectivearenotusedtodescribedata.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 2MSC: Client Needs: Safe and Effective Care Environment: Management of Care2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types ofdata would be:a.Objective.b.Reflective.c.Subjective.d.Introspective.ANS: CSubjective data are what the person says about him or herself during history taking. Objectivedata are what the health professional observes by inspecting, percussing, palpating, andauscultating during the physical examination. The termsreflectiveandintrospectiveare not usedto describe data.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 2MSC: Client Needs: Safe and Effective Care Environment: Management of Care3. The patients record, laboratory studies, objective data, and subjective data combine to formthe:a.Data base.b.Admitting data.c.Financial statement.d.Discharge summary.ANS: ATogether with the patients record and laboratory studies, the objective and subjective data formthe data base. The other items are not part of the patients record, laboratory studies, or data.DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 2MSC: Client Needs: Safe and Effective Care Environment: Management of Care4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. Thenurses next action should be to:a.Immediately notify the patients physician.b.Document the sound exactly as it was heard.c.Validate the data by asking a coworker to listen to the breath sounds.d.Assess again in 20 minutes to note whether the sound is still present.ANS: C
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 16 preview imageWhenunsureofasoundheardwhilelisteningtoapatientsbreathsounds,thenursevalidatesthedatatoensureaccuracy.Ifthenursehaslessexperienceinanarea,thenheorsheasksanexperttolisten.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 2MSC: Client Needs: Safe and Effective Care Environment: Management of Care5. The nurse is conducting a class for new graduate nurses. During the teaching session, thenurse should keep in mind that novice nurses, without a background of skills and experiencefrom which to draw, are more likely to make their decisions using:a.Intuition.b.A set of rules.c.Articles in journals.d.Advice from supervisors.ANS: BNovice nurses operate from a set of defined, structured rules. The expert practitioner usesintuitive links.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 3MSC: Client Needs: General6. Expert nurses learn to attend to a pattern of assessment data and act without consciouslylabeling it. These responses are referred to as:a.Intuition.b.The nursing process.c.Clinical knowledge.d.Diagnostic reasoning.ANS: AIntuition is characterized by pattern recognitionexpert nurses learn to attend to a pattern ofassessment data and act without consciously labeling it. The other options are not correct.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 4MSC: Client Needs: General7. The nurse is reviewing information about evidence-based practice (EBP). Which statementbest reflects EBP?a.EBP relies on tradition for support of best practices.b.EBP is simply the use of best practice techniques for the treatment of patients.c.EBP emphasizes the use of best evidence with the clinicians experience.d.The patients own preferences are not important with EBP.ANS: CEBP is a systematic approach to practice that emphasizes the use of best evidence in combinationwith the clinicians experience, as well as patient preferences and values, when making decisionsabout care and treatment. EBP is more than simply using the best practice techniques to treatpatients, and questioning tradition is important when no compelling and supportive researchevidence exists.DIF: Cognitive Level: Applying (Application) REF:dm. 5MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 17 preview image8.Thenurseisconductingaclassonprioritysettingforagroupofnewgraduatenurses.Whichisanexampleofafirst-levelpriorityproblem?a.Patientwithpostoperativepainb.Newlydiagnosedpatientwithdiabeteswhoneedsdiabeticteachingc.Individualwithasmalllacerationonthesoleofthefootd.IndividualwithshortnessofbreathandrespiratorydistressANS:DFirst-levelpriorityproblemsarethosethatareemergent,lifethreatening,andimmediate(e.g.,establishinganairway,supportingbreathing,maintainingcirculation,monitoringabnormalvitalsigns)(seeTable1-1).DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 4MSC: Client Needs: Safe and Effective Care Environment: Management of Care9. When considering priority setting of problems, the nurse keeps in mind that second-levelpriority problems include which of these aspects?a.Low self-esteemb.Lack of knowledgec.Abnormal laboratory valuesd.Severely abnormal vital signsANS: CSecond-level priority problems are those that require prompt intervention to forestall furtherdeterioration (e.g., mental status change, acute pain, abnormal laboratory values, risks to safetyor security) (see Table 1-1).DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 4MSC: Client Needs: Safe and Effective Care Environment: Management of Care10. Which critical thinking skill helps the nurse see relationships among the data?a.Validationb.Clustering related cuesc.Identifying gaps in datad.Distinguishing relevant from irrelevantANS: BClustering related cues helps the nurse see relationships among the data.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 2MSC: Client Needs: Safe and Effective Care Environment: Management of Care11. The nurse knows that developing appropriate nursing interventions for a patient relies on theappropriateness of the __________ diagnosis.a.Nursingb.Medicalc.Admissiond.CollaborativeANS: A
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 18 preview imageAnaccuratenursingdiagnosisprovidesthebasisfortheselectionofnursinginterventionstoachieveoutcomesforwhichthenurseisaccountable.Theotheritemsdonotcontributetothedevelopmentofappropriatenursinginterventions.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 6MSC: Client Needs: Safe and Effective Care Environment: Management of Care12. The nursing process is a sequential method of problem solving that nurses use and includeswhich steps?a.Assessment, treatment, planning, evaluation, discharge, and follow-upb.Admission, assessment, diagnosis, treatment, and discharge planningc.Admission, diagnosis, treatment, evaluation, and discharge planningd.Assessment, diagnosis, outcome identification, planning, implementation, and evaluationANS: DThe nursing process is a method of problem solving that includes assessment, diagnosis,outcome identification, planning, implementation, and evaluation.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 3MSC: Client Needs: Safe and Effective Care Environment: Management of Care13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is havingdifficulty breathing. How should the nurse prioritize these problems?a.Breathing, pain, and sleepb.Breathing, sleep, and painc.Sleep, breathing, and paind.Sleep, pain, and breathingANS: AFirst-level priority problems are immediate priorities, remembering the ABCs (airway, breathing,and circulation), followed by second-level problems, and then third-level problems.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 4MSC: Client Needs: Safe and Effective Care Environment: Management of Care14. Which of these would be formulated by a nurse using diagnostic reasoning?a.Nursing diagnosisb.Medical diagnosisc.Diagnostic hypothesisd.Diagnostic assessmentANS: CDiagnostic reasoning calls for the nurse to formulate a diagnostic hypothesis; the nursing processcalls for a nursing diagnosis.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 2MSC: Client Needs: General15. Barriers to incorporating EBP include:a.Nurses lack of research skills in evaluating the quality of research studies.b.Lack of significant research studies.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 19 preview imagec.Insufficientclinicalskillsofnurses.d.Inadequatephysicalassessmentskills.ANS:AAsindividuals,nurseslackresearchskillsinevaluatingthequalityofresearchstudies,areisolatedfromothercolleagueswhoareknowledgeableinresearch,andoftenlackthetimetovisitthelibrarytoreadresearch.Theotherresponsesarenotconsideredbarriers.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 6MSC: Client Needs: General16. What step of the nursing process includes data collection by health history, physicalexamination, and interview?a.Planningb.Diagnosisc.Evaluationd.AssessmentANS: DData collection, including performing the health history, physical examination, and interview, isthe assessment step of the nursing process (see Figure 1-2).DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 2MSC: Client Needs: General17. During a staff meeting, nurses discuss the problems with accessing research studies toincorporate evidence-based clinical decision making into their practice. Which suggestion by thenurse manager would best help these problems?a.Form a committee to conduct research studies.b.Post published research studies on the units bulletin boards.c.Encourage the nurses to visit the library to review studies.d.Teach the nurses how to conduct electronic searches for research studies.ANS: DFacilitating support for EBP would include teaching the nurses how to conduct electronicsearches; time to visit the library may not be available for many nurses. Actually conductingresearch studies may be helpful in the long-run but not an immediate solution to reviewingexisting research.DIF: Cognitive Level: Applying (Application) REF:dm. 6MSC: Client Needs: Safe and Effective Care Environment: Management of Care18. When reviewing the concepts of health, the nurse recalls that the components of holistichealth include which of these?a.Disease originates from the external environment.b.The individual human is a closed system.c.Nurses are responsible for a patients health state.d.Holistic health views the mind, body, and spirit as interdependent.ANS: D
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 20 preview imageConsiderationofthewholepersonistheessenceofholistichealth,whichviewsthemind,body,andspiritasinterdependent.Thebasisofdiseaseoriginatesfromboththeexternalenvironmentandfromwithintheperson.Boththeindividualhumanandtheexternalenvironmentareopensystems,continuallychangingandadapting,andeachpersonisresponsibleforhisorherownpersonalhealthstate.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 7MSC: Client Needs: Safe and Effective Care Environment: Management of Care19. The nurse recognizes that the concept of prevention in describing health is essential because:a.Disease can be prevented by treating the external environment.b.The majority of deaths among Americans under age 65 years are not preventable.c.Prevention places the emphasis on the link between health and personal behavior.d.The means to prevention is through treatment provided by primary health care practitioners.ANS: CA natural progression to prevention rounds out the present concept of health. Guidelines toprevention place the emphasis on the link between health and personal behavior.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 7MSC: Client Needs: General20. The nurse is performing a physical assessment on a newly admitted patient. An example ofobjective information obtained during the physical assessment includes the:a.Patients history of allergies.b.Patients use of medications at home.c.Last menstrual period 1 month ago.d.2 5 cm scar on the right lower forearm.ANS: DObjective data are the patients record, laboratory studies, and condition that the healthprofessional observes by inspecting, percussing, palpating, and auscultating during the physicalexamination. The other responses reflect subjective data.DIF: Cognitive Level: Applying (Application) REF:dm. 2MSC: Client Needs: Safe and Effective Care Environment: Management of Care21. A visiting nurse is making an initial home visit for a patient who has many chronic medicalproblems. Which type of data base is most appropriate to collect in this setting?a.A follow-up data base to evaluate changes at appropriate intervalsb.An episodic data base because of the continuing, complex medical problems of this patientc.A complete health data base because of the nurses primary responsibility for monitoring the patientsd.An emergency data base because of the need to collect information and make accurate diagnoses rapANS: CThe complete data base is collected in a primary care setting, such as a pediatric or familypractice clinic, independent or group private practice, college health service, womens health careagency, visiting nurse agency, or community health agency. In these settings, the nurse is thefirst health professional to see the patient and has the primary responsibility for monitoring thepersons health care.DIF: Cognitive Level: Applying (Application) REF:dm. 6
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 21 preview imageMSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare22.Whichsituationismostappropriateduringwhichthenurseperformsafocusedorproblem-centeredhistory?a.Patientisadmittedtoalong-termcarefacility.b.Patienthasasuddenandsevereshortnessofbreath.c.Patientisadmittedtothehospitalforsurgerythefollowingday.d.Patientinanoutpatientclinichascoldandinfluenza-likesymptoms.ANS:DInafocusedorproblem-centereddatabase,thenursecollectsaminidatabase,whichissmallerinscopethanthecompleteddatabase.Thisminidatabaseprimarilyconcernsoneproblem,onecuecomplex,oronebodysystem.DIF: Cognitive Level: Applying (Application) REF:dm. 7MSC: Client Needs: Safe and Effective Care Environment: Management of Care23. A patient is at the clinic to have her blood pressure checked. She has been coming to theclinic weekly since she changed medications 2 months ago. The nurse should:a.Collect a follow-up data base and then check her blood pressure.b.Ask her to read her health record and indicate any changes since her last visit.c.Check only her blood pressure because her complete health history was documented 2 months ago.d.Obtain a complete health history before checking her blood pressure because much of her history inchanged.ANS: AA follow-up data base is used in all settings to follow up short-term or chronic health problems.The other responses are not appropriate for the situation.DIF: Cognitive Level: Applying (Application) REF:dm. 7MSC: Client Needs: Safe and Effective Care Environment: Management of Care24. A patient is brought by ambulance to the emergency department with multiple traumasreceived in an automobile accident. He is alert and cooperative, but his injuries are quite severe.How would the nurse proceed with data collection?a.Collect history information first, then perform the physical examination and institute life-saving meb.Simultaneously ask history questions while performing the examination and initiating life-saving mc.Collect all information on the history form, including social support patterns, strengths, and copingd.Perform life-saving measures and delay asking any history questions until the patient is transferred tunit.ANS: BThe emergency data base calls for a rapid collection of the data base, often concurrentlycompiled with life-saving measures. The other responses are not appropriate for the situation.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 7MSC: Client Needs: Safe and Effective Care Environment: Management of Care25. A 42-year-old patient of Asian descent is being seen at the clinic for an initial examination.The nurse knows that including cultural information in his health assessment is important to:a.Identify the cause of his illness.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 22 preview imageb.Makeaccuratediseasediagnoses.c.Provideculturalhealthrightsfortheindividual.d.Provideculturallysensitiveandappropriatecare.ANS:DTheinclusionofculturalconsiderationsinthehealthassessmentisofparamountimportancetogatheringdatathatareaccurateandmeaningfulandtointerveningwithculturallysensitiveandappropriatecare.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 8MSC: Client Needs: Psychosocial Integrity26. In the health promotion model, the focus of the health professional includes:a.Changing the patients perceptions of disease.b.Identifying biomedical model interventions.c.Identifying negative health acts of the consumer.d.Helping the consumer choose a healthier lifestyle.ANS: DIn the health promotion model, the focus of the health professional is on helping the consumerchoose a healthier lifestyle.DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 8MSC: Client Needs: Health Promotion and Maintenance27. The nurse has implemented several planned interventions to address the nursing diagnosis ofacute pain. Which would be the next appropriate action?a.Establish priorities.b.Identify expected outcomes.c.Evaluate the individuals condition, and compare actual outcomes with expected outcomes.d.Interpret data, and then identify clusters of cues and make inferences.ANS: CEvaluation is the next step after the implementation phase of the nursing process. During thisstep, the nurse evaluates the individuals condition and compares the actual outcomes withexpected outcomes (See Figure 1-2).DIF: Cognitive Level: Applying (Application) REF:dm. 3MSC: Client Needs: Safe and Effective Care Environment: Management of Care28. Which statementbestdescribes a proficient nurse? A proficient nurse is one who:a.Has little experience with a specified population and uses rules to guide performance.b.Has an intuitive grasp of a clinical situation and quickly identifies the accurate solution.c.Sees actions in the context of daily plans for patients.d.Understands a patient situation as a whole rather than a list of tasks and recognizes the long-term goANS: DThe proficient nurse, with more time and experience than the novice nurse, is able to understanda patient situation as a whole rather than as a list of tasks. The proficient nurse is able to see howtodays nursing actions can apply to the point the nurse wants the patient to reach at a future time.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 23 preview imageChapter 3 Caring forPatients in a Culturally Diverse SocietyMULTIPLECHOICE1.Thenurseisreviewingthedevelopmentofculture.Whichstatementiscorrectregardingthedevelopmentofonesculture?Cultureis:a.Geneticallydeterminedonthebasisofracialbackground.b.Learnedthroughlanguageacquisitionandsocialization.c.Anonspecificphenomenonandisadaptivebutunnecessary.d.Biologicallydeterminedonthebasisofphysicalcharacteristics.ANS:BCultureislearnedfrombirththroughlanguageacquisitionandsocialization.Itisnotbiologicallyorgeneticallydeterminedandislearnedbytheindividual.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 14MSC: Client Needs: Psychosocial Integrity2. During a class on the aspects of culture, the nurse shares that culture has four basiccharacteristics. Which statement correctly reflects one of these characteristics?a.Cultures are static and unchanging, despite changes around them.b.Cultures are never specific, which makes them hard to identify.c.Culture is most clearly reflected in a persons language and behavior.d.Culture adapts to specific environmental factors and available natural resources.ANS: DCulture has four basic characteristics. Culture adapts to specific conditions related toenvironmental and technical factors and to the availability of natural resources, and it is dynamicand ever changing. Culture is learned from birth through the process of language acquisition andsocialization, but it is not most clearly reflected in ones language and behavior.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 14MSC: Client Needs: Psychosocial Integrity3. During a seminar on cultural aspects of nursing, the nurse recognizes that the definition statingthe specific and distinct knowledge, beliefs, skills, and customs acquired by members of asociety reflects which term?a.Moresb.Normsc.Cultured.Social learningANS: CThe culture that develops in any given society is always specific and distinctive, encompassingall of the knowledge, beliefs, customs, and skills acquired by members of the society. The otherterms do not fit the given definition.DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 14
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 24 preview imageMSC:ClientNeeds:PsychosocialIntegrity4.Whendiscussingtheuseofthetermsubculture,thenurserecognizesthatitisbestdescribedas:a.Fittingasmanypeopleintothemajoritycultureaspossible.b.Definingsmallgroupsofpeoplewhodonotwanttobeidentifiedwiththelargerculture.c.Singlingoutgroupsofpeoplewhosufferdifferentialandunequaltreatmentasaresultofculturalvad.IdentifyingfairlylargegroupsofpeoplewithsharedcharacteristicsthatarenotcommontoallmemANS:DWithincultures,groupsofpeoplesharedifferentbeliefs,values,andattitudes.Differencesoccurbecauseofethnicity,religion,education,occupation,age,andgender.Whensuchgroupsfunctionwithinalargeculture,theyarereferredtoassubculturalgroups.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 14MSC: Client Needs: Psychosocial Integrity5. When reviewing the demographics of ethnic groups in the United States, the nurse recalls thatthe largest and fastest growing population is:a.Hispanic.b.Black.c.Asian.d.American Indian.ANS: AHispanics are the largest and fastest growing population in the United States, followed byAsians, Blacks, American Indians and Alaska natives, and other groups.DIF: Cognitive Level: Remembering (Knowledge) REF:dm. 11MSC: Client Needs: General6. During an assessment, the nurse notices that a patient is handling a small charm that is tied toa leather strip around his neck. Which action by the nurse is appropriate?a.Ask the patient about the item and its significance.b.Ask the patient to lock the item with other valuables in the hospitals safe.c.Tell the patient that a family member should take valuables home.d.No action is necessary.ANS: AThe nurse should inquire about the amulets meaning. Amulets, such as charms, are oftenconsidered an important means of protection from evil spirits by some cultures.DIF: Cognitive Level: Applying (Application) REF:dm. 19MSC: Client Needs: Psychosocial Integrity7. The nurse manager is explaining culturally competent care during a staff meeting. Whichstatement accurately describes the concept of culturally competent care? The caregiver:a.Is able to speak the patients native language.b.Possesses some basic knowledge of the patients cultural background.c.Applies the proper background knowledge of a patients cultural background to provide the best poss
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 25 preview imaged.Understandsandattendstothetotalcontextofthepatientssituation.ANS:DCulturallycompetentimpliesthatthecaregiverunderstandsandattendstothetotalcontextoftheindividualssituation.Thiscompetencyincludesawarenessofimmigrationstatus,stressfactors,othersocialfactors,andculturalsimilaritiesanddifferences.Itdoesnotrequirethecaregivertospeakthepatientsnativelanguage.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 24MSC: Client Needs: Psychosocial Integrity8. The nurse recognizes that an example of a person who isheritageconsistentwould be a:a.Woman who has adapted her clothing to the clothing style of her new country.b.Woman who follows the traditions that her mother followed regarding meals.c.Man who is not sure of his ancestors country of origin.d.Child who is not able to speak his parents native language.ANS: BSomeone who is heritage consistent lives a lifestyle that reflects his or her traditional heritage,not the norms and customs of the new country.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 24MSC: Client Needs: Psychosocial Integrity9. After a class on culture and ethnicity, the new graduate nurse reflects a correct understandingof the concept of ethnicity with which statement?a.Ethnicity is dynamic and ever changing.b.Ethnicity is the belief in a higher power.c.Ethnicity pertains to a social group within the social system that claims shared values and traditionsd.Ethnicity is learned from birth through the processes of language acquisition and socialization.ANS: CEthnicity pertains to a social group within the social system that claims to have variable traits,such as a common geographic origin, migratory status, religion, race, language, values,traditions, symbols, or food preferences.Cultureis dynamic, ever changing, and learned frombirth through the processes of language acquisition and socialization. Religion is the belief in ahigher power.DIF: Cognitive Level: Applying (Application) REF:dm. 14MSC: Client Needs: Psychosocial Integrity10. The nurse is comparing the concepts of religion and spirituality. Which of the following is anappropriate component of ones spirituality?a.Belief in and the worship of God or godsb.Attendance at a specific church or place of worshipc.Personal effort made to find purpose and meaning in lifed.Being closely tied to ones ethnic backgroundANS: CSpirituality refers to each persons unique life experiences and his or her personal effort to findpurpose and meaning in life. The other responses apply to religion.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 26 preview imageDIF: Cognitive Level: Applying (Application) REF:dm. 15MSC: Client Needs: Psychosocial Integrity11. A woman who has lived in the United States for a year after moving from Europe has learnedto speak English and is almost finished with her college studies. She now dresses like her peersand says that her family in Europe would hardly recognize her. This nurse recognizes that thissituation illustrates which concept?a.Assimilationb.Heritage consistencyc.Biculturalismd.AcculturationANS: AAssimilation is the process by which a person develops a new cultural identity and becomes likemembers of the dominant culture. This concept does not reflect heritage consistency.Biculturalism is a dual pattern of identification; acculturation is the process of adapting to andacquiring another culture.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 15MSC: Client Needs: Psychosocial Integrity12. The nurse is conducting a heritage assessment. Which question is most appropriate for thisassessment?a.What is your religion?b.Do you mostly participate in the religious traditions of your family?c.Do you smoke?d.Do you have a history of heart disease?ANS: BAsking questions about participation in the religious traditions of family enables the nurse toassess a persons heritage. Simply asking about ones religion, smoking history, or health historydoes not reflect heritage.DIF: Cognitive Level: Applying (Application) REF:dm. 24MSC: Client Needs: Psychosocial Integrity13. In the majority culture of America, coughing, sweating, and diarrhea are symptoms of anillness. For some individuals of Mexican-American origin, however, these symptoms are anormal part of living. The nurse recognizes that this difference is true, probably becauseMexican-Americans:a.Have less efficient immune systems and are often ill.b.Consider these symptoms part of normal living, not symptoms of ill health.c.Come from Mexico, and coughing is normal and healthy there.d.Are usually in a lower socioeconomic group and are more likely to be sick.ANS: BThe nurse needs to identify the meaning of health to the patient, remembering that concepts arederived, in part, from the way in which members of the cultural group define health.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 17MSC: Client Needs: Psychosocial Integrity
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 27 preview image14.Thenurseisreviewingtheoriesofillness.Thegermtheory,whichstatesthatmicroscopicorganismssuchasbacteriaandvirusesareresponsibleforspecificdiseaseconditions,isabasicbeliefofwhichtheoryofillness?a.Holisticb.Biomedicalc.Naturalisticd.MagicoreligiousANS:BAmongthebiomedicalexplanationsfordiseaseisthegermtheory,whichstatesthatmicroscopicorganismssuchasbacteriaandvirusesareresponsibleforspecificdiseaseconditions.Thenaturalistic,orholistic,perspectiveholdsthattheforcesofnaturemustbekeptinnaturalbalance.Themagicoreligiousperspectiveholdsthatsupernaturalforcesdominateandcauseillnessorhealth.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 18MSC: Client Needs: Psychosocial Integrity15. An Asian-American woman is experiencing diarrhea, which is believed to be cold or yin. Thenurse expects that the woman is likely to try to treat it with:a.Foods that are hot or yang.b.Readings and Eastern medicine meditations.c.High doses of medicines believed to be cold.d.No treatment is tried because diarrhea is an expected part of life.ANS: AYin foods are cold and yang foods are hot. Cold foods are eaten with a hot illness, and hot foodsare eaten with a cold illness. The other explanations do not reflect the yin/yang theory.DIF: Cognitive Level: Applying (Application) REF:dm. 18MSC: Client Needs: Psychosocial Integrity16. Many Asians believe in the yin/yang theory, which is rooted in the ancient Chinesephilosophy of Tao. Which statement most accurately reflects health in an Asian with this belief?a.A person is able to work and produce.b.A person is happy, stable, and feels good.c.All aspects of the person are in perfect balance.d.A person is able to care for others and function socially.ANS: CMany Asians believe in the yin/yang theory, in which health is believed to exist when all aspectsof the person are in perfect balance. The other statements do not describe this theory.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 18MSC: Client Needs: Psychosocial Integrity17. Illness is considered part of lifes rhythmic course and is an outward sign of disharmonywithin. This statement most accurately reflects the views about illness from which theory?a.Naturalisticb.Biomedical
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 28 preview imagec.Reductionistd.MagicoreligiousANS:AThenaturalisticperspectivestatesthatthelawsofnaturecreateimbalances,chaos,anddisease.FromtheperspectiveoftheChinese,forexample,illnessisnotconsideredanintroducingagent;rather,illnessisconsideredapartoflifesrhythmiccourseandanoutwardsignofdisharmonywithin.Theotheroptionsarenotcorrect.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 18MSC: Client Needs: Psychosocial Integrity18. An individual who takes the magicoreligious perspective of illness and disease is likely tobelieve that his or her illness was caused by:a.Germs and viruses.b.Supernatural forces.c.Eating imbalanced foods.d.An imbalance within his or her spiritual nature.ANS: BThe basic premise of the magicoreligious perspective is that the world is seen as an arena inwhich supernatural forces dominate. The fate of the world and those in it depends on the actionsof supernatural forces for good or evil. The other answers do not reflect the magicoreligiousperspective.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 18MSC: Client Needs: Psychosocial Integrity19. If an American Indian woman has come to the clinic to seek help with regulating herdiabetes, then the nurse can expect that she:a.Will comply with the treatment prescribed.b.Has obviously given up her belief in naturalistic causes of disease.c.May also be seeking the assistance of a shaman or medicine man.d.Will need extra help in dealing with her illness and may be experiencing a crisis of faith.ANS: CWhen self-treatment is unsuccessful, the individual may turn to the lay or folk healing systems,to spiritual or religious healing, or to scientific biomedicine. In addition to seeking help from abiomedical or scientific health care provider, patients may also seek help from folk or religioushealers.DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 19MSC: Client Needs: Psychosocial Integrity20. An older Mexican-American woman with traditional beliefs has been admitted to an inpatientcare unit. A culturally sensitive nurse would:a.Contact the hospital administrator about the best course of action.b.Automatically get a curandero for her, because requesting one herself is not culturally appropriate.c.Further assess the patients cultural beliefs and offer the patient assistance in contacting a curanderodesires.
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 29 preview imaged.AskthefamilywhattheywouldliketodobecauseMexican-Americanstraditionallygivecontroloftheirfamilies.ANS:CInadditiontoseekinghelpfromthebiomedicalorscientifichealthcareprovider,patientsmayalsoseekhelpfromfolkorreligioushealers.Somepeople,suchasthoseofMexican-AmericanorAmerican-Indianorigins,maybelievethatthecureisincompleteunlessthebody,mind,andspiritarealsohealed(althoughthedivisionofthepersonintopartsisaWesternconcept).DIF: Cognitive Level: Analyzing (Analysis) REF:dm. 19MSC: Client Needs: Psychosocial Integrity21. A 63-year-old Chinese-American man enters the hospital with complaints of chest pain,shortness of breath, and palpitations. Which statement most accurately reflects the nurses bestcourse of action?a.The nurse should focus on performing a full cardiac assessment.b.The nurse should focus on psychosomatic complaints because the patient has just learned that his wc.This patient is not in any danger at present; therefore, the nurse should send him home with instructphysician.d.It is unclear what is happening with this patient; consequently, the nurse should perform an assessmphysical and the psychosocial realms.ANS: DWide cultural variations exist in the manner in which certain symptoms and disease conditionsare perceived, diagnosed, labeled, and treated. Chinese-Americans sometimes convert mentalexperiences or states into bodily symptoms (e.g., complaining of cardiac symptoms because thecenter of emotion in the Chinese culture is the heart).DIF: Cognitive Level: Analyzing (Analysis) REF: pp. 17-18MSC: Client Needs: Psychosocial Integrity22. Symptoms, such as pain, are often influenced by a persons cultural heritage. Which of thefollowing is atruestatement regarding pain?a.Nurses attitudes toward their patients pain are unrelated to their own experiences with pain.b.Nurses need to recognize that many cultures practice silent suffering as a response to pain.c.A nurses area of clinical practice will most likely determine his or her assessment of a patients pain.d.A nurses years of clinical experience and current position are strong indicators of his or her responsANS: BSilent suffering is a potential response to pain in many cultures. The nurses assessment of painneeds to be embedded in a cultural context. The other responses are not correct.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 22MSC: Client Needs: Psychosocial Integrity23. The nurse is reviewing concepts of cultural aspects of pain. Which statementistrueregarding pain?a.All patients will behave the same way when in pain.b.Just as patients vary in their perceptions of pain, so will they vary in their expressions of pain.c.Cultural norms have very little to do with pain tolerance, because pain tolerance is always biologica
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 30 preview imaged.ApatientsexpressionofpainislargelydependentontheamountoftissueinjuryassociatedwiththeANS:BInadditiontoexpectingvariationsinpainperceptionandtolerance,thenurseshouldexpectvariationsintheexpressionofpain.Itiswellknownthatindividualsturntotheirsocialenvironmentforvalidationandcomparison.Theotherstatementsareincorrect.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 22MSC: Client Needs: Psychosocial Integrity24. During a class on religion and spirituality, the nurse is asked to define spirituality. Whichanswer is correct? Spirituality:a.Is a personal search to discover a supreme being.b.Is an organized system of beliefs concerning the cause, nature, and purpose of the universe.c.Is a belief that each person exists forever in some form, such as a belief in reincarnation or the afterld.Arises out of each persons unique life experience and his or her personal effort to find purpose in lifANS: DSpirituality arises out of each persons unique life experience and his or her personal effort to findpurpose and meaning in life. The other definitions reflect the concept of religion.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 15MSC: Client Needs: Psychosocial Integrity25. The nurse recognizes that working with children with a different cultural perspective may beespecially difficult because:a.Children have spiritual needs that are influenced by their stages of development.b.Children have spiritual needs that are direct reflections of what is occurring in their homes.c.Religious beliefs rarely affect the parents perceptions of the illness.d.Parents are often the decision makers, and they have no knowledge of their childrens spiritual needsANS: AIllness during childhood may be an especially difficult clinical situation. Children, as well asadults, have spiritual needs that vary according to the childs developmental level and thereligious climate that exists in the family. The other statements are not correct.DIF: Cognitive Level: Applying (Application) REF:dm. 21MSC: Client Needs: Psychosocial Integrity26. A 30-year-old woman has recently moved to the United States with her husband. They areliving with the womans sister until they can get a home of their own. When company arrives tovisit with the womans sister, the woman feels suddenly shy and retreats to the back bedroom tohide until the company leaves. She explains that her reaction to guests is simply because shedoes not know how to speak perfect English. This woman could be experiencing:a.Culture shock.b.Cultural taboos.c.Cultural unfamiliarity.d.Culture disorientation.ANS: A
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Test Bank For Textbook of Physical Diagnosis: History and Examination, 7th Edition - Page 31 preview imageCultureshockisatermusedtodescribethestateofdisorientationorinabilitytorespondtothebehaviorofadifferentculturalgroupbecauseofitssuddenstrangeness,unfamiliarity,andincompatibilitywiththeindividualsperceptionsandexpectations.Theothertermsarenotcorrect.DIF:CognitiveLevel:Analyzing(Analysis)REF:pp.21-22MSC:ClientNeeds:PsychosocialIntegrity27.Afterasymptomisrecognized,thefirsteffortattreatmentisoftenself-care.Whichofthefollowingstatementsaboutself-careistrue?Self-careis:a.Notrecognizedasvaluablebymosthealthcareproviders.b.Usuallyineffectiveandmaydelaymoreeffectivetreatment.c.Alwayslessexpensivethanbiomedicalalternatives.d.Influencedbytheaccessibilityofover-the-countermedicines.ANS:DAfterasymptomisidentified,thefirsteffortattreatmentisoftenself-care.Theavailabilityofover-the-countermedications,therelativelyhighliteracylevelofAmericans,andtheinfluenceofthemassmediaincommunicatinghealth-relatedinformationtothegeneralpopulationhavecontributedtothehighpercentageofcasesofself-treatment.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 19MSC: Client Needs: Psychosocial Integrity28. The nurse is reviewing the hot/cold theory of health and illness. Which statement bestdescribes the basic tenets of this theory?a.The causation of illness is based on supernatural forces that influence the humors of the body.b.Herbs and medicines are classified on their physical characteristics of hot and cold and the humors oc.The four humors of the body consist of blood, yellow bile, spiritual connectedness, and social aspecd.The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore thumors of the body.ANS: DThe hot/cold theory of health and illness is based on the four humors of the body: blood, phlegm,black bile, and yellow bile. These humors regulate the basic bodily functions, described in termsof temperature, dryness, and moisture. The treatment of disease consists of adding or subtractingcold, heat, dryness, or wetness to restore the balance of the humors. The other statements are notcorrect.DIF: Cognitive Level: Understanding (Comprehension) REF:dm. 18MSC: Client Needs: Psychosocial Integrity29. In the hot/cold theory, illnesses are believed to be caused by hot or cold entering the body.Which of these patient conditions is most consistent with a cold condition?a.Patient with diabetes and renal failureb.Teenager with an abscessed toothc.Child with symptoms of itching and a rashd.Older man with gastrointestinal discomfortANS: D
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