Test Bank For Brunner and Suddarth's Textbook Of Medical-Surgical Nursing, 13th Edition

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Chapter 11.Thepublichealthnurseispresentingahealthpromotionclasstoagroupofnewmothers.Howshouldthenursebestdefinehealth?A)Healthisbeingdiseasefree.B)Healthishavingfulfillmentinalldomainsoflife.C)Healthishavingpsychologicalandphysiologicalharmony.D)Healthisbeingconnectedinbody,mind,andspirit.Ans:DFeedback:TheWorldHealthOrganization(WHO)defineshealthinthepreambletoitsconstitutionasa“ stateofcompletephysical,mental,andsocialwell-beingandnotmerelytheabsenceofdiseaseandinfirmity.”TheotheranswersareincorrectbecausetheyarenotcongruentwiththeWHOdefinitionofhealth.2.Anurseisspeakingtoagroupofprospectivenursingstudentsaboutwhatitisliketobeanurse.Whatisonecharacteristicthenursewouldciteasnecessarytopossesstobeaneffectivenurse?A)SensitivitytoculturaldifferencesB)Team-focusedapproachtoproblem-solvingC)StrictadherencetoroutineD)AbilitytofacecriticismAns:AFeedback:Topromoteaneffectivenurse-patientrelationshipandpositiveoutcomesofcare,nursingcaremustbeculturallycompetent,appropriate,andsensitivetoculturaldifferences.Team-focusednursingandstrictadherencetoroutinearenotcharacteristicsneededtobeaneffectivenurse.Theabilitytohandlecriticismisimportant,buttoalesserdegreethanculturalcompetence.3.Withincreasesinlongevity,peoplehavehadtobecomemoreknowledgeableabouttheirhealthandtheprofessionalhealthcarethattheyreceive.Oneoutcomeofthisphenomenonisthedevelopmentoforganizedself-careeducationprograms.Whichofthefollowingdotheseprogramsprioritize?A)AdequateprenatalcareB)Governmentadvocacyandlobbying

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C)JudicioususeofonlinecommunitiesD)ManagementofillnessAns:DFeedback:Organizedself-careeducationprogramsemphasizehealthpromotion,diseaseprevention,managementofillness,self-care,andjudicioususeoftheprofessionalhealthcaresystem.Prenatalcare,lobbying,andInternetactivitiesaresecondary.4.Thehomehealthnurseisassistingapatientandhisfamilyinplanningthepatient’sreturntoworkaftersurgeryandthedevelopmentofpostsurgicalcomplications.Thenurseispreparingaplanofcarethataddressesthepatient’smultifacetedneeds.TowhichlevelofMaslow’shierarchyofbasicneedsdoesthepatient’sneedforself-fulfillmentrelate?A)PhysiologicB)TranscendenceC)LoveandbelongingD)Self-actualizationAns:DFeedback:Maslow’shighestlevelofhumanneedsisself-actualization,whichincludesself-fulfillment,desiretoknowandunderstand,andaestheticneeds.Theotheranswersareincorrectbecauseself-fulfillmentdoesnotrelatedirectlytothem.5.Theviewthathealthandillnessarenotstaticstatesbutthattheyexistonacontinuumiscentraltoprofessionalhealthcaresystems.Whenplanningcare,thisviewaidsthenurseinappreciatingwhichofthefollowing?A)Careshouldfocusprimarilyonthetreatmentofdisease.B)Aperson’sstateofhealthisever-changing.C)Apersoncantransitionfromhealthtoillnessrapidly.D)Careshouldfocusonthepatient’scompliancewithinterventions.Ans:BFeedback:Byviewinghealthandillnessonacontinuum,itispossibletoconsiderapersonasbeingneithercompletelyhealthynorcompletelyill.Instead,aperson’sstateofhealthisever-changingandhasthepotentialtorangefromhigh-levelwellnesstoextremelypoorhealthandimminentdeath.Theotheranswersareincorrectbecausepatientcareshouldnotfocusjustonthetreatmentofdisease.Rapiddeclinesinhealthand“ compliance”withtreatmentarenotkeytothisviewofhealth.

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6.Agroupofnursingstudentsareparticipatinginacommunityhealthclinic.Whenprovidingcareinthiscontext,whatshouldthestudentsteachparticipantsaboutdiseaseprevention?A)Itisbestachievedthroughattendingself-helpgroups.B)Itisbestachievedbyreducingpsychologicalstress.C)Itisbestachievedbybeinganactiveparticipantinthecommunity.D)Itisbestachievedbyexhibitingbehaviorsthatpromotehealth.Ans:DFeedback:Today,increasingemphasisisplacedonhealth,healthpromotion,wellness,andself-care.Healthisseenasresultingfromalifestyleorientedtowardwellness.Nursesincommunityhealthclinicsdonotteachthatdiseasepreventionisbestachievedthroughattendingself-helpgroups,byreducingstress,orbybeinganactiveparticipantinthecommunity,thougheachoftheseactivitiesisconsistentwithahealthylifestyle.7.Anurseonamedical-surgicalunithasaskedtorepresenttheunitonthehospital’squalitycommittee.Whendescribingqualityimprovementprogramstonursingcolleaguesandmembersofotherhealthdisciplines,whatcharacteristicshouldthenursecite?A)Theseprogramsestablishconsequencesforhealthcareprofessionals’actions.B)Theseprogramsfocusontheprocessesusedtoprovidecare.C)Theseprogramsidentifyspecificincidentsrelatedtoquality.D)Theseprogramsseektojustifyhealthcarecostsandsystems.Ans:BFeedback:Numerousmodelsseektoimprovethequalityofhealthcaredelivery.Acommonalityamongthemisafocusontheprocessesthatareusedtoprovidecare.Consequences,afocusonincidents,andjustificationforhealthcarecostsarenotuniversalcharacteristicsofqualityimprovementefforts.8.Nursesinacutecaresettingsmustworkwithotherhealthcareteammemberstomaintainqualitycarewhilefacingpressurestocareforpatientswhoarehospitalizedforshorterperiodsoftimethaninthepast.Toensurepositivehealthoutcomeswhenpatientsreturntotheirhomes,whatactionshouldthenurseprioritize?A)PromotionofhealthliteracyduringhospitalizationB)ClosecommunicationwithinsurersC)Thoroughandevidence-baseddischargeplanningD)Participationincontinuingeducationinitiatives

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Ans:CFeedback:Followingdischargesthatoccurafterincreasinglyshorthospitalstays,nursesinthecommunitycareforpatientswhoneedhigh-technologyacutecareservicesaswellaslong-termcareinthehome.Thisisdependentoneffectivedischargeplanningtoagreaterdegreethancontinuingeducation,communicationwithinsurers,orpromotionofhealthliteracy.9.Youareadmittingapatienttoyourmedicalunitafterthepatienthasbeentransferredfromtheemergencydepartment.Whatisyourprioritynursingactionatthistime?A)IdentifyingtheimmediateneedsofthepatientB)Checkingtheadmittingphysician’sordersC)ObtainingabaselinesetofvitalsignsD)AllowingthefamilytobewiththepatientAns:AFeedback:Amongthenurse’simportantfunctionsinhealthcaredelivery,identifyingthepatient’simmediateneedsandworkinginconcertwiththepatienttoaddressthemismostimportant.Theothernursingfunctionsareimportant,buttheyarenotthemostimportantfunctions.10.Anurseonapostsurgicalunitisprovidingcarebasedonaclinicalpathway.Whenperformingassessmentsandinterventionswiththeaidofapathway,thenurseshouldprioritizewhatgoal?A)HelpingthepatienttoachievespecificoutcomesB)BalancingrisksandbenefitsofinterventionsC)Documentingthepatient’sresponsetotherapyD)StayingaccountabletotheinterdisciplinaryteamAns:AFeedback:PathwaysareanEBPtoolthatisusedprimarilytomovepatientstowardpredeterminedoutcomes.Documentation,accountability,andbalancingrisksandbenefitsareappropriate,buthelpingthepatientachieveoutcomesisparamount.11.StaffnursesinanICUsettinghavenoticedthattheirpatientsrequiredlowerandfewerdosesofanalgesiawhennoiselevelsontheunitwereconsciouslyreduced.TheyinformedanadvancedpracticeRNofthisandaskedtheAPRNtoquantifytheeffectsofnoiseonthepainlevelsofhospitalizedpatients.HowdoesthisdemonstratearoleoftheAPRN?A)Involvingpatientsintheircarewhilehospitalized

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B)ContributingtothescientificbasisofnursingpracticeC)CritiquingthequalityofpatientcareD)ExplainingmedicalstudiestopatientsandRNsAns:BFeedback:ResearchiswithinthepurviewoftheAPRN.TheactivitydescribeddoesnotexemplifyexplainingstudiestoRNs,critiquingcare,orinvolvingpatientsintheircare.12.Nursesnowhavetheoptiontopracticeinavarietyofsettingsandoneofthefastestgrowingvenuesofpracticeforthenurseintoday’shealthcareenvironmentishomehealthcare.Whatisthemainbasisforthegrowthinthishealthcaresetting?A)ChronicnursingshortageB)WesternfocusontreatmentofdiseaseC)Nurses’preferencesfordayshiftsinsteadofeveningornightshiftsD)DischargeofpatientswhoaremorecriticallyillAns:DFeedback:Withshorterhospitalstaysandincreaseduseofoutpatienthealthcareservices,morenursingcareisprovidedinthehomeandcommunitysetting.Theotheranswersareincorrectbecausetheyarenotthebasisforthegrowthinnursingcaredeliveredinthehomesetting.13.Nurseshavedifferenteducationalbackgroundsandfunctionundermanytitlesintheirpracticesetting.Ifanursepracticinginanoncologyclinichadthegoalofimprovingpatientoutcomesandnursingcarebyinfluencingthepatient,thenurse,andthehealthcaresystem,whatwouldmostaccuratelydescribethisnurse’stitle?A)NursingcareexpertB)ClinicalnursespecialistC)NursemanagerD)StaffnurseAns:BFeedback:Clinicalnursespecialistsarepreparedasspecialistswhopracticewithinacircumscribedareaofcare(e.g.,cardiovascular,oncology).Theydefinetheirrolesashavingfivemajorcomponents:clinicalpractice,education,management,consultation,andresearch.Theotheranswersareincorrectbecausetheyarenotthemostaccuratetitlesforthisnurse.

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14.Nursingcontinuestorecognizeandparticipateincollaborationwithotherhealthcaredisciplinestomeetthecomplexneedsofthepatient.Whichofthefollowingisthebestexampleofacollaborativepracticemodel?A)Thenurseandthephysicianjointlymakingclinicaldecisions.B)Thenurseaccompanyingthephysicianonrounds.C)Thenursemakingareferralonbehalfofthepatient.D)Thenurseattendinganappointmentwiththepatient.Ans:AFeedback:Thecollaborativemodel,oravariationofit,promotessharedparticipation,responsibility,andaccountabilityinahealthcareenvironmentthatisstrivingtomeetthecomplexhealthcareneedsofthepublic.Theotheranswersareincorrectbecausetheyarenotexamplesofacollaborativepracticemodel.15.Ahospicenurseiscaringforapatientwhoisdyingoflymphoma.AccordingtoMaslow’shierarchyofneeds,whatdimensionofcareshouldthenurseconsiderprimaryinimportancewhencaringforadyingpatient?A)SpiritualB)SocialC)PhysiologicD)EmotionalAns:CFeedback:Maslowrankedhumanneedsasfollows:physiologicneeds;safetyandsecurity;senseofbelongingandaffection;esteemandself-respect;andself-actualization,whichincludesself-fulfillment,desiretoknowandunderstand,andaestheticneeds.Suchahierarchyofneedsisausefulframeworkthatcanbeappliedtothevariousnursingmodelsforassessmentofapatient’sstrengths,limitations,andneedfornursinginterventions.Theotheranswersareincorrectbecausetheyarenotofprimaryimportancewhencaringforadyingpatient,thougheachshouldcertainlybeaddressed.16.Anurseisplanningamedicalpatient’scarewithconsiderationofMaslow’shierarchyofneeds.Withinthisframeworkofunderstanding,whatwouldbethenurse’sfirstpriority?A)AllowingthefamilytoseeanewlyadmittedpatientB)AmbulatingthepatientinthehallwayC)Administeringpainmedication

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D)Teachingthepatienttoself-administerinsulinsafelyAns:CFeedback:InMaslow’shierarchyofneeds,painreliefaddressesthepatient’sbasicphysiologicneed.Activity,suchasambulation,isahigherlevelneedabovethephysiologicneed.Allowingthepatienttoseefamilyaddressesahigherlevelneedrelatedtoloveandbelonging.Teachingthepatientisalsoahigherlevelneedrelatedtothedesiretoknowandunderstandandisnotappropriateatthistime,asthebasicphysiologicneedofpaincontrolmustbeaddressedbeforethepatientcanaddressthesehigherlevelneeds.17.Amedical-surgicalnurseisawareofthescopeofpracticeasdefinedinthestatewherethenurseprovidescare.Thisnurse’scompliancewiththenursepracticeactdemonstratesadherencetowhichofthefollowing?A)NationalCouncilofNursing’sguidelinesforcareB)NationalLeagueforNursing’sCodeofConductC)AmericanNursesAssociation’sSocialPolicyStatementD)DepartmentofHealthandHumanService’sWhitePaperonNursingAns:CFeedback:NurseshavearesponsibilitytocarryouttheirroleasdescribedintheSocialPolicyStatementtocomplywiththenursepracticeactofthestateinwhichtheypracticeandtocomplywiththeCodeofEthicsforNursesasspelledoutbytheANA(2001)andtheInternationalCouncilofNurses(InternationalCouncilofNurses[ICN],2006).Theotheranswersareincorrect;theCodeofEthicsfornursingisnotincludedintheANA’swhitepaper.TheDHHShasnotpublishedawhitepaperonnursingnorhastheNLNpublishedaspecificcodeofconduct.18.Nursingis,bynecessity,aflexibleprofession.Ithasadaptedtomeetboththeexpectationsandthechanginghealthneedsofouragingpopulation.Whatisonefactorthathasimpactedtheneedforcertifiednursepractitioners(CNPs)?A)TheincreasedneedforprimarycareprovidersB)TheneedtoimprovepatientdiagnosticservicesC)ThepushtodriveinstitutionalexcellenceD)TheneedtodecreasethenumberofmedicalerrorsAns:AFeedback:CNPswhoareeducationallypreparedwithapopulationfocusinadult-gerontologyorpediatrics

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receiveadditionalfocusedtraininginprimarycareoracutecare.CNPshelpmeettheneedforprimarycareproviders.Diagnosticservices,institutionalexcellence,andreductionofmedicalerrorsarecongruentwiththeCNProle,buttheseconsiderationsarethenotprimaryimpetusfortheincreasedroleforCNPs.19.Anurseisprovidingcareforapatientwhoispostoperativedayonefollowingabowelresectionforthetreatmentofcolorectalcancer.HowcanthenursebestexemplifytheQSENcompetencyofqualityimprovement?A)ByliaisingwiththemembersoftheinterdisciplinarycareteamB)BycriticallyappraisingtheoutcomesofcarethatisprovidedC)Byintegratingthepatient’spreferencesintotheplanofcareD)BydocumentingcareintheelectronichealthrecordinatimelyfashionAns:BFeedback:EvaluationofoutcomesiscentraltotheQSENcompetencyofqualityimprovements.Eachoftheotherlistedactivitiesisacomponentofqualitynursingcare,butnoneclearlyexemplifiesqualityimprovementactivities.20.Professionalnursingexpandsandgrowsbecauseoffactorsdrivenbythechangingneedsofhealthcareconsumers.Whichofthefollowingisafactorthatnursesshouldreflectintheplanningandprovisionofhealthcare?A)DecreasedaccesstohealthcareinformationbyindividualsB)GradualincreasesintheculturalunityoftheAmericanpopulationC)IncreasingmeanandmedianageoftheAmericanpopulationD)DecreasingconsumerexpectationsrelatedtohealthcareoutcomesAns:CFeedback:Thedeclineinbirthrateandtheincreaseinlifespanduetoimprovedhealthcarehaveresultedinfewerschool-agechildrenandmoreseniorcitizens,manyofwhomarewomen.Thepopulationhasbecomemoreculturallydiverseasincreasingnumbersofpeoplefromdifferentnationalbackgroundsenterthecountry.Accesstoinformationandconsumerexpectationscontinuetoincrease.21.Apublichealthnursehasbeencommissionedtodraftahealthpromotionprogramthatmeetsthehealthcareneedsandexpectationsofthecommunity.Whichofthefollowingfocusesismostlikelytoinfluencethenurse’schoiceofinterventions?A)Managementofchronicconditionsanddisability

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B)Increasingneedforself-careamongayoungerpopulationC)AshiftingfocustodiseasemanagementD)AnincreasingfocusonacuteconditionsandrehabilitationAns:AFeedback:Inresponsetocurrentpriorities,healthcaremustfocusmoreonmanagementofchronicconditionsanddisabilitythaninprevioustimes.Theotheranswersareincorrectbecausethechangeinfocusofhealthcareisnotanincreasingneedforself-careamongouragingpopulation;ourfocusisshiftingawayfromdiseasemanagement,nottowardit;andwearemovingawayfromthemanagementofacuteconditionstomanagingchronicconditions.22.Acommunityhealthnursehaswitnessedsignificantshiftsinpatternsofdiseaseoverthecourseofafour-decadecareer.WhichofthefollowingfocusesmostclearlydemonstratesthechangingpatternofdiseaseintheUnitedStates?A)Type1diabetesmanagementB)Treatmentofcommunity-acquiredpneumoniaC)RehabilitationfromtraumaticbraininjuriesD)ManagementofacuteStaphylococcusaureusinfectionsAns:AFeedback:Managementofchronicdiseasessuchasdiabetesisapriorityfocusofthecurrenthealthcareenvironment.Thissupersedesthetreatmentofacuteinfectionsandrehabilitationneeds.23.TheANAhasidentifiedseveralphenomenatowardwhichthefocusofnursingcareshouldbedirected,andanurseisplanningcarethatreflectsthesepriorities.Whichofthenurse’sactionsbestdemonstratesthesepriorities?A)Encouragingthepatient’sdependenceoncaregiversB)Fosteringthepatient’sabilitytomakechoicesC)Teachingthepatientaboutnurses’rolesinthehealthcaresystemD)Assessingthepatient’sadherencetotreatmentAns:BFeedback:TheANAidentifiesseveralfocusesfornursingcareandresearch,includingtheabilitytomakechoices.TheotheranswersareincorrectbecausetheyarenotphenomenaidentifiedbytheANA.24.Theroleofthecertifiednursepractitioner(CNP)hasbecomeadominantrolefornursesinall

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levelsofhealthcare.WhichofthefollowingactivitiesareconsideredintegraltotheCNProle?Selectallthatapply.A)EducatingpatientsandfamilymembersB)CoordinatingcarewithotherdisciplinesC)UsingdirectprovisionofinterventionsD)EducatingregisterednursesandpracticalnursesE)CoordinatingpaymentplansforpatientsAns:A,B,CFeedback:Thisroleisadominantonefornursesinprimary,secondary,andtertiaryhealthcaresettingsandinhomecareandcommunitynursing.Nurseshelppatientsmeettheirneedsbyusingdirectintervention,byteachingpatientsandfamilymemberstoperformcare,andbycoordinatingandcollaboratingwithotherdisciplinestoprovideneededservices.TheotheranswersareincorrectbecauseNPsdonotcommonlyperformeducationofnursesandtheydonotfocusonmattersrelatedtopayment.25.TheANAhasidentifiedcentralcharacteristicsofnursingpracticethatareapplicableacrossthewidevarietyofcontextsinwhichnursespractice.Anursecanbestdemonstratetheseprinciplesbyperformingwhichofthefollowingactions?A)TeachingthepublicabouttheroleofnursingB)TakingactiontocontrolthecostsofhealthcareC)EnsuringthatallofhisorheractionsexemplifycaringD)MakingsuretocarryadequateliabilityinsuranceAns:CFeedback:TheANAemphasizesthefactthatcaringiscentraltothepracticeoftheregisterednurse.TheANAdoesnotidentifyteachingthepublicaboutnursing,controllingcosts,ormaintaininginsuranceasacentraltenetofnursingpractice.26.Anursehasacceptedapositionasaclinicalnurseleader(CNL),anewrolethathasbeenlaunchedwithinthepastdecade.Inthisrole,thenurseshouldprioritizewhichofthefollowingactivities?A)ActingasaspokespersonforthenursingprofessionB)GeneratinganddisseminatingnewnursingknowledgeC)Diagnosingandtreatinghealthproblemsthathaveapredictablecourse

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D)HelpingpatientstonavigatethehealthcaresystemAns:DFeedback:TheCNLisanursegeneralistwithamaster’sdegreeinnursingandaspecialbackgroundinclinicalleadership,educatedtohelppatientsnavigatethroughthecomplexhealthcaresystem.TheotheranswersareincorrectbecausetheyarenotwhatnursinghasidentifiedastheCNLrole.27.Ourworldisconnectedbyasophisticatedcommunicationsystemthatmakesmuchhealthinformationinstantlyaccessible,nomatterwherethepatientisbeingtreated.Thisinstantaccesstohealthinformationhasimpactedhealthcaredeliverystrategies,includingthedeliveryofnursingcare.Whatisonewaythedeliveryofhealthcarehasbeenimpactedbythisphenomenon?A)BriskchangesaswellasswiftobsolescenceB)RapidchangethatisnearlypermanentC)LimitationsonthesettingswherecarecanbeprovidedD)IncreasedneedforsocialacceptanceAns:AFeedback:Thesophisticatedcommunicationsystemsthatconnectmostpartsoftheworld,withthecapabilityofrapidstorage,retrieval,anddisseminationofinformation,havestimulatedbriskchangeaswellasswiftobsolescenceinhealthcaredeliverystrategies.Theotheranswersareincorrectbecause,althoughwehaverapidchangeinthedeliveryofnursingcare,itdoesnotlastalongtime;itisevolvingashealthcareitselfevolves.Givingnursingcarehasnotbecomeeasier,itbecomesmorecomplexwitheverychange;anditdoesnotneedtobemoresociallyacceptable;itneedstobemoreculturallysensitive.28.Withthechangingpopulationofhealthcareconsumers,ithasbecomenecessaryfornursestoworkmorecloselywithothernurses,aswhenacutecarenursescollaboratewithpublichealthandhomehealthnurses.Whatnursingfunctionhasincreasedinimportancebecauseofthisphenomenon?A)PrescribingmedicationB)PerformingdischargeplanningC)PromotingfamilyinvolvementD)FormingcollegialrelationshipsAns:BFeedback:Theimportanceofeffectivedischargeplanningandqualityimprovementcannotbeoverstated.

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Theotheranswersareincorrectbecausegivingmedicationandfamilyinvolvementinthepatient’scarehavenotgrowninimportance.Makingandmaintainingcollegialrelationshipshasbecomeanecessityinworkinginthehealthcaredeliverysystem.Effectivedischargeplanningaidsingettingpatientsoutoftheinpatientsettingsooner,cuttingcosts,andmakingrehabilitationinthecommunityandhomesettingpossible.29.Anursehasintegratedtheprinciplesofevidence-basedpracticeintocare.EBPhasthepotentialtohelpthenurseachievewhatgoal?A)IncreasingcareersatisfactionB)ObtainingfederalgrantmoneyC)EnsuringhighqualitypatientcareD)Enhancingthepublic’sesteemfornursingAns:CFeedback:QualityimprovementistheultimategoalofEBP.Careersatisfaction,publicesteem,andgrantmoneyarenotpriorities.30.Acasemanagerhasbeenhiredataruralhospitalthathasacombinedmedical-surgicalunit.Whendefiningthisnewrole,whichofthefollowingoutcomesshouldbeprioritizedbythehospital’sleadership?A)DecreasedneedforphysicianservicesB)ImprovedpatientandfamilyeducationC)IncreasedadherencetotheprinciplesofEBPD)IncreasedcoordinationofhealthservicesAns:DFeedback:Casemanagementisasystemofcoordinatinghealthcareservicestoensurecost-effectiveness,accountability,andqualitycare.Thecasemanagercoordinatesthecareofacaseloadofpatientsthroughfacilitatingcommunicationbetweennurses,otherhealthcarepersonnelwhoprovidecare,andinsurancecompanies.Reducingtheneedforphysicianservicesisnotacentralgoal.EducationandEBPareconsistentwithcasemanagement,buttheyarenotcentraltothisparticularrole.31.Ahospital’scurrentqualityimprovementprogramhasintegratedtheprinciplesoftheInstituteforHealthcareImprovement(IHI)5MillionLivesCampaign.Howcanthehospitalbestachievethecampaigngoalsofreducingpreventableharmanddeath?A)ByadheringtoEBPguidelines

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B)Byreducingnurse-to-patientratiosandincreasingaccountabilityC)ByhavingresearchersfromoutsidethefacilityevaluatecareD)ByinvolvingpatientsandfamiliesintheircareplanningAns:AFeedback:The5MillionLivesCampaignpositsthatifevidence-basedguidelinesitadvocatedwerevoluntarilyimplementedbyU.S.hospitals,5millionliveswouldbesavedfromeitherharmordeathoveratwo-yearperiod.Nurse-to-patientratios,familyparticipation,andindependentevaluationarenotstatedcomponentsofthecampaign.32.Overthepastseveraldecades,nursingroleshavechangedandexpandedinmanyways.Whichofthefollowingfactorshasprovidedthestrongestimpetusforthischange?A)TheneedtodecreasethecostofhealthcareB)TheneedtoimprovethequalityofnursingeducationC)TheneedtoincreasethenumberofnursingjobsavailableD)TheneedtoincreasethepublicperceptionofnursingAns:AFeedback:Theroleofthenursehasexpandedtoimprovethedistributionofhealthcareservicesandtodecreasethecostofhealthcare.Theotheranswersareincorrectbecausetheexpansionofrolesinnursingdidnotoccurtoimproveeducation,increasethenumberofnursingjobs,orincreasepublicperception.33.Advancedpracticenursingroleshavegrowninnumberandinvisibilityinrecentyears.Whatcharacteristicsetsthesenursesapartfromtheregisterednurse?A)CollaborationwithotherhealthcareprovidersB)EducationthatgoesbeyondthatoftheRNC)AdvanceddocumentationskillsD)AbilitytoprovidecareinthesurgicalcontextAns:BFeedback:ThereiswidevarietyinAPRNroles.However,acommonalityisthattheyrequireeducationbeyondthatoftheprofessionalRN.Allnursescollaboratewithotherhealthcareproviderstoprovidenursingcaretotheirpatients.Advanceddocumentationskillsarenotwhatsetsadvancedpracticenursesapartfromthestaffnurse.RNshavetheabilitytoprovidecareintheoperating

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room.34.CNPsareeducatedasspecialistsinareassuchasfamilycare,pediatrics,orgeriatrics.Inmoststates,whatrightdoCNPshavethatRNsdonotpossess?A)PerformhealthinterventionsindependentlyB)MakereferralstomembersofotherhealthdisciplinesC)PrescribemedicationsD)PerformsurgeryindependentlyAns:CFeedback:Inmoststates,nursepractitionershaveprescriptiveauthority.SurgeryisbeyondtheCNPscopeofpracticeandallprofessionalnursesmayperforminterventionsandmakecertainreferrals.35.Ateamofcommunityhealthnursesareplanningtodraftaproposalforaprogramthatwillincreasethecommunity’salignmentwiththeprinciplescontainedintheHealthyPeople2020report.Whichofthefollowingactivitieswouldbestdemonstratetheprioritiesidentifiedinthisreport?A)AddressingdeterminantsofhealthsuchascleanenvironmentsandsafetyinthecommunityB)LobbyingforincreasedfundingtothecountyhospitalwheremanyresidentsreceiveprimarycareC)CollaboratingwithhealthprofessionalsinneighboringcommunitiestopoolresourcesandincreaseefficienciesD)CreatingclinicalplacementswherenursingstudentsandmembersofotherhealthdisciplinescangainexperienceinacommunitysettingAns:AFeedback:HealthyPeople2020addressessocialdeterminantsofhealthsuchassafetyandthestateoftheenvironment.Thisreportdoesnotspecificallyaddressmatterssuchashospitalfunding,nursingeducation,orresourceallocation.36.Anurseisawarethatanincreasingemphasisisbeingplacedonhealth,healthpromotion,wellness,andself-care.Whichofthefollowingactivitieswouldbestdemonstratetheprinciplesofhealthpromotion?A)AdischargeplanninginitiativebetweenacutecareandcommunitycarenursesB)CollaborationbetweenseveralschoolsofnursinginanurbanareaC)Creationofasmokingpreventionprogramundertakeninamiddleschool

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D)Establishmentofawebsitewherepatientscancheckemergencydepartmentwait-timesAns:CFeedback:Smokingpreventionisaclearexampleofhealthpromotion.Eachoftheotherlistedactivitieshasthepotentialtobebeneficial,butnoneisconsideredhealthpromotion.37.AgroupofnursingstudentsarelearningaboutrecentchangesinthepatternofdiseaseintheUnitedStates.Whichofthefollowingstatementsbestdescribesthesecurrentchanges?A)Infectiousdiseasescontinuetodecreaseinincidenceandprevalence.B)Chronicillnessesarebecomingincreasinglyresistanttotreatment.C)Mostacute,infectiousdiseaseshavebeeneradicated.D)Most,butnotall,communicablediseasesaredeclining.Ans:DFeedback:Althoughsomeinfectiousdiseaseshavebeencontrolledoreradicated,othersareontherise.Antibioticresistanceisamoreseriousprobleminacute,notchronic,illnesses.38.TheJointCommissionandtheCentersforMedicareandMedicaidServices(CMS)areevaluatingalarge,universitymedicalcenteraccordingtocoremeasures.Evaluatorsshouldperformthisevaluationinwhatway?A)Byauditingthemedicalcenter’selectronichealthrecordsB)ByperformingfocusgroupsandinterviewswithcareprovidersfromnumerousdisciplinesC)ByperformingstatisticalanalysisofpatientsatisfactionsurveysD)Bycomparingthecenter’spatientoutcomestobestpracticeindicatorsAns:DFeedback:Coremeasuresareusedtogaugehowwellahospitalgivescaretoitspatientswhoareadmittedtoseektreatmentforaspecificdiseaseorwhoneedaspecifictreatmentascomparedtoevidence-basedguidelinesandstandardsofcare.Benchmarkstandardsofqualityareusedtocomparethecareortreatmentpatientsreceivewiththebestpracticestandards.Patientsatisfactionisconsidered,butthisisnottheonlycriterion.39.LeadershipofamedicalunithavebeeninstructedtointegratetheprinciplesoftheQualityandSafetyEducationforNurses(QSEN)competencyofqualityimprovement.Whatactionshouldtheunit’sleaderstake?A)ProvideaccesstoonlinejournalsandWeb-basedclinicalresourcesfornursingstaff.

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B)Useflowchartstodocumenttheprocessesofcarethatareusedontheunit.C)Enforcecontinuingeducationrequirementsforallcareproviders.D)Reducetheuseofchemicalandphysicalrestraintsontheunit.Ans:BFeedback:Oneofthequalityimprovementskillsistousetools,suchasflowchartsandcause-effectdiagrams,tomakeprocessesofcareexplicit.Eachoftheotherlistedactionshasthepotentialtobenefitpatientsandcaregivers,butnoneisanexplicitknowledge,skill,orattitudeassociatedwiththisQSENcompetency.40.TheIOMReportHealthProfessionsEducation:ABridgetoQualityissuedanumberofchallengestotheeducationalprogramsthatteachnursesandmembersofotherhealthprofessions.Accordingtothisreport,whatactivityshouldeducationalinstitutionsprioritize?A)Moreclearlydelineateeachprofession’sscopeofpracticeduringeducationB)MovetowarddevelopingasinglehealthcurriculumthatcanbeadaptedforanyhealthprofessionC)IncludeinterdisciplinarycorecompetenciesintocurriculaD)ElicitinputfrompatientsandfamiliesintohealthcarecurriculaAns:CFeedback:HealthProfessionsEducation:ABridgetoQualitychallengedhealthprofessions’educationprogramstointegrateinterdisciplinarycorecompetenciesintotheirrespectivecurriculatoincludepatient-centeredcare,interdisciplinaryteamworkandcollaboration,evidence-basedpractice,qualityimprovement,safety,andinformatics.Thisreportdidnotspecifyclearerdefinitionsofscopeofpractice,patientinput,orasinglecurriculum.Page 1Chapter 21.Acommunityhealthnursehasscheduledahypertensionclinicinalocalshoppingmallinwhichshoppershavetheopportunitytohavetheirbloodpressuremeasuredandlearnabouthypertension.Thisnursingactivitywouldbeanexampleofwhichtypeofpreventionactivity?A)TertiarypreventionB)SecondarypreventionC)Primaryprevention

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D)DiseasepreventionAns:BFeedback:Secondarypreventioncentersonhealthmaintenanceaimatearlydetectionandprevention.Diseasepreventionisnotaformofhealthcarebutisafocusonprimaryprevention.2.Thenursinginstructorispreparingagroupofstudentsfortheirhomecarerotation.Inpreparation,thegroupdiscussesthepatientsthattheyaremostlikelytocareforinthehome.Whichofthefollowinggroupsarethemostcommonrecipientsofhomecareservices?A)MentallyillpatientsB)PatientsreceivingrehabilitationaftersurgeryC)TerminallyillandpalliativepatientsD)ElderlypatientsAns:DFeedback:Theelderlyarethemostfrequentusersofhomecareservices.Thepatientmustbeacutelyill,homebound,andinneedofskillednursingservicestobeeligibleforthisservice.Theotheranswersareincorrectbecauseitistheelderlywhoareseenmostfrequentlyinthehomehealthsetting,thougheachoftheotherlistedgroupsmaysometimesreceivehomecare.3.Arecentnursinggraduatehasbeensurprisedatthesharpcontrastbetweensomepatients’lifestylesintheirhomesandthenurse’sownpracticesandbeliefs.Toworktherapeuticallywiththepatient,whatmustthenursedo?A)Requestanotherassignmentifthereisdissonancewiththepatient’slifestyle.B)Askthepatienttocometotheagencytoreceivetreatment,ifpossible.C)Resolvetoconveyrespectforthepatient’sbeliefsandchoices.D)Trytoadaptthepatient’shometothenormsofahospitalenvironment.Ans:CFeedback:Toworksuccessfullywithpatientsinanysetting,thenursemustbenonjudgmentalandconveyrespectforpatients’beliefs,eveniftheydiffersharplyfromthenurse’s.Thiscanbedifficultwhenapatient’slifestyleinvolvesactivitiesthatanurseconsidersharmfulorunacceptable,suchassmoking,useofalcohol,drugabuse,orovereating.Thenurseshouldnotrequestanotherassignmentbecauseofadifferenceinbeliefs,nordonursesaskforthepatienttocometoyouattheagencytoreceivetreatment.Itisalsoinappropriatetoconvertthepatient’shometoahospital-likeenvironment.

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4.Infectioncontrolisahighpriorityineverysettingwherenursingcareisprovided.Whenperformingahomevisit,howshouldthenursebestimplementtheprinciplesofinfectioncontrol?A)Performhandhygienebeforeandaftergivingdirectpatientcare.B)Removethepatient’swounddressingsfromthehomepromptly.C)Disinfectthepatient’ssyringespriortodisposal.D)Establishasterilefieldinthepatient’shomebeforeprovidingcare.Ans:AFeedback:Infectioncontrolisasimportantinthehomeasitisinthehospital,butitcanbemorechallenginginthehomeandrequirescreativeapproaches.Asinanysituation,itisimportanttocleanone’shandsbeforeandaftergivingdirectpatientcare,eveninahomethatdoesnothaverunningwater.Removingthewounddressingsfromthehomeanddisinfectingallworkareasinthehomearenotthebestimplementationsofinfectioncontrolinthehome.Usedsyringesareneverdisinfectedandasterilefieldisnotalwaysnecessary.5.Anadultpatientisreadytobedischargedfromthehospitalafterundergoingatransmetatarsalamputation.Whenshouldyourpatient’sdischargeplanningbegin?A)ThedaypriortodischargeB)ThedayofestimateddischargeC)ThedaythatthepatientisadmittedD)OncethenursingcareplanhasbeenfinalizedAns:CFeedback:Dischargeplanningbeginswiththepatient’sadmissiontothehospitalandmustconsiderthepossibleneedforfollow-uphomecare.Dischargeplanningshouldbeginpriortotheotherlistedtimes.6.Ahomehealthnurseispreparingtomaketheinitialvisittoanewpatient’shome.Whenplanningeducationalinterventions,whatinformationshouldthenurseprovidetothepatientandhisorherfamily?A)AvailablecommunityresourcestomeettheirneedsB)InformationonotherpatientsintheareawithsimilarhealthcareneedsC)Thenurse’scontactinformationandcredentialsD)DatesandtimesofallscheduledhomecarevisitsAns:A

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Feedback:Thecommunity-basednurseisresponsibleforinformingthepatientandfamilyaboutthecommunityresourcesavailabletomeettheirneeds.Duringinitialandsubsequenthomevisits,thenursehelpsthepatientandfamilyidentifythesecommunityservicesandencouragesthemtocontacttheappropriateagencies.Whenappropriate,nursesmaymaketheinitialcontact.Theotheranswersareincorrectbecauseitisinappropriatetoeverprovideinformationonotherpatientstoapatient.Thenurse’scredentialsarenotnormallydiscussed.Givingthepatientthedatesandtimesoftheirscheduledhomevisitsisappropriate,butmaynotalwaysbepossible.Itismoreimportanttoprovidethemwithresourcesavailablewithinthecommunitytomeettheirneeds.7.Thehomehealthnursereceivesareferralfromthehospitalforapatientwhoneedsahomevisitforwoundcare.Afterobtainingthereferral,whatwouldbethefirstactionthenurseshouldtake?A)Havecommunityservicesmakecontactwiththepatient.B)Obtainaphysician’sorderforthevisit.C)Callthepatienttoobtainpermissiontovisit.D)Arrangeforahomehealthaidetoinitiallyvisitthepatient.Ans:CFeedback:Afterreceivingareferral,thefirststepistocallthepatientandobtainpermissiontomakethevisit.Thenthenurseshouldschedulethevisitandverifytheaddress.Aphysician’sorderisnotnecessarytoscheduleavisitwiththepatient.Thenursemayidentifycommunityservicesortheneedforahomehealthaideafterassessingthepatientandthehomeenvironmentduringthefirstvisitwiththepatient.Thiswouldnotbedelegatedtoahomehealthaide.8.Atthebeginningofadaythatwillinvolveseveralhomevisits,thenursehasensuredthatthehealthcareagencyhasacopyofherdailyschedule.Whatistherationaleforthenurse’saction?A)Itallowstheagencytokeeptrackforpaymenttothenurse.B)Itsupportssafetyprecautionsforthenursewhenmakingahomecarevisit.C)Itallowsforgreaterflexibilityforthenurseandhisorhercolleaguesforchangesinassignments.D)Itallowsthepatienttocancelappointmentswithminimalinconvenience.Ans:BFeedback:Wheneveranursemakesahomevisit,theagencyshouldknowthenurse’sscheduleandthelocationsofthevisits.Theotheranswersareincorrectbecauseprovidingtheagencywithacopyofthedailyscheduleisnotforthepurposeofcorrectlypayingthenurseorfortheeaseofthenurseinchangingassignments.Itisalsonotintendedforthepatient’seaseincancelingappointments.

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9.Therearespecificlegalguidelinesandregulationsforthedocumentationrelatedtohomecare.WhenprovidingcareforapatientwhoisaMedicaidrecipient,whatismostimportantforthenursetodocument?A)ThemedicaldiagnosisandthesuppliesneededtocareforthepatientB)Asummaryofthepatient’sincometaxpaidduringthepreviousyearC)ThespecificqualityofnursingcarethatisneededD)Thepatient’shomeboundstatusandthespecificneedforskillednursingcareAns:DFeedback:Medicare,Medicaid,andthird-partypayersrequiredocumentationofthepatient’shomeboundstatusandtheneedforskilledprofessionalnursingcare.Themedicaldiagnosisandspecificdetailedinformationonthefunctionallimitationsofthepatientareusuallypartofthedocumentation.Theotheranswersareincorrectbecausenursingdocumentationdoesnotincludeneededsupplies,taxinformation,orthequalityofcareneeded.10.Yourpatienthashadatotalkneereplacementandwillneedtowalkwithatwo-wheeledwalkerfor6weeks.Heisbeingdischargedhomewithareferralforhomehealthcare.Whatwillthehomecarenurseneedtoassessduringtheinitialnursingassessmentinthehome?A)AssistanceofneighborsB)QualificationforMedicareandMedicaidC)CostsrelatedtothevisitsD)CharacteristicsofthehomeenvironmentAns:DFeedback:Theinitialassessmentincludesevaluatingthepatient,thehomeenvironment,thepatient’sself-careabilitiesorthefamily’sabilitytoprovidecare,andthepatient’sneedforadditionalresources.Normallyanassessmentisnotmadeofassistanceonthepartofneighborsorthecostsofthevisit.MedicareandMedicaidqualificationswouldnormallybedeterminedbeforehand.11.Anursewhohasanadvanceddegreeinprimarycareforapediatricpopulationisemployedinahealthclinic.Inwhatroleisthisnursefunctioning?A)NursepractitionerB)CasecoordinatorC)ClinicalnursespecialistD)Clinicsupervisor

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Ans:AFeedback:Nursepractitioners,educatedinprimarycare,oftenpracticeinambulatorycaresettingsthatfocusongerontology,pediatrics,familyoradulthealth,orwomen’shealth.Casecoordinatorsandclinicalsupervisorsdonotnecessarilyrequireanadvanceddegree,andaclinicalnursespecialistisnoteducatedinprimarycare.PrimarycareisthespecificfocusofCNPs.12.Anurseisbasedinanautomotiveassemblyplantandworkswiththeplant’semployeesintheareasofhealthpromotionandbasicprimarycare.Whatnursingroleisthisnurseperforming?A)OccupationalhealthnurseB)CommunitynursespecialistC)NurseclinicianD)PublichealthnurseAns:AFeedback:Occupationalhealthnursesmayprovidedirectcaretopatientswhoareill,conducthealtheducationprogramsfortheindustrystaff,orsetuphealthprograms.Theotheranswersareincorrectbecausetheyarenotconsistentwithanurse’splacementinamanufacturingsetting.13.Aschoolnursehasbeenworkingcloselywithastudentwhohascysticfibrosis.Thenurseisawarethatchildrenwithhealthproblemsareatmajorriskforwhatproblem?A)MentalhealthdisordersB)GradualreductioninintelligenceC)PsychologicalstressduetoadesiretooverachieveD)UnderachievementinschoolAns:DFeedback:School-agedchildrenandadolescentswithhealthproblemsareatmajorriskforunderachievingorfailinginschool.Thesestudentsdonotnecessarilyhaveahighriskofmentalhealthdisordersoradesiretooverachieve.Healthproblemsdonotnormallycauseaprogressivedeclineinintelligence.14.Acommunityhealthnurseisawarethatrestorationofhealthoftendependsonappropriateinterventionsperformedearlyinthecourseofadisease.Whichpatientismostlikelytoseekhealthcarelateinthecourseofhisorherdiseaseprocessanddeterioratemorequicklythanotherpatients?A)Apatientwhohasbeenhomelessforanextendedperiodoftime

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B)ApatientwhorecentlyimmigratedtotheUnitedStatesC)Apatientwhois88yearsoldandwhohasenjoyedrelativelygoodhealthD)AteenageboyAns:AFeedback:Becauseofnumerousbarriers,thehomelessseekhealthcarelateinthecourseofadiseaseanddeterioratemorequicklythanpatientswhoarenothomeless.Manyoftheirhealthproblemsarerelatedinlargeparttotheirlivingsituation.Theotheranswersareincorrectbecausethesepopulationsdonotasoftenseekcarelateinthecourseoftheirdiseaseprocessanddeterioratequickerthanotherpopulations.15.Arecentnursingschoolgraduatehaschosentopursueacommunitynursingpositionbecauseofincreasingopportunitiesfornursesincommunitysettings.Whatchangesinthehealthcaresystemhavecreatedanincreasedneedfornursestopracticeincommunity-basedsettings?Selectallthatapply.A)TighterinsuranceregulationsB)YoungerpopulationC)IncreasedruralpopulationD)ChangesinfederallegislationE)DecreasinghospitalrevenuesAns:A,D,EFeedback:Changesinfederallegislation,tighterinsuranceregulations,decreasinghospitalrevenues,andalternativehealthcaredeliverysystemshavealsoaffectedthewaysinwhichhealthcareisdelivered.Ourcountrydoesnothaveanincreasedruralpopulationnorisourpopulationyounger.16.Anursingstudenthastaughtacolleaguethatnursingpracticeisnotlimitedtohospitalsettings,explainingthatnursesarenowworkinginambulatoryhealthclinics,hospicesettings,andhomelesssheltersandclinics.Whatfactorhasmostinfluencedthisincreaseddiversityinpracticesettingsfornurses?A)PopulationshifttomoreruralareasB)ShiftofhealthcaredeliveryintothecommunityC)AdventofprimarycareclinicsD)IncreaseduseofrehabilitationhospitalsAns:B

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Feedback:Ashealthcaredeliveryshiftsintothecommunity,morenursesareworkinginavarietyofcommunity-basedsettings.Thesesettingsincludepublichealthdepartments,ambulatoryhealthclinics,long-termcarefacilities,hospicesettings,industrialsettings(asoccupationalnurses),homelesssheltersandclinics,nursingcenters,homehealthagencies,urgentcarecenters,same-daysurgicalcenters,short-stayfacilities,andpatients’homes.Theotheranswersareincorrectbecauseourpopulationhasnotshiftedtoamoreruralbase,andtheuseofprimarycareclinicshasnotinfluencedanincreaseinpracticesettingsortheuseofrehabilitationhospitals.17.Anurseiscollaboratingwithateamofcommunitynursestoidentifythevisionandmissionforcommunitycare.Whatisthecentralfocusofcommunity-basednursing?A)IncreasedhealthliteracyinthecommunityB)DistributingownershipforthehealthofthecommunityC)PromotingandmaintainingthehealthofindividualsandfamiliesD)IdentifyinglinksbetweenlifestyleandhealthAns:CFeedback:Community-basednursingpracticefocusescentrallyonpromotingandmaintainingthehealthofindividualsandfamilies,preventingandminimizingtheprogressionofdisease,andimprovingqualityoflife.Healthliteracyisnotagoalinitself,butratherameanstopromotinghealth.Distributingownershipandidentifyinglinksbetweenlifestyleandhealtharenottheessenceofcommunity-basedcare.18.Youarethecommunity-basednursewhoperformstheroleofcasemanagerforasmalltownabout60milesfromamajorhealthcarecenter.Whenplanningcareinyourcommunity,whatisthemostimportantvariableincommunity-basednursingthatyoushouldintegrateintoyourplanning?A)EligibilityrequirementsforservicesB)CommunityresourcesavailabletopatientsC)TransportationcoststothemedicalcenterD)PossiblechargesforanyservicesprovidedAns:BFeedback:Acommunity-basednursemustbeknowledgeableaboutcommunityresourcesavailabletopatientsaswellasservicesprovidedbylocalagencies,eligibilityrequirements,andanypossiblechargesfortheservices.Theotheranswersareincorrectbecausetheyarenotthemostimportantfactorsaboutwhichacommunity-basednursemustbeknowledgeable.

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19.Anurban,community-basednurseislookingforcommunityresourcesforapatientwhohascomplexrehabilitationneedscoupledwithseveralcomorbid,chronichealthconditions.Whereisthebestplaceforthenursetosearchforappropriateresources?A)AhospitaldirectoryB)ThehospitalintranetC)AcommunitydirectoryD)Thenurse’sownpersonalnetworkAns:CFeedback:Mostcommunitieshavedirectoriesofhealthandsocialserviceagenciesthatthenursecanconsult.Theotheranswersareincorrectbecausehospitaldirectoriesandintranetsusuallyonlyincludepeopleaffiliatedwiththehospital.Thenurse’spersonalnetworkofcontactsmayormaynotbeofuse.20.Youareacommunity-basedcaremanagerinamedium-sizedcommunitythatdoesnothaveanup-to-dateresourcedirectoryavailable.Asaresult,youhavebeengiventhetaskofbeginningtocompilesuchadirectory.Whatwouldbeimportanttoincludeinthisdirectory?Selectallthatapply.A)LinkstoonlinehealthsciencesjournalsB)ListsofsocialserviceworkersinthecommunityC)EligibilityrequirementsforservicesD)ListsofthemostcommonlyusedresourcesE)CostsassociatedwithservicesAns:C,D,EFeedback:Ifacommunitydoesnothavearesourcebooklet,anagencymaydeveloponeforitsstaff.Itshouldincludethecommonlyusedcommunityresourcesthatpatientsneed,aswellasthecostsoftheservicesandeligibilityrequirements.Theotheranswersareincorrectbecauseacommunityresourcebookletusuallywouldnotincludelinkstoonlineprofessionaljournalsanditwouldnotidentifyspecificsocialserviceworkers,onlyagencies.21.Youareassessinganewpatientandhishomeenvironmentfollowingthepatient’sreferralforcommunity-basedcare.Whichofthefollowingisthemostimportantresponsibilitythatyou,asacommunity-basednurse,haveatthisinitialvisit?A)Encouragethepatientandhisfamilytobecomemoreinvolvedintheircommunity.B)Encouragethepatientandhisfamilytodelegatesomeonetocontactcommunityresources.

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C)Encouragethepatientandhisfamilytofocusprimarilyononlinesupports.D)Encouragethepatientandhisfamilytoconnectwithappropriatecommunityresources.Ans:DFeedback:Duringinitialandsubsequenthomevisits,thenursehelpsthepatientandfamilyidentifycommunityservicesandencouragesthemtocontacttheappropriateagencies.Thisispreferabletodelegatinganotherpersontomakecontact.Whenappropriate,nursesmaymaketheinitialcontact.Ahome-healthnursewouldnotnormallyencouragethepatienttobecomemoreinvolvedinthecommunityasameansofpromotinghealth.Onlineformsofsupportcanbeuseful,buttheyarenotthesoleformofsupportthatmostpatientsneed.22.Anurseiscomparingsomeofthesimilaritiesanddifferencesbetweenthecarethatisprovidedincommunity-andhospital-basedsettings.Whattypeofcareisprovidedinbothofthesesettings?A)DieticiansB)AmbulatoryhealthcareC)OccupationalhealthcareD)HospicecareAns:BFeedback:Ambulatoryhealthcareisprovidedforpatientsincommunityorhospital-basedsettings.Thetypesofagenciesthatprovidesuchcarearemedicalclinics,ambulatorycareunits,urgentcarecenters,cardiacrehabilitationprograms,mentalhealthcenters,studenthealthcenters,communityoutreachprograms,andnursingcenters.Dieticiansarenotgenerallycommunity-basedandhospicecareisnotgenerallyprovidedinhospitalsettings.Occupationalhealthcareissituatedinworkplaces.23.Acommunity-basedcasemanagerissendingacommunitynursetoperformaninitialhomeassessmentofanewlyreferredpatient.Toensuresafety,thecasemanagermustmakethenurseawareofwhichofthefollowing?A)Thepotentialforat-riskworkingenvironmentsB)Self-defensestrategiesC)LocationsofemergencyservicesintheareaD)StandardprecautionsforinfectioncontrolAns:AFeedback:Basedontheprincipleofduediligence,agenciesmustinformemployeesofat-riskworking

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environments.Agencieshavepoliciesandproceduresconcerningthepromotionofsafetyforclinicalstaff,andtrainingisprovidedtofacilitatepersonalsafety.Thephysicallocationofemergencyservicesisnotimportant,thoughmethodsforcontactingemergencyservicesareapriority.Infectioncontrolispartofthenurse’sownprofessionalresponsibility.Self-defensestrategiesarenotalwaysaddressedandarenotlegallymandated.24.Ahomehealthnurseismakingavisittoanewpatientwhoisreceivinghomecarefollowingamastectomy.Duringthevisit,thepatient’shusbandarriveshomeinanintoxicatedstateandspeakstobothyouandthepatientinanabusivemanner.Whatisyourbestresponse?A)Ignorethehusbandandfocusonthepatient.B)Returntoyouragencyandnotifyyoursupervisor.C)Callthepolicefromyourcellphone.D)Removethepatientfromthehomeimmediately.Ans:BFeedback:Ifadangeroussituationisencounteredduringavisit,thenurseshouldreturntotheagencyandcontacthisorhersupervisororlawenforcementofficials,orboth.Ignoringthehusbandorcallingthepolicewhileinthehomeorattemptingtoremovethepatientfromthehomecouldfurtherendangeryouandthepatient.25.Thecommunity-healthnursehasreceivedareferralforanewpatientwhoresidesinahigh-crimearea.Whatisthemostimportantrequestthatthenurseshouldmakeoftheagencytobestensuresafety?A)AnearlymorningorlateafternoonappointmentB)AnassignedparkingspaceintheneighborhoodC)AcolleaguetoaccompanythenurseonthevisitD)SomeonetowaitinthecarwhilethenursemakesthevisitAns:CFeedback:Whenmakingvisitsinhigh-crimeareas,visitwithanotherpersonratherthanalone.Apersonwhoiswaitinginthecarisoflittlebenefit.Anearlymorningorlateafternoonappointmentwouldnotnecessarilyguaranteesafety.Similarly,assignedparkingwouldnotguaranteethenurse’ssafetywhileperformingthevisit.26.Ahomehealthnursehasbeenassignedtothecareofan82year-oldwomanwhohasbeendischargedhomefollowinghipreplacementsurgery.Atwhatlevelofcareisthisnursemostlikelypracticing?

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A)PreventativecareB)PrimarypreventionC)SecondarypreventionD)TertiarypreventionAns:DFeedback:Nursesincommunity-basedpracticeprovidepreventivecareatthreelevels:primary,secondary,andtertiary.Tertiarypreventionfocusesonminimizingdeteriorationandimprovingqualityoflife,includingrehabilitationtoassistpatientsinachievingtheirmaximumpotentialbyworkingthroughtheirphysicalorpsychologicalchallenges.Homecarenursesoftenfocusontertiarypreventivenursingcare,althoughprimaryandsecondarypreventionarealsoaddressed.Preventivecareisanumbrellatermforallthreelevelsofcare.27.Youareadmittingtwonewpatientstoyourlocalhomehealthcareservice.Thesepatientslivewithintwoblocksofeachotherandbothhomesareinahigh-crimearea.Whatactionbestprotectsyourpersonalsafety?A)Driveacarthatishardtobreakinto.B)Keepyoursatchelclosetoyouatalltimes.C)Donotleaveanythinginthecarthatmightbestolen.D)Donotwearexpensivejewelry.Ans:DFeedback:Donotdriveanexpensivecarorwearexpensivejewelrywhenmakingvisits.Whilealloftheseanswersmightbewiseprecautionstotake,theothersuggestionsaddresspropertyratherthanpersonalsafety.28.Intwodaysyouarescheduledtodischargeapatienthomeafterlefthipreplacement.Youhaveinitiatedahomehealthreferralandyouhavemetwithateamofpeoplewhohavebeeninvolvedwiththispatient’sdischargeplanning.Knowingthatthepatientlivesalone,whowouldbeappropriatepeopletobeonthedischargeplanningteam?Selectallthatapply.A)HomehealthnurseB)PhysicaltherapistC)PharmacytechnicianD)SocialworkerE)Meal-on-Wheelsprovider

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Ans:A,B,DFeedback:Thedevelopmentofacomprehensivedischargeplanrequirescollaborationwithprofessionalsatboththereferringagencyandthehomecareagency,aswellasothercommunityagenciesthatprovidespecificresourcesupondischarge.ThepharmacytechniciandoesnotparticipateindischargeplanningandthereisnoindicationthatMeals-on-Wheelsarenecessary.29.Ahomehealthnurseisconductingahomevisittoapatientwhoreceiveswoundcaretwiceweeklyforadiabeticfootulcer.Whileperformingthedressingchange,thenurserealizesthatsheforgottobringtheadhesivegauzespecifiedinthewoundcareregimen.Whatisthenurse’sbestaction?A)Phoneacolleaguetobringtherequiredsuppliesassoonaspossible.B)Improvise,ifpossible,usingsterilegauzeandadhesivetape.C)Leavethewoundopentoairandteachthepatientaboutinfectioncontrol.D)Scheduleareturnvisitforthefollowingday.Ans:BFeedback:Improvisationisanecessityinmanyhomehealthsituations.Itwouldbelogisticallydifficulttohavethesuppliesdeliveredandleavingthewoundopentoairmaybecontraindicated.Areturnvisitthenextdaydoesnotresolvetheimmediateproblem.30.Dischargeplanningisanintegralpartofcommunity-healthnursingandhomehealth.Whichofthefollowingisprioritizedinthedischarge-planningprocess?A)Identifyingthepatient’sspecificneedsB)MakingasocialservicesreferralC)GettingphysicaltherapyinvolvedincareD)NotifyingthepharmacyofthedischargedateAns:AFeedback:Thedischargeplanningprocessinvolvesidentifyingthepatient’sneedsanddevelopingathoroughplantomeetthem.Theotheroptionsmightbeappropriateforsomepatients,buttheyarenotallappropriateforeverypatient.31.Withinthepublichealthsystemtherehasbeenanincreaseddemandformedical,nursing,andsocialservices.Thenurseshouldrecognizewhatphenomenonasthebasisforthisincreaseddemand?A)Increaseduseofcomplementaryandalternativetherapies

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B)ThegrowingnumberofolderadultsintheUnitedStatesC)TheriseinincomedisparityintheUnitedStatesD)IncreasingprofitpotentialforhomehealthservicesAns:BFeedback:ThegrowingnumberofolderadultsintheUnitedStatesincreasesthedemandformedical,nursing,andsocialserviceswithinthepublichealthsystem.Incomedisparities,profitpotential,andincreaseduseofcomplementarytherapiesdonotaccountforthischange.32.Nursingcareisprovidedinanincreasinglydiversevarietyofsettings.Despitethevarietyinsettings,somecharacteristicsofprofessionalnursingpracticearerequiredinanyandeverysetting.Thesecharacteristicsincludewhichofthefollowing?A)AdvancededucationB)CertificationinachosenspecialtyC)CulturalcompetenceD)IndependentpracticeAns:CFeedback:Culturalcompetenceisnecessaryinanyandeverycaresetting.Theotheranswersareincorrectbecauseanadvancededucation,specialtycertification,andtheabilitytopracticeindependentlyarenotconsistenciesbetweeneverynursingcaredeliverysetting.33.MedicareisafederalprogramthatfinancesmanyAmericans’homehealthcareexpenses.TheMedicareprogramfacilitateswhataspectofhomehealthcare?A)ProvidingcarewithouttheoversightofaphysicianB)WritingnecessarymedicationordersforthepatientC)Orderingphysical,occupational,andspeechtherapyifneededD)ManagingandevaluatingpatientcareforseriouslyillpatientsAns:DFeedback:ManyhomehealthcareexpendituresarefinancedbyMedicare,whichallowsnursestomanageandevaluatepatientcareforseriouslyillpatientswhohavecomplex,labileconditionsandareathighriskforrehospitalization.Homehealthnurses,despitewhofundstheirvisits,donotprovidecarewithouttheoversightofaphysician;theydonotnormallywritemedicationorders;nordotheyordertheservicesofancillaryspecialistssuchasphysical,occupational,orspeechtherapists.

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34.Youareaschoolnursewhowillworkwithanincomingkindergartenstudentwhohasadiagnosisofcerebralpalsy.Whywouldyoumakeahomevisitbeforeschoolstarts?A)ToprovideanticipatoryguidancetothefamilyB)Toassessthesafetyofthechild’sassistivedevicesC)ToarrangeforateachingaidetoworkwiththechildD)Toprovidefollow-upcareafterthechild’sclinicvisitAns:AFeedback:Publichealth,parish,andschoolnursesmaymakevisitstoprovideanticipatoryguidancetohigh-riskfamiliesandfollow-upcaretopatientswithcommunicablediseases.Theotheranswersareincorrectbecausetheyarenotfunctionsoftheschoolnurse.35.Ahomehealthnursehasbeenworkingforseveralmonthswithamalepatientwhoisreceivingrehabilitativeservices.Thenurseisawarethatmaintainingthepatient’sconfidentialityisapriority.Howcanthenursebestprotectthepatient’srighttoconfidentiality?A)Avoidbringingthepatient’smedicalrecordtothehome.B)Discussthepatient’sconditionandcareonlywhenheisaloneinthehome.C)Keepthepatient’smedicalrecordsecuredatalltimes.D)Askthepatienttoavoiddiscussinghishomecarewithfriendsandneighbors.Ans:CFeedback:Ifthenursecarriesapatient’smedicalrecordintoahouse,itmustbeputinasecureplacetopreventitfrombeingpickedupbyothersorfrombeingmisplaced.Thisdoesnotmean,however,thatitmustneverbebroughttothehome.Itisnotnormallynecessarytolimitdiscussionstotimeswhenthepatientisalone.Thepatienthastherighttodecidewithwhomhewilldiscusshisconditionandcare.36.Ahomehealthnursehascompletedavisittoapatientandhasimmediatelybeguntodocumentthevisit.Accuratedocumentationthatiscorrectlyformattedisnecessaryforwhichofthefollowingreasons?A)Accuratedocumentationguaranteesthatthenursewillnotbelegallyliableforunexpectedoutcomes.B)Accuratedocumentationensuresthattheagencyiscorrectlyreimbursedforthevisit.C)Accuratedocumentationallowsthepatienttogaugehisorherprogressovertime.D)Accuratedocumentationfacilitatessafedelegationofcaretounlicensedcaregivers.

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