Test Bank for Brunner and Suddarths Textbook of Medical-Surgical Nursing, 14th Edition

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1322416483104124144164183220240260280300319338357376396415434472490508526545564582601620638656674692710728746764782800819837855874893453Table of ContentsTable of ContentsChapter 01: Health Care Delivery and Evidence-Based Nursing PracticeChapter 02: Community-Based Nursing PracticeChapter 03: Critical Thinking, Ethical Decision Making and the Nursing ProcessChapter 04: Health Education and PromotionChapter 05: Adult Health and Nutritional AssessmentChapter 06: Individual and Family Homeostasis, Stress, and AdaptationChapter 07: Overview of Transcultural NursingChapter 08: Overview of Genetics and Genomics in NursingChapter 09: Chronic Illness and DisabilityChapter 10: Principles and Practices of RehabilitationChapter 11: Health Care of the Older AdultChapter 12: Pain ManagementChapter 13: Fluid and Electrolytes: Balance and DisturbanceChapter 14: Shock and Multiple Organ Dysfunction SyndromeChapter 15: Management of Patients with Oncologic DisordersChapter 16: End-of-Life CareChapter 17: Preoperative Nursing ManagementChapter 18: Intraoperative Nursing ManagementChapter 19: Postoperative Nursing ManagementChapter 20: Assessment of Respiratory FunctionChapter 21: Respiratory Care ModalitiesChapter 22: Management of Patients With Upper Respiratory Tract DisordersChapter 23: Management of Patients with Chest and Lower Respiratory Tract DisordersChapter 24: Management of Patients With Chronic Pulmonary DiseaseChapter 25: Assessment of Cardiovascular FunctionChapter 26: Management of Patients With Dysrhythmias and Conduction ProblemsChapter 27: Management of Patients With Coronary Vascular DisordersChapter 28: Management of Patients With Structural, Infectious, and Inflammatory CardiacDisordersChapter 29: Management of Patients With Complications from Heart DiseaseChapter 30: Assessment and Management of Patients With Vascular Disorders andProblems of Peripheral CirculationChapter 31: Assessment and Management of Patients With HypertensionChapter 32: Assessment of Hematologic Function and Treatment ModalitiesChapter 33: Management of Patients With Nonmalignant Hematologic DisordersChapter 34: Management of Patients With Hematologic NeoplasmsChapter 35: Assessment of Immune FunctionChapter 36: Management of Patients With Immune Deficiency DisordersChapter 37: Assessment and Management of Patients With Allergic DisordersChapter 38: Assessment and Management of Patients With Rheumatic DisordersChapter 39: Assessment of Musculoskeletal FunctionChapter 40: Musculoskeletal Care ModalitiesChapter 41: Management of Patients With Musculoskeletal DisordersChapter 42: Management of Patients With Musculoskeletal TraumaChapter 43: Assessment of Digestive and Gastrointestinal FunctionChapter 44: Digestive and Gastrointestinal Treatment ModalitiesChapter 45: Management of Patients with Oral and Esophageal DisordersChapter 46: Management of Patients with Gastric and Duodenal DisordersChapter 47: Management of Patients With Intestinal and Rectal DisordersTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)1

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91192194095997899610151034107210911129114711651221123912571276129413311349136710541110118412031312Chapter 48: Assessment and Management of Patients with ObesityChapter 49: Assessment and Management of Patients with Hepatic DisordersChapter 50: Assessment and Management of Patients with Biliary DisordersChapter 51: Assessment and Management of Patients with DiabetesChapter 52: Assessment and Management of Patients with Endocrine DisordersChapter 53: Assessment of Kidney and Urinary FunctionChapter 54: Management of Patients with Kidney DisordersChapter 55: Management of Patients with Urinary DisordersChapter 56: Assessment and Management of Patients With Female Physiologic ProcessesChapter 57: Management of Patients with Female Reproductive DisordersChapter 58: Assessment and Management of Patients with Breast DisordersChapter 59: Assessment and Management of Patients With Male Reproductive DisordersChapter 60: Assessment of Integumentary FunctionChapter 61: Managements of Patients with Dermatologic ProblemsChapter 62: Managements of Patients with Burn InjuryChapter 63: Assessment and Management of Patients with Eye and Vision DisordersChapter 64: Assessment and Management of Patients with Hearing and Balance DisordersChapter 65: Assessment of Neurologic FunctionChapter 66: Management of Patients with Neurologic DysfunctionChapter 67: Management of Patients with Cerebrovascular DisordersChapter 68: Management of Patients with Neurologic TraumaChapter 69: Management of Patients with Neurologic Infections, Autoimmune Disorders,and NeuropathiesChapter 70: Management of Patients With Oncologic or Degenerative Neurologic DisordersChapter 71: Management of Patients With Infectious DiseasesChapter 72: Emergency NursingChapter 73: Terrorism, Mass Casualty, and Disaster NursingTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)2

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Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice1.The public health nurse is presenting a health promotion class to a group of new mothers. How shouldthe nurse best define health?A)Health is being disease free.B)Health is having fulfillment in all domains of life.C)Health is having psychological and physiological harmony.D)Health is being connected in body, mind, and spirit.Ans:DFeedback:The World Health Organization (WHO) defines health in the preamble to its constitution as a state ofcomplete physical, mental, and social well-being and not merely the absence of disease and infirmity.The other answers are incorrect because they are not congruent with the WHO definition of health.2.A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What isone characteristic the nurse would cite as necessary to possess to be an effective nurse?A)Sensitivity to cultural differencesB)Team-focused approach to problem-solvingC)Strict adherence to routineD)Ability to face criticismAns:AFeedback:To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must beculturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strictadherence to routine are not characteristics needed to be an effective nurse. The ability to handlecriticism is important, but to a lesser degree than cultural competence.3.With increases in longevity, people have had to become more knowledgeable about their health and theprofessional health care that they receive. One outcome of this phenomenon is the development oforganized self-care education programs. Which of the following do these programs prioritize?Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)3

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A)Adequate prenatal careB)Government advocacy and lobbyingC)Judicious use of online communitiesD)Management of illnessAns:DFeedback:Organized self-care education programs emphasize health promotion, disease prevention, managementof illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, andInternet activities are secondary.4.The home health nurse is assisting a patient and his family in planning the patients return to work aftersurgery and the development of postsurgical complications. The nurse is preparing a plan of care thataddresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does thepatients need for self-fulfillment relate?A)PhysiologicB)TranscendenceC)Love and belongingD)Self-actualizationAns:DFeedback:Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire toknow and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment doesnot relate directly to them.5.The view that health and illness are not static states but that they exist on a continuum is central toprofessional health care systems. When planning care, this view aids the nurse in appreciating which ofthe following?A)Care should focus primarily on the treatment of disease.B)A persons state of health is ever-changing.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)4

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C)A person can transition from health to illness rapidly.D)Care should focus on the patients compliance with interventions.Ans:BFeedback:By viewing health and illness on a continuum, it is possible to consider a person as being neithercompletely healthy nor completely ill. Instead, a persons state of health is ever-changing and has thepotential to range from high-level wellness to extremely poor health and imminent death. The otheranswers are incorrect because patient care should not focus just on the treatment of disease. Rapiddeclines in health and compliance with treatment are not key to this view of health.6.A group of nursing students are participating in a community health clinic. When providing care in thiscontext, what should the students teach participants about disease prevention?A)It is best achieved through attending self-help groups.B)It is best achieved by reducing psychological stress.C)It is best achieved by being an active participant in the community.D)It is best achieved by exhibiting behaviors that promote health.Ans:DFeedback:Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seenas resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teachthat disease prevention is best achieved through attending self-help groups, by reducing stress, or bybeing an active participant in the community, though each of these activities is consistent with a healthylifestyle.7.A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee.When describing quality improvement programs to nursing colleagues and members of other healthdisciplines, what characteristic should the nurse cite?A)These programs establish consequences for health care professionals actions.B)These programs focus on the processes used to provide care.C)These programs identify specific incidents related to quality.D)These programs seek to justify health care costs and systems.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)5

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Ans:BFeedback:Numerous models seek to improve the quality of health care delivery. A commonality among them is afocus on the processes that are used to provide care. Consequences, a focus on incidents, andjustification for health care costs are not universal characteristics of quality improvement efforts.8.Nurses in acute care settings must work with other health care team members to maintain quality carewhile facing pressures to care for patients who are hospitalized for shorter periods of time than in thepast. To ensure positive health outcomes when patients return to their homes, what action should thenurse prioritize?A)Promotion of health literacy during hospitalizationB)Close communication with insurersC)Thorough and evidence-based discharge planningD)Participation in continuing education initiativesAns:CFeedback:Following discharges that occur after increasingly short hospital stays, nurses in the community care forpatients who need high-technology acute care services as well as long-term care in the home. This isdependent on effective discharge planning to a greater degree than continuing education, communicationwith insurers, or promotion of health literacy.9.You are admitting a patient to your medical unit after the patient has been transferred from theemergency department. What is your priority nursing action at this time?A)Identifying the immediate needs of the patientB)Checking the admitting physicians ordersC)Obtaining a baseline set of vital signsD)Allowing the family to be with the patientAns:AFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)6

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Among the nurses important functions in health care delivery, identifying the patients immediate needsand working in concert with the patient to address them is most important. The other nursing functionsare important, but they are not the most important functions.10.A nurse on a postsurgical unit is providing care based on a clinical pathway. When performingassessments and interventions with the aid of a pathway, the nurse should prioritize what goal?A)Helping the patient to achieve specific outcomesB)Balancing risks and benefits of interventionsC)Documenting the patients response to therapyD)Staying accountable to the interdisciplinary teamAns:AFeedback:Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes.Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patientachieve outcomes is paramount.11.Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses ofanalgesia when noise levels on the unit were consciously reduced. They informed an advanced practiceRN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalizedpatients. How does this demonstrate a role of the APRN?A)Involving patients in their care while hospitalizedB)Contributing to the scientific basis of nursing practiceC)Critiquing the quality of patient careD)Explaining medical studies to patients and RNsAns:BFeedback:Research is within the purview of the APRN. The activity described does not exemplify explainingstudies to RNs, critiquing care, or involving patients in their care.12.Nurses now have the option to practice in a variety of settings and one of the fastest growing venues ofpractice for the nurse in todays health care environment is home health care. What is the main basis forTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)7

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the growth in this health care setting?A)Chronic nursing shortageB)Western focus on treatment of diseaseC)Nurses preferences for day shifts instead of evening or night shiftsD)Discharge of patients who are more critically illAns:DFeedback:With shorter hospital stays and increased use of outpatient health care services, more nursing care isprovided in the home and community setting. The other answers are incorrect because they are not thebasis for the growth in nursing care delivered in the home setting.13.Nurses have different educational backgrounds and function under many titles in their practice setting. Ifa nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care byinfluencing the patient, the nurse, and the health care system, what would most accurately describe thisnurses title?A)Nursing care expertB)Clinical nurse specialistC)Nurse managerD)Staff nurseAns:BFeedback:Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care(e.g., cardiovascular, oncology). They define their roles as having five major components: clinicalpractice, education, management, consultation, and research. The other answers are incorrect becausethey are not the most accurate titles for this nurse.14.Nursing continues to recognize and participate in collaboration with other health care disciplines to meetthe complex needs of the patient. Which of the following is the best example of a collaborative practicemodel?A)The nurse and the physician jointly making clinical decisions.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)8

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B)The nurse accompanying the physician on rounds.C)The nurse making a referral on behalf of the patient.D)The nurse attending an appointment with the patient.Ans:AFeedback:The collaborative model, or a variation of it, promotes shared participation, responsibility, andaccountability in a health care environment that is striving to meet the complex health care needs of thepublic. The other answers are incorrect because they are not examples of a collaborative practice model.15.A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy ofneeds, what dimension of care should the nurse consider primary in importance when caring for a dyingpatient?A)SpiritualB)SocialC)PhysiologicD)EmotionalAns:CFeedback:Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging andaffection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to knowand understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be appliedto the various nursing models for assessment of a patients strengths, limitations, and need for nursinginterventions. The other answers are incorrect because they are not of primary importance when caringfor a dying patient, though each should certainly be addressed.16.A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Withinthis framework of understanding, what would be the nurses first priority?A)Allowing the family to see a newly admitted patientB)Ambulating the patient in the hallwayC)Administering pain medicationTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)9

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D)Teaching the patient to self-administer insulin safelyAns:CFeedback:In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, suchas ambulation, is a higher level need above the physiologic need. Allowing the patient to see familyaddresses a higher level need related to love and belonging. Teaching the patient is also a higher levelneed related to the desire to know and understand and is not appropriate at this time, as the basicphysiologic need of pain control must be addressed before the patient can address these higher levelneeds.17.A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurseprovides care. This nurses compliance with the nurse practice act demonstrates adherence to which ofthe following?A)National Council of Nursings guidelines for careB)National League for Nursings Code of ConductC)American Nurses Associations Social Policy StatementD)Department of Health and Human Services White Paper on NursingAns:CFeedback:Nurses have a responsibility to carry out their role as described in the Social Policy Statement to complywith the nurse practice act of the state in which they practice and to comply with the Code of Ethics forNurses as spelled out by the ANA (2001) and the International Council of Nurses (International Councilof Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not includedin the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLNpublished a specific code of conduct.18.Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and thechanging health needs of our aging population. What is one factor that has impacted the need forcertified nurse practitioners (CNPs)?A)The increased need for primary care providersB)The need to improve patient diagnostic servicesC)The push to drive institutional excellenceTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)10

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D)The need to decrease the number of medical errorsAns:AFeedback:CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receiveadditional focused training in primary care or acute care. CNPs help meet the need for primary careproviders. Diagnostic services, institutional excellence, and reduction of medical errors are congruentwith the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.19.A nurse is providing care for a patient who is postoperative day one following a bowel resection for thetreatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of qualityimprovement?A)By liaising with the members of the interdisciplinary care teamB)By critically appraising the outcomes of care that is providedC)By integrating the patients preferences into the plan of careD)By documenting care in the electronic health record in a timely fashionAns:BFeedback:Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the otherlisted activities is a component of quality nursing care, but none clearly exemplifies quality improvementactivities.20.Professional nursing expands and grows because of factors driven by the changing needs of health careconsumers. Which of the following is a factor that nurses should reflect in the planning and provision ofhealth care?A)Decreased access to health care information by individualsB)Gradual increases in the cultural unity of the American populationC)Increasing mean and median age of the American populationD)Decreasing consumer expectations related to health care outcomesAns:CFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)11

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The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewerschool-age children and more senior citizens, many of whom are women.The population has become more culturally diverse as increasing numbers of people from differentnational backgrounds enter the country. Access to information and consumer expectations continue toincrease.21.A public health nurse has been commissioned to draft a health promotion program that meets the healthcare needs and expectations of the community. Which of the following focuses is most likely toinfluence the nurses choice of interventions?A)Management of chronic conditions and disabilityB)Increasing need for self-care among a younger populationC)A shifting focus to disease managementD)An increasing focus on acute conditions and rehabilitationAns:AFeedback:In response to current priorities, health care must focus more on management of chronic conditions anddisability than in previous times. The other answers are incorrect because the change in focus of healthcare is not an increasing need for self-care among our aging population; our focus is shifting away fromdisease management, not toward it; and we are moving away from the management of acute conditionsto managing chronic conditions.22.A community health nurse has witnessed significant shifts in patterns of disease over the course of afour-decade career. Which of the following focuses most clearly demonstrates the changing pattern ofdisease in the United States?A)Type 1 diabetes managementB)Treatment of community-acquired pneumoniaC)Rehabilitation from traumatic brain injuriesD)Management of acuteStaphylococcus aureusinfectionsAns:AFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)12

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Management of chronic diseases such as diabetes is a priority focus of the current health careenvironment. This supersedes the treatment of acute infections and rehabilitation needs.23.The ANA has identified several phenomena toward which the focus of nursing care should be directed,and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstratesthese priorities?A)Encouraging the patients dependence on caregiversB)Fostering the patients ability to make choicesC)Teaching the patient about nurses roles in the health care systemD)Assessing the patients adherence to treatmentAns:BFeedback:The ANA identifies several focuses for nursing care and research, including the ability to make choices.The other answers are incorrect because they are not phenomena identified by the ANA.24.The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels ofhealth care. Which of the following activities are considered integral to the CNP role? Select all thatapply.A)Educating patients and family membersB)Coordinating care with other disciplinesC)Using direct provision of interventionsD)Educating registered nurses and practical nursesE)Coordinating payment plans for patientsAns:A, B, CFeedback:This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and inhome care and community nursing. Nurses help patients meet their needs by using direct intervention,by teaching patients and family members to perform care, and by coordinating and collaborating withother disciplines to provide needed services. The other answers are incorrect because NPs do notcommonly perform education of nurses and they do not focus on matters related to payment.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)13

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25.The ANA has identified central characteristics of nursing practice that are applicable across the widevariety of contexts in which nurses practice. A nurse can best demonstrate these principles byperforming which of the following actions?A)Teaching the public about the role of nursingB)Taking action to control the costs of health careC)Ensuring that all of his or her actions exemplify caringD)Making sure to carry adequate liability insuranceAns:CFeedback:The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANAdoes not identify teaching the public about nursing, controlling costs, or maintaining insurance as acentral tenet of nursing practice.26.A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launchedwithin the past decade. In this role, the nurse should prioritize which of the following activities?A)Acting as a spokesperson for the nursing professionB)Generating and disseminating new nursing knowledgeC)Diagnosing and treating health problems that have a predictable courseD)Helping patients to navigate the health care systemAns:DFeedback:The CNL is a nurse generalist with a masters degree in nursing and a special background in clinicalleadership, educated to help patients navigate through the complex health care system. The otheranswers are incorrect because they are not what nursing has identified as the CNL role.27.Our world is connected by a sophisticated communication system that makes much health informationinstantly accessible, no matter where the patient is being treated. This instant access to healthinformation has impacted health care delivery strategies, including the delivery of nursing care. What isone way the delivery of health care has been impacted by this phenomenon?A)Brisk changes as well as swift obsolescenceTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)14

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B)Rapid change that is nearly permanentC)Limitations on the settings where care can be providedD)Increased need for social acceptanceAns:AFeedback:The sophisticated communication systems that connect most parts of the world, with the capability ofrapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swiftobsolescence in health care delivery strategies. The other answers are incorrect because, although wehave rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health careitself evolves. Giving nursing care has not become easier, it becomes more complex with every change;and it does not need to be more socially acceptable; it needs to be more culturally sensitive.28.With the changing population of health care consumers, it has become necessary for nurses to workmore closely with other nurses, as when acute care nurses collaborate with public health and homehealth nurses. What nursing function has increased in importance because of this phenomenon?A)Prescribing medicationB)Performing discharge planningC)Promoting family involvementD)Forming collegial relationshipsAns:BFeedback:The importance of effective discharge planning and quality improvement cannot be overstated. Theother answers are incorrect because giving medication and family involvement in the patients care havenot grown in importance. Making and maintaining collegial relationships has become a necessity inworking in the health care delivery system. Effective discharge planning aids in getting patients out ofthe inpatient setting sooner, cutting costs, and making rehabilitation in the community and home settingpossible.29.A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to helpthe nurse achieve what goal?A)Increasing career satisfactionB)Obtaining federal grant moneyTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)15

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C)Ensuring high quality patient careD)Enhancing the publics esteem for nursingAns:CFeedback:Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant moneyare not priorities.30.A case manager has been hired at a rural hospital that has a combined medical-surgical unit. Whendefining this new role, which of the following outcomes should be prioritized by the hospitalsleadership?A)Decreased need for physician servicesB)Improved patient and family educationC)Increased adherence to the principles of EBPD)Increased coordination of health servicesAns:DFeedback:Case management is a system of coordinating health care services to ensure cost-effectiveness,accountability, and quality care. The case manager coordinates the care of a caseload of patients throughfacilitating communication between nurses, other health care personnel who provide care, and insurancecompanies. Reducing the need for physician services is not a central goal. Education and EBP areconsistent with case management, but they are not central to this particular role.31.A hospitals current quality improvement program has integrated the principles of the Institute forHealthcare Improvement (IHI)5 Million Lives Campaign. How can the hospital best achieve thecampaign goals of reducing preventable harm and death?A)By adhering to EBP guidelinesB)By reducing nurse-to-patient ratios and increasing accountabilityC)By having researchers from outside the facility evaluate careD)By involving patients and families in their care planningTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)16

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Ans:AFeedback:The5 Million Lives Campaignposits that if evidence-based guidelines it advocated were voluntarilyimplemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a two-year period. Nurse-to-patient ratios, family participation, and independent evaluation are not statedcomponents of the campaign.32.Over the past several decades, nursing roles have changed and expanded in many ways. Which of thefollowing factors has provided the strongest impetus for this change?A)The need to decrease the cost of health careB)The need to improve the quality of nursing educationC)The need to increase the number of nursing jobs availableD)The need to increase the public perception of nursingAns:AFeedback:The role of the nurse has expanded to improve the distribution of health care services and to decrease thecost of health care. The other answers are incorrect because the expansion of roles in nursing did notoccur to improve education, increase the number of nursing jobs, or increase public perception.33.Advanced practice nursing roles have grown in number and in visibility in recent years. Whatcharacteristic sets these nurses apart from the registered nurse?A)Collaboration with other health care providersB)Education that goes beyond that of the RNC)Advanced documentation skillsD)Ability to provide care in the surgical contextAns:BFeedback:There is wide variety in APRN roles. However, a commonality is that they require education beyond thatof the professional RN. All nurses collaborate with other health care providers to provide nursing care toTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)17

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their patients. Advanced documentation skills are not what sets advanced practice nurses apart from thestaff nurse. RNs have the ability to provide care in the operating room.34.CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states,what right do CNPs have that RNs do not possess?A)Perform health interventions independentlyB)Make referrals to members of other health disciplinesC)Prescribe medicationsD)Perform surgery independentlyAns:CFeedback:In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope ofpractice and all professional nurses may perform interventions and make certain referrals.35.A team of community health nurses are planning to draft a proposal for a program that will increase thecommunitys alignment with the principles contained in theHealthy People 2020report. Which of thefollowing activities would best demonstrate the priorities identified in this report?A)Addressing determinants of health such as clean environments and safety in the communityB)Lobbying for increased funding to the county hospital where many residents receive primary careC)Collaborating with health professionals in neighboring communities to pool resources and increaseefficienciesD)Creating clinical placements where nursing students and members of other health disciplines cangain experience in a community settingAns:AFeedback:Healthy People 2020addresses social determinants of health such as safety and the state of theenvironment. This report does not specifically address matters such as hospital funding, nursingeducation, or resource allocation.36.A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, andself-care. Which of the following activities would best demonstrate the principles of health promotion?Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)18

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A)A discharge planning initiative between acute care and community care nursesB)Collaboration between several schools of nursing in an urban areaC)Creation of a smoking prevention program undertaken in a middle schoolD)Establishment of a website where patients can check emergency department wait-timesAns:CFeedback:Smoking prevention is a clear example of health promotion. Each of the other listed activities has thepotential to be beneficial, but none is considered health promotion.37.A group of nursing students are learning about recent changes in the pattern of disease in the UnitedStates. Which of the following statements best describes these current changes?A)Infectious diseases continue to decrease in incidence and prevalence.B)Chronic illnesses are becoming increasingly resistant to treatment.C)Most acute, infectious diseases have been eradicated.D)Most, but not all, communicable diseases are declining.Ans:DFeedback:Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibioticresistance is a more serious problem in acute, not chronic, illnesses.38.The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating alarge, university medical center according to core measures. Evaluators should perform this evaluationin what way?A)By auditing the medical centers electronic health recordsB)By performing focus groups and interviews with care providers from numerous disciplinesC)By performing statistical analysis of patient satisfaction surveysD)By comparing the centers patient outcomes to best practice indicatorsTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)19

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Ans:DFeedback:Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seektreatment for a specific disease or who need a specific treatment as compared to evidence-basedguidelines and standards of care. Benchmark standards of quality are used to compare the care ortreatment patients receive with the best practice standards. Patient satisfaction is considered, but this isnot the only criterion.39.Leadership of a medical unit have been instructed to integrate the principles of the Quality and SafetyEducation for Nurses (QSEN) competency of quality improvement. What action should the units leaderstake?A)Provide access to online journals and Web-based clinical resources for nursing staff.B)Use flow charts to document the processes of care that are used on the unit.C)Enforce continuing education requirements for all care providers.D)Reduce the use of chemical and physical restraints on the unit.Ans:BFeedback:One of the quality improvement skills is to use tools, such as flow charts and cause-effect diagrams, tomake processes of care explicit. Each of the other listed actions has the potential to benefit patients andcare givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency.40.The IOM ReportHealth Professions Education: A Bridge to Qualityissued a number of challenges tothe educational programs that teach nurses and members of other health professions. According to thisreport, what activity should educational institutions prioritize?A)More clearly delineate each professions scope of practice during educationB)Move toward developing a single health curriculum that can be adapted for any health professionC)Include interdisciplinary core competencies into curriculaD)Elicit input from patients and families into health care curriculaAns:CFeedback:Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)20

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Health Professions Education: A Bridge to Qualitychallenged health professions education programs tointegrate interdisciplinary core competencies into their respective curricula to include patient-centeredcare, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement,safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input,or a single curriculum.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)21

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Chapter 02: Community-Based Nursing Practice1.A community health nurse has scheduled a hypertension clinic in a local shopping mall in whichshoppers have the opportunity to have their blood pressure measured and learn about hypertension. Thisnursing activity would be an example of which type of prevention activity?A)Tertiary preventionB)Secondary preventionC)Primary preventionD)Disease preventionAns:BFeedback:Secondary prevention centers on health maintenance aim at early detection and prevention. Diseaseprevention is not a form of health care but is a focus on primary prevention.2.The nursing instructor is preparing a group of students for their home care rotation. In preparation, thegroup discusses the patients that they are most likely to care for in the home. Which of the followinggroups are the most common recipients of home care services?A)Mentally ill patientsB)Patients receiving rehabilitation after surgeryC)Terminally ill and palliative patientsD)Elderly patientsAns:DFeedback:The elderly are the most frequent users of home care services. The patient must be acutely ill, homebound, and in need of skilled nursing services to be eligible for this service. The other answers areincorrect because it is the elderly who are seen most frequently in the home health setting, though eachof the other listed groups may sometimes receive home care.3.A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles intheir homes and the nurses own practices and beliefs. To work therapeutically with the patient, whatTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)22

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must the nurse do?A)Request another assignment if there is dissonance with the patients lifestyle.B)Ask the patient to come to the agency to receive treatment, if possible.C)Resolve to convey respect for the patients beliefs and choices.D)Try to adapt the patients home to the norms of a hospital environment.Ans:CFeedback:To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respectfor patients beliefs, even if they differ sharply from the nurses. This can be difficult when a patientslifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use ofalcohol, drug abuse, or overeating. The nurse should not request another assignment because of adifference in beliefs, nor do nurses ask for the patient to come to you at the agency to receive treatment.It is also inappropriate to convert the patients home to a hospital-like environment.4.Infection control is a high priority in every setting where nursing care is provided. When performing ahome visit, how should the nurse best implement the principles of infection control?A)Perform hand hygiene before and after giving direct patient care.B)Remove the patients wound dressings from the home promptly.C)Disinfect the patients syringes prior to disposal.D)Establish a sterile field in the patients home before providing care.Ans:AFeedback:Infection control is as important in the home as it is in the hospital, but it can be more challenging in thehome and requires creative approaches. As in any situation, it is important to clean ones hands beforeand after giving direct patient care, even in a home that does not have running water. Removing thewound dressings from the home and disinfecting all work areas in the home are not the bestimplementations of infection control in the home. Used syringes are never disinfected and a sterile fieldis not always necessary.5.An adult patient is ready to be discharged from the hospital after undergoing a transmetatarsalamputation. When should your patients discharge planning begin?Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)23

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A)The day prior to dischargeB)The day of estimated dischargeC)The day that the patient is admittedD)Once the nursing care plan has been finalizedAns:CFeedback:Discharge planning begins with the patients admission to the hospital and must consider the possibleneed for follow-up home care. Discharge planning should begin prior to the other listed times.6.A home health nurse is preparing to make the initial visit to a new patients home. When planningeducational interventions, what information should the nurse provide to the patient and his or herfamily?A)Available community resources to meet their needsB)Information on other patients in the area with similar health care needsC)The nurses contact information and credentialsD)Dates and times of all scheduled home care visitsAns:AFeedback:The community-based nurse is responsible for informing the patient and family about the communityresources available to meet their needs. During initial and subsequent home visits, the nurse helps thepatient and family identify these community services and encourages them to contact the appropriateagencies. When appropriate, nurses may make the initial contact. The other answers are incorrectbecause it is inappropriate to ever provide information on other patients to a patient. The nursescredentials are not normally discussed. Giving the patient the dates and times of their scheduled homevisits is appropriate, but may not always be possible. It is more important to provide them with resourcesavailable within the community to meet their needs.7.The home health nurse receives a referral from the hospital for a patient who needs a home visit forwound care. After obtaining the referral, what would be the first action the nurse should take?A)Have community services make contact with the patient.B)Obtain a physicians order for the visit.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)24

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C)Call the patient to obtain permission to visit.D)Arrange for a home health aide to initially visit the patient.Ans:CFeedback:After receiving a referral, the first step is to call the patient and obtain permission to make the visit. Thenthe nurse should schedule the visit and verify the address. A physicians order is not necessary toschedule a visit with the patient. The nurse may identify community services or the need for a homehealth aide after assessing the patient and the home environment during the first visit with the patient.This would not be delegated to a home health aide.8.At the beginning of a day that will involve several home visits, the nurse has ensured that the health careagency has a copy of her daily schedule. What is the rationale for the nurses action?A)It allows the agency to keep track for payment to the nurse.B)It supports safety precautions for the nurse when making a home care visit.C)It allows for greater flexibility for the nurse and his or her colleagues for changes in assignments.D)It allows the patient to cancel appointments with minimal inconvenience.Ans:BFeedback:Whenever a nurse makes a home visit, the agency should know the nurses schedule and the locations ofthe visits. The other answers are incorrect because providing the agency with a copy of the dailyschedule is not for the purpose of correctly paying the nurse or for the ease of the nurse in changingassignments. It is also not intended for the patients ease in canceling appointments.9.There are specific legal guidelines and regulations for the documentation related to home care. Whenproviding care for a patient who is a Medicaid recipient, what is most important for the nurse todocument?A)The medical diagnosis and the supplies needed to care for the patientB)A summary of the patients income tax paid during the previous yearC)The specific quality of nursing care that is neededTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)25

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D)The patients homebound status and the specific need for skilled nursing careAns:DFeedback:Medicare, Medicaid, and third-party payers require documentation of the patients homebound status andthe need for skilled professional nursing care. The medical diagnosis and specific detailed informationon the functional limitations of the patient are usually part of the documentation. The other answers areincorrect because nursing documentation does not include needed supplies, tax information, or thequality of care needed.10.Your patient has had a total knee replacement and will need to walk with a two-wheeled walker for 6weeks. He is being discharged home with a referral for home health care. What will the home care nurseneed to assess during the initial nursing assessment in the home?A)Assistance of neighborsB)Qualification for Medicare and MedicaidC)Costs related to the visitsD)Characteristics of the home environmentAns:DFeedback:The initial assessment includes evaluating the patient, the home environment, the patients self-careabilities or the familys ability to provide care, and the patients need for additional resources. Normallyan assessment is not made of assistance on the part of neighbors or the costs of the visit. Medicare andMedicaid qualifications would normally be determined beforehand.11.A nurse who has an advanced degree in primary care for a pediatric population is employed in a healthclinic. In what role is this nurse functioning?A)Nurse practitionerB)Case coordinatorC)Clinical nurse specialistD)Clinic supervisorAns:ATest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)26

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Feedback:Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus ongerontology, pediatrics, family or adult health, or womens health. Case coordinators and clinicalsupervisors do not necessarily require an advanced degree, and a clinical nurse specialist is not educatedin primary care. Primary care is the specific focus of CNPs.12.A nurse is based in an automotive assembly plant and works with the plants employees in the areas ofhealth promotion and basic primary care. What nursing role is this nurse performing?A)Occupational health nurseB)Community nurse specialistC)Nurse clinicianD)Public health nurseAns:AFeedback:Occupational health nurses may provide direct care to patients who are ill, conduct health educationprograms for the industry staff, or set up health programs. The other answers are incorrect because theyare not consistent with a nurses placement in a manufacturing setting.13.A school nurse has been working closely with a student who has cystic fibrosis. The nurse is aware thatchildren with health problems are at major risk for what problem?A)Mental health disordersB)Gradual reduction in intelligenceC)Psychological stress due to a desire to overachieveD)Underachievement in schoolAns:DFeedback:School-aged children and adolescents with health problems are at major risk for underachieving orfailing in school. These students do not necessarily have a high risk of mental health disorders or adesire to overachieve. Health problems do not normally cause a progressive decline in intelligence.Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)27

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14.A community health nurse is aware that restoration of health often depends on appropriate interventionsperformed early in the course of a disease. Which patient is most likely to seek health care late in thecourse of his or her disease process and deteriorate more quickly than other patients?A)A patient who has been homeless for an extended period of timeB)A patient who recently immigrated to the United StatesC)A patient who is 88 years old and who has enjoyed relatively good healthD)A teenage boyAns:AFeedback:Because of numerous barriers, the homeless seek health care late in the course of a disease anddeteriorate more quickly than patients who are not homeless. Many of their health problems are relatedin large part to their living situation. The other answers are incorrect because these populations do not asoften seek care late in the course of their disease process and deteriorate quicker than other populations.15.A recent nursing school graduate has chosen to pursue a community nursing position because ofincreasing opportunities for nurses in community settings. What changes in the health care system havecreated an increased need for nurses to practice in community-based settings? Select all that apply.A)Tighter insurance regulationsB)Younger populationC)Increased rural populationD)Changes in federal legislationE)Decreasing hospital revenuesAns:A, D, EFeedback:Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, andalternative health care delivery systems have also affected the ways in which health care is delivered.Our country does not have an increased rural population nor is our population younger.16.A nursing student has taught a colleague that nursing practice is not limited to hospital settings,explaining that nurses are now working in ambulatory health clinics, hospice settings, and homelessshelters and clinics. What factor has most influenced this increased diversity in practice settings forTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)28

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nurses?A)Population shift to more rural areasB)Shift of health care delivery into the communityC)Advent of primary care clinicsD)Increased use of rehabilitation hospitalsAns:BFeedback:As health care delivery shifts into the community, more nurses are working in a variety of community-based settings. These settings include public health departments, ambulatory health clinics, long-termcare facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics,nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stayfacilities, and patients homes. The other answers are incorrect because our population has not shifted to amore rural base, and the use of primary care clinics has not influenced an increase in practice settings orthe use of rehabilitation hospitals.17.A nurse is collaborating with a team of community nurses to identify the vision and mission forcommunity care. What is the central focus of community-based nursing?A)Increased health literacy in the communityB)Distributing ownership for the health of the communityC)Promoting and maintaining the health of individuals and familiesD)Identifying links between lifestyle and healthAns:CFeedback:Community-based nursing practice focuses centrally on promoting and maintaining the health ofindividuals and families, preventing and minimizing the progression of disease, and improving quality oflife. Health literacy is not a goal in itself, but rather a means to promoting health. Distributing ownershipand identifying links between lifestyle and health are not the essence of community-based care.18.You are the community-based nurse who performs the role of case manager for a small town about 60miles from a major health care center. When planning care in your community, what is the mostimportant variable in community-based nursing that you should integrate into your planning?Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)29

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A)Eligibility requirements for servicesB)Community resources available to patientsC)Transportation costs to the medical centerD)Possible charges for any services providedAns:BFeedback:A community-based nurse must be knowledgeable about community resources available to patients aswell as services provided by local agencies, eligibility requirements, and any possible charges for theservices. The other answers are incorrect because they are not the most important factors about which acommunity-based nurse must be knowledgeable.19.An urban, community-based nurse is looking for community resources for a patient who has complexrehabilitation needs coupled with several comorbid, chronic health conditions. Where is the best placefor the nurse to search for appropriate resources?A)A hospital directoryB)The hospital intranetC)A community directoryD)The nurses own personal networkAns:CFeedback:Most communities have directories of health and social service agencies that the nurse can consult. Theother answers are incorrect because hospital directories and intranets usually only include peopleaffiliated with the hospital. The nurses personal network of contacts may or may not be of use.20.You are a community-based care manager in a medium-sized community that does not have an up-to-date resource directory available. As a result, you have been given the task of beginning to compile sucha directory. What would be important to include in this directory? Select all that apply.A)Links to online health sciences journalsB)Lists of social service workers in the communityTest Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)30

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