Test Bank for Fundamentals of Nursing, 11th edition (Chapters 1-24)

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Test Bank For Fundamentals of Nursing 11th Edition Potter PerryAll chapters - Verified Answers

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MULTIPLECHOICE1.Whichnursemostlikelykeptrecordsonsanitationtechniquesandthe effectsonhealth?a.FlorenceNightingaleb.MaryNuttingc.ClaraBartond.LillianWaldANS:ANightingale was the first practicing nurse epidemiologist. Her statistical analyses connectedpoor sanitation with cholera and dysentery. Mary Nutting, Clara Barton, and Lillian Waldcame after Nightingale, each contributing to the nursing profession in her own way. MaryNutting was instrumental in moving nursing education into universities. Clara Barton foundedtheAmerican RedCross.Lillian Waldhelped open theHenryStreet Settlement.DIF:Understand(comprehension)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:EvaluationMSC:HealthPromotionandMaintenance2.The nurse prescribes strategies and alternatives to attain expected outcome. Which standard ofnursingpracticeis thenursefollowing?a.Assessmentb.Diagnosisc.Planningd.ImplementationANS:CIn planning, the registered nurse develops a plan that prescribes strategies and alternatives toattainexpectedoutcomes.Duringassessment,theregisterednursecollectscomprehensivedata pertinent to the patient’s health and/or the situation. In diagnosis, the registered nurseanalyzes the assessment data to determine the diagnoses or issues. During implementation, theregisterednurseimplements (carries out) theidentifiedplan.DIF:Understand(comprehension)OBJ:Discussthedevelopment ofprofessionalnursingroles.TOP:PlanningMSC:Managementof Care3.An experienced medical-surgical nurse chooses to work in obstetrics. Which level ofproficiencyis thenurseupon initial transition to theobstetrical floor?a.Noviceb.Proficientc.Competentd.AdvancedbeginnerANS:A

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A beginning nursing student or any nurse entering a situation in which there is no previouslevel of experience (e.g., an experienced operating room nurse chooses to now practice inhome health) is an example of a novice nurse. A proficient nurse perceives a patient’s clinicalsituation as a whole, is able to assess an entire situation, and can readily transfer knowledgegained from multiple previous experiences to a situation. A competent nurse understands theorganization and specific care required by the type of patients (e.g., surgical, oncology, ororthopedic patients). This nurse is a competent practitioner who is able to anticipate nursingcare and establish long-range goals. A nurse who has had some level of experience with thesituation is an advanced beginner. This experience may only be observational in nature, butthenurseis able to identifymeaningful aspects orprinciples ofnursingcare.DIF:Apply(application)OBJ:Discussthedevelopment ofprofessionalnursingroles.TOP:EvaluationMSC:Managementof Care4.A nurse assesses a patient’s fluid status and decides that the patient needs to drink more fluids.The nurse then encourages the patient to drink more fluids. Which conceptis the nursedemonstrating?a.Licensureb.Autonomyc.Certificationd.AccountabilityANS:BAutonomy is an essential element of professional nursing that involves the initiation ofindependent nursing interventions without medical orders. To obtain licensure in the UnitedStates, the RN candidate must pass the NCLEX-RN. Beyond the NCLEX-RN, thenursemay choose to work toward certification in a specific area of nursing practice. Accountabilitymeans that you are responsible, professionally and legally, for the type and quality of nursingcareprovided.DIF:Apply(application)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:ImplementationMSC:Managementof Care5.A nurse prepares the budget and policies for an intensive care unit. Which role is the nurseimplementing?a.Educatorb.Managerc.Advocated.CaregiverANS:B

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Amanagercoordinatestheactivitiesof membersof thenursingstaffindeliveringnursingcare and has personnel, policy, and budgetary responsibility for a specific nursing unit orfacility. As an educator, you explain concepts and facts about health, describe the reason forroutine care activities, demonstrate procedures such as self-care activities, reinforce learningor patient behavior, and evaluate the patient’s progress in learning. As a patient advocate, youprotect your patient’s human and legal rights and provide assistance in asserting these rights ifthe need arises. As a caregiver,you help patients maintain and regain health, manage diseaseand symptoms, and attain a maximal level function and independence through the healingprocess.DIF:Apply(application)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:ImplementationMSC:Managementof Care6.The nurse has been working in the clinical setting for several years as an advanced practicenurse. However, the nurse has a strong desire to pursue research and theory development. Tofulfillthis desire, which program should thenurseattend?a.DoctorofNursingSciencedegree (DNSc)b.DoctorofPhilosophydegree(PhD)c.DoctorofNursingPracticedegree (DNP)d.DoctorintheScienceofNursingdegree(DSN)ANS:BSome doctoral programs prepare nurses for more rigorous research and theory developmentand award the research-oriented Doctor of Philosophy (PhD) in nursing. Professional doctoralprograms in nursing (DSN or DNSc) prepare graduates to apply research findings to clinicalnursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nursepractitioners.DIF:Understand(comprehension)OBJ:Compare and contrastthe educational programs available for professional registered nurse (RN)education.TOP:Teaching/LearningMSC:Managementof Care7.A nurse attends a workshop on current nursing issues provided by the American NursesAssociation.Which typeofeducation did thenursereceive?a.Graduateeducationb.Inserviceeducationc.Continuingeducationd.RegisterednurseeducationANS:CContinuing educationinvolvesformal,organizededucationalprogramsofferedbyuniversities, hospitals, state nurses associations, professional nursing organizations, andeducational and health care institutions. After obtaining a baccalaureate degree in nursing, youcanpursue graduate education leading to a master’s or doctoral degree in any number ofgraduate fields, including nursing. Inservice education programs are instruction or trainingprovided by a health care facility or institution. Registered nurse education is the educationpreparationfor an individual intendingto bean RN.DIF:Apply(application)OBJ:Compareandcontrasttheeducationalprogramsavailableforprofessionalregisterednurse(RN)

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education.TOP:Teaching/LearningMSC:Management of Care8.A nurse identifies gaps between local and best practices. Which Quality and Safety EducationforNurses(QSEN) competencyis thenursedemonstrating?a.Safetyb.Patient-centeredcarec.Qualityimprovementd.Teamwork andcollaborationANS:CQuality improvement identifies gaps between local and best practices. Safety minimizes riskof harm to patients and providers through both system effectiveness and individualperformance. Patient-centered care recognizes the patient or designee as the source of controland full partner in providing compassionate and coordinated care based on respect forpatient’s preferences, values, and needs. Teamwork and collaboration allows effectivefunctioning within nursing and interprofessional teams, fostering open communication,mutualrespect, and shared decision making.DIF:Understand(comprehension)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:EvaluationMSC:Managementof Care9.Anursehascompassionfatigue.Whatisthenurseexperiencing?a.Lateralviolenceandintrapersonal conflictb.Burnoutand secondarytraumatic stressc.Short-termgriefandsinglestressord.PhysicalandmentalexhaustionANS:BCompassion fatigue is a term used to describe a state of burnout and secondary traumaticstress.Compassion fatiguemaycontributetowhat is described as lateralviolence(nurse-nurse interactions, not intrapersonal). Frequent, intense, or prolonged exposure to griefand loss places nurses at risk for developing compassion fatigue. Stressors, not a singlestressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnoutonly.DIF:Understand(comprehension)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:AssessmentMSC:HealthPromotionandMaintenance10.A patient is scheduled for surgery. When getting ready to obtain the informed consent, thepatient tellsthe nurse,―Ihaveno ideawhat isgoingto happen.Icouldn’taskanyquestions.‖The nurse does not allow the patient to sign the permit and notifies the health care provider ofthesituation. Which role is thenursedisplaying?a.Managerb.Patienteducatorc.Patientadvocated.ClinicalnursespecialistANS:C

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As a patient advocate, the nurse protects the patient’s human and legal rights, including theright of the patient to understand procedures before signing permits. Although nurses can beeducators, it is the responsibility of the surgeon to provide education for the patient inpreparation for surgery, and it is the nurse’s responsibility to notify the health care provider ifthe patient is not properly educated. Managers coordinate the activities of members of thenursing staff in delivering nursing care, and clinical nurse specialists are experts in aspecialized areaof nursingpracticeinavarietyofsettings.DIF:Apply(application)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:EvaluationMSC:Managementof Care11.The patient requires routine gynecological services after giving birth to her son, and whileseeing the nurse-midwife, the patient asks for a referral to a pediatrician for the newborn.Whichaction should the nurse-midwifetakeinitially?a.Providethereferralasrequested.b.Offerto providethenewborncare.c.Referthepatientto thesupervisingprovider.d.Tellthepatientthatisnotallowedtomakereferrals.ANS:BThe practice of nurse-midwifery involves providing independent care for women duringnormal pregnancy, labor, and delivery, as well as care for the newborn. After being apprisedof the midwifery role, if the patient insists on seeing a pediatrician, the nurse-midwife shouldprovide the referral. The supervising provider is an obstetric provider, not a pediatrician. Anurse-midwifecan makereferrals.DIF:Analyze(analysis)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:ImplementationMSC:Managementof Care12.The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Whichactivityis appropriate foraCRNA?a.ManagesgynecologicalservicessuchasPAPsmears.b.Worksundertheguidanceofananesthesiologist.c.ObtainsaPhDdegreein anesthesiology.d.Coordinatesacutemedicalconditions.ANS:BNurse anesthetists provide surgical anesthesia under the guidance and supervision of ananesthesiologist, who is a physician (health care provider) with advanced knowledge ofsurgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronicstable medical conditions; certified nurse-midwives provide gynecological services such asroutine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in anurseanesthesiaaccredited program. A PhD is nota requirement.DIF:Understand(comprehension)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:ImplementationMSC:Managementof Care

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13.Anurseteaches a groupofnursingstudentsaboutnursepracticeacts.Which informationismostimportantto includein theteachingsessionaboutnursepractice acts?a.Protectsthenurse.b.Protectsthepublic.c.Protectstheprovider.d.Protectsthehospital.ANS:BThe nurse practice acts regulate the scope of nursing practice and protect public health,safety,andwelfare. Theydo not protect thenurse, provider, orhospital.DIF:Understand(comprehension)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:Teaching/LearningMSC:Management ofCare14.A bill has been submitted to the State House of Representatives that is designed to reduce thecost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensivecareunits to 3:1. What should thenurserealize?a.Legislationispoliticsbeyondthenurse’scontrol.b.Nationalprogramshave nobearingonstatepolitics.c.Theindividualnursecaninfluencelegislativedecisions.d.Focusingonnursingcareprovidesthe bestpatientbenefit.ANS:CNurses can influence policy decisions at all governmental levels. One way is to get involvedby participating in local and nationalefforts. This effort is critical in exerting nurses’influence early in the political process. Legislation is not beyond the nurse’s control. Nationalprogram can have bearing on state politics. The question is focusing on legislation and healthcarecosts, not nursing care.DIF:Analyze(analysis)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:EvaluationMSC:Management of Care15.A nurse is using a guide that provides principles of right and wrong to provide care topatients.Which guide is thenurseusing?a.Codeofethicsb.Standardsofpracticec.Standardsofprofessional performanced.Qualityand safetyeducation fornursesANS:AThecode of ethics is the philosophical ideals of right and wrong that define the principles youwill use to provide care to your patients. The standards of practice describe a competent levelof nursing care. The ANA Standards of Professional Performance describe a competent levelof behavior in the professional role. Quality and safety education for nurses addresses thechallenge to prepare nurses with the competencies needed to continuously improve the qualityofcarein their workenvironments.DIF:Understand(comprehension)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:ImplementationMSC:Management ofCare

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16.A graduate of a baccalaureate degree program plans to start working as a registered nurse(RN)in theemergencydepartment. Which actionmust thenursetakefirst?a.Obtaincertificationforanemergencynurse.b.PasstheNationalCouncil LicensureExamination.c.Takea courseongenomicstoprovidecompetentemergencycare.d.CompletetheHospitalConsumerAssessmentof HealthcareProvidersSystems.ANS:BCurrently, in the United States, the most common way to become a registered nurse (RN) isthrough completion of an associate degree or baccalaureate degree program. Graduates ofbothprogramsareeligibletotaketheNationalCouncilLicensureExaminationforRegisteredNurses(NCLEX-RN)tobecome registerednursesin thestatein whichtheywill practice.Certification can be obtained after passing the NCLEX and working for the specified amountof time. Genomics is a newer term that describes the study of all the genes in a person andinteractions of these genes with one anotherand with that person’s environment. Consumerscan also access Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS)toobtain information about patients’perspectiveson hospital care.DIF:Remember(knowledge)OBJ:Compare and contrast the educational programs available for professional registered nurse (RN)education.TOP:ImplementationMSC:Managementof Care17.While providing care to a patient, the nurse is responsible, both professionally and legally, fortheappropriatenessandproper executionofthe care.Whichconceptdoesthis describe?a.Autonomyb.Accountabilityc.Patientadvocacyd.PatienteducationANS:BAccountability means that the nurse is responsible, professionally and legally, for the type andquality of nursing care provided. Autonomy is an essential element of professional nursingthat involves the initiation of independent nursing interventions without medical orders. As apatient advocate, the nurse protects the patient’s human and legal rights and providesassistance in asserting these rights if the need arises. As an educator, the nurse explainsconcepts and facts about health, describes the reasons for routine care activities, demonstratesprocedures such as self-care activities, reinforces learning or patient behavior, and evaluatesthepatient’s progressin learning.DIF:Remember(knowledge)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:EvaluationMSC:Management of Care18.Anurseisteachingthestaffabout Benner’slevelsofproficiency. Inwhichordershouldthenurseplacethe levels from beginninglevel to endinglevel?1.Expert2.Novice3.Proficient4.Competent5.Advancedbeginner

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a.2, 4, 5, 1, 3b.2, 5, 4, 3, 1c.4, 2, 5, 3, 1d.4, 5, 2, 1, 3ANS:BBenner’s levels of proficiency are as follows: novice, advanced beginner, competent,proficient,andexpert.DIF:Understand(comprehension)OBJ:Discussthedevelopment ofprofessionalnursingroles.TOP:Teaching/LearningMSC:Managementof CareMULTIPLERESPONSE1.A nurse is preparing a teaching session about contemporary influences on nursing. Whichexamplesshould the nurseinclude?(Select all thatapply.)a.Humanrightsb.AffordableCareActc.Demographicchangesd.Medicallyunderservede.Decreasinghealth carecostsANS:A,B,C, DMultiple external forces affect nursing, including the need for nurses’ self-care, AffordableCare Act (ACA) and rising (not decreasing) health care costs, demographic changes of thepopulation,human rights, and increasingnumbersof medicallyunderserved.DIF:Understand(comprehension)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:Teaching/LearningMSC:Management ofCare2.After licensure, the nurse wants to stay current in knowledge and skills. Which programs arethemostcommon waysnursescan do this?(Selectallthat apply.)a.Master’sdegreeb.Inserviceeducationc.Doctoralpreparationd.Continuingeducatione.NationalCouncilLicensureExaminationretakesANS:B,DContinuing education programs help nurses maintain current nursing skills, gain newknowledge and theory, and obtain new skills reflecting the changes in the health care deliverysystem. Inservice education programs are provided by a health care facility to increase theknowledge, skills, and competencies of nurses employed by the institution. Both can help thenurse stay current. Master’s degree programs are valuable for those in the role of nurseeducator, nurse administrator, or advanced practice nurse. Professional doctoral programs innursing(DSN orDNSc)prepare graduates toapplyresearch findingsto clinicalnursing.National Council Licensure Examination retakes are not to keep current; this test is taken toenterRN practice.

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DIF:Understand(comprehension)OBJ:Compare and contrast the educational programs available for professional registered nurse (RN)education.TOP:Teaching/LearningMSC:Managementof Care3.A nurse wants to become an advanced practice registered nurse. Which options should thenurseconsider?(Select all that apply.)a.Patientadvocateb.Nurseadministratorc.Certifiednurse-midwifed.Clinicalnursespecialiste.CertifiednursepractitionerANS:C,D,EAlthoughall nursesshould functionaspatientadvocates,―advanced practicenurse‖isanumbrellatermforanadvancedclinicalnursesuch asacertifiednursepractitioner,clinicalnurse specialist, certified registered nurse anesthetist, or certified nurse-midwife. A nurseadministratoris not an exampleof advanced practice.DIF:Understand(comprehension)OBJ:Discusstherolesandcareer opportunitiesfornurses.TOP:Teaching/LearningMSC:Managementof Care4.The nurse manager from the oncology unit has had two callouts; the orthopedic unit has hadmultiple discharges and probably will have to cancel one or two of its nurses. The orthopedicunit hasagreed to―float‖two ofitsnursestotheoncologyunit if oncologycan―float‖anursing assistant to the orthopedic unit to help with obtaining vitalsigns. Which concepts doesthissituation entail?(Select all that apply.)a.Autonomyb.Informaticsc.Accountabilityd.Politicalactivisme.Teamwork andcollaborationANS:A,C,EStaffing is an independent nursing intervention and is an example of autonomy. Along withincreased autonomy comes accountability or responsibility for outcomes of an action. Whennurses work together, this is teamwork and collaboration. Informatics is theuse of informationand technology to communicate, manage knowledge, mitigate error, and support decisionmaking. Political activism usually involves more than day-to-day activities such as unitstaffing.DIF:Analyze(analysis)OBJ:Discusstheinfluenceofsocial,historical,political,andeconomicchangesonnursingpractices.TOP:EvaluationMSC:Management of CareChapter 02: Health Care Delivery SystemPotter:FundamentalsofNursing,11thEditionMULTIPLECHOICE

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1.The nurse is caring for a patient whose insurance coverage is Medicare. The nurse shouldconsiderwhich information when planningcareforthis patient?a.Capitationprovidesthehospitalwithameansofrecoveringvariable charges.b.Thehospitalwill bepaid forthefull costof thepatient’shospitalization.c.Diagnosis-related groups (DRGs)provideafixedreimbursementofcost.d.Medicarewillpaythenationalaverageforthepatient’scondition.ANS:CIn 1983, Congress established the prospective payment system (PPS), which grouped inpatienthospital services for Medicare patients into diagnosis-related groups (DRGs), each of whichprovides a fixed reimbursement amount basedon assigned DRG, regardless of a patient’slength of stay or use of services. Capitation means that providers receive a fixed amount perpatient or enrollee of a health care plan. DRG reimbursement is based on case severity,rural/urban/regionalcosts, andteachingcosts,notnational averages.DIF:Understand(comprehension)OBJ:Explaintheconceptof―payforvalue,‖usedtorewardhospitalsfinancially.TOP:PlanningMSC:Managementof Care2.A nurse is teaching the staff about integrated health care systems. Which model of care shouldthenurseincludein theteachingabout seam-lesscaredelivery?a.AffordableCareActb.HospitalValue–BasedPurchasingc.BundledPaymentsforCareImprovementsd.Thepatient-centeredmedicalhomemodelANS:DBasically, two types of integrated health care systems are found: an organizational structurethat follows economic imperatives (such as combining financing with all providers, fromhospitals, clinics, and physicians to home care and long-term care facilities) and a structurethat supports an organized care delivery approach (coordinating care activities and servicesinto seamless functioning). The patient-centered medical home model is an example of anintegrated health care system that strengthens the physician-patient relationship withcoordinated, goal-oriented, individualized care. All the other options are more related to thefinancialaccessibilityofhealth care.DIF:Understand(comprehension)OBJ:Explaintheconceptof―payforvalue,‖usedtorewardhospitalsfinancially.TOP:Teaching/LearningMSC:Management of Care3.A nurse is teaching a family about health care plans. Which information from the nurseindicatesacorrect understandingof theAffordableCareAct?a.Afamilycan choosewhethertohavehealth insurancewith no consequences.b.PrimarycarephysicianpaymentsfromMedicaidservicescanequalMedicare.c.Adultchildrenuptoage 26areallowedcoverage ontheparent’splan.d.Qualityhospital outcome scores aretied directlytopatient satisfaction.ANS:C

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The Affordable Care Act ties payment to organizations offering Medicare Advantage plans tothe quality ratings of the coverage they offer. If hospitals perform poorly in quality scores,they receive lower payments for services. Quality outcome measures include patientsatisfaction, more effective management of care by reducing complications and readmissionsand improving care coordination. All individuals are required to have some form of healthinsuranceby2014 orpayapenaltythrough the taxcode. Primarycarephysician payments forMedicaid services increased to equal Medicare payments. Implementation of insuranceregulations prevents private insurance companies from denying insurance coverage for anyreasonandfromcharginghigher premiums basedon healthstatus and gender.DIF:Remember(knowledge)OBJ:Explaintheconceptof―payforvalue,‖usedtorewardhospitalsfinancially.TOP:Teaching/LearningMSC:Management of Care4.A nurse is caring for a patient in the hospital. When should the nurse begin dischargeplanning?a.Whenthepatientisready.b.Closetothetimeofdischarge.c.Uponadmission tothehospital.d.Afteranorderiswritten/prescribed.ANS:CDischarge planning begins the moment a patient is admitted to a health care facility. When thepatient is ready may be too late. Close to the time of discharge and after an order iswritten/prescribed are too late to help the transition of patient care from the hospital to homeorothercare facility.DIF:Remember(knowledge)OBJ:Discusstheroleofnursesinvarioushealthcaresettings.TOP:PlanningMSC:Managementof Care5.The nurse is applying for a position with a home care organization that specializes in spinalcordinjury.In which typeofhealth carefacilitydoes the nursewant to work?a.Secondaryacuteb.Continuingc.Restoratived.TertiaryANS:CPatients recovering from an acute or chronic illness or disability often require additionalservices(restorative care)toreturntotheirprevious leveloffunctionorreachanewlevel offunction limited by their illness or disability. Restorative careincludes cardiovascular andpulmonaryrehabilitation,sports medicine,spinal cordinjuryprograms, and home care.Secondary acute care involves emergency care, acute medical-surgical care, and radiologicalprocedures. Continuing care involves assisted living, psychiatric care, and older-adult daycare.Tertiarycareincludes intensive careand subacutecare.DIF:Understand(comprehension)OBJ:Discusstheroleofnursesinvarioushealthcaresettings.TOP:ImplementationMSC:Managementof Care

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6.A nurse provides immunization to children and adults through the public health department.Whichtypeof health careis thenurseproviding?a.Primarycareb.Preventivecarec.Restorativecared.ContinuingcareANS:BPreventive care includes immunizations, screenings, counseling, crisis prevention, andcommunity safety legislation. Primary care is health promotion that includes prenatal andwell-baby care, nutrition counseling, family planning, and exercise classes. Restorative careincludesrehabilitation, sportsmedicine, spinalcord injuryprograms, andhome care.Continuingcareis assisted livingand psychiatriccareand older-adult daycare.DIF:Understand(comprehension)OBJ:Summarize the six levels of health care.TOP:ImplementationMSC:Health PromotionandMaintenance7.Inorderto receivepayment forcareprovided,nursingcentersmust complywith requirementsoutlinedin what federal legislation?a.OmnibusBudgetReconciliationActb.MedicareActc.MedicaidActd.AffordableCareActANS:ANursing centers must comply with the Omnibus Budget Reconciliation Act of 1987 and itsminimum requirements for nursing facilities to receive payment from Medicare and Medicaid.The Affordable Care Act ties payment to organizations offering Medicare Advantage plans tothe qualityratings of thecoveragetheyoffer.DIF:Understand(comprehension)OBJ:Explaintheconceptof―payforvalue,‖usedtorewardhospitalsfinancially.TOP:ImplementationMSC:Managementof Care8.The nurse is trying to determine risk factors unique to home care patients. What resourceshouldthe nurseaccess?a.PewHealthProfessions Commissionb.TheOutcomeandAssessment InformationSet(OASIS)c.AmericanNursesCredentialingCenter(ANCC)MagnetRecognitionProgramd.Hospital Consumer of Assessment of Healthcare Providers and Systems(HCAHPS)ANS:B

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OASIS (the Outcome and Assessment Information Set) includes a group of standardized coreassessment items for an adult home care patient. OASIS forms the basis for measuring patientoutcomesforthe purposesof outcome-based quality.Dataitems within OASISincludesocio-demographic, environmental, support system, health status, functional status, and healthservice utilization characteristics of a patient. The OASIS assessment tool was designed togather the data items needed to measure both outcomes and patient risk factors in the homesetting. The Pew Health Professions Commission, a national and interdisciplinary group ofhealthcareleaders,recommended 21 competenciesforhealth careprofessionals in thetwenty-first century. The Hospital Consumer of Assessment of Healthcare Providers andSystems (HCAHPS) is a standardized survey developed to measure patient perceptions oftheir hospital experience. The Magnet Recognition Program recognizes health careorganizationsthat achieveexcellencein nursingpractice.DIF:Understand(comprehension)OBJ:Discussthefeaturesofanintegratedhealthcaresystem.TOP:AssessmentMSC:Managementof Care9.An older-adult patient has extensive wound care needs after discharge from the hospital.Whichfacilityshould thenursediscuss with the patient?a.Hospiceb.Respitecarec.Assistedlivingd.SkillednursingANS:DAnintermediatecareorskillednursingfacilityoffersskilledcare fromalicensed nursingstaff. This often includes administration of IV fluids, wound care, long-term ventilatormanagement, and physical rehabilitation. A hospice is a system of family-centered care thatallows patients to live with comfort, independence, and dignity while easing the pains ofterminal illness.Respitecareisaservicethat provides short-term relief or―time off‖forpeople providing home care to an individual who is ill, disabled, or frail. Assisted living offersan attractive long-term care setting with an environment more like home and greater residentautonomy.DIF:Apply(application)OBJ:Summarizethesixlevelsofhealthcare.TOP:Teaching/LearningMSC:ManagementofCare10.A nurse working in a community hospital’s emergency department provides care to a patienthavingchest pain. Which level of careisthenurseproviding?a.Continuingcareb.Restorativecarec.Preventivecared.TertiarycareANS:D

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Hospital emergency departments, urgent care centers, critical care units, and inpatientmedical-surgicalunitsprovidesecondaryandtertiarylevelsofcare.Patientsrecoveringfroman acute or chronic illness or disability often require additional services (restorative care) toreturn to their previous level of function or reach a new level of function limited by theirillness or disability. Continuing care is available within institutional settings (e.g., nursingcenters or nursing homes, group homes, and retirement communities), communities (e.g.,adult day care and senior centers), or the home (e.g., home care, home-delivered meals, andhospice). Preventive care is more disease oriented and focused on reducing and controllingrisk factors for disease through activities such as immunization and occupational healthprograms.DIF:Apply(application)OBJ:Summarizethesixlevelsofhealthcare.TOP:ImplementationMSC:ManagementofCare11.A nurse is teaching about the primary focus of community wellness. Which informationshouldthe nurseincludein theteachingsession?a.Coordinationofhealthcareservicesb.Effectivecostcontainmentforservicesc.Appropriateservicedeliveryto servicepopulationd.Identificationofservices neededtoaddressindividualneedsANS:AWellness care focuses on the health of populations and their communities rather than simplycuring an individual’s disease. In wellness care, nurses can help lead communities and healthcare systems in coordinating resources to better serve their populations. All the remainingoptionsarecomponentsofcarecoordination.DIF:Understand(comprehension)OBJ:Discuss the nursing implications regarding issues facing the health care system.TOP:Teaching/LearningMSC:Management of Care12.A nurse is using research findings to improve clinical practice and improved care delivery.Whichtechnique is thenurseusing?a.Performancescoresb.Integrateddeliverynetworksc.Nursing-sensitiveoutcomesd.UtilizationreviewcommitteesANS:APerformance improvement activities are typically clinical projects conceived in response toidentified clinical problems and designed to use research findings to improve clinical practiceby applying earned scores. Larger health care systems have integrated delivery networks(IDNs) that include a network of facilities, providers, and services organized to deliver acontinuumof caretoa population ofpatients at acapitatedcost in aparticularsetting.Nursing-sensitive outcomes are patient outcomes and nursing workforce characteristics thatare directly related to nursing care such as changes in patients’ symptom experiences,functional status, safety, psychological distress, registered nurse (RN) job satisfaction, totalnursinghours per patientday,and costs.Medicare-qualified hospitals hadphysician-supervised utilization review (UR) committees to review the admissions and toidentify and eliminate overuse of diagnostic and treatment services ordered by physicianscaringforpatients on Medicare.

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DIF:Understand(comprehension)OBJ:Discussthefeaturesofanintegratedhealthcaresystem.TOP:ImplementationMSC:Managementof Care13.Whichfindingindicatesthebestqualityimprovementprocess?a.Staffidentifiesthewaittimeintheemergencydepartmentistoolong.b.Administrationidentifiesthedesignofthefacility’slobbyincreasespatientstress.c.Director of the hospital identifies the payment schedule does not pay enough forovertime.d.Health care providers identify the inconsistencies of some of the facility’s policyandprocedures.ANS:AThe quality improvement process begins at the staff level,where problems are defined by thestaff. It isnot identifiedbyadministration,the hospitaldirector, orhealth careproviders.DIF:Apply(application)OBJ:Discussthefeaturesofanintegratedhealthcaresystem.TOP:EvaluationMSC:Managementof Care14.A nurse is providing home care to a home-bound patient treated with intravenous (IV) therapyand enteral nutrition. What is the home health nurse’s primary objective after providingnecessarycare?a.Screeningb.Educationc.Dependenced.CounselingANS:BHealthpromotionandeducationaretraditionallytheprimaryobjectivesof homecare,yetatpresent most patients receive home care because they need nursing care. Screening ispreventivecare. Thehomehealthnursefocuses onpatient andfamilyindependence.Counselingisthroughpsychiatriccare.DIF:Understand(comprehension)OBJ:Discuss thenursing implications regarding issues facing the health care system.TOP:PlanningMSC:Managementof Care15.A nurse hears a co-worker state that anybody could be a nurse since it is so automated withinfusion devices and electronic monitoring; technology is doing the work. What is the nurse’sbestresponse?a.―Technologyusehasto becombinedwithnursingjudgment.‖b.―Thefocus ofeffectivenursingcareistechnology.‖c.―If it’ssoeasy,whydon’tyou do it?‖d.―That istruein thetwentiethcentury.‖ANS:A

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In many ways, technology makes work easier, but it does not replace nursing judgment.Technology does not replace your critical eye and clinical judgment. Most importantly, it isessential to remember that the focus of nursing care is not the machine or the technology; it isthe patient.Using―why‖is not beneficialwhencommunicatingwithothers.Agreeingwiththestatement furthers misconceptions.DIF:Apply(application)OBJ:Explainapproachesnursescanusetoimprovepatientsatisfaction.TOP:CommunicationandDocumentationMSC:Management of Care16.Anurseis completinga minimum dataset.Which areaisthenurseworking?a.Nursingcenterb.Psychiatricfacilityc.Rehabilitationcenterd.AdultdaycarecenterANS:ANurses who work in a nursing center (nursing home or nursing facility) are required tocomplete a minimum data set on each patient. Minimum data set is not needed for psychiatric,rehabilitation, or adult day care centers. Patients who suffer emotional andbehavioralproblems such as depression, violent behavior, and eating disorders often require specialcounselingandtreatmentinpsychiatricfacilities.Rehabilitationrestoresa persontothefullestphysical, mental, social, vocational, and economic potential possible. Patients requirerehabilitation after a physical or mental illness, injury, or chemical addiction. Adult day carecenters provide a variety of health and social services to specific patient populations who livealone or with family in the community. Services offered during the day allow family memberstomaintaintheirlifestylesandemploymentandstillprovidehomecarefortheirrelatives.DIF:Understand(comprehension)OBJ:Discusstheroleofnursesinvarioushealthcaresettings.TOP:ImplementationMSC:Managementof CareMULTIPLERESPONSE1.Which government-instituted programs should the nurse include in a teaching session aboutcontrollinghealth carecosts?(Select all that apply.)a.Professionalstandardsrevieworganizationsb.Prospectivepaymentsystemsc.Diagnosis-relatedgroupsd.Third-partypayerse.―Neverevents‖ANS:A,B,C

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The federal government, the biggest consumer of health care, which pays for Medicare andMedicaid, has created professional standards review organizations (PSROs) to review thequality, quantity, and costs of hospital care. One of the most significant factors that influencedpayment for health care was the prospective payment system (PPS). Established by Congressin 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients whoreceivedMedicarebenefitswereno longerable tochargewhatever apatient’s carecost.Instead,thePPSgrouped inpatienthospital servicesforMedicarepatientsintodiagnosis-related groups (DRGs). In 2011, the National Quality Forum(not a governmentfacility)definedalistof 29―neverevents‖that aredevastatingandpreventable.Through mostof the twentieth century, few incentives existed for controlling health care costs. Insurers orthird-party payers paid for whatever health care providers ordered for a patient’s care andtreatment.DIF:Understand(comprehension)OBJ:Discuss the nursing implications regarding issues facing the health care system.TOP:Teaching/LearningMSC:Management of Care2.A nurse is teaching the staff about the Institute of Medicine competencies. Which examplesindicatethestaff hasacorrectunderstandingoftheteaching?(Selectall that apply.)a.Useinformatics.b.Usetransparency.c.Applyglobalization.d.Applyqualityimprovement.e.Useevidence-basedpractice.ANS:A,D,EThe Institute of Medicine competencies include: provide patient-centered care, work ininterdisciplinary teams, use evidence-based practice, apply quality improvement, and useinformatics. Transparency is included in the 10 rules of performance in a redesigned healthcare system, not a competency. While globalization is important in health care, it is not acompetency.DIF:Understand(comprehension)OBJ:Explain approaches nurses can use to improve patient satisfaction.TOP:Teaching/LearningMSC:ManagementofCare3.A nurse is evaluating care based upon the nursing quality indicators. Which areas should thenurseevaluate?(Select all that apply.)a.Patientsatisfactionlevelb.Hospitalreadmissionratesc.Nursinghoursper patientdayd.Patientfalls/fallswithinjuriese.Valuestreamanalysisfor qualityANS:B,C, D

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The American Nurses Association developed the National Database of Nursing QualityIndicators (NDNQI) to measure and evaluate nursing-sensitive outcomes with the purpose ofimproving patient safety and quality care. Nursing quality indicators include the following:hospital readmission rates, nursing hours per patient day, and patient falls/falls with injuries.While every major health care organization measures certain aspects of patient satisfaction, itis not a nursing quality indicator. Value stream analysis is a method that focuses onimprovementofprocesses in a health careinstitution.DIF:Apply(application)OBJ:Discusstheroleofnursesinvarioushealthcaresettings.TOP:EvaluationMSC:Managementof Care4.A nurse is working in a health care organization that has achieved Magnet status. Whichcomponentsareindicators of this status?(Select all that apply.)a.Empiricalqualityresultsb.Structuralempowermentc.Transformationalleadershipd.Exemplaryprofessional practicee.WillingnesstorecommendtheagencyANS:A,B,C, DThe American Nurses Credentialing Center (ANCC) established the Magnet RecognitionProgram to recognize health care organizations that achieve excellence in nursing practice.The five components are transformational leadership; structural empowerment; exemplaryprofessional practice; new knowledge, innovation, and improvements; and empirical qualityresults. Willingness to recommend the hospital/agency is a component of the HospitalConsumerofAssessmentofHealthcareProvidersandSystems survey.DIF:Understand(comprehension)OBJ:Discuss the nursing implications regarding issues facing the health care system.TOP:AssessmentMSC:Managementof CareMATCHINGA nurse is teaching about the different types of health care model. Match the correctinformationto thetypeof healthcaremodel thenurse should includein the teachingsession.a.Insuranceforlow-incomefamiliesb.Federalinsuranceforpeopleaged65andolderc.Ties payment to organizations offering Medicare Advantage plans to the qualityratingsofthe coveragetheyofferd.Usesdiagnosis-related groupmodel1.Prospectivepaymentsystem(IPPS)2.AffordableCareAct3.Medicaid4.Medicare1.ANS:DDIF:Understand (comprehension)OBJ:Discussthefactorsthataffectaperson’saccesstohealthcare.TOP:Teaching/LearningMSC:ManagementofCare

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2.ANS:CDIF:Understand (comprehension)OBJ:Discussthefactorsthataffectaperson’saccessto healthcare.TOP:Teaching/LearningMSC:ManagementofCare3.ANS:ADIF:Understand (comprehension)OBJ:Discussthefactorsthataffectaperson’saccesstohealthcare.TOP:Teaching/LearningMSC:ManagementofCare4.ANS:BDIF:Understand (comprehension)OBJ:Discussthefactorsthataffectaperson’saccesstohealthcare.TOP:Teaching/LearningMSC:ManagementofCareChapter 03: Community-Based Nursing PracticePotter:Fundamentals ofNursing,11thEditionMULTIPLECHOICE1.Anurseisworkingasapublichealthnurse.Whatwillbethenurse’sprimaryfocus?a.Theindividual as onememberof a groupb.Individualsandfamiliesc.Needsof apopulationd.HealthpromotionANS:CPublic health nursing primary focus is understanding the needs of a population.Community-based care focuses on health promotion. Community health nursing focuses onhealthcareof individuals, families,andgroups within thecommunity.DIF:Understand(comprehension)OBJ:Explain the relationship between public health and community health nursing.TOP:CaringMSC:Managementof Care2.A nurse wants to become a specialist in public health nursing. Which educational requirementwill thenursehaveto obtain?a.Abaccalaureatedegreeinnursingb.Preparationatthebasicentrylevelc.Thesamelevel of education as thecommunityhealth nursed.Agraduateleveleducation withafocus inpublic healthscienceANS:DA specialist in public health has a graduate level education with a focus in public healthscience. Public health nursing requires preparation at the basic entry level and sometimesrequires a baccalaureate degree in nursing. A community health nurse is not the same thing asapublichealth nursingspecialist.DIF:Understand(comprehension)OBJ:Explain the relationship between public health and community health nursing.TOP:Teaching/LearningMSC:Management of Care3.Anurseis workingasacommunityhealth nurse.Which action is apriorityforthis nurse?a.Providedirect careto subpopulations.b.Focuson theneeds oftheillindividual.c.Providefirstlevel ofcontactto healthcaresystems.d.Focus on providingcareinvarious communitysettings.

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ANS:ACommunity health nursing is nursing practice in the community, with the primary focus onthe health care of individuals, families, and groups within the community. In addition, thecommunity health nurse provides direct care services to subpopulations within a community.Community-based nursing centers function as the first level of contact between members of acommunity and the health care system. Community-based nursing focuses on providing carein various community settings, such as the home or a clinic and involves acute and chroniccare.DIF:Apply(application)OBJ:Contrastcommunityhealthnursingfromcommunity-basednursing.TOP:ImplementationMSC:HealthPromotionandMaintenance4.A nurse is focusing on acute and chronic care of individuals and families within a communitywhileenhancingpatient autonomy.Which typeof nursingcareis thenurse providing?a.Publichealthb.Communityhealthc.Community-basedd.CommunityassessmentANS:CCommunity-based nursing involves acute and chronic care of individuals and families andenhances their capacity for self-care while promoting autonomy in decision making. Publichealth nursing focuses on the needs of a population. Community health nursingcares for thecommunity as a whole and considers the individual or the family as only one member of agroup at risk. Community assessment is the systematic data collection on the population,monitoring the health status of the population, and making information available about thehealthof thecommunity.DIF:Understand(comprehension)OBJ:Contrast community health nursing from community-based nursing.TOP:ImplementationMSC:ManagementofCare5.Thecommunityhealth nurseis administeringflu shotstochildren ata localplayground.Whatistherationale forthisnurse’s action?a.Topreventindividualillnessb.Toprevent communityoutbreak of illnessc.Toprevent outbreak of illnessin thefamilyd.Topreventneeds ofthelocal populationgroupsANS:BThe nurse is trying to prevent a community outbreak of illness. By focusing on subpopulations(children), the community health nurse cares for the community as a whole and considers theindividual or the family as only one member of a group at risk. Community-based nursing, asopposed to community health nursing, focuses on the needs of the individual or family. Publichealthnursing focuses onmeetingthe population groups’ needs.DIF:Apply(application)OBJ:Discuss the roleof the community health nurse.TOP:PlanningMSC:HealthPromotion andMaintenance

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6.A nurse attended a seminar on community-based health care. Which information indicates thenursehas agood understandingofcommunity-based health care?a.Itoccursinhospitals.b.Itsfocusisonillindividuals.c.Itspriorityis health promotion.d.Itprovides services primarilyto thepoor.ANS:CCommunity-based health care is a model of care that reaches everyone in the community(including the poor and underinsured), focuses on primary rather than institutional or acutecare, and provides knowledge about health and health promotion and models ofcare to thecommunity. Community-based health care occurs outside traditional health care institutionssuchashospitals.DIF:Understand(comprehension)OBJ:Explain the relationship between public health and community health nursing.TOP:Teaching/LearningMSC:HealthPromotionandMaintenance7.AnurseisusingtheHealthy People 2030to establishgoals forthecommunity. Whichgoal ispriority?a.Reducehealthcarecosts.b.Increaselifeexpectancy.c.Provideservicesclosetowherepatientslive.d.Isolatepatientstopreventthespreadofdisease.ANS:BThe overall goals ofHealthy People 2030are to increase life expectancy and quality of lifeand eliminate health disparities through an improved delivery of health care services. It doesnot focus on reducing health care costs, providing services close to where patients live, orisolatingpatients to prevent thespread of disease.DIF:Understand(comprehension)OBJ:Discuss the role of the nurse in community-based practice.TOP:PlanningMSC:HealthPromotionandMaintenance8.A nurse is working in community-based nursing. Which competency ispriorityfor thisnurse?a.Caregiverb.Collaboratorc.Changeagentd.CasemanagerANS:AFirst and foremost is the role of caregiver. While collaborator, change agent, and casemanager areimportant, theyarenot thepriority.DIF:Understand(comprehension)OBJ:Explain the competencies important for success in community-based nursing practice.TOP:ImplementationMSC:ManagementofCare

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9.A nurse observes an outbreak of lice in a certain school district. The nurse collects data andidentifiesa common practice of sharing lockers, caps, and hairbrushes. The nurse shares theinformationwith the school. Which community-based nursingcompetencydid thenurseuse?a.Educatorb.Caregiverc.Casemanagerd.EpidemiologistANS:DAs an epidemiologist, you are involved in case finding, health teaching, and tracking incidentrates of an illness (outbreak of lice). The nurse did not teach the students about lice. The nursedid not provide care for the lice. The nurse did not coordinate needed resources and servicesforagroupof patient’s well-being (casemanager).DIF:Understand(comprehension)OBJ:Describe the competencies important for success in community-based nursing practice.TOP:ImplementationMSC:Safetyand Infection Control10.A nurse is providing screening at a health fair. Which finding indicates the person may be avulnerablepatientwho ismostlikelytodevelop health problems?a.Onewho ispregnant.b.Onewhohasexcessiverisks.c.Onewhohasunlimitedaccesstohealth care.d.Onewhousesnontraditionalhealingpractices.ANS:BVulnerable populations are the patients who are more likely to develop health problems as aresult of excessive risks or limits in access to health care services or who are dependent onothers for care. Pregnancy is not a cause of vulnerability, except incases where the mother isan adolescent, is addicted to drugs, or is at high risk for other reasons. A person who hasunlimited access to health care is not vulnerable. Frequently, the immigrant populationpractices nontraditional healing practices. Many of these healing practices are effective andcomplementtraditional therapies.DIF:Analyze(analysis)OBJ:Identify characteristics of patients from vulnerable populations that influence thecommunity-basednurse’sapproachtocare.TOP:AssessmentMSC:Health Promotion andMaintenance11.Theinstructoristeachingstudentnursesaboutidentifyingmembersofvulnerablepopulationswhenthenursingstudentasks,―Whyisitthatnotallpoorpeopleareconsideredmembersofvulnerablepopulations?‖Howshouldthenurserespond?a.―Allpoor people aremembersof avulnerable population.‖b.―Poorpeople aremembers ofavulnerable population onlyif theytakedrugs.‖c.―Poorpeople aremembers ofavulnerable population onlyif theyarehomeless.‖d.―Members ofvulnerablegroupsfrequentlyhaveacombination ofrisk factors.‖ANS:D

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Membersofvulnerablegroupsfrequentlyhavemanyrisksora combinationofriskfactorsthat make them more sensitive to the negative effects of individual risk factors. Individual riskfactors are not always overwhelming, depending on the patient’s beliefs and values andsourcesof social support.DIF:Apply(application)OBJ:Identify characteristics of patients from vulnerable populations that influence thecommunity-basednurse’sapproachtocare.TOP:Teaching/LearningMSC:Health Promotion andMaintenance12.The nurse is making a home visit to a Korean mother after the birth of girl. The spouse ispressing different parts of the patient’s hand and lower arm to relieve a headache. What is thenurse’snext action?a.Tellthe spouseto stopand givethemotheracetaminophen.b.Letthespousefinish andthengive themothermedication.c.Askthe motherand/or spouseto explain the procedure.d.Explaintothespousethat itwill notwork.ANS:CThe nurse should not judge the patient’s/family’s beliefs and values about health. The nurseneeds to understand cultural beliefs, values, and practices to determine their specific needs.Acetaminophen may not be an acceptable alternative for this family.Criticizing the family’sbeliefsand practices or sayingtheywill not work mayonlycreateabarrier tocare.DIF:Analyze(analysis)OBJ:Identify characteristics of patients from vulnerable populations that influence thecommunity-basednurse’sapproachtocare.TOP:ImplementationMSC:PsychosocialIntegrity13.Anurseisassessingthe socialsystem ofacommunity. Which areashould thenurseassess?a.Housingb.Economicstatusc.Volunteerprogramsd.PredominantethnicgroupsANS:CSocial systems include volunteer programs, education system, government, and healthsystems. Housing and economic status are included in the structure assessment. Predominantethnicgroups areacomponent of the population assessment.DIF:Understand(comprehension)OBJ:Identify elements of a community assessment.TOP:AssessmentMSC:PsychosocialIntegrity14.The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs anabortion. The nurse, acting as a counselor, provides the patient with information onalternatives to abortion. After discussing the options,the patient still expresses an interest inanabortion. What should thenurse, in thecounselorrole, do next?a.Encouragethe patient tospeakwitha―Right-to-Life‖advocate.b.Refusetoprovidea referraltoanabortion service.c.Providereferraltoanabortionservice.d.Delayreferraltoanabortion service.

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ANS:CAs a counselor, the nurse is responsible for providing information, listening objectively, andbeing supportive, caring, and trustworthy and providing a referral to an abortion service. Therole of counselor should not be influenced by personal biases or values. The nurse does notmakedecisions, likegoingto a―Right-to-Life‖advocate, butrather helpsthepatient reachdecisions that are best for him or her. To refuse to provide a referral or to delay referral wouldnotbe supportiveof thepatient’s decision.DIF:Apply(application)OBJ:Explain the competencies important for success in community-based nursing practice.TOP:ImplementationMSC:PsychosocialIntegrity15.BeforeapatientdiagnosedinthebeginningstageofAlzheimer’sdiseaseis discharged,thecommunity-based nurse is making a visit to the patient’s home. The patient’s daughter andfamilylivein thehomewith thepatient. What isthe major focus of this visit?a.Teachingthefamilyhowtomonitorbloodpressure.b.Demonstratingtechniquesforprovidingcare.c.Stressingto thefamilyhow difficult itwill beto providecareat home.d.Encouragingthefamilytosendthe patienttoanextendedcarefacility.ANS:BTheroleofthecommunityhealthnurse,whendealingwithpatientswithAlzheimer’sdisease,is to maintain the best possible functioning, protection, and safety for the patient. The nurseshould demonstrate to the primary family caregiver techniques for dressing, feeding, andtoiletingthepatientwhileprovidingencouragementand emotionalsupporttothecaregiver.Monitoring blood pressure is not necessary for an Alzheimer’s patient; blood pressure wouldbe for a patient with hypertension. The nurse should protect the patient’s rights and maintainfamilystability, not encourageplacement inanextended carefacility.DIF:Analyze(analysis)OBJ:Explain the competencies important for success in community-based nursing practice.TOP:ImplementationMSC:ManagementofCare16.While conducting a community assessment, the nurse seeks data on the average householdincome and the number of residents on public assistance. In doing so, the nurse is evaluatingwhich component ofacommunityassessment?a.Structureb.Populationc.Socialsystemd.WelfaresystemANS:AEconomic status is part of the community structure. Population would involve age and genderdistribution, growth trends, density, education level, and ethnic or religious groups. Thewelfare system is part of the social system that also includes the education, government,communication,and health systems.DIF:Understand(comprehension)OBJ:Identify elements of a community assessment.TOP:AssessmentMSC:Health Promotion andMaintenance

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17.The nurse uses statistics on increased incidence ofcommunicable disease to influencelegislatures to pass a bill for mandatory vaccinations to enroll in school. Which type ofnursingwill the nurseusein this process?a.Publichealthnursingb.Community-basednursingc.Communityhealthnursingd.VulnerablepopulationnursingANS:AA public health nurse understands factors that influence health promotion and healthmaintenance, the trends and patterns influencing the incidence of disease within populations,environmental factors contributing to health and illness, and the political processes used toaffectpublicpolicy. Communityhealth nursingis nursingpracticeinthecommunity,with theprimaryfocus onthehealthcareofindividuals, families,andgroupswithinthecommunity.Community-based nursing care takes place in community settings such as the home or aclinic, where the focus is on the needs of the individual or family. While there is no specificvulnerablepopulation nursing, all typesof nursing should careforthesepopulations.DIF:Analyze(analysis)OBJ:Explain the relationship between public health and community health nursing.TOP:EvaluationMSC:Health Promotion andMaintenanceMULTIPLERESPONSE1.A community-based nursing is working with a family. For which key areas will the nurseneedastrongknowledgebase?(Select all that apply.)a.Familytheoryb.Communicationc.Groupdynamicsd.Culturaldiversitye.Individual-centeredcareANS:A,B,C, DWith the individual and family as the patients, the context of community-based nursing isfamily-centered care (not individual-centered care) within the community. This focus requiresa strong knowledge base in family theory, principles of communication, group dynamics, andcultural diversity. The nurse leans to partner with patients and families, not just withindividuals.DIF:Understand(comprehension)OBJ:Discusstheroleofthenurseincommunity-basedpractice.TOP:Teaching/LearningMSC:HealthPromotionandMaintenance2.Offering which community-based nursing activities indicates the nurse is working in the roleofeducator?(Select all that apply.)a.Prenatalclassesb.Achild safetyprogramc.Todefendpatients’decisionsd.Creativesolutionstolocalproblemse.Tocoordinateresources afterdischarge

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ANS:A,BPrenatal classes, infant care, child safety, and cancer screening are just some of the healtheducation programs provided in a community practice setting. Offers to defend patients’decisions is the role of patient advocate. Offers creative solutions to local problems indicates achange agent. Collaboratorwill offer tocoordinateresources afterdischarge.DIF:Apply(application)OBJ:Explain the competencies important for successin community-based nursing practice.TOP:Teaching/LearningMSC:HealthPromotion andMaintenance3.A nurse is caring for vulnerable populations in a local community. Which patients will thenursecarefor in this community?(Select all that apply.)a.A47-year-old immigrantwho speaksonlySpanishb.A35-year-old livinginown homec.A22-year-oldpregnantwomand.A40-year-oldschizophrenice.A15-year-old rapevictimANS:A,D,EIndividuals living in poverty, older adults, people who are homeless, immigrant populations,individualsinabusiverelationships(rape),substanceabusers,andpeoplewithseverementalillnesses (schizophrenic) are examples of vulnerable populations. Middle-aged people livingin their own home are not an example of a vulnerable population. Pregnancy is not anexampleof avulnerablepopulation.DIF:Analyze(analysis)OBJ:Identify characteristics of patients from vulnerable populations that influence thecommunity-basednurse’sapproachtocare.TOP:ImplementationMSC:PsychosocialIntegrityMATCHINGA nurse is assessing a community. Match each community element the nurse will assess withthecorrect example.a.Educationlevelb.Housingc.Government1.Structure2.Population3.Socialsystem1.ANS:BDIF:Understand(comprehension)OBJ:Identifyelementsofacommunityassessment.TOP:AssessmentMSC:Health Promotion andMaintenance2.ANS:ADIF:Understand(comprehension)OBJ:Identifyelementsofacommunityassessment.TOP:AssessmentMSC:Health Promotion andMaintenance3.ANS:CDIF:Understand(comprehension)OBJ:Identifyelementsofacommunityassessment.TOP:AssessmentMSC:Health Promotion andMaintenance

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Chapter 04: Theoretical Foundations of Nursing PracticePotter:FundamentalsofNursing,11thEditionMULTIPLECHOICE1.Thenursinginstructor is teachingaclass on nursingtheory.Oneof thestudentsasks,―Whydo we need to know this stuff? It doesn’t really affect patients.‖ What is the instructor’sbestresponse?a.―Youarecorrect, butwehaveto learn itanyway.‖b.―This keeps thefocus ofnursingnarrow.‖c.―Theorieshelp explainwhynursesdowhat theydo.‖d.―Exposureto theorieswill helpyou later in graduateschool.‖ANS:CTheories offer well-grounded rationales for how and why nurses perform specificinterventions and for predicting and/or prescribing nursing care measures. Although nursingtheory will help the nurse in graduate school, it is also an important basis for the nurse’sapproachto dailypatient care,and it expandsscientificknowledgeoftheprofession.DIF:Apply(application)OBJ:Explainhowtheoryisusedin nursingpractice.TOP:ImplementationMSC:ManagementofCare2.The nurse is caring for a patient who does not follow the prescribed regimen for diabetesmanagement. As a prescriber to Orem’s theory, the nurse interviews the patient in an attemptto identifythe causeof thepatient’s―nonadherence.‖What istherationaleforthe nurse’sbehavior?a.Orem’stheoryisusefulindesigninginterventionstopromoteself-care.b.Orem’stheoryfocusesonculturalissuesthatmayaffectcompliance.c.Orem’stheoryallows for reductionofanxietywithcommunication.d.Orem’stheoryhelpsnursesmanipulatethepatient’senvironment.ANS:AWhen applying Orem’s theory, a nurse continually assesses a patient’s ability to performself-care and intervenes as needed to ensure that the patients meet physical, psychological,sociological,anddevelopmental needs.Accordingto Orem,peoplewho participateinself-care activities are more likely to improve their health outcomes. Leininger’s culture caretheory focuses on culture diversity and provides culturally specific nursing care. According toPeplau, nurses help patients reduce anxiety by converting it into constructive actions, usingtherapeutic communication. Nightingale’s grand theory is a patient’s environment can bemanipulated bynurses torestoreapatient to health.DIF:Understand(comprehension)OBJ:Explain how theory is used in nursing practice.TOP:EvaluationMSC:ManagementofCare3.A nurse is testing meditation for migraine headaches and the expected outcome of care whenperformingthis intervention. Which typeoftheoryis thenurseusing?a.Grandb.Prescriptivec.Descriptived.Middle-range

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ANS:BA prescriptive theory details nursing interventions (meditation) for a specific phenomenon(migraineheadaches)andtheexpectedoutcomeofthecare.Grandtheoriesarebroadinscopeand complex and require further specification through research; it does not provide guidancefor specific nursing interventions. Descriptive theories do not direct specific nursing activitiesbut help to explain patient assessment. A middle-range theory tends to focus on a conceptfound in a specific field of nursing, such as uncertainty, incontinence, social support, qualityoflife, and caring, ratherthan reflect on awide varietyof nursingcaresituations.DIF:Understand(comprehension)OBJ:Discuss types of nursing theories.TOP:ImplementationMSC:Management of Care4.The nurse researcher is evaluating whether holding pressure at an injection site after injectingthe anticoagulant enoxaparin will reduce bruising at the injection site. This study involves aprescriptivetheory. Whatisthe nurse’srationaleforinvolvingaprescriptivetheory?a.Itexplains whybruising occurs.b.Itisbroad inscopeandcomplex.c.Ittestsaspecificnursingintervention.d.Itreflectsa widevarietyofnursingcaresituations.ANS:CPrescriptive theories detail nursing interventions for a specific phenomenon and the expectedoutcome of the care but it does not explain why. Grand theories are broad in scope andcomplexand focus on awidevarietyof nursingcaresituations.DIF:Understand(comprehension)OBJ:Discuss types of nursing theories.TOP:PlanningMSC:Managementof Care5.Anurseisusingnursingtheoryandthe nursingprocesssimultaneouslytoplan nursingcare.Howwill the nurseuse nursingtheoryand the nursingprocess in practice?a.Nursingtheorycan directhow anurseuses the nursingprocess.b.Nursingtheoryrequires thenursingprocess to develop knowledge.c.Nursingtheorywiththenursingprocess has aminor rolein professionalnursing.d.Nursingtheorycombinedwith thenursingprocessisspecificto certainillpatients.ANS:ANursing theory can direct how a nurse uses the nursing process. Integration of theory intopractice (nursing process) serves as the basis for professional nursing. The nursing processprovides a systematic process for the delivery of care, not the knowledge component of thediscipline.Usefultheories areadaptabletodifferent patientsand toall caresettings.DIF:Understand(comprehension)OBJ:Explain how theory is used in nursing practice.TOP:ImplementationMSC:Managementof Care6.The nurse views the patient as an open system that needs help in coping with stressors. Whichtheoristis thenurseusing?a.Kingb.Levinec.Neumand.Johnson

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ANS:CNeuman views a patient as being an open system that is in constant energy exchange with theenvironment that the nurse must help cope with stressors. King views a patient as a uniquepersonal system that is constantly interacting/transacting with other systems that the nursehelps with goal attainment. Levine believes nurses promote balance between nursinginterventionsandpatientparticipation toassistin conservingenergyneededforhealing.Johnson perceives patients as a collection of subsystems that forms an overall behavioralsystemfocusingon balance.DIF:Understand(comprehension)OBJ:Determine how to apply different nursing theories in different patient situations.TOP:EvaluationMSC:Management of Care7.The nurse is caring for a patient diagnosed with essential hypertension. The health careprovider prescribes blood pressure medication that the nurse administers. The nurse thenmonitors the patient’s blood pressure for several days to help determine effectiveness. Whichsystemcomponent is thenurseevaluating?a.Inputb.Outputc.Contentd.FeedbackANS:BOutput is the end product of a system and, in the case of the nursing process, it is defined aswhether the patient’s health status improves or remains stable as a result of nursing care. Inputconsistsofthe datathatcomefroma patient’sassessment.Feedbackservestoinformasystem about how it functions. Content is the product and information obtained from thesystem.DIF:Understand(comprehension)OBJ:Reviewselectedsharedtheoriesfromotherdisciplines.TOP:EvaluationMSC:Managementof Care8.Apatient is admitted with possible methicillin-resistantStaphylococcus aureus(MRSA) andis placed in isolation until cultures can be obtained and declared noninfectious. During theisolation process, the nurse encourages family visits. Which level of Maslow’s hierarchy ofneedsis the nursepromotingwhen thefamilyis encouragedto visit?a.Firstlevelb.Secondlevelc.Thirdleveld.FourthlevelANS:CThe third level contains love and belonging needs, including family and friends. The firstlevel includes physiological needs. The second level includes safety and security needs. Thefourth level encompasses esteem and self-esteem needs. The fifth and final level is the needforself-actualization.DIF:Understand(comprehension)OBJ:Reviewselectedsharedtheoriesfromotherdisciplines.TOP:ImplementationMSC:PsychosocialIntegrity

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