Fundamentals of Nursing Care-Concepts, Connections & Skills Edition 3Test Bank

Chapter 1 The Vista of Nursing 1. The first practicing nurse epidemiologist was a. Florence Nightingale. b. Mildred Montag. c. Clara Barton. d. Mary Agnes Snively. ANS: A Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mildred Montag, Clara Barton, and Mary Agnes Snively came after Nightingale, each contributing to the nursing profession in her own way. Clara Barton founded the American Red Cross. Dr. Mildred Montag established the first associate degree nursing program in 1952. Mary Agnes Snively began forming the Canadian National Association of Trained Nurses in 1883. 2. The American Red Cross was founded by a. Florence Nightingale. b. Harriet Tubman. c. Clara Barton. d. Mary Mahoney. ANS: C In 1882, the United States ratified the American Red Cross, founded by Clara Barton. Florence Nightingale established the Training School for Nurses in London, England, in 1860. Harriet Tubman was active in the Underground Railroad movement during the American Civil War. Mary Mahoney was the first professionally trained African American nurse. TO GET MORE MATERIALS HESI, ATI. KAPLAN - 3. Nurses working in the Henry Street Settlement in 1893 were among the first nurses to demonstrate autonomy in practice. This was because those nurses a. Had no ability to work in the hospital setting. b. Were required to use critical thinking skills. c. Focused solely on healing the very ill. d. Planned their care around research findings. ANS: B In 1893, nurses working in the Henry Street Settlement were some of the first to demonstrate autonomy in practice because they encountered situations that required quick and innovative problem solving and critical thinking, and provided therapies aimed at maintaining wellness, as well as curing the ill. Nursing hospitals expanded in the late nineteenth century and were major providers of nursing care. Not until the early twentieth century was there a movement toward a scientific, research-based body of nursing knowledge. 4. In 1923, the Goldmark Report was an important study that a. Formed formal nurse midwifery programs. b. Established the Center for Ethics and Human Rights. c. Revised the ANA code of ethics. d. Led to the development of the Yale School of Nursing. ANS: D In 1923, the Goldmark Report identified the need for increased financial support for university- based schools of nursing. As a result, the Yale School of Nursing was developed. Graduate nurse midwifery TO GET MORE MATERIALS HESI, ATI. KAPLAN - programs did not come into existence until the 1940s, and the Center for Ethics and Human Rights was founded in 1990. The ANA code of ethics was published in 1985 and was last updated in 2001. 5. The major difference between a baccalaureate degree nursing program and an associates degree nursing program is that the baccalaureate program includes studies in a. Basic sciences and theoretical courses. b. Social sciences and humanities. c. Theoretical and clinical courses. d. Basic sciences and clinical courses. ANS: B Both associates degree programs and baccalaureate programs focus on basic sciences and on theoretical and clinical courses. Baccalaureate programs, however, also focus on courses in the social sciences, arts, and humanities to support nursing theory. 6. The nurse has been working in the clinical setting for several years as an advanced practice nurse and has earned her masters degree as a family nurse practitioner. However, she seems unfulfilled and has a strong desire to do research. To fulfill her desire, the nurse most likely would apply to attend a program that would lead to a a. Doctor of Nursing Science degree (DNSc). b. Doctor of Philosophy degree (PhD). c. Doctor of Nursing Practice degree (DNP). d. Doctor in the Science of Nursing degree (DSN). ANS: B PhD programs emphasize basic research and theory and are research oriented. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners. TO GET MORE MATERIALS HESI, ATI. KAPLAN - 7. The nurse is caring for her patients and is focused on managing their care as opposed to managing and performing skills. This nurse demonstrates which level of proficiency according to Benner? a. Novice b. Competent c. Proficient d. Expert ANS: C The proficient nurse focuses on managing care as opposed to managing and performing skills. The novice nurse deals with a specific set of rules or procedures, which are usually stepwise and linear. The competent nurse understands the organization and the specific care required by specific types of patients and has experience with psychomotor skills. The expert nurse identifies patient-centered problems, as well as problems related to the health care system. 8. Which of the following resources guides faculty on structure and evaluation of the nursing curriculum? a. ANAs Standards of Nursing Practice b. Essentials of Baccalaureate Education c. NLNAC Interpretive Guidelines d. Standards of Professional Performance ANS: B The American Association of Colleges of Nursing (AACN) published Essentials of Baccalaureate Education for Professional Nursing: A Final Report (1998), which guides faculty on structure and evaluation of the curriculum and the performance of the graduate. The ANAs Standards of Nursing Practice demonstrates the critical thinking model known as the nursing process. Standards of Professional Performance TO GET MORE MATERIALS HESI, ATI. KAPLAN - describes a competent level of behavior in the professional role. NLNAC Interpretive Guidelines identifies core competencies for the professional nurse. 9. The nurse is caring for the patient who has had major abdominal surgery and also has a large sacral pressure sore. The nurse implements coughing and deep breathing exercises and consults the wound care specialist to evaluate and prescribe care for the pressure sore, even though no physician order has provided instructions to do so. In doing this, the nurse is implementing the element of a. Autonomy. b. Accountability. c. Advanced practice. d. Nurse practitioner. ANS: A Autonomy is an essential element of professional nursing. Some independent nursing interventions such as implementing coughing and deep breathing exercises and collaboration with other health professionals can be initiated without medical orders. Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Advanced practice nurse is an umbrella term for advanced clinical nurses such as nurse practitioners who provide care to a group of patients. 10. The physician is planning to take the patient to surgery in the morning and leaves an order for the nurse to get the patient to sign the surgical permit. The physicians note indicates that the patient has been educated on the procedure. However, the patient tells the nurse, I have no idea what hes going to do. He rushed in and rushed out so fast, I couldnt ask any questions. The nurse does not allow the patient to sign the permit and calls the physician to inform him of the patients statement. This is an example of the nurse acting as a. Patient advocate. b. Patient educator. TO GET MORE MATERIALS HESI, ATI. KAPLAN - c. Manager. d. Clinical nurse specialist. ANS: A As a patient advocate, the nurse protects the patients human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurses responsibility to notify the physician if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings. 11. The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse midwife, she asks for a referral to a pediatrician for the newborn. The nurse midwife should a. Provide the referral as requested. b. Offer to provide the newborn care. c. Refer the patient to the supervising physician. d. Tell the patient that she cannot make referrals. ANS: B The practice of nurse midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. As an independent practitioner, supervising physicians are not required by the certified nurse midwife (CNM). However, a CNM practices with a health care agency that provides medical consultation, collaborative management, and referral. After being apprised of the CNM role, if the patient insists on seeing a pediatrician, the nurse midwife should provide the referral. TO GET MORE MATERIALS HESI, ATI. KAPLAN - 12. The student nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). It is important for the student to understand that the CRNA a. Works under the guidance of an anesthesiologist. b. Manages acute medical conditions. c. Manages gynecological services such as PAP smears. d. Must have a PhD degree in anesthesiology. ANS: A Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement. 13. The nurse is speaking in front of a group of ninth grade students about nursing as a profession. One student states that she does not want to be a nurse because all nurses do is take care of sick people and play politics. The most appropriate response that the nurse could give and expand on is that a. Nursing is ideal for the person who hates politics. b. Nursing focuses on curing the persons disease. c. Nursing is not political because it has its own knowledge base. d. An area of nursing exists for every interest. TO GET MORE MATERIALS HESI, ATI. KAPLAN - ANS: D It is important to remember that opportunities are limitless for caring, compassionate, and competent nursing care; an area of nursing exists for every interest. Current philosophies and definitions of nursing demonstrate the holistic trend in nursingto address the whole person in all dimensions, in health and illness, and in interaction with family and community. Political activism and commitment are a part of professionalism and are an important aspect of the delivery of health care. Nursing continues to draw on the social sciences and other fields as the focus of nursing care expands. 14. A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. The nurse realizes that a. Legislation is politics beyond the nurses control. b. National programs have no bearing on state politics. c. The individual nurse can influence legislative decisions. d. Focusing on nursing care provides the best patient benefit. ANS: C Nurses can influence policy decisions at all governmental levels. One way is to get involved in ANAs national efforts, such as Nursings Agenda for the Future: A Call to the Nation. This effort is critical in exerting nurses influence early in the political process. Nurses need to become serious students of social needs, activists in influencing policy to meet those needs, and generous contributors of time and money to nursing organizations and candidates to help legislate conditions that are likely to produce the best care possible. 15. During the American Civil War, which of the following women was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom? TO GET MORE MATERIALS HESI, ATI. KAPLAN - a. Harriet Tubman b. Clara Barton c. Dorothea Dix d. Mary Ann Ball (Mother Bickerdyke) ANS: A Harriet Tubman was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom. Clara Barton, founder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death. As superintendent of the female nurses of the Union Army, Dorothea Lynde Dix organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops. Mother Bickerdyke organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers. 16. Graduates of baccalaureate degree or associates degree nursing programs are eligible to take which of the following to become registered nurses in the state in which they will practice? a. Continuing education credits b. In-service education programs c. National Council Licensure Examination d. Graduate education ANS: C Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associates degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurse associations, professional nursing organizations, and educational and health care institutions. In-service education programs consist of instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and TO GET MORE MATERIALS HESI, ATI. KAPLAN - other health care professionals. A nurse who is completing a graduate program can receive a masters degree in nursing. 17. Which concept means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided? a. Autonomy b. Accountability c. Patient advocacy d. Patient education ANS: B Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patients human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patients progress in learning. MULTIPLE RESPONSE 1. The nurse in the twenty-first century is facing an extremely complex profession with multiple external forces affecting the nursing profession. Factors influencing the nursing profession include which of the following? (Select all that apply.) a. Demography b. Womens health care TO GET MORE MATERIALS HESI, ATI. KAPLAN - c. Human rights d. The threat of bioterrorism e. The medically underserved ANS: A, B, C, D, E Multiple external forces affect nursing. These include demographic changes in the population, human rights, increasing numbers of medically underserved, and the threat of bioterrorism. The womens movement brought greater sensitivity to the health care needs of women and the role of women in health care research. 2. After licensure, the practicing nurse is required to update his or her knowledge about the latest research and practice developments. The most common way nurses do this is through programs. (Select all that apply.) a. Continuing education b. Masters degree c. In-service education d. DNP ANS: A, C Continuing education updates the nurses knowledge about the latest research and practice developments. In-service education programs are provided by a health care agency to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can provide the nurse with continuing education credit. Masters degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. The DNP is a practice doctorate that prepares advanced practice nurses. TO GET MORE MATERIALS HESI, ATI. KAPLAN - 3. Which of the following is (are) an example of an advanced practice nurse? (Select all that apply.) a. Nurse practitioner b. Clinical nurse specialist c. Patient advocate d. Certified registered nurse anesthetist e. Nurse midwife ANS: A, B, D, E Although all nurses should function as patient advocates, advanced practice nurse is an umbrella term for an advanced clinical nurse such as a nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or nurse midwife. 4. The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to float two of its nurses to the oncology unit if oncology can float a nursing assistant to the orthopedic unit to help with obtaining vital signs. This is an example of (Select all that apply.) a. Autonomy. b. Accountability. c. Political activism. d. Politics. ANS: A, B, D Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. Nurses are involved in politics when seeking additional resources. However, political activism usually involves more than dayto-day activities such as unit staffing. TO GET MORE MATERIALS HESI, ATI. KAPLAN - Chapter 2 Health-Care Delivery, Settings and Economics 1. Public health nursing differs from community health nursing in that public health nursing a. Focuses on individuals and families. b. Understands the needs of a population. c. Ignores political processes. d. Considers the individual as one member of a group. ANS: B Public health nursing requires understanding the needs of a population. A public health nurse understands factors that influence the political processes used to affect public policy. The primary focus of community health nursing is the care of individuals, families, and groups in the community. By focusing on subpopulations, the community health nurse cares for the community as a whole and considers the individual or family as only one member of a group at risk. 2. A specialist in public health nursing requires a. The same level of education as the community health nurse. b. Preparation at the basic entry level. c. An advanced degree regardless of public health experience. d. A graduate level education with a focus in public health science. ANS: D TO GET MORE MATERIALS HESI, ATI. KAPLAN - A specialist in public health has a graduate level education with a focus in public health science. Public health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree in nursing. Not all hiring agencies require an advanced degree in community health nursing. However, nurses with a graduate degree in nursing who practice in community settings are considered community health nurse specialists, regardless of their public health experience. 3. The community health nurse differs from the community-based nurse in that the community health nurse a. Understands the needs of the population. b. Focuses on the needs of the individual. c. Is the first level of contact in the health care system. d. Involves the family in decision making. ANS: A The community health nurse understands the needs of a population or community through experience with individual families in working through their social and health care issues. The community-based nurse focuses on the needs of the individual or family. Community-based nursing centers function as the first level of contact between members of a community and the health care system. The communitybased nurse learns to partner with patients and families so that ultimately the patient and the family become involved in planning, decision making, implementation, and evaluation of health care approaches. 4. The type of nursing that focuses on acute and chronic care of individuals and families while enhancing patient autonomy is known as nursing. a. Public health b. Community health TO GET MORE MATERIALS HESI, ATI. KAPLAN - c. Community-based d. Community-focused ANS: C Community-based nursing involves acute and chronic care of individuals and families and enhances their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses on the needs of a population. Community health nursing cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community-focused nursing understands the needs of a population or community. 5. The community health nurse is administering flu shots to children at a local playground. In doing so, the nurses focus is on a. Preventing individual illness. b. Preventing community outbreak of illness. c. Preventing outbreak of illness in the family. d. The needs of the individual or family. ANS: B By focusing on subpopulations, the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community- based nursing, as opposed to community health nursing, focuses on the needs of the individual or family. 6. The community health nurse is providing counseling to a group of teenage girls related to birth control and disease prevention. The nurse does this because a. Focusing on subpopulations leads to community health. TO GET MORE MATERIALS HESI, ATI. KAPLAN - b. Community health nursing focuses on individuals only. c. Community health nursing excludes direct care to subpopulations. d. The focus is on preventing illness and unwanted pregnancy. ANS: A By focusing on subpopulations, the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community health nursing is a nursing practice in the community, with the primary focus on the health care of individuals, families, and groups in a community. Subpopulations are often a clinical focus. The goal is to protect, promote, or maintain health, not to prevent illness. 7. Community-based nursing care takes place in community settings such as the home or a clinic. Ideally, this is done to a. Exert greater control over individual or family decisions. b. Provide services close to where patients live. c. Isolate patients and prevent the spread of disease. d. Reduce the need for self-care. ANS: B The ideal is to provide health care services close to where patients live. This lessens the cost of care as well as the stress associated with the financial burdens of care. The focus is on the needs of the individual or family. The nurse learns to partner with patients and families so they assume responsibility for their health care decisions. 8. The community-based nurse is caring for a patient who is home bound by arthritis and chronic lung problems. The patient, however, receives many visitors from the neighborhood and from former coworkers, as well as frequent phone calls from extended family. When concerned about how the large number of visitors may be fatiguing the patient, the nurse should TO GET MORE MATERIALS HESI, ATI. KAPLAN - a. Restrict the number of visitors for the patients welfare. b. Voice concerns to the patient and proceed according to the patients wishes. c. Allow visitors to come and go freely as they have been. d. Create visiting hours when the patient may see nonfamily members. ANS: B With the individual and the family as patients, the context of community-based nursing is familycentered care within the community. This focus requires a strong knowledge base in family theory, principles of communication, group dynamics, and cultural diversity. The nurse learns to partner with patients and families, so ultimately the patient and the family assume responsibility for their health care decisions. 9. The student nurse is trying to determine what type of nurse she wants to be after graduation. In class, she states that community health nursing is probably not for her because community nursing focuses only on community issues such as preventing epidemics. The instructors most appropriate response would be that community health nursing a. Focuses on the health care of individuals, families, and groups in a community. b. Focuses only on the health of a specific subgroup in a community. c. Requires an advanced nursing degree, so the student need not worry. d. Focuses only on maintaining the health of the community. ANS: A Community health nursing is a nursing practice with the primary focus on the health care of individuals, families, and groups in a community. The goal is to preserve, protect, promote, or maintain health. Not all hiring agencies require an advanced degree. TO GET MORE MATERIALS HESI, ATI. KAPLAN - 10. Vulnerable populations include those patients who are more likely to develop health problems as a result of a. Pregnancy. b. Nontraditional healing practices. c. Excessive risk. d. Unlimited access to health care. ANS: C Vulnerable populations are those patients who are more likely to develop health problems as a result of excess risks or limits in access to health care services, or who are dependent on others for care. Pregnancy is not a cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs, or is at high risk for other reasons. Frequently, the immigrant population practices nontraditional healing practices. Many of these healing practices are effective and complement traditional therapies. 11. The instructor is teaching student nurses about identifying members of vulnerable populations when the nursing student asks, Why is it that not all poor people are considered members of vulnerable populations? The instructors best answer would be a. All poor people are members of a vulnerable population. b. Poor people are members of a vulnerable population only if they take drugs. c. Poor people are members of a vulnerable population only if they are homeless. d. Members of vulnerable groups frequently have a combination of risk factors. ANS: D TO GET MORE MATERIALS HESI, ATI. KAPLAN - Members of vulnerable groups frequently have many risks or a combination of risk factors that make them more sensitive to the negative effects of individual risk factors. Individual risk factors are not always overwhelming, depending on the patients beliefs and values and sources of social support. 12. The nurse is making a home visit to a Korean family whose daughter gave birth 6 weeks earlier. She finds the daughter in bed with a severe headache. The daughters father is holding her hand and is pressing different parts of the hand and lower arm. The mother explains that the father is trying to cure the headache by using pressure points. The nurses best response would be to a. Tell the father to stop and give the daughter Tylenol. b. Ask the mother and/or father to explain the procedure. c. Explain to the father that what he is doing will not work. d. Let the father finish and then give the daughter Tylenol. ANS: B The nurse should not judge the patients/familys beliefs and values about health. The nurse needs to create a comfortable, nonthreatening environment and to learn as much as possible about the patients culture and values that influence his or her health care practices. Tylenol may not be an acceptable alternative for this family. Criticizing the familys beliefs and practices will only create a barrier to care. 13. The nurse is working in a community clinic when a man and woman bring a 12 year-old boy in, stating that the child fell down a flight of stairs and hurt his arm. The nurse notices several other bruises on the childs body at varying stages of healing. The boy is placed on the stretcher. When asked how he hurt himself, he states that he does not remember. However, the nurse notices that the boy continuously avoids looking at the man, while the man stares at him constantly. The nurse should a. Ask the boy if the man hurt him. b. Confront the man directly. c. Ask the man and woman to step out. TO GET MORE MATERIALS HESI, ATI. KAPLAN - d. Ask the woman if the man hurt the boy. ANS: C Ask the man and woman to step out. When dealing with patients at risk for or who have suffered abuse, it is important to provide protection and to interview the patient at a time when he or she has privacy, and the individual suspected of being the abuser is not present. The boy may be less likely to be forthcoming with his attacker in the room. Confronting the man directly may lead to violence. The woman may also be a victim of abuse and may fear retribution if she discusses their problems with health care providers. 14. The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion. The nurse provides the patient with information on alternatives to abortion, but after several sessions, the patient still insists on having the abortion. The competency of the counselor requires the nurse to a. Insist that the patient speak with a Right-to-Life advocate. b. Provide a referral to an abortion service. c. Refuse to provide referral to an abortion service. d. Delay referral to an abortion service.