Test Bank: Brunner and Suddarth’s Textbook of Medical Surgical Nursing 13th Hinkle 978-1451130607
Chapter 1 Health Care Delivery and Evidence-Based Nursing Practice
1. The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health?
- A) Health is being disease free.
- B) Health is having fulfillment in all domains of life.
- C) Health is having psychological and physiological harmony.
- D) Health is being connected in body, mind, and spirit.
Ans: D Feedback:
The World Health Organization (WHO) defines health in the preamble to its constitution as a ìstate of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.î The other answers are incorrect because they are not congruent with the WHO definition of health.
2. A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is one characteristic the nurse would cite as necessary to possess to be an effective nurse?
- A) Sensitivity to cultural differences
- B) Team-focused approach to problem-solving
- C) Strict adherence to routine
- D) Ability to face criticism
To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict adherence to routine are not characteristics needed to be an effective nurse. The ability to handle criticism is important, but to a lesser degree than cultural competence.
3. With increases in longevity, people have had to become more knowledgeable about their health and the professional health care that they receive. One outcome of this phenomenon is the development of organized self-care education programs. Which of the following do these programs prioritize?
- A) Adequate prenatal care
- B) Government advocacy and lobbying
- C) Judicious use of online communities
- D) Management of illness
Organized self-care education programs emphasize health promotion, disease prevention, management of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and Internet activities are secondary.
4. The home health nurse is assisting a patient and his family in planning the patient’s return to work after surgery and the development of postsurgical complications. The nurse is preparing a plan of care that addresses the patient’s multifaceted needs. To which level of Maslow’s hierarchy of basic needs does the patient’s need for self- fulfillment relate?
- A) Physiologic
- B) Transcendence
- C) Love and belonging
- D) Self-actualization
Maslow’s highest level of human needs is self-actualization, which includes self- fulfillment, desire to know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does not relate directly to them.
5. The view that health and illness are not static states but that they exist on a continuum is central to professional health care systems. When planning care, this view aids the nurse in appreciating which of the following?
- A) Care should focus primarily on the treatment of disease.
- B) A person’s state of health is ever-changing.
- C) A person can transition from health to illness rapidly.
- D) Care should focus on the patient’s compliance with interventions.
By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a person’s state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The other answers are incorrect because patient care should not focus just on the treatment of disease. Rapid declines in health and ìcomplianceî with treatment are not key to this view of health.
6. A group of nursing students are participating in a community health clinic. When providing care in this context, what should the students teach participants about disease prevention?
- A) It is best achieved through attending self-help groups.
- B) It is best achieved by reducing psychological stress.
- C) It is best achieved by being an active participant in the community.
- D) It is best achieved by exhibiting behaviors that promote health.
Today, increasing emphasis is placed on health, health promotion, wellness, and self- care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle.
7. A nurse on a medical-surgical unit has asked to represent the unit on the hospital’s quality committee. When describing quality improvement programs to nursing colleagues and members of other health disciplines, what characteristic should the nurse cite?
- A) These programs establish consequences for health care professionals’ actions.
- B) These programs focus on the processes used to provide care.
- C) These programs identify specific incidents related to quality.
- D) These programs seek to justify health care costs and systems.
Numerous models seek to improve the quality of health care delivery. A commonality among them is a focus on the processes that are used to provide care. Consequences, a focus on incidents, and justification for health care costs are not universal characteristics of quality improvement efforts.
8. Nurses in acute care settings must work with other health care team members to maintain quality care while facing pressures to care for patients who are hospitalized for shorter periods of time than in the past. To ensure positive health outcomes when patients return to their homes, what action should the nurse prioritize?
- A) Promotion of health literacy during hospitalization
- B) Close communication with insurers
- C) Thorough and evidence-based discharge planning
- D) Participation in continuing education initiatives
Following discharges that occur after increasingly short hospital stays, nurses in the community care for patients who need high-technology acute care services as well as long-term care in the home. This is dependent on effective discharge planning to a greater degree than continuing education, communication with insurers, or promotion of health literacy.
9. You are admitting a patient to your medical unit after the patient has been transferred from the emergency department. What is your priority nursing action at this time?
- A) Identifying the immediate needs of the patient
- B) Checking the admitting physician’s orders
- C) Obtaining a baseline set of vital signs
- D) Allowing the family to be with the patient
Among the nurse’s important functions in health care delivery, identifying the patient’s immediate needs and working in concert with the patient to address them is most important. The other nursing functions are important, but they are not the most important functions.
10. A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?
- A) Helping the patient to achieve specific outcomes
- B) Balancing risks and benefits of interventions
- C) Documenting the patient’s response to therapy
- D) Staying accountable to the interdisciplinary team
Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount.
11. Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized patients. How does this demonstrate a role of the APRN?
- A) Involving patients in their care while hospitalized
- B) Contributing to the scientific basis of nursing practice
- C) Critiquing the quality of patient care
- D) Explaining medical studies to patients and RNs
Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving patients in their care.
12. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of practice for the nurse in today’s health care environment is home health care. What is the main basis for the growth in this health care setting?
- A) Chronic nursing shortage
- B) Western focus on treatment of disease
- C) Nurses’ preferences for day shifts instead of evening or night shifts
- D) Discharge of patients who are more critically ill
With shorter hospital stays and increased use of outpatient health care services, more nursing care is provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting.
13. Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurse’s title?
- A) Nursing care expert
- B) Clinical nurse specialist
- C) Nurse manager
- D) Staff nurse
Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care (e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse.
14. Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the patient. Which of the following is the best example of a collaborative practice model?
- A) The nurse and the physician jointly making clinical decisions.
- B) The nurse accompanying the physician on rounds.
- C) The nurse making a referral on behalf of the patient.
- D) The nurse attending an appointment with the patient.
The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model.
15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslow’s hierarchy of needs, what dimension of care should the nurse consider primary in importance when caring for a dying patient?
- A) Spiritual
- B) Social
- C) Physiologic
- D) Emotional
Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for a dying patient, though each should certainly be addressed.
16. A nurse is planning a medical patient’s care with consideration of Maslow’s hierarchy of needs. Within this framework of understanding, what would be the nurse’s first priority?
- A) Allowing the family to see a newly admitted patient
- B) Ambulating the patient in the hallway
- C) Administering pain medication
- D) Teaching the patient to self-administer insulin safely
In Maslow’s hierarchy of needs, pain relief addresses the patient’s basic physiologic need. Activity, such as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family addresses a higher level need related to love and belonging. Teaching the patient is also a higher level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the patient can address these higher level needs.
17. A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurse’s compliance with the nurse practice act demonstrates adherence to which of the following?
- A) National Council of Nursing’s guidelines for care
- B) National League for Nursing’s Code of Conduct
- C) American Nurses Association’s Social Policy Statement
- D) Department of Health and Human Service’s White Paper on Nursing
Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included in the ANA’s white paper. The DHHS has not published a white paper on nursing nor has the NLN published a specific code of conduct.
18. Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the changing health needs of our aging population. What is one factor that has impacted the need for certified nurse practitioners (CNPs)?
- A) The increased need for primary care providers
- B) The need to improve patient diagnostic services
- C) The push to drive institutional excellence
- D) The need to decrease the number of medical errors
CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primary care or acute care. CNPs help meet the need for primary care providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.
19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement?
- A) By liaising with the members of the interdisciplinary care team
- B) By critically appraising the outcomes of care that is provided
- C) By integrating the patient’s preferences into the plan of care
- D) By documenting care in the electronic health record in a timely fashion
Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement activities.
20. Professional nursing expands and grows because of factors driven by the changing needs of health care consumers. Which of the following is a factor that nurses should reflect in the planning and provision of health care?
- A) Decreased access to health care information by individuals
- B) Gradual increases in the cultural unity of the American population
- C) Increasing mean and median age of the American population
- D) Decreasing consumer expectations related to health care outcomes
The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer school-age children and more senior citizens, many of whom are women.
The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. Access to information and consumer expectations continue to increase.
21. A public health nurse has been commissioned to draft a health promotion program that meets the health care needs and expectations of the community. Which of the following focuses is most likely to influence the nurse’s choice of interventions?
- A) Management of chronic conditions and disability
- B) Increasing need for self-care among a younger population
- C) A shifting focus to disease management
- D) An increasing focus on acute conditions and rehabilitation
In response to current priorities, health care must focus more on management of chronic conditions and disability than in previous times. The other answers are incorrect because the change in focus of health care is not an increasing need for self- care among our aging population; our focus is shifting away from disease management, not toward it; and we are moving away from the management of acute conditions to managing chronic conditions.
22. A community health nurse has witnessed significant shifts in patterns of disease over the course of a four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of disease in the United States?
- A) Type 1 diabetes management
- B) Treatment of community-acquired pneumonia
- C) Rehabilitation from traumatic brain injuries
- D) Management of acute Staphylococcus aureus infections
Management of chronic diseases such as diabetes is a priority focus of the current health care environment. This supersedes the treatment of acute infections and rehabilitation needs.
23. The ANA has identified several phenomena toward which the focus of nursing care should be directed, and a nurse is planning care that reflects these priorities. Which of the nurse’s actions best demonstrates these priorities?
- A) Encouraging the patient’s dependence on caregivers
- B) Fostering the patient’s ability to make choices
- C) Teaching the patient about nurses’ roles in the health care system
- D) Assessing the patient’s adherence to treatment
The ANA identifies several focuses for nursing care and research, including the ability to make choices. The other answers are incorrect because they are not phenomena identified by the ANA.
24. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of health care. Which of the following activities are considered integral to the CNP role? Select all that apply.
- A) Educating patients and family members
- B) Coordinating care with other disciplines
- C) Using direct provision of interventions
- D) Educating registered nurses and practical nurses
- E) Coordinating payment plans for patients
Ans: A, B, C
This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in home care and community nursing. Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to perform care, and by coordinating and collaborating with other disciplines to provide needed services. The other answers are incorrect because NPs do not commonly perform education of nurses and they do not focus on matters related to payment.
25. The ANA has identified central characteristics of nursing practice that are applicable across the wide variety of contexts in which nurses practice. A nurse can best demonstrate these principles by performing which of the following actions?
- A) Teaching the public about the role of nursing
- B) Taking action to control the costs of health care
- C) Ensuring that all of his or her actions exemplify caring
- D) Making sure to carry adequate liability insurance
The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a central tenet of nursing practice.
26. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched within the past decade. In this role, the nurse should prioritize which of the following activities?
- A) Acting as a spokesperson for the nursing profession
- B) Generating and disseminating new nursing knowledge
- C) Diagnosing and treating health problems that have a predictable course
- D) Helping patients to navigate the health care system
The CNL is a nurse generalist with a master’s degree in nursing and a special background in clinical leadership, educated to help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role.
27. Our world is connected by a sophisticated communication system that makes much health information instantly accessible, no matter where the patient is being treated. This instant access to health information has impacted health care delivery strategies, including the delivery of nursing care. What is one way the delivery of health care has been impacted by this phenomenon?
- A) Brisk changes as well as swift obsolescence
- B) Rapid change that is nearly permanent
- C) Limitations on the settings where care can be provided
- D) Increased need for social acceptance
The sophisticated communication systems that connect most parts of the world, with the capability of rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift obsolescence in health care delivery strategies. The other answers are incorrect because, although we have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care itself evolves. Giving nursing care has not become easier, it becomes more complex with every change; and it does not need to be more socially acceptable; it needs to be more culturally sensitive.
28. With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses, as when acute care nurses collaborate with public health and home health nurses. What nursing function has increased in importance because of this phenomenon?
- A) Prescribing medication
- B) Performing discharge planning
- C) Promoting family involvement
- D) Forming collegial relationships
The importance of effective discharge planning and quality improvement cannot be overstated. The other answers are incorrect because giving medication and family involvement in the patient’s care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible.
29. A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help the nurse achieve what goal?
- A) Increasing career satisfaction
- B) Obtaining federal grant money
- C) Ensuring high quality patient care
- D) Enhancing the public’s esteem for nursing
Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money are not priorities.
30. A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospital’s leadership?
- A) Decreased need for physician services
- B) Improved patient and family education
- C) Increased adherence to the principles of EBP
- D) Increased coordination of health services
Case management is a system of coordinating health care services to ensure cost- effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies. Reducing the need for physician services is not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role.
31. A hospital’s current quality improvement program has integrated the principles of the Institute for Healthcare Improvement (IHI) 5 Million Lives Campaign. How can the hospital best achieve the campaign goals of reducing preventable harm and death?
- A) By adhering to EBP guidelines
- B) By reducing nurse-to-patient ratios and increasing accountability
- C) By having researchers from outside the facility evaluate care
- D) By involving patients and families in their care planning
The 5 Million Lives Campaign posits that if evidence-based guidelines it advocated were voluntarily implemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a two-year period. Nurse-to-patient ratios, family participation, and independent evaluation are not stated components of the campaign.
32. Over the past several decades, nursing roles have changed and expanded in many ways. Which of the following factors has provided the strongest impetus for this change?
- A) The need to decrease the cost of health care
- B) The need to improve the quality of nursing education
- C) The need to increase the number of nursing jobs available
- D) The need to increase the public perception of nursing
Ans: A Feedback:
The role of the nurse has expanded to improve the distribution of health care services and to decrease the cost of health care. The other answers are incorrect because the expansion of roles in nursing did not occur to improve education, increase the number of nursing jobs, or increase public perception.
33. Advanced practice nursing roles have grown in number and in visibility in recent years. What characteristic sets these nurses apart from the registered nurse?
- A) Collaboration with other health care providers
- B) Education that goes beyond that of the RN
- C) Advanced documentation skills
- D) Ability to provide care in the surgical context
There is wide variety in APRN roles. However, a commonality is that they require education beyond that of the professional RN. All nurses collaborate with other health care providers to provide nursing care to their patients. Advanced documentation skills are not what sets advanced practice nurses apart from the staff nurse. RNs have the ability to provide care in the operating room.
34. CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states, what right do CNPs have that RNs do not possess?
- A) Perform health interventions independently
- B) Make referrals to members of other health disciplines
- C) Prescribe medications
- D) Perform surgery independently
In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope of practice and all professional nurses may perform interventions and make certain referrals.
35. A team of community health nurses are planning to draft a proposal for a program that will increase the community’s alignment with the principles contained in the Healthy People 2020 report. Which of the following activities would best demonstrate the priorities identified in this report?
- A) Addressing determinants of health such as clean environments and safety in the community
- B) Lobbying for increased funding to the county hospital where many residents receive primary care
- C) Collaborating with health professionals in neighboring communities to pool resources and increase efficiencies
- D) Creating clinical placements where nursing students and members of other health disciplines can gain experience in a community setting
Healthy People 2020 addresses social determinants of health such as safety and the state of the environment. This report does not specifically address matters such as hospital funding, nursing education, or resource allocation.
36. A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and self-care. Which of the following activities would best demonstrate the principles of health promotion?
- A) A discharge planning initiative between acute care and community care nurses
- B) Collaboration between several schools of nursing in an urban area
- C) Creation of a smoking prevention program undertaken in a middle school
- D) Establishment of a website where patients can check emergency department wait-times
Smoking prevention is a clear example of health promotion. Each of the other listed activities has the potential to be beneficial, but none is considered health promotion.
37. A group of nursing students are learning about recent changes in the pattern of disease in the United States. Which of the following statements best describes these current changes?
- A) Infectious diseases continue to decrease in incidence and prevalence.
- B) Chronic illnesses are becoming increasingly resistant to treatment.
- C) Most acute, infectious diseases have been eradicated.
- D) Most, but not all, communicable diseases are declining.
Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibiotic resistance is a more serious problem in acute, not chronic, illnesses.
38. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a large, university medical center according to core measures. Evaluators should perform this evaluation in what way?
- A) By auditing the medical center’s electronic health records
- B) By performing focus groups and interviews with care providers from numerous disciplines
- C) By performing statistical analysis of patient satisfaction surveys
- D) By comparing the center’s patient outcomes to best practice indicators
Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seek treatment for a specific disease or who need a specific treatment as compared to evidence-based guidelines and standards of care. Benchmark standards of quality are used to compare the care or treatment patients receive with the best practice standards. Patient satisfaction is considered, but this is not the only criterion.
39. Leadership of a medical unit have been instructed to integrate the principles of the Quality and Safety Education for Nurses (QSEN) competency of quality improvement. What action should the unit’s leaders take?
- A) Provide access to online journals and Web-based clinical resources for nursingstaff.
- B) Use flow charts to document the processes of care that are used on the unit.
- C) Enforce continuing education requirements for all care providers.
- D) Reduce the use of chemical and physical restraints on the unit.
One of the quality improvement skills is to use tools, such as flow charts and cause- effect diagrams, to make processes of care explicit. Each of the other listed actions has the potential to benefit patients and care givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency.
40. The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to the educational programs that teach nurses and members of other health professions. According to this report, what activity should educational institutions prioritize?
- A) More clearly delineate each profession’s scope of practice during education
- B) Move toward developing a single health curriculum that can be adapted for anyhealth profession
- C) Include interdisciplinary core competencies into curricula
- D) Elicit input from patients and families into health care curricula
Health Professions Education: A Bridge to Quality challenged health professions’ education programs to integrate interdisciplinary core competencies into their respective curricula to include patient-centered care, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input, or a single curriculum.