NUR 160 - Fundamentals of nursing study questions (9th Edition) - Test Bank(2019/20) Chapter 5 to 50, Multiple choice Questions & Correct Answers Explained.

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Fundamentals of nursing study questions NUR 160 Chapter 04: Theoretical Foundations of Nursing Practice Chapter 04: Theoretical Foundations of Nursing Practice Potter et al.: Fundamentals of Nursi... ng, 9th Edition MULTIPLE CHOICE 1. The nursing instructor is teaching a class on nursing theory. One of the students asks, “Why do we need to know this stuff? It doesn’t really affect patients.” What is the instructor’s bestresponse? a. “You are correct, but we have to learn it anyway.” b. “This keeps the focus of nursing narrow.” c. “Theories help explain why nurses do what they do.” d. “Exposure to theories will help you later in graduate school.” ANS: C Theories offer well­grounded rationales for how and why nurses perform specific interventions and for predicting and/or prescribing nursing care measures. Although nursing theory will help the nurse in graduate school, it is also an important basis for the nurse’s approach to daily patient care, and it expands scientific knowledge of the profession. DIF:Apply (application)REF:41 OBJ: Explain the influence of nursing theory on a nurse’s approach to practice. TOP:ImplementationMSC:Management of Care 2. The nurse is caring for a patient who does not follow the prescribed regimen for diabetes management. As a prescriber to Orem’s theory, the nurse interviews the patient in an attempt to identify the cause of the patient’s “noncompliance.” What is the rationale for the nurse’s behavior? a. Orem’s theory is useful in designing interventions to promote self-care. b. Orem’s theory focuses on cultural issues that may affect compliance. c. Orem’s theory allows for reduction of anxiety with communication. d. Orem’s theory helps nurses manipulate the patient’s environment. ANS: A When applying Orem’s theory, a nurse continually assesses a patient’s ability to perform self­care and intervenes as needed to ensure that the patients meet physical, psychological, sociological, and developmental needs. According to Orem, people who participate in self­care activities are more likely to improve their health outcomes. Leiniger’s culture care theory focuses on culture diversity and provides culturally specific nursing care. According to Peplau, nurses help patients reduce anxiety by converting it into constructive actions, using therapeutic communication. Nightingale’s grand theory is a patient’s environment can be manipulated by nurses to restore a patient to health. DIF:Apply (application)REF:47­48 OBJ: Explain the influence of nursing theory on a nurse’s approach to practice. TOP:EvaluationMSC:Management of Care 3. A nurse is testing meditation for migraine headaches and the expected outcome of care when performing this intervention. Which type of theory is the nurse using? a. Grand b. Prescriptive c. Descriptive d. Middle-range ANS: B A prescriptive theory details nursing interventions (meditation) for a specific phenomenon (migraine headaches) and the expected outcome of the care. Grand theories are broad in scope and complex and require further specification through research; it does not provide guidance for specific nursing interventions. Descriptive theories do not direct specific nursing activities but help to explain patient assessment. A middle­range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations. DIF:Apply (application)REF:44 OBJ:Describe types of nursing theories.TOP:Implementation MSC:Management of Care 4. The nurse researcher is evaluating whether holding pressure at an injection site after injecting the anticoagulant enoxaparin will reduce bruising at the injection site. This study involves a prescriptive theory. What is the nurse’s rationale for involving a prescriptive theory? a. It explains why bruising occurs. b. It is broad in scope and complex. c. It tests a specific nursing intervention. d. It reflects a wide variety of nursing care situations. ANS: C Prescriptive theories detail nursing interventions for a specific phenomenon and the expected outcome of the care but it does not explain why. Grand theories are broad in scope and complex and focus on a wide variety of nursing care situations. DIF:Apply (application)REF:44 OBJ: Describe types of nursing theories. TOP: Planning MSC: Management of Care 5. A nurse is using nursing theory and the nursing process simultaneously to plan nursing care. How will the nurse use nursing theory and the nursing process in practice? a. Nursing theory can direct how a nurse uses the nursing process. b. Nursing theory requires the nursing process to develop knowledge. c. Nursing theory with the nursing process has a minor role in professional nursing. d. Nursing theory combined with the nursing process is specific to certain ill patients. ANS: A Nursing theory can direct how a nurse uses the nursing process. Integration of theory into practice (nursing process) serves as the basis for professional nursing. The nursing process provides a systematic process for the delivery of care, not the knowledge component of the discipline. Useful theories are adaptable to different patients and to all care settings. DIF:Understand (comprehension)REF:44­45 OBJ: Describe the relationship among nursing theory, the nursing process, and patient needs. TOP:ImplementationMSC:Management of Care 6. The nurse views the patient as an open system that needs help in coping with stressors. Which theorist is the nurse using? a. King b. Levine c. Neuman d. Johnson ANS: C Neuman views a patient as being an open system that is in constant energy exchange with the environment that the nurse must help cope with stressors. King views a patient as a unique personal system that is constantly interacting/transacting with other systems that the nurse helps with goal attainment. Levine believes nurses promote balance between nursing interventions and patient participation to assist in conserving energy needed for healing. Johnson perceives patients as a collection of subsystems that forms an overall behavioral system focusing on balance. DIF:Apply (application)REF:46 OBJ: Review selected nursing theories. TOP: Evaluation MSC: Management of Care 7. The nurse is caring for a patient diagnosed with essential hypertension. The health care provider prescribes blood pressure medication that the nurse administers. The nurse then monitors the patient’s blood pressure for several days to help determine effectiveness. Which system component is the nurse evaluating? a. Input b. Output c. Content d. Feedback ANS: B Output is the end product of a system and, in the case of the nursing process, it is defined as whether the patient’s health status improves or remains stable as a result of nursing care. Input consists of the data that come from a patient’s assessment. Feedback serves to inform a system about how it functions. Content is the product and information obtained from the system. DIF:Apply (application)REF:45 OBJ: Review selected shared theories from other disciplines. TOP: Evaluation MSC:Management of Care 8. A patient is admitted with possible methicillin­resistant Staphylococcus aureus (MRSA) and is placed in isolation until cultures can be obtained and declared noninfectious. During the isolation process, the nurse encourages family visits. Which level of Maslow’s hierarchy of needs is the nurse promoting when the family is encouraged to visit? a. First level b. Second level c. Third level d. Fourth level ANS: C The third level contains love and belonging needs, including family and friends. The first level includes physiological needs. The second level includes safety and security needs. The fourth level encompasses esteem and self­esteem needs. The fifth and final level is the need for selfactualization. DIF:Apply (application)REF:46 OBJ: Review selected shared theories from other disciplines. TOP: Implementation MSC: Psychosocial Integrity 9. A nurse is caring for pediatric patients and using the developmental theory to plan nursing care. What is the focus of this nurse’s care? a. Humans have an orderly, predictive process of growth and development. b. Humans respond to threats by adapting with growth and development. c. Humans respond with cognitive principles for growth and development. d. Humans have psychosocial domains to growth and development. ANS: A With development theory, human growth and development is an orderly predictive process that begins with conception and continues through death. Stress/adaptation theories describe how humans respond to threats by adapting in order to maintain function and life. Educational theories explain the teaching­learning process by examining behavioral, cognitive, and adult­learning principles. Psychosocial theories explain human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains. DIF:Apply (application)REF:46 OBJ: Review selected shared theories from other disciplines. TOP: Evaluation MSC:Health Promotion and Maintenance 10. Upon assessment, the nurse notices that the patient’s respirations have increased, and the tip of the nose and earlobes are becoming cyanotic. The nurse finds that the patient’s pulse rate is over 100 beats per minute. According to Maslow’s hierarchy of needs, which patient need should the nurse address first? a. Self-esteem b. Physiological c. Self-actualization d. Love and belonging ANS: B Maslow’s hierarchy is useful in setting patient priorities. Basic physiological and safety needs are usually the first priority. After the physiological and safety needs are met, the nurse can move to love and belonging, self­esteem, and self­actualization. DIF:Apply (application)REF:46 OBJ: Review selected shared theories from other disciplines. TOP: Implementation MSC:Management of Care 11. Which behavior from a nurse indicates the nurse is using Nightingale’s theory to plan nursing care? a. Knows all about the disease processes affecting patients b. Focuses on medication administration and treatments c. Thinks about the patients and patients’ environments d. Considers nursing knowledge and medicine the same ANS: C Nightingale’s theory provides nurses with a way to think about patients and their environment. Nightingale’s concept of the environment was the focus of nursing care, and her firm conviction was that nursing knowledge is distinct from medical knowledge. Nightingale did not view nursing as limited to the administration of medications and treatments. DIF:Understand (comprehension)REF:44­ 45 OBJ: Review selected nursing theories. TOP: Planning MSC: Management of Care 12. The home health nurse listens to the patient’s concerns about having “open­heart” surgery. The nurse explains the different surgical procedures and other options, like cardiac rehabilitation. After several visits, the patient wants cardiac rehabilitation. The nurse notifies the health care provider and sets up a referral. Which theory is the nurse using? a. Peplau’s theory b. Henderson’s theory c. Nightingale’s theory d. Orem’s self-care deficit theory ANS: A Peplau’s theory focuses on the individual, the nurse, and the interactive process or nurse­patient relationship. The nurse serves as a resource person, counselor, and surrogate. Henderson’s theory focuses on helping the patient with activities that the patient would perform unaided if he or she were able. Nightingale viewed nursing not as limited to the administration of medications and treatments but rather as oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. The goal of Orem’s theory is to help the patient perform self­care. DIF:Apply (application)REF:45 OBJ:Review selected nursing theories.TOP:Implementation MSC: Psychosocial Integrity 13. The nurse is caring for a patient who is actively bleeding. The health care provider prescribes blood transfusions. The patient is a Jehovah’s Witness and does not want blood products. The nurse contacts the health care provider to request alternative treatment. Which theory is the nurse using? a. Roy’s theory b. Leininger’s theory c. Watson’s theory d. Orem’s theory ANS: B The goal of Leininger’s theory is to provide the patient with culturally specific nursing care that integrates the patient’s cultural traditions, values, and beliefs into the plan of care. The goal of Roy’s model is to help the person adapt to changes in physiological needs, self­concept, role function, and interdependence domains. Watson’s theory believes that the purpose of nursing action is to understand the interrelationship between health, illness, and human behavior. The goal of Orem’s theory is to help the patient perform self­care. DIF:Apply (application)REF:48 OBJ:Review selected nursing theories.TOP:Implementation MSC:Management of Care 14. The patient is terminally ill and is receiving hospice care. The nurse cares for the patient by bathing, shaving, and repositioning him. The patient would like a Catholic priest called to provide the Sacrament of the Sick. The nurse places a call and arranges for the priest’s visit. Which theory does this nurse’s care represent? a. Roy’s theory b. Watson’s theory c. Henderson’s theory d. Orem’s self-care deficit theory ANS: C Henderson defines nursing as assisting the patient with 14 activities (hygiene, positioning) until patients can meet these needs for themselves—or assist patients to have a peaceful death. Roy’s model is to help the person adapt to changes in physiological needs, self­concept, role function, and interdependence domains. Watson’s theory believes that the purpose of nursing is to understand the interrelationship between health, illness, and human behavior. The goal of Orem’s theory is to help the patient perform self­care. DIF:Apply (application)REF:46 OBJ: Review selected nursing theories. TOP: Evaluation MSC: Management of Care 15. The patient is newly diagnosed with diabetes and will be discharged in the next day or so. The nurse is teaching the patient how to draw up and self­administer insulin. Which nursing theory is the nurse utilizing? a. Watson’s theory b. Orem’s theory c. Roger’s theory d. Henderson’s theory ANS: B The goal of Orem’s theory is to help the patient perform self­care. In Watson’s theory, the nurse is concerned with promoting and restoring health and preventing illness. Roger’s theory considers caring as a fundamental component of professional nursing practice and is based upon 10 curative factors. Henderson defines nursing as assisting patients with 14 activities until patients can meet these needs for themselves. DIF:Apply (application)REF:47­48 OBJ:Review selected nursing theories.TOP:Implementation MSC:Health Promotion and Maintenance 16. A nurse is conducting research about the needs of depressed patients. The nurse writes the following: Depression is a patient reporting a score above 7 on the Hamilton Depression Rating Scale. What did the nurse write? a. Operational definition b. Conceptual definition c. Paradigm d. Concept ANS: A Operational definitions state how concepts are measured (Hamilton Depression Rating Scale). Theoretical or conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on the theorist’s perspective (a mood disorder causing severe sadness and apathy). A paradigm is a pattern of beliefs used to describe a discipline’s domain. Think of concepts as ideas and mental images, like depression is a concept. DIF:Analyze (analysis)REF:42 OBJ: Describe theory­based nursing practice. TOP: Evaluation MSC:Management of Care 17. Which action indicates the nurse is using the nursing process in patient care? a. Generates nursing knowledge for use in nursing practice. b. Conceptualizes an aspect of nursing to predict nursing care. c. Develops nursing care as a specific, distinct phenomenon. d. Delivers nursing care using a systematic approach. ANS: D The nursing process provides a systematic approach for the delivery of nursing care. Theory generates nursing knowledge for use in practice; the nursing process is not a theory. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. An interdisciplinary theory explains a phenomenon specific to the discipline that developed the theory. DIF:Analyze (analysis)REF:44 OBJ: Describe the relationship among nursing theory, the nursing process, and patient needs. TOP:EvaluationMSC:Management of Care 18. A nurse is using theoretical knowledge in nursing practice to provide patient care. Which nursing behavior is an example of theoretical knowledge? a. Reads about different concepts b. Reflects on clinical experiences c. Combines the art and science of nursing d. Creates a narrow understanding of nursing practice ANS: A Theoretical knowledge is acquired through “reading, observing, or discussing” concepts. The goals of theoretical knowledge are to stimulate thinking and create a broad understanding of nursing science and practices. Experiential, or clinical, knowledge is formed from nurses’ clinical experiences. Both types of knowledge are needed in order to provide safe, comprehensive nursing care. DIF:Understand (comprehension)REF:48 OBJ: Describe theory­based nursing practice. TOP: Teaching/Learning MSC:Management of Care 19. A nurse is using Maslow’s hierarchy of needs to prioritize care. Place the levels in order of basic priority to highest priority that the nurse will follow. 1. Physiological 2. Self­esteem 3. Self­actualization 4. Safety and security 5. Love and belonging a. 4, 1, 2, 3, 5 b. 1, 4, 5, 3, 2 c. 4, 5, 3, 2, 1 d. 1, 4, 5, 2, 3 ANS: D Maslow’s hierarchy is as follows: physiological, safety and security, love and belonging, self­esteem, and self­actualization. DIF:Understand (comprehension)REF:46 OBJ: Review selected shared theories from other disciplines. TOP: Caring MSC:Management of Care MULTIPLE RESPONSE 1. A nurse is using a nursing metaparadigm to define nursing. Which concepts will the nurse include? (Select all that apply.) a. Person b. Disease c. Health d. Nursing e. Environment ANS: A, C, D, E Nursing’s metaparadigm includes four concepts: person, health, environment/situation, and nursing. Disease is not part of nursing’s metaparadigm. DIF:Understand (comprehension)REF:42­43 OBJ: Explain the influence of nursing theory on a nurse’s approach to practice. TOP:PlanningMSC:Management of Care 2. A nurse wants to incorporate psychosocial theories into nursing practice. Which elements will the nurse include? (Select all that apply.) a. Physiological needs of the patient b. Psychological needs of the patient c. Sociocultural needs of the patient d. Cognitive needs of the patient e. Spiritual needs of the patient ANS: A, B, C, E When nursing incorporates psychosocial theories into nursing practice, the nurse strives to meet the physiological, psychological, sociocultural, developmental, and spiritual needs of patients. Cognitive needs of the patient are included in educational theories. DIF:Understand (comprehension)REF:46 OBJ: Review selected shared theories from other disciplines. TOP: Caring MSC: Psychosocial Integrity Chapter 05: Evidence-Based Practice Chapter 05: Evidence­Based Practice Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse uses evidence­based practice (EBP) to provide nursing care. What is the bestrationale for the nurse’s behavior? a. EBP is a guide for nurses in making clinical decisions. b. EBP is based on the latest textbook information. c. EBP is easily attained at the bedside. d. EBP is always right for all situations. ANS: A Evidence­based practice (EBP) is a guide for nurses to structure how to make appropriate, timely, and effective clinical decisions. A textbook relies on the scientific literature, which may be outdated by the time the book is published. Unfortunately, much of the best evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills. DIF:Understand (comprehension)REF:52 OBJ: Discuss the benefits of evidence­based practice. TOP: Evaluation MSC:Management of Care 2. In caring for patients, what must the nurse remember about evidence­based practice (EBP)? a. EBP is the only valid source of knowledge that should be used. b. EBP is secondary to traditional or convenient care knowledge. c. EBP is dependent on patient values and expectations. d. EBP is not shown to provide better patient outcomes. ANS: C Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience. Although these sources have value, it is important to learn to rely more on research evidence than on nonresearch evidence. Evidence­based care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs. DIF:Understand (comprehension)REF:53 OBJ: Discuss the benefits of evidence­based practice. TOP: Implementation MSC:Management of Care 3. A nurse wants to change a patient procedure. Which action will the nurse take to easily find research evidence to support this change? a. Read all the articles found on the Internet. b. Make a general search of the Internet. c. Use a PICOT format for the search. d. Start with a broad question. ANS: C The more focused the question is, the easier it becomes to search for evidence in the scientific literature. The PICO format allows the nurse to ask focused questions that are intervention based. Inappropriately formed questions (general search or broad question) will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. DIF:Apply (application)REF:54 OBJ: Describe the steps of evidence­based practice. TOP: Implementation MSC:Management of Care 4. A nurse has collected several research findings for evidence­based practice. Which article will be the best for the nurse to use? a. An article that uses randomized controlled trials (RCT) b. An article that is an opinion of expert committees c. An article that uses qualitative research d. An article that is peer-reviewed ANS: A Individual RCTs are the highest level of evidence or “gold standard” for research. A peer­reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence. DIF:Understand (comprehension)REF:55­56 OBJ: Explain the levels of evidence available in the literature. TOP: Assessment MSC:Management of Care 5. The nurse is reviewing a research article on a patient care topic. Which area should entice the nurse to read the article? a. Literature review b. Introduction c. Methods d. Results ANS: B The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The literature review or background offers a detailed background of the level of science or clinical information about the topic of the article. The methods or design section explains how a research study was organized and conducted. The results or conclusion section details the results of the study and explains whether a hypothesis is supported. DIF:Understand (comprehension)REF:56 OBJ:Describe the steps of evidence­based practice. TOP: Communication and Documentation MSC: Management of Care 6. The nurse is caring for a patient with chronic low back pain. The nurse wants to determine the best evidence­based practice regarding clinical guidelines for low back pain. What is the best database for the nurse to access? a. MEDLINE b. EMBASE c. PsycINFO d. AHRQ ANS: D The Agency for Healthcare Research and Quality (AHRQ) includes clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines. DIF:Apply (application)REF:55 OBJ: Describe the steps of evidence­based practice. TOP: Implementation MSC:Management of Care 7. A nurse writes the following PICOT question: How do patients with breast cancer rate their quality of life? How should the nurse evaluate this question? a. A true PICOT question regardless of the number of elements b. A true PICOT question because the intervention comes before the control c. Not a true PICOT question because the comparison comes after the intervention d. Not a true PICOT question because the time is not designated ANS: A A meaningful PICOT question can contain only a P and O: How do patients with breast cancer (P) rate their quality of life (O)? Note that a well­designed PICOT question does not have to follow the sequence of P, I, C, O, and T. The aim is to ask a question that contains as many of the PICOT elements as possible. DIF: Analyze (analysis) REF: 54 OBJ: Develop a PICOT question. TOP:EvaluationMSC:Management of Care 8. A nurse is reviewing literature for an evidence­based practice study. Which study should the nurse use for the most reliable level of evidence that uses statistics to show effectiveness? a. Meta-analysis b. Systematic review c. Single random controlled trial d. Control trial without randomization ANS: A The main difference is that in a meta­analysis the researcher uses statistics to show the effect of an intervention on an outcome. In a systematic review no statistics are used to draw conclusions about the evidence. A single random controlled trial (RCT) is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted. DIF:Analyze (analysis)REF:55 OBJ: Explain the levels of evidence available in the literature. TOP: Planning MSC:Management of Care 9. A nurse is reviewing research studies for evidence­based practice. Which article should the nurse use for qualitative nursing research? a. An article about the number of falls after use of no side rails b. An article about infection rates after use of a new wound dressing c. An article about the percentage of new admissions on a new floor d. An article about emotional needs of dying patients and their families ANS: D Studying emotional needs is a qualitative study. Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients’ perceptions of illness. The number of falls, infection rates, and percentages of new admissions are all examples of quantitative research. DIF:Analyze (analysis)REF:60 OBJ: Explain how nursing research improves nursing practice. TOP: Assessment MSC:Management of Care 10. A nurse develops the following PICOT question: Do patients who listen to music achieve better control of their anxiety and pain after surgery when compared with patients who receive standard nursing care following surgery? Which information will the nurse use as the “C”? a. After surgery b. Who listen to music c. Who receive standard nursing care d. Achieve better control of their anxiety and pain ANS: C Do patients (P) who listen to music (I) achieve better control of their anxiety and pain (O) after surgery (T) when compared with patients who receive standard nursing care following surgery (C)? DIF: Understand (comprehension) REF: 54 OBJ: Develop a PICOT question. TOP:ImplementationMSC:Management of Care 11. The nurse uses a PICOT question to develop an evidence­based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more evidence than is available at this time. What is the nurse’s best option? a. Conduct a pilot study to investigate findings. b. Drop the idea of making the change at this time. c. Insist that management hire the needed staff to facilitate the change. d. Seek employment in another institution that may have the staff needed. ANS: A When evidence is not strong enough to apply in practice, the next option is to conduct a pilot study to investigate the PICOT question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines. DIF:Apply (application)REF:57 OBJ: Discuss ways to apply evidence in practice. TOP: Implementation MSC:Management of Care 12. The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation from patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. Which type of research is the nurse conducting? a. Nonexperimental research b. Experimental research c. Qualitative research d. Evaluation research ANS: C Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent’s decision to smoke cigarettes. DIF:Analyze (analysis)REF:60 OBJ: Explain how nursing research improves nursing practice. TOP: Implementation MSC:Management of Care 13. In conducting a research study, the nurse researcher guarantees the subject no information will be reported in any manner that will identify the subject and only the research team will have access to the information. Which concept is the nurse researcher fulfilling? a. Bias b. Confidentiality c. Informed consent d. The research process ANS: B Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Biases are opinions that may influence the results of research. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer. DIF:Understand (comprehension)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 14. The nurse researcher is preparing to publish the findings and is preparing to add the limitations to the manuscript. Which area of the manuscript will the nurse researcher add this information? a. Abstract b. Conclusion c. Study design d. Clinical implications ANS: B During results or conclusions, the researcher interprets the findings of the study, including limitations. An abstract summarizes the purpose of the article with major findings. Study design involves selection of research methods and type of study conducted. The researcher explains how to apply findings in a practice setting for the type of subjects studied in the clinical implications section. DIF:Understand (comprehension)REF:56 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 15. A nurse is trying to decrease the rate of falls on the unit. After reviewing the literature, a strategy is implemented on the unit. After 3 months, the nurse finds that the falls have decreased. Which process did the nurse institute? a. Performance improvement b. Peer-reviewed project c. Generalizability study d. Qualitative research ANS: A Performance improvement focuses on performance issues like falls or pressure ulcer incidence. A peer­reviewed article is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published. Generalizability is not a study/research; it is if the results of a study can be compared to other patients with similar experiences. This is a quantitative study, not a qualitative study. DIF:Apply (application)REF:57 OBJ: Explain the relationship between evidence­based practice and performance improvement. TOP:ImplementationMSC:Management of Care 16. A nurse identifies a clinical problem with pressure ulcers. Which step should the nurse take next in the research process? a. Analyze results. b. Conduct the study. c. Determine method. d. Develop a hypothesis. ANS: D After identifying an area of interest or clinical problem, the steps of the research process are as follows: Develop research question(s)/hypotheses; determine how the study will be conducted; conduct the study; and analyze results of the study. DIF:Apply (application)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 17. After reviewing the literature, the evidence­based practice committee institutes a practice change that bedrails should be left in the down position and hourly nursing rounds should be conducted. The results indicate over a 40% reduction in falls. What is the committee’s next step? a. Evaluate the changes in 1 month. b. Implement the changes as a pilot study. c. Wait a month before implementing the changes. d. Communicate to staff the results of this project. ANS: D The last step of evidence­based practice (EBP) is to share the outcomes of EBP changes with others. Changes must be evaluated before the outcomes are shared. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either hospital wide or as a pilot study). Waiting should not be an option unless the results are not to the committee’s liking. DIF:Apply (application)REF:57 OBJ: Discuss ways to apply evidence in practice. TOP: Implementation MSC:Management of Care 18. A nurse is developing a care delivery outcomes research project. Which population will the nurse study? a. Nurses b. Patients c. Administrators d. Health care providers ANS: B Similar to the expected outcomes you develop in a plan of care, a care delivery outcome focuses on the recipients of service (e.g., patient, family, or community) and not the providers (e.g., nurse or physician/health care provider). Administrators are not recipients of service. DIF:Understand (comprehension)REF:58 OBJ: Explain how nursing research improves nursing practice. TOP: Implementation MSC:Management of Care 19. A nurse is implementing an evidence­based practice project regarding infection rates. After reviewing research literature, which other evidence should the nurse review? a. Quality improvement data b. Inductive reasoning data c. Informed consent data d. Biased data ANS: A When implementing an evidence­based practice project, it is important to first review evidence from appropriate research and quality improvement data. Inductive reasoning is used to develop generalizations or theories from specific observations; this study needs specifics. Informed consent is not data but a process and form that subjects must sign before participating in research projects/studies. Biased data is based on opinions; facts are needed for this study. DIF:Understand (comprehension)REF:61 OBJ: Explain the relationship between evidence­based practice and performance improvement. TOP:ImplementationMSC:Management of Care 20. A nurse is using the research process. Place in order the sequence that the nurse will follow. 1. Analyze results. 2. Conduct the study. 3. Identify clinical problem. 4. Develop research question. 5. Determine how study will be conducted. a. 3, 4, 5, 2, 1 b. 4, 3, 5, 2, 1 c. 3, 5, 4, 2, 1 d. 4, 5, 3, 2, 1 ANS: A The steps of the research process are as follows: (1) Identify area of interest or clinical problem, (2) develop research question(s)/hypotheses, (3) determine how study will be conducted, (4) conduct the study, and (5) analyze results of the study. DIF:Understand (comprehension)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care MULTIPLE RESPONSE 1. The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which methods will provide the nurse with the right kind of data? (Select all that apply.) a. Surveys b. Phenomenology c. Grounded theory d. Evaluation research e. Nonexperimental research ANS: A, D, E Experimental research, nonexperimental research, surveys, and evaluation research are all forms of quantitative research that allow for precise measurement. Phenomenology and grounded theory are forms of qualitative research. DIF:Understand (comprehension)REF:59­60 OBJ: Explain how nursing research improves nursing practice. TOP: Assessment MSC:Management of Care 2. Before conducting any study with human subjects, the nurse researcher must obtain informed consent. What must the nurse researcher ensure to obtain informed consent? (Select all that apply.) a. Gives complete information about the purpose b. Allows free choice to participate or withdraw c. Understands how confidentiality is maintained d. Identifies risks and benefits of participation e. Ensures that subjects complete the study ANS: A, B, C, D Informed consent means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity. Completion of the study is not needed for informed consent. DIF:Understand (comprehension)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 3. The nurse is reviewing nursing research literature related to a potential practice problem on the nursing unit. What is the rationale for the nurse’s action? (Select all that apply.) a. Nursing research ensures the nurse’s promotion. b. Nursing research identifies new knowledge. c. Nursing research improves professional practice. d. Nursing research enhances effective use of resources. e. Nursing research leads to decreases in budget expenditures. ANS: B, C, D Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Nursing research itself does not lead to a decrease in budget expenditures; however it does lead to using health care resources effectively. A promotion is not a direct result of nursing research. DIF:Understand (comprehension)REF:58 OBJ: Discuss priorities for nursing research. TOP: Implementation MSC:Management of Care Chapter 07: Caring in Nursing Practice Chapter 07: Caring in Nursing Practice Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is caring for a patient in pain. Which nursing approach is priority? a. Relationship-centered b. Technology-centered c. High tech-centered d. Family-centered ANS: A It is important to preserve a relationship­centered approach to patient care for all aspects of nursing, whether the care focuses on pain management, teaching self­care, or basic hygiene measures. While technology, high tech, and family are important, they are not the priority. DIF:Understand (comprehension)REF:79 OBJ: Discuss the role that caring plays in building the nurse­patient relationship. TOP: Implementation MSC: Psychosocial Integrity 2. A nurse is providing pain medication to patients after surgery. Which component is key for the nurse’s personal philosophy of nursing? a. Caring b. Technology c. Informatics d. Therapeutics ANS: A The American Organization of Nurse Executives describes caring and knowledge as the core of nursing, with caring being a key component of what a nurse brings to a patient experience. While technology, informatics, and therapeutics are important, they are not the key components of nursing. DIF:Understand (comprehension)REF:79 OBJ: Describe the significance of caring as part of the nurses’ personal philosophy of nursing. TOP:CaringMSC:Management of Care 3. A nurse attends a seminar on nursing theories for caring. Which information from the nurse indicates a correct understanding of these theories? a. Benner identifies caring as highly connected involving patient and nurse. b. Swanson develops four caring processes to convey caring in nursing. c. Watson’s transcultural caring views inclusion of culture as caring. d. Leininger’s theory places care before cure and is transformative. ANS: A Benner believes caring is highly connected involving each nurse­patient encounter. Swanson developed five caring processes, not four. Watson’s theory places care before cure and is transformative, whereas Leininger’s transcultural caring views inclusion of culture as caring. DIF:Understand (comprehension)REF:80 OBJ: Compare and contrast theories on caring. TOP: Teaching/Learning MSC:Management of Care 4. The patient has a colostomy but has not yet been able to look at it. The nurse teaches the patient how to care for the colostomy. The nurse sits with the patient, and together they form a plan on how to approach dealing with colostomy care. Which caring process is the nurse performing? a. Knowing b. Doing for c. Enabling d. Maintaining belief ANS: C Enabling is facilitating another’s passage through a life transition and unfamiliar events. Working with the patient to find alternate ways to perform the task is doing just that. Knowing is striving to understand an event because it has meaning in the life of another. This must be done before enabling can occur. Doing for is doing for the other as he or she would do for self if it were at all possible. The nurse in this situation is not doing for the patient but is teaching/informing on how to care for the colostomy. Maintaining belief is sustaining faith in the other’s capacity to get through an event or transition and face a future with meaning. This may be an underlying theme to the process but is not what the nurse is actually doing. DIF:Analyze (analysis)REF:82 OBJ: Compare and contrast theories on caring. TOP: Teaching/Learning MSC: Basic Care and Comfort 5. A nurse is using Watson’s model to provide care to patients. Which carative factor will the nurse use? a. Maintaining belief b. Instilling faith-hope c. Maintaining ethics d. Instilling values ANS: B Watson has 10 carative factors, one of which is instilling faith­hope. Maintaining belief is a caring process of Swanson’s theory. Ethics and values are important in caring but they are not examples of Watson’s carative factors. DIF:Understand (comprehension)REF:80­81 OBJ: Compare and contrast theories on caring. TOP: Caring MSC: Psychosocial Integrity 6. A nurse provides care that is receptive to patients’ and families’ perceptions of caring. Which action will the nurse take? a. Provides clear, accurate information b. Just performs nursing tasks competently c. Does as much for the patient as possible d. Focuses solely on the patient’s diagnosis ANS: A Research indicates caring behaviors of nurses from the patient’s/families’ perspective include the following: (1) Providing honest, clear, and accurate information; (2) asking permission before doing something to a patient; (3) helping patients do as much for themselves as possible; and (4) teaching the family how to keep the relative physically comfortable. Patients continue to value nurses’ effectiveness in performing tasks, but clearly patients value the affective dimension of nursing care. DIF:Understand (comprehension)REF:87 OBJ: Discuss the evidence that exists about patients’ perceptions of caring. TOP: Implementation MSC: Basic Care and Comfort 7. A nurse follows the “ethics of care” when working with patients. Which action will the nurse take? a. Becomes the patient’s advocate based on the patient’s wishes b. Makes decisions for the patient solely using analytical principles c. Uses only intellectual principles to determine what is best for the patient d. Ignores unequal family relationships since that is a personal matter for the family ANS: A An ethic of care places the nurse as the patient’s advocate, solving ethical dilemmas by attending to relationships and by giving priority to each patient’s unique personhood. An ethic of care is unique so that professional nurses do not make professional decisions based solely on intellectual or analytical principles. Instead, an ethic of care places “caring” at the center of decision making. Nurses who function from an ethic of care are sensitive to unequal relationships that lead to abuse of one person’s power over another—intentional or otherwise. DIF:Understand (comprehension)REF:83­84 OBJ:Explain how an ethic of care influences nurses’ decision making. TOP:ImplementationMSC:Management of Care 8. A nurse is providing presence to a patient and the family. Which nursing action does this involve? a. Focusing on the task that needs to be done b. Providing closeness and a sense of caring c. Jumping in to provide patient comfort d. Being there without an identified goal ANS: B Providing presence is a person­to­person encounter conveying closeness and a sense of caring. “Being there” seems to depend on the fact that a nurse is attentive to the patient more than the task. “Being with” means being available and at the patient’s disposal. If the patient accepts the nurse, the nurse will be invited to see, share, and touch the patient’s vulnerability and suffering. Jumping in may not be welcomed. Being there is something the nurse offers to the patient with the purpose of achieving some patient care goal. DIF:Understand (comprehension)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Implementation MSC: Psychosocial Integrity 9. The patient is afraid to have a thoracentesis at the bedside. The nurse sits with the patient and asks about the fears. During the procedure, the nurse stays with the patient, explaining each step and providing encouragement. What is the nurse displaying? a. Providing touch b. Providing a presence c. Providing family care d. Providing a listening ear ANS: B The nurse’s presence helps to calm anxiety and fear related to stressful situations. Giving reassurance and thorough explanations about a procedure, remaining at the patient’s side, and coaching the patient through the experience all convey a presence that is invaluable to the patient’s well­being. Listening and touch can be part of the “presence” but are not its entirety. No family was involved in this scenario. DIF:Apply (application)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Caring MSC: Psychosocial Integrity 10. The patient is terminal and very near death. When the nurse checks the patient and finds no pulse or blood pressure, the family begins sobbing and hugging each other. Some family members hold the patient’s hand. The nurse is overwhelmed by the presence of grief and leaves the room. What is the nurse demonstrating? a. Caring touch b. Protective touch c. Therapeutic touch d. Task-oriented touch ANS: B Protective touch is also a kind of touch that protects the nurse emotionally. A nurse withdraws or distances herself or himself from a patient when he or she is unable to tolerate suffering or needs to escape from a situation that is causing tension. Caring touch is a form of nonverbal communication that influences a patient’s comfort and security, enhances self­esteem, and improves mental wellbeing. Therapeutic touch is a type of alternative therapy for healing. Task­oriented touch is done when performing a task or procedure. DIF:Apply (application)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Implementation MSC: Psychosocial Integrity 11. Which action indicates a nurse is using caring touch with a patient? a. Inserts a catheter b. Rubs a patient’s back c. Prevents a patient from falling d. Administers an injection ANS: B Caring touch is the way a nurse holds a patient’s hand, gives a back massage, or gently positions a patient. Touch that occurs when tasks are being performed, such as insertion of a catheter or administering an injection, is known as “task­oriented touch.” Touch used to protect the patient (holding and bracing a patient to avoid a fall) or nurse (withdraws from tension­filled situations) is known as “protective touch.” DIF:Understand (comprehension)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Caring MSC: Basic Care and Comfort 12. The nurse is caring for a patient who has been sullen and quiet for the past three days. Suddenly, the patient says, “I’m really nervous about surgery tomorrow, but I’m more worried about how it will affect my family.” What should the nurse do first? a. Assure the patient that everything will be all right. b. Tell the patient that there is no need to worry. c. Listen to the patient’s concerns and fears. d. Inform the patient a social worker is available. ANS: C Listening to the meaning of what a patient says helps create a mutual relationship. Assuring and telling a patient not to worry are not truly listening; these do not convey listening. Although contacting a social worker could be an appropriate measure for this patient, the nurse should first listen to what the patient is saying. DIF:Apply (application)REF:85 OBJ: Describe the therapeutic benefit of listening to patients. TOP: Implementation MSC: Psychosocial Integrity 13. The patient is about to undergo a certain procedure and has voiced concern about outcomes and prognosis. The nurse caring for the patient underwent a similar procedure and stops to listen. Which response by the nurse may be most beneficial? a. “I had a similar procedure and I can tell you what I went through.” b. “I think you’ll be all right, but, of course, there are no sure guarantees.” c. “I don’t think you have anything to worry about. They do lots of these.” d. “I can call the doctor and cancel the procedure, if you are really concerned.” ANS: A When an ill person chooses to tell his story, it involves reaching out to another human being. Telling the story implies a relationship that develops only if the clinician exchanges his or her stories as well. Professionals do not routinely take seriously their own need to be known as part of a clinical relationship. Yet, unless the professional acknowledges this need, there is no reciprocal relationship, only an interaction. Offering false reassurances and cliches, telling not to worry, or offering to cancel the procedure does not open up that relationship and dismisses the patient’s concerns. DIF:Apply (application)REF:85 OBJ:Describe the therapeutic benefit of listening to patients. TOP: Communication and Documentation MSC: Psychosocial Integrity 14. In making rounds, the nurse meets a patient for the first time. The nurse asks the patient when morning medications are taken, such as before breakfast, after breakfast, or during breakfast. What does knowing the patient allow the nurse to do? a. Choose the most appropriate time to give the medication. b. Know what information to put on the medication error report form. c. Explain to the patient that the medication will not be given at the usual time. d. Evaluate whether or not the patient is taking the medication correctly at home. ANS: A “Knowing the patient” is at the core of the process nurses use to make clinical decisions. Knowing when the patient normally takes the medication will allow the nurse to keep the patient on as near normal a schedule as possible. Nothing in this question infers that the patient will not get the medications on time or that a medication error report will need to be completed. Although the nurse can evaluate whether or not the patient is taking the medication correctly at home, the main purpose, within this scenario, is to determine the most appropriate time to administer the medication. DIF:Apply (application)REF:85 | 87 OBJ: Explain the relationship between knowing a patient and clinical decision making. TOP: Caring MSC: Basic Care and Comfort MULTIPLE RESPONSE 1. A nurse cares for patients. Which areas does caring influence? (Select all that apply.) a. The way in which patients feel b. The way in which patients learn c. The way in which patients think d. The way in which patients study e. The way in which patients behave ANS: A, C, E Caring is a universal phenomenon that influences the ways in which people think, feel, and behave in relation to one another. How people learn and study involves other concepts such as teaching/learning. DIF:Understand (comprehension)REF:80 OBJ: Discuss the role that caring plays in building the nurse­patient relationship. TOP: Caring MSC: Psychosocial Integrity 2. Which actions by the nurse should be done in order to get to know the patient? (Select all that apply.) a. Avoid assumptions b. Focus on the patient c. Engage in a caring relationship d. Form the relationship very quickly e. Not address spiritual or higher needs ANS: A, B, C To know a patient means that the nurse avoids assumptions, focuses on the patient, and engages in a caring relationship with the patient that reveals information and cues that facilitate critical thinking and clinical judgments. Knowing develops over time as a nurse learns the clinical conditions within a specialty and the behaviors and physiological responses of patients. DIF:Understand (comprehension)REF:85 OBJ: Explain the relationship between knowing a patient and clinical decision making. TOP: Caring MSC: Psychosocial Integrity 3. Which actions by the nurse indicate compassion and caring to patients? (Select all that apply.) a. Saying “I’m here” b. Including the family in care c. Staying with the patient during a bedside test d. Relying on monitors and technology e. Refining work processes on the unit ANS: A, B, C Our patients tell us that a simple touch, a simple phrase, “I’m here,” or a promise to remain at the bedside represent caring and compassion. Caring for an individual cannot occur in isolation from that person’s family. As a nurse it is important to know the family almost as thoroughly as you know a patient. A reliance on technology and cost­effective health care strategies and efforts to standardize and refine work processes all undermine the nature of caring. DIF:Apply (application)REF:84 | 86 | 87 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity MATCHING Match the examples to the areas the nurse will promote connectedness for patient’s spirituality needs. a. Connection with others b. Connection with higher power c. Connection with oneself 1. Intrapersonally 2. Interpersonally 3. Transpersonally 1.ANS:CDIF:Understand (comprehension)REF:86 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity 2.ANS:ADIF:Understand (comprehension)REF:86 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity 3.ANS:BDIF:Understand (comprehension)REF:86 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity Chapter 08: Caring for the Cancer Survivor Chapter 08: Caring for the Cancer Survivor Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is working on a cancer unit. The unit uses the National Coalition for Cancer Survivorship definition for a cancer survivor. Which definition will the nurse use? a. Been cancer free for 5 years after diagnosis b. Been cancer free for 3 years after diagnosis c. Had cancer and is declared cancer free d. Had cancer and extends until death ANS: D Cancer survivorship begins at the time of cancer diagnosis, includes treatment, and extends to the rest of the person’s life. Being cancer free for any length of time does not relate to the definition of a cancer survivor put forth by the National Coalition for Cancer Survivorship. DIF:Understand (comprehension)REF:90 OBJ: Discuss the concept of cancer survivorship. TOP: Implementation MSC: Physiological Adaptation 2. A nurse is providing follow­up care for cancer survivors. Which condition should the nurse most monitor for in these patients? a. Cancer b. Infection c. Weight gain d. Low blood pressure ANS: A Cancer survivors are at increased risk for cancer (either a recurrence of the cancer for which they were treated or a second cancer). The increased risk for developing a second cancer is the result of cancer treatment, genetic factors or other susceptibility, or an interaction between treatment and susceptibility. Infection, weight gain, and low blood pressure are not common conditions for cancer survivors. DIF:Apply (application)REF:91 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP: Assessment MSC: Physiological Adaptation 3. A nurse is assessing a cancer survivor for chemotherapy­induced peripheral neurotoxicity (CPIN). Which assessment finding is consistent with CPIN? a. Hearing loss b. Devastating depression c. Extreme loss of motor functioning d. Numbness and tingling in hands and feet ANS: D Chemotherapy­induced peripheral neurotoxicity (CPIN) refers to peripheral nerve damage resulting from the effects of certain chemotherapeutic agents. Damage to large sensory nerves causes feelings of numbness and tingling in the hands and feet. Motor function may also be affected, but usually to a lesser degree than sensory function. Hearing loss and depression are not signs and symptoms of CPIN. DIF:Apply (application)REF:91 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP: Assessment MSC: Physiological Adaptation 4. A cancer survivor is in the intensive care unit (ICU). Some of the patient’s family is from out of town and would like to see the patient even though it is not “official” visiting hours. The patient is anxious to see family members. The nurse allows the family to visit. What is the rationale for the nurse’s actions? a. The nurse disagrees with the established time for visiting. b. The nurse realizes that the patient is dying. c. The nurse feels there is no real reason to have limited visiting hours. d. The nurse believes that the visit will help relieve psychological stress. ANS: D Survivors who have social and emotional support systems are likely to have less psychological distress. Relationships are critical for cancer survivors. The nurse does not necessarily have problems with the standard visiting hours. Not enough information is provided to indicate that the patient is near death, and not all patients in the ICU are dying. DIF:Apply (application)REF:93 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP: Implementation MSC: Psychosocial Integrity 5. A nurse is taking a history on a patient with cancer. Which assessment is priority? a. Fatigue b. Vision c. Dehydration d. Blood pressure ANS: A Cancer­related fatigue (CRF) and associated sleep disturbances are among the most frequent and distressing complaints of people with cancer. Vision, dehydration, and blood pressure are not frequent side effects of cancer. DIF:Apply (application)REF:92 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP: Assessment MSC: Physiological Adaptation 6. A breast cancer survivor has chemotherapy­related cognitive impairment. Which area should the nurse assess? a. Pain b. Grief c. Nightmares d. Short-term memory ANS: D Breast cancer survivors report having difficulty with short­term memory, focusing, working, reading with comprehension, and driving with chemotherapy­related cognitive impairment (CRCI). Pain occurs with other long­term effects of cancer survival but does not occur with CRCI. Grief and nightmares occur with post­traumatic stress disorder. DIF:Apply (application)REF:92 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP: Assessment MSC: Physiological Adaptation 7. The nurse is caring for a young woman with breast cancer. The stress between the woman and spouse is obvious, as is anxiety among the children. What is the nurse’s best action in this situation? a. Help find or develop an educational program for the patient and spouse. b. Encourage the patient to agree with the spouse. c. Support the spouse, and explain that the spouse knows what is best. d. Take the children away and recommend foster care. ANS: A It is a nurse’s responsibility to educate (develop an educational program) cancer survivors and their families about the effects of cancer and cancer treatment. Spouses often do not know what to do to support the survivor, and they struggle with how to help; therefore, agreeing even if disagreeing does not help and the spouse does not always know what is best. Foster care is not necessary at this time. DIF:Apply (application)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Implementation MSC: Psychosocial Integrity 8. The nurse is caring for a patient who is undergoing chemotherapy and radiation for cancer. The patient asks the nurse about the value of cancer screening when therapy is over. What is the nurse’s best response? a. “It should be done on an ongoing schedule.” b. “It is not something that should be discussed right now.” c. “It probably will not be needed since the cancer has been cured.” d. “It usually is not done but can be done if the patient wants peace of mind.” ANS: A Because survivors are at increased risk for developing a second cancer and/or chronic illness, it is important to educate them about lifestyle behaviors and the importance of participating in ongoing cancer screening and early detection practices. Lifelong cancer screening provides the opportunity to identify new cancers in early stages. Cancer screening should be discussed and should be done even if the cancer is cured. DIF:Apply (application)REF:96 OBJ:Explain the nursing implications related to cancer survivorship. TOP:Communication and Documentation MSC:Health Promotion and Maintenance 9. The nurse is caring for a patient diagnosed with cancer. The family of the patient asks the nurse for resources about the cancer. What should the nurse do? a. Refer family members to the health care provider. b. Inform them that few options are available. c. Maintain confidentiality by keeping silent. d. Provide the family with the information. ANS: D The nurse’s role is to tell patients and families about the different resources available so they can make informed choices. The physician is a resource, but the nurse can educate and help as well. There are numerous organizations that provide resources to cancer survivors. The nurse must maintain patient confidentiality, not resource confidentiality. DIF:Apply (application)REF:96 OBJ:Explain the nursing implications related to cancer survivorship. TOP: Implementation MSC: Psychosocial Integrity 10. The nurse is caring for a patient with known coronary artery disease who has recently been diagnosed with lung cancer. What should the nurse do? a. Focus the assessment solely on the cancer diagnosis since it is the newer diagnosis. b. Ask questions about cardiac symptoms and their relationship to the cancer. c. Ignore symptom management and focus on palliative care. d. Say nothing because cancer survivors dislike prying. ANS: B The nurse needs to consider not only the effects of cancer and its treatment but also how it will affect any other medical condition. For example, if a patient also has heart disease, how will the fatigue related to chemotherapy affect this individual? The nurse must focus on both, not just the cancer diagnosis. Nurses do not ignore symptom management; given the symptoms that a patient identifies, the nurse will explore each one to gain a complete picture of the patient’s health status. Saying nothing is inappropriate; patients will appreciate the nurse’s sensitivity and interest in their wellbeing. DIF:Apply (application)REF:94 OBJ:Explain the nursing implications related to cancer survivorship. TOP: Implementation MSC: Physiological Adaptation 11. The patient has lung cancer and voices concerns about cancer treatments affecting sexuality. What is the nurse’s best reply? a. “That is something to ask the health care provider.” b. “Chemotherapy will work in the lungs and should have no effect on sexuality.” c. “How cancer treatment affects sexuality depends on how active you are and your age.” d. “Sexual changes are common with cancer therapy. Let me get someone who can answer your questions.” ANS: D Cancer therapies have the potential to cause fatigue, apathy, nausea, vomiting, malaise, and sleep disturbances, all of which interfere with a patient’s sexual functioning. It helps if the nurse can develop a comfort level in acknowledging with patients that sexual changes are common at any age level. When patients begin to discuss their sexuality, be familiar with the expert resources in your institution (e.g., psychologist, social worker) available for patient referral. The issue should not be pushed onto the health care provider. DIF:Apply (application)REF:95 OBJ:Explain the nursing implications related to cancer survivorship. TOP: Communication and Documentation MSC: Psychosocial Integrity 12. The nurse is caring for a patient who has successfully undergone cancer therapy and will be discharged home soon. The patient is concerned about going home and not knowing what to do. Which information is the most valuable for the nurse to share with the patient? a. The nurse will develop a plan of care that will tell exactly what needs to be done. b. If any issues arise, call the health care provider and follow the instructions. c. Proper cancer treatment has been provided, and nothing else is required. d. There is a team that will provide support and care that may be needed. ANS: D When a survivor is released from an oncologist, the internist and other health care providers provide and coordinate care based on knowledge of prior cancer history and treatment. To meet the health care needs of cancer survivors, it is essential for a “survivorship care plan” to be written by the principal provider (not the nurse) who coordinates the patient’s oncology treatment. Depending upon the issue, there may be several health care providers who may be a better choice. Proper cancer treatment will include a follow­up plan or “survivorship care plan.” The nurse will still advise the patient to call the health care provider if there are issues and to follow the instructions given, but acknowledging the team approach that is used and available support is most valuable to the patient at the time of discharge. DIF:Apply (application)REF:97 OBJ: Discuss the essential components of survivorship care. TOP: Teaching/Learning MSC:Management of Care 13. When planning for cancer survivor care needs, which information should the nurse consider? a. Survivorship care plans are reviewed with the patient at home. b. All health care agencies provide survivorship care plans. c. Some survivors are discharged with no survivor plan. d. The plan does not deal with future cancer screenings. ANS: C Some patients receive care at cancer centers without this type of resource and may not have a survivor care plan. Thus nurses and other health care providers need to become more vigilant in recognizing cancer survivors and attempting to link them with the support and resources they require. Ideally, the nurse reviews a survivorship care plan with a patient at the time of discharge from a treatment program and not at home. The plan becomes a guide for any future cancer or cancer­related care. DIF:Understand (comprehension)REF:97 OBJ: Discuss the essential components of survivorship care. TOP: Planning MSC:Management of Care MULTIPLE RESPONSE 1. A cancer survivor patient has anxiety and depression. Which therapies should the nurse include in the plan of care? (Select all that apply.) a. Keep information to a minimum with health care providers. b. Teach the use of problem-oriented coping processes. c. Encourage the use of social support systems. d. Use cognitive behavioral interventions. e. Schedule exercise when convenient. ANS: B, C, D Patients who use problem­oriented, active, and emotionally expressive coping processes also manage stress well. Survivors who have social and emotional support systems and maintain open communication with their treatment providers will also likely have less psychological distress. Interventions to treat anxiety and depression in cancer survivors include education, routine (not when convenient) exercise, adequate sleep, and reassurance that anxiety and depression are commonly seen in cancer survivors. DIF:Apply (application)REF:93 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP:PlanningMSC:Management of Care 2. A nurse is working in a cancer facility that follows the Institute of Medicine’s (IOM) recommendations for essential components of survivorship care. Which recommendations will be the nurse’s focus? (Select all that apply.) a. Cessation of noncancer follow-up and care b. Prevention and detection of new and recurrent cancers c. Intervention for consequences of cancer and its treatment d. Coordination between specialists and primary care providers e. Surveillance for cancer spread, recurrence, or second cancers ANS: B, C, D, E The Institute of Medicine (IOM) recommends four essential components of survivorship care: (1) Prevention and detection of new cancers and recurrent cancer; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for consequences of cancer and its treatment (e.g., medical problems, symptoms, psychological distress); and (4) coordination between specialists and primary care providers. The patient should continue with noncancer follow­up and care. DIF:Understand (comprehension)REF:96­97 OBJ: Discuss the essential components of survivorship care. TOP: Caring MSC:Management of Care MATCHING A nurse is assessing a cancer survivor and the caregiver. Which examples describe the possible caregiving patterns the nurse may observe? a. Patients and caregivers share activities of care. b. Family provides most of the care because the patient is unable. c. Patients mostly care for self with caregivers in a standby role. 1. The self­caregiving pattern 2. The collaborative care pattern 3. The family caregiving pattern 1.ANS:CDIF:Understand (comprehension)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Caring MSC: Psychosocial Integrity 2.ANS:ADIF:Understand (comprehension)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Caring MSC: Psychosocial Integrity 3.ANS:BDIF:Understand (comprehension)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Caring MSC: Psychosocial Integrity Chapter 11: Developmental Theories Chapter 11: Developmental Theories Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. When caring for a middle­aged adult exhibiting maladaptive coping skills, the nurse is trying to determine the cause of the patient’s behavior. Which information from a growth and development perspective should the nurse consider when planning care? a. Individuals have uniform patterns of growth and development. b. Culture usually has no effect on predictable patterns of growth and development. c. Health is promoted based on how many developmental failures a patient experiences. d. When individuals experience repeated developmental failures, inadequacies sometimes result. ANS: D If individuals have repeated development failures, inadequacies sometimes result should be considered. Developmental failures could manifest with ineffective coping skills. However, when an individual experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and development. DIF:Understand (comprehension)REF:132 OBJ: Discuss factors influencing growth and development. TOP: Planning MSC:Health Promotion and Maintenance 2. A nurse is measuring an infant’s head circumference and height. Which area is the nurse assessing? a. Moral development b. Cognitive development c. Biophysical development d. Psychosocial development ANS: C Biophysical development is how our physical bodies grow and change. Moral development is the difference between right and wrong. Cognitive development comprises changes in intelligence, use of language, and development of thinking. Psychosocial development consists of variations in emotions and relationships with others. DIF:Apply (application)REF:132 OBJ: Describe biophysical developmental theories. TOP: Assessment MSC:Health Promotion and Maintenance 3. Which question will be most appropriate for a nurse to ask when assessing an adult patient for growth and developmental delays? a. “How many times per week do you exercise?” b. “Are you able to stand on one foot for 5 seconds?” c. “Would you please describe your usual activities during the day?” d. “How many hours a day do you spend watching television or sitting in front of a computer?” ANS: C Asking the patient to describe usual daily activities will provide the nurse with useful information about the patient’s current patterns. Understanding normal growth and development helps nurses predict, prevent, and detect deviations from patients’ own expected patterns. How many hours are spent watching television or in front of a computer and how many times the patient exercises in a week would not provide the nurse with as much information about the patient’s expected patterns when stated patterns are compared with expected patterns for the patient’s age group to detect delays. The question about standing on one foot is for a child, not an adult. DIF:Analyze (analysis)REF:132 OBJ: Discuss nursing implications for the application of developmental principles to patient care. TOP:AssessmentMSC:Health Promotion and Maintenance 4. A nurse is using the proximodistal pattern to assess an infant’s growth and development as normal. Which assessment finding will the nurse determine as normal? a. Bangs objects before turns b. Lifts head before grasps c. Walks before crawls d. Laughs before coos ANS: B Lifting the head before grasping is a normal finding according to proximodistal growth. The proximodistal growth pattern starts at the center of the body and moves toward the extremities (e.g., organ systems in the trunk of the body develop before arms and legs). The infant should turn before banging objects and crawl before walking according to the proximodistal pattern of growth. The infant should coo before laughing, but this is not an example of proximodistal; this is an example of language development. DIF:Analyze (analysis)REF:133 OBJ: Describe biophysical developmental theories. TOP: Assessment MSC:Health Promotion and Maintenance 5. A nurse is assessing an 18­month­old toddler. The nurse distinguishes normal from abnormal findings by remembering Gesell’s theory of development. Which information will the nurse consider? a. Growth in humans is determined solely by heredity. b. Environmental influence does not influence development. c. The cephalocaudal pattern describes the sequence in which growth is fastest at the top. d. Gene activity influences development but does not affect the sequence of development. ANS: C Gesell’s theory of development states that the cephalocaudal pattern describes the sequence in which growth is fastest at the top (e.g., head/brain develop faster than arm and leg coordination). Growth in humans is determined by heredity, genes, and environment. Environment does influence development. Gesell’s theory states that genes direct the sequence of development, but environmental factors also influence development, resulting in developmental changes. DIF:Understand (comprehension)REF:133 OBJ: Describe biophysical developmental theories. TOP: Assessment MSC:Health Promotion and Maintenance 6. A nurse is working with a patient who wants needs to be met and is impatient and demanding when these needs are not met immediately. How should the nurse interpret this finding according to Freud? a. The id is functioning. b. The ego is functioning. c. The superego is functioning. d. The Oedipus complex is functioning. ANS: A The id is functioning. The id (i.e., basic instinctual impulses driven to achieve pleasure) is the most primitive part of the personality and originates in the infant. The infant, in this case the patient, cannot tolerate delay and must have needs met immediately. The ego represents the reality component, mediating conflicts between the environment and the forces of the id. The ego helps people judge reality accurately, regulate impulses, and make good decisions. The third component, the superego, performs regulating, restraining, and prohibiting actions. Often referred to as the conscience, the superego is influenced by the standards of outside social forces (e.g., parent or teacher). The child fantasizes about the parent of the opposite sex as his or her first love interest, known as the Oedipus or Electra complex. By the end of this stage, the child attempts to reduce this conflict by identifying with the parent of the same sex as a way to win recognition and acceptance. DIF:Analyze (analysis)REF:133­134 OBJ: Describe and compare the psychoanalytical/psychosocial theories proposed by Freud and Erikson. TOP: Evaluation MSC: Psychosocial Integrity 7. The nurse is teaching a young­adult couple about promoting the health and psychosocial development of their 8­year­old child. Which information from the parent indicates a correct understanding of the teaching? a. “We will provide consistent, devoted relationships to meet needs.” b. “We will limit choices and provide punishment for mistakes.” c. “We will provide proper support for learning new skills.” d. “We will instill a strong identity of who our child is.” ANS: C An 8­year­child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised (proper support) for accomplishments such as learning new skills. Developing a strong identity is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame and doubt. Providing consistent, devoted relationship to meet needs is usually a part of the trust versus mistrust stage. DIF:Analyze (analysis)REF:134 OBJ:Describe and compare the psychoanalytical/psychosocial theories proposed by Freud and Erikson.TOP:Teaching/Learning MSC:Health Promotion and Maintenance 8. A nurse is using Jean Piaget’s developmental theory to focus on cognitive development. Which area will the nurse assess in this patient? a. Latency b. Formal operations c. Intimacy versus isolation d. The postconventional level ANS: B Jean Piaget’s theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations, and formal operations. Intimacy versus isolation is part of Erik Erikson’s psychosocial theory of development. Latency is stage 4 of Freud’s five­stage psychosexual theory of development. The postconventional level of reasoning is part of Kohlberg’s theory of moral development. DIF:Understand (comprehension)REF:136 OBJ: Describe Piaget’s theory of cognitive development. TOP: Assessment MSC:Health Promotion and Maintenance 9. A nurse is assessing a 17­year­old adolescent’s cognitive development. Which behavior indicates the adolescent has reached formal operations? a. Uses play to understand surroundings b. Discusses the topic of justice in society c. Hits other students to deal with environmental change d. Questions where the ice is hiding when ice has melted in a drink ANS: B Discussing the topic of justice demonstrates that the adolescent is concerned about issues that affect others besides self. In the formal operations period, as adolescents mature, their thinking moves to abstract and theoretical subjects. They have the capacity to reason with respect to possibilities. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to 12 years), children are able to coordinate two concrete perspectives in social and scientific thinking, such as understanding the difference between “hiding” and “melting.” DIF:Analyze (analysis)REF:136­137 OBJ: Describe Piaget’s theory of cognitive development. TOP: Evaluation MSC:Health Promotion and Maintenance 10. A nurse is caring for a 4­year­old patient. Which object will the nurse allow the child to play with safely to foster cognitive development? a. The pump administering intravenous fluids b. A book to read alone in a quiet place c. The blood pressure cuff d. A baseball bat ANS: C Children should be allowed to play with any equipment that is safe, like a blood pressure cuff. A 4­ year­old child would be in the preoperational period of cognitive development. Children at this stage are still egocentric. Play is very important to foster cognitive development. The IV pump and bat are not safe pieces of equipment for a 4­year­old child to play with. A 4­year­old child is of preschool age and more than likely is not able to read yet. Also, the book does not allow for any human interaction and communication if he or she reads alone. DIF:Analyze (analysis)REF:136 OBJ: Describe Piaget’s theory of cognitive development. TOP: Planning MSC:Health Promotion and Maintenance 11. A patient follows all the instructions a nurse provides because the patient wants to be perceived as a “good” patient. How should the nurse interpret this information according to moral development? a. The patient is in postformal thought reasoning. b. The patient is in postconventional reasoning. c. The patient is in preconventional reasoning. d. The patient is in conventional reasoning. ANS: D The patient is in conventional reasoning, specifically stage 3: Good Boy­Nice Girl Orientation. The patient wants to win approval from the nurse by “being good.” Developmentalists proposed a fifth stage of cognitive (not moral) development termed postformal thought. Within this stage, adults demonstrate the ability to recognize that answers vary from situation to situation and that solutions need to be sensible. The person finds a balance between basic human rights and obligations and societal rules and regulations in the level of postconventional reasoning. Individuals move away from moral decisions based on authority or conformity to groups to define their own moral values and principles. Preconventional reasoning is the premoral level, in which there is limited cognitive thinking and the individual’s thinking is primarily egocentric. At this stage, thinking is mostly based on likes and pleasures. DIF:Apply (application)REF:137 OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Assessment MSC: Psychosocial Integrity 12. An 18­month­old patient is brought into the clinic for evaluation because the parent is concerned. The 18­month­old child hits siblings and says only “No” when communicating verbally. Which recommendation by the nurse will be best for this situation? a. Assure the mother that the child is developmentally within specified norms. b. Encourage the mother to seek psychological counseling for the child. c. Consult the social worker because the child is hitting other children. d. Remove all toys from the child’s room until this behavior ceases. ANS: A Assure the mother that the child is displaying normal behavior. At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking, grasping, and kicking as normal schemas to deal with the environment. The social worker does not need to be consulted in this case nor is psychological counseling warranted, because the child is exhibiting normal behaviors. Play is an important part of all children’s development. Removing toys and the opportunity to play with them may actually hinder the child’s development. DIF:Analyze (analysis)REF:136 OBJ: Discuss nursing implications for the application of developmental principles to patient care. TOP: Implementation MSC: Health Promotion and Maintenance 13. A formerly independent older adult becomes severely withdrawn upon admission to a nursing home. Which action should the nurse take first? a. Offer a reward to the patient for participation in all events. b. Encourage the patient to eat meals in the dining room with others. c. Allow the patient to incorporate personal belongings into the room. d. Advise the patient of the importance of attending mandatory activities. ANS: C The nurse should first allow the patient to actively participate in an independent activity (the patient was formerly independent), such as preparing the room with personal belongings. Erikson’s theory proposes that the older adult faces integrity versus despair. Offering a reward does not address the need for continued independence. Encouraging eating in the dining room would be a step after fixing the room since it does not address independence, and the question is asking for the first action. Advising the patient to attend all mandatory activities as the first intervention does not allow for the patient’s independence. Some activities may be mandatory, but by first allowing the patient to decorate room, the nurse is fostering independence and is helping the patient feel welcome and more at home, fostering integrity. DIF:Apply (application)REF:134­135 OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Implementation MSC: Management of Care 14. The nurse is caring for a 14­year­old patient in the hospital. Which goal will be priority? a. Maintain industry b. Maintain identity c. Maintain intimacy d. Maintain initiative ANS: B According to Erikson, a 14­year­old adolescent is developing an identity versus role confusion. Maintaining initiative is for 3 to 6 year olds. Maintaining industry is for 6 to 11 year olds. Maintaining intimacy is for young adults. DIF:Apply (application)REF:134 OBJ: Discuss nursing implications for the application of developmental principles to patient care. TOP:PlanningMSC:Health Promotion and Maintenance 15. The nurse is teaching the parents of a 3­year­old child who is at risk for developmental delays. Which instruction will the nurse include in the teaching plan? a. Insist that your child discuss various points of view. b. Encourage play as your child is exploring the surroundings. c. Discuss world events with your child to foster language development. d. Actively encourage your child to read lengthy books to foster reading abilities. ANS: B A 3­year­old child is going to use play to learn and discover the surrounding environment. Children at this age are egocentric and often are unable to see the world from any perspective other than their own. Very young children are not able to understand and comment on world events because their thinking has not advanced to abstract reasoning yet. A 3­year­old child is likely unable to read; lengthy is not appropriate. DIF:Apply (application)REF:136 OBJ:Apply developmental theories when planning interventions in the care of patients throughout the life span.TOP:Teaching/Learning MSC:Health Promotion and Maintenance 16. A nurse is caring for a young adult after surgery. Which action by the nurse will be priority? a. Allow involvement of peers b. Allow involvement of partner c. Allow involvement of volunteer activities d. Allow involvement of consistent schedule ANS: B Nurses must understand that during hospitalization, a young adult’s need for intimacy remains present; thus young adults benefit from the support of their partner or significant other during this time. Involvement of peers is priority for adolescents. Volunteer activities are priority for middle­aged adults. Consistent schedule is priority for infants and toddlers. DIF:Apply (application)REF:134 OBJ: Discuss nursing implications for the application of developmental principles to patient care. TOP: Implementation MSC: Health Promotion and Maintenance 17. A nurse takes the history of a middle­aged patient in a health clinic. Which information indicates the patient has achieved generativity? a. Married for 30 years b. Teaches preschoolers c. Has no regrets with life choices d. Cares for aging parents after work ANS: B Teaching preschoolers indicates generativity. Middle­aged adults achieve success (generativity) in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement. Married for 30 years indicates achievement of intimacy. Has no regrets is ego integrity. Caring for aging parents is admirable but it does not indicate development of the next generation (generativity). DIF:Apply (application)REF:134 OBJ: Discuss nursing implications for the application of developmental principles to patient care. TOP:AssessmentMSC:Health Promotion and Maintenance 18. Which action should the nurse take when teaching a 5­year­old patient about a scheduled surgery? a. Do not discuss the procedure with the child to decrease anxiety. b. Let the child know the surgery will be at 9:00 AM in the morning. c. Insist that the parents wait outside the room to ensure privacy of the child. d. Allow the child to touch and hold medical equipment such as thermometers. ANS: D Nursing interventions during the preoperational period (ages 2 to 7 years) should recognize the use of play (such as handling equipment) to help the child understand the events taking place. The nurse should talk to the child about the procedure in terms the child can understand. Children at this stage have difficulty conceptualizing time; telling the child surgery is at 9:00 AM in the morning is inappropriate. Parents should be allowed in the room. DIF:Apply (application)REF:136 OBJ:Apply developmental theories when planning interventions in the care of patients throughout the life span.TOP:Teaching/Learning MSC:Health Promotion and Maintenance 19. A nurse works on a pediatric unit and is using a psychosocial developmental approach to child care. In which order from the first to the last will the nurse place the developmental stages? 1. Initiative versus guilt 2. Trust versus mistrust 3. Industry versus inferiority 4. Identity versus role confusion 5. Autonomy versus shame and doubt a. 2, 5, 3, 1, 4 b. 2, 1, 3, 5, 4 c. 2, 3, 1, 5, 4 d. 2, 5, 1, 3, 4 ANS: D Erikson uses a psychosocial approach to development. The stages are as follows: trust versus mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; and identity versus role confusion. DIF:Understand (comprehension)REF:134 OBJ: Describe and compare the psychoanalytical/psychosocial theories proposed by Freud and Erikson. TOP: Caring MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is developing a plan of care concerning growth and development for a hospitalized adolescent. What should the nurse do? (Select all that apply.) a. Apply developmental theories when making observations of the adolescent’s patterns of growth and development. b. Compare the adolescent’s assessment findings versus normal findings. c. Recognize her own (the nurse’s) moral developmental level. d. Stick with one developmental theory for consistency. e. Apply a unidimensional life span perspective. ANS: A, B, C Today’s nurses need to be knowledgeable about several theoretical perspectives when working with patients. These theories form the basis for meaningful observation of an individual’s pattern of growth and development. They provide important guidelines for nurses to recognize deviations from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision­making process. No one theory successfully describes all the intricacies of human growth and development. Growth and development, as supported by a life span perspective, is multidimensional, not unidimensional. DIF:Apply (application)REF:138 OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Planning MSC: Health Promotion and Maintenance 2. A nurse is assessing temperaments of children. Which terms should the nurse use to describe findings? (Select all that apply.) a. The easy child b. The defiant child c. The difficult child d. The slow-to-warm up child e. The momma’s boy or daddy’s girl ANS: A, C, D Psychiatrists identified three basic classes of temperament: the easy child; the difficult child; and the slow­to­warm up child. There is no momma’s boy or daddy’s girl or defiant child. DIF:Understand (comprehension)REF:135 OBJ: Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Assessment MSC: Health Promotion and Maintenance Chapter 12: Conception Through Adolescence Chapter 12: Conception Through Adolescence Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A mother has delivered a healthy newborn. Which action is priority? a. Encourage close physical contact as soon as possible after birth. b. Isolate the newborn in the nursery during the first hour after delivery. c. Never leave the newborn alone with the mother during the first 8 hours after delivery. d. Do not allow the newborn to remain with parents until the second hour after delivery. ANS: A After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Early parent­child interaction encourages parent­child attachment. Most healthy newborns are awake and alert for the first halfhour after birth. This is a good time for parent­child interaction to begin. No evidence in the scenario suggests that the baby cannot be left alone with the parents during the first 8 hours or that the baby should remain in the nursery during the first hour. DIF:Apply (application)REF:142 OBJ: Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Implementation MSC:Health Promotion and Maintenance 2. A nurse teaches a new mother about the associated health risks to the infant. Which statement by the mother indicates a correct understanding of the teaching? a. “I will feed my baby every 4 hours around-the-clock.” b. “I need to leave the blankets off my baby to prevent smothering.” c. “I need to remind friends who want to hold my baby to wash their hands.” d. “I will throw away the bulb syringe now because my baby is breathing fine.” ANS: C Good handwashing technique is the most important factor in protecting the newborn from infection. You can help prevent infection by instructing parents and visitors to wash their hands before touching the infant. The nurse can help parents identify ways to meet needs by counseling them to feed their baby on demand rather than on a rigid schedule. Newborns are susceptible to heat loss and cold stress. Place the healthy newborn directly on the mother’s abdomen, covering with warm blankets. Removal of nasopharyngeal and oropharyngeal secretions remains a priority of care to maintain a patent airway; keeping the bulb syringe is important. DIF:Apply (application)REF:142 OBJ: Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Teaching/Learning MSC:Health Promotion and Maintenance 3. A nurse is working in the delivery room. Which action is priority immediately after birth? a. Open the airway. b. Determine gestational age. c. Monitor infant-parent interactions. d. Promote parent-newborn physical contact. ANS: A Opening the airway is the priority. The most extreme physiological change occurs when the newborn leaves the utero circulation and develops independent respiratory functioning. Direct nursing care includes maintaining an open airway, stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Following a comprehensive physical assessment, the nurse assesses gestational age and interactions between infant and parents. DIF:Apply (application)REF:142 OBJ: Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Implementation MSC:Management of Care 4. A nurse is assessing a newborn that was just born. Which newborn finding will cause the nurse to intervene immediately? a. Molding b. A lack of reflexes c. Cyanotic hands and feet d. A soft, protuberant abdomen ANS: B A lack of reflexes must be addressed quickly. Assessment of these reflexes is vital because the newborn depends largely on reflexes for survival and in response to its environment. Molding, or overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal pelvis and is a common occurrence with vaginal births. Normal physical characteristics include the continued presence of lanugo on the skin of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen. DIF:Analyze (analysis)REF:143 OBJ: Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Assessment MSC:Health Promotion and Maintenance 5. A nurse performs an assessment on a healthy newborn. Which assessment finding will the nurse document as normal? a. Cyanosis of the feet and hands for the first 48 hours b. Triangle-shaped anterior fontanel c. Sporadic motor movements d. Weight of 4800 grams ANS: C Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities. Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. The diamond shape of the anterior fontanel and the triangular shape of the posterior fontanel are found between the unfused bones of the skull. The average newborn is 2700 to 4000 grams (6 to 9 pounds), not 4800 grams. DIF:Understand (comprehension)REF:143 OBJ: Describe characteristics of physical growth of the unborn child and from birth to adolescence. TOP:AssessmentMSC:Health Promotion and Maintenance 6. A nurse is teaching the staff about development. Which information indicates the nurse needs to follow up? a. “Development proceeds in a cephalocaudal pattern.” b. “Development proceeds in a proximal-distal pattern.” c. “Development proceeds at a slower rate during the embryonic stage.” d. “Development proceeds at a predictive rate from the moment of conception.” ANS: C Development proceeds at a slower rate during embryonic stage indicates the nurse needs to follow up to correct the misconception. From the moment of conception until birth, human development proceeds at a predictive and rapid rate. All the rest of the information is correct and does not need follow­up. Development proceeds in a cephalocaudal and proximal­distal pattern. DIF:Understand (comprehension)REF:141 OBJ: Describe characteristics of physical growth of the unborn child and from birth to adolescence. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 7. A nurse is comparing physical growth patterns between school­aged children and adolescents. Which principle should the nurse consider? a. Physical growth usually slows during the adolescent period. b. Secondary sex characteristics usually develop during the adolescent years. c. Boys usually exceed girls in height and weight by the end of the school years. d. The distribution of muscle and fat remains constant during the adolescent years. ANS: B Sexual maturation in adolescence occurs with the development of primary and secondary sexual characteristics. Physical growth usually slows during the school­aged period, and then a growth spurt occurs during adolescence. Girls usually exceed boys in height and weight by the end of the school years. As height and weight increase during adolescence, the distribution of muscle and fat changes. DIF:Understand (comprehension)REF:153 OBJ: Describe characteristics of physical growth of the unborn child and from birth to adolescence. TOP:PlanningMSC:Health Promotion and Maintenance 8. The parent brings a child to the clinic for a 12­month well visit. The child weighed 6 pounds 2 ounces and was 21 inches long at birth. Which finding will cause the nurse to intervene? a. Height of 30 inches b. Weight of 16 pounds c. Is not yet potty-trained d. Is not yet walking up stairs ANS: B Size increases rapidly during the first year of life. Birth weight doubles in approximately 5 months and triples by 12 months. This infant should weigh at least 18 (6 × 3) pounds by this calculation. This child needs the nurse to intervene for further assessment. Height increases an average of 1 inch during each of the first 6 months and about 1/2 inch each month until 12 months: 21 + 6 + 3 = 30 (30 inches is the predicted height). Patterns of body function are just now starting to stabilize. It is quite normal for a 12­month­old child to not be potty­trained or walking up stairs yet. These milestones usually occur in the toddler period of development (12 to 36 months). DIF:Analyze (analysis)REF:145 OBJ: Describe characteristics of physical growth of the unborn child and from birth to adolescence. TOP:AssessmentMSC:Health Promotion and Maintenance 9. A nurse is assessing the cognitive changes in a preschooler. Which standard will the nurse use to determine normal? a. The ability to think abstractly and deal effectively with hypothetical problems b. The ability to think in a logical manner about the here and now c. The ability to assume the view of another person d. The ability to classify objects by size or color ANS: D Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color. Cognitive changes that provide the ability to think in a logical manner about the here and now occur during the school­aged years. It is during the teenaged years when the individual thinks abstractly and deals effectively with hypothetical problems. The toddler is unable to assume the view of another. DIF:Understand (comprehension)REF:149 OBJ: Describe cognitive and psychosocial development from birth to adolescence. TOP:AssessmentMSC:Health Promotion and Maintenance 10. The nurse is teaching a parenting class. One of the topics is development. Which statement from a parent indicates more teaching is needed? a. “The toddler may use parallel play.” b. “The preschooler has the ability to play in small groups.” c. “The school-aged child still needs total assistance in all safety activities.” d. “The toddler may have temper tantrums from parent’s acting on safety rules.” ANS: C At this age (school­age), encourage children to take responsibility for their own safety. The toddler continues to engage in solitary play but also begins to participate in parallel play, which is playing beside rather than with another child. The play of preschool children becomes more social after the third birthday as it shifts from parallel to associative play with others in small groups. The toddler’s strong will is frequently exhibited in negative behavior when caregivers attempt to direct actions. Temper tantrums result when parental restrictions frustrate toddlers. DIF:Apply (application)REF:153 OBJ: Describe cognitive and psychosocial development from birth to adolescence. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 11. The nurse is observing a 2­year­old hospitalized patient in the playroom. Which activity will the nurse most likely observe? a. Seeking out same sex children to play with b. Participating as the leader of a small group activity c. Sitting beside another child while playing with blocks d. Separating building blocks into groups by size and color ANS: C The child beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating as a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate their ability to think more complexly by classifying objects according to size or color. A 2­year­old child does not have this ability yet. Gender does not become a factor until the child reaches school­age when the child prefers same sex peers to opposite sex peers. DIF:Analyze (analysis)REF:148 OBJ: Explain the role of play in the development of a child. TOP: Assessment MSC:Health Promotion and Maintenance 12. A nurse is communicating with a newly admitted teenaged patient. Which action should the nurse take? a. Avoid questioning the patient about cigarette use when the nurse observes a cigarette lighter lying on the bedside table. b. Complete the admission database as quickly as possible by asking yes and no questions. c. Look for meaning behind the patient’s words and actions. d. Ignore the patient’s withdrawn behavior. ANS: C Good communication skills are critical for adolescents. Look for meaning behind the adolescent’s words and actions. Following are some hints for communicating with adolescents: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and school opens the channels for further discussion. Ask open­ended questions. (Yes and no questions are closed­ended questions.) The nurse should inquire about a patient’s withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues about adolescents’ emotional states. DIF:Apply (application)REF:154 OBJ: Describe cognitive and psychosocial development from birth to adolescence. TOP: Implementation MSC: Health Promotion and Maintenance 13. A nurse is caring for a preschooler. Which fear should the nurse most plan to minimize? a. Fear of bodily harm b. Fear of weight gain c. Fear of separation d. Fear of strangers ANS: A The greatest fear of preschoolers appears to be that of bodily harm; this is evident in children’s fear of the dark, animals, thunderstorms, and medical personnel. Toddlers who become ill and require hospitalization are most stressed by the separation from their parents. Persons with anorexia nervosa have an intense fear of gaining weight. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond differently to the two. DIF:Apply (application)REF:150 OBJ: Describe cognitive and psychosocial development from birth to adolescence. TOP:PlanningMSC:Health Promotion and Maintenance 14. A nurse is teaching a class about the effects of nutrition on fetal growth and development. A pregnant patient asks the nurse how much weight should normally be gained over the pregnancy. Which information should the nurse share with the patient? a. About 10 to 20 pounds b. About 15 to 25 pounds c. About 20 to 30 pounds d. About 25 to 35 pounds ANS: D The diet of a woman both before and during pregnancy has a significant effect on fetal development. For women who are at normal weight for height, the recommended weight gain is 25 to 35 pounds over three trimesters. Weight gains of 10 to 20, 15 to 25, and 20 to 30 pounds are too low. DIF:Understand (comprehension)REF:142 OBJ: Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Teaching/Learning MSC:Health Promotion and Maintenance 15. The nurse is caring for an infant. Which activity is most appropriate for the nurse to offer to the infant? a. Set of cards to organize and separate into groups b. Set of sock puppets with movable eyes c. Set of plastic stacking rings d. Set of paperback book ANS: C Adults and nurses facilitate infant learning by planning activities that promote the development of milestones and providing toys that are safe for the infant to explore with the mouth and manipulate with the hands such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color, making the cards more appropriate for them. Neither group is ready for paperback books. The sock puppet with movable eyes could create a choking hazard if one of the eyes comes off. DIF:Understand (comprehension)REF:146 OBJ: Explain the role of play in the development of a child. TOP: Implementation MSC:Health Promotion and Maintenance 16. A mother expresses concern because her 5­year­old child frequently talks about friends who don’t exist. What is the nurse’s best response to this mother’s concern? a. “Have you considered a child psychological evaluation?” b. “You should stop your child from playing electronic games.” c. “Pretend play is a sign your child watches too much television.” d. “It’s very normal for a child this age to have imaginary playmates.” ANS: D At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow the child to distinguish between reality and fantasy. The child does not need a psychological evaluation because this is normal behavior. Television, videos, electronic games, and computer programs help support development and the learning of basic skills. However, these should be only one part of the child’s total play activities. Pretend play is not a sign of watching too much television. DIF:Apply (application)REF:150 OBJ:Explain the role of play in the development of a child. TOP:Communication and Documentation MSC:Health Promotion and Maintenance 17. A school nurse is encouraging children to play a game of kickball. Which group of children is the nurse most likely addressing? a. Infant b. Toddler c. Preschool d. School-aged ANS: D A game of kickball would be best suited for school­aged children because in this age group, play involves peers and the pursuit of group goals. Although solitary activities are not eliminated, group play overshadows them. Younger children typically are not able to participate cooperatively in groups yet. Infants begin to play simple social games such as patty­cake and peek­a­boo. Toddlers engage in solitary play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not identical activities; however, no division of labor or rigid organization or rules are observed. By the age of 5, the group has a temporary leader for each activity. DIF:Apply (application)REF:152 OBJ: Explain the role of play in the development of a child. TOP: Evaluation MSC:Health Promotion and Maintenance 18. Which assessment finding of a school­aged patient should alert the nurse to a possible developmental delay? a. Verbalization of “I have no friends” b. Absence of secondary sex characteristics c. Curiosity about sexuality d. Lack of group identity ANS: A School­aged children should begin to develop friendships and to socialize with others. Interaction with peers allows them to define their own accomplishments in relation to others as they work to develop a positive self­image. The absence of secondary sex characteristics is a major concern of adolescents, not school­aged children, because physical evidence of maturity encourages the development of masculine and feminine behaviors in the adolescent. Lack of group relationships is also a concern of adolescents, not of school­aged children, because adolescents seek a group identity to fulfill their esteem and acceptance needs. Today many researchers believe that schoolaged children have a great deal of curiosity about their sexuality. Some experiment, but this is usually transitory. DIF:Analyze (analysis)REF:152 OBJ: Explain the role of play in the development of a child. TOP: Assessment MSC:Health Promotion and Maintenance 19. The nurse is teaching a parent about developmental needs of a 9­month­old infant. Which statement from the parent indicates a correct understanding of the teaching? a. “My child will begin to speak in sentences by 1 year of age.” b. “My child will probably enjoy playing peek-a-boo.” c. “My child will sleep about 7 to 8 hours a night.” d. “My child will be ready to try low-fat milk.” ANS: B By 9 months, infants play simple social games such as patty­cake and peek­a­boo. By 1 year, infants not only recognize their own names but are also able to say three to five words and understand almost 100 words; a 2 year old is generally able to speak in two­word sentences. The use of whole cow’s milk, 2% cow’s milk, or alternate milk products before the age of 12 months is not recommended. By 6 months, most infants are nocturnal and sleep between 9 and 11 hours at night. Total daily sleep averages 15 hours. DIF:Apply (application)REF:152 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 20. A nurse is teaching the parents of a school­aged child about accidents most common in this age group. Which topic should the nurse address? a. Falls b. Fires c. Drownings d. Poisonings ANS: B Because accidents such as fires and car and bicycle crashes are the leading cause of death and injury in the school­age period, safety is a priority health teaching consideration. Falls, drownings, and poisonings are priority for toddlers. DIF:Apply (application)REF:153 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 21. Which information from the parent of an 8­month­old infant will cause the nurse to intervene? a. My baby rides in the front-facing car seat when I go to the grocery store. b. I made sure the slats on the crib were less than 2 inches apart. c. I removed the mobile after my baby could reach it. d. My baby cries every time he sees a new person. ANS: A The nurse should intervene when parents let infants and toddlers ride in a front­facing car seat. All infants and toddlers should ride in a rear­facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer or their car safety seat. Parents also need to inspect an older crib to make sure the slats are no more than 6 cm (2.4 inches) apart. Instruct parents to remove mobiles as soon as the infant is able to reach them. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond differently to the two; this is a normal finding. DIF:Analyze (analysis)REF:144 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Implementation MSC: Health Promotion and Maintenance 22. The nurse is preparing to teach a group of parents with infants about growth and development. Which information should the nurse include in the teaching session? a. 3-month-old infants will be able to bang objects together. b. 4-month-old infants will be able to sit alone with support. c. 5-month-old infants will be able to creep on hands and knees. d. 6-month-old infants will be able to turn from back to abdomen. ANS: D 6­month­old infants will be able to turn from back to abdomen. 6 to 8 month olds can sit alone without support and bang objects together. 8 to 10 month olds can creep on hands and knees. DIF:Apply (application)REF:145 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 23. Which statement, if made by a parent, will require further instruction from the nurse? a. “I should not be surprised that my teenage son has so many friends.” b. “I get worried because my teenage son thinks he’s indestructible.” c. “I should cover for my 10-year-old son when he makes mistakes until he learns the ropes.” d. “I usually have nutritious snacks available because my 10-year-old son is always hungry right after school.” ANS: C The nurse will need to teach the parent of a school­aged child covering for the child’s mistakes; this is a misconception that needs to be corrected. Parents have to learn to allow their school­aged child (6 to 12 years old) to make decisions, accept responsibility, and learn from life’s experiences. All the other statements are normal and do not need further teaching. Teenagers typically are very social and have many friends. Adolescents seek a group identity because they need esteem and acceptance. Adolescents feel they are indestructible, which leads to risk­taking behaviors. Schoolage children are developing eating patterns that are independent of parental supervision. Having nutritious snacks available is a healthy option. DIF:Apply (application)REF:151 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 24. A nurse is teaching parents about appropriate activities for different age groups. Which toy, if selected by the parent of a 12­month­old infant, will indicate a correct understanding of the teaching? a. Busy box b. Electronic games c. Game requiring two to four people d. Small, plastic alphabet letters and magnets ANS: A Adults facilitate infant learning by planning activities that promote the development of milestones and by providing toys that are safe for the infant to explore with the mouth and manipulate with the hands, such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. For the toddler (not the infant), television, videos, electronic games, and computer programs help support development and learning of basic skills. Infants are not capable of participating in small group activities. By age 4, children play in groups of two or three. Adults should provide toys that are safe for the infant to explore with the mouth. Small, plastic letters and magnets could be choking hazards for an infant. DIF:Apply (application)REF:146 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is teaching a parenting class for families with adolescents. Which health concerns will the nurse include in the teaching session? (Select all that apply.) a. Suicide b. Eating disorders c. Violence/Homicide d. Sexually transmitted infections e. Gonadotropic hormone stimulation ANS: A, B, C, D Suicide is a major leading cause of death in adolescents 15 to 24 years of age. Adolescent overweight and obesity are current concerns in the United States, and most teens try dieting at some time to control weight. Unfortunately the number of eating disorders is on the rise in adolescent girls. Homicide is the second leading cause of death in the 15­ to 24­year­old age­group, and for AfricanAmerican teenagers it is the most likely cause of death. Sexually transmitted diseases annually affect three million sexually active adolescents. Gonadotropic hormones stimulate ovarian cells to produce estrogen and testicular cells to produce testosterone. These hormones are normally occurring and contribute to the development of secondary sex characteristics, such as hair growth and voice changes, and play an essential role in reproduction. It is not a health concern. DIF:Understand (comprehension)REF:155­156 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance MATCHING A nurse is teaching parents about the fine motor skills of infants to help parents understand development growth and needs. Match the information to the correct age that the nurse should include in the teaching session. a. Can place objects into containers b. Pulls a string to obtain an object c. Can hold a baby bottle d. Holds rattle for short periods e. Uses pincer grasp well 1. 2 to 4 months 2. 4 to 6 months 3. 6 to 8 months 4. 8 to 10 months 5. 10 to 12 months 1.ANS:DDIF:Understand (comprehension)REF:145 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 2.ANS:CDIF:Understand (comprehension)REF:145 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 3.ANS:BDIF:Understand (comprehension)REF:145 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 4.ANS:EDIF:Understand (comprehension)REF:145 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 5.ANS:ADIF:Understand (comprehension)REF:145 OBJ: Discuss ways in which the nurse is able to help parents meet their child’s developmental needs. TOP: Teaching/Learning MSC: Health Promotion and Maintenance Chapter 13: Young and Middle Adults Chapter 13: Young and Middle Adults Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is caring for a young adult. Which goal is priority? a. Maintain peer relationships. b. Maintain family relationships. c. Maintain parenteral relationships. d. Maintain recreational relationships. ANS: B Family is important during young adulthood. Challenges may include the demands of working and raising families. Peer is more important in the adolescent years. Young adults are much freer from parental control. While recreation is important, the family and work are the priorities in young adults. DIF:Apply (application)REF:159 OBJ: List and discuss major life events of young and middle adults and the childbearing family. TOP:PlanningMSC:Health Promotion and Maintenance 2. The nurse is caring for a hospitalized young­adult male who works as a dishwasher at a local restaurant. He states that he would like to get a better job but has no education. How can the nurse best assist this patient psychosocially? a. By providing information and referrals b. By focusing on the patient’s medical diagnoses c. By telling the patient that he needs to go back to school d. By expecting the patient to be flexible in decision making ANS: A Support from the nurse, access to information, and appropriate referrals provide opportunities for achievement of a patient’s potential. Health is not merely the absence of disease (focusing on medical diagnoses) but involves wellness in all human dimensions. Telling a patient what to do (go back to school) is inappropriate. Each person (not the nurse) needs to make these decisions based on individual factors. Insecure persons tend to be more rigid in making decisions. DIF:Analyze (analysis)REF:160 OBJ: Discuss cognitive and psychosocial changes occurring during the adult years. TOP: Implementation MSC: Health Promotion and Maintenance 3. Which goal is priority when the nurse is caring for a middle­aged adult? a. Maintain immediate family relationships. b. Maintain future generation relationships. c. Maintain personal career relationships. d. Maintain work relationships. ANS: B Many middle­aged adults find particular joy in helping their children and other young people become productive and responsible adults. While immediate family is important, this goal is priority in young adults, not as important in middle­aged adults. During this period, personal and career achievements have often already been experienced; therefore, these goals are not priority. DIF:Apply (application)REF:166 OBJ: List and discuss the major life events of young and middle adults and the childbearing family. TOP:PlanningMSC:Health Promotion and Maintenance 4. A nurse is teaching young adults about health risks. Which statement from a young adult indicates a correct understanding of the teaching? a. “It’s probably safe for me to start smoking. At my age, there’s not enough time for cancer to develop.” b. “My mother had appendicitis so this increases my chance for developing appendicitis.” c. “Controlling the amount of stress in my life may decrease the risk of illness.” d. “I don’t do drugs. I do drink coffee, but caffeine is not a drug.” ANS: C Lifestyle habits that activate the stress response increase the risk of illness; so, controlling this will decrease risk. Smoking is a well­documented risk factor for pulmonary, cardiac, and vascular disease as well as cancer in smokers and in individuals who receive secondhand smoke. The presence of certain chronic illnesses (not acute illnesses—appendicitis) in the family increases the family member’s risk of developing a disease. Caffeine is a naturally occurring legal stimulant that is readily available. Caffeine stimulates catecholamine release, which, in turn, stimulates the central nervous system; it also increases gastric acid secretion, heart rate, and basal metabolic rate. DIF:Understand (comprehension)REF:162 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 5. A nurse is choosing an appropriate topic for a young­adult health fair. Which topic should the nurse include? a. Retirement b. Menopause c. Climacteric factors d. Unplanned pregnancies ANS: D Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes for the mother (young adult), infant, and family. Retirement is an issue for middle­aged, not young adults. The onset of menopause and the climacteric affect the sexual health of the middle­aged adult, not the young adult. DIF:Understand (comprehension)REF:163 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:PlanningMSC:Health Promotion and Maintenance 6. A nurse is assessing the risk of intimate partner violence (IPV) for patients. Which population should the nurse focus on most for IVP? a. White males b. Pregnant females c. Middle-aged adults d. Nonsubstance abusers ANS: B The greatest risk of violence occurs during the reproductive years. A pregnant woman has a 35.6% greater risk of being a victim of IPV than a nonpregnant woman. White males, middle­aged adults, and nonsubstance abusers are not as high risk as pregnant women. DIF:Understand (comprehension)REF:163 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 7. A patient states that she is pregnant and concerned because she does not know what to expect, and she wants her husband to play an active part in the birthing process. Which information should the nurse share with the patient? a. Lamaze classes can prepare pregnant women and their partners for what is coming. b. The frequency of sexual intercourse is key to helping the husband feel valued. c. After the birth, the stress of pregnancy will disappear and will be replaced by relief. d. After the baby is born, the wife should accept the extra responsibilities of motherhood. ANS: A Childbirth education classes (like Lamaze) can prepare pregnant women, their partners, and other support persons to participate in the birthing process. The psychodynamic aspect of sexual activity is as important as the type or frequency of sexual intercourse to young adults; however, this does not relate to the issue the patient reports (lack of knowledge and participation). The stress that many women experience after childbirth has a significant impact on the health of postpartum women. Ideally partners should share all responsibilities; however, this does not relate to the patient’s concerns. DIF:Apply (application)REF:161 OBJ: Describe developmental tasks of the young adult, the childbearing family, and the middle adult. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 8. Which information from the nurse indicates a correct understanding of emerging adulthood? a. It is a type of young adulthood. b. It is a type of extended adolescence. c. It is a type of independent exploration. d. It is a type of marriage and parenthood. ANS: C This newly identified stage of development from age 18 to 25 (emerging adulthood) has been described as neither an extended adolescence, as it is much freer from parental control and is much more a period of independent exploration, nor young adulthood, as most young people in their twenties have not made the transitions historically associated with adult status, especially marriage and parenthood. DIF:Understand (comprehension)REF:159 OBJ:Discuss development theories of young and middle adults. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 9. A nurse is planning care for a 30 year old. Which goal is priority? a. Refine self-perception. b. Master career plans. c. Examine life goals. d. Achieve intimacy. ANS: B From 29 to 34, the person directs enormous energy toward achievement and mastery of the surrounding world. The years from 35 to 43 are a time of vigorous examination of life goals and relationships. Between the ages of 23 and 28, the person refines self­perception and ability for intimacy. DIF:Apply (application)REF:160 OBJ: Discuss cognitive and psychosocial changes occurring during the adult years. TOP:PlanningMSC:Health Promotion and Maintenance 10. A nurse is planning care for young­adult patients. Which information should the nurse consider when planning care? a. Fertility issues do not occur in young adulthood. b. Young adults tend to suffer more from severe illness. c. Substance abuse is easy to observe in young-adult patients. d. Young adults are quite active but are at risk for illness in later years. ANS: D Young adults are generally active and experience severe illnesses less frequently. However, their lifestyles may put them at risk for illnesses or disabilities during their middle or older­adult years. An estimated 10% to 15% of reproductive couples are infertile, and many are young adults. Substance abuse is not always diagnosable, particularly in its early stages. DIF:Understand (comprehension)REF:160 OBJ: Describe normal physical changes in young and middle adulthood and pregnancy. TOP:PlanningMSC:Health Promotion and Maintenance 11. During a routine physical assessment, the nurse obtaining a health history notes that a 50­yearold female patient reports pain and redness in the right breast. Which action is best for the nurse to take in response to this finding? a. Assess the patient as thoroughly as possible. b. Explain to the patient that breast tenderness is normal at her age. c. Tell the patient that redness is not a cause for concern and is quite common. d. Inform her that redness is the precursor to normal unilateral breast enlargement. ANS: A A comprehensive assessment offers direction for health promotion recommendations, as well as for planning and implementing any acutely needed intervention. Redness or painful breasts are abnormal physical assessment findings in the middle­aged adult. Increased size of one breast is an abnormal physical assessment finding in the middle­aged adult. DIF:Apply (application)REF:166 OBJ: Describe normal physical changes in young and middle adulthood and pregnancy. TOP: Implementation MSC: Health Promotion and Maintenance 12. A 55­year­old female presents to the outpatient clinic describing irregular menstrual periods and hot flashes. Which information should the nurse share with the patient? a. The patient’s assessment points toward normal menopause. b. Those symptoms are normal when a woman undergoes the climacteric. c. An assessment is not really needed because these problems are normal for older women. d. The patient should stop regular exercise because that is probably causing these symptoms. ANS: A The most significant physiological changes during middle age are menopause in women and the climacteric in men. Menopause typically occurs between 45 and 60 years of age. The nurse should continue with the examination because a comprehensive assessment offers direction for health promotion recommendations, as well as for planning and implementing any acutely needed interventions. Exercise should not be stopped, especially in middle­aged adults. DIF:Apply (application)REF:166 OBJ: Describe normal physical changes in young and middle adulthood and pregnancy. TOP:AssessmentMSC:Health Promotion and Maintenance 13. The nurse is teaching a class to pregnant women about common physiological changes during pregnancy. Which information should the nurse include in the teaching session? a. Pregnancy is not a time to be having sexual activity. b. Urinary frequency will occur early in the pregnancy. c. Breast tenderness should be reported as soon as possible. d. Late in the pregnancy Braxton Hicks contraction may occur. ANS: D During the third trimester (late pregnancy), increases in Braxton Hicks contractions (irregular, short contractions), fatigue, and urinary frequency (not early) occur. Normally, women commonly have morning sickness, breast enlargement and tenderness, and fatigue. Women need to be reassured that sexual activity will not harm the fetus. DIF:Apply (application)REF:165 OBJ: Describe normal physical changes in young and middle adulthood and pregnancy. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 14. A nurse discusses the risks of repeated sun exposure with a young­adult patient. Which response will the nurse most expect from this patient? a. “I should consider participating in a health fair about safe sun practices.” b. “I’ll make an appointment with my doctor right away for a full skin check.” c. “I’ve had this mole my whole life. So what if it changed color? My skin is fine.” d. “I have a mole that has been bothering me. I’ll call my family doctor for an appointment to get it checked.” ANS: C Most typically young adults would say that their skin is fine. Young adults often ignore physical symptoms and often postpone seeking health care. Making an appointment right away with the doctor and participating in health fairs are not typical behaviors of young adults for the same reason. DIF:Analyze (analysis)REF:160 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 15. Upon assessment of a middle­aged adult, the nurse observes uneven weight bearing and decreased range of joint motion. Which area is priority? a. Abuse potential b. Fall precautions c. Stroke prevention d. Self-esteem issues ANS: B With uneven weight bearing and decreased range of joint motion, falling is a priority. Abuse potential would indicate other findings such as bruising or unkept appearance. While stroke prevention is important in a middle­aged adult, these are not the signs of stroke. While self­esteem issues may arise from physical changes, safety is a priority over self­esteem issues. DIF:Analyze (analysis)REF:167 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 16. A young­adult patient is brought to the hospital by police after crashing the car in a high­speed chase when trying to avoid arrest for spousal abuse. Which action should the nurse take? a. Question the patient about drug use. b. Offer the patient a cup of coffee to calm nerves. c. Discretely assess the patient for sexually transmitted infections. d. Deal with the issue at hand, not asking about previous illnesses. ANS: A Reports of arrests because of driving while intoxicated, wife or child abuse, or disorderly conduct are reasons for the nurse to investigate the possibility of drug abuse more carefully. Caffeine is a naturally occurring legal stimulant that stimulates the central nervous system and is not the choice for calming nerves. Although sexually transmitted infections occur in the young adult, this is not an action a nurse should take in this situation. The nurse may obtain important information by making specific inquiries about past medical problems, changes in food intake or sleep patterns, and problems of emotional lability. DIF:Apply (application)REF:163 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP: Implementation MSC: Psychosocial Integrity 17. A nurse determines that a middle­aged patient is a typical example of the “sandwich generation.” What did the nurse discover the patient is caught between? a. Job responsibilities or family responsibilities b. Stopping old habits and starting new ones c. Caring for children and aging parents d. Advancing in career or retiring ANS: C Middle­aged adults also begin to help aging parents while being responsible for their own children, placing them in the sandwich generation. It does not include job and family responsibilities; old habits and new ones; or career and retiring. DIF:Apply (application)REF:166 OBJ: Discuss the significance of family in the life of the adult. TOP: Assessment MSC:Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is assessing a middle­aged patient’s barriers to change in eating habits. Which areas will the nurse assess that are external barriers? (Select all that apply.) a. Lack of facilities b. Lack of materials c. Lack of knowledge d. Lack of social supports e. Lack of short- and long-term goals ANS: A, B, D External barriers to change include lack of facilities, materials, and social supports. Internal barriers are lack of knowledge, insufficient skills, and undefined short­ and long­term goals. DIF:Understand (comprehension)REF:169 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 2. A home health nurse is providing care to a middle­aged couple with children at home. The patient has a debilitating chronic illness. Which areas will the nurse need to assess? (Select all that apply.) a. Adherence to treatment and rehabilitation regimens b. Coping mechanisms of patient and family c. Need for community services or referrals d. Knowledge base of patient only e. Use of a doula for care ANS: A, B, C Along with the current health status of the chronically ill middle­aged adult, you need to assess the knowledge base of both the patient and family. In addition, you must determine the coping mechanisms of the patient and family; adherence to treatment and rehabilitation regimens; and the need for community and social services, along with appropriate referrals. A doula is a support person to be present during labor to assist women who have no other source of support. DIF:Understand (comprehension)REF:170 OBJ: Discuss the significance of family in the life of the adult. TOP: Assessment MSC: Psychosocial Integrity 3. A nurse is providing prenatal care to a first­time mother. Which information will the nurse share with the patient? (Select all that apply.) a. Regular trend for postpartum depression b. Protection against urinary infection c. Strategies for empty nest syndrome d. Exercise patterns e. Proper diet ANS: B, D, E Prenatal care includes a thorough physical assessment of the pregnant woman during regularly scheduled intervals. Information regarding STIs and other vaginal infections and urinary infections that will adversely affect the fetus and counseling about exercise patterns, diet, and child care are important for a pregnant woman. Empty nest syndrome occurs as children leave the home. Postpartum depression is rare. DIF:Understand (comprehension)REF:165 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP: Teaching/Learning MSC: Health Promotion and Maintenance MATCHING A nurse is assessing young and middle­aged adults for work­related conditions. Match the job to the work­related conditions that the nurse is assessing. a. Liver disease b. Carpal tunnel syndrome c. Asbestosis d. Farmer’s lung e. Bladder cancer 1. Insulators 2. Dry cleaners 3. Dye workers 4. Office computer workers 5. Agricultural workers 1.ANS:CDIF:Understand (comprehension)REF:164 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 2.ANS:ADIF:Understand (comprehension)REF:164 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 3.ANS:EDIF:Understand (comprehension)REF:164 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 4.ANS:BDIF:Understand (comprehension)REF:164 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance 5.ANS:DDIF:Understand (comprehension)REF:164 OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult. TOP:AssessmentMSC:Health Promotion and Maintenance Chapter 14: Older Adult Chapter 14: Older Adult Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is obtaining a history on an older adult. Which finding will the nurse most typically find? a. Lives in a nursing home b. Lives with a spouse c. Lives divorced d. Lives alone ANS: B In 2012, 57% of older adults in non­institutional settings lived with a spouse (45% of older women, 71% of older men); 28% lived alone (35% of older women, 19% of older men); and only 3.5% of all older adults resided in institutions such as nursing homes or centers. Most older adults have lost a spouse due to death rather than divorce. DIF:Apply (application)REF:173 OBJ:Identify common myths and stereotypes about older adults. TOP:AssessmentMSC:Health Promotion and Maintenance 2. A nurse is developing a plan of care for an older adult. Which information will the nurse consider? a. Should be standardized because most geriatric patients have the same needs b. Needs to be individualized to the patient’s unique needs c. Focuses on the disabilities that all aging persons face d. Must be based on chronological age alone ANS: B Every older adult is unique, and the nurse needs to approach each one as a unique individual. The nursing care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Aging does not automatically lead to disability and dependence. Chronological age often has little relation to the reality of aging for an older adult. DIF:Understand (comprehension)REF:173 OBJ:Identify common myths and stereotypes about older adults. TOP:PlanningMSC:Health Promotion and Maintenance 3. Which information from a co­worker on a gerontological unit will cause the nurse to intervene? a. Most older people have dependent functioning. b. Most older people have strengths we should focus on. c. Most older people should be involved in care decision. d. Most older people should be encouraged to have independence. ANS: A Most older people remain functionally independent despite the increasing prevalence of chronic disease; therefore, this misconception should be addressed. It is critical for you to respect older adults and actively involve them in care decisions and activities. You also need to identify an older adult’s strengths and abilities during the assessment and encourage independence as an integral part of your plan of care. DIF:Understand (comprehension)REF:173 OBJ:Identify common myths and stereotypes about older adults. TOP: Implementation MSC: Health Promotion and Maintenance 4. A nurse suspects an older­adult patient is experiencing caregiver neglect. Which assessment findings are consistent with the nurse’s suspicions? a. Flea bites and lice infestation b. Left at a grocery store c. Refuses to take a bath d. Cuts and bruises ANS: A Caregiver neglect includes unsafe and unclean living conditions, soiled bedding, and animal or insect infestation. Abandonment includes desertion at a hospital, nursing facility, or public location such as a shopping center. Self­neglect includes refusal or failure to provide oneself with basic necessities such as food, water, clothing, shelter, personal hygiene, medication, and safety. Physical abuse includes hitting, beating, pushing, slapping, kicking, physical restraint, inappropriate use of drugs, fractures, lacerations, rope burns, and untreated injuries. DIF:Apply (application)REF:188 OBJ: Describe the multi­faceted aspects of elder mistreatment. TOP: Assessment MSC: Psychosocial Integrity 5. A nurse is teaching a group of older­adult patients. Which teaching strategy is best for the nurse to use? a. Provide several topics of discussion at once to promote independence and making choices. b. Avoid uncomfortable silences after questions by helping patients complete their statements. c. Ask patients to recall past experiences that correspond with their interests. d. Speak in a high pitch to help patients hear better. ANS: C Teaching strategies include the use of past experiences to connect new learning with previous knowledge, focusing on a single topic to help the patient concentrate, giving the patient enough time in which to respond because older adults’ reaction times are longer than those of younger persons, and keeping the tone of voice low; older adults are able to hear low sounds better than highfrequency sounds. DIF:Understand (comprehension)REF:184 OBJ: Discuss issues related to psychosocial changes of aging. TOP: Teaching/Learning MSC:Health Promotion and Maintenance 6. An older patient has fallen and suffered a hip fracture. As a consequence, the patient’s family is concerned about the patient’s ability to care for self, especially during this convalescence. What should the nurse do? a. Stress that older patients usually ask for help when needed. b. Inform the family that placement in a nursing center is a permanent solution. c. Tell the family to enroll the patient in a ceramics class to maintain quality of life. d. Provide information and answer questions as family members make choices among care options. ANS: D Nurses help older adults and their families by providing information and answering questions as they make choices among care options. Some older adults deny functional declines and refuse to ask for assistance with tasks that place their safety at great risk. The decision to enter a nursing center is never final, and a nursing center resident sometimes is discharged to home or to another less­acute residence. What defines quality of life varies and is unique for each person. DIF:Understand (comprehension)REF:175 OBJ: Discuss common developmental tasks of older adults. TOP: Implementation MSC:Health Promotion and Maintenance 7. What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing center? a. Have the family members evaluate nursing home staff according to their ability to get tasks done efficiently and safely. b. Make sure that nursing home staff members get patients out of bed and dressed according to staff’s preferences. c. Explain that it is important for the family to visit the center and inspect it personally. d. Suggest a nursing center that has standards as close to hospital standards as possible. ANS: C An important step in the process of selecting a nursing home is to visit the nursing home. The nursing home should not feel like a hospital. It is a home, a place where people live. Members of the nursing home staff should focus on the person, not the task. Residents should be out of bed and dressed according to their preferences, not staff preferences. DIF:Apply (application)REF:175 OBJ: Discuss common developmental tasks of older adults. TOP: Implementation MSC:Management of Care 8. A 70­year­old patient who suffers from worsening dementia is no longer able to live alone. The nurse is discussing health care services and possible long­term living arrangements with the patient’s only son. What will the nurse suggest? a. An apartment setting with neighbors close by b. Having the patient utilize weekly home health visits c. A nursing center because home care is no longer safe d. That placement is irrelevant because the patient is retreating to a place of inactivity ANS: C Some family caregivers consider nursing center placement when in­home care becomes increasingly difficult or when convalescence from hospitalization requires more assistance than the family is able to provide. An apartment setting and the use of home health visits are not appropriate because living at home is unsafe. Dementia is not a time of inactivity but an impairment of intellectual functioning. DIF:Analyze (analysis)REF:175 OBJ: Discuss common developmental tasks of older adults. TOP: Implementation MSC:Management of Care 9. A nurse is caring for an older adult. Which goal is priority? a. Adjusting to career b. Adjusting to divorce c. Adjusting to retirement d. Adjusting to grandchildren ANS: C Adjusting to retirement is one of the developmental tasks for an older person. A young or middleaged adult has to adjust to career and/or divorce. A middle­aged adult has to adjust to grandchildren. DIF:Apply (application)REF:174 OBJ: Discuss common developmental tasks of older adults. TOP: Planning MSC:Health Promotion and Maintenance 10. A nurse is observing for the universal loss in an older­adult patient. What is the nurse assessing? a. Loss of finances through changes in income b. Loss of relationships through death c. Loss of career through retirement d. Loss of home through relocation ANS: B The universal loss for older adults usually revolves around the loss of relationships through death. Life transitions, of which loss is a major component, include retirement and the associated financial changes, changes in roles and relationships, alterations in health and functional ability, changes in one’s social network, and relocation. However, these are not the universal loss. DIF:Understand (comprehension)REF:181 OBJ: Discuss issues related to psychosocial changes of aging. TOP: Assessment MSC: Psychosocial Integrity 11. A nurse is discussing sexuality with an older adult. Which action will the nurse take? a. Ask closed-ended questions about specific symptoms the patient may experience. b. Provide information about the prevention of sexually transmitted infections. c. Discuss the issues of sexuality in a group in a private room. d. Explain that sexuality is not necessary as one ages. ANS: B Include information about the prevention of sexually transmitted infections when appropriate. Openended questions inviting an older adult to explain sexual activities or concerns elicit more information than a list of closed­ended questions about specific activities or symptoms. You need to provide privacy for any discussion of sexuality and maintain a nonjudgmental attitude. Sexuality and the need to express sexual feelings remain throughout the human life span. DIF:Understand (comprehension)REF:182 OBJ: Discuss issues related to psychosocial changes of aging. TOP: Implementation MSC:Health Promotion and Maintenance 12. A nurse is teaching a health promotion class for older adults. In which order will the nurse list the most common to least common conditions that can lead to death in older adults? 1. Chronic obstructive lung disease 2. Cerebrovascular accidents 3. Heart disease 4. Cancer a. 4, 1, 2, 3 b. 3, 4, 1, 2 c. 2, 3, 4, 1 d. 1, 2, 3, 4 ANS: B Heart disease is the leading cause of death in older adults followed by cancer, chronic lung disease, and stroke (cerebrovascular accidents). DIF:Apply (application)REF:184 OBJ: Describe selected health concerns of older adults. TOP: Teaching/Learning MSC:Health Promotion and Maintenance 13. A nurse is observing skin integrity of an older adult. Which finding will the nurse document as a normal finding? a. Oily skin b. Faster nail growth c. Decreased elasticity d. Increased facial hair in men ANS: C Loss of skin elasticity is a common finding in the older adult. Other common findings include pigmentation changes, glandular atrophy (oil, moisture, and sweat glands), thinning hair (facial hair: decreased in men, increased in women), slower nail growth, and atrophy of epidermal arterioles. DIF:Understand (comprehension)REF:177 OBJ: Describe common physiological changes of aging. TOP: Assessment MSC:Health Promotion and Maintenance 14. An older­adult patient in no acute distress reports being less able to taste and smell. What is the nurse’s best response to this information? a. Notify the health care provider immediately to rule out cranial nerve damage. b. Schedule the patient for an appointment at a smell and taste disorders clinic. c. Perform testing on the vestibulocochlear nerve and a hearing test. d. Explain to the patient that diminished senses are normal findings. ANS: D Diminished taste and smell senses are common findings in older adults. Scheduling an appointment at a smell and taste disorders clinic, testing the vestibulocochlear nerve, or an attempt to rule out cranial nerve damage is unnecessary at this time as per the information provided. DIF:Apply (application)REF:177 OBJ: Describe common physiological changes of aging. TOP: Implementation MSC:Health Promotion and Maintenance 15. A nurse is assessing an older adult for cognitive changes. Which symptom will the nurse report as normal? a. Disorientation b. Poor judgment c. Slower reaction time d. Loss of language skills ANS: C Slower reaction time is a common change in the older adult. Symptoms of cognitive impairment, such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgment are not normal aging changes and require further investigation of underlying causes. DIF:Understand (comprehension)REF:177 | 179 OBJ: Describe common physiological changes of aging. TOP: Assessment MSC:Health Promotion and Maintenance 16. An older patient with dementia and confusion is admitted to the nursing unit after hip replacement surgery. Which action will the nurse include in the plan of care? a. Keep a routine. b. Continue to reorient. c. Allow several choices. d. Socially isolate patient. ANS: A Patients with dementia need a routine. Continuing to reorient a patient with dementia is nonproductive and not advised. Patients with dementia need limited choices. Social interaction based on the patient’s abilities is to be promoted. DIF:Apply (application)REF:181 OBJ: Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging. TOP: Planning MSC: Physiological Adaptation 17. A nurse is helping an older­adult patient with instrumental activities of daily living. The nurse will be assisting the patient with which activity? a. Taking a bath b. Getting dressed c. Making a phone call d. Going to the bathroom ANS: C Instrumental activities of daily living or IADLs (such as the ability to write a check, shop, prepare meals, or make phone calls) and activities of daily living or ADLs (such as bathing, dressing, and toileting) are essential to independent living. DIF:Apply (application)REF:179 OBJ:Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging.TOP:Implementation MSC:Health Promotion and Maintenance 18. A male older­adult patient expresses concern and anxiety about decreased penile firmness during an erection. What is the nurse’s best response? a. Tell the patient that libido will always decrease, as well as the sexual desires. b. Tell the patient that touching should be avoided unless intercourse is planned. c. Tell the patient that heterosexuality will help maintain stronger libido. d. Tell the patient that this change is expected in aging adults. ANS: D Aging men typically experience an erection that is less firm and shorter acting and have a less forceful ejaculation. Testosterone lessens with age and sometimes (not always) leads to a loss of libido. However, for both men and women sexual desires, thoughts, and actions continue throughout all decades of life. Sexuality involves love, warmth, sharing, and touching, not just the act of intercourse. Touch complements traditional sexual methods or serves as an alternative sexual expression when physical intercourse is not desired or possible. Clearly not all older adults are heterosexual, and there is emerging research on older adult, lesbian, gay, bisexual, and transgender individuals and their health care needs. DIF:Apply (application)REF:177­178 OBJ:Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging.TOP:Implementation MSC:Health Promotion and Maintenance 19. A patient asks the nurse what the term polypharmacy means. Which info [Show More]

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