Content |
Chapter 01: Drug Definitions, Standards, and Information Sources
Willihnganz: Clayton’s Basic Pharmacology for Nurses, 18th Edition
MULTIPLE CHOICE
1.What is the name under which a drug is listed by the US Food and Drug Administration (FDA)?
a. |
Brand |
b. |
Nonproprietary |
c. |
Official |
d. |
Trademark |
ANS: C
The official name is the name under which a drug is listed by the FDA. The brand name, or trademark, is the name given to a drug by its manufacturer. The nonproprietary, or generic, name is provided by the United States Adopted Names Council
DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 1
NAT: NCLEX Client Needs Category: Safe, Effective Care Environment
TOP: Nursing Process Step: Assessment CON: Patient Education
- Which source contains information specific to nutritional supplements?
a. |
USP Dictionary of USAN & International Drug Names |
b. |
Natural Medicines Comprehensive Database |
c. |
United States Pharmacopoeia/National Formulary (USP NF) |
d. |
Drug Interaction Facts |
ANS: C
United States Pharmacopoeia/National Formulary contains information specific to nutritional supplements. USP Dictionary of USAN & International Drug Names is a compilation of drug names, pronunciation guide, and possible future FDA approved drugs; it does not include nutritional supplements. Natural Medicines Comprehensive Database contains evidence-based information on herbal medicines and herbal combination products; it does not include information specific to nutritional supplements. Drug Interaction Facts contains comprehensive information on drug interaction facts; it does not include nutritional supplements.
DIF: Cognitive Level: Knowledge REF: p. 2 | p. 3 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment CON: Nutrition | Patient Education
3.What is the most comprehensive reference available to research a drug interaction?
a. |
Drug Facts and Comparisons |
b. |
Drug Interaction Facts |
c. |
Handbook on Injectable Drugs |
d. |
Martindale—The Complete Drug Reference |
ANS: B
First published in 1983, Drug Interaction Facts is the most comprehensive book available on drug interactions. In addition to monographs listing various aspects of drug interactions, this information is reviewed and updated by an internationally renowned group of physicians and pharmacists with clinical and scientific expertise.
DIF: Cognitive Level: Comprehension REF: p. 4 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment
4.The physician has written an order for a drug with which the nurse is unfamiliar. Which section of the Physicians’ Desk Reference (PDR) is most helpful to get information about this drug?
a. |
Manufacturer’s section |
b. |
Brand and Generic name section |
c. |
Product category section |
d. |
Product information section |
ANS: B
A physician’s order would include the brand and/or generic name of the drug. The alphabetic index in the PDR would make this section the most user-friendly. Based on a physician’s order, manufacturer’s information and classification information would not be known. The Manufacturer’s section is a roster of manufacturers. The product category section lists products subdivided by therapeutic classes, such as analgesics, laxatives, oxytocics, and antibiotics. The product information section contains reprints of the package inserts for the major products of manufacturers.
DIF: Cognitive Level: Comprehension REF: p. 4 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Planning CON: Safety | Patient Education | Clinical Judgment
5.Which online drug reference makes available to healthcare providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines?
a. |
American Drug Index |
b. |
American Hospital Formulary |
c. |
DailyMed |
d. |
Physicians’ Desk Reference (PDR) |
ANS: C
DailyMed makes available to healthcare providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines. The American Drug Index is not appropriate for patient use. The American Hospital Formulary is not appropriate for patient use. The PDR is not appropriate for patient use.
DIF: Cognitive Level: Knowledge REF: p. 3 | p. 5 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Implementation
CON: Safety | Patient Education | Clinical Judgment
6.Which legislation authorizes the FDA to determine the safety of a drug before its marketing?
a. |
Federal Food, Drug, and Cosmetic Act (1938) |
b. |
Durham Humphrey Amendment (1952) |
c. |
Controlled Substances Act (1970) |
d. |
Kefauver Harris Drug Amendment (1962) |
ANS: A
The Federal Food, Drug, and Cosmetic Act of 1938 authorized the FDA to determine the safety of all drugs before marketing. Later amendments and acts helped tighten FDA control and ensure drug safety. The Durham Humphrey Amendment defines the kinds of drugs that cannot be used safely without medical supervision and restricts their sale to prescription by a licensed practitioner. The Controlled Substances Act addresses only controlled substances and their categorization. The Kefauver Harris Drug Amendment ensures drug efficacy and greater drug safety. Drug manufacturers are required to prove to the FDA the effectiveness of their products before marketing them.
DIF: Cognitive Level: Knowledge REF: p. 5 OBJ: 6
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment
CON: Safety | Patient Education | Evidence | Health Care Law
7.Meperidine (Demerol) is a narcotic with a high potential for physical and psychological dependency. Under which classification does this drug fall?
ANS: B
Meperidine (Demerol) is a Schedule II drug; it has a high potential for abuse and may lead to severe psychological and physical dependence. Schedule I drugs have high potential for abuse and no recognized medical use. Schedule III drugs have some potential for abuse. Use may lead to low to moderate physical dependence or high psychological dependence. Schedule IV drugs have low potential for abuse. Use may lead to limited physical or psychological dependence.
DIF: Cognitive Level: Comprehension REF: p. 5 OBJ: 2
NAT: NCLEX Client Needs Category: Safe, Effective Care Environment
TOP: Nursing Process Step: Assessment CON: Patient Education | Addiction | Pain
8:What would the FDA do to expedite drug development and approval for an outbreak of smallpox, for which there is no known treatment?
a. |
List smallpox as a health orphan disease. |
b. |
Omit the preclinical research phase. |
c. |
Extend the clinical research phase. |
d. |
Fast track the investigational drug. |
ANS: D |
Sample Questions
Chapter 04: Genetic Issues
Urden: Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
- What is a genetic variant that exists in greater than 1% of the population termed?
a. |
Genetic mutation |
b. |
Genetic polymorphism |
c. |
Genetic deletion |
d. |
Tandem repeat |
ANS: B
When a genetic variant occurs frequently and is present in 1% or more of the population, it is described as a genetic polymorphism. The term genetic mutation refers to a change in the DNA genetic sequence that can be inherited that occurs in less than 1% of the population. Genetic material in the chromosome can also be deleted and new information from another chromosome can be inserted or can be a tandem repeat (multiple repeats of the same sequence).
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 43
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Which type of genetic disorder occurs when there is an interaction between genetic and environmental factors such as that which occurs with type 2 diabetes?
a. |
Chromosome |
b. |
Mitochondrial |
c. |
Multifactorial disorders |
d. |
Allele dysfunction |
ANS: C
In multifactorial disorders there is an interaction between vulnerable genes and the environment. Cardiovascular atherosclerotic diseases and type 2 diabetes are examples of multifactorial disorders that result from an interaction of genetic and environmental factors.
PTS: 1 DIF: Cognitive Level: Understanding REF: p. 46
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Prader-Willi syndrome (PWS) is a rare genetic disorder in which genes on chromosome 15 (q11.2-13) are deleted. What type of disorder is PWS?
a. |
Chromosome disorder |
b. |
Mitochondrial disorder |
c. |
Complex gene disorder |
d. |
Multifactorial disorder |
ANS: A
Prader-Willi syndrome (PWS) is a chromosome disorder as a result of several missing genes on chromosome 15. In chromosome disorders, the entire chromosome or very large segments of the chromosome are damaged, missing, duplicated, or otherwise altered.
PTS: 1 DIF: Cognitive Level: Applying REF: p. 45
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- A family pedigree is used to determine whether a disease has a genetic component. What does a proband indicate in a family pedigree?
a. |
The disease being mother related or father related |
b. |
The first person in the family who was diagnosed with the disorder |
c. |
Who in the family is the xy band |
d. |
The disease genotype including locus |
ANS: B
For nurses, it is important to ask questions that elucidate which family members are affected versus those who are unaffected and then to identify the individuals who may carry the gene in question but who do not have symptoms (carriers). The proband is the name given to the first person diagnosed in the family pedigree. Homozygous versus heterozygous determines if the disorder is carried by a gene from one or both parents. The xy band determines if the disorder is carried through the sex genes. A disease locus is the genetic address of the disorder.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 46
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Philadelphia translocation is a specific chromosomal abnormality that occurs from a reciprocal translocation between chromosomes 9 and 22, where parts of these two chromosomes switch places. This abnormality is associated with which disease?
a. |
Hemophilia A |
b. |
Chronic myelogenous leukemia |
c. |
Obesity |
d. |
Marfan syndrome |
ANS: B
Philadelphia chromosome or Philadelphia translocation is a specific chromosomal abnormality associated with chronic myelogenous leukemia. It occurs from a reciprocal translocation between chromosomes 9 and 22, where parts of these two chromosomes switch places. Hemophilia A is a sex-linked inheritance. Obesity is being studied with the FTO gene on chromosome 16. Marfan syndrome is classified as a single-gene disorder.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 42
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What was the goal of the Human Genome Project?
a. |
Identifying haplotype tags |
b. |
Exposing untaggable SNPs and recombination hot spots |
c. |
Producing a catalog of human genome variation |
d. |
Mapping all the human genes |
ANS: D
The Human Genome Project was a huge international collaborative project that began in 1990 with the goal of making a map of all the human genes (the genome). The final genome sequence was published in 2003. The HapMap project was to identify haplotype tags. The Genome-Wide Association Studies was used to expose untaggable SNPs and recombination hot spots. The 1000 Genomes project was used to map all the human genes.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 49
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- The patient is placed under general anesthesia for a carotid endarterectomy. During the surgery, the patient develops muscle contracture with skeletal muscle rigidity, acidosis, and elevated temperature. What is a possible cause for malignant hyperthermia?
a. |
Polymorphism in RYR1 at chromosome 19q13.1 |
b. |
Variant in the VKOR1 gene |
c. |
Variant in the cytochrome P450 enzyme CYP2C9 gene |
d. |
Halothane overdose |
ANS: A
Individuals with polymorphisms in the ryanodine receptor gene (RYR1) at chromosome 19q13.1 are at risk of a rare pharmacogenetic condition known as malignant hyperthermia. In affected individuals, exposure to inhalation anesthetics and depolarizing muscle relaxants during general anesthesia induces life-threatening muscle contracture with skeletal muscle rigidity, acidosis, and elevated temperature. Warfarin is being researched as a variant in the VKOR1 gene and in the cytochrome P450 enzyme CYP2C9 gene.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 53|Box 4-3
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What is the study of heredity particularly as it relates to the transfer heritable physical characteristics called?
a. |
Chromatids |
b. |
Karyotype |
c. |
Genetics |
d. |
Histones |
ANS: C
Genetics refers to the study of heredity, particularly as it relates to the ability of individual genes to transfer heritable physical characteristics. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. A karyotype is the arrangement of human chromosomes from largest to smallest. A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 54
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Each chromosome consists of an unbroken strand of DNA inside the nucleus of the cell. What is the arrangement of human chromosomes termed?
a. |
Chromatids |
b. |
Karyotype |
c. |
Genomics |
d. |
Histones |
ANS: B
A karyotype is the arrangement of human chromosomes from largest to smallest. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. Genomics refers to the study of all of the genetic material within cells and encompasses the environmental interaction and impact on biologic and physical characteristics. A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 39
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What is the study of all the genetic material within the cell and its impact on biologic and physical characteristics called?
a. |
Chromatids |
b. |
Karyotype |
c. |
Genomics |
d. |
Histones |
ANS: C
Genomics refers to the study of all of the genetic material within cells and encompasses the environmental interaction and impact on biologic and physical characteristics. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. A karyotype is the arrangement of human chromosomes from largest to smallest. A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 39
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- A specialized class of proteins that organizes the double-stranded DNA into what looks like a tightly coiled telephone cord is known which of the following?
a. |
Chromatids |
b. |
Karyotype |
c. |
Genomics |
d. |
Histones |
ANS: D
A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord. Genomics refers to the study of all of the genetic material within cells and encompasses the environmental interaction and impact on biologic and physical characteristics. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. A karyotype is the arrangement of human chromosomes from largest to smallest.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 39
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- To achieve a consistent distance across the width of the DNA strand, the nucleotide base guanine (G) can only be paired with what other genetic material?
a. |
Adenine (A) |
b. |
Thymine (T) |
c. |
Cytosine (C) |
d. |
Sex chromosome X |
ANS: C
Four nucleotide bases—adenine (A), thymine (T), guanine (G), and cytosine (C)—comprise the “letters” in the genetic DNA “alphabet.” The bases in the double helix are paired T with A and G with C. The nucleotide bases are designed so that only G can pair with C and only T can pair with A to achieve a consistent distance across the width of the DNA strand. The TA and GC combinations are known as base pairs.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 40
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Why are monozygotic twins separated at birth used to study the effects of genetics versus environment?
a. |
They share an identical genome. |
b. |
They have different sex chromosomes. |
c. |
They have mirror chromosomes. |
d. |
They have identical health issues. |
ANS: A
Studies of identical twins offer a unique opportunity to investigate the association of genetics, environment, and health. Identical twins are monozygotic and share an identical genome. Monozygotic twins are the same sex. Studies occur much less frequently today because tremendous efforts are made to keep siblings together when they are adopted. Genetics can be stable in a study group, but the environment and health issues are dynamic even in a controlled study group.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 48
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- The process that is used to make polypeptide chains that constitute proteins can be written as:
a. |
RNA ® DNA ® protein. |
b. |
DNA ® RNA ® protein. |
c. |
Protein ® RNA ® DNA. |
d. |
Protein ® DNA ® RNA. |
ANS: B
The nucleotides A, T, C, and G can be thought of as “letters” of a genetic alphabet that are combined into three-letter “words” that are transcribed (written) by the intermediary of ribonucleic acid (RNA). The RNA translates the three-letter words into the amino acids used to make the polypeptide chains that constitute proteins. This process may be written as DNA ® RNA ® protein.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 41
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What are the studies called that are done on large, extended families who have several family members affected with a rare disease?
a. |
Genetic association |
b. |
Genetic epidemiology |
c. |
Kinships |
d. |
Phenotypes |
ANS: C
In genetic epidemiologic research of a rare disease, it can be a challenge to find enough people to study. One method is to work with large, extended families, known as kinships, which have several family members affected with the disease. Genetic association studies are usually conducted in large, unrelated groups based on demonstration of a phenotype (disease trait or symptoms) and associated genotype. Genetic epidemiology represents the fusion of epidemiologic studies and genetic and genomic research methods. Phenotypes are different at different stages of a disease and are influenced by medications, environmental factors, and gene–gene interaction.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 48
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What is an example of direct-to-consumer genomic testing?
a. |
Genetic testing through amniocentesis |
b. |
Paternity testing from buccal swabs of the child and father |
c. |
Biopsy of a lump for cancer |
d. |
Drug testing using hair follicles |
ANS: B
An example of direct-to-consumer testing is paternity testing from buccal swabs of the child and father. Genetic testing can be done through biopsies and amniocentesis, but they are performed in a facility by a medical professional. Drug testing and genomic testing are two different tests and are unrelated.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 53
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What was the Genetic Information Nondiscrimination Act (GINA) of 2008 designed to prevent from happening?
a. |
Abuse of genetic information in employment and health insurance decisions |
b. |
Genetic counselors from reporting results to the health insurance companies |
c. |
Mandatory genetics testing of all individuals with certain diseases |
d. |
Information sharing between biobanks that are studying the same genetic disorders |
ANS: A
The Genetic Information Nondiscrimination Act (GINA) of 2008 is an essential piece of legislation designed to prevent abuse of genetic information in employment and health insurance decisions in the United States. One of the paramount concerns in the genomic era is to protect the privacy of individuals’ unique genetic information. Many countries have established biobanks as repositories of genetic material, and many tissue samples are stored in medical center tissue banks. Some people who may be at risk for a disorder disease will not be tested because they fear that a positive result may affect their employability. GINA also mandates that genetic information about an individual and his or her family has the same protections as health information.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 53
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
MULTIPLE RESPONSE
- Which patients would be candidates for genetic testing for long QT syndrome (LQTS)? (Select all that apply.)
a. |
Patients with prolonged QT interval during a cardiac and genetic work-up |
b. |
Family history of positive genotype and negative phenotype |
c. |
Patients diagnosed with torsades de pointes |
d. |
Family history of sudden cardiac death |
e. |
Family history of bleeding disorders |
f. |
Family history of obesity |
ANS: A, B, C, D |
Chapter 05: Comfort and Sedation
Sole: Introduction to Critical Care Nursing, 7th Edition
MULTIPLE CHOICE
1.Nociceptors differ from other nerve receptors in the body in that they:
a. |
adapt very little to continual pain response. |
b. |
inhibit the infiltration of neutrophils and eosinophils. |
c. |
play no role in the inflammatory response. |
d. |
transmit only the thermal stimuli. |
ANS: A
Nociceptors are stimulated by mechanical, chemical, or thermal stimuli. Nociceptors differ from other nerve receptors in the body in that they adapt very little to the pain response. The body continues to experience pain until the stimulus is discontinued or therapy is initiated. This is a protective mechanism so that the body tissues being damaged will be removed from harm. Nociceptors usually initiate inflammatory responses near injured capillaries. As such, the response promotes infiltration of injured tissues with neutrophils and eosinophils.
DIF: Cognitive Level: Remember/Knowledge REF: p. 54
OBJ:Discuss the physiology of pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
2.A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating the ventilator well and has not required any sedation. On assessment, the nurse notes the patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min. The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The patient responds appropriately to the nurse’s commands. The nurse should:
a. |
assess the patient’s level of pain. |
b. |
decrease the ventilator rate. |
c. |
provide sedation as ordered. |
d. |
suction the patient again. |
ANS: A
Pulse, respirations, and blood pressure frequently result from activation of the sympathetic nervous system by the pain stimulus. Because the patient is postoperative, the patient should be assessed for the presence of pain and need for pain medication. Decreasing the ventilator rate will not help in this situation. Providing sedation may calm the patient but will not solve the problem if the physiological changes are from pain. The patient has just been suctioned and the airway is clear. There is no need to suction again.
DIF: Cognitive Level: Analyze/Analysis REF: p. 55
OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
3.The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse’s first priority is to
a. |
administer antianxiety medications as ordered. |
b. |
administer pain medication as ordered. |
c. |
identify and treat the underlying cause. |
d. |
reassess the patient hourly to determine whether symptoms resolve on their own. |
ANS: C
When patients exhibit signs of anxiety or agitation, the first priority is to identify and treat the underlying cause, which could be hypoxemia, hypoglycemia, hypotension, pain, or withdrawal from alcohol and drugs. Treatment is not initiated until assessment is completed. Medication may not be needed if the underlying cause can be resolved.
DIF: Cognitive Level: Apply/Application REF: p. 70 | Table 5-11
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
4.Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use because they
a. |
can be used only on heavily sedated patients. |
b. |
can be used only on pediatric patients. |
c. |
provide raw EEG data and a numeric value. |
d. |
require only five leads. |
ANS: C
The BIS and PSI have very simple steps for application, and results are displayed as raw EEG data and the numeric value. A single electrode is placed across the patient’s forehead and is attached to a monitor. These monitors can be used in both children and adults and in patients with varying levels of sedation.
DIF: Cognitive Level: Understand/Comprehension REF: p. 60
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
5.The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with nontraditional modes. The nurse understands that neuromuscular blocking agents provide:
a. |
antianxiety effects. |
b. |
complete analgesia. |
c. |
high levels of sedation. |
d. |
no sedation or analgesia. |
ANS: D
Neuromuscular blocking (NMB) agents do not possess any sedative or analgesic properties. Patients who receive NMBs must also receive sedatives and pain medication.
DIF: Cognitive Level: Remember/Knowledge REF: p. 72
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
6.The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis?
a. |
Glasgow Coma Scale score of 3 |
b. |
Train-of-four yields two twitches |
c. |
Bispectral index of 60 |
d. |
CAM-ICU positive |
ANS: B
A train-of-four response of two twitches (out of four) using a peripheral nerve stimulator indicates adequate paralysis. The Glasgow Coma Scale does not assess paralysis; it is an indicator of consciousness. The bispectral index provides an assessment of sedation. The CAM-ICU is a tool to assess delirium.
DIF: Cognitive Level: Remember/Knowledge REF: p. 73
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
7.The nurse is concerned that the patient will pull out the endotracheal tube. As part of the nursing management, the nurse obtains an order for
a. |
arm binders or splints. |
b. |
a higher dosage of lorazepam. |
c. |
propofol. |
d. |
soft wrist restraints. |
ANS: D
The priority in caring for agitated patients is safety. The least restrictive methods of keeping the patient safe are appropriate. If possible, the tube or device causing irritation should be removed, but if that is not possible, the nurse must prevent the patient from pulling it out. Restraints are associated with an increased incidence of agitation and delirium. Therefore, restraints should not be used unless as a last resort for combative patients. The least amount of sedation is also recommended; therefore, neither increasing the dosage of lorazepam nor adding propofol is indicated and would be likely to prolong mechanical ventilation.
DIF: Cognitive Level: Apply/Application REF: p. 61
OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
8.The primary mode of action for neuromuscular blocking agents used in the management of some ventilated patients is
a. |
analgesia. |
b. |
anticonvulsant therapy. |
c. |
paralysis. |
d. |
sedation. |
ANS: C
These agents cause respiratory muscle paralysis. They do not provide analgesia or sedation. They do not have anticonvulsant properties.
DIF: Cognitive Level: Remember/Knowledge REF: p. 72
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
9.The most important nursing intervention for patients who receive neuromuscular blocking agents is to
a. |
administer sedatives in conjunction with the neuromuscular blocking agents. |
b. |
assess neurological status every 30 minutes. |
c. |
avoid interaction with the patient, because he or she won’t be able to hear. |
d. |
restrain the patient to avoid self-extubation. |
ANS: A
Neuromuscular blocking agents cause paralysis only; they do not cause sedation. Therefore, concomitant administration of sedatives is essential. Neurological status is monitored according to unit protocol. Nurses should communicate with all critically ill patients, regardless of their status. If the patient is paralyzed, restraining devices may not be needed.
DIF: Cognitive Level: Apply/Application REF: p. 72
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
10.The best way to monitor agitation and effectiveness of treating it in the critically ill patient is to use a/the:
a. |
Confusion Assessment Method (CAM-ICU). |
b. |
FACES assessment tool. |
c. |
Glasgow Coma Scale. |
d. |
Richmond Agitation Sedation Scale. |
ANS: D
Various sedation scales are available to assist the nurse in monitoring the level of sedation and assessing response to treatment. The Richmond Agitation Sedation Scale is a commonly used tool that has been validated. The CAM-ICU assesses for delirium. The FACES scale assesses pain. The Glasgow Coma Scale assesses neurological status.
DIF: Cognitive Level: Remember/Knowledge REF: p. 59 | Table 5-5
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
11.The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen?
a. |
Creatinine: 3.1 mg/dL |
b. |
Platelet count 350,000 billion/L |
c. |
White blood count 13, 550 mm3 |
d. |
ALT 25 U/L |
ANS: A
Ibuprofen can result in renal insufficiency, which may be noted in an elevated serum creatinine level. Thrombocytopenia (low platelet count) is another possible side effect. This platelet count is elevated. An elevated white blood count indicates infection. Although ibuprofen is cleared primarily by the kidneys, it is also important to assess liver function, which would show elevated liver enzymes, not low values such as shown here.
DIF: Cognitive Level: Analyze/Analysis REF: p. 71
OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
12.The nurse is assessing pain levels in a critically ill patient using the Behavioral Pain Scale. The nurse recognizes __________ as indicating the greatest level of pain.
a. |
brow lowering |
b. |
eyelid closing |
c. |
grimacing |
d. |
relaxed facial expression |
ANS: C
The Behavioral Pain Scale issues the most points, indicating the greatest amount of pain, to assessment of facial grimacing.
DIF: Cognitive Level: Understand/Comprehension REF: p. 58 | Table 5-3
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
13.The nurse wishes to assess the quality of a patient’s pain. Which of the following questions is appropriate to obtain this assessment if the patient is able to give a verbal response?
a. |
“Is the pain constant or intermittent?” |
b. |
“Is the pain sharp, dull, or crushing?” |
c. |
“What makes the pain better? Worse?” |
d. |
“When did the pain start?” |
ANS: B
If the patient can describe the pain, the nurse can assess quality, such as sharp, dull, or crushing. The other responses relate to continuous or intermittent presence, what provides relief, and duration.
DIF: Cognitive Level: Understand/Comprehension REF: p. 56
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
14.The nurse is assessing the patient’s pain using the Critical Care Pain Observation Tool. Which of the following assessments would indicate the greatest likelihood of pain and need for nursing intervention?
a. |
Absence of vocal sounds |
b. |
Fighting the ventilator |
c. |
Moving legs in bed |
d. |
Relaxed muscles in upper extremities |
ANS: B
Fighting the ventilator is rated with the greatest number of points for compliance with the ventilator, and could indicate pain or anxiety. Absence of vocal sounds (e.g., no crying) and relaxed muscles do not indicate pain and are not given a point value. The patient may be moving the legs as a method of range of motion, not necessarily in response to pain. The patient needs to be assessed for restlessness if the movement is excessive.
DIF: Cognitive Level: Apply/Application REF: p. 59 | Table 5-4
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
15.The nurse is caring for four patients on the progressive care unit. Which patient is at greatest risk for developing delirium?
a. |
36-year-old recovering from a motor vehicle crash; being treated with an evidence-based alcohol withdrawal protocol. |
b. |
54-year-old postoperative aortic aneurysm resection with a 40 pack-year history of smoking |
c. |
86-year-old from nursing home with dementia, postoperative from colon resection, still being mechanically ventilated |
d. |
95-year-old with community-acquired pneumonia; family has brought in eyeglasses and hearing aid |
ANS: C
From this list, the 86-year-old postoperative nursing home resident is at greatest risk due to advanced age, cognitive impairment, and some degree of respiratory failure. The 96-year-old has been provided eyeglasses and a hearing aid, which will decrease the risk of delirium. Smoking is a possible risk for delirium. The 36-year-old is receiving medications as part of an alcohol withdrawal protocol, which should decrease the risk for delirium.
DIF: Cognitive Level: Analyze/Analysis REF: p. 61 | Table 5-8
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
16.The nurse is caring for a patient with hyperactive delirium. The nurse focuses interventions toward keeping the patient:
a. |
comfortable. |
b. |
nourished. |
c. |
safe. |
d. |
sedated. |
ANS: C
The greatest priority in managing delirium is to keep the patient safe. Sedation may contribute to the development of delirium. Comfort and nutrition are important, but they are not priorities.
DIF: Cognitive Level: Understand/Comprehension REF: p. 61
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
17.The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period. Which of the following nursing interventions would improve the patient’s well-being and reduce anxiety the most?
a. |
Arrange for the patient’s dog to be brought into the unit (per protocol). |
b. |
Provide aromatherapy with scents such as lavender that are known to help anxiety. |
c. |
Secure the harpist to come and play soothing music for an hour every afternoon. |
d. |
Wheel the patient out near the unit aquarium to observe the tropical fish. |
ANS: A
Nonpharmacological approaches are helpful in reducing stress and anxiety, and each of these activities has the potential for improving the patient’s well-being. The patient is likely to benefit most from the presence of his or her own dog rather than the other activities, however; if unit protocol does not allow the patient’s own dog, the nurse should investigate the use of therapy animals or the other options.
DIF: Cognitive Level: Apply/Application REF: p. 64
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Psychological Integrity
18.The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia (PCA)?
a. |
Patient with a C4 fracture and quadriplegia |
b. |
Patient with a femur fracture and closed head injury |
c. |
Postoperative patient who had elective bariatric surgery |
d. |
Postoperative cardiac surgery patient with mild dementia |
ANS: C
The patient undergoing bariatric surgery (an elective procedure) is the best candidate for PCA as this patient should be awake, cognitively intact, and will have the acute pain related to the surgical procedure. The quadriplegic would be unable to operate the PCA pump. The cardiac surgery patient with mild dementia may not understand how to operate the pump. Likewise, the patient with the closed head injury may not be cognitively intact.
DIF: Cognitive Level: Analyze/Analysis REF: p. 71 | Box 5-6
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
19.The nurse is caring for a patient receiving a benzodiazepine intermittently. The nurse understands that the best way to administer such drugs is to:
a. |
administer around the clock, rather than as needed, to ensure constant sedation. |
b. |
administer the medications through the feeding tube to prevent complications. |
c. |
give the highest allowable dose for the greatest effect. |
d. |
titrate to a predefined endpoint using a standard sedation scale. |
ANS: D
The best approach for administering benzodiazepines (and all sedatives) is to administer and titrate to a desired endpoint using a standard sedation scale. Administering around the clock as well as giving the highest allowable dose without basing it on an assessment target may result in excessive sedation. For greatest effect, most benzodiazepines are given intravenously.
DIF: Cognitive Level: Apply/Application REF: p. 72
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
20.The nurse is concerned about the risk of alcohol withdrawal syndrome in a postoperative patient. Which statement by the nurse indicates understanding of management of this patient?
a. |
“Alcohol withdrawal is common; we see it all of the time in the trauma unit.” |
b. |
“There is no way to assess for alcohol withdrawal.” |
c. |
“This patient will require less pain medication.” |
d. |
“We have initiated the alcohol withdrawal protocol.” |
ANS: D
The most important treatment of alcohol withdrawal syndrome is prevention. Many units have protocols that are initiated early to prevent the syndrome. Alcohol withdrawal syndrome is common; however, this statement does not indicate knowledge of management. The patient experiencing alcohol withdrawal may exhibit a variety of symptoms, such as disorientation, agitation, and tachycardia. Patients with substance abuse require increased dosages of pain medications.
DIF: Cognitive Level: Understand/Comprehension REF: p. 74
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
MULTIPLE RESPONSE
1.Nonpharmacological approaches to pain and/or anxiety that may best meet the needs of critically ill patients include: (Select all that apply.)
a. |
anaerobic exercise. |
b. |
art therapy. |
c. |
guided imagery. |
d. |
music therapy. |
e. |
animal therapy. |
ANS: C, D, E
Guided imagery is a powerful technique for controlling pain and anxiety, especially that associated with painful procedures. Similar to guided imagery, a music therapy program offers patients a diversionary technique for pain and anxiety relief. Likewise animal therapy has many benefits for the critically ill patient. Anaerobic exercise is not a nonpharmacological approach for managing pain and anxiety. Most critically ill patients are not able to participate in art therapy.
DIF: Cognitive Level: Remember/Knowledge REF: pp. 62-64
OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
2.Which of the following statements regarding pain and anxiety are true? (Select all that apply.)
a. |
Anxiety is a state marked by apprehension, agitation, autonomic arousal, and/or fearful withdrawal. |
b. |
Critically ill patients often experience anxiety, but they rarely experience pain. |
c. |
Pain and anxiety are often interrelated and may be difficult to differentiate because their physiological and behavioral manifestations are similar. |
d. |
Pain is defined by each patient; it is whatever the person experiencing the pain says it is. |
e. |
While anxiety is unpleasant, it does not contribute to mortality or morbidity of the critically ill patient. |
ANS: A, C, D
Pain is defined by each patient, anxiety is associated with marked apprehension, and pain and anxiety are often interrelated. Critically ill patients commonly have both pain and anxiety. Anxiety does increase both morbidity and mortality in critically ill patients, especially those with cardiovascular disease.
DIF: Cognitive Level: Understand/Comprehension REF: p. 53
OBJ: Define pain and anxiety. TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
3.Which of the following factors predispose the critically ill patient to pain and anxiety? (Select all that apply.)
a. |
Inability to communicate |
b. |
Invasive procedures |
c. |
Monitoring devices |
d. |
Nursing care |
e. |
Preexisting conditions |
ANS: A, B, C, D, E
All of these factors predispose the patient to pain or anxiety.
DIF: Cognitive Level: Remember/Knowledge REF: pp. 53-54
OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
4.Choose the items that are common to both pain and anxiety. (Select all that apply.)
a. |
Cyclical exacerbation of one another |
b. |
Require good nursing assessment for proper treatment |
c. |
Response only to real phenomena |
d. |
Subjective in nature |
e. |
Perception may be influenced by prior experience |
ANS: A, B, D, E
Both pain and anxiety are subjective in nature. One can exacerbate the other in a vicious cycle that often requires good nursing assessment to manage the precipitating problem and break the cycle. Anxiety is a response to a real or perceived fear. Pain is a response to real or “phantom” phenomenon but always involves transmission of nerve impulses. Both relate to the patient’s perceptions of pain and fear. Previous experiences of both pain and/or anxiety can influence the patient’s perception of both. Anxiety is a response to real or perceived fear, and pain is a response to a real or “phantom” phenomenon.
DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-54
OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
5.Anxiety differs from pain in that: (Select all that apply.)
a. |
it is confined to neurological processes in the brain. |
b. |
it is linked to reward and punishment centers in the limbic system. |
c. |
it is subjective. |
d. |
there is no actual tissue injury. |
e. |
it can be increased by noise and light. |
ANS: A, B, D, E
Unlike pain, anxiety is linked to the reward and punishment centers in the limbic system of the brain. It is totally neurological and does not involve tissue injury. Like pain, it is a subjective phenomenon. Noise, light, and other stimuli can increase the intensity of anxiety. Both anxiety and pain are subjective in nature.
DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-55
OBJ:Discuss the physiology of pain and anxiety.
TOP: Nursing Process Step: Assessment
6.Factors in the critical care unit that may predispose the client to increased pain and anxiety include: (Select all that apply.)
a. |
an endotracheal tube. |
b. |
frequent vital signs. |
c. |
monitor alarms. |
d. |
room temperature. |
e. |
hostile environment. |
ANS: A, B, C, D, E
Anxiety is likely to result from loss of control, the inability to communicate, continuous noise and lighting, excessive stimulation (including repeated vital sign measurements), lack of mobility, and uncomfortable room temperatures. Increased anxiety levels often lead to increased pain perception. Environments that are perceived as hostile also contribute.
DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-54
OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
7.In the healthy individual, pain and anxiety: (Select all that apply.)
a. |
activate the sympathetic nervous system (SNS). |
b. |
decrease stress levels. |
c. |
help remove one from harm. |
d. |
increase performance levels. |
e. |
limit sympathetic nervous system activity. |
ANS: A, C, D
In the healthy person, pain and anxiety are adaptive mechanisms used to increase performance levels or to remove one from potential harm. The “fight or flight” response occurs in response to pain and/or anxiety and involves the activation of the sympathetic nervous system. Pain and anxiety, however, can induce significant stress. The SNS is activated, not limited, by pain and/or anxiety.
DIF: Cognitive Level: Remember/Knowledge REF: p. 55
OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
8.The nurse is caring for a patient who is intubated and on a ventilator following extensive abdominal surgery. Although the patient is responsive, the nurse is not able to read the patient’s lips as the patient attempts to mouth the words. Which of the following assessment tools would be the most appropriate for the nurse to use when assessing the patient’s pain level? (Select all that apply.)
a. |
The FACES scale |
b. |
Pain Intensity Scale |
c. |
The PQRST method |
d. |
The Visual Analogue Scale |
e. |
The CAM tool |
ANS: A, D | Test Bank for Wongs Nursing Care of Infants and Children 11th Edition by Hockenberry
ISBN-10: 032354939X, ISBN-13: 9780323549394
Table of Contents
Section I: Children, Their Families, and the Nurse
1. Perspectives of Pediatric Nursing
2. Social, Cultural, Religious, and Family Influences on Child Health Promotion
3. Hereditary Influences on Health Promotion of the Child and Family
Section II: Childhood and Family Assessment
4. Communication, Physical, and Developmental Assessment of the Child and Family
5. Pain in Children: Significance, Assessment, and Management Strategies
6. Childhood Communicable and Infectious Diseases
Section III: Family-Centered Care of the Newborn
7. Health Promotion of the Newborn and Family
8. Health Problems of the Newborn
9. The High-Risk Newborn and Family
Section IV: Family-Centered Care of the Infant
10. Health Promotion of the Infant and Family
11. Health Problems of the Infant
Section V: Family-Centered Care of the Toddler and Preschooler
12. Health Promotion of the Toddler and Family
13. Health Promotion of the Preschooler and Family
14. Health Problems of Early Childhood
Section VI: Family-Centered Care of the School-Age Child
15. Health Promotion of the School-Age Child and Family
16. Health Problems of the School-Age Child
Section VII: Family-Centered Care of the Adolescent
17. Health Promotion of the Adolescent and Family
18. Health Problems of the Adolescent
Section VIII: Family-Centered Care of the Child with Special Needs
19. Impact of Chronic Illness, Disability, or End of Life Care for the Child and Family
20. The Child with Cognitive, Sensory, or Communication Impairment
Section IX: The Child Who is Hospitalized
21. Family-Centered Care of the Child During Illness and Hospitalization
22. Pediatric Nursing Interventions and Skills
Section X: Childhood Nutrition and Elimination Problems
23. The Child with Fluid and Electrolyte Imbalance
24. The Child with Renal Dysfunction
25. The Child with Gastrointestinal Dysfunction
Section XI: Childhood Oxygenation Problems
26. The Child with Respiratory Dysfunction
Section XII: Childhood Blood Production and Circulation Problems
27. The Child with Cardiovascular Dysfunction
28. The Child with Hematologic or Immunologic Dysfunction
Section XIII: Childhood Regulatory Problems
29. The Child with Cancer
30. The Child with Cerebral Dysfunction
31. The Child with Endocrine Dysfunction
Section XIV: Childhood Physical Mobility Problems
32. The Child with Integumentary Dysfunction
33. The Child with Musculoskeletal or Articular Dysfunction
34. The Child with Neuromuscular or Muscular Dysfunction | Medical-Surgical Nursing: Making Connections to Practice 1st edition Hoffman, Sullivan Test Bank
Chapter 1: Foundations for Medical-Surgical Nursing
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. The medical-surgical nurse identifies a clinical practice issue and wants to determine if there is sufficient evidence to support a change in practice. Which type of study provides the strongest evidence to support a
practice change?
1) Randomized control study
2) Quasi-experimental study
3) Case-control study
4) Cohort study
____ 2. The medical-surgical unit recently implemented a patient-centered care model. Which action implemented by
the nurse supports this model?
1) Evaluating care
2) Assessing needs
3) Diagnosing problems
4) Providing compassion
____ 3. Which action should the nurse implement when providing patient care in order to support The Joint
Commission’s (TJC) National Patient Safety Goals (NPSG)?
1) Silencing a cardiorespiratory monitor
2) Identifying each patient using one source
3) Determining patient safety issues upon admission
4) Decreasing the amount of pain medication administered
____ 4. Which interprofessional role does the nurse often assume when providing patient care in an acute care
setting?
1) Social worker
2) Client advocate
3) Care coordinator
4) Massage therapist
____ 5. The medical-surgical nurse wants to determine if a policy change is needed for an identified clinical problem.
Which is the first action the nurse should implement?
1) Developing a question
2) Disseminating the findings
3) Conducting a review of the literature
4) Evaluating outcomes of practice change
____ 6. The nurse is evaluating the level of evidence found during a recent review of the literature. Which evidence
carries the lowest level of support for a practice change?
1) Level IV
2) Level V
3) Level VI
4) Level VII
____ 7. The nurse is reviewing evidence from a quasi-experimental research study. Which level of evidence should
the nurse identify for this research study?
1) Level ITestBankWorld.org
2) Level II
3) Level III
4) Level IV
____ 8. Which level of evidence should the nurse identify when reviewing evidence from a single descriptive research
study?
1) Level IV
2) Level V
3) Level VI
4) Level VII
____ 9. Which statement should the nurse make when communicating the “S” in the SBAR approach for effective
communication?
1) “The patient presented to the emergency department at 0200 with lower left abdominal
pain.”
2) “The patient rated the pain upon admission as a 9 on a 10-point numeric scale.”
3) “The patient has no significant issues in the medical history.”
4) “The patient was given a prescribed opioid analgesic at 0300.”
____ 10. The staff nurse is communicating with the change nurse about the change of status of the patient. The nurse
would begin her communication with which statement if correctly using the SBAR format?
1) “The patient’s heartrate is 110.”
2) “I think this patient needs to be transferred to the critical care unit.”
3) “The patient is a 68-year-old male patient admitted last night.”
4) “The patient is complaining of chest pain.”
____ 11. Which nursing action exemplifies the Quality and Safety Education for Nursing (QSEN) competency of
safety?
1) Advocating for a patient who is experiencing pain
2) Considering the patient’s culture when planning care
3) Evaluating patient learning style prior to implementing discharge instructions
4) Assessing the right drug prior to administering a prescribed patient medication
____ 12. Which type of nursing is the root of all other nursing practice areas?
1) Pediatric nursing
2) Geriatric nursing
3) Medical-surgical nursing
4) Mental health-psychiatric nursing
____ 13. Which did the Nursing Executive Center of The Advisory Board identify as an academic-practice gap for new
graduate nurses?
1) Patient advocacy
2) Patient education
3) Disease pathophysiology
4) Therapeutic communication
____ 14. Which statement regarding the use of the nursing process in clinical practice is accurate?
1) “The nursing process is closely related to clinical decision-making.”
2) “The nursing process is used by all members of the interprofessional team to plan care.”
3) “The nursing process has 4 basic steps: assessment, planning, implementation,
evaluation.”
4) “The nursing process is being replaced by the implementation of evidence-based practice.”TestBankWorld.org
____ 15. Which is the basis of nursing care practices and protocols?
1) Assessment
2) Evaluation
3) Diagnosis
4) Research
____ 16. Which is a common theme regarding patient dissatisfaction related to care provided in the hospital setting?
1) Space in hospital rooms
2) Medications received to treat pain
3) Time spent with the health-care team
4) Poor quality food received from dietary
____ 17. The nurse manager is preparing a medical-surgical unit for The Joint Commission (TJC) visit With the nurse
manager presenting staff education focusing on TJC benchmarks, which of the following topics would be
most appropriate?
1) Implementation of evidence-based practice
2) Implementation of patient-centered care
3) Implementation of medical asepsis practices
4) Implementation of interprofessional care
____ 18. Which aspect of patient-centered care should the nurse manager evaluate prior to The Joint Commission site
visit for accreditation?
1) Visitation rights
2) Education level of staff
3) Fall prevention protocol
4) Infection control practices
____ 19. The medical-surgical nurse is providing patient care. Which circumstance would necessitate the nurse
verifying the patient’s identification using at least two sources?
1) Prior to delivering a meal tray
2) Prior to passive range of motion
3) Prior to medication administration
4) Prior to documenting in the medical record
____ 20. The nurse is providing care to several patients on a medical-surgical unit. Which situation would necessitate
the nurse to use SBAR during the hand-off process?
1) Wound care
2) Discharge to home
3) Transfer to radiology
4) Medication education
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 21. The staff nurse is teaching a group of student nurses the situations that necessitate hand-off communication.
Which student responses indicate the need for further education related to this procedure? Select all that
apply.
1) “A hand-off is required prior to administering a medication.”
2) “A hand-off is required during change of shift.”
3) “A hand-off is required for a patient is transferred to the surgical suite.”TestBankWorld.org
4) “A hand-off is required whenever the nurse receives a new patient assignment.”
5) “A hand-off is required prior to family visitation.”
____ 22. Which actions by the nurse enhance patient safety during medication administration? Select all that apply.
1) Answering the call bell while transporting medications for a different patient
2) Identifying the patient using two sources prior to administering the medication
3) Holding a medication if the patient’s diagnosis does not support its use
4) Administering the medication two hours after the scheduled time
5) Having another nurse verify the prescribed dose of insulin the patient is to receive
____ 23. The medical-surgical nurse assumes care for a patient who is receiving continuous cardiopulmonary
monitoring. Which actions by the nurse enhance safety for this patient? Select all that apply.
1) Silencing the alarm during family visitation
2) Assessing the alarm parameters at the start of the shift
3) Responding to the alarm in a timely fashion
4) Decreasing the alarm volume to enhance restful sleep
5) Adjusting alarm parameters based on specified practitioner prescription
____ 24. The nurse is planning an interprofessional care conference for a patient who is approaching discharge from
the hospital. Which members of the interprofessional team should the nurse invite to attend? Select all that
apply.
1) Physician
2) Pharmacist
3) Unit secretary
4) Social worker
5) Home care aide
____ 25. The nurse manager wants to designate a member of the nursing team as the care coordinator for a patient who
will require significant care during the hospitalization. Which skills should this nurse possess in order to
assume this role? Select all that apply.
1) Effective clinical reasoning
2) Effective communication skills
3) Effective infection control procedures
4) Effective documentation
5) Effective intravenous skillsTestBankWorld.org
Chapter 1: Foundations for Medical-Surgical Nursing
Answer Section
MULTIPLE CHOICE
1. ANS: 1
Chapter number and title: 1, Foundations for Medical Surgical Practice
Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical
nursing
Chapter page reference: 003-004
Heading: Evidence-Based Nursing Care
Integrated Processes: Nursing Process: Planning
Client Need: Safe and Effective Care Environment/Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Systematic reviews of randomized control studies (Level I) are the highest level of
evidence because they include data from selected studies that randomly assigned
participants to control and experimental groups. The lower the numerical rating of the
level of evidence indicates the highest level of evidence; therefore, this type of study
provides the strongest evidence to support a practice change.
2 Quasi-experimental studies are considered Level III; therefore, this study does not
provide the strongest evidence to support a practice change.
3 Case-control studies are considered Level IV; therefore, this study does not provide the
strongest evidence to support a practice change.
4 Cohort studies are considered Level IV; therefore, this study does not provide the
strongest evidence to support a practice change.
PTS: 1 CON: Evidence-Based Practice
2. ANS: 4
Chapter number and title: 1, Foundations of Medical-Surgical Practice
Chapter learning objective: Explaining the importance of patient-centered care in the management of
medical-surgical patients
Chapter page reference: 004-005
Heading: Patient-Centered Care in the Medical-Surgical Setting
Integrated Processes: Caring
Client Need: Psychosocial Integrity
Cognitive level: Application [Applying]
Concept: Nursing Roles
Difficulty: Moderate
Feedback
1 Evaluation is a step in the nursing process; however, this is not an action that supports
the patient-centered care model.
2 Assessment is a step in the nursing process; however, this is not an action that supports
the patient-centered care model.TestBankWorld.org
3 Diagnosis is a step in the nursing process; however, this is not an action that supports
the patient-centered care model.
4 Compassion is a competency closely associated with patient-centered care; therefore,
this action supports the patient-centered model of care.
PTS: 1 CON: Nursing Roles
3. ANS: 3
Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice
Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety
Education for Nurses (QSEN) competencies
Chapter page reference: 005-006
Heading: Patient Safety Outcomes
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment/Management of Care
Cognitive level: Application [Applying]
Concept: Safety
Difficulty: Moderate
Feedback
1 Safely using alarms is a NPSG identified by TJC. Silencing a cardiorespiratory monitor
is not nursing action that supports this NPSG.
2 Patient identification using two separate resources is a NPSG identified by TJC.
Identifying a patient using only one source does not support this NPSG.
3 Identification of patient safety risks is a NPSG identified by the TJC. Determining
patient safety issues upon admission supports this NPSG.
4 Safe use of medication is a NPSG identified by the TJC. Decreasing the amount of pain
medication administered does not support this NPSG.
PTS: 1 CON: Safety
4. ANS: 3
Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice
Chapter learning objective: Describing the role and competencies of medical-surgical nursing
Chapter page reference: 006-007
Heading: Interprofessional Collaboration and Communication
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment/Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Nursing Roles
Difficulty: Easy
Feedback
1 The nurse does not often assume the interprofessional role of social worker when
providing patient care in an acute care setting.
2 The nurse does not often assume the interprofessional role of client advocate role when
providing patient care in an acute care setting.
3 The nurse often assumes the interprofessional role of care coordinator when providing
patient care in an acute care setting.
4 The nurse does not often assume the interprofessional role of massage therapist when
providing patient care in an acute care setting.TestBankWorld.org
PTS: 1 CON: Nursing Roles
5. ANS: 1
Chapter number and title: 1, Foundations of Medical-Surgical Practice
Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical
nursing
Chapter page reference: 003
Heading: Box 1.3 Steps of Evidence-Based Practice
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment/Management of Care
Cognitive level: Analysis [Analyzing]
Concept: Evidence-Based Practice
Difficulty: Difficult
Feedback
1 The first step of evidence-based practice is to develop a question based on the clinical
issue.
2 The last step of evidence-based practice is to disseminate findings.
3 The second step of evidence-based practice is to conduct a review of the literature, or
current evidence, available.
4 The fifth step of evidence-based practice is to evaluate the outcomes associated with the
practice change.
PTS: 1 CON: Evidence-Based Practice
6. ANS: 4
Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice
Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical
nursing
Chapter page reference: 004
Heading: Box 1.4 Evaluating Levels of Evidence
Integrated Processes: Nursing Process: Planning
Client Need: Safe and Effective Care Environment/Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 The lower the numeric value of the evidence the greater the support for a change in
practice. Level IV evidence does not carry the lowest level of support for a practice
change.
2 The lower the numeric value of the evidence the greater the support for a change in
practice. Level V evidence does not carry the lowest level of support for a practice
change.
3 The lower the numeric value of the evidence the greater the support for a change in
practice. Level VI evidence does not carry the lowest level of support for a practice
change.
4 The lower the numeric value of the evidence the greater the support for a change in
practice. Level VII evidence carries the lowest level of support for a practice change.
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