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Test Bank for Dental Public Health and Research 4th Edition by Nathe

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Test Bank for Dental Public Health and Research 4th Edition by Nathe

Dental Public Health and Research, 4e (Nathe)

Chapter 1   Dental Public Health: An Overview

1) When fulfilling the administrator role, a dental public health hygienist ________.

  1. A) Lobbies to change laws
  2. B) Conducts research
  3. C) Provides clinical care
  4. D) Educates and promotes dental health
  5. E) Develops and coordinates public health programs

Answer:  E

2) Dental public health is the science of providing oral health care and education to the public and emphasizes the science of ________.

  1. A) Dentistry
  2. B) Urgent health care
  3. C) Prosthodontics
  4. D) Dental hygiene
  5. E) None of the above

Answer:  D

3) Factors affecting dental care delivery include which of the following?

  1. A) The development of the dental hygiene profession
  2. B) Access issues
  3. C) The decrease in periodontal diseases
  4. D) Both A and B
  5. E) None of the above

Answer:  D

4) The patient’s ability to sue a dental provider, if that provider fails to diagnose and treat periodontal disease, is defined as ________.

  1. A) Access issues
  2. B) Dental insurance premiums
  3. C) Socioeconomic status
  4. D) Copayment issues
  5. E) Malpractice

Answer:  E

5) Dental public health is a component of ________.

  1. A) Public Affairs
  2. B) Public Relations
  3. C) Public Health
  4. D) Community Affairs
  5. E) Both A and D

Answer:  C

6) Which of the following involves the monitoring of the health of communities?

  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above

Answer:  A

7) Which of the following is the process by which society makes decisions about problems?

  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above

Answer:  B

8) Which of the following involves making certain that all populations have access to appropriate and cost-effective services to read agreed-upon public health goals?

  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above

Answer:  C

9) Which of the following includes the research for new insights and innovative solutions to health problems?

  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above

Answer:  D

10) Which of the following dictates services to ensure the promotion of health and prevention of disease and injury?

  1. A) Needs Assessment
  2. B) Public Health Goals
  3. C) Health Care Reform
  4. D) Public Health Demands
  5. E) Human Services Planning

Answer:  B

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DescriptionBy: Nathe Edition: 4th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Patton Edition: 7th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Townsend Edition: 8th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadEdition: 8th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Ehrlich Edition: 8th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Sole Edition: 7th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant Download
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Test Bank for Dental Public Health and Research 4th Edition by Nathe

Dental Public Health and Research, 4e (Nathe) Chapter 1   Dental Public Health: An Overview 1) When fulfilling the administrator role, a dental public health hygienist ________.
  1. A) Lobbies to change laws
  2. B) Conducts research
  3. C) Provides clinical care
  4. D) Educates and promotes dental health
  5. E) Develops and coordinates public health programs
Answer:  E 2) Dental public health is the science of providing oral health care and education to the public and emphasizes the science of ________.
  1. A) Dentistry
  2. B) Urgent health care
  3. C) Prosthodontics
  4. D) Dental hygiene
  5. E) None of the above
Answer:  D 3) Factors affecting dental care delivery include which of the following?
  1. A) The development of the dental hygiene profession
  2. B) Access issues
  3. C) The decrease in periodontal diseases
  4. D) Both A and B
  5. E) None of the above
Answer:  D 4) The patient's ability to sue a dental provider, if that provider fails to diagnose and treat periodontal disease, is defined as ________.
  1. A) Access issues
  2. B) Dental insurance premiums
  3. C) Socioeconomic status
  4. D) Copayment issues
  5. E) Malpractice
Answer:  E 5) Dental public health is a component of ________.
  1. A) Public Affairs
  2. B) Public Relations
  3. C) Public Health
  4. D) Community Affairs
  5. E) Both A and D
Answer:  C 6) Which of the following involves the monitoring of the health of communities?
  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above
Answer:  A 7) Which of the following is the process by which society makes decisions about problems?
  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above
Answer:  B 8) Which of the following involves making certain that all populations have access to appropriate and cost-effective services to read agreed-upon public health goals?
  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above
Answer:  C 9) Which of the following includes the research for new insights and innovative solutions to health problems?
  1. A) Assessment
  2. B) Policy Development
  3. C) Assurance
  4. D) Serving All Functions
  5. E) None of the above
Answer:  D 10) Which of the following dictates services to ensure the promotion of health and prevention of disease and injury?
  1. A) Needs Assessment
  2. B) Public Health Goals
  3. C) Health Care Reform
  4. D) Public Health Demands
  5. E) Human Services Planning
Answer:  B

Test Bank for The Human Body in Health and Disease 7th Edition by Patton

MULTIPLE CHOICE 1.   Which word is derived from the Greek word meaning “cutting up”?
a. Dissection
b. Physiology
c. Pathology
d. Anatomy
ANS:   D                     PTS:    1                      DIF:    Memorization REF:    P. 3                  TOP:    Introduction 2.   Which word is defined as the study of the function of living organisms and their parts?
a. Dissection
b. Physiology
c. Pathology
d. Anatomy
ANS:   B                     PTS:    1                      DIF:    Memorization REF:    p. 3                  TOP:    Introduction 3.   Which word is defined as the scientific study of disease?
a. Dissection
b. Physiology
c. Pathology
d. Anatomy
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    P. 3                  TOP:    Introduction 4.   Cells
a. are more complex than tissues.
b. are the first level of organization in the body.
c. are the smallest living units of structure and function in the body.
d. both B and C.
ANS:   C                     PTS:    1                      DIF:    Application     REF:    p. 6 TOP:    Structural levels of organization 5.   A group of cells that act together to perform a function is called a(n)
a. molecule.
b. organ.
c. tissue.
d. organism.
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    p. 6                  TOP:    Structural levels of organization 6.   The heart is an example of a(n)
a. organ.
b. tissue.
c. organism.
d. system.
ANS:   A                     PTS:    1                      DIF:    Application     REF:    p. 6 TOP:    Structural levels of organization 7.   The levels of organization from most simple to most complex are
a. cell chemical organ tissue system.
b. tissue cell chemical organ system.
c. chemical tissue cell organ system.
d. chemical cell tissue organ system.
ANS:   D                     PTS:    1                      DIF:    Memorization REF:    p. 5                  TOP:    Structural levels of organization 8.   When using directional terms to describe the body, it is assumed that the body is in what position?
a. Supine
b. Anatomical
c. Lateral
d. Prone
ANS:   B                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical position 9.   The supine position
a. describes the body lying face up.
b. is also called anatomical position.
c. describes the body lying face down.
d. both A and B.
ANS:   A                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical position 10.   The prone position
a. describes the body lying face up.
b. is also called the anatomical position.
c. describes the body lying face down.
d. both B and C.
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical position 11.   Because humans walk upright, the term dorsal can be used in place of the term
a. inferior.
b. posterior.
c. anterior.
d. distal.
ANS:   B                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical direction 12.   The opposite term for posterior in humans is
a. superior.
b. anterior.
c. ventral.
d. both B and C.
ANS:   D                     PTS:    1                      DIF:    Application     REF:    p. 7 TOP:    Anatomical direction 13.   The opposite term for superficial is
a. deep.
b. inferior.
c. posterior.
d. medial.
ANS:   A                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical direction 14.   The body section that divides the right ear from the left ear is a _____ section.
a. frontal
b. sagittal
c. coronal
d. transverse
ANS:   B                     PTS:    1                      DIF:    Application     REF:    p. 9 TOP:    Planes or body sections 15.   The body section that divides the nose from the back of the head is a _____ section.
a. frontal
b. sagittal
c. midsagittal
d. transverse
ANS:   A                     PTS:    1                      DIF:    Application     REF:    p. 9 TOP:    Planes or body sections 16.   A section that divides the body into mirror images is a _____ section.
a. frontal
b. coronal
c. midsagittal
d. transverse
ANS:   C                     PTS:    1                      DIF:    Application     REF:    p. 9 TOP:    Planes or body sections 17.   The two major body cavities are called
a. thoracic and abdominal.
b. thoracic and pelvic.
c. dorsal and ventral.
d. mediastinum and pleural.
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    p. 9                  TOP:    Body cavities 18.   The liver can be found in the
a. upper right quadrant.
b. epigastric region.
c. hypogastric region.
d. both A and B.
ANS:   D                     PTS:    1                      DIF:    Application     REF:    p. 10 TOP:    Body cavities 19.   The word “leg” correctly describes the
a. area from the hip to the foot.
b. area from the knee to the ankle.
c. area between the hip and the knee.
d. femoral area.
ANS:   B                     PTS:    1                      DIF:    Memorization REF:    p. 13                TOP:    Body regions 20.   The human body tries to maintain a constant body temperature. This is an example of
a. homeostasis.
b. a positive feedback loop.
c. an effector.
d. a sensor.
ANS:   A                     PTS:    1                      DIF:    Application     REF:    p. 14 TOP:    The balance of body functions 21.   The part of a feedback loop that has the direct effect on the regulated condition is called
a. homeostasis.
b. the effector.
c. the sensor.
d. the control center.
ANS:   B                     PTS:    1                      DIF:    Memorization REF:    p. 14                TOP:    The balance of body functions 22.   The part of the feedback loop that detects a change in the regulated condition is called
a. homeostasis.
b. the effector.
c. the sensor.
d. the control center.
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    p. 14                TOP:    The balance of body functions 23.   The part of the feedback loop that compares the present condition within a body part or region to its homeostatic condition is called
a. homeostasis.
b. the effector.
c. the sensor.
d. the control center.
ANS:   D                     PTS:    1                      DIF:    Memorization REF:    p. 14                TOP:    The balance of body functions 24.   When your body temperature drops below normal, your muscles begin to contract rapidly, making you shiver and generating heat. In this case your muscles are acting as the
a. sensor.
b. effector.
c. control center.
d. both A and C.
ANS:   B                     PTS:    1                      DIF:    Synthesis         REF:    p. 14 TOP:    The balance of body functions 25.   Which of the following body functions is an example of a positive feedback loop?
a. Maintaining a pH of 7.45 in the body
b. Forming a blood clot
c. Uterine contractions during labor
d. Both B and C
ANS:   D                     PTS:    1                      DIF:    Application     REF:    pp. 15-16 TOP:    The balance of body functions 26.   The level of organization that precedes the organ level is the _____ level.
a. system
b. cellular
c. tissue
d. chemical
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    p. 5                  TOP:    Structural levels of organization 27.   Which of these terms cannot be applied to a body in the anatomical position?
a. Dorsal
b. Posterior
c. Supine
d. Both A and B
ANS:   C                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical position 28.   Which term means toward the head?
a. Anterior
b. Superior
c. Superficial
d. Ventral
ANS:   B                     PTS:    1                      DIF:    Memorization REF:    p. 7                  TOP:    Anatomical direction 29.   Which describes the anatomical relationship of the wrist to the elbow?
a. The elbow is proximal to the wrist.
b. The elbow is distal to the wrist.
c. The elbow is superficial to the wrist.
d. The elbow is lateral to the wrist.
ANS:   A                     PTS:    1                      DIF:    Application     REF:    p. 7
Chapter 1. The Concept of Stress Adaptation

Test Bank for Psychiatric Mental Health Nursing 8th Edition by Townsend

Multiple Choice
  1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data?
  2. The client is experiencing severe distress and is at risk for physical and psychological illness.
  3. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness.
  4. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports.
  5. The client may view these losses as challenges and perceive them as opportunities.
ANS: C The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500 or more, indicates high stress in a client’s life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an art degree.” How should the nurse characterize the client’s appraisal of the job loss stressor?
  2. Irrelevant
  3. Harm/loss
  4. Threatening
  5. Challenging
ANS: D The client perceives the situation of job loss as a challenge and an opportunity for growth. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity
  1. Which client statement should alert a nurse that a client may be responding maladaptively to stress?
  2. “I’ve found that avoiding contact with others helps me cope.”
  3. “I really enjoy journaling; it’s my private time.”
  4. “I signed up for a yoga class this week.”
  5. “I made an appointment to meet with a therapist.”
ANS: A Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems.  KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing?
  2. Alarm reaction stage
  3. Stage of resistance
  4. Stage of exhaustion
  5. Fight-or-flight stage
ANS: C At the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity
  1. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client’s mother states, “That’s not something to be stressed about!” Which is the most appropriate nursing response?
  2. “Teenagers! They don’t know a thing about real stress.”
  3. “Stress occurs only when there is a loss.”
  4. “When you are in poor physical condition, you can’t experience psychological well-being.”
  5. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”
ANS: D Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  1. A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time?
  2. Meditation
  3. Problem-solving training
  4. Relaxation
  5. Journaling
ANS: B The student must assess his or her situation and determine the best course of action. Problem-solving training, by providing structure and objectivity, can assist in decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  1. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?
  2. Encourage the student to use the alternative coping mechanism of relaxation exercises.
  3. Complete the problem-solving process for the client.
  4. Work through the problem-solving process with the client.
  5. Encourage the client to keep a journal.
ANS: C During times of high anxiety and stress, clients will need more assistance in problem-solving and decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  1. A school nurse is assessing a distraught female high school student who is overly concerned because her parents can’t afford horseback riding lessons. How should the nurse interpret the student’s reaction to her perceived problem?
  2. The problem is endangering her well-being.
  3. The problem is personally relevant to her.
  4. The problem is based on immaturity.
  5. The problem is exceeding her capacity to cope.
ANS: B Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation or event. Self-image is of particular importance to adolescents, who feel entitled to have all the advantages that other adolescents experience. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess?
  2. An achieved state of relaxation
  3. An achieved insight into one’s feelings
  4. A demonstration of appropriate role behaviors
  5. An enhanced ability to problem-solve
ANS: A Meditation produces relaxation by creating a special state of consciousness through focused concentration. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. A distraught, single, first-time mother cries and asks a nurse, “How can I go to work if I can’t afford childcare?” What is the nurse’s initial action in assisting the client with the problem-solving process?
  2. Determine the risks and benefits for each alternative.
  3. Formulate goals for resolution of the problem.
  4. Evaluate the outcome of the implemented alternative.
  5. Assess the facts of the situation.
ANS: D Before any other steps can be taken, accurate information about the situation must be gathered and assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Test Bank for Psychiatric Mental Health Nursing, 8th Edition Wanda Mohr

Chapter 01- Introduction to Psychiatric-Mental Health Nursing

  1. A nurse is giving a presentation about preventing mental illness to college freshmen. A student asks, “What does it mean to be mentally healthy?” Which of the following potential responses by the nurse is best?
  A)           “Mental health is difficult to define and depends on cultural norms.”   B)            “Mental health is marked by productivity, fulfilling relationships, and adaptability.”   C)            “Mental health is characterized by the absence of mental illness.”   D)           “Mental health is the performance of behavior that is accepted as normal.”  
  1. A 48-year-old independent, successful woman is recovering from a modified radical mastectomy. She states she was grateful that during the first few weeks after surgery her mother stayed with her and did “everything” for her. Which element of mental health does this reflect?
  A)           Reality orientation   B)            Mastery of the environment   C)            Self-governance   D)           Tolerance of the unknown  
  1. Why is the document Mental Health: A Report of the Surgeon General (1999) most significant?
  A)           Because it states clearly that there are effective treatments for mental illness   B)            Because it allocates research money to psychiatric facilities   C)            Because it sets new guidelines for use of restraints   D)           Because it establishes reimbursement guidelines for third-party payers  
  1. While a nurse is performing an admission assessment for a mental health client, the client states that all of his problems have been caused by his parents. The nurse knows that psychological factors that can influence mental health include which of the following?
 
A)           Neuroanatomy   B)            Emotional developmental level   C)            Values and beliefs   D)           Religion  
  1. What is the primary purpose of the five-axis system used in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision(DSM-IV-TR)?
  A)           To separate the various mental disorders into five related categories   B)            To give a comprehensive picture of client functioning   C)            To improve prognostic ability   D)           To provide a decision-making algorithm for pharmacologic treatment  
  1. One limitation of the DSM relates to diagnostic labels given to children. The most problematic issue caused by applying adult categories to children is which of the following?
  A)           It prevents the proper treatment of childhood disorders.   B)            The criteria for diagnosis of a disorder are flexible for an adult, but not for children.   C)            Categories are based on manifestations of adult disorders, not research in children.   D)           The DSM was written before childhood psychological conditions were recognized.  
  1. Which of the following represents a problem complicating the treatment of people with mental illness?
  A)           Insurers' reimbursement decisions   B)            Increased responsibility for care by state mental hospitals   C)            Overuse of the well-coordinated mental health care system   D)           Lack of effective treatments  
  1. Julie, a 47-year-old woman, missed 1 week of work when she was hospitalized with bipolar disorder. She was placed on medication and was able to return to work. When asked about her absence, Julie informed coworkers that she was suffering from influenza. What is the most likely reason Julie lied about her illness?
  A)           This is a sign that the medication is not effectively treating her illness.   B)            Fear of rejection, isolation, and discrimination based on her mental health diagnosis
 
C)            Due to workplace policies that encourage the firing of those with mental illnesses   D)           To avoid eliciting sympathy among her coworkers  
  1. A 22-year-old man with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client attended a prestigious art school and enjoyed many social and leisure activities. Of the following long-term goals for this client, which is consistent with an overarching recovery goal for all clients with mental disorders?
  A)           The client will not injure himself.   B)            The client's symptoms will be reduced.   C)            The client will show interest in social and leisure activities.   D)           The client will resume pre-illness functioning.  
  1. Which of the following approaches to care best reflects cultural competence?
  A)           Always assign nurses of a specific ethnic background to clients with the same ethnic background.   B)            Learn the behaviors and values associated with people of specific ethnic backgrounds.   C)            Assess the culturally mediated beliefs of each client.   D)           Believe that people are more alike than they are different.       Chapter 02- Neuroscience-Biology and Behavior  
  1. The basic units of structure and function in the nervous system are called which of the following?
  A)            Glial cells   B)            Neurons   C)            Axons   D)            Dendrites  
  1. The structure and function of a neuron form the basis for the overall function of the nervous system. What are the components of a neuron?
  A)            A glial cell, nucleus, organelles, dendrites, and axons   B)            A glial cell, nucleus, dendrites, and synapses   C)            A cell body, nucleus, organelles, dendrites, and axons   D)            A cell body, nucleus, axon, and synapses  
  1. A patient has researched the role of neurotransmitters in her mental illness. What is the role of neurotransmitters?
 
A)            Excite the receptor cell located inside the synaptic cleft.   B)            Inhibit the receptor cell found inside of glial cells.   C)            Communicate information within the receptor cell.   D)            Communicate information from one cell or cell group to another.  
  1. Because neurotransmitters are responsible for immediately transmitting impulses between nerve cells, they are known as which of the following?
  A)            First messengers   B)            Second messengers   C)            Receptors   D)            Synapses  
  1. A nurse is caring for a patient who is addicted to alcohol and drugs and is discussing the pathway of the brain responsible for this behavior. The nurse should know that the pathway of the brain thought to be involved in pleasurable sensations and the euphoria resulting from use of drugs is called the:
  A)            Tuberinfundibular dopamine pathway   B)            Nigrostriatal dopamine pathway   C)            Mesocortical dopamine pathway   D)            Mesolimbic dopamine pathway  
  1. A client lives with acquired deficits in emotional control, memory, and learning. What part of this client's brain is most likely affected?
  A)            Basal ganglia   B)            Brainstem   C)            Limbic system   D)            Cerebellum  
  1. You are caring for a mental health client who has developed difficulty with balance and muscle tone after a car accident that involved a head injury. Based on this information, what area of the brain was most likely injured in the accident?
  A)            Diencephalon   B)            Brainstem   C)            Cerebellum   D)            Pons  
  1. A client who experiences dysfunction in the hypothalamus is most likely to have
  A)            Maintaining homeostasis   B)            Processing sensory input
 
C)            Secreting melatonin   D)            Integrating motor activities  
  1. Sensory deprivation in infancy and childhood has adversely affected a boy's brain development. Which characteristic of the brain was most directly involved in this process?
  A)            Neuroplasticity   B)            Reactive plasticity   C)            Adaptive plasticity   D)            Synaptic plasticity  
  1. Rather than being 100%, concordance rates for schizophrenia in monozygotic twins are only 50%. Which of the following statements best explains this phenomenon?
  A)            Genetic predisposition to disease is frequently overstated.   B)            One twin is inherently more vulnerable in every case.   C)            Environmental experiences affect gene expression.   D)            The genetic pathway responsible for vulnerability is unrelated to being a twin.       Chapter 03- Conceptual Frameworks and Theories  
  1. A psychiatric–mental health nurse is aware of the importance of theories in the development and delivery of care. Which of the following is the best definition of a theory?
  A)            A group of related concepts or ideas   B)            A person's or group's beliefs about how something happens or works   C)            A prediction about two or more concepts   D)            A researchable question related to health care  
  1. Which of the following explains why theories are important to psychiatric–mental health nursing?
  A)            Theories provide more treatment options for clients.   B)            Theories add professionalism to health care.   C)            Theories simplify treatment decisions for most clients.   D)            Theories lead to the expansion of knowledge.  
  1. A client has been told by a psychologist that memories in his unconscious are contributing to his depression. This reasoning implies that the psychologist ascribes to what theory?
  A)            Psychoanalytic theory   B)            Behavior theory   C)            Cognitive–behavioral theory
 
D)            The humanistic perspective  
  1. A client's current plan of care includes interventions that are rooted in the concepts of reinforcement. Which theory of human behavior is being prioritized during this client's care?
  A)            Humanistic theory   B)            Sociocultural theory   C)            Behavioral theory   D)            Psychoanalytic theory  
  1. A client and her therapist have been discussing the notion that her psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. This discussion is congruent with what theory?
  A)            Humanistic theory   B)            Interpersonal theory   C)            Biophysiological theory   D)            Sociocultural theory  
  1. During marital counseling, a man complains that his wife often “bombards” him with problems as soon as he settles down at home after work, which results in a prolonged argument. The wife admits that she does this but states she feels neglected and that her husband does not take the family problems seriously. She doesn't want her marriage to turn out like her parents' marriage. The wife admits that she sometimes provokes an argument in order to gain her husband's attention. How would a behaviorist most likely explain the wife's actions?
  A)            She has repressed painful memories about her emotionally distant father and is working out her anger at the parent in the marital relationship.   B)            Her thoughts about her parents' unhappy marriage are a justification for her behavior.   C)            She has an underlying anxiety disorder.   D)            The long argument in which she and her husband participate positively reinforces her behavior.  
  1. An adult man recalls that he was teased as a child about his inability to participate in sports. He began to avoid situations in which others might evaluate his behavior. He seeks treatment now because he is an accomplished musician but cannot perform for an audience. According to behavioral theory, his behavior is an example of which of the following concepts?
  A)            Discrimination   B)            Modeling   C)            Generalization   D)            Shaping  
  1. The nurse is working with a client who admits to having low self-esteem. The care team has determined that cognitive restructuring will likely enhance the client's self-esteem. Which of the following best describes the goals of this intervention?
 
A)            Avoid negative self-talk   B)            Replace negative self-talk with positive statements   C)            Change distorted thinking and the subsequent behaviors   D)            Use adaptive defense mechanisms  
  1. A 55-year-old woman is being treated for narcissistic personality disorder. The therapist demonstrates caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory?
  A)            Shaping   B)            Discrimination   C)            Modeling   D)            Conditioning  
  1. In a group therapy session, group members confront a 35-year-old woman about her abuse of prescription pain medications. The woman states that, because a physician has prescribed her medication, she is not a drug addict. The nurse identifies this as an example of which of the following defense mechanisms?
  A)            Regression   B)            Projection   C)            Denial   D)            Sublimation     Chapter 04- Evidence-Based Practice  
  1. The nurse demonstrates a commitment to the health, safety, and welfare of people by providing evidence-based practice. What does the term “evidence-based practice” mean?
  A)            Care that integrates research and clinical expertise with the client's characteristics, culture, and preferences   B)            Care that bases decision making on established clinical protocols   C)            Care based on prior outcomes from the nurse's practice   D)            Care based on outcomes and research conducted by the practitioner  
  1. Many pseudoscientific practitioners function openly and market themselves as mainstream
  “therapists.” Why does the public often respond favorably to unconventional therapies?   A)            Pseudoscientific therapies are frequently more effective than conventional therapies.   B)            Further advancements can be made in effective pseudoscientific treatments with continued practice.   C)            Malpractice is minimized because pseudoscientific treatments are not empirically supported.
 
D)            Some clients and families are disenchanted with the outcomes of professionally approved treatments.  
  1. Nursing is both an art and a science. Which statement best represents how evidence-based practice encompasses these two aspects of nursing?
  A)            The art of nursing has been replaced by evidence-based practice.   B)            Multiple theoretical perspectives no longer guide evidence-based nursing care.   C)            The art of nursing is demonstrated through carrying out the science of nursing in a skillful, knowledgeable, intelligent, and ethical manner.   D)            The artful side of nursing is of less value to positive patient outcomes than is the science of nursing.  
  1. Evidence-based practice is based on the scientific method and empirical evidence. Which of the following is a principle of empirical evidence?
  A)            Scientific observations are subjective inferences made by the knowledgeable nurse researcher.   B)            Empirical studies may be designed to report the physical and mental effects of subjective experiences.   C)            Empirical evidence is not appropriate in the field of mental health because cognitions and emotions are subjective and unpredictable.   D)            Empirical knowledge is verifiable only with valid and reliable measurement instruments.  
  1. The nurse is part of team conducting a research study that involves controlled observations. Controlled observations involve which of the following activities?
  A)            Putting information together to form a new understanding   B)            Watching something carefully and noting events   C)            Testing a hypothesis or prediction   D)            Determining whether data are reliable and supportive  
  1. Two patients with schizophrenia have consented to be involved in clinical trials to determine the efficacy of a new antipsychotic medication. The researcher administers the new drug to one subject and a sugar pill to another subject. The patient who received the sugar pill received a treatment that is considered which of the following?
  A)            Sham treatment   B)            Unethical treatment   C)            Placebo   D)            Supplemental therapy  
  1. A research team has been formed to study a new medication and its effects on depression. The researcher wants to use a design where neither the clients nor the research staff will know who is receiving the medication or the placebo. What type of study is this group conducting?
  A)            An empirical study   B)            An evidence-based study   C)            A case-control study
 
D)            A double-blind study  
  1. A researcher is determining whether data that were obtained in a psychiatric nursing study are reliable and whether the data support the study hypothesis. In what part of the scientific process is the researcher functioning?
  A)            Experimentation   B)            Analysis   C)            Synthesis   D)            Prediction  
  1. The nurse is working with a 42-year-old female patient who is mildly overweight. The patient expresses a desire to “tone up” before summer and is interested in trying an over-the-counter weight loss remedy. The nurse should perform health education related to what subject?
  A)            To be wary of any product that claims rapid or effortless results without exercise   B)            The relatively low risk of using natural remedies   C)            The small amount of active ingredient in most over-the-counter treatments   D)            To choose a product that reports data indicating a high degree of effectiveness  
  1. Many people get health care information from the Internet. Hence, evidence-based health care can be threatened by the proliferation of pseudoscientific information available to the public. Which measure is currently being taken to prevent the misinformation of the healthcare consumer?
  A)            Evidence-based knowledge is currently only disseminated in professional journals and publications.   B)            The Food and Drug Administration (FDA) has been denied the jurisdiction to prosecute unscrupulous internet marketers.   C)            Public education is being performed by the Federal Trade Commission (FTC) through a campaign called Operation Cure All.   D)            Websites publicizing misinformation on the Internet are being screened and blocked.       Chapter 05- Legal and Ethical Aspects  
  1. A psychiatric–mental health nurse has been consistently aware of the need to adhere to standards of practice during interactions with clients and their families. What is a standard of nursing practice?
  A)            The body of text in the state nurse practice act   B)            A document outlining minimum expectations for safe nursing practice   C)            Unwritten but traditional practices that constitute safe nursing care
 
D)            Part of the federal nurse practice act  
  1. Nursing students are reviewing the nurse practice act in the state where they reside. A state's nurse practice act has which of the following functions?
  A)            Makes recommendations for how nurses should practice   B)            Defines the scope and limit of nursing practice   C)            Defines specific situations that constitute malpractice   D)            Follows federal laws about nursing practice

Test Bank for Medical Terminology for Health Professions 8th Edition by Ehrlich

Match each definition with the correct word part.
a. ​abnormal condition
b. ​deficient
c. ​excessive
d. ​pain, suffering
e. ​surgical removal
 
1. ​-algia
ANSWER:   d
 
2. ​-ectomy
ANSWER:   e
 
3. ​hyper-
ANSWER:   c
 
4. ​hypo-
ANSWER:   b
 
5. ​-osis
ANSWER:   a
 
Match each definition with the correct word part.
a. ​excessive bleeding
b. ​flow or discharge
c. ​rupture
d. ​surgical repair
e. ​surgical suturing
 
6. ​-plasty
ANSWER:   d
 
7. ​-rrhage
ANSWER:   a
 
8. ​-rrhaphy
ANSWER:   e
 
9. ​-rrhea
ANSWER:   b
 
10. ​-rrhexis
ANSWER:   c
 
Match each definition with the correct word part.
a. abnormal hardening​
b. ​surgical incision
c. ​bad, difficult, painful
d. ​creation of an artificial opening
e. ​inflammation
 
11. ​dys-
ANSWER:   c
 
12. ​-itis
ANSWER:   e
 
13. ​-ostomy
ANSWER:   d
 
14. ​-otomy
ANSWER:   b
 
15. ​-sclerosis
ANSWER:   a
 
Match each definition with the correct term.
a. subjective evidence of disease​
b. ​objective evidence of disease
c. ​signs and symptoms that occur together
d. ​sudden onset of a disease
e. ​temporary disappearance of symptoms
 
16. ​acute
ANSWER:   d
 
17. ​remission
ANSWER:   e
 
18. ​sign
ANSWER:   b
 
19. ​symptom
ANSWER:   a
 
20. ​syndrome
ANSWER:   c
 
Match each definition with the correct term.
a. any disease of the stomach​
b. ​frequent watery stools
c. ​pertaining to the lining of an artery
d. ​swelling
e. ​formation of pus
 
21. ​diarrhea
ANSWER:   b
 
22. ​edema
ANSWER:   d
 
23. ​endarterial
ANSWER:   c
 
24. ​gastrosis
ANSWER:   a
 
25. ​suppuration
ANSWER:   e
 
Match each definition with the correct term.
a. ​torn and jagged wound
b. ​higher-than-normal blood pressure
c. ​localized response to a tissue injury
d. ​lower-than-normal blood pressure
e. ​pathologic tissue change caused by disease or injury
 
26. ​hypertension
ANSWER:   b
 
27. ​hypotension
ANSWER:   d
 
28. ​inflammation
ANSWER:   c
 
29. ​laceration
ANSWER:   a
 
30. ​lesion
ANSWER:   e
 
Match each definition with the correct term.
a. abnormal passage between organs
b. crack-like sore of the skin
c. identification of a disease
d. prediction of a disease outcome
e. the study of all aspects of diseases
 
31. ​diagnosis
ANSWER:   c
 
32. ​fissure
ANSWER:   b
 
33. ​fistula
ANSWER:   a
 
34. ​pathology
ANSWER:   e
 
35. ​prognosis
ANSWER:   d

Test Bank for Introduction to Critical Care Nursing 7th Edition by Sole

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
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