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

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By: Sole

Edition: 7th Edition

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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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Content

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

Test Bank for Pharmacology and the Nursing Process 9th Edition

Contents Chapter 01: The Nursing Process and Drug Therapy................................................................................. 4 Chapter 02: Pharmacologic Principles...................................................................................................... 8 Chapter 03: Lifespan Considerations...................................................................................................... 14 Chapter 04: Cultural, Legal, and Ethical Considerations.......................................................................... 20 Chapter 05: Medication Errors: Preventing and Responding .................................................................. 26 Chapter 06: Patient Education and Drug Therapy................................................................................... 29 Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements ........................................... 34 Chapter 08: Gene Therapy and Pharmacogenomics............................................................................... 38 Chapter 09: Photo Atlas of Drug Administration .................................................................................... 41 Chapter 10: Analgesic Drugs.................................................................................................................. 50 Chapter 11: General and Local Anesthetics............................................................................................ 57 Chapter 12: Central Nervous System Depressants and Muscle Relaxants............................................... 61 Chapter 13: Central Nervous System Stimulants and Related Drugs....................................................... 66 Chapter 14: Antiepileptic Drugs............................................................................................................. 70 Chapter 15: Antiparkinson Drugs.............................................................................................................76 Chapter 16: Psychotherapeutic Drugs.................................................................................................... 81 Chapter 17: Substance Use Disorder...................................................................................................... 88 Chapter 18: Adrenergic Drugs................................................................................................................ 93 Chapter 19: Adrenergic-Blocking Drugs.................................................................................................. 98 Chapter 20: Cholinergic Drugs ............................................................................................................. 103 Chapter 21: Cholinergic-Blocking Drugs............................................................................................... 108 Chapter 22: Antihypertensive Drugs.................................................................................................... 113 Chapter 23: Antianginal Drugs............................................................................................................. 119 Chapter 24: Heart Failure Drugs........................................................................................................... 125 Chapter 25: Antidysrhythmic Drugs..................................................................................................... 131 Chapter 26: Coagulation Modifier Drugs.............................................................................................. 137 Chapter 27: Antilipemic Drugs............................................................................................................. 143 Chapter 28: Diuretic Drugs................................................................................................................... 148 Chapter 29: Fluids and Electrolytes...................................................................................................... 154 Chapter 30: Pituitary Drugs.................................................................................................................. 160 Chapter 31: Thyroid and Antithyroid Drugs.......................................................................................... 163 Chapter 32: Antidiabetic Drugs............................................................................................................ 168 Chapter 33: Adrenal Drugs................................................................................................................... 177 Chapter 34: Women’s Health Drugs..................................................................................................... 181 Chapter 35: Men’s Health Drugs.......................................................................................................... 188 Chapter 36: Antihistamines, Decongestants, Antitussives, and Expectorants ....................................... 193 Chapter 37: Respiratory Drugs............................................................................................................. 198 Chapter 38: Antibiotics Part 1.............................................................................................................. 204 Chapter 39: Antibiotics Part 2.............................................................................................................. 211 Chapter 40: Antiviral Drugs.................................................................................................................. 216 Chapter 41: Antitubercular Drugs ........................................................................................................ 221 Chapter 42: Antifungal Drugs............................................................................................................... 226 Chapter 43: Antimalarial, Antiprotozoal, and Anthelmintic Drugs ........................................................ 231 Chapter 44: Anti-inflammatory and Antigout Drugs............................................................................. 236 Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs..................... 242 Chapter 46: Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific Drugs and Miscellaneous Drugs......... 248 Chapter 47: Biologic Response–Modifying and Antirheumatic Drugs ................................................... 253 Chapter 48: Immunosuppressant Drugs............................................................................................... 258 Chapter 49: Immunizing Drugs............................................................................................................. 263 Chapter 50: Acid-Controlling Drugs...................................................................................................... 268 Chapter 51: Bowel Disorder Drugs....................................................................................................... 274 Chapter 52: Antiemetic and Antinausea Drugs..................................................................................... 281 Chapter 53: Vitamins and Minerals...................................................................................................... 286 Chapter 54: Anemia Drugs................................................................................................................... 292 Chapter 55: Nutritional Supplements................................................................................................... 299 Chapter 56: Dermatologic Drugs.......................................................................................................... 304 Chapter 57: Ophthalmic Drugs............................................................................................................. 310 Chapter 58: Otic Drugs ............................

Test Bank for Neonatal and Pediatric Respiratory Care , (4th Edition)

CONTENTS SECTION 1: FETAL DEVELOPMENT, ASSESSMENT, AND DELIVERY 1. Fetal Lung Development 2. Fetal Gas Exchange and Circulation 3. Antenatal Assessment and High-Risk Delivery SECTION 2: ASSESSMENT AND MONITORING OF THE NEONATAL AND PEDIATRIC PATIENT 4. Exam and Assessment of the Neonatal and Pediatric Patient 5. Pulmonary Function Testing and Bedside Pulmonary Mechanics 6. Radiographic Assessment 7. Bronchoscopy 8. Invasive Blood Gas Analysis and Monitoring 9. Non-Invasive Monitoring in Neonatal and Pediatric Care SECTION 3: THERAPEUTIC PROCEDURES FOR TREATMENT OF NEONATAL AND PEDIATRIC DISORDERS 10. Oxygen Administration 11. Aerosols and Administration of Medication 12. Airway Clearance Techniques and Lung Volume Expansion 13. Airway Management 14. Surfactant Replacement 15. Non-Invasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate 16. Non-Invasive Mechanical Ventilation of the Child 17. Mechanical Ventilation of the Neonatal and Pediatric Patient 18. Administration of Gas Mixtures 19. Extracorporeal Life Support 20. Pharmacology 21. Thoracic Organ Transplantation 22. Neonatal Complications and Pulmonary Disorders SECTION 4: NEONATAL AND PEDIATRIC DISORDERS: PRESENTATION, DIAGNOSIS, AND TREATMENT 23. Congenital and Surgical Disorders that Affect Respiratory Care 24. Congenital Cardiac Defects 25. Sudden Infant Death Syndrome and Sleep Disorders 26. Pediatric Airway Disorders and Pulmonary Infections 27. Asthma 28. Cystic Fibrosis 29. Acute Respiratory Distress Syndrome 30. Shock, Sepsis, and Anaphylaxis 31. Pediatric Trauma 32. Disorders of the Pleura 33. Neurological and Neuromuscular Disorders SECTION 5: NEONATAL AND PEDIATRIC TRANSIENT AND AMBULATORY CARE 34. Transport of Infants and Children 35. Home Care 36. Quality and Safety NEW!

Test Bank for Maternal Child Nursing Care 6th Edition Perry

NURSINGTB.COM Chapter 01: 21st Century Maternity Nursing Perry: Maternal Child Nursing Care, 6th Edition MULTIPLE CHOICE 1. When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is: a. diabetes mellitus. b. mitral valve prolapse (MVP). c. chronic hypertension. d. anemia. ANS: A The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy, not chronic hypertension, is one of the most frequently reported maternal medical risk factors. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 2. To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into her care delivery. The SBAR technique of communication is an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym? a. Situation, baseline assessment, response b. Situation, background, assessment, recommendation c. Subjective background, assessment, recommendation d. Situation, background, anticipated recommendation ANS: B The situation, background, assessment, recommendation (SBAR) technique provides a specific framework for communication among health care providers. Failure to communicate is one of the major reasons for errors in health care. The SBAR technique has the potential to serve as a means to reduce errors. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Assessment, Planning MSC: Client Needs: Safe and Effective Care Environment 3. The role of the professional nurse caring for childbearing families has evolved to emphasize: a. providing care to patients directly at the bedside. b. primarily hospital care of maternity patients. c. practice using an evidence-based approach. d. planning patient care to cover longer hospital stays. ANS: C NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM Professional nurses are part of the team of health care providers who collaboratively care for patients throughout the childbearing cycle. Providing care to patients directly at the bedside is one of the nurse’s tasks; however, it does not encompass the concept of the evolved professional nurse. Throughout the prenatal period, nurses care for women in clinics and physician’s offices and teach classes to help families prepare for childbirth. Nurses also care for childbearing families in birthing centers and in the home. Nurses have been critically important in developing strategies to improve the well-being of women and their infants and have led the efforts to implement clinical practice guidelines using an evidence-based approach. Maternity patients have experienced a decreased, rather than an increased, length of stay over the past two decades. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 4. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments. ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but a nutrition assessment is not the most important action a nurse should take in this situation. The patient may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a patient is to receive. PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 5. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic patient with limited English proficiency. It is important for the nurse to: a. use maternity jargon in order for the patient to become familiar with these terms. b. speak quickly and efficiently to expedite the visit. c. provide the patient with handouts. d. assess whether the patient understands the discussion. ANS: D Nurses contribute to health literacy by using simple, common words; avoiding jargon; and evaluating whether the patient understands the discussion. Speaking slowly and clearly and focusing on what is important increase understanding. Most patient education materials are written at too high a level for the average adult and may not be useful for a patient with limited English proficiency. NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 6. When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman’s: a. age. b. minority status. c. educational level. d. inability to pay. ANS: D The most significant barrier to health care access is the inability to pay for services; this is compounded by the fact that many physicians refuse to care for women who cannot pay. Although adolescent pregnant patients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority women; however, minority status is not the most significant barrier to access of care. Disparities in educational level are associated with morbidity and mortality rates; however, educational level is not the most significant barrier to access of care. PTS: 1 DIF: Cognitive Level: Knowledge OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 7. When the nurse is unsure about how to perform a patient care procedure, the best action would be to: a. ask another nurse. b. discuss the procedure with the patient’s physician. c. look up the procedure in a nursing textbook. d. consult the agency’s procedure manual and follow the guidelines for the procedure. ANS: D It is always best to follow the agency’s policies and procedures manual when seeking information on correct patient procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe patient care delivery. Physicians are responsible for their own patient care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state or hospital policies. PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 8. From the nurse’s perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further? a. Implementing programs to ensure women’s early participation in ongoing prenatal care. b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days. NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM c. Expanding the number of neonatal intensive care units (NICUs). d. Mandating that all pregnant women receive care from an obstetrician. ANS: A Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs would offer better access for high risk care, but this factor is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 9. Alternative and complementary therapies: a. replace conventional Western modalities of treatment. b. are used by only a small number of American adults. c. recognize the value of patients’ input into their health care. d. focus primarily on the disease an individual is experiencing. ANS: C Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient’s input and honor the individual’s beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 10. A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence? a. She is Hispanic. b. She delivered a girl. c. The standards of care were not met. d. She refused fetal monitoring. ANS: C Not meeting the standards of care is a legitimate factor for a case of negligence. The patient’s race is not a factor for a case of negligence. The infant’s gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the patient has the right to refuse treatment. This refusal is not a case for negligence; however, informed consent should be properly obtained, and the patient should sign an against medical advice form for refusal of any treatment that is within the standard of care. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Planning NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM MSC: Client Needs: Health Promotion and Maintenance 11. A newly graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Her research finds that these costs are much higher compared with other developed countries as a result of: a. a higher rate of obesity among pregnant women. b. limited access to technology. c. increased usage of health care services along with lower prices. d. homogeneity of the population. ANS: A Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.5% of the gross domestic product is spent on health care. Higher spending in the United States compared with 12 other industrialized countries is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. Of the U.S. population, 16% is uninsured and has limited access to health care. Maternal morbidity and mortality are directly related to racial disparities. PTS: 1 DIF: Cognitive Level: Analysis OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 12. The term used to describe legal and professional responsibility for practice for maternity nurses is: a. collegiality. b. ethics. c. evaluation. d. accountability. ANS: D Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with one’s colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 13. Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for patients. The most concerning pitfall for nurses using this technology is: a. violation of patient privacy and confidentiality. b. institutions and colleagues may be cast in an unfavorable light. c. unintended negative consequences for using social media. d. lack of institutional policy governing online contact. ANS: A NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM The most significant pitfall for nurses using this technology is the violation of patient privacy and confidentiality. Furthermore, institutions and colleagues can be cast in unfavorable lights with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Board of Nursing for injudicious posts. The American Nurses Association has published six principles for social networking and nurses. All institutions should have policies guiding the use of social media, and nurses should be familiar with these guidelines. PTS: 1 DIF: Cognitive Level: Analysis OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 14. An important development that affects maternity nursing is integrative health care, which: a. seeks to provide the same health care for all racial and ethnic groups. b. blends complementary and alternative therapies with conventional Western treatment. c. focuses on the disease or condition rather than the background of the patient. d. has been mandated by Congress. ANS: B Integrative health care tries to mix the old with the new at the discretion of the patient and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 15. The nurse caring for a pregnant patient should be aware that the U.S. birth rate shows which trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years old are beginning to decline. c. Cigarette smoking among pregnant women continues to increase. d. The rates of maternal death owing to racial disparity are elevated in the United States. ANS: A Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. In the United States, there is significant racial disparity in the rates of maternal death. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 16. Maternity nursing care that is based on knowledge gained through research and clinical trials is: a. derived from the Nursing Intervention Classification. b. known as evidence-based practice. c. at odds with the Cochrane School of traditional nursing. NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM d. an outgrowth of telemedicine. ANS: B Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 17. The level of practice a reasonably prudent nurse provides is called: a. the standard of care. b. risk management. c. a sentinel event. d. failure to rescue. ANS: A Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care. PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Diagnosis MSC: Client Needs: Safe and Effective Care Environment 18. While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the patient has undergone female genital mutilation (FGM). The nurse’s best response to this patient is: a. “this is a very abnormal practice and rarely seen in the United States.” b. “do you know who performed this so that it can be reported to the authorities?” c. “we will be able to restore your circumcision fully after delivery.” d. “the extent of your circumcision will affect the potential for complications.” ANS: D “The extent of your circumcision will affect the potential for complications” is the most appropriate response. The patient may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGM is practiced, nurses will increasingly encounter women who have undergone the procedure. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Responding with, “This is a very abnormal practice and rarely seen in the United States” is culturally insensitive. The infibulation may have occurred during infancy or childhood. The patient will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a woman’s health. PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM 19. To ensure patient safety, the practicing nurse must have knowledge of the current Joint Commission’s “Do Not Use” list of abbreviations. Which of the following is acceptable for use? a. q.o.d. or Q.O.D. b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero ANS: C The abbreviations “i.u.” and “I.U.” are no longer acceptable because they could be misread as “I.V.” or the number “10.” The abbreviation “q.o.d. or Q.O.D.” should be written out as “every other day.” The period after the “Q” could be mistaken for an “I”; the “o” could also be mistaken for an “i.” With MSO4 or MgSO4, it is too easy to confuse one medication for another. These medications are used for very different purposes and could put a patient at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number to avoid confusion (i.e., 0.4 rather than .4). PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 20. Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore, it is important for the nurse to be aware that significant progress has been made in: a. the reduction of fetal deaths and use of prenatal care. b. low birth weight and preterm birth. c. elimination of health disparities based on race. d. infant mortality and the prevention of birth defects. ANS: A Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of Dimes, persistent disparities still exist between African-Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families. PTS: 1 DIF: Cognitive Level: Knowledge OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 1. Which interventions would help alleviate the problems associated with access to health care for maternity patients? (Select all that apply.) a. Provide transportation to prenatal visits. b. Provide child care so that a pregnant woman may keep prenatal visits. c. Mandate that physicians make house calls. NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM d. Provide low-cost or no-cost health care insurance. e. Provide job training. ANS: A, B, D Lack of transportation to visits, lack of child care, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. House calls are not a cost-effective approach to health care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote. PTS: 1 DIF: Cognitive Level: Implementation OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance MATCHING Medical errors are a leading cause of death in the United States. The National Quality Forum has recommended numerous safe practices that nursing can promote to reduce errors. Match each safe practice with the correct statement. a. Ask the patient to “teach back.” b. Comply with CDC guidelines. c. Ensure that information is documented in a timely manner. d. Promote interventions that will reduce patient risk. e. Reduce exposure to radiation. 1. Hand hygiene 2. Informed consent 3. Culture measurement, feedback, and intervention 4. Pediatric imaging 5. Patient care information 1. ANS: B PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 2. ANS: A PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 3. ANS: D PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 4. ANS: E PTS: 1 DIF: Cognitive Level: Application NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BANKNURSINGTB.COM OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 5. ANS: C PTS: 1 DIF: Cognitive Level: Application OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. NURSINGTB.COM MATERNAL CHILD NURSING CARE 6TH EDITION PERRY TEST BAN  
Chapter 01: Foundations of Maternity, Women’s Health, and Child Health Nursing

McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition

MULTIPLE CHOICE
  1. Which factor significantly contributed to the shift from home births to hospital births in the early 20th century?
a. Puerperal sepsis was identified as a risk factor in labor and delivery.
b. Forceps were developed to facilitate difficult births.
c. The importance of early parental-infant contact was identified.
d. Technologic developments became available to physicians.
ANS:  D Technologic developments were available to physicians, not lay midwives. So in-hospital births increased in order to take advantage of these advancements. Puerperal sepsis has been a known problem for generations. In the late 19th century, Semmelweis discovered how it could be prevented with improved hygienic practices. The development of forceps is an example of a technology advance made in the early 20th century but is not the only reason birthplaces moved. Unlike home births, early hospital births hindered bonding between parents and their infants. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 1                OBJ:   Integrated Process: Teaching-Learning MSC:  Client Needs: Safe and Effective Care Environment
  1. Family-centered maternity care developed in response to
a. demands by physicians for family involvement in childbirth.
b. the Sheppard-Towner Act of 1921.
c. parental requests that infants be allowed to remain with them rather than in a nursery.
d. changes in pharmacologic management of labor.
ANS:  C As research began to identify the benefits of early extended parent-infant contact, parents began to insist that the infant remain with them. This gradually developed into the practice of rooming-in and finally to family-centered maternity care. Family-centered care was a request by parents, not physicians. The Sheppard-Towner Act of 1921 provided funds for state-managed programs for mothers and children. The changes in pharmacologic management of labor were not a factor in family-centered maternity care. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 2                OBJ:   Integrated Process: Teaching-Learning MSC:  Client Needs: Psychosocial Integrity
  1. Which setting for childbirth allows the least amount of parent-infant contact?
a. Labor/delivery/recovery/postpartum room
b. Birth center
c. Traditional hospital birth
d. Home birth
ANS:  C In the traditional hospital setting, the mother may see the infant for only short feeding periods, and the infant is cared for in a separate nursery. The labor/delivery/recovery/postpartum room setting allows increased parent-infant contact. Birth centers are set up to allow an increase in parent-infant contact. Home births allow an increase in parent-infant contact. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 2                OBJ:   Nursing Process: Planning MSC:  Client Needs: Health Promotion and Maintenance
  1. As a result of changes in health care delivery and funding, a current trend seen in the pediatric setting is
a. increased hospitalization of children.
b. decreased number of children living in poverty.
c. an increase in ambulatory care.
d. decreased use of managed care.
ANS:  C One effect of managed care has been that pediatric health care delivery has shifted dramatically from the acute care setting to the ambulatory setting in order to provide more cost-efficient care. The number of hospital beds being used has decreased as more care is given in outpatient settings and in the home. The number of children living in poverty has increased over the past decade. One of the biggest changes in health care has been the growth of managed care. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 5                OBJ:   Nursing Process: Planning MSC:  Client Needs: Safe and Effective Care Environment
  1. The Women, Infants, and Children (WIC) program provides
a. well-child examinations for infants and children living at the poverty level.
b. immunizations for high-risk infants and children.
c. screening for infants with developmental disorders.
d. supplemental food supplies to low-income pregnant or breastfeeding women.
ANS:  D WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breastfeeding and to their children until age 5 years. Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment Program provides for well-child examinations and for treatment of any medical problems diagnosed during such checkups. Children in the WIC program are often referred for immunizations, but that is not the primary focus of the program. Public Law 99-457 is part of the Individuals with Disabilities Education Act that provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities. PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 8 OBJ:   Integrated Process: Teaching-Learning MSC:  Client Needs: Health Promotion and Maintenance
  1. In most states, adolescents who are not emancipated minors must have the permission of their parents before
a. treatment for drug abuse.
b. treatment for sexually transmitted diseases (STDs).
c. accessing birth control.
d. surgery.
ANS:  D Minors are not considered capable of giving informed consent, so a surgical procedure would require consent of the parent or guardian. Exceptions exist for obtaining treatment for drug abuse or STDs or for getting birth control in most states. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 17              OBJ:   Nursing Process: Planning MSC:  Client Needs: Safe and Effective Care Environment
  1. The maternity nurse should have a clear understanding of the correct use of a clinical pathway. One characteristic of clinical pathways is that they
a. are developed and implemented by nurses.
b. are used primarily in the pediatric setting.
c. set specific time lines for sequencing interventions.
d. are part of the nursing process.
ANS:  C Clinical pathways are standardized, interdisciplinary plans of care devised for patients with a particular health problem. They are used to identify patient outcomes, specify time lines to achieve those outcomes, direct appropriate interventions and sequencing of interventions, include interventions from a variety of disciplines, promote collaboration, and involve a comprehensive approach to care. They are developed by multiple health care professionals and reflect interdisciplinary care. They can be used in multiple settings and for patients throughout the life span. They are not part of the nursing process but can be used in conjunction with the nursing process to provide care to patients. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 7                OBJ:   Nursing Process: Planning MSC:  Client Needs: Safe and Effective Care Environment
  1. The fastest growing group of homeless people is
a. men and women preparing for retirement.
b. migrant workers.
c. single women and their children.
d. intravenous (IV) substance abusers.
ANS:  C Pregnancy and birth, especially for a teenager, are important contributing factors for becoming homeless. People preparing for retirement, migrant workers, and IV substance abusers are not among the fastest growing groups of homeless people. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 14              OBJ:   Nursing Process: Assessment MSC:  Client Needs: Physiologic Integrity
  1. A nurse wishes to work to reduce infant mortality in the United States. Which activity would this nurse most likely participate in?
a. Creating pamphlets in several different languages using an interpreter.
b. Assisting women to enroll in Medicaid by their third trimester.
c. Volunteering to provide prenatal care at community centers.
d. Working as an intake counselor at a women’s shelter.
ANS:  C Prenatal care is vital to reducing infant mortality and medical costs. This nurse would most likely participate in community service providing prenatal care outreach activities in community centers, particularly in low-income areas. Pamphlets in other languages, enrolling in Medicaid, and working at a women’s shelter all might impact infant mortality, but the greatest effect would be from assisting women to get consistent prenatal care. PTS:   1                    DIF:    Cognitive Level: Application/Applying REF:   p. 14              OBJ:   Nursing Process: Implementation MSC:  Client Needs: Health Promotion and Maintenance
  1. The intrapartum woman sees no need for a routine admission fetal monitoring strip. If she continues to refuse, what is the first action the nurse should take?
a. Consult the family of the woman.
b. Notify the provider of the situation.
c. Document the woman’s refusal in the nurse’s notes.
d. Make a referral to the hospital ethics committee.
ANS:  B Patients must be allowed to make choices voluntarily without undue influence or coercion from others. The physician, especially if unaware of the patient’s decision, should be notified immediately. Both professionals can work to ensure the mother understands the rationale for the action and the possible consequences of refusal. The woman herself is the decision-maker, unless incapacitated. Documentation should occur but is not the first action. This situation does not rise to the level of an ethical issue so there is no reason to call the ethics committee. PTS:   1                    DIF:    Cognitive Level: Application/Applying REF:   p. 18              OBJ:   Nursing Process: Implementation MSC:  Client Needs: Safe and Effective Care Environment
  1. Which statement is true regarding the “quality assurance” or “incident” report?
a. The report assures the legal department that no problem exists.
b. Reports are a permanent part of the patient’s chart.
c. The nurse’s notes should contain, “Incident report filed, and copy placed in chart.”
d. This report is a form of documentation of an event that may result in legal action.
ANS:  D An incident report is used when something occurs that might result in legal action, such as a patient fall or medication error. It warns the legal department that there may be a problem in a particular patient’s care. Incident reports are not part of the patient’s chart; thus the nurses’ notes should not contain any reference to them. PTS:   1                    DIF:    Cognitive Level: Knowledge/Remembering REF:   p. 18              OBJ:   Integrated Process: Communication and Documentation MSC:  Client Needs: Safe and Effective Care Environment
  1. Elective abortion is considered an ethical issue because
a. abortion law is unclear about a woman’s constitutional rights.
b. the Supreme Court ruled that life begins at conception.
c. a conflict exists between the rights of the woman and the rights of the fetus.
d. it requires third-party consent.
ANS:  C

Test Bank Focus on Nursing Pharmacology 8th Edition

Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch) Table of Contents Chapter 01 - Introduction to Drugs Chapter 02 - Drugs and the Body Chapter 03 - Toxic Effects of Drugs Chapter 04 - The Nursing Process in Drug Therapy and Patient Safety Chapter 05 - Dosage Calculations Chapter 06 - Challenges to Effective Drug Therapy Chapter 07 - Introduction to Cell Physiology Chapter 08 - Antiinfective Agents Chapter 09 - Antibiotics Chapter 10 - Antiviral Agents Chapter 11 - Antifungal Agents Chapter 12 - Antiprotozoal Agents Chapter 13 - Anthelmintic Agents Chapter 14 - Antineoplastic Agents Chapter 15 - Introduction to the Immune Response and Inflammation Chapter 16 - Antiinflammatory, Antiarthritis, and Related Agents Chapter 17 - Immune Modulators Chapter 18 - Vaccines and Sera Chapter 19 - Introduction to Nerves and the Nervous System Chapter 20 - Anxiolytic and Hypnotic Agents Chapter 21 - Antidepressant Agents Chapter 22 - Psychotherapeutic Agents Chapter 23 - Antiseizure Agents Chapter 24 - Antiparkinsonism Agents Chapter 25 - Muscle Relaxants Chapter 26 - Narcotics, Narcotic Antagonists, and Antimigraine Agents Chapter 27 - General and Local Anesthetic Agents Chapter 28 - Neuromuscular Junction Blocking Agents Chapter 29 - Introduction to the Autonomic Nervous System Chapter 30 - Adrenergic Agonists Chapter 31 - Adrenergic Antagonists Chapter 32 - Cholinergic Agonists Chapter 33 - Anticholinergic Agents Chapter 34 - Introduction to the Endocrine System Chapter 35 - Hypothalamic and Pituitary Agents Chapter 36 - Adrenocortical Agents Chapter 37 - Thyroid and Parathyroid Agents Chapter 38 - Agents to Control Blood Glucose Levels Chapter 39 - Introduction to the Reproductive System Chapter 40 - Drugs Affecting the Female Reproductive System Chapter 41 - Drugs Affecting the Male Reproductive System Chapter 42 - Introduction to the Cardiovascular System Chapter 43 - Drugs Affecting Blood Pressure Chapter 44 - Agents for Treating Heart Failure Chapter 45 - Antiarrhythmic Agents Chapter 46 - Antianginal Agents Chapter 47 - Lipid-Lowering Agents Chapter 48 - Drugs Affecting Blood Coagulation Chapter 49 - Drugs Used to Treat Anemias Chapter 50 - Introduction to the Renal System Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch) 2 Chapter 51 - Diuretic Agents Chapter 52 - Drugs Affecting the Urinary Tract and the Bladder Chapter 53 - Introduction to the Respiratory System Chapter 54 - Drugs Acting on the Upper Respiratory Tract Chapter 55 - Drugs Acting on the Lower Respiratory Tract Chapter 56 - Introduction to the Gastrointestinal System Chapter 57 - Drugs Affecting Gastrointestinal Secretions Chapter 58 - Drugs Affecting Gastrointestinal Motility Chapter 59 - Antiemetic Agents
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