| Content | Leadership and Management for Nurses, 3e (Finkelman)
Chapter 1 Conceptual Base for Leadership and Management
1) The nurse manager has asked that all staff nurses develop effective leadership competencies. How should the staff nurses interpret this request?
- This is an unrealistic expectation, because only managers are leaders.
- This is possible if the nurses learn about and use relevant leadership and management theories and styles.
- In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done.
- Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.
Answer: 2
Explanation: 1. A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders.
- In today's healthcare environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices.
- Control, competition, and getting the job done are past theories and styles that are not as useful in today's environment.
- Leadership is a skill that can be learned.
Page Ref: 7
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment
Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO 08. Analyze the need for more nursing leaders.
2) Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization?
- The control of the organization is centralized, and decisions are made by upper-level management.
- Staff nurses are expected to provide support and nurturing for management's decisions.
- The organization's approach to leadership is autocratic and bureaucratic.
- Staff nurses provide input into planning and changes for their own unit.
Answer: 4
Explanation: 1. In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization.
- The theory is that the staff should be nurtured to promote greater leadership competency.
- According to Drucker, when staff participate in the core functions of management, the organization is more effective.
- According to Drucker, when staff participates in the core functions of management such as planning and changes for their own units, the organization is more effective.
Page Ref: 7-8
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment
Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories and implications for nursing leadership and management.
3) Which behavior demonstrates the nurse's competency as an emotionally intelligent leader?
- The nurse is proficient in technical skills.
- The nurse relies on policies, not options.
- The nurse supports team members.
- Productivity is not a major concern.
Answer: 3
Explanation: 1. While technical skill is important for all nurses, it is not a hallmark of a competent leader.
- Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered.
- In Emotional Intelligent theory, team members support each other and feel supported by the team leader.
- This statement reflects the country club leadership style.
Page Ref: 11
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment
Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship-centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories and implications for nursing leadership and management. |
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• We offer a free sample so you know exactly what to expect | Test Bank For Essentials of Psychiatric Mental Health Nursing 8th Morgan
Chapter 1: Mental Health and Mental Illness
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A nurse is assessing a client who experiences occasional feelings of sadness because of the recent
death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed.
How would the nurse interpret the client’s behaviors?
1. The client’s behaviors demonstrate mental illness in the form of depression.
2. The client’s behaviors are inappropriate, which indicates the presence of mental
illness.
3. The client’s behaviors are not congruent with cultural norms.
4. The client’s behaviors demonstrate no functional impairment, indicating no mental
illness.
____ 2. At which point would the nurse determine that a client is at risk for developing a mental illness?
1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.
2. When maladaptive responses to stress are coupled with interference in daily
functioning.
3. When a client communicates significant distress.
4. When a client uses defense mechanisms as ego protection.
____ 3. A client has been given a diagnosis of human immunodeficiency virus (HIV). Which statement
made by the client does the nurse recognize as the bargaining stage of grief?
1. “I hate my partner for giving me this disease I will die from!”
2. “If I don’t do intravenous (IV) drugs anymore, God won’t let me die.”
3. “I am going to support groups and learn more about the disease.”
4. “Can you please re-draw the test results, I think they may be wrong?”
____ 4. A nurse notes that a client is extremely withdrawn, delusional, and emotionally exhausted. The
nurse assesses the client’s anxiety as which level?
1. Mild anxiety
2. Moderate anxiety
3. Severe anxiety
4. Panic anxiety
____ 5. A psychiatric nurse intern states, “This client’s use of defense mechanisms should be eliminated.”
Which is a correct evaluation of this nurse’s statement?
1. Defense mechanisms can be appropriate responses to stress and need not be
eliminated.
2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and
should always be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should be
discouraged and not completely eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered and
encouraged.
ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH MORGAN TEST BANK
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____ 6. During an intake assessment, a nurse asks both physiological and psychosocial questions. The
client angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s best
response?
1. “It is just a routine part of our assessment. All clients are asked these same
questions.”
2. “Why are you concerned about these types of questions?”
3. “Psychological factors, like excessive stress, have been found to affect medical
conditions.”
4. “We can skip these questions, if you like. It isn’t imperative that we complete this
section.”
____ 7. A client who is being treated for chronic kidney disease complains to the health-care provider that
he does not like the food available to him while hospitalized. The health-care provider insists that
the client strictly adhere to the diet plan. What action can be expected is the client uses the defense
mechanism of displacement?
1. The client assertively confronts the health-care provider.
2. The client insists on being discharged and goes for a long, brisk walk.
3. The client snaps at the nurse and criticizes the nursing care provided.
4. The client hides his anger by explaining the logical reasoning for the diet to his
spouse.
____ 8. A fourth-grade boy teases and makes jokes about a cute girl in his class. A nurse would recognize
this behavior as indicative of which defense mechanism?
1. Displacement
2. Projection
3. Reaction formation
4. Sublimation
____ 9. Which nursing statement regarding the concept of psychosis is most accurate?
1. Individuals experiencing psychoses are aware that their behaviors are maladaptive.
2. Individuals experiencing psychoses experience little distress.
3. Individuals experiencing psychoses are aware of experiencing psychological
problems.
4. Individuals experiencing psychoses are based in reality.
____ 10. When under stress, a client routinely uses alcohol to excess. When the client’s husband finds her
drunk, the husband yells at the client about her chronic alcohol abuse. Which action alerts the
nurse to the client’s use of the defense mechanism of denial?
1. The client hides liquor bottles in a closet.
2. The client yells at her son for slouching in his chair.
3. The client burns dinner on purpose.
4. The client says to the spouse, “I don’t drink too much!”
____ 11. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which
statement by the wife would indicate to a nurse that the client is in the acceptance stage of grief?
1. “If only we could have tried again, things might have worked out.”
2. “I am so mad that the children and I had to put up with him as long as we did.”
3. “Yes, it was a difficult relationship, but I think I have learned from the
ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH MORGAN TEST BANK
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experience.”
4. “I have a difficult time getting out of bed most days.”
____ 12. According to Maslow’s hierarchy of needs, which client action would demonstrate the highest
achievement in terms of mental health?
1. Maintaining a long-term, faithful, intimate relationship
2. Achieving a sense of self-confidence
3. Possessing a feeling of self-fulfillment and realizing full potential
4. Developing a sense of purpose and the ability to direct activities
____ 13. According to Maslow’s hierarchy of needs, which situation on an inpatient psychiatric unit would
require priority intervention by a nurse?
1. A client rudely complaining about limited visiting hours
2. A client exhibiting aggressive behavior toward another client
3. A client stating that no one cares
4. A client verbalizing feelings of failure
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 14. Which describes a defense mechanism an individual may use to relieve anxiety in a stressful
situation? (Select all that apply.)
1. Homework
2. Smoking
3. Itching
4. Nail biting
5. Sleeping
____ 15. The nurse is reviewing the DSM-5 definition of a mental health disorder and notes the definition
includes a disturbance in which areas? (Select all that apply.)
1. Cognition
2. Physical
3. Emotional regulation
4. Behavior
5. Developmental
Completion
Complete each statement.
16. _______________________ is a diffuse apprehension that is vague in nature and is associated
with feelings of uncertainty and helplessness.
17. _______________________ is a subjective state of emotional, physical, and social responses to
the loss of a valued entity.
Other
ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH MORGAN TEST BANK
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18. Place in order the Kübler Ross stages of grief from 1-5. (Enter the number of each step in the
proper sequence, using comma and space format, such as: 1, 2, 3, 4.)
1. Bargaining
2. Denial
3. Acceptance
4. Depression
5. Anger |
Sample Questions
Chapter 04: Genetic Issues
Urden: Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
- What is a genetic variant that exists in greater than 1% of the population termed?
| a. |
Genetic mutation |
| b. |
Genetic polymorphism |
| c. |
Genetic deletion |
| d. |
Tandem repeat |
ANS: B
When a genetic variant occurs frequently and is present in 1% or more of the population, it is described as a genetic polymorphism. The term genetic mutation refers to a change in the DNA genetic sequence that can be inherited that occurs in less than 1% of the population. Genetic material in the chromosome can also be deleted and new information from another chromosome can be inserted or can be a tandem repeat (multiple repeats of the same sequence).
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 43
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Which type of genetic disorder occurs when there is an interaction between genetic and environmental factors such as that which occurs with type 2 diabetes?
| a. |
Chromosome |
| b. |
Mitochondrial |
| c. |
Multifactorial disorders |
| d. |
Allele dysfunction |
ANS: C
In multifactorial disorders there is an interaction between vulnerable genes and the environment. Cardiovascular atherosclerotic diseases and type 2 diabetes are examples of multifactorial disorders that result from an interaction of genetic and environmental factors.
PTS: 1 DIF: Cognitive Level: Understanding REF: p. 46
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Prader-Willi syndrome (PWS) is a rare genetic disorder in which genes on chromosome 15 (q11.2-13) are deleted. What type of disorder is PWS?
| a. |
Chromosome disorder |
| b. |
Mitochondrial disorder |
| c. |
Complex gene disorder |
| d. |
Multifactorial disorder |
ANS: A
Prader-Willi syndrome (PWS) is a chromosome disorder as a result of several missing genes on chromosome 15. In chromosome disorders, the entire chromosome or very large segments of the chromosome are damaged, missing, duplicated, or otherwise altered.
PTS: 1 DIF: Cognitive Level: Applying REF: p. 45
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- A family pedigree is used to determine whether a disease has a genetic component. What does a proband indicate in a family pedigree?
| a. |
The disease being mother related or father related |
| b. |
The first person in the family who was diagnosed with the disorder |
| c. |
Who in the family is the xy band |
| d. |
The disease genotype including locus |
ANS: B
For nurses, it is important to ask questions that elucidate which family members are affected versus those who are unaffected and then to identify the individuals who may carry the gene in question but who do not have symptoms (carriers). The proband is the name given to the first person diagnosed in the family pedigree. Homozygous versus heterozygous determines if the disorder is carried by a gene from one or both parents. The xy band determines if the disorder is carried through the sex genes. A disease locus is the genetic address of the disorder.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 46
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Philadelphia translocation is a specific chromosomal abnormality that occurs from a reciprocal translocation between chromosomes 9 and 22, where parts of these two chromosomes switch places. This abnormality is associated with which disease?
| a. |
Hemophilia A |
| b. |
Chronic myelogenous leukemia |
| c. |
Obesity |
| d. |
Marfan syndrome |
ANS: B
Philadelphia chromosome or Philadelphia translocation is a specific chromosomal abnormality associated with chronic myelogenous leukemia. It occurs from a reciprocal translocation between chromosomes 9 and 22, where parts of these two chromosomes switch places. Hemophilia A is a sex-linked inheritance. Obesity is being studied with the FTO gene on chromosome 16. Marfan syndrome is classified as a single-gene disorder.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 42
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What was the goal of the Human Genome Project?
| a. |
Identifying haplotype tags |
| b. |
Exposing untaggable SNPs and recombination hot spots |
| c. |
Producing a catalog of human genome variation |
| d. |
Mapping all the human genes |
ANS: D
The Human Genome Project was a huge international collaborative project that began in 1990 with the goal of making a map of all the human genes (the genome). The final genome sequence was published in 2003. The HapMap project was to identify haplotype tags. The Genome-Wide Association Studies was used to expose untaggable SNPs and recombination hot spots. The 1000 Genomes project was used to map all the human genes.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 49
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- The patient is placed under general anesthesia for a carotid endarterectomy. During the surgery, the patient develops muscle contracture with skeletal muscle rigidity, acidosis, and elevated temperature. What is a possible cause for malignant hyperthermia?
| a. |
Polymorphism in RYR1 at chromosome 19q13.1 |
| b. |
Variant in the VKOR1 gene |
| c. |
Variant in the cytochrome P450 enzyme CYP2C9 gene |
| d. |
Halothane overdose |
ANS: A
Individuals with polymorphisms in the ryanodine receptor gene (RYR1) at chromosome 19q13.1 are at risk of a rare pharmacogenetic condition known as malignant hyperthermia. In affected individuals, exposure to inhalation anesthetics and depolarizing muscle relaxants during general anesthesia induces life-threatening muscle contracture with skeletal muscle rigidity, acidosis, and elevated temperature. Warfarin is being researched as a variant in the VKOR1 gene and in the cytochrome P450 enzyme CYP2C9 gene.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 53|Box 4-3
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What is the study of heredity particularly as it relates to the transfer heritable physical characteristics called?
| a. |
Chromatids |
| b. |
Karyotype |
| c. |
Genetics |
| d. |
Histones |
ANS: C
Genetics refers to the study of heredity, particularly as it relates to the ability of individual genes to transfer heritable physical characteristics. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. A karyotype is the arrangement of human chromosomes from largest to smallest. A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 54
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Each chromosome consists of an unbroken strand of DNA inside the nucleus of the cell. What is the arrangement of human chromosomes termed?
| a. |
Chromatids |
| b. |
Karyotype |
| c. |
Genomics |
| d. |
Histones |
ANS: B
A karyotype is the arrangement of human chromosomes from largest to smallest. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. Genomics refers to the study of all of the genetic material within cells and encompasses the environmental interaction and impact on biologic and physical characteristics. A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 39
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What is the study of all the genetic material within the cell and its impact on biologic and physical characteristics called?
| a. |
Chromatids |
| b. |
Karyotype |
| c. |
Genomics |
| d. |
Histones |
ANS: C
Genomics refers to the study of all of the genetic material within cells and encompasses the environmental interaction and impact on biologic and physical characteristics. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. A karyotype is the arrangement of human chromosomes from largest to smallest. A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 39
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- A specialized class of proteins that organizes the double-stranded DNA into what looks like a tightly coiled telephone cord is known which of the following?
| a. |
Chromatids |
| b. |
Karyotype |
| c. |
Genomics |
| d. |
Histones |
ANS: D
A specialized class of proteins called histones organizes the double-stranded DNA into what looks like a tightly coiled telephone cord. Genomics refers to the study of all of the genetic material within cells and encompasses the environmental interaction and impact on biologic and physical characteristics. Each somatic chromosome, also called an autosome, is made of two strands, called chromatids, which are joined near the center. A karyotype is the arrangement of human chromosomes from largest to smallest.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 39
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- To achieve a consistent distance across the width of the DNA strand, the nucleotide base guanine (G) can only be paired with what other genetic material?
| a. |
Adenine (A) |
| b. |
Thymine (T) |
| c. |
Cytosine (C) |
| d. |
Sex chromosome X |
ANS: C
Four nucleotide bases—adenine (A), thymine (T), guanine (G), and cytosine (C)—comprise the “letters” in the genetic DNA “alphabet.” The bases in the double helix are paired T with A and G with C. The nucleotide bases are designed so that only G can pair with C and only T can pair with A to achieve a consistent distance across the width of the DNA strand. The TA and GC combinations are known as base pairs.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 40
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- Why are monozygotic twins separated at birth used to study the effects of genetics versus environment?
| a. |
They share an identical genome. |
| b. |
They have different sex chromosomes. |
| c. |
They have mirror chromosomes. |
| d. |
They have identical health issues. |
ANS: A
Studies of identical twins offer a unique opportunity to investigate the association of genetics, environment, and health. Identical twins are monozygotic and share an identical genome. Monozygotic twins are the same sex. Studies occur much less frequently today because tremendous efforts are made to keep siblings together when they are adopted. Genetics can be stable in a study group, but the environment and health issues are dynamic even in a controlled study group.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 48
OBJ: Nursing Process Step: General TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- The process that is used to make polypeptide chains that constitute proteins can be written as:
| a. |
RNA ® DNA ® protein. |
| b. |
DNA ® RNA ® protein. |
| c. |
Protein ® RNA ® DNA. |
| d. |
Protein ® DNA ® RNA. |
ANS: B
The nucleotides A, T, C, and G can be thought of as “letters” of a genetic alphabet that are combined into three-letter “words” that are transcribed (written) by the intermediary of ribonucleic acid (RNA). The RNA translates the three-letter words into the amino acids used to make the polypeptide chains that constitute proteins. This process may be written as DNA ® RNA ® protein.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 41
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What are the studies called that are done on large, extended families who have several family members affected with a rare disease?
| a. |
Genetic association |
| b. |
Genetic epidemiology |
| c. |
Kinships |
| d. |
Phenotypes |
ANS: C
In genetic epidemiologic research of a rare disease, it can be a challenge to find enough people to study. One method is to work with large, extended families, known as kinships, which have several family members affected with the disease. Genetic association studies are usually conducted in large, unrelated groups based on demonstration of a phenotype (disease trait or symptoms) and associated genotype. Genetic epidemiology represents the fusion of epidemiologic studies and genetic and genomic research methods. Phenotypes are different at different stages of a disease and are influenced by medications, environmental factors, and gene–gene interaction.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 48
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What is an example of direct-to-consumer genomic testing?
| a. |
Genetic testing through amniocentesis |
| b. |
Paternity testing from buccal swabs of the child and father |
| c. |
Biopsy of a lump for cancer |
| d. |
Drug testing using hair follicles |
ANS: B
An example of direct-to-consumer testing is paternity testing from buccal swabs of the child and father. Genetic testing can be done through biopsies and amniocentesis, but they are performed in a facility by a medical professional. Drug testing and genomic testing are two different tests and are unrelated.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 53
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
- What was the Genetic Information Nondiscrimination Act (GINA) of 2008 designed to prevent from happening?
| a. |
Abuse of genetic information in employment and health insurance decisions |
| b. |
Genetic counselors from reporting results to the health insurance companies |
| c. |
Mandatory genetics testing of all individuals with certain diseases |
| d. |
Information sharing between biobanks that are studying the same genetic disorders |
ANS: A
The Genetic Information Nondiscrimination Act (GINA) of 2008 is an essential piece of legislation designed to prevent abuse of genetic information in employment and health insurance decisions in the United States. One of the paramount concerns in the genomic era is to protect the privacy of individuals’ unique genetic information. Many countries have established biobanks as repositories of genetic material, and many tissue samples are stored in medical center tissue banks. Some people who may be at risk for a disorder disease will not be tested because they fear that a positive result may affect their employability. GINA also mandates that genetic information about an individual and his or her family has the same protections as health information.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 53
OBJ: Nursing Process Step: Diagnosis TOP: Genetics in Critical Care
MSC: NCLEX: Health Promotion and Maintenance
MULTIPLE RESPONSE
- Which patients would be candidates for genetic testing for long QT syndrome (LQTS)? (Select all that apply.)
| a. |
Patients with prolonged QT interval during a cardiac and genetic work-up |
| b. |
Family history of positive genotype and negative phenotype |
| c. |
Patients diagnosed with torsades de pointes |
| d. |
Family history of sudden cardiac death |
| e. |
Family history of bleeding disorders |
| f. |
Family history of obesity |
ANS: A, B, C, D |
Chapter 01: Community Health Nursing
Stanhope: Community Health Nursing in Canada, 3rd Canadian Edition
MULTIPLE CHOICE
1. Which of the following best describes community health nursing?
| a. |
Giving care with a focus on the aggregate’s needs |
| b. |
Giving care with a focus on the group’s needs |
| c. |
Focusing on the health care of individual clients in the community |
| d. |
Working with an approach of unique client care |
ANS: C
By definition, community health nursing is the health care of individual clients in the community.
DIF: Cognitive Level: Knowledge/Remember REF: p. 3
OBJ: 1.6
TOP: Client Need: Safe and Effective Care Environment - Management of Care
2. Which of the following best describes primary health care?
| a. |
A comprehensive way to address issues of social justice |
| b. |
Giving the care to manage acute or chronic conditions |
| c. |
Giving direct care to ill individuals within their family setting |
| d. |
Having the goal of health promotion and disease prevention |
ANS: A
By definition, primary health care is comprehensive and addresses issues of social justice and equity. Social justice in the context of health refers to ensuring fairness and equality in health services so that vulnerable individuals in society have easy access to health care.
DIF: Cognitive Level: Knowledge/Remember REF: p. 10
OBJ: 1.4 TOP: Client Need: Health Promotion and Maintenance
3. The health of which of the following is the primary focus of public health nurses (PHNs)?
| a. |
Families |
| b. |
Groups |
| c. |
Individuals |
| d. |
Populations |
ANS: D
PHNs use knowledge of nursing, social sciences, and public health sciences for the promotion and protection of health and for the prevention of disease among populations.
DIF: Cognitive Level: Knowledge/Remember REF: p. 13, Table 1-4 | p. 20
OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance
4. Which change is the primary explanation for life expectancy increasing so notably since the early 1900s?
| a. |
An increase in findings from medical laboratory research |
| b. |
Incredible advances in surgical techniques and procedures |
| c. |
Improved sanitation and other public health activities |
| d. |
Increased use of antibiotics to fight infections |
ANS: C
Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy since the early 1900s.
DIF: Cognitive Level: Knowledge/Remember REF: pp. 12-13
OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance
5. Which community health nursing practice area receives funding from the private sector?
| a. |
Telenurses |
| b. |
Corrections nurses |
| c. |
Nurse entrepreneurs |
| d. |
Street or outreach nurses |
ANS: C
The nurse entrepreneur receives private funding, whereas all of the other community health nurse (CHN) roles are with provincially or federally funded positions.
DIF: Cognitive Level: Knowledge/Remember REF: p. 22, Table 1-4 Examples
OBJ: 1.6
TOP: Client Need: Safe and Effective Care Environment - Management of Care
6. A PHN strives to prevent disease and disability, often in partnership with other community groups. Which statement is an appropriate summary of the PHN’s role?
| a. |
The PHN asks the political leaders what interventions should be chosen. |
| b. |
The PHN assesses the community and decides on appropriate interventions. |
| c. |
The PHN uses data from the main health care institutions in the community to determine needed health services. |
| d. |
The PHN works with community members to carry out public health functions. |
ANS: D
It is crucial that the PHN work with members of the community to carry out core public health functions.
DIF: Cognitive Level: Application/Apply REF: p. 13, How To box
OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance
7. Which of the following is used as a measurement of population health?
| a. |
Health status indicators |
| b. |
The levels of prevention |
| c. |
The number of memberships at the local fitness centre |
| d. |
Reported provincial alcohol and tobacco sales in any given month |
ANS: A
Population health refers to the health outcomes of a population as measured by determinants of health and health outcomes.
DIF: Cognitive Level: Knowledge/Remember REF: p. 16
OBJ: 1.2 TOP: Client Need: Health Promotion and Maintenance
8. A registered nurse (RN), has just been employed as a CHN. Which question would be most relevant to her practice as she begins her position?
| a. |
“Which community groups are at greatest risk for problems?” |
| b. |
“Which patients should I see first as I begin my day?” |
| c. |
“With which physicians will I be collaborating most closely?” |
| d. |
“Who is the nursing assistant to whom I can refer patients?” |
ANS: A
CHNs apply the nursing process to the entire community; asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses focus on particular individuals.
DIF: Cognitive Level: Application/Apply REF: p. 15
OBJ: 1.6 TOP: Client Need: Health Promotion and Maintenance
9. The CHN working with women at the senior citizens’ centre reminds them that the only way the centre will be able to afford a driver and a van service for those who cannot drive themselves is to continue to write letters to their local city council representatives, requesting funding for such a service. What is the CHN doing?
| a. |
Ensuring that the women do not expect the CHN herself to do anything about their problem |
| b. |
Demonstrating that she understands the women’s concerns and needs |
| c. |
Expressing empathy, support, and concern |
| d. |
Helping the women engage in political action locally |
ANS: D
CHNs have an imperative to work with the members of the community to carry out public health functions such as political action.
DIF: Cognitive Level: Application/Apply REF: p. 13, How To box
OBJ: 1.5 | 1.6
TOP: Client Need: Safe and Effective Care Environment - Management of Care
10. Which activity is an example of the “advocate” role of the CHN?
| a. |
Organizing home care support for a newly discharged older adult client |
| b. |
Acting as a member of a community action group for provision of accessible transit choices |
| c. |
Doing prenatal assessments |
| d. |
Facilitating a self-help group for smoking cessation |
ANS: B
An advocate provides a voice to client concerns when acting as a member of a community action group for provision of accessible transit choices.
DIF: Cognitive Level: Application/Apply REF: p. 19, Table 1-3
OBJ: 1.6
TOP: Client Need: Safe and Effective Care Environment - Management of Care
11. In which scenario is the PHN most comprehensively fulfilling collaborative practice responsibilities?
| a. |
The PHN meets with several groups about community recreation issues. |
| b. |
The PHN spends the day attending meetings at various health agencies. |
| c. |
The PHN talks to several people about their particular health concerns. |
| d. |
The PHN watches television, including a telecast of a city council meeting on the local cable station. |
ANS: B
Any of these might represent a PHN communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the PHN who spends the day attending meetings at various health agencies is most comprehensively fulfilling requirements effectively, since health is broader than recreation, individual concerns are not as important as aggregate priorities, and watching television is only one-way communication.
DIF: Cognitive Level: Synthesis/Synthesize REF: pp. 15-16
OBJ: 1.5
TOP: Client Need: Safe and Effective Care Environment - Management of Care
12. A CHN often has to make resource allocation decisions. In such cases, which approach will most help the CHN to arrive at the decision?
| a. |
Choosing a moral or ethical principle |
| b. |
Choosing the cheapest, most economical approach |
| c. |
Choosing the most rational outcome |
| d. |
Choosing the needs of the aggregate, rather than the needs of a few individuals |
ANS: D
Although all of the answers represent components of the CHN’s decision-making process, the predominant needs of the population outweigh the expressed needs of one person or a few people.
DIF: Cognitive Level: Application/Apply REF: pp. 7-8
OBJ: 1.3
TOP: Client Need: Safe and Effective Care Environment - Management of Care
13. Which situation most closely represents the focus of public health nursing?
| a. |
Assessing the services and effectiveness of the school health clinic |
| b. |
Caring for patients after their outpatient surgeries |
| c. |
Giving care to schoolchildren at the school clinic and to the children’s families |
| d. |
Treating paediatric patients at an outpatient clinic |
ANS: A
A public health or population-focused approach would consider the entire group of children receiving care, to see if services are effective in achieving the goal of improving the health of the school population.
DIF: Cognitive Level: Application/Apply REF: p. 13, How To box
OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance
14. Which public health service best represents primary prevention?
| a. |
Developing a health education program about the dangers of smoking |
| b. |
Providing a diabetes clinic for adults in low-income neighbourhoods |
| c. |
Providing an influenza vaccination program in a community retirement village |
| d. |
Teaching school-aged children about the positive effects of exercise |
ANS: C
Although all the services listed are appropriate and valuable, providing influenza vaccines to healthy adults represents the primary level of health prevention.
DIF: Cognitive Level: Application/Apply REF: p. 14
OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance
15. What term is used interchangeably with the term subpopulations?
| a. |
Groups |
| b. |
Aggregates |
| c. |
Clients |
| d. |
Communities |
ANS: B
Generally, subpopulations are referred to as aggregates within the larger community population.
DIF: Cognitive Level: Knowledge/Remember REF: p. 16
OBJ: 1.2 TOP: Client Need: Health Promotion and Maintenance
| Chapter 01: Foundations of Maternity, Women’s Health, and Child Health Nursing
MULTIPLE CHOICE
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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 |
