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Test Bank for Maternal Child Nursing Care 2nd Edition by Ward

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By: Ward

Edition: 2nd Edition

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Resource Type: Test bank

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Delivery: Instant Download

Test Bank for Maternal Child Nursing Care 2nd Edition by Ward

Chapter 1: Traditional and Community Nursing Care for Women, Families, and Children

MULTIPLE CHOICE

1.The clinic nurse understands the new description of nursing art/aesthetics as the way that nurses and patients help each other through a circular process. What is the event that begins this process?

A. A health threat
B. Experiencing new possibilities for health
C. Hope and understanding for the future
D. Relationship building

ANS: A

Nursing aesthetics consists of the low-tech, high-touch caring in a nurse–patient encounter. This transformative process begins with a health threat. The event that begins the process is not experiencing new possibilities for health, hope and understanding for the future, or relationship building.

Cognitive Level: Knowledge/Remembering

Content Area: Pediatrics/Maternity

Patient Needs: Safe and Effective Care Environment: Management of Care

Integrated Process: Caring

Difficulty: Moderate

PTS: 1

2.A nurse manager in a community clinic is concerned because the local refugee population does not seek health care routinely. What action by the nurse would be most helpful?

A. Assess clinic staff and procedures for evidence of ethnocentrism.
B. Put up flyers advertising the clinic’s services in local retailers.
C. Reward preventative health patients with coupons for needed items.
D. Try to meet with community leaders to work on the problem.

ANS: A

Ethnocentrism is the view that the beliefs, values, and behaviors of one culture are superior to those of other cultures. Ethnocentrism is dangerous in health care because it is blind to the possibilities of other solutions and viewpoints and alienates people in need of health care. The nurse manager would be wise to assess the clinic’s staff and procedures for ethnocentrism. Meeting with a community leader is always a good idea to learn the viewpoints of the community, but unless ethnocentric behaviors change, it is unlikely that the refugee community will increase its use of the clinic. Flyers and incentives may also be helpful in some cases, but not as helpful as reducing the barriers imposed by ethnocentrism.

Cognitive Level: Application/Applying

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Caring

Difficulty: Moderate

PTS: 1

3.The nursing faculty explains to students that ethnopluralism is an important force shaping health care today. What concept is most important in understanding this trend?

A. The decreased need for cultural competency
B. The growth in one ethnic group in a single area
C. The increased impact of diverse cultures on health care
D. The percentage increase of the non-Caucasian population

ANS: C

Ethnopluralism means diverse cultures. As the population of different ethnic (non-Euro-Caucasian) groups grows, their impact on health care will increase exponentially. Ethnopluralism is not just the growth of one ethnic group in one location. It is also more than just the percentage change in the non-Euro-Caucasian population, although that is part of the phenomenon. As ethnopluralism continues to impact health care, providers will need to be more, not less, culturally competent.

Cognitive Level: Knowledge/Remembering

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Teaching/Learning

Difficulty: Moderate

PTS: 1

4.A nursing faculty member is explaining recent shifts in nursing practice. What change has been important in applying the nursing process?

A. A change to a spiral or circular process
B. A focus on more independent nursing actions
C. A return to the nurse-as-expert model of care
D. An emphasis on attaining a disease-free state

ANS: A

The nursing process has recently changed from a linear one to a spiral or circular process in which the patient/family is motivated toward promotion, maintenance, and restoration of health. The focus has not changed to include more independent actions, a return to the nurse-as-expert model, or an emphasis on attaining a disease-free state of being.

Cognitive Level: Comprehension/Understanding

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Difficulty: Easy

PTS: 1

5.A nurse is working in an urban clinic with a diverse population. What action by the nurse is most important?

A. Determine patients’ definitions of health and desired outcomes of health care.
B. Explain policies such as appointment cancellations to ensure compliance.
C. Learn to speak one or two common languages of the patients in the clinic.
D. Read about different folk remedies common among the populations seen.

ANS: A

Divergent populations enter the health-care system with differing beliefs about health care and wellness and differing expectations for the outcomes of such experiences. Understanding these expectations will help the nurse plan care that has a better chance of meeting these expectations. Learning languages and becoming familiar with folk remedies is helpful as well, but these two solutions are very limited in scope and a nurse cannot hope to become proficient in all the languages/behaviors of every population seen, leaving some patients with a lessened experience. Explaining policies is important too, but simply telling someone the rules does not take his or her cultural norms into account and may not be successful.

Cognitive Level: Application/Applying

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Nursing Process: Assessment

Difficulty: Moderate

PTS: 1

6.A nurse is working with a minority group that has a high incidence of cardiovascular disease, including hypertension and stroke. When participating in a community health fair with this group, what action by the nurse will be most effective?

A. Educate the participants about weight loss and a low-sodium, low-fat diet.
B. Explain the genetic basis for the high incidence of cardiovascular disease in the group.
C. Help participants make lifestyle changes that are culturally congruent.
D. Present statistics on the mortality and morbidity of cardiovascular disease.

ANS: C

The ever-increasing culturally diverse population interacting with the health-care system brings its own beliefs, values, and health-related practices that impact health and well-being. In order to help people make healthy lifestyle changes, the changes must be culturally congruent and acceptable. Forcing an incongruent practice makes it highly unlikely to succeed. Education is important, but it must be done in a culturally congruent way. Pathophysiology and statistical knowledge, by itself, is not likely to be beneficial.

Cognitive Level: Application/Applying

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Teaching/Learning

Difficulty: Difficult

PTS: 1

7.What does the practicing nurse understand to be the most important influence on interdependent, assertive nursing practice today?

A. Higher education of registered nurses
B. Improved working conditions and salaries
C. Increased numbers of female physicians
D. Use of the nursing process for patient care

ANS: D

Nurses were passive, deferential, and compliant to the knowledge and orders of mostly male physicians until the late 20th century. The nursing process changed that. The nursing process is a framework for systematic problem solving and implementation of both independent and dependent nursing actions. The nursing process allows nurses to make decisions regarding patient care based on critical thinking and clinical judgment. The other options listed were not vital in creating a nursing practice that is interdependent and assertive.

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Safe and Effective Care Environment: Management of Care

Integrated Process: Nursing Process

Difficulty: Difficult

PTS: 1

8.A child who has been hospitalized for a long time is preparing to go home, where care will be continued. Which action by the nurse is most beneficial to assist the family in this transition?

A. Advise the family to call the local visiting nurses association for home visits.
B. Call the child’s school to inquire about requirements for returning to school.
C. Consult a social worker to help evaluate insurance coverage and transportation.
D. Give the family brochures for the local support group for chronically ill children.

ANS: C

Preparing a family for home-based care, or other community-based care, involves ensuring that the family is able to provide the care needed by the child at home or in another setting. This can include discussing specialized equipment in the home, health insurance coverage, transportation, and/or returning to school. If the family needs or desires visiting nurses, the nursing staff or social worker at the hospital should arrange this for the family. Calling the school to get information about the child’s return to school yields helpful information, but may not be needed yet, and is too limited in scope to be the best answer. Simply giving parents brochures for support groups may or may not be helpful; the parents may not be literate or may not understand the benefit without discussion.

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Communication and Documentation

Difficulty: Difficult

PTS: 1

9.A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal?

A. Encourage family members to be present in the exam room and to ask questions.
B. Incorporate the use of a community health map for all new patients in the clinic.
C. Recognize family members as experts on their child and incorporate them in decision making.
D. Use evidence-based practice to develop policies and procedures used in the clinic.

ANS: C

The role of the family-centered nurse is to facilitate and assist the family in making informed choices that lead to the outcome the patient and family desire. This requires the nurse to give up the paternalistic role of authority on health care. The family knows the child best and should be assumed to make decisions that are in the best interests of both child and family. The other options are all good interventions, but are too limited in scope to be the best way to create a family-centered environment.

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Caring

Difficulty: Difficult

PTS: 1

10.A clinic nurse is explaining to a student nurse the function of the community health map in assessing families. Which description of this assessment tool is most accurate?

A. It assesses how the family interacts with outside social systems.
B. It locates health-care settings in, or close to, their neighborhood.
C. It outlines family problems and social resources to help with them.
D. It shows how the health of the community impacts each family.

ANS: A

A community health map is an assessment tool for family structure, function, and support networks. It displays significant related data and helps the nurse focus on the family as it interacts with the social systems within and around the family. Its purpose is not to locate local health-care settings. The focus is on family health and past successes and current strengths, not on family problems. Correlations can be made between the health of the community and the health of those living in that community, but this is not the purpose of the community health map.

Cognitive Level: Comprehension/Understanding

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Difficulty: Moderate

PTS: 1

11.A nurse wishes to improve his or her cultural sensitivity while working with patients. Which action by the nurse would best indicate progress toward this goal?

A. Demonstrate good knowledge of different cultural health beliefs
B. Effectively respond to the needs of people of different cultures
C. Interact respectfully with patients who have differing health beliefs
D. Recognizes that he or she will never be the expert in other cultures

ANS: C

Cultural sensitivity is a way of approaching people who hold health beliefs different from one’s own. A nurse with this characteristic is respectful of and open to others. Cultural competence is the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures. Cultural humility is the recognition that one will never master all information about another culture.

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Caring

Difficulty: Difficult

PTS: 1

12.A nurse manager is evaluating staff members on their cultural competence. Which action best demonstrates this characteristic?

A. Attends workshops on cultural diversity and health practices
B. Participates in community health events with minority populations
C. Plans care with the family members within their cultural beliefs
D. Uses family members as interpreters to make them feel important

ANS: C

The culturally sensitive nurse is able to understand and respond to the needs of individuals and families from different cultures. This nurse plans interventions with a solid knowledge of the values and practices of the members of the culture. Being open, listening to the family, and involving them in care demonstrates respect, unifies the nurse–patient relationship, and will motivate the patient (and family) to make positive health changes. Attending workshops is a good way to learn about diverse cultures and attending community events with diverse populations can increase cultural knowledge, but these actions are too limited in scope to demonstrate cultural competence. Nurses should use professional interpreters when needed.

Cognitive Level: Evaluation/Evaluating

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Caring

Difficulty: Difficult

PTS: 1

13.A nurse is incorporating a cultural assessment into nursing care. Which assessment question by the nurse leads the supervisor to conclude that this nurse needs further education on cultural assessment?

A. What customs and traditions are important to you?
B. What kind of insurance coverage do you have?
C. When you are stressed or worried, what comforts you?
D. Who in your family is important for support?

ANS: B

Cultural influences include family support systems, religious and spiritual beliefs, customs and traditions, communication patterns, coping strategies, and problem-solving techniques. Asking about insurance coverage is not directly related to culture, although this can give information about the patient/family’s living environment and ability to access resources.

Cognitive Level: Evaluation/Evaluating

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

Integrated Process: Communication and Documentation

Difficulty: Moderate

PTS: 1

14.A nurse is working with a cultural group that has many proscriptions against women seeking health care. What action by women in this community would indicate that they have successfully negotiated a new role in seeking care?

A. Are able to make and keep medical appointments
B. Can afford to pay for desired health-care services
C. Follow their traditional roles and responsibilities
D. Seek health-care advice from family members

ANS: A

Cultural proscriptions are beliefs, practices, and values of a group that tell women and children what they should not do. In many traditional cultures, women do not have permission, decision-making power, or means to access the health-care system. If the women from such a culture successfully negotiate their roles regarding health care, they can access the health-care system on their own. The ability to afford services is not related, although cultural proscriptions might forbid women from making such a transaction. If they follow their traditional roles or seek health care from family members, they have not demonstrated a successful negotiation of a new role.

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Caring

Difficulty: Difficult

PTS: 1

15.A patient wishes to use complementary therapy when managing a chronic health condition. Which action by the nurse is most appropriate?

A. Advise the patient that stopping medical treatment may cause it to worsen.
B. Inform the patient that there are no complementary therapies for this condition.
C. Investigate herbs that can be substituted for prescription drugs.
D. Suggest the patient add massage therapy to the medical regimen.

ANS: D

Complementary therapy is nontraditional treatment that is used in addition to traditional medical care. Alternative therapies are used in place of traditional therapies. Adding massage to the medical regimen is an example of using complementary therapy. Substituting herbs for prescription medication is an example of alternative therapy. Because the patient is asking about complementary therapy, there is no need to warn him or her of the effects of stopping treatment. There are always complementary therapies that can be added to a medical regimen.

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Difficulty: Moderate

PTS: 1

16.A nurse is working with a family that uses multiple complementary and alternative medicine (CAM) modalities. What action by the nurse is best?

A. Allow the family to continue these practices as desired.
B. Assess how these practices reflect religious beliefs.
C. Inform the family that most of these practices do not work.
D. Provide evidence-based information about the therapies.

ANS: D

The nurse working with individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information. Although the nurse cannot stop the family from using CAM, he or she should not pass up the teaching opportunity. Many CAM practices have demonstrated benefit, so telling the family they don’t work is false information. A culturally competent nurse will assess how religious and spiritual beliefs affect health-care practices, but the nurse needs to advocate for the patient/family by providing solid information.

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DescriptionBy: Ward Edition: 2nd Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadEdition: 1st Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Townsend Edition: 8th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Perry Edition: 9th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadEdition: 8th Edition Format: Downloadable ZIP Fille Resource Type: Test bank Duration: Unlimited downloads Delivery: Instant DownloadBy: Ackley Edition: 11th Edition Format: Downloadable ZIP Fille Resource Type: Solution manual Duration: Unlimited downloads Delivery: Instant Download
Content

Test Bank for Maternal Child Nursing Care 2nd Edition by Ward

Chapter 1: Traditional and Community Nursing Care for Women, Families, and Children

MULTIPLE CHOICE 1.The clinic nurse understands the new description of nursing art/aesthetics as the way that nurses and patients help each other through a circular process. What is the event that begins this process?
A. A health threat
B. Experiencing new possibilities for health
C. Hope and understanding for the future
D. Relationship building
ANS: A Nursing aesthetics consists of the low-tech, high-touch caring in a nurse–patient encounter. This transformative process begins with a health threat. The event that begins the process is not experiencing new possibilities for health, hope and understanding for the future, or relationship building. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 2.A nurse manager in a community clinic is concerned because the local refugee population does not seek health care routinely. What action by the nurse would be most helpful?
A. Assess clinic staff and procedures for evidence of ethnocentrism.
B. Put up flyers advertising the clinic’s services in local retailers.
C. Reward preventative health patients with coupons for needed items.
D. Try to meet with community leaders to work on the problem.
ANS: A Ethnocentrism is the view that the beliefs, values, and behaviors of one culture are superior to those of other cultures. Ethnocentrism is dangerous in health care because it is blind to the possibilities of other solutions and viewpoints and alienates people in need of health care. The nurse manager would be wise to assess the clinic’s staff and procedures for ethnocentrism. Meeting with a community leader is always a good idea to learn the viewpoints of the community, but unless ethnocentric behaviors change, it is unlikely that the refugee community will increase its use of the clinic. Flyers and incentives may also be helpful in some cases, but not as helpful as reducing the barriers imposed by ethnocentrism. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1 3.The nursing faculty explains to students that ethnopluralism is an important force shaping health care today. What concept is most important in understanding this trend?
A. The decreased need for cultural competency
B. The growth in one ethnic group in a single area
C. The increased impact of diverse cultures on health care
D. The percentage increase of the non-Caucasian population
ANS: C Ethnopluralism means diverse cultures. As the population of different ethnic (non-Euro-Caucasian) groups grows, their impact on health care will increase exponentially. Ethnopluralism is not just the growth of one ethnic group in one location. It is also more than just the percentage change in the non-Euro-Caucasian population, although that is part of the phenomenon. As ethnopluralism continues to impact health care, providers will need to be more, not less, culturally competent. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4.A nursing faculty member is explaining recent shifts in nursing practice. What change has been important in applying the nursing process?
A. A change to a spiral or circular process
B. A focus on more independent nursing actions
C. A return to the nurse-as-expert model of care
D. An emphasis on attaining a disease-free state
ANS: A The nursing process has recently changed from a linear one to a spiral or circular process in which the patient/family is motivated toward promotion, maintenance, and restoration of health. The focus has not changed to include more independent actions, a return to the nurse-as-expert model, or an emphasis on attaining a disease-free state of being. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 5.A nurse is working in an urban clinic with a diverse population. What action by the nurse is most important?
A. Determine patients’ definitions of health and desired outcomes of health care.
B. Explain policies such as appointment cancellations to ensure compliance.
C. Learn to speak one or two common languages of the patients in the clinic.
D. Read about different folk remedies common among the populations seen.
ANS: A Divergent populations enter the health-care system with differing beliefs about health care and wellness and differing expectations for the outcomes of such experiences. Understanding these expectations will help the nurse plan care that has a better chance of meeting these expectations. Learning languages and becoming familiar with folk remedies is helpful as well, but these two solutions are very limited in scope and a nurse cannot hope to become proficient in all the languages/behaviors of every population seen, leaving some patients with a lessened experience. Explaining policies is important too, but simply telling someone the rules does not take his or her cultural norms into account and may not be successful. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 6.A nurse is working with a minority group that has a high incidence of cardiovascular disease, including hypertension and stroke. When participating in a community health fair with this group, what action by the nurse will be most effective?
A. Educate the participants about weight loss and a low-sodium, low-fat diet.
B. Explain the genetic basis for the high incidence of cardiovascular disease in the group.
C. Help participants make lifestyle changes that are culturally congruent.
D. Present statistics on the mortality and morbidity of cardiovascular disease.
ANS: C The ever-increasing culturally diverse population interacting with the health-care system brings its own beliefs, values, and health-related practices that impact health and well-being. In order to help people make healthy lifestyle changes, the changes must be culturally congruent and acceptable. Forcing an incongruent practice makes it highly unlikely to succeed. Education is important, but it must be done in a culturally congruent way. Pathophysiology and statistical knowledge, by itself, is not likely to be beneficial. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 7.What does the practicing nurse understand to be the most important influence on interdependent, assertive nursing practice today?
A. Higher education of registered nurses
B. Improved working conditions and salaries
C. Increased numbers of female physicians
D. Use of the nursing process for patient care
ANS: D Nurses were passive, deferential, and compliant to the knowledge and orders of mostly male physicians until the late 20th century. The nursing process changed that. The nursing process is a framework for systematic problem solving and implementation of both independent and dependent nursing actions. The nursing process allows nurses to make decisions regarding patient care based on critical thinking and clinical judgment. The other options listed were not vital in creating a nursing practice that is interdependent and assertive. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process Difficulty: Difficult PTS: 1 8.A child who has been hospitalized for a long time is preparing to go home, where care will be continued. Which action by the nurse is most beneficial to assist the family in this transition?
A. Advise the family to call the local visiting nurses association for home visits.
B. Call the child’s school to inquire about requirements for returning to school.
C. Consult a social worker to help evaluate insurance coverage and transportation.
D. Give the family brochures for the local support group for chronically ill children.
ANS: C Preparing a family for home-based care, or other community-based care, involves ensuring that the family is able to provide the care needed by the child at home or in another setting. This can include discussing specialized equipment in the home, health insurance coverage, transportation, and/or returning to school. If the family needs or desires visiting nurses, the nursing staff or social worker at the hospital should arrange this for the family. Calling the school to get information about the child’s return to school yields helpful information, but may not be needed yet, and is too limited in scope to be the best answer. Simply giving parents brochures for support groups may or may not be helpful; the parents may not be literate or may not understand the benefit without discussion. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 9.A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal?
A. Encourage family members to be present in the exam room and to ask questions.
B. Incorporate the use of a community health map for all new patients in the clinic.
C. Recognize family members as experts on their child and incorporate them in decision making.
D. Use evidence-based practice to develop policies and procedures used in the clinic.
ANS: C The role of the family-centered nurse is to facilitate and assist the family in making informed choices that lead to the outcome the patient and family desire. This requires the nurse to give up the paternalistic role of authority on health care. The family knows the child best and should be assumed to make decisions that are in the best interests of both child and family. The other options are all good interventions, but are too limited in scope to be the best way to create a family-centered environment. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 10.A clinic nurse is explaining to a student nurse the function of the community health map in assessing families. Which description of this assessment tool is most accurate?
A. It assesses how the family interacts with outside social systems.
B. It locates health-care settings in, or close to, their neighborhood.
C. It outlines family problems and social resources to help with them.
D. It shows how the health of the community impacts each family.
ANS: A A community health map is an assessment tool for family structure, function, and support networks. It displays significant related data and helps the nurse focus on the family as it interacts with the social systems within and around the family. Its purpose is not to locate local health-care settings. The focus is on family health and past successes and current strengths, not on family problems. Correlations can be made between the health of the community and the health of those living in that community, but this is not the purpose of the community health map. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 11.A nurse wishes to improve his or her cultural sensitivity while working with patients. Which action by the nurse would best indicate progress toward this goal?
A. Demonstrate good knowledge of different cultural health beliefs
B. Effectively respond to the needs of people of different cultures
C. Interact respectfully with patients who have differing health beliefs
D. Recognizes that he or she will never be the expert in other cultures
ANS: C Cultural sensitivity is a way of approaching people who hold health beliefs different from one’s own. A nurse with this characteristic is respectful of and open to others. Cultural competence is the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures. Cultural humility is the recognition that one will never master all information about another culture. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 12.A nurse manager is evaluating staff members on their cultural competence. Which action best demonstrates this characteristic?
A. Attends workshops on cultural diversity and health practices
B. Participates in community health events with minority populations
C. Plans care with the family members within their cultural beliefs
D. Uses family members as interpreters to make them feel important
ANS: C The culturally sensitive nurse is able to understand and respond to the needs of individuals and families from different cultures. This nurse plans interventions with a solid knowledge of the values and practices of the members of the culture. Being open, listening to the family, and involving them in care demonstrates respect, unifies the nurse–patient relationship, and will motivate the patient (and family) to make positive health changes. Attending workshops is a good way to learn about diverse cultures and attending community events with diverse populations can increase cultural knowledge, but these actions are too limited in scope to demonstrate cultural competence. Nurses should use professional interpreters when needed. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 13.A nurse is incorporating a cultural assessment into nursing care. Which assessment question by the nurse leads the supervisor to conclude that this nurse needs further education on cultural assessment?
A. What customs and traditions are important to you?
B. What kind of insurance coverage do you have?
C. When you are stressed or worried, what comforts you?
D. Who in your family is important for support?
ANS: B Cultural influences include family support systems, religious and spiritual beliefs, customs and traditions, communication patterns, coping strategies, and problem-solving techniques. Asking about insurance coverage is not directly related to culture, although this can give information about the patient/family’s living environment and ability to access resources. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 14.A nurse is working with a cultural group that has many proscriptions against women seeking health care. What action by women in this community would indicate that they have successfully negotiated a new role in seeking care?
A. Are able to make and keep medical appointments
B. Can afford to pay for desired health-care services
C. Follow their traditional roles and responsibilities
D. Seek health-care advice from family members
ANS: A Cultural proscriptions are beliefs, practices, and values of a group that tell women and children what they should not do. In many traditional cultures, women do not have permission, decision-making power, or means to access the health-care system. If the women from such a culture successfully negotiate their roles regarding health care, they can access the health-care system on their own. The ability to afford services is not related, although cultural proscriptions might forbid women from making such a transaction. If they follow their traditional roles or seek health care from family members, they have not demonstrated a successful negotiation of a new role. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Difficult PTS: 1 15.A patient wishes to use complementary therapy when managing a chronic health condition. Which action by the nurse is most appropriate?
A. Advise the patient that stopping medical treatment may cause it to worsen.
B. Inform the patient that there are no complementary therapies for this condition.
C. Investigate herbs that can be substituted for prescription drugs.
D. Suggest the patient add massage therapy to the medical regimen.
ANS: D Complementary therapy is nontraditional treatment that is used in addition to traditional medical care. Alternative therapies are used in place of traditional therapies. Adding massage to the medical regimen is an example of using complementary therapy. Substituting herbs for prescription medication is an example of alternative therapy. Because the patient is asking about complementary therapy, there is no need to warn him or her of the effects of stopping treatment. There are always complementary therapies that can be added to a medical regimen. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 16.A nurse is working with a family that uses multiple complementary and alternative medicine (CAM) modalities. What action by the nurse is best?
A. Allow the family to continue these practices as desired.
B. Assess how these practices reflect religious beliefs.
C. Inform the family that most of these practices do not work.
D. Provide evidence-based information about the therapies.
ANS: D The nurse working with individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information. Although the nurse cannot stop the family from using CAM, he or she should not pass up the teaching opportunity. Many CAM practices have demonstrated benefit, so telling the family they don’t work is false information. A culturally competent nurse will assess how religious and spiritual beliefs affect health-care practices, but the nurse needs to advocate for the patient/family by providing solid information.

Medical-Surgical Nursing: Making Connections to Practice 1st edition Hoffman, Sullivan Test Bank

 

Chapter 1: Foundations for Medical-Surgical Nursing

Multiple Choice Identify the choice that best completes the statement or answers the question.

____ 1. The medical-surgical nurse identifies a clinical practice issue and wants to determine if there is sufficient evidence to support a change in practice. Which type of study provides the strongest evidence to support a practice change? 1) Randomized control study 2) Quasi-experimental study 3) Case-control study 4) Cohort study

____ 2. The medical-surgical unit recently implemented a patient-centered care model. Which action implemented by the nurse supports this model? 1) Evaluating care 2) Assessing needs 3) Diagnosing problems 4) Providing compassion

____ 3. Which action should the nurse implement when providing patient care in order to support The Joint Commission’s (TJC) National Patient Safety Goals (NPSG)? 1) Silencing a cardiorespiratory monitor 2) Identifying each patient using one source 3) Determining patient safety issues upon admission 4) Decreasing the amount of pain medication administered

____ 4. Which interprofessional role does the nurse often assume when providing patient care in an acute care setting? 1) Social worker 2) Client advocate 3) Care coordinator 4) Massage therapist

____ 5. The medical-surgical nurse wants to determine if a policy change is needed for an identified clinical problem. Which is the first action the nurse should implement? 1) Developing a question 2) Disseminating the findings 3) Conducting a review of the literature 4) Evaluating outcomes of practice change

____ 6. The nurse is evaluating the level of evidence found during a recent review of the literature. Which evidence carries the lowest level of support for a practice change? 1) Level IV 2) Level V 3) Level VI 4) Level VII

____ 7. The nurse is reviewing evidence from a quasi-experimental research study. Which level of evidence should the nurse identify for this research study? 1) Level ITestBankWorld.org 2) Level II 3) Level III 4) Level IV

____ 8. Which level of evidence should the nurse identify when reviewing evidence from a single descriptive research study? 1) Level IV 2) Level V 3) Level VI 4) Level VII

____ 9. Which statement should the nurse make when communicating the “S” in the SBAR approach for effective communication? 1) “The patient presented to the emergency department at 0200 with lower left abdominal pain.” 2) “The patient rated the pain upon admission as a 9 on a 10-point numeric scale.” 3) “The patient has no significant issues in the medical history.” 4) “The patient was given a prescribed opioid analgesic at 0300.” ____ 10. The staff nurse is communicating with the change nurse about the change of status of the patient. The nurse would begin her communication with which statement if correctly using the SBAR format? 1) “The patient’s heartrate is 110.” 2) “I think this patient needs to be transferred to the critical care unit.” 3) “The patient is a 68-year-old male patient admitted last night.” 4) “The patient is complaining of chest pain.” ____ 11. Which nursing action exemplifies the Quality and Safety Education for Nursing (QSEN) competency of safety? 1) Advocating for a patient who is experiencing pain 2) Considering the patient’s culture when planning care 3) Evaluating patient learning style prior to implementing discharge instructions 4) Assessing the right drug prior to administering a prescribed patient medication ____ 12. Which type of nursing is the root of all other nursing practice areas? 1) Pediatric nursing 2) Geriatric nursing 3) Medical-surgical nursing 4) Mental health-psychiatric nursing ____ 13. Which did the Nursing Executive Center of The Advisory Board identify as an academic-practice gap for new graduate nurses? 1) Patient advocacy 2) Patient education 3) Disease pathophysiology 4) Therapeutic communication ____ 14. Which statement regarding the use of the nursing process in clinical practice is accurate? 1) “The nursing process is closely related to clinical decision-making.” 2) “The nursing process is used by all members of the interprofessional team to plan care.” 3) “The nursing process has 4 basic steps: assessment, planning, implementation, evaluation.” 4) “The nursing process is being replaced by the implementation of evidence-based practice.”TestBankWorld.org ____ 15. Which is the basis of nursing care practices and protocols? 1) Assessment 2) Evaluation 3) Diagnosis 4) Research ____ 16. Which is a common theme regarding patient dissatisfaction related to care provided in the hospital setting? 1) Space in hospital rooms 2) Medications received to treat pain 3) Time spent with the health-care team 4) Poor quality food received from dietary ____ 17. The nurse manager is preparing a medical-surgical unit for The Joint Commission (TJC) visit With the nurse manager presenting staff education focusing on TJC benchmarks, which of the following topics would be most appropriate? 1) Implementation of evidence-based practice 2) Implementation of patient-centered care 3) Implementation of medical asepsis practices 4) Implementation of interprofessional care ____ 18. Which aspect of patient-centered care should the nurse manager evaluate prior to The Joint Commission site visit for accreditation? 1) Visitation rights 2) Education level of staff 3) Fall prevention protocol 4) Infection control practices ____ 19. The medical-surgical nurse is providing patient care. Which circumstance would necessitate the nurse verifying the patient’s identification using at least two sources? 1) Prior to delivering a meal tray 2) Prior to passive range of motion 3) Prior to medication administration 4) Prior to documenting in the medical record ____ 20. The nurse is providing care to several patients on a medical-surgical unit. Which situation would necessitate the nurse to use SBAR during the hand-off process? 1) Wound care 2) Discharge to home 3) Transfer to radiology 4) Medication education Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 21. The staff nurse is teaching a group of student nurses the situations that necessitate hand-off communication. Which student responses indicate the need for further education related to this procedure? Select all that apply. 1) “A hand-off is required prior to administering a medication.” 2) “A hand-off is required during change of shift.” 3) “A hand-off is required for a patient is transferred to the surgical suite.”TestBankWorld.org 4) “A hand-off is required whenever the nurse receives a new patient assignment.” 5) “A hand-off is required prior to family visitation.” ____ 22. Which actions by the nurse enhance patient safety during medication administration? Select all that apply. 1) Answering the call bell while transporting medications for a different patient 2) Identifying the patient using two sources prior to administering the medication 3) Holding a medication if the patient’s diagnosis does not support its use 4) Administering the medication two hours after the scheduled time 5) Having another nurse verify the prescribed dose of insulin the patient is to receive ____ 23. The medical-surgical nurse assumes care for a patient who is receiving continuous cardiopulmonary monitoring. Which actions by the nurse enhance safety for this patient? Select all that apply. 1) Silencing the alarm during family visitation 2) Assessing the alarm parameters at the start of the shift 3) Responding to the alarm in a timely fashion 4) Decreasing the alarm volume to enhance restful sleep 5) Adjusting alarm parameters based on specified practitioner prescription ____ 24. The nurse is planning an interprofessional care conference for a patient who is approaching discharge from the hospital. Which members of the interprofessional team should the nurse invite to attend? Select all that apply. 1) Physician 2) Pharmacist 3) Unit secretary 4) Social worker 5) Home care aide ____ 25. The nurse manager wants to designate a member of the nursing team as the care coordinator for a patient who will require significant care during the hospitalization. Which skills should this nurse possess in order to assume this role? Select all that apply. 1) Effective clinical reasoning 2) Effective communication skills 3) Effective infection control procedures 4) Effective documentation 5) Effective intravenous skillsTestBankWorld.org Chapter 1: Foundations for Medical-Surgical Nursing Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter number and title: 1, Foundations for Medical Surgical Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 003-004 Heading: Evidence-Based Nursing Care Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Comprehension [Understanding] Concept: Evidence-Based Practice Difficulty: Easy Feedback 1 Systematic reviews of randomized control studies (Level I) are the highest level of evidence because they include data from selected studies that randomly assigned participants to control and experimental groups. The lower the numerical rating of the level of evidence indicates the highest level of evidence; therefore, this type of study provides the strongest evidence to support a practice change. 2 Quasi-experimental studies are considered Level III; therefore, this study does not provide the strongest evidence to support a practice change. 3 Case-control studies are considered Level IV; therefore, this study does not provide the strongest evidence to support a practice change. 4 Cohort studies are considered Level IV; therefore, this study does not provide the strongest evidence to support a practice change. PTS: 1 CON: Evidence-Based Practice 2. ANS: 4 Chapter number and title: 1, Foundations of Medical-Surgical Practice Chapter learning objective: Explaining the importance of patient-centered care in the management of medical-surgical patients Chapter page reference: 004-005 Heading: Patient-Centered Care in the Medical-Surgical Setting Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive level: Application [Applying] Concept: Nursing Roles Difficulty: Moderate Feedback 1 Evaluation is a step in the nursing process; however, this is not an action that supports the patient-centered care model. 2 Assessment is a step in the nursing process; however, this is not an action that supports the patient-centered care model.TestBankWorld.org 3 Diagnosis is a step in the nursing process; however, this is not an action that supports the patient-centered care model. 4 Compassion is a competency closely associated with patient-centered care; therefore, this action supports the patient-centered model of care. PTS: 1 CON: Nursing Roles 3. ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing implications to medical-surgical nurses of Quality and Safety Education for Nurses (QSEN) competencies Chapter page reference: 005-006 Heading: Patient Safety Outcomes Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 Safely using alarms is a NPSG identified by TJC. Silencing a cardiorespiratory monitor is not nursing action that supports this NPSG. 2 Patient identification using two separate resources is a NPSG identified by TJC. Identifying a patient using only one source does not support this NPSG. 3 Identification of patient safety risks is a NPSG identified by the TJC. Determining patient safety issues upon admission supports this NPSG. 4 Safe use of medication is a NPSG identified by the TJC. Decreasing the amount of pain medication administered does not support this NPSG. PTS: 1 CON: Safety 4. ANS: 3 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Describing the role and competencies of medical-surgical nursing Chapter page reference: 006-007 Heading: Interprofessional Collaboration and Communication Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Comprehension [Understanding] Concept: Nursing Roles Difficulty: Easy Feedback 1 The nurse does not often assume the interprofessional role of social worker when providing patient care in an acute care setting. 2 The nurse does not often assume the interprofessional role of client advocate role when providing patient care in an acute care setting. 3 The nurse often assumes the interprofessional role of care coordinator when providing patient care in an acute care setting. 4 The nurse does not often assume the interprofessional role of massage therapist when providing patient care in an acute care setting.TestBankWorld.org PTS: 1 CON: Nursing Roles 5. ANS: 1 Chapter number and title: 1, Foundations of Medical-Surgical Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 003 Heading: Box 1.3 Steps of Evidence-Based Practice Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Analysis [Analyzing] Concept: Evidence-Based Practice Difficulty: Difficult Feedback 1 The first step of evidence-based practice is to develop a question based on the clinical issue. 2 The last step of evidence-based practice is to disseminate findings. 3 The second step of evidence-based practice is to conduct a review of the literature, or current evidence, available. 4 The fifth step of evidence-based practice is to evaluate the outcomes associated with the practice change. PTS: 1 CON: Evidence-Based Practice 6. ANS: 4 Chapter number and title: 1, Foundations of Medical-Surgical Nursing Practice Chapter learning objective: Discussing the incorporation of evidence-based practices into medical-surgical nursing Chapter page reference: 004 Heading: Box 1.4 Evaluating Levels of Evidence Integrated Processes: Nursing Process: Planning Client Need: Safe and Effective Care Environment/Management of Care Cognitive level: Comprehension [Understanding] Concept: Evidence-Based Practice Difficulty: Easy Feedback 1 The lower the numeric value of the evidence the greater the support for a change in practice. Level IV evidence does not carry the lowest level of support for a practice change. 2 The lower the numeric value of the evidence the greater the support for a change in practice. Level V evidence does not carry the lowest level of support for a practice change. 3 The lower the numeric value of the evidence the greater the support for a change in practice. Level VI evidence does not carry the lowest level of support for a practice change. 4 The lower the numeric value of the evidence the greater the support for a change in practice. Level VII evidence carries the lowest level of support for a practice change.

Chapter 1. The Concept of Stress Adaptation

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

Multiple Choice
  1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data?
  2. The client is experiencing severe distress and is at risk for physical and psychological illness.
  3. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness.
  4. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports.
  5. The client may view these losses as challenges and perceive them as opportunities.
ANS: C The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500 or more, indicates high stress in a client’s life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an art degree.” How should the nurse characterize the client’s appraisal of the job loss stressor?
  2. Irrelevant
  3. Harm/loss
  4. Threatening
  5. Challenging
ANS: D The client perceives the situation of job loss as a challenge and an opportunity for growth. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity
  1. Which client statement should alert a nurse that a client may be responding maladaptively to stress?
  2. “I’ve found that avoiding contact with others helps me cope.”
  3. “I really enjoy journaling; it’s my private time.”
  4. “I signed up for a yoga class this week.”
  5. “I made an appointment to meet with a therapist.”
ANS: A Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems.  KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing?
  2. Alarm reaction stage
  3. Stage of resistance
  4. Stage of exhaustion
  5. Fight-or-flight stage
ANS: C At the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity
  1. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client’s mother states, “That’s not something to be stressed about!” Which is the most appropriate nursing response?
  2. “Teenagers! They don’t know a thing about real stress.”
  3. “Stress occurs only when there is a loss.”
  4. “When you are in poor physical condition, you can’t experience psychological well-being.”
  5. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”
ANS: D Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  1. A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time?
  2. Meditation
  3. Problem-solving training
  4. Relaxation
  5. Journaling
ANS: B The student must assess his or her situation and determine the best course of action. Problem-solving training, by providing structure and objectivity, can assist in decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  1. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?
  2. Encourage the student to use the alternative coping mechanism of relaxation exercises.
  3. Complete the problem-solving process for the client.
  4. Work through the problem-solving process with the client.
  5. Encourage the client to keep a journal.
ANS: C During times of high anxiety and stress, clients will need more assistance in problem-solving and decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
  1. A school nurse is assessing a distraught female high school student who is overly concerned because her parents can’t afford horseback riding lessons. How should the nurse interpret the student’s reaction to her perceived problem?
  2. The problem is endangering her well-being.
  3. The problem is personally relevant to her.
  4. The problem is based on immaturity.
  5. The problem is exceeding her capacity to cope.
ANS: B Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation or event. Self-image is of particular importance to adolescents, who feel entitled to have all the advantages that other adolescents experience. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess?
  2. An achieved state of relaxation
  3. An achieved insight into one’s feelings
  4. A demonstration of appropriate role behaviors
  5. An enhanced ability to problem-solve
ANS: A Meditation produces relaxation by creating a special state of consciousness through focused concentration. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity
  1. A distraught, single, first-time mother cries and asks a nurse, “How can I go to work if I can’t afford childcare?” What is the nurse’s initial action in assisting the client with the problem-solving process?
  2. Determine the risks and benefits for each alternative.
  3. Formulate goals for resolution of the problem.
  4. Evaluate the outcome of the implemented alternative.
  5. Assess the facts of the situation.
ANS: D Before any other steps can be taken, accurate information about the situation must be gathered and assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity
Chapter 01: Using Evidence in Practice Perry et al.: Clinical Nursing Skills & Techniques, 9th Edition   MULTIPLE CHOICE  
  1. Evidence-based practice is a problem-solving approach to making decisions about patient care that is grounded in:
a. the latest information found in textbooks.
b. systematically conducted research studies.
c. tradition in clinical practice.
d. quality improvement and risk-management data.
    ANS:   B The best evidence comes from well-designed, systematically conducted research studies described in scientific journals. Portions of a textbook often become outdated by the time it is published. Many health care settings do not have a process to help staff adopt new evidence in practice, and nurses in practice settings lack easy access to risk-management data, relying instead on tradition or convenience. Some sources of evidence do not originate from research. These include quality improvement and risk-management data; infection control data; retrospective or concurrent chart reviews; and clinicians’ expertise. Although non–research-based evidence is often very valuable, it is important that you learn to rely more on research-based evidence.   DIF:    Cognitive Level: Comprehension       REF:    Text reference: p. 2 OBJ:    Discuss the benefits of evidence-based practice. TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Assessment MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. When evidence-based practice is used, patient care will be:
a. standardized for all.
b. unhampered by patient culture.
c. variable according to the situation.
d. safe from the hazards of critical thinking.
    ANS:   C Using your clinical expertise and considering patients’ cultures, values, and preferences ensures that you will apply available evidence in practice ethically and appropriately. Even when you use the best evidence available, application and outcomes will differ; as a nurse, you will develop critical thinking skills to determine whether evidence is relevant and appropriate.   DIF:    Cognitive Level: Application             REF:    Text reference: p. 2 OBJ:    Discuss the benefits of evidence-based practice. TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Assessment MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. When a PICOT question is developed, the letter that corresponds with the usual standard of care is:
a. P.
b. I.
c. C.
d. O.
    ANS:   C C = Comparison of interest. What standard of care or current intervention do you usually use now in practice? P = Patient population of interest. Identify your patient by age, gender, ethnicity, disease, or health problem. I = Intervention of interest. What intervention (e.g., treatment, diagnostic test, and prognostic factor) do you think is worthwhile to use in practice? O = Outcome. What result (e.g., change in patient’s behavior, physical finding, and change in patient’s perception) do you wish to achieve or observe as the result of an intervention?   DIF:    Cognitive Level: Knowledge             REF:    Text reference: p. 3 OBJ:    Develop a PICO question.                 TOP:    PICO KEY:   Nursing Process Step: Implementation MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. A well-developed PICOT question helps the nurse:
a. search for evidence.
b. include all five elements of the sequence.
c. find as many articles as possible in a literature search.
d. accept standard clinical routines.
    ANS:   A The more focused a question that you ask is, the easier it is to search for evidence in the scientific literature. A well-designed PICOT question does not have to include all five elements, nor does it have to follow the PICOT sequence. Do not be satisfied with clinical routines. Always question and use critical thinking to consider better ways to provide patient care.   DIF:    Cognitive Level: Analysis                  REF:    Text reference: p. 3 OBJ:    Describe the six steps of evidence-based practice. TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Implementation MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. The nurse is not sure that the procedure the patient requires is the best possible for the situation. Utilizing which of the following resources would be the quickest way to review research on the topic?
a. CINAHL
b. PubMed
c. MEDLINE
d. The Cochrane Database
    ANS:   D The Cochrane Community Database of Systematic Reviews is a valuable source of synthesized evidence (i.e., pre-appraised evidence). The Cochrane Database includes the full text of regularly updated systematic reviews and protocols for reviews currently happening. MEDLINE, CINAHL, and PubMed are among the most comprehensive databases and represent the scientific knowledge base of health care.   DIF:    Cognitive Level: Synthesis                REF:    Text reference: p. 4 OBJ:    Describe the six steps of evidence-based practice. TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Implementation MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. The nurse is getting ready to develop a plan of care for a patient who has a specific need. The best source for developing this plan of care would probably be:
a. The Cochrane Database.
b. MEDLINE.
c. NGC.
d. CINAHL.
    ANS:   C The National Guidelines Clearinghouse (NGC) is a database supported by the Agency for Healthcare Research and Quality (AHRQ). It contains clinical guidelines—systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific patient population. The NGC is a valuable source when you want to develop a plan of care for a patient. The Cochrane Community Database of Systematic Reviews, MEDLINE, and CINAHL are all valuable sources of synthesized evidence (i.e., pre-appraised evidence).   DIF:    Cognitive Level: Synthesis                REF:    Text reference: p. 4 OBJ:    Describe the six steps of evidence-based practice. TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Implementation MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. The nurse has done a literature search and found 25 possible articles on the topic that she is studying. To determine which of those 25 best fit her inquiry, the nurse first should look at:
a. the abstracts.
b. the literature reviews.
c. the “Methods” sections.
d. the narrative sections.
    ANS:   A An abstract is a brief summary of an article that quickly tells you whether the article is research based or clinically based. An abstract summarizes the purpose of the study or clinical query, the major themes or findings, and the implications for nursing practice. The literature review usually gives you a good idea of how past research led to the researcher’s question. The “Methods” or “Design” section explains how a research study is organized and conducted to answer the research question or to test the hypothesis. The narrative of a manuscript differs according to the type of evidence-based article—clinical or research.   DIF:    Cognitive Level: Application             REF:    Text reference: p. 7 OBJ:    Discuss elements to review when critiquing the scientific literature. TOP:    Randomized Controlled Trials           KEY:   Nursing Process Step: Implementation MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. The nurse wants to determine the effects of cardiac rehabilitation program attendance on the level of postmyocardial depression for individuals who have had a myocardial infarction. The type of study that would best capture this information would be a:
a. randomized controlled trial.
b. qualitative study.
c. case control study.
d. descriptive study.
    ANS:   B Qualitative studies examine individuals’ experiences with health problems and the contexts in which these experiences occur. A qualitative study is best in this case of an individual nurse who wants to examine the effectiveness of a local program. Randomized controlled trials involve close monitoring of control groups and treatment groups to test an intervention against the usual standard of care. Case control studies typically compare one group of subjects with a certain condition against another group without the condition, to look for associations between the condition and predictor variables. Descriptive studies focus mainly on describing the concepts under study.   DIF:    Cognitive Level: Synthesis                REF:    Text reference: p. 6 OBJ:    Discuss ways to apply evidence in nursing practice. TOP:    Randomized Controlled Trials           KEY:   Nursing Process Step: Implementation MSC:   NCLEX: Safe and Effective Care Environment (management of care)  
  1. Six months after an early mobility protocol was implemented, the incidence of deep vein thrombosis in patients was decreased. This is an example of what stage in the EBP process?
a. Asking a clinical question
b. Applying the evidence
c. Evaluating the practice decision
d. Communicating your results
    ANS:   C After implementing a practice change, your next step is to evaluate the effect. You do this by analyzing the outcomes data that you collected during the pilot project. Outcomes evaluation tells you whether your practice change improved conditions, created no change, or worsened conditions.   DIF:    Cognitive Level: Application             REF:    Text reference: p. 9 OBJ:    Discuss ways to apply evidence in nursing practice. TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Evaluation MSC:   NCLEX: Safe and Effective Care Environment (safety and infection control)   MULTIPLE RESPONSE  
  1. To use evidence-based practice appropriately, you need to collect the most relevant and best evidence and to critically appraise the evidence you gather. This process also includes: (Select all that apply.)
a. asking a clinical question.
b. applying the evidence.
c. evaluating the practice decision.
d. communicating your results.
    ANS:   A, B, C, D

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

Chapter 01- Introduction to Psychiatric-Mental Health Nursing

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

Solution Manual for Nursing Diagnosis Handbook 11th Edition by Ackley

Ackley: Nursing Diagnosis Handbook, 11th Edition Table of Contents     41 cases  Lecture Notes

Problem-Based Learning/Critical Thinking

Case Study - Restless Leg Syndrome

Case Scenario Abdul Malek is a 21 year old college student. He attends the local state university and is a junior studying graphic design.  Three (3) weeks into his fall semester, Abdul’s professors notice that he is falling asleep in class and often looks restless. Abdul taps his foot and squirms around in his seat. Abdul, who is usually an excellent student, has failed his first test in his Graphic Design II course. His professor asks him to see his advisor because the fear is that Abdul has become chemically impaired. His advisor sends Abdul to the student health services and his case is reviewed by the nurse.  Nursing Assessment  Abdul is a well-developed 22 year old male with a BMI of 20. His vital signs are: blood pressure 104/78; temperature 98.4 degrees F.; heart rate – 64 BPM; respiratory rate – 16 per minute. A nutritional history confirms a well-balanced diet with the exclusion of pork products. Abdul had been working out every day at the University gym but reports that he is currently “too tired” to do so.  Abdul denies drug or alcohol use and this is confirmed by serum analysis. Abdul complains about sleeping poorly and feeling as if, “I am moving all night.” He states that he often wakes up his dorm mate and feels badly about that.  The nurse reclines Abdul on the examination table and checks his deep tendon reflexes (DTRs) which are all 2 . The nurse asks Abdul to relax and dims the lights while she consults with the primary care practitioner. While the nurse is out of the examination room Abdul dozes and when the nurse returns the nurse observes Abdul’s right leg jerking several times before she arouses him.
  1. ASSESS
  2. Identify significant symptoms by underlining them in the assessment.
  3. List those symptoms that indicate the client has a health problem (those you have underlined).
  • falling asleep in class
  • often looks restless
  • taps his foot
  • squirms around in his seat
  • failed his first test
  •  “too tired
  • complains about sleeping poorly
  • I am moving all night
  • often wakes up
  • dozes
  • right leg jerking several times
  1. Group the symptoms that are similar.
  • falling asleep in class
  • often looks restless
  • taps his foot
  • squirms around in his seat
  • failed his first test
  • complains about sleeping poorly
  • dozes
  •  “too tired
  • I am moving all night
  • often wakes up
  • right leg jerking several times
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