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Test Bank Maternity And Pediatric Nursing 3rd Edition

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Test Bank Maternity and Women’s Health Care 12th Edition Lowdermilk

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Chapter 01: 21st Century Maternity and Women’s Health Nursing
Lowdermilk: Maternity & Women’s Health Care, 12th Edition

MULTIPLE CHOICE

1. In evaluating the level of a pregnant woman’s risk of having a low-birth-weight (LBW)
infant, which factor is the most important for the nurse to consider?
a. African-American race
b. Cigarette smoking
c. Poor nutritional status
d. Limited maternal education
ANS: A
The rise in the overall LBW rates were due to increases in LBW births to non-Hispanic
black women (13.35%) and Hispanic women (7.21%); non-Hispanic black infants are
almost twice as likely as non-Hispanic white infants to be of LBW and to die in the first
year of life.. Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in
potential infant mortality rates, but it is not the most important. Additionally, smoking is a
modifiable risk factor. Poor nutrition is an important factor in potential infant mortality
rates, but it is not the most important. Additionally, nutritional status is a modifiable risk
factor. Maternal education is an important factor in potential infant mortality rates, but it is
not the most important. Additionally, maternal education is a modifiable risk factor.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care
2. A 23-year-old African-American woman is pregnant with her first child. Based on current
statistics for infant mortality, which intervention is most important for the nurse to include
in the client’s plan of care?
a. Perform a nutrition assessment.
b. Refer the woman to a social worker.
c. Advise the woman to see an obstetrician, not a midwife.
d. Explain to the woman the importance of keeping her prenatal care appointments.
ANS: D
Consistent prenatal care is the best method of preventing or controlling risk factors
associated with infant mortality. Nutritional status is an important modifiable risk factor, but
it is not the most important action a nurse should take in this situation. The client may need
assistance from a social worker at some time during her pregnancy, but a referral to a social
worker is not the most important aspect the nurse should address at this time. If the woman
has identifiable high-risk problems, then her health care may need to be provided by a
physician. However, it cannot be assumed that all African-American women have high-risk
issues. In addition, advising the woman to see an obstetrician is not the most important
aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to
advise or manage the type of care a client is to receive.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
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MSC: Client Needs: Health Promotion and Maintenance
3. During a prenatal intake interview, the nurse is in the process of obtaining an initial
assessment of a 21-year-old Hispanic client with limited English proficiency. Which
intervention is the most important for the nurse to implement?
a. Use maternity jargon to enable the client to become familiar with these terms.
b. Speak quickly and efficiently to expedite the visit.
c. Provide the client with handouts.
d. Assess whether the client understands the discussion.
ANS: D
Nurses contribute to health literacy by using simple, common words, avoiding jargon, and
evaluating whether the client understands the discussion. Speaking slowly and clearly and
focusing on what is important will increase understanding. Most client education materials
are written at a level too high for the average adult and may not be useful for a client with
limited English proficiency.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
4. The nurses working at a newly established birthing center have begun to compare their
performance in providing maternal-newborn care against clinical standards. This
comparison process is most commonly known as what?
a. Best practices network
b. Clinical benchmarking
c. Outcomes-oriented practice
d. Evidence-based practice
ANS: C
Outcomes-oriented practice measures the effectiveness of the interventions and quality of
care against benchmarks or standards. The term best practice refers to a program or service
that has been recognized for its excellence. Clinical benchmarking is a process used to
compare one’s own performance against the performance of the best in an area of service.
The term evidence-based practice refers to the provision of care based on evidence gained
through research and clinical trials.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
5. Which statement best exemplifies contemporary maternity nursing?
a. Use of midwives for all vaginal deliveries
b. Family-centered care
c. Free-standing birth clinics
d. Physician-driven care
ANS: B
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Contemporary maternity nursing focuses on the family’s needs and desires. Fathers,
partners, grandparents, and siblings may be present for the birth and participate in activities
such as cutting the baby’s umbilical cord. Both midwives and physicians perform vaginal
deliveries. Free-standing clinics are an example of alternative birth options. Contemporary
maternity nursing is driven by the relationship between nurses and their clients.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
6. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being
in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the
woman have a legitimate legal case for negligence?
a. Inexperienced maternity nurse was assigned to care for the client.
b. Client was past her due date by 3 days.
c. Standard of care was not met.
d. Client refused electronic fetal monitoring.
ANS: C
Not meeting the standard of care is a legitimate factor for a case of negligence. An
inexperienced maternity nurse would need to display competency before being assigned to
care for clients on his or her own. This client may have been past her due date; however, a
term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the
standard of care, the client has the right to refuse treatment. This refusal is not a case for
negligence, but informed consent should be properly obtained, and the client should have
signed an against medical advice form when refusing any treatment that is within the
standard of care.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
7. When the nurse is unsure how to perform a client care procedure that is high risk and low
volume, his or her best action in this situation would be what?
a. Ask another nurse.
b. Discuss the procedure with the client’s physician.
c. Look up the procedure in a nursing textbook.
d. First consult the agency procedure manual
ANS: D
Following the agency’s policies and procedures manual is always best when seeking
information on correct client procedures. These policies should reflect the current standards
of care and the individual state’s guidelines. Each nurse is responsible for his or her own
practice. Relying on another nurse may not always be a safe practice. Each nurse is
obligated to follow the standards of care for safe client care delivery. Physicians are
responsible for their own client care activity. Nurses may follow safe orders from
physicians, but they are also responsible for the activities that they, as nurses, are to carry
out. Information provided in a nursing textbook is basic information for general knowledge.
Furthermore, the information in a textbook may not reflect the current standard of care or
the individual state or hospital policies.
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PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
8. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what
trend?
a. Births to unmarried women are more likely to have less favorable outcomes.
b. Birth rates for women 40 to 44 years of age are declining.
c. Cigarette smoking among pregnant women continues to increase.
d. Rates of pregnancy and abortion among teenagers are lower in the United States
than in any other industrialized country.
ANS: A
LBW infants and preterm births are more likely because of the large number of teenagers in
the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer
pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States
than in any other industrial country.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
9. A recently graduated nurse is attempting to understand the reason for increasing health care
spending in the United States. Which information gathered from research best explains the
rationale for these higher costs compared with other developed countries?
a. Higher rate of obesity among pregnant women
b. Limited access to technology
c. Increased use of health care services along with lower prices
d. Homogeneity of the population
ANS: A
Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.5% of
the gross domestic product is spent on health care. Higher spending in the United States, as
compared with 12 other industrialized countries, is related to higher prices and readily
accessible technology along with greater obesity rates among women. More than one third
of women in the United States are obese. In the population in the United States, 16% are
uninsured and have limited access to health care. Maternal morbidity and mortality are
directly related to racial disparities.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Teaching and Learning
MSC: Client Needs: Safe and Effective Care Environment
10. Which statement best describes maternity nursing care that is based on knowledge gained
through research and clinical trials?
a. Maternity nursing care is derived from the Nursing Intervention Classification.
b. Maternity nursing care is known as evidence-based practice.
c. Maternity nursing care is at odds with the Cochrane School of traditional nursing.
d. Maternity nursing care is an outgrowth of telemedicine.
ANS: B
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Evidence-based practice is based on knowledge gained from research and clinical trials. The
Nursing Intervention Classification is a method of standardizing language and categorizing
care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based
practice movement. Telemedicine uses communication technologies to support health care.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Safe and Effective Care Environment
11. What is the minimum level of practice that a reasonably prudent nurse is expected to
provide?
a. Standard of care
b. Risk management
c. Sentinel event
d. Failure to rescue
ANS: A
Guidelines for standards of care are published by various professional nursing organizations.
Risk management identifies risks and establishes preventive practices, but it does not define
the standard of care. Sentinel events are unexpected negative occurrences. They do not
establish the standard of care. Failure to rescue is an evaluative process for nursing, but it
does not define the standard of care.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
12. Using social media technology, nurses can link with other nurses who may share similar
interests, insights about practice, and advocate for clients. Which factor is the most
concerning pitfall for nurses using this technology?
a. Violation of client privacy and confidentiality
b. Institutions and colleagues who may be cast in an unfavorable light
c. Unintended negative consequences for using social media
d. Lack of institutional policy governing online contact
ANS: A
The most significant pitfall for nurses using this technology is the violation of client privacy
and confidentiality. Furthermore, institutions and colleagues can be cast in an unfavorable
light with negative consequences for those posting information. Nursing students have been
expelled from school and nurses have been fired or reprimanded by their Board of Nursing
for injudicious posts. The American Nurses Association has published six principles for
social networking and the nurse. All institutions should have policies guiding the use of
social media, and the nurse should be familiar with these guidelines.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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13. During a prenatal intake interview, the client informs the nurse that she would prefer a
midwife to provide both her care during pregnancy and deliver her infant. Which
information is most appropriate for the nurse to share with this client about resulting care?
a. Midwifery care is a good option for clients who are uninsured.
b. She will receive fewer interventions during the birth process.
c. She should be aware that midwives are not certified.
d. Her delivery can take place only at home or in a birth center.
ANS: B
This client will be able to participate actively in all decisions related to the birth process and
is likely to receive fewer interventions during the birth process. Midwifery services are
available to all low-risk pregnant women, regardless of the type of insurance they have.
Midwifery care in all developed countries is strictly regulated by a governing body to ensure
that core competencies are met. In the United States, this body is the American College of
Nurse-Midwives (ACNM). Midwives can provide care and delivery at home, in
freestanding birth centers, and in community and teaching hospitals.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
14. While obtaining a detailed history from a woman who has recently immigrated from
Somalia, the nurse realizes that the client has undergone female genital mutilation. What is
the nurse’s most appropriate response in this situation?
a. “This is a very abnormal practice and rarely seen in the United States.”
b. “Are you aware of who performed this mutilation so that it can be reported to the
authorities?”
c. “We will be able to restore fully your circumcision after delivery.”
d. “The extent of your circumcision will affect the potential for complications.”
ANS: D
The extent of the circumcision is important. The client may experience pain, bleeding,
scarring, or infection and may require surgery before childbirth. Although this practice is
not prevalent in the United States, it is very common in many African and Middle Eastern
countries for religious reasons. Mentioning that the practice is abnormal and rarely seen in
the United States is culturally insensitive. The infibulation may have occurred during
infancy or childhood; consequently, the client will have little to no recollection of the event.
She would have considered this to be a normal milestone during her growth and
development. The International Council of Nurses has spoken out against this procedure as
harmful to a woman’s health.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
15. Maternity nurses can enhance communication among health care providers by using the
SBAR technique. The acronym SBAR stands for what?
a. Situation, background, assessment, recommendation
b. Situation, baseline, assessment, recommendation
c. Subjective, background, analysis, recommendation
d. Subjective, background, analysis, review
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ANS: A
SBAR is an easy-to-remember, useful, and concrete mechanism for communicating
important information that requires a clinician’s immediate attention. Baseline is not
discussed as part of SBAR. Subjective and analysis are not specific to the SBAR acronym.
Subjective, analysis, and review are not specific to the SBAR acronym.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. Greater than one third of women in the United States are now obese (body mass index
[BMI] of 30 or greater). Less than one quarter of women in Canada exhibit the same BMI.
Obesity in the pregnant woman increases both maternal medical risk factors and negative
outcomes for the infant. The nurse is about to perform an assessment on a client who is 28
weeks pregnant and has a BMI of 35. What are the most frequently reported complications
for which the nurse must be alert while assessing this client? (Select all that apply.)
a. Potential miscarriage
b. Diabetes
c. Fetal death in utero
d. Decreased fertility
e. Hypertension
ANS: B, E
The two most frequently reported maternal medical risk factors associated with obesity are
hypertension associated with pregnancy and diabetes. Decreased fertility, miscarriage, fetal
death, and congenital anomalies are also associated with obesity. These clients often
experience longer hospital stays and increased use of health services.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. The Patient Protection and Affordable Care Act (ACA) was signed into law by President
Obama in early 2010. The Act provides some immediate benefits, and other provisions will
take place over the next several years. The practicing nurse should have a thorough
understanding of how these changes will benefit his or her clients. Which outcomes are
goals of the ACA? (Select all that apply.)
a. Insurance affordability
b. Improve public health
c. Treatment of illness
d. Elimination of Medicare and Medicaid
e. Cost containment
ANS: A, B, E
The ACA goals are to make insurance more affordable, contain costs, and strengthen
Medicare and Medicaid. The Act contains provisions that promote the prevention of illness
and improve access to public health. The ultimate goal of the Act is to improve the quality
of care for all Americans while reducing waste, fraud, and abuse of the current system.
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PTS: 1 DIF: Cognitive Level: Comprehend
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
3. Which statements indicate that the nurse is practicing appropriate family-centered care
techniques? (Select all that apply.)
a. The nurse commands the pregnant woman to do as she is told.
b. The nurse allows time for the partner to ask questions.
c. The nurse allows the mother and father to make choices when possible.
d. The nurse informs the family about what is going to happen.
e. The nurse tells the client’s sister, who is a nurse, that she cannot be in the room
during the delivery.
ANS: B, C
Including the partner in the care process and allowing the couple to make choices are
important elements of family-centered care. The nurse should never tell the client what to
do. Family-centered care involves collaboration between the health care team and the client.
Unless an institutional policy limits the number of attendants at a delivery, the client should
be allowed to have whomever she wants present (except when the situation is an emergency
and guests are asked to leave).
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
4. Which methods help alleviate the problems associated with access to health care for the
maternity client? (Select all that apply.)
a. Provide transportation to prenatal visits.
b. Provide child care to enable a pregnant woman to keep prenatal visits.
c. Increase the number of providers that will care for Medicaid clients.
d. Provide low-cost or no-cost health care insurance.
e. Provide job training.
ANS: A, B, C, D
Lack of transportation to prenatal visits, child care, access to skilled obstetric providers, and
affordable health insurance are prohibitive factors associated with the lack of prenatal care.
Although job training may result in employment and income, the likelihood of significant
changes during the time frame of the pregnancy is remote.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
NURSINGTB.COM
Maternity and Women’s Health Care 12th Edition Lowdermilk Test Bank

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Test Bank Maternity and Women’s Health Care 12th Edition Lowdermilk

Etestbank.net Chapter 01: 21st Century Maternity and Women’s Health Nursing Lowdermilk: Maternity & Women’s Health Care, 12th Edition MULTIPLE CHOICE 1. In evaluating the level of a pregnant woman’s risk of having a low-birth-weight (LBW) infant, which factor is the most important for the nurse to consider? a. African-American race b. Cigarette smoking c. Poor nutritional status d. Limited maternal education ANS: A The rise in the overall LBW rates were due to increases in LBW births to non-Hispanic black women (13.35%) and Hispanic women (7.21%); non-Hispanic black infants are almost twice as likely as non-Hispanic white infants to be of LBW and to die in the first year of life.. Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor. Poor nutrition is an important factor in potential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an important factor in potential infant mortality rates, but it is not the most important. Additionally, maternal education is a modifiable risk factor. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care 2. A 23-year-old African-American woman is pregnant with her first child. Based on current statistics for infant mortality, which intervention is most important for the nurse to include in the client’s plan of care? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments. ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, then her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Planning NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M MSC: Client Needs: Health Promotion and Maintenance 3. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic client with limited English proficiency. Which intervention is the most important for the nurse to implement? a. Use maternity jargon to enable the client to become familiar with these terms. b. Speak quickly and efficiently to expedite the visit. c. Provide the client with handouts. d. Assess whether the client understands the discussion. ANS: D Nurses contribute to health literacy by using simple, common words, avoiding jargon, and evaluating whether the client understands the discussion. Speaking slowly and clearly and focusing on what is important will increase understanding. Most client education materials are written at a level too high for the average adult and may not be useful for a client with limited English proficiency. PTS: 1 DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 4. The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process is most commonly known as what? a. Best practices network b. Clinical benchmarking c. Outcomes-oriented practice d. Evidence-based practice ANS: C Outcomes-oriented practice measures the effectiveness of the interventions and quality of care against benchmarks or standards. The term best practice refers to a program or service that has been recognized for its excellence. Clinical benchmarking is a process used to compare one’s own performance against the performance of the best in an area of service. The term evidence-based practice refers to the provision of care based on evidence gained through research and clinical trials. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment 5. Which statement best exemplifies contemporary maternity nursing? a. Use of midwives for all vaginal deliveries b. Family-centered care c. Free-standing birth clinics d. Physician-driven care ANS: B NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M Contemporary maternity nursing focuses on the family’s needs and desires. Fathers, partners, grandparents, and siblings may be present for the birth and participate in activities such as cutting the baby’s umbilical cord. Both midwives and physicians perform vaginal deliveries. Free-standing clinics are an example of alternative birth options. Contemporary maternity nursing is driven by the relationship between nurses and their clients. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 6. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence? a. Inexperienced maternity nurse was assigned to care for the client. b. Client was past her due date by 3 days. c. Standard of care was not met. d. Client refused electronic fetal monitoring. ANS: C Not meeting the standard of care is a legitimate factor for a case of negligence. An inexperienced maternity nurse would need to display competency before being assigned to care for clients on his or her own. This client may have been past her due date; however, a term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the client should have signed an against medical advice form when refusing any treatment that is within the standard of care. PTS: 1 DIF: Cognitive Level: Analyze TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 7. When the nurse is unsure how to perform a client care procedure that is high risk and low volume, his or her best action in this situation would be what? a. Ask another nurse. b. Discuss the procedure with the client’s physician. c. Look up the procedure in a nursing textbook. d. First consult the agency procedure manual ANS: D Following the agency’s policies and procedures manual is always best when seeking information on correct client procedures. These policies should reflect the current standards of care and the individual state’s guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be a safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they, as nurses, are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or the individual state or hospital policies. NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 8. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years of age are declining. c. Cigarette smoking among pregnant women continues to increase. d. Rates of pregnancy and abortion among teenagers are lower in the United States than in any other industrialized country. ANS: A LBW infants and preterm births are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. A recently graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Which information gathered from research best explains the rationale for these higher costs compared with other developed countries? a. Higher rate of obesity among pregnant women b. Limited access to technology c. Increased use of health care services along with lower prices d. Homogeneity of the population ANS: A Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.5% of the gross domestic product is spent on health care. Higher spending in the United States, as compared with 12 other industrialized countries, is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. In the population in the United States, 16% are uninsured and have limited access to health care. Maternal morbidity and mortality are directly related to racial disparities. PTS: 1 DIF: Cognitive Level: Understand TOP: Teaching and Learning MSC: Client Needs: Safe and Effective Care Environment 10. Which statement best describes maternity nursing care that is based on knowledge gained through research and clinical trials? a. Maternity nursing care is derived from the Nursing Intervention Classification. b. Maternity nursing care is known as evidence-based practice. c. Maternity nursing care is at odds with the Cochrane School of traditional nursing. d. Maternity nursing care is an outgrowth of telemedicine. ANS: B NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Diagnosis MSC: Client Needs: Safe and Effective Care Environment 11. What is the minimum level of practice that a reasonably prudent nurse is expected to provide? a. Standard of care b. Risk management c. Sentinel event d. Failure to rescue ANS: A Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care. PTS: 1 DIF: Cognitive Level: Remember TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 12. Using social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for clients. Which factor is the most concerning pitfall for nurses using this technology? a. Violation of client privacy and confidentiality b. Institutions and colleagues who may be cast in an unfavorable light c. Unintended negative consequences for using social media d. Lack of institutional policy governing online contact ANS: A The most significant pitfall for nurses using this technology is the violation of client privacy and confidentiality. Furthermore, institutions and colleagues can be cast in an unfavorable light with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Board of Nursing for injudicious posts. The American Nurses Association has published six principles for social networking and the nurse. All institutions should have policies guiding the use of social media, and the nurse should be familiar with these guidelines. PTS: 1 DIF: Cognitive Level: Analyze TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M 13. During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide both her care during pregnancy and deliver her infant. Which information is most appropriate for the nurse to share with this client about resulting care? a. Midwifery care is a good option for clients who are uninsured. b. She will receive fewer interventions during the birth process. c. She should be aware that midwives are not certified. d. Her delivery can take place only at home or in a birth center. ANS: B This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process. Midwifery services are available to all low-risk pregnant women, regardless of the type of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body to ensure that core competencies are met. In the United States, this body is the American College of Nurse-Midwives (ACNM). Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 14. While obtaining a detailed history from a woman who has recently immigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation. What is the nurse’s most appropriate response in this situation? a. “This is a very abnormal practice and rarely seen in the United States.” b. “Are you aware of who performed this mutilation so that it can be reported to the authorities?” c. “We will be able to restore fully your circumcision after delivery.” d. “The extent of your circumcision will affect the potential for complications.” ANS: D The extent of the circumcision is important. The client may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Mentioning that the practice is abnormal and rarely seen in the United States is culturally insensitive. The infibulation may have occurred during infancy or childhood; consequently, the client will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a woman’s health. PTS: 1 DIF: Cognitive Level: Analyze TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 15. Maternity nurses can enhance communication among health care providers by using the SBAR technique. The acronym SBAR stands for what? a. Situation, background, assessment, recommendation b. Situation, baseline, assessment, recommendation c. Subjective, background, analysis, recommendation d. Subjective, background, analysis, review NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M ANS: A SBAR is an easy-to-remember, useful, and concrete mechanism for communicating important information that requires a clinician’s immediate attention. Baseline is not discussed as part of SBAR. Subjective and analysis are not specific to the SBAR acronym. Subjective, analysis, and review are not specific to the SBAR acronym. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 1. Greater than one third of women in the United States are now obese (body mass index [BMI] of 30 or greater). Less than one quarter of women in Canada exhibit the same BMI. Obesity in the pregnant woman increases both maternal medical risk factors and negative outcomes for the infant. The nurse is about to perform an assessment on a client who is 28 weeks pregnant and has a BMI of 35. What are the most frequently reported complications for which the nurse must be alert while assessing this client? (Select all that apply.) a. Potential miscarriage b. Diabetes c. Fetal death in utero d. Decreased fertility e. Hypertension ANS: B, E The two most frequently reported maternal medical risk factors associated with obesity are hypertension associated with pregnancy and diabetes. Decreased fertility, miscarriage, fetal death, and congenital anomalies are also associated with obesity. These clients often experience longer hospital stays and increased use of health services. PTS: 1 DIF: Cognitive Level: Apply TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 2. The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama in early 2010. The Act provides some immediate benefits, and other provisions will take place over the next several years. The practicing nurse should have a thorough understanding of how these changes will benefit his or her clients. Which outcomes are goals of the ACA? (Select all that apply.) a. Insurance affordability b. Improve public health c. Treatment of illness d. Elimination of Medicare and Medicaid e. Cost containment ANS: A, B, E The ACA goals are to make insurance more affordable, contain costs, and strengthen Medicare and Medicaid. The Act contains provisions that promote the prevention of illness and improve access to public health. The ultimate goal of the Act is to improve the quality of care for all Americans while reducing waste, fraud, and abuse of the current system. NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test BankNU RS IN GT B.CO M PTS: 1 DIF: Cognitive Level: Comprehend TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 3. Which statements indicate that the nurse is practicing appropriate family-centered care techniques? (Select all that apply.) a. The nurse commands the pregnant woman to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the client’s sister, who is a nurse, that she cannot be in the room during the delivery. ANS: B, C Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the client what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave). PTS: 1 DIF: Cognitive Level: Analyze TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 4. Which methods help alleviate the problems associated with access to health care for the maternity client? (Select all that apply.) a. Provide transportation to prenatal visits. b. Provide child care to enable a pregnant woman to keep prenatal visits. c. Increase the number of providers that will care for Medicaid clients. d. Provide low-cost or no-cost health care insurance. e. Provide job training. ANS: A, B, C, D Lack of transportation to prenatal visits, child care, access to skilled obstetric providers, and affordable health insurance are prohibitive factors associated with the lack of prenatal care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote. PTS: 1 DIF: Cognitive Level: Understand TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance NURSINGTB.COM Maternity and Women’s Health Care 12th Edition Lowdermilk Test Bank

Test Bank Focus on Nursing Pharmacology 8th Edition

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

Test Bank for Public Health Science and Nursing Practice Caring For Populations by Savage

Chapter 10: Mental Health MULTIPLE RESPONSE 1.According to Healthy People 2020, which of the following are characteristics of mental health? Select all that apply.
A. Engaging in productive activities
B. Having fulfilling relationships
C. Experiencing alterations in thinking
D. Adapting to change
E. Coping with challenges
ANS: A, B, D, E Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders. pp. 225-226 Heading: Introduction Integrated Processes: N/A Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Moderate
Feedback
1. Mental health is a state of successful performance of mental function, including engagement in productive activities.
2. Mental health is a state of successful performance of mental function, including being able to form fulfilling relationships with other people.
3. This is incorrect; it is an example of a mental disorder. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior that are associated with distress or impaired functioning.
4. Mental health is a state of successful performance of mental function, including the ability to adapt to change.
5. Mental health is a state of successful performance of mental function, including the ability to cope with challenges.
PTS:1CON:Promoting Health MULTIPLE CHOICE 2.In 2010, approximately how many people in the United States reported experiencing mental disorders in the previous year?
A. 15%
B. 50%
C. 30%
D. 25%
ANS: D Objective: 1. Define the burden of disease related to mental disorders using current epidemiological frameworks. pp. 226-227 Heading: Epidemiology of Mental Disorders Integrated Processes: N/A Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Moderate
Feedback
A This is incorrect. In the United States in 2010 an estimated 25% of adults reported having mental disorders in the previous year.
B This is incorrect. In the United States in 2010 an estimated 25% of adults reported having mental disorders in the previous year.
C This is incorrect. In the United States in 2010 an estimated 25% of adults reported having mental disorders in the previous year.
D In the United States in 2010 an estimated 25% of adults reported having mental disorders in the previous year.
PTS:1CON:Promoting Health 3.A student nurse is studying stress and mental health. The student nurse learns that ____ is based on an individual’s ability to access protective factors that exist at different levels in order to withstand chronic stress or recover from traumatic life events.
A. Intervention
B. Support
C. Resilience
D. Therapy
ANS: C Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders. pp. 229-231 Heading: Protective Factors: Building Resilience Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Trauma; Stress; Promoting Health; Nursing Roles Difficulty: Moderate
Feedback
A This is incorrect. Resilience is based on an individual’s ability to access protective factors that exist at different levels in order to withstand chronic stress or recover from traumatic life events. Preventive and treatment interventions are useful tools to build on an individual’s natural resilience to promote positive outcomes.
B This is incorrect. Resilience is based on an individual’s ability to access protective factors that exist at different levels in order to withstand chronic stress or recover from traumatic life events. Support from family, friends, and community is an important part of strengthening an individual’s resilience.
C Resilience is based on an individual’s ability to access protective factors that exist at different levels in order to withstand chronic stress or recover from traumatic life events.
D This is incorrect. Resilience is based on an individual’s ability to access protective factors that exist at different levels in order to withstand chronic stress or recover from traumatic life events. Therapy is an important part of an overall treatment plan, in conjunction with intervention, support, and an individual’s capacity for resilience.
PTS: 1 CON: Trauma | Stress | Promoting Health | Nursing Roles 4.____ addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder.
A. Indicated prevention
B. Selective prevention
C. Universal prevention
D. Both 1 and 2
ANS: A Objective: 4. Apply current evidence-based population level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations. pp. 232-233 Heading: Prevention of Mental Disorders and Promotion of Mental Health > Institute of Medicine Model of Prevention Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Moderate
Feedback
A Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder. The purpose of indicated techniques is to delay or reduce the severity of a mental disorder.
B Selective prevention includes interventions provided to specific subgroups that are known to be at high risk for mental disorders owing to biological, psychological, social, or environmental factors but that have not yet been diagnosed with mental disorders. High-risk subgroups include but are not limited to those with a family history of mental disorders, history of adverse childhood events, or victims of violence.
C Universal prevention refers to prevention interventions provided to the entire population, not just those who may be at risk. The interventions include but are not limited to public service announcements provided to the public at large through billboards, media messages (print and electronic), or general health education programs.
D Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder. The purpose of indicated techniques is to delay or reduce the severity of a mental disorder. Selective prevention includes interventions provided to specific subgroups that are known to be at high risk for mental disorders owing to biological, psychological, social, or environmental factors but that have not yet been diagnosed with mental disorders. High-risk subgroups include but are not limited to those with a family history of mental disorders, history of adverse childhood events, or victims of violence.
PTS:1CON:Promoting Health 5.The public health nurse (PHN) recognizes that which of the following are used as screening tools for depression?
A. Patient Health Questionnaire 2
B. Center for Epidemiological Studies Depression Scale (CESD-10)
C. Brief Symptom Checklist-18 of the My Mood Monitor (M-3)
D. Both 1 and 2
ANS: D Objective: 5. Describe systems approaches to the promotion of mental health and the prevention and treatment of mental health disorders. p. 232 Heading: Prevention of Mental Disorders and Promotion of Mental Health > Measure of Mental Health: Health-Related Quality of Life Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Mood; Assessment Difficulty: Moderate
Feedback
A Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10.
B Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10.
C This is incorrect. Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10. Screening tools for anxiety disorders include the Brief Symptom Checklist-18 of the My Mood Monitor (M-3).
D Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10.
PTS:1CON:Promoting Health | Mood | Assessment 6.During a course on mental disorders, a PHN learns that the term serious mental illness (SMI) refers to diagnosable mental disorders that may disrupt a person’s ability to function and may qualify that person for support services. The PHN also notes that the mental disorders that can lead to SMI include:
A. Mild depression
B. Panic disorder
C. Schizophrenia
D. Both 2 and 3
ANS: D Objective: 1. Define the burden of disease related to mental disorders using current epidemiological frameworks. pp. 225-226 Heading: Introduction Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition; Mood; Stress; Promoting Health; Nursing Roles Difficulty: Moderate
Feedback
A This is incorrect. Major depression, however, is one of the mental disorders that can lead to SMI.
B Both panic disorder and schizophrenia, among other mental disorders, can lead to SMI.
C Both schizophrenia and panic disorder, among other mental disorders, can lead to SMI.
D The mental disorders that can lead to SMI include major depression, panic disorder, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and borderline personality disorder.
PTS: 1 CON: Cognition | Mood | Stress | Promoting Health | Nursing Roles 7.While studying the prevalence of mental health disorders worldwide, a PHN learns about the World Mental Health Survey, which is used to determine estimates of human capital costs and prevalence of mental disorders in a wide range of countries. The survey was developed by
A. The Centers for Disease Control and Prevention (CDC)
B. The World Health Organization (WHO)
C. The Institute of Medicine (IOM)
D. The World Health Assembly
ANS: B Objective: 1. Define the burden of disease related to mental disorders using current epidemiological frameworks. p. 227 Heading: Epidemiology of Mental Disorders > Surveillance of Mental Health Disorders Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate
Feedback
A This is incorrect. WHO developed the World Mental Health Survey to estimate human capital costs and mental disorders prevalence on a global scale. The CDC conducts many types of surveys on the prevalence of mental disorders but the organization did not develop the World Mental Health Survey.
B The WHO developed the World Mental Health Survey to estimate human capital costs and mental disorders prevalence on a global scale.
C This is incorrect. WHO developed the World Mental Health Survey to estimate human capital costs and mental disorders prevalence on a global scale. The IOM is involved in screening for mental health disorders and addresses the need for appropriate behavioral health treatment in its report, Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series.
D This is incorrect. WHO developed the World Mental Health Survey to estimate human capital costs and mental disorders prevalence on a global scale. The World Health Assembly issued a resolution on mental health that aims to reduce the global burden of mental disorders and improve overall mental health worldwide.
PTS: 1 CON: Promoting Health | Nursing Roles 8.Which ethnic group has the highest 12-month prevalence of a mental disorder?
A. Hispanics
B. African Americans
C. Asian Americans
D. Non-Hispanic whites
ANS: D Objective: 1. Define the burden of disease related to mental disorders using current epidemiological frameworks. pp. 227-228 Heading: Epidemiology of Mental Disorders > Prevalence of Mental Health Disorders Integrated Processes: N/A Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Moderate
Feedback
A This is incorrect. Non-Hispanic whites have the highest 12-month prevalence rate for mental disorders at 21% compared with 16% for Hispanics.
B This is incorrect. Non-Hispanic whites have the highest 12-month prevalence rate for mental disorders at 21% compared with 15% for African Americans.
C This is incorrect. Non-Hispanic whites have the highest 12-month prevalence rate for mental disorders at 21% compared with 9% for Asian Americans.
D Non-Hispanic whites have the highest 12-month prevalence rate for mental disorders at 21%.
PTS:1CON:Promoting Health 9.A PHN learns in a behavioral health class that the relationship between physiology and mental health plays an important role in mental disorders. Which of the following physiological factors may contribute to the development of mental disorders?
A. Conditions that affect brain chemistry, such as medication side effects or toxins
B. Physical trauma
C. 1 and 2
D. Unstable family life
ANS: C Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders. pp. 228-229 Heading: Behavioral, Biological, Environmental, and Socioeconomic Risk Factors > Individual Level Risk Factors for Mental Disorders Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Application] Concept: Cognition; Trauma; Promoting Health Difficulty: Moderate
Feedback
A Both conditions that affect brain chemistry and physical trauma are the physiological factors that may contribute to the development of mental disorders.
B Both physical trauma and conditions that affect brain chemistry are physiological factors that may contribute to the development of mental disorders.
C Conditions that affect brain chemistry and physical trauma are two of the physiological factors that may contribute to the development of mental disorders.
D This is incorrect. Conditions that affect brain chemistry and physical trauma are two of the physiological factors that may contribute to the development of mental disorders. An unstable family life is not a physiological factor, although it may also contribute to the development of mental disorders.
PTS:1CON:Cognition | Trauma | Promoting Health 10.Which of the following community environment factors play a role in the development of mental disorders?
A. Living in high crime areas
B. Poverty
C. Both 1 and 2
D. Family instability
ANS: C Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders. p. 229 Heading: Behavioral, Biological, Environmental, and Socioeconomic Risk Factors > Community-Level Risk Factors for Mental Disorders Integrated Processes: N/A Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Easy
Feedback
A Living in high crime areas is a factor, along with poverty.
B Both poverty and living in high crime areas play a role in the development of mental disorders.
C Both poverty and living in high crime areas play a role in the development of mental disorders.
D This is incorrect. Although family instability often contributes to the development of mental disorders, it is not considered a community environment factor.
PTS:1CON:Promoting Health 11.____ is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable.
A. Indicated prevention
B. Stigma
C. Risk factors
D. Transinstitutionalization
ANS: B Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders. pp. 231-232 Heading: Culture, Stigma, and Mental Health Disorders Integrated Processes: N/A Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Moderate
Feedback
A This is incorrect. Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable. Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder.
B Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable.
C This is incorrect. Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable. Risk factors increase an individual’s chance of developing a mental disorder.
D This is incorrect. Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable. Transinstitutionalization refers to the growing number of mentally ill persons who are homeless, in jail, in shelters, or in other facilities instead of being home or in a hospital.
PTS:1CON:Promoting Health 12.A nurse interested in working with persons with mental disorders who live in poverty understands that the most effective treatment involves multiple sectors of society, such as government agencies, grass roots groups, nonprofits, and businesses, working in tandem. This interrelationship is called:
A. Indicated prevention
B. Intersectoral strategies
C. Health-Related Quality of Life
D. Institute of Medicine Model of Prevention
ANS: B Objective: 4. Apply current evidence-based population level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations. p. 233 Heading: Prevention of Mental Disorders and Promotion of Mental Health > Promotion of Mental Health and Policy Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration Difficulty: Moderate
Feedback
A This is incorrect. Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots citizens groups, nonprofits, and businesses. Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder.
B Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots citizens groups, nonprofits, and businesses.
C This is incorrect. Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots citizens groups, nonprofits, and businesses. Health-Related Quality of Life is the self-perceived impact of physical and emotional health on overall quality of life.
D This is incorrect. Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots citizens groups, nonprofits, and businesses. The Institute of Medicine Model of Prevention is a framework for mental disorders that clearly separates prevention into three categories with specific interventions at each level.
PTS: 1 CON: Promoting Health | Collaboration 13.A recent graduate nurse working in an urban labor and delivery unit had a patient who experienced a difficult labor. The mother, suffering from postpartum depression (PPD), committed suicide a year after giving birth. Although the nurse knew the basics about PPD, the nurse immediately studied the condition in depth and learned that PPD:
A. Can be triggered by a massive hormone drop following delivery
B. Can intensify to cause delusions
C. Occurs soon after delivery
D. All of the above
ANS: D Objective: 4. Apply current evidence-based population level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations. pp. 233-235 Heading: Prevention of Mental Disorders and Promotion of Mental Health > Secondary Prevention: Screening for Mental Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Pregnancy; Mood; Violence; Promoting Health; Nursing Roles Difficulty: Moderate
Feedback
A PPD can be triggered by a massive post-delivery hormone drop, intensify enough to cause delusions, and occur soon after delivery.
B PPD can be triggered by a massive post-delivery hormone drop, intensify enough to cause delusions, and occur soon after delivery.
C PPD can be triggered by a massive post-delivery hormone drop, intensify enough to cause delusions, and occur soon after delivery.
D PPD can be triggered by a massive post-delivery hormone drop, intensify enough to cause delusions, and occur soon after delivery.
PTS: 1 CON: Pregnancy | Mood | Violence | Promoting Health | Nursing Roles 14.A nurse working in labor and delivery requested permission from the nurse manager to conduct a quality improvement project to screen patients that might be susceptible to PPD. After completing the project, which of the following screening guidelines did the unit incorporate?
A. All patients will be screened for PPD when they are admitted to the labor and delivery unit.
B. Patients at high risk are referred to the attending obstetrician.
C. Before being discharged, all new mothers will complete a questionnaire specific to PPD symptoms.
D. All of the above
ANS: D Objective: Apply current evidence-based population level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations. pp. 233-235 Heading: Prevention of Mental Disorders and Promotion of Mental Health > Secondary Prevention: Screening for Mental Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Pregnancy; Mood; Promoting Health; Assessment; Quality Improvement Difficulty: Moderate
Feedback
A This is incorrect. Screening, high-risk referrals to the attending obstetrician and completion of a PPD symptom questionnaire were all incorporated.
B This is incorrect. Screening, high-risk referrals to the attending obstetrician and completion of a PPD symptom questionnaire were all incorporated.
C This is incorrect. Screening, high-risk referrals to the attending obstetrician and completion of a PPD symptom questionnaire were all incorporated.
D Screening, high-risk referrals to the attending obstetrician and completion of a PPD symptom questionnaire were all incorporated.
PTS:1 CON: Pregnancy | Mood | Promoting Health | Assessment | Quality Improvement 15.A PHN treats a patient who may be depressed. To verify suspicions, the PHN checks ____, the definitive clinical guide for diagnosing mental disorders and providing consistency and accuracy in the screening for mental disorders.
A. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
B. The Center for Epidemiological Studies Depression Scale (CESD-10)
C. Patient Health Questionnaire 2
D. Brief System Checklist-18 of the My Mood Monitor
ANS: A

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

Chapter 05: Comfort and Sedation

Sole: Introduction to Critical Care Nursing, 7th Edition

MULTIPLE CHOICE 1.Nociceptors differ from other nerve receptors in the body in that they:
a. adapt very little to continual pain response.
b. inhibit the infiltration of neutrophils and eosinophils.
c. play no role in the inflammatory response.
d. transmit only the thermal stimuli.
ANS: A Nociceptors are stimulated by mechanical, chemical, or thermal stimuli. Nociceptors differ from other nerve receptors in the body in that they adapt very little to the pain response. The body continues to experience pain until the stimulus is discontinued or therapy is initiated. This is a protective mechanism so that the body tissues being damaged will be removed from harm. Nociceptors usually initiate inflammatory responses near injured capillaries. As such, the response promotes infiltration of injured tissues with neutrophils and eosinophils. DIF: Cognitive Level: Remember/Knowledge REF: p. 54 OBJ:Discuss the physiology of pain and anxiety. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 2.A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating the ventilator well and has not required any sedation. On assessment, the nurse notes the patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min. The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The patient responds appropriately to the nurse’s commands. The nurse should:
a. assess the patient’s level of pain.
b. decrease the ventilator rate.
c. provide sedation as ordered.
d. suction the patient again.
ANS: A Pulse, respirations, and blood pressure frequently result from activation of the sympathetic nervous system by the pain stimulus. Because the patient is postoperative, the patient should be assessed for the presence of pain and need for pain medication. Decreasing the ventilator rate will not help in this situation. Providing sedation may calm the patient but will not solve the problem if the physiological changes are from pain. The patient has just been suctioned and the airway is clear. There is no need to suction again. DIF: Cognitive Level: Analyze/Analysis REF: p. 55 OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 3.The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse’s first priority is to
a. administer antianxiety medications as ordered.
b. administer pain medication as ordered.
c. identify and treat the underlying cause.
d. reassess the patient hourly to determine whether symptoms resolve on their own.
ANS: C When patients exhibit signs of anxiety or agitation, the first priority is to identify and treat the underlying cause, which could be hypoxemia, hypoglycemia, hypotension, pain, or withdrawal from alcohol and drugs. Treatment is not initiated until assessment is completed. Medication may not be needed if the underlying cause can be resolved. DIF: Cognitive Level: Apply/Application REF: p. 70 | Table 5-11 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 4.Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use because they
a. can be used only on heavily sedated patients.
b. can be used only on pediatric patients.
c. provide raw EEG data and a numeric value.
d. require only five leads.
ANS: C The BIS and PSI have very simple steps for application, and results are displayed as raw EEG data and the numeric value. A single electrode is placed across the patient’s forehead and is attached to a monitor. These monitors can be used in both children and adults and in patients with varying levels of sedation. DIF: Cognitive Level: Understand/Comprehension REF: p. 60 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 5.The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with nontraditional modes. The nurse understands that neuromuscular blocking agents provide:
a. antianxiety effects.
b. complete analgesia.
c. high levels of sedation.
d. no sedation or analgesia.
ANS: D Neuromuscular blocking (NMB) agents do not possess any sedative or analgesic properties. Patients who receive NMBs must also receive sedatives and pain medication. DIF: Cognitive Level: Remember/Knowledge REF: p. 72 OBJ: Discuss assessment and management challenges in subsets of critically ill patients. TOP:Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 6.The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis?
a. Glasgow Coma Scale score of 3
b. Train-of-four yields two twitches
c. Bispectral index of 60
d. CAM-ICU positive
ANS: B A train-of-four response of two twitches (out of four) using a peripheral nerve stimulator indicates adequate paralysis. The Glasgow Coma Scale does not assess paralysis; it is an indicator of consciousness. The bispectral index provides an assessment of sedation. The CAM-ICU is a tool to assess delirium. DIF: Cognitive Level: Remember/Knowledge REF: p. 73 OBJ: Discuss assessment and management challenges in subsets of critically ill patients. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 7.The nurse is concerned that the patient will pull out the endotracheal tube. As part of the nursing management, the nurse obtains an order for
a. arm binders or splints.
b. a higher dosage of lorazepam.
c. propofol.
d. soft wrist restraints.
ANS: D The priority in caring for agitated patients is safety. The least restrictive methods of keeping the patient safe are appropriate. If possible, the tube or device causing irritation should be removed, but if that is not possible, the nurse must prevent the patient from pulling it out. Restraints are associated with an increased incidence of agitation and delirium. Therefore, restraints should not be used unless as a last resort for combative patients. The least amount of sedation is also recommended; therefore, neither increasing the dosage of lorazepam nor adding propofol is indicated and would be likely to prolong mechanical ventilation. DIF: Cognitive Level: Apply/Application REF: p. 61 OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 8.The primary mode of action for neuromuscular blocking agents used in the management of some ventilated patients is
a. analgesia.
b. anticonvulsant therapy.
c. paralysis.
d. sedation.
ANS: C These agents cause respiratory muscle paralysis. They do not provide analgesia or sedation. They do not have anticonvulsant properties. DIF: Cognitive Level: Remember/Knowledge REF: p. 72 OBJ: Discuss assessment and management challenges in subsets of critically ill patients. TOP:Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 9.The most important nursing intervention for patients who receive neuromuscular blocking agents is to
a. administer sedatives in conjunction with the neuromuscular blocking agents.
b. assess neurological status every 30 minutes.
c. avoid interaction with the patient, because he or she won’t be able to hear.
d. restrain the patient to avoid self-extubation.
ANS: A Neuromuscular blocking agents cause paralysis only; they do not cause sedation. Therefore, concomitant administration of sedatives is essential. Neurological status is monitored according to unit protocol. Nurses should communicate with all critically ill patients, regardless of their status. If the patient is paralyzed, restraining devices may not be needed. DIF: Cognitive Level: Apply/Application REF: p. 72 OBJ: Discuss assessment and management challenges in subsets of critically ill patients. TOP:Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 10.The best way to monitor agitation and effectiveness of treating it in the critically ill patient is to use a/the:
a. Confusion Assessment Method (CAM-ICU).
b. FACES assessment tool.
c. Glasgow Coma Scale.
d. Richmond Agitation Sedation Scale.
ANS: D Various sedation scales are available to assist the nurse in monitoring the level of sedation and assessing response to treatment. The Richmond Agitation Sedation Scale is a commonly used tool that has been validated. The CAM-ICU assesses for delirium. The FACES scale assesses pain. The Glasgow Coma Scale assesses neurological status. DIF: Cognitive Level: Remember/Knowledge REF: p. 59 | Table 5-5 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 11.The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen?
a. Creatinine: 3.1 mg/dL
b. Platelet count 350,000 billion/L
c. White blood count 13, 550 mm3
d. ALT 25 U/L
ANS: A Ibuprofen can result in renal insufficiency, which may be noted in an elevated serum creatinine level. Thrombocytopenia (low platelet count) is another possible side effect. This platelet count is elevated. An elevated white blood count indicates infection. Although ibuprofen is cleared primarily by the kidneys, it is also important to assess liver function, which would show elevated liver enzymes, not low values such as shown here. DIF: Cognitive Level: Analyze/Analysis REF: p. 71 OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 12.The nurse is assessing pain levels in a critically ill patient using the Behavioral Pain Scale. The nurse recognizes __________ as indicating the greatest level of pain.
a. brow lowering
b. eyelid closing
c. grimacing
d. relaxed facial expression
ANS: C The Behavioral Pain Scale issues the most points, indicating the greatest amount of pain, to assessment of facial grimacing. DIF: Cognitive Level: Understand/Comprehension REF: p. 58 | Table 5-3 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 13.The nurse wishes to assess the quality of a patient’s pain. Which of the following questions is appropriate to obtain this assessment if the patient is able to give a verbal response?
a. “Is the pain constant or intermittent?”
b. “Is the pain sharp, dull, or crushing?”
c. “What makes the pain better? Worse?”
d. “When did the pain start?”
ANS: B If the patient can describe the pain, the nurse can assess quality, such as sharp, dull, or crushing. The other responses relate to continuous or intermittent presence, what provides relief, and duration. DIF: Cognitive Level: Understand/Comprehension REF: p. 56 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 14.The nurse is assessing the patient’s pain using the Critical Care Pain Observation Tool. Which of the following assessments would indicate the greatest likelihood of pain and need for nursing intervention?
a. Absence of vocal sounds
b. Fighting the ventilator
c. Moving legs in bed
d. Relaxed muscles in upper extremities
ANS: B Fighting the ventilator is rated with the greatest number of points for compliance with the ventilator, and could indicate pain or anxiety. Absence of vocal sounds (e.g., no crying) and relaxed muscles do not indicate pain and are not given a point value. The patient may be moving the legs as a method of range of motion, not necessarily in response to pain. The patient needs to be assessed for restlessness if the movement is excessive. DIF: Cognitive Level: Apply/Application REF: p. 59 | Table 5-4 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 15.The nurse is caring for four patients on the progressive care unit. Which patient is at greatest risk for developing delirium?
a. 36-year-old recovering from a motor vehicle crash; being treated with an evidence-based alcohol withdrawal protocol.
b. 54-year-old postoperative aortic aneurysm resection with a 40 pack-year history of smoking
c. 86-year-old from nursing home with dementia, postoperative from colon resection, still being mechanically ventilated
d. 95-year-old with community-acquired pneumonia; family has brought in eyeglasses and hearing aid
ANS: C From this list, the 86-year-old postoperative nursing home resident is at greatest risk due to advanced age, cognitive impairment, and some degree of respiratory failure. The 96-year-old has been provided eyeglasses and a hearing aid, which will decrease the risk of delirium. Smoking is a possible risk for delirium. The 36-year-old is receiving medications as part of an alcohol withdrawal protocol, which should decrease the risk for delirium. DIF: Cognitive Level: Analyze/Analysis REF: p. 61 | Table 5-8 OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 16.The nurse is caring for a patient with hyperactive delirium. The nurse focuses interventions toward keeping the patient:
a. comfortable.
b. nourished.
c. safe.
d. sedated.
ANS: C The greatest priority in managing delirium is to keep the patient safe. Sedation may contribute to the development of delirium. Comfort and nutrition are important, but they are not priorities. DIF: Cognitive Level: Understand/Comprehension REF: p. 61 OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 17.The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period. Which of the following nursing interventions would improve the patient’s well-being and reduce anxiety the most?
a. Arrange for the patient’s dog to be brought into the unit (per protocol).
b. Provide aromatherapy with scents such as lavender that are known to help anxiety.
c. Secure the harpist to come and play soothing music for an hour every afternoon.
d. Wheel the patient out near the unit aquarium to observe the tropical fish.
ANS: A Nonpharmacological approaches are helpful in reducing stress and anxiety, and each of these activities has the potential for improving the patient’s well-being. The patient is likely to benefit most from the presence of his or her own dog rather than the other activities, however; if unit protocol does not allow the patient’s own dog, the nurse should investigate the use of therapy animals or the other options. DIF: Cognitive Level: Apply/Application REF: p. 64 OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention MSC: NCLEX Client Needs Category: Psychological Integrity 18.The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia (PCA)?
a. Patient with a C4 fracture and quadriplegia
b. Patient with a femur fracture and closed head injury
c. Postoperative patient who had elective bariatric surgery
d. Postoperative cardiac surgery patient with mild dementia
ANS: C The patient undergoing bariatric surgery (an elective procedure) is the best candidate for PCA as this patient should be awake, cognitively intact, and will have the acute pain related to the surgical procedure. The quadriplegic would be unable to operate the PCA pump. The cardiac surgery patient with mild dementia may not understand how to operate the pump. Likewise, the patient with the closed head injury may not be cognitively intact. DIF: Cognitive Level: Analyze/Analysis REF: p. 71 | Box 5-6 OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention MSC: NCLEX Client Needs Category: Physiological Integrity 19.The nurse is caring for a patient receiving a benzodiazepine intermittently. The nurse understands that the best way to administer such drugs is to:
a. administer around the clock, rather than as needed, to ensure constant sedation.
b. administer the medications through the feeding tube to prevent complications.
c. give the highest allowable dose for the greatest effect.
d. titrate to a predefined endpoint using a standard sedation scale.
ANS: D The best approach for administering benzodiazepines (and all sedatives) is to administer and titrate to a desired endpoint using a standard sedation scale. Administering around the clock as well as giving the highest allowable dose without basing it on an assessment target may result in excessive sedation. For greatest effect, most benzodiazepines are given intravenously. DIF: Cognitive Level: Apply/Application REF: p. 72 OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention MSC: NCLEX Client Needs Category: Physiological Integrity 20.The nurse is concerned about the risk of alcohol withdrawal syndrome in a postoperative patient. Which statement by the nurse indicates understanding of management of this patient?
a. “Alcohol withdrawal is common; we see it all of the time in the trauma unit.”
b. “There is no way to assess for alcohol withdrawal.”
c. “This patient will require less pain medication.”
d. “We have initiated the alcohol withdrawal protocol.”
ANS: D The most important treatment of alcohol withdrawal syndrome is prevention. Many units have protocols that are initiated early to prevent the syndrome. Alcohol withdrawal syndrome is common; however, this statement does not indicate knowledge of management. The patient experiencing alcohol withdrawal may exhibit a variety of symptoms, such as disorientation, agitation, and tachycardia. Patients with substance abuse require increased dosages of pain medications. DIF: Cognitive Level: Understand/Comprehension REF: p. 74 OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention MSC: NCLEX Client Needs Category: Physiological Integrity MULTIPLE RESPONSE 1.Nonpharmacological approaches to pain and/or anxiety that may best meet the needs of critically ill patients include: (Select all that apply.)
a. anaerobic exercise.
b. art therapy.
c. guided imagery.
d. music therapy.
e. animal therapy.
ANS: C, D, E Guided imagery is a powerful technique for controlling pain and anxiety, especially that associated with painful procedures. Similar to guided imagery, a music therapy program offers patients a diversionary technique for pain and anxiety relief. Likewise animal therapy has many benefits for the critically ill patient. Anaerobic exercise is not a nonpharmacological approach for managing pain and anxiety. Most critically ill patients are not able to participate in art therapy. DIF: Cognitive Level: Remember/Knowledge REF: pp. 62-64 OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 2.Which of the following statements regarding pain and anxiety are true? (Select all that apply.)
a. Anxiety is a state marked by apprehension, agitation, autonomic arousal, and/or fearful withdrawal.
b. Critically ill patients often experience anxiety, but they rarely experience pain.
c. Pain and anxiety are often interrelated and may be difficult to differentiate because their physiological and behavioral manifestations are similar.
d. Pain is defined by each patient; it is whatever the person experiencing the pain says it is.
e. While anxiety is unpleasant, it does not contribute to mortality or morbidity of the critically ill patient.
ANS: A, C, D Pain is defined by each patient, anxiety is associated with marked apprehension, and pain and anxiety are often interrelated. Critically ill patients commonly have both pain and anxiety. Anxiety does increase both morbidity and mortality in critically ill patients, especially those with cardiovascular disease. DIF: Cognitive Level: Understand/Comprehension REF: p. 53 OBJ: Define pain and anxiety. TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 3.Which of the following factors predispose the critically ill patient to pain and anxiety? (Select all that apply.)
a. Inability to communicate
b. Invasive procedures
c. Monitoring devices
d. Nursing care
e. Preexisting conditions
ANS: A, B, C, D, E All of these factors predispose the patient to pain or anxiety. DIF: Cognitive Level: Remember/Knowledge REF: pp. 53-54 OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 4.Choose the items that are common to both pain and anxiety. (Select all that apply.)
a. Cyclical exacerbation of one another
b. Require good nursing assessment for proper treatment
c. Response only to real phenomena
d. Subjective in nature
e. Perception may be influenced by prior experience
ANS: A, B, D, E Both pain and anxiety are subjective in nature. One can exacerbate the other in a vicious cycle that often requires good nursing assessment to manage the precipitating problem and break the cycle. Anxiety is a response to a real or perceived fear. Pain is a response to real or “phantom” phenomenon but always involves transmission of nerve impulses. Both relate to the patient’s perceptions of pain and fear. Previous experiences of both pain and/or anxiety can influence the patient’s perception of both. Anxiety is a response to real or perceived fear, and pain is a response to a real or “phantom” phenomenon. DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-54 OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 5.Anxiety differs from pain in that: (Select all that apply.)
a. it is confined to neurological processes in the brain.
b. it is linked to reward and punishment centers in the limbic system.
c. it is subjective.
d. there is no actual tissue injury.
e. it can be increased by noise and light.
ANS: A, B, D, E Unlike pain, anxiety is linked to the reward and punishment centers in the limbic system of the brain. It is totally neurological and does not involve tissue injury. Like pain, it is a subjective phenomenon. Noise, light, and other stimuli can increase the intensity of anxiety. Both anxiety and pain are subjective in nature. DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-55 OBJ:Discuss the physiology of pain and anxiety. TOP: Nursing Process Step: Assessment 6.Factors in the critical care unit that may predispose the client to increased pain and anxiety include: (Select all that apply.)
a. an endotracheal tube.
b. frequent vital signs.
c. monitor alarms.
d. room temperature.
e. hostile environment.
ANS: A, B, C, D, E Anxiety is likely to result from loss of control, the inability to communicate, continuous noise and lighting, excessive stimulation (including repeated vital sign measurements), lack of mobility, and uncomfortable room temperatures. Increased anxiety levels often lead to increased pain perception. Environments that are perceived as hostile also contribute. DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-54 OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 7.In the healthy individual, pain and anxiety: (Select all that apply.)
a. activate the sympathetic nervous system (SNS).
b. decrease stress levels.
c. help remove one from harm.
d. increase performance levels.
e. limit sympathetic nervous system activity.
ANS: A, C, D In the healthy person, pain and anxiety are adaptive mechanisms used to increase performance levels or to remove one from potential harm. The “fight or flight” response occurs in response to pain and/or anxiety and involves the activation of the sympathetic nervous system. Pain and anxiety, however, can induce significant stress. The SNS is activated, not limited, by pain and/or anxiety. DIF: Cognitive Level: Remember/Knowledge REF: p. 55 OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients. TOP:Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 8.The nurse is caring for a patient who is intubated and on a ventilator following extensive abdominal surgery. Although the patient is responsive, the nurse is not able to read the patient’s lips as the patient attempts to mouth the words. Which of the following assessment tools would be the most appropriate for the nurse to use when assessing the patient’s pain level? (Select all that apply.)
a. The FACES scale
b. Pain Intensity Scale
c. The PQRST method
d. The Visual Analogue Scale
e. The CAM tool
ANS: A, D
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 Essentials of Psychiatric Mental Health Nursing 8th Morgan

Chapter 1: Mental Health and Mental Illness Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A nurse is assessing a client who experiences occasional feelings of sadness because of the recent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed. How would the nurse interpret the client’s behaviors? 1. The client’s behaviors demonstrate mental illness in the form of depression. 2. The client’s behaviors are inappropriate, which indicates the presence of mental illness. 3. The client’s behaviors are not congruent with cultural norms. 4. The client’s behaviors demonstrate no functional impairment, indicating no mental illness. ____ 2. At which point would the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection. ____ 3. A client has been given a diagnosis of human immunodeficiency virus (HIV). Which statement made by the client does the nurse recognize as the bargaining stage of grief? 1. “I hate my partner for giving me this disease I will die from!” 2. “If I don’t do intravenous (IV) drugs anymore, God won’t let me die.” 3. “I am going to support groups and learn more about the disease.” 4. “Can you please re-draw the test results, I think they may be wrong?” ____ 4. A nurse notes that a client is extremely withdrawn, delusional, and emotionally exhausted. The nurse assesses the client’s anxiety as which level? 1. Mild anxiety 2. Moderate anxiety 3. Severe anxiety 4. Panic anxiety ____ 5. A psychiatric nurse intern states, “This client’s use of defense mechanisms should be eliminated.” Which is a correct evaluation of this nurse’s statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not completely eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged. ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH MORGAN TEST BANK Copyright © 2020 F. A. Davis Company ____ 6. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s best response? 1. “It is just a routine part of our assessment. All clients are asked these same questions.” 2. “Why are you concerned about these types of questions?” 3. “Psychological factors, like excessive stress, have been found to affect medical conditions.” 4. “We can skip these questions, if you like. It isn’t imperative that we complete this section.” ____ 7. A client who is being treated for chronic kidney disease complains to the health-care provider that he does not like the food available to him while hospitalized. The health-care provider insists that the client strictly adhere to the diet plan. What action can be expected is the client uses the defense mechanism of displacement? 1. The client assertively confronts the health-care provider. 2. The client insists on being discharged and goes for a long, brisk walk. 3. The client snaps at the nurse and criticizes the nursing care provided. 4. The client hides his anger by explaining the logical reasoning for the diet to his spouse. ____ 8. A fourth-grade boy teases and makes jokes about a cute girl in his class. A nurse would recognize this behavior as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation ____ 9. Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality. ____ 10. When under stress, a client routinely uses alcohol to excess. When the client’s husband finds her drunk, the husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client’s use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, “I don’t drink too much!” ____ 11. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife would indicate to a nurse that the client is in the acceptance stage of grief? 1. “If only we could have tried again, things might have worked out.” 2. “I am so mad that the children and I had to put up with him as long as we did.” 3. “Yes, it was a difficult relationship, but I think I have learned from the ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH MORGAN TEST BANK WWW.NURSINGTB.COMN U R S I N G T B . C O M Copyright © 2020 F. A. Davis Company experience.” 4. “I have a difficult time getting out of bed most days.” ____ 12. According to Maslow’s hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? 1. Maintaining a long-term, faithful, intimate relationship 2. Achieving a sense of self-confidence 3. Possessing a feeling of self-fulfillment and realizing full potential 4. Developing a sense of purpose and the ability to direct activities ____ 13. According to Maslow’s hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? 1. A client rudely complaining about limited visiting hours 2. A client exhibiting aggressive behavior toward another client 3. A client stating that no one cares 4. A client verbalizing feelings of failure Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 14. Which describes a defense mechanism an individual may use to relieve anxiety in a stressful situation? (Select all that apply.) 1. Homework 2. Smoking 3. Itching 4. Nail biting 5. Sleeping ____ 15. The nurse is reviewing the DSM-5 definition of a mental health disorder and notes the definition includes a disturbance in which areas? (Select all that apply.) 1. Cognition 2. Physical 3. Emotional regulation 4. Behavior 5. Developmental Completion Complete each statement. 16. _______________________ is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. 17. _______________________ is a subjective state of emotional, physical, and social responses to the loss of a valued entity. Other ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH MORGAN TEST BANK Copyright © 2020 F. A. Davis Company 18. Place in order the Kübler Ross stages of grief from 1-5. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Bargaining 2. Denial 3. Acceptance 4. Depression 5. Anger
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