Test Bank for Brunner and Suddarths Textbook of Medical-Surgical Nursing, 14th Edition

Name: Test Bank for Brunner and Suddarths Textbook of Medical-Surgical Nursing, 14th Edition
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Be exam-ready with Test Bank for Brunner and Suddarths Textbook of Medical-Surgical Nursing, 14th Edition—a must-have collection of test questions and solutions.

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Table of Contents
Table of Contents
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
Chapter 02: Community-Based Nursing Practice
Chapter 03: Critical Thinking, Ethical Decision Making and the Nursing Process
Chapter 04: Health Education and Promotion
Chapter 05: Adult Health and Nutritional Assessment
Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation
Chapter 07: Overview of Transcultural Nursing
Chapter 08: Overview of Genetics and Genomics in Nursing
Chapter 09: Chronic Illness and Disability
Chapter 10: Principles and Practices of Rehabilitation
Chapter 11: Health Care of the Older Adult
Chapter 12: Pain Management
Chapter 13: Fluid and Electrolytes: Balance and Disturbance
Chapter 14: Shock and Multiple Organ Dysfunction Syndrome
Chapter 15: Management of Patients with Oncologic Disorders
Chapter 16: End-of-Life Care
Chapter 17: Preoperative Nursing Management
Chapter 18: Intraoperative Nursing Management
Chapter 19: Postoperative Nursing Management
Chapter 20: Assessment of Respiratory Function
Chapter 21: Respiratory Care Modalities
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders
Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders
Chapter 24: Management of Patients With Chronic Pulmonary Disease
Chapter 25: Assessment of Cardiovascular Function
Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems
Chapter 27: Management of Patients With Coronary Vascular Disorders
Chapter 28: Management of Patients With Structural, Infectious, and Inflammatory Cardiac
Disorders
Chapter 29: Management of Patients With Complications from Heart Disease
Chapter 30: Assessment and Management of Patients With Vascular Disorders and
Problems of Peripheral Circulation
Chapter 31: Assessment and Management of Patients With Hypertension
Chapter 32: Assessment of Hematologic Function and Treatment Modalities
Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders
Chapter 34: Management of Patients With Hematologic Neoplasms
Chapter 35: Assessment of Immune Function
Chapter 36: Management of Patients With Immune Deficiency Disorders
Chapter 37: Assessment and Management of Patients With Allergic Disorders
Chapter 38: Assessment and Management of Patients With Rheumatic Disorders
Chapter 39: Assessment of Musculoskeletal Function
Chapter 40: Musculoskeletal Care Modalities
Chapter 41: Management of Patients With Musculoskeletal Disorders
Chapter 42: Management of Patients With Musculoskeletal Trauma
Chapter 43: Assessment of Digestive and Gastrointestinal Function
Chapter 44: Digestive and Gastrointestinal Treatment Modalities
Chapter 45: Management of Patients with Oral and Esophageal Disorders
Chapter 46: Management of Patients with Gastric and Duodenal Disorders
Chapter 47: Management of Patients With Intestinal and Rectal Disorders
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Chapter 48: Assessment and Management of Patients with Obesity
Chapter 49: Assessment and Management of Patients with Hepatic Disorders
Chapter 50: Assessment and Management of Patients with Biliary Disorders
Chapter 51: Assessment and Management of Patients with Diabetes
Chapter 52: Assessment and Management of Patients with Endocrine Disorders
Chapter 53: Assessment of Kidney and Urinary Function
Chapter 54: Management of Patients with Kidney Disorders
Chapter 55: Management of Patients with Urinary Disorders
Chapter 56: Assessment and Management of Patients With Female Physiologic Processes
Chapter 57: Management of Patients with Female Reproductive Disorders
Chapter 58: Assessment and Management of Patients with Breast Disorders
Chapter 59: Assessment and Management of Patients With Male Reproductive Disorders
Chapter 60: Assessment of Integumentary Function
Chapter 61: Managements of Patients with Dermatologic Problems
Chapter 62: Managements of Patients with Burn Injury
Chapter 63: Assessment and Management of Patients with Eye and Vision Disorders
Chapter 64: Assessment and Management of Patients with Hearing and Balance Disorders
Chapter 65: Assessment of Neurologic Function
Chapter 66: Management of Patients with Neurologic Dysfunction
Chapter 67: Management of Patients with Cerebrovascular Disorders
Chapter 68: Management of Patients with Neurologic Trauma
Chapter 69: Management of Patients with Neurologic Infections, Autoimmune Disorders,
and Neuropathies
Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders
Chapter 71: Management of Patients With Infectious Diseases
Chapter 72: Emergency Nursing
Chapter 73: Terrorism, Mass Casualty, and Disaster Nursing
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Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
1. The public health nurse is presenting a health promotion class to a group of new mothers. How should
the nurse best define health?
A) Health is being disease free.
B) Health is having fulfillment in all domains of life.
C) Health is having psychological and physiological harmony.
D) Health is being connected in body, mind, and spirit.
Ans: D
Feedback:
The World Health Organization (WHO) defines health in the preamble to its constitution as a state of
complete physical, mental, and social well-being and not merely the absence of disease and infirmity.
The other answers are incorrect because they are not congruent with the WHO definition of health.
2. A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is
one characteristic the nurse would cite as necessary to possess to be an effective nurse?
A) Sensitivity to cultural differences
B) Team-focused approach to problem-solving
C) Strict adherence to routine
D) Ability to face criticism
Ans: A
Feedback:
To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be
culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict
adherence to routine are not characteristics needed to be an effective nurse. The ability to handle
criticism is important, but to a lesser degree than cultural competence.
3. With increases in longevity, people have had to become more knowledgeable about their health and the
professional health care that they receive. One outcome of this phenomenon is the development of
organized self-care education programs. Which of the following do these programs prioritize?
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A) Adequate prenatal care
B) Government advocacy and lobbying
C) Judicious use of online communities
D) Management of illness
Ans: D
Feedback:
Organized self-care education programs emphasize health promotion, disease prevention, management
of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and
Internet activities are secondary.
4. The home health nurse is assisting a patient and his family in planning the patients return to work after
surgery and the development of postsurgical complications. The nurse is preparing a plan of care that
addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the
patients need for self-fulfillment relate?
A) Physiologic
B) Transcendence
C) Love and belonging
D) Self-actualization
Ans: D
Feedback:
Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to
know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does
not relate directly to them.
5. The view that health and illness are not static states but that they exist on a continuum is central to
professional health care systems. When planning care, this view aids the nurse in appreciating which of
the following?
A) Care should focus primarily on the treatment of disease.
B) A persons state of health is ever-changing.
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C) A person can transition from health to illness rapidly.
D) Care should focus on the patients compliance with interventions.
Ans: B
Feedback:
By viewing health and illness on a continuum, it is possible to consider a person as being neither
completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the
potential to range from high-level wellness to extremely poor health and imminent death. The other
answers are incorrect because patient care should not focus just on the treatment of disease. Rapid
declines in health and compliance with treatment are not key to this view of health.
6. A group of nursing students are participating in a community health clinic. When providing care in this
context, what should the students teach participants about disease prevention?
A) It is best achieved through attending self-help groups.
B) It is best achieved by reducing psychological stress.
C) It is best achieved by being an active participant in the community.
D) It is best achieved by exhibiting behaviors that promote health.
Ans: D
Feedback:
Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen
as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach
that disease prevention is best achieved through attending self-help groups, by reducing stress, or by
being an active participant in the community, though each of these activities is consistent with a healthy
lifestyle.
7. A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee.
When describing quality improvement programs to nursing colleagues and members of other health
disciplines, what characteristic should the nurse cite?
A) These programs establish consequences for health care professionals actions.
B) These programs focus on the processes used to provide care.
C) These programs identify specific incidents related to quality.
D) These programs seek to justify health care costs and systems.
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Ans: B
Feedback:
Numerous models seek to improve the quality of health care delivery. A commonality among them is a
focus on the processes that are used to provide care. Consequences, a focus on incidents, and
justification for health care costs are not universal characteristics of quality improvement efforts.
8. Nurses in acute care settings must work with other health care team members to maintain quality care
while facing pressures to care for patients who are hospitalized for shorter periods of time than in the
past. To ensure positive health outcomes when patients return to their homes, what action should the
nurse prioritize?
A) Promotion of health literacy during hospitalization
B) Close communication with insurers
C) Thorough and evidence-based discharge planning
D) Participation in continuing education initiatives
Ans: C
Feedback:
Following discharges that occur after increasingly short hospital stays, nurses in the community care for
patients who need high-technology acute care services as well as long-term care in the home. This is
dependent on effective discharge planning to a greater degree than continuing education, communication
with insurers, or promotion of health literacy.
9. You are admitting a patient to your medical unit after the patient has been transferred from the
emergency department. What is your priority nursing action at this time?
A) Identifying the immediate needs of the patient
B) Checking the admitting physicians orders
C) Obtaining a baseline set of vital signs
D) Allowing the family to be with the patient
Ans: A
Feedback:
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Among the nurses important functions in health care delivery, identifying the patients immediate needs
and working in concert with the patient to address them is most important. The other nursing functions
are important, but they are not the most important functions.
10. A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing
assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?
A) Helping the patient to achieve specific outcomes
B) Balancing risks and benefits of interventions
C) Documenting the patients response to therapy
D) Staying accountable to the interdisciplinary team
Ans: A
Feedback:
Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes.
Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient
achieve outcomes is paramount.
11. Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of
analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice
RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized
patients. How does this demonstrate a role of the APRN?
A) Involving patients in their care while hospitalized
B) Contributing to the scientific basis of nursing practice
C) Critiquing the quality of patient care
D) Explaining medical studies to patients and RNs
Ans: B
Feedback:
Research is within the purview of the APRN. The activity described does not exemplify explaining
studies to RNs, critiquing care, or involving patients in their care.
12. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of
practice for the nurse in todays health care environment is home health care. What is the main basis for
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the growth in this health care setting?
A) Chronic nursing shortage
B) Western focus on treatment of disease
C) Nurses preferences for day shifts instead of evening or night shifts
D) Discharge of patients who are more critically ill
Ans: D
Feedback:
With shorter hospital stays and increased use of outpatient health care services, more nursing care is
provided in the home and community setting. The other answers are incorrect because they are not the
basis for the growth in nursing care delivered in the home setting.
13. Nurses have different educational backgrounds and function under many titles in their practice setting. If
a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by
influencing the patient, the nurse, and the health care system, what would most accurately describe this
nurses title?
A) Nursing care expert
B) Clinical nurse specialist
C) Nurse manager
D) Staff nurse
Ans: B
Feedback:
Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care
(e.g., cardiovascular, oncology). They define their roles as having five major components: clinical
practice, education, management, consultation, and research. The other answers are incorrect because
they are not the most accurate titles for this nurse.
14. Nursing continues to recognize and participate in collaboration with other health care disciplines to meet
the complex needs of the patient. Which of the following is the best example of a collaborative practice
model?
A) The nurse and the physician jointly making clinical decisions.
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B) The nurse accompanying the physician on rounds.
C) The nurse making a referral on behalf of the patient.
D) The nurse attending an appointment with the patient.
Ans: A
Feedback:
The collaborative model, or a variation of it, promotes shared participation, responsibility, and
accountability in a health care environment that is striving to meet the complex health care needs of the
public. The other answers are incorrect because they are not examples of a collaborative practice model.
15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of
needs, what dimension of care should the nurse consider primary in importance when caring for a dying
patient?
A) Spiritual
B) Social
C) Physiologic
D) Emotional
Ans: C
Feedback:
Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and
affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know
and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied
to the various nursing models for assessment of a patients strengths, limitations, and need for nursing
interventions. The other answers are incorrect because they are not of primary importance when caring
for a dying patient, though each should certainly be addressed.
16. A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within
this framework of understanding, what would be the nurses first priority?
A) Allowing the family to see a newly admitted patient
B) Ambulating the patient in the hallway
C) Administering pain medication
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D) Teaching the patient to self-administer insulin safely
Ans: C
Feedback:
In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such
as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family
addresses a higher level need related to love and belonging. Teaching the patient is also a higher level
need related to the desire to know and understand and is not appropriate at this time, as the basic
physiologic need of pain control must be addressed before the patient can address these higher level
needs.
17. A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse
provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of
the following?
A) National Council of Nursings guidelines for care
B) National League for Nursings Code of Conduct
C) American Nurses Associations Social Policy Statement
D) Department of Health and Human Services White Paper on Nursing
Ans: C
Feedback:
Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply
with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for
Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council
of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included
in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN
published a specific code of conduct.
18. Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the
changing health needs of our aging population. What is one factor that has impacted the need for
certified nurse practitioners (CNPs)?
A) The increased need for primary care providers
B) The need to improve patient diagnostic services
C) The push to drive institutional excellence
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D) The need to decrease the number of medical errors
Ans: A
Feedback:
CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive
additional focused training in primary care or acute care. CNPs help meet the need for primary care
providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent
with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.
19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the
treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality
improvement?
A) By liaising with the members of the interdisciplinary care team
B) By critically appraising the outcomes of care that is provided
C) By integrating the patients preferences into the plan of care
D) By documenting care in the electronic health record in a timely fashion
Ans: B
Feedback:
Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other
listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement
activities.
20. Professional nursing expands and grows because of factors driven by the changing needs of health care
consumers. Which of the following is a factor that nurses should reflect in the planning and provision of
health care?
A) Decreased access to health care information by individuals
B) Gradual increases in the cultural unity of the American population
C) Increasing mean and median age of the American population
D) Decreasing consumer expectations related to health care outcomes
Ans: C
Feedback:
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The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer
school-age children and more senior citizens, many of whom are women.
The population has become more culturally diverse as increasing numbers of people from different
national backgrounds enter the country. Access to information and consumer expectations continue to
increase.
21. A public health nurse has been commissioned to draft a health promotion program that meets the health
care needs and expectations of the community. Which of the following focuses is most likely to
influence the nurses choice of interventions?
A) Management of chronic conditions and disability
B) Increasing need for self-care among a younger population
C) A shifting focus to disease management
D) An increasing focus on acute conditions and rehabilitation
Ans: A
Feedback:
In response to current priorities, health care must focus more on management of chronic conditions and
disability than in previous times. The other answers are incorrect because the change in focus of health
care is not an increasing need for self-care among our aging population; our focus is shifting away from
disease management, not toward it; and we are moving away from the management of acute conditions
to managing chronic conditions.
22. A community health nurse has witnessed significant shifts in patterns of disease over the course of a
four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of
disease in the United States?
A) Type 1 diabetes management
B) Treatment of community-acquired pneumonia
C) Rehabilitation from traumatic brain injuries
D) Management of acute Staphylococcus aureus infections
Ans: A
Feedback:
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Management of chronic diseases such as diabetes is a priority focus of the current health care
environment. This supersedes the treatment of acute infections and rehabilitation needs.
23. The ANA has identified several phenomena toward which the focus of nursing care should be directed,
and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates
these priorities?
A) Encouraging the patients dependence on caregivers
B) Fostering the patients ability to make choices
C) Teaching the patient about nurses roles in the health care system
D) Assessing the patients adherence to treatment
Ans: B
Feedback:
The ANA identifies several focuses for nursing care and research, including the ability to make choices.
The other answers are incorrect because they are not phenomena identified by the ANA.
24. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of
health care. Which of the following activities are considered integral to the CNP role? Select all that
apply.
A) Educating patients and family members
B) Coordinating care with other disciplines
C) Using direct provision of interventions
D) Educating registered nurses and practical nurses
E) Coordinating payment plans for patients
Ans: A, B, C
Feedback:
This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in
home care and community nursing. Nurses help patients meet their needs by using direct intervention,
by teaching patients and family members to perform care, and by coordinating and collaborating with
other disciplines to provide needed services. The other answers are incorrect because NPs do not
commonly perform education of nurses and they do not focus on matters related to payment.
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25. The ANA has identified central characteristics of nursing practice that are applicable across the wide
variety of contexts in which nurses practice. A nurse can best demonstrate these principles by
performing which of the following actions?
A) Teaching the public about the role of nursing
B) Taking action to control the costs of health care
C) Ensuring that all of his or her actions exemplify caring
D) Making sure to carry adequate liability insurance
Ans: C
Feedback:
The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA
does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a
central tenet of nursing practice.
26. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched
within the past decade. In this role, the nurse should prioritize which of the following activities?
A) Acting as a spokesperson for the nursing profession
B) Generating and disseminating new nursing knowledge
C) Diagnosing and treating health problems that have a predictable course
D) Helping patients to navigate the health care system
Ans: D
Feedback:
The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical
leadership, educated to help patients navigate through the complex health care system. The other
answers are incorrect because they are not what nursing has identified as the CNL role.
27. Our world is connected by a sophisticated communication system that makes much health information
instantly accessible, no matter where the patient is being treated. This instant access to health
information has impacted health care delivery strategies, including the delivery of nursing care. What is
one way the delivery of health care has been impacted by this phenomenon?
A) Brisk changes as well as swift obsolescence
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B) Rapid change that is nearly permanent
C) Limitations on the settings where care can be provided
D) Increased need for social acceptance
Ans: A
Feedback:
The sophisticated communication systems that connect most parts of the world, with the capability of
rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift
obsolescence in health care delivery strategies. The other answers are incorrect because, although we
have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care
itself evolves. Giving nursing care has not become easier, it becomes more complex with every change;
and it does not need to be more socially acceptable; it needs to be more culturally sensitive.
28. With the changing population of health care consumers, it has become necessary for nurses to work
more closely with other nurses, as when acute care nurses collaborate with public health and home
health nurses. What nursing function has increased in importance because of this phenomenon?
A) Prescribing medication
B) Performing discharge planning
C) Promoting family involvement
D) Forming collegial relationships
Ans: B
Feedback:
The importance of effective discharge planning and quality improvement cannot be overstated. The
other answers are incorrect because giving medication and family involvement in the patients care have
not grown in importance. Making and maintaining collegial relationships has become a necessity in
working in the health care delivery system. Effective discharge planning aids in getting patients out of
the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting
possible.
29. A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help
the nurse achieve what goal?
A) Increasing career satisfaction
B) Obtaining federal grant money
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C) Ensuring high quality patient care
D) Enhancing the publics esteem for nursing
Ans: C
Feedback:
Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money
are not priorities.
30. A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When
defining this new role, which of the following outcomes should be prioritized by the hospitals
leadership?
A) Decreased need for physician services
B) Improved patient and family education
C) Increased adherence to the principles of EBP
D) Increased coordination of health services
Ans: D
Feedback:
Case management is a system of coordinating health care services to ensure cost-effectiveness,
accountability, and quality care. The case manager coordinates the care of a caseload of patients through
facilitating communication between nurses, other health care personnel who provide care, and insurance
companies. Reducing the need for physician services is not a central goal. Education and EBP are
consistent with case management, but they are not central to this particular role.
31. A hospitals current quality improvement program has integrated the principles of the Institute for
Healthcare Improvement (IHI) 5 Million Lives Campaign. How can the hospital best achieve the
campaign goals of reducing preventable harm and death?
A) By adhering to EBP guidelines
B) By reducing nurse-to-patient ratios and increasing accountability
C) By having researchers from outside the facility evaluate care
D) By involving patients and families in their care planning
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Ans: A
Feedback:
The 5 Million Lives Campaign posits that if evidence-based guidelines it advocated were voluntarily
implemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a two-
year period. Nurse-to-patient ratios, family participation, and independent evaluation are not stated
components of the campaign.
32. Over the past several decades, nursing roles have changed and expanded in many ways. Which of the
following factors has provided the strongest impetus for this change?
A) The need to decrease the cost of health care
B) The need to improve the quality of nursing education
C) The need to increase the number of nursing jobs available
D) The need to increase the public perception of nursing
Ans: A
Feedback:
The role of the nurse has expanded to improve the distribution of health care services and to decrease the
cost of health care. The other answers are incorrect because the expansion of roles in nursing did not
occur to improve education, increase the number of nursing jobs, or increase public perception.
33. Advanced practice nursing roles have grown in number and in visibility in recent years. What
characteristic sets these nurses apart from the registered nurse?
A) Collaboration with other health care providers
B) Education that goes beyond that of the RN
C) Advanced documentation skills
D) Ability to provide care in the surgical context
Ans: B
Feedback:
There is wide variety in APRN roles. However, a commonality is that they require education beyond that
of the professional RN. All nurses collaborate with other health care providers to provide nursing care to
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their patients. Advanced documentation skills are not what sets advanced practice nurses apart from the
staff nurse. RNs have the ability to provide care in the operating room.
34. CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states,
what right do CNPs have that RNs do not possess?
A) Perform health interventions independently
B) Make referrals to members of other health disciplines
C) Prescribe medications
D) Perform surgery independently
Ans: C
Feedback:
In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope of
practice and all professional nurses may perform interventions and make certain referrals.
35. A team of community health nurses are planning to draft a proposal for a program that will increase the
communitys alignment with the principles contained in the Healthy People 2020report. Which of the
following activities would best demonstrate the priorities identified in this report?
A) Addressing determinants of health such as clean environments and safety in the community
B) Lobbying for increased funding to the county hospital where many residents receive primary care
C) Collaborating with health professionals in neighboring communities to pool resources and increase
efficiencies
D) Creating clinical placements where nursing students and members of other health disciplines can
gain experience in a community setting
Ans: A
Feedback:
Healthy People 2020 addresses social determinants of health such as safety and the state of the
environment. This report does not specifically address matters such as hospital funding, nursing
education, or resource allocation.
36. A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and
self-care. Which of the following activities would best demonstrate the principles of health promotion?
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A) A discharge planning initiative between acute care and community care nurses
B) Collaboration between several schools of nursing in an urban area
C) Creation of a smoking prevention program undertaken in a middle school
D) Establishment of a website where patients can check emergency department wait-times
Ans: C
Feedback:
Smoking prevention is a clear example of health promotion. Each of the other listed activities has the
potential to be beneficial, but none is considered health promotion.
37. A group of nursing students are learning about recent changes in the pattern of disease in the United
States. Which of the following statements best describes these current changes?
A) Infectious diseases continue to decrease in incidence and prevalence.
B) Chronic illnesses are becoming increasingly resistant to treatment.
C) Most acute, infectious diseases have been eradicated.
D) Most, but not all, communicable diseases are declining.
Ans: D
Feedback:
Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibiotic
resistance is a more serious problem in acute, not chronic, illnesses.
38. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a
large, university medical center according to core measures. Evaluators should perform this evaluation
in what way?
A) By auditing the medical centers electronic health records
B) By performing focus groups and interviews with care providers from numerous disciplines
C) By performing statistical analysis of patient satisfaction surveys
D) By comparing the centers patient outcomes to best practice indicators
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Ans: D
Feedback:
Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seek
treatment for a specific disease or who need a specific treatment as compared to evidence-based
guidelines and standards of care. Benchmark standards of quality are used to compare the care or
treatment patients receive with the best practice standards. Patient satisfaction is considered, but this is
not the only criterion.
39. Leadership of a medical unit have been instructed to integrate the principles of the Quality and Safety
Education for Nurses (QSEN) competency of quality improvement. What action should the units leaders
take?
A) Provide access to online journals and Web-based clinical resources for nursing staff.
B) Use flow charts to document the processes of care that are used on the unit.
C) Enforce continuing education requirements for all care providers.
D) Reduce the use of chemical and physical restraints on the unit.
Ans: B
Feedback:
One of the quality improvement skills is to use tools, such as flow charts and cause-effect diagrams, to
make processes of care explicit. Each of the other listed actions has the potential to benefit patients and
care givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency.
40. The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to
the educational programs that teach nurses and members of other health professions. According to this
report, what activity should educational institutions prioritize?
A) More clearly delineate each professions scope of practice during education
B) Move toward developing a single health curriculum that can be adapted for any health profession
C) Include interdisciplinary core competencies into curricula
D) Elicit input from patients and families into health care curricula
Ans: C
Feedback:
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Health Professions Education: A Bridge to Quality challenged health professions education programs to
integrate interdisciplinary core competencies into their respective curricula to include patient-centered
care, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement,
safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input,
or a single curriculum.
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Chapter 02: Community-Based Nursing Practice
1. A community health nurse has scheduled a hypertension clinic in a local shopping mall in which
shoppers have the opportunity to have their blood pressure measured and learn about hypertension. This
nursing activity would be an example of which type of prevention activity?
A) Tertiary prevention
B) Secondary prevention
C) Primary prevention
D) Disease prevention
Ans: B
Feedback:
Secondary prevention centers on health maintenance aim at early detection and prevention. Disease
prevention is not a form of health care but is a focus on primary prevention.
2. The nursing instructor is preparing a group of students for their home care rotation. In preparation, the
group discusses the patients that they are most likely to care for in the home. Which of the following
groups are the most common recipients of home care services?
A) Mentally ill patients
B) Patients receiving rehabilitation after surgery
C) Terminally ill and palliative patients
D) Elderly patients
Ans: D
Feedback:
The elderly are the most frequent users of home care services. The patient must be acutely ill, home
bound, and in need of skilled nursing services to be eligible for this service. The other answers are
incorrect because it is the elderly who are seen most frequently in the home health setting, though each
of the other listed groups may sometimes receive home care.
3. A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles in
their homes and the nurses own practices and beliefs. To work therapeutically with the patient, what
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must the nurse do?
A) Request another assignment if there is dissonance with the patients lifestyle.
B) Ask the patient to come to the agency to receive treatment, if possible.
C) Resolve to convey respect for the patients beliefs and choices.
D) Try to adapt the patients home to the norms of a hospital environment.
Ans: C
Feedback:
To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respect
for patients beliefs, even if they differ sharply from the nurses. This can be difficult when a patients
lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of
alcohol, drug abuse, or overeating. The nurse should not request another assignment because of a
difference in beliefs, nor do nurses ask for the patient to come to you at the agency to receive treatment.
It is also inappropriate to convert the patients home to a hospital-like environment.
4. Infection control is a high priority in every setting where nursing care is provided. When performing a
home visit, how should the nurse best implement the principles of infection control?
A) Perform hand hygiene before and after giving direct patient care.
B) Remove the patients wound dressings from the home promptly.
C) Disinfect the patients syringes prior to disposal.
D) Establish a sterile field in the patients home before providing care.
Ans: A
Feedback:
Infection control is as important in the home as it is in the hospital, but it can be more challenging in the
home and requires creative approaches. As in any situation, it is important to clean ones hands before
and after giving direct patient care, even in a home that does not have running water. Removing the
wound dressings from the home and disinfecting all work areas in the home are not the best
implementations of infection control in the home. Used syringes are never disinfected and a sterile field
is not always necessary.
5. An adult patient is ready to be discharged from the hospital after undergoing a transmetatarsal
amputation. When should your patients discharge planning begin?
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A) The day prior to discharge
B) The day of estimated discharge
C) The day that the patient is admitted
D) Once the nursing care plan has been finalized
Ans: C
Feedback:
Discharge planning begins with the patients admission to the hospital and must consider the possible
need for follow-up home care. Discharge planning should begin prior to the other listed times.
6. A home health nurse is preparing to make the initial visit to a new patients home. When planning
educational interventions, what information should the nurse provide to the patient and his or her
family?
A) Available community resources to meet their needs
B) Information on other patients in the area with similar health care needs
C) The nurses contact information and credentials
D) Dates and times of all scheduled home care visits
Ans: A
Feedback:
The community-based nurse is responsible for informing the patient and family about the community
resources available to meet their needs. During initial and subsequent home visits, the nurse helps the
patient and family identify these community services and encourages them to contact the appropriate
agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect
because it is inappropriate to ever provide information on other patients to a patient. The nurses
credentials are not normally discussed. Giving the patient the dates and times of their scheduled home
visits is appropriate, but may not always be possible. It is more important to provide them with resources
available within the community to meet their needs.
7. The home health nurse receives a referral from the hospital for a patient who needs a home visit for
wound care. After obtaining the referral, what would be the first action the nurse should take?
A) Have community services make contact with the patient.
B) Obtain a physicians order for the visit.
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C) Call the patient to obtain permission to visit.
D) Arrange for a home health aide to initially visit the patient.
Ans: C
Feedback:
After receiving a referral, the first step is to call the patient and obtain permission to make the visit. Then
the nurse should schedule the visit and verify the address. A physicians order is not necessary to
schedule a visit with the patient. The nurse may identify community services or the need for a home
health aide after assessing the patient and the home environment during the first visit with the patient.
This would not be delegated to a home health aide.
8. At the beginning of a day that will involve several home visits, the nurse has ensured that the health care
agency has a copy of her daily schedule. What is the rationale for the nurses action?
A) It allows the agency to keep track for payment to the nurse.
B) It supports safety precautions for the nurse when making a home care visit.
C) It allows for greater flexibility for the nurse and his or her colleagues for changes in assignments.
D) It allows the patient to cancel appointments with minimal inconvenience.
Ans: B
Feedback:
Whenever a nurse makes a home visit, the agency should know the nurses schedule and the locations of
the visits. The other answers are incorrect because providing the agency with a copy of the daily
schedule is not for the purpose of correctly paying the nurse or for the ease of the nurse in changing
assignments. It is also not intended for the patients ease in canceling appointments.
9. There are specific legal guidelines and regulations for the documentation related to home care. When
providing care for a patient who is a Medicaid recipient, what is most important for the nurse to
document?
A) The medical diagnosis and the supplies needed to care for the patient
B) A summary of the patients income tax paid during the previous year
C) The specific quality of nursing care that is needed
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D) The patients homebound status and the specific need for skilled nursing care
Ans: D
Feedback:
Medicare, Medicaid, and third-party payers require documentation of the patients homebound status and
the need for skilled professional nursing care. The medical diagnosis and specific detailed information
on the functional limitations of the patient are usually part of the documentation. The other answers are
incorrect because nursing documentation does not include needed supplies, tax information, or the
quality of care needed.
10. Your patient has had a total knee replacement and will need to walk with a two-wheeled walker for 6
weeks. He is being discharged home with a referral for home health care. What will the home care nurse
need to assess during the initial nursing assessment in the home?
A) Assistance of neighbors
B) Qualification for Medicare and Medicaid
C) Costs related to the visits
D) Characteristics of the home environment
Ans: D
Feedback:
The initial assessment includes evaluating the patient, the home environment, the patients self-care
abilities or the familys ability to provide care, and the patients need for additional resources. Normally
an assessment is not made of assistance on the part of neighbors or the costs of the visit. Medicare and
Medicaid qualifications would normally be determined beforehand.
11. A nurse who has an advanced degree in primary care for a pediatric population is employed in a health
clinic. In what role is this nurse functioning?
A) Nurse practitioner
B) Case coordinator
C) Clinical nurse specialist
D) Clinic supervisor
Ans: A
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Feedback:
Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on
gerontology, pediatrics, family or adult health, or womens health. Case coordinators and clinical
supervisors do not necessarily require an advanced degree, and a clinical nurse specialist is not educated
in primary care. Primary care is the specific focus of CNPs.
12. A nurse is based in an automotive assembly plant and works with the plants employees in the areas of
health promotion and basic primary care. What nursing role is this nurse performing?
A) Occupational health nurse
B) Community nurse specialist
C) Nurse clinician
D) Public health nurse
Ans: A
Feedback:
Occupational health nurses may provide direct care to patients who are ill, conduct health education
programs for the industry staff, or set up health programs. The other answers are incorrect because they
are not consistent with a nurses placement in a manufacturing setting.
13. A school nurse has been working closely with a student who has cystic fibrosis. The nurse is aware that
children with health problems are at major risk for what problem?
A) Mental health disorders
B) Gradual reduction in intelligence
C) Psychological stress due to a desire to overachieve
D) Underachievement in school
Ans: D
Feedback:
School-aged children and adolescents with health problems are at major risk for underachieving or
failing in school. These students do not necessarily have a high risk of mental health disorders or a
desire to overachieve. Health problems do not normally cause a progressive decline in intelligence.
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14. A community health nurse is aware that restoration of health often depends on appropriate interventions
performed early in the course of a disease. Which patient is most likely to seek health care late in the
course of his or her disease process and deteriorate more quickly than other patients?
A) A patient who has been homeless for an extended period of time
B) A patient who recently immigrated to the United States
C) A patient who is 88 years old and who has enjoyed relatively good health
D) A teenage boy
Ans: A
Feedback:
Because of numerous barriers, the homeless seek health care late in the course of a disease and
deteriorate more quickly than patients who are not homeless. Many of their health problems are related
in large part to their living situation. The other answers are incorrect because these populations do not as
often seek care late in the course of their disease process and deteriorate quicker than other populations.
15. A recent nursing school graduate has chosen to pursue a community nursing position because of
increasing opportunities for nurses in community settings. What changes in the health care system have
created an increased need for nurses to practice in community-based settings? Select all that apply.
A) Tighter insurance regulations
B) Younger population
C) Increased rural population
D) Changes in federal legislation
E) Decreasing hospital revenues
Ans: A, D, E
Feedback:
Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, and
alternative health care delivery systems have also affected the ways in which health care is delivered.
Our country does not have an increased rural population nor is our population younger.
16. A nursing student has taught a colleague that nursing practice is not limited to hospital settings,
explaining that nurses are now working in ambulatory health clinics, hospice settings, and homeless
shelters and clinics. What factor has most influenced this increased diversity in practice settings for
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nurses?
A) Population shift to more rural areas
B) Shift of health care delivery into the community
C) Advent of primary care clinics
D) Increased use of rehabilitation hospitals
Ans: B
Feedback:
As health care delivery shifts into the community, more nurses are working in a variety of community-
based settings. These settings include public health departments, ambulatory health clinics, long-term
care facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics,
nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay
facilities, and patients homes. The other answers are incorrect because our population has not shifted to a
more rural base, and the use of primary care clinics has not influenced an increase in practice settings or
the use of rehabilitation hospitals.
17. A nurse is collaborating with a team of community nurses to identify the vision and mission for
community care. What is the central focus of community-based nursing?
A) Increased health literacy in the community
B) Distributing ownership for the health of the community
C) Promoting and maintaining the health of individuals and families
D) Identifying links between lifestyle and health
Ans: C
Feedback:
Community-based nursing practice focuses centrally on promoting and maintaining the health of
individuals and families, preventing and minimizing the progression of disease, and improving quality of
life. Health literacy is not a goal in itself, but rather a means to promoting health. Distributing ownership
and identifying links between lifestyle and health are not the essence of community-based care.
18. You are the community-based nurse who performs the role of case manager for a small town about 60
miles from a major health care center. When planning care in your community, what is the most
important variable in community-based nursing that you should integrate into your planning?
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A) Eligibility requirements for services
B) Community resources available to patients
C) Transportation costs to the medical center
D) Possible charges for any services provided
Ans: B
Feedback:
A community-based nurse must be knowledgeable about community resources available to patients as
well as services provided by local agencies, eligibility requirements, and any possible charges for the
services. The other answers are incorrect because they are not the most important factors about which a
community-based nurse must be knowledgeable.
19. An urban, community-based nurse is looking for community resources for a patient who has complex
rehabilitation needs coupled with several comorbid, chronic health conditions. Where is the best place
for the nurse to search for appropriate resources?
A) A hospital directory
B) The hospital intranet
C) A community directory
D) The nurses own personal network
Ans: C
Feedback:
Most communities have directories of health and social service agencies that the nurse can consult. The
other answers are incorrect because hospital directories and intranets usually only include people
affiliated with the hospital. The nurses personal network of contacts may or may not be of use.
20. You are a community-based care manager in a medium-sized community that does not have an up-to-
date resource directory available. As a result, you have been given the task of beginning to compile such
a directory. What would be important to include in this directory? Select all that apply.
A) Links to online health sciences journals
B) Lists of social service workers in the community
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