Test Bank For CURRENT Medical Diagnosis and Treatment 2019, 58th Edition

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CURRENT Medical Diagnosis and Treatment2019 Testbank/StudyguideChapter 1. Disease Prevention & Health Promotion____1.Whichofthefollowingbehaviorsindicatesthehighestpotentialforspreadinginfectionsamongclients?Thenurse:1)disinfectsdirtyhandswithantibacterialsoap.2)allowsalcohol-basedrubtodryfor10seconds.3)washeshandsonlyafterleavingeachroom.4)usescoldwaterformedicalasepsis.____2.Whatisthemostfrequentcauseofthespreadofinfectionamonginstitutionalizedpatients?1)Airbornemicrobesfromotherpatients2)Contactwithcontaminatedequipment3)Handsofhealthcareworkers4)Exposurefromfamilymembers____3.Whichofthefollowingnursingactivitiesisofhighestpriorityformaintainingmedicalasepsis?1)Washinghands2)Donninggloves3)Applyingsteriledrapes4)Wearingagown____4.Apatientinfectedwithavirusbutwhodoesnothaveanyoutwardsignofthediseaseisconsidereda:1)pathogen.2)fomite.3)vector.4)carrier.____5.Apatientisadmittedtothehospitalwithtuberculosis.Whichprecautionsmustthenurseinstitutewhencaringforthispatient?1)Droplettransmission2)Airbornetransmission3)Directcontact4)Indirectcontact

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____6.Apatientbecomesinfectedwithoralcandidiasis(thrush)whilereceivingintravenousantibioticstotreatasystemicinfection.Whichtypeofinfectionhasthepatientdeveloped?1)Endogenousnosocomial2)Exogenousnosocomial3)Latent4)Primary____7.Apatientadmittedtothehospitalwithpneumoniahasbeenreceivingantibioticsfor2days.Hisconditionhasstabilized,andhistemperaturehasreturnedtonormal.Whichstageofinfectionisthepatientmostlikelyexperiencing?1)Incubation2)Prodromal3)Decline4)Convalescence____8.Thenurseassistsasurgeonwithcentralvenouscatheterinsertion.Whichactionisnecessarytohelpmaintainsteriletechnique?1)Closingthepatientsdoortolimitroomtrafficwhilepreparingthesterilefield2)Usingcleanprocedureglovestohandlesterileequipment3)Placingthenonsterilesyringescontainingflushsolutiononthesterilefield4)Remaining6inchesawayfromthesterilefieldduringtheprocedure____9.Apatientdevelopslocalizedheatanderythemaoveranareaonthelowerleg.Thesefindingsareindicativeofwhichsecondarydefenseagainstinfection?1)Phagocytosis2)Complementcascade3)Inflammation4)Immunity____10.Thepatientsuddenlydevelopshives,shortnessofbreath,andwheezingafterreceivinganantibiotic.Whichantibodyisprimarilyresponsibleforthispatientsresponse?1)IgA2)IgE3)IgG4)IgM____11.Whattypeofimmunityisprovidedbyintravenous(IV)administrationofimmunoglobulinG?1)Cell-mediated2)Passive3)Humoral4)Active

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____12.Apatientasksthenursewhythereisnovaccineavailableforthecommoncold.Whichresponsebythenurseiscorrect?1)Thevirusmutatestoorapidlytodevelopavaccine.2)Vaccinesaredevelopedonlyforveryseriousillnesses.3)ResearchersarefocusingeffortsonanHIVvaccine.4)Thevirusforthecommoncoldhasnotbeenidentified.____13.Apatientwhohasatemperatureof101F(38.3C)mostlikelyrequires:1)acetaminophen(Tylenol).2)increasedfluids.3)bedrest.4)tepidbath.____14.Whyisalotionwithoutpetroleumpreferredoverapetroleum-basedproductasaskinprotectant?It:1)Preventsmicroorganismsfromadheringtotheskin.2)Facilitatestheabsorptionoflatexproteinsthroughtheskin.3)Decreasestheriskoflatexallergies.4)Preventstheskinfromdryingandchaffing.____15.Forwhichrangeoftimemustanursewashherhandsbeforeworkingintheoperatingroom?1)1to2minutes2)2to4minutes3)2to6minutes4)6to10minutes____16.Howshouldthenursedisposeofthebreakfasttrayofapatientwhorequiresairborneisolation?1)Placethetrayinaspeciallymarkedtrashcaninsidethepatientsroom.2)Placethetrayinaspecialisolationbagheldbyasecondhealthcareworkeratthepatientsdoor.3)Returnthetraywithanotetodietaryservicessoitcanbecleanedandreusedforthenextmeal.4)Carrythetraytoanisolationtrashreceptaclelocatedinthedirtyutilityroomanddisposeofitthere.____17.Howmuchliquidsoapshouldthenurseuseforeffectivehandwashing?Atleast:1)2mL2)3mL3)6mL4)7mL

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____18.Toassureeffectiveness,whenshouldthenursestoprubbingantiseptichandsolutionoverallsurfacesofthehands?1)Whenfingersfeelsticky2)After5to10seconds3)Whenleavingtheclientsroom4)Oncefingersandhandsfeeldry____19.Apatientisadmittedtothehospitalforchemotherapyandhasalowwhitebloodcellcount.Whichprecautionshouldthestafftakewiththispatient?1)Contact2)Protective3)Droplet4)Airborne____20.Whiledonningsterilegloves,thenursenoticestheedgesoftheglovepackageareslightlyyellow.Theyellowareaisover1inchawayfromtheglovesandonlyappearstobeontheoutsideoftheglovepackage.Whatisthebestactionforthenursetotakeatthispoint?1)Continueusingtheglovesinsidethepackagebecausethepackageisintact.2)Removeglovesfromsterilefieldanduseanewpairofsterilegloves.3)Throwallsuppliesawaythatweretobeusedandbeginagain.4)Usetheglovesandmakesuretheyellowedgesofthepackagedonottouchtheclient.____21.Thenurseisremovingpersonalprotectiveequipment(PPE).Whichitemshouldberemovedfirst?1)Gown2)Gloves3)Faceshield4)Haircovering____22.Anurseissplashedinthefacebybodyfluidduringaprocedure.Prioritizethenursesactions,listingthemostimportantonefirst.A.ContactemployeehealthB.CompleteanincidentreportC.WashtheexposedareaD.Reporttoanothernursethatsheisleavingtheimmediatearea.1)1,2,3,42)2,3,4,13)3,4,1,24)4,1,2,3MultipleResponseIdentifyoneormorechoicesthatbestcompletethestatementoranswerthequestion.____1.Inwhichsituationwouldusingstandardprecautionsbeadequate?Selectallthatapply.

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1)Whileinterviewingaclientwithaproductivecough2)Whilehelpingaclienttoperformhisownhygienecare3)Whileaidingaclienttoambulateaftersurgery4)Whileinsertingaperipheralintravenouscatheter____2.Whichofthefollowingprotect(s)thebodyagainstinfection?Selectallthatapply.1)Eatingahealthywell-balanceddiet2)Beinganolderadultoraninfant3)Leisureactivitiesthreetimesaweek4)Exercisingfor30minutes5daysaweek____3.Thenurseisteachingagroupofnewlyhirednursingassistivepersonnel(NAP)aboutproperhandwashing.ThenursewillknowthattheteachingwaseffectiveiftheNAPdemonstratewhat?Selectallthatapply.TheNAP:1)usesapapertoweltoturnoffthefaucet.2)holdsfingertipsabovethewristswhilerinsingoffthesoap.3)removesallringsandwatchbeforewashinghands.4)cleansunderneatheachfingernail.____4.Alcohol-basedsolutionsforhandhygienecanbeusedtocombatwhichtypesoforganisms?Selectallthatapply.1)Virus2)Bacterialspores3)Yeast4)Mold____5.Apatientwithtuberculosisisscheduledforcomputedtomography(CT).Howshouldthenurseproceed?Selectallthatapply.1)Questiontheorderbecausethepatientmustremaininisolation.2)PlaceanN-95respiratormaskonthepatientandtransporthimtothetest.3)PlaceasurgicalmaskonthepatientandtransporthimtoCTlab.4)Notifythecomputedtomographydepartmentaboutprecautionspriortotransport.True/FalseIndicatewhetherthestatementistrueorfalse.____1.Bacteriaarenecessaryforhumanhealthandwell-being.Chapter1.DiseasepreventionAnswerSectionMULTIPLECHOICE1.ANS:3Patientsacquireinfectionbycontactwithotherpatients,familymembers,andhealthcareequipment.Butmostinfectionamongpatientsisspreadthroughthehandsofhealthcareworkers.Handwashinginterruptsthetransmissionandshouldbedonebeforeandafterallcontactwith

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patients,regardlessofthediagnosis.Whenthehandsaresoiled,healthcarestaffshoulduseantibacterialsoapwithwarmwatertoremovedirtanddebrisfromtheskinsurface.Whennovisibledirtispresent,analcohol-basedrubshouldbeappliedandallowedtodryfor10to15seconds.2.ANS:3Patientsareexposedtomicrobesbycontact(directcontact,airborne,orotherwise)withotherpatients,familymembers,andcontaminatedhealthcareequipment.Someofthesearepathogenic(causeillness)andsomearenonpathogenic(donotcauseillness).Butmostmicrobescausinginfectionamongpatientsarespreadbydirectcontactonthehandsofhealthcareworkers.3.ANS:1Scrupuloushandwashingisthemostimportantpartofmedicalasepsis.Donninggloves,applyingsteriledrapesbeforeprocedures,andwearingaprotectivegownmaybeneededtoensureasepsis,buttheyarenotthemostimportantaspectbecausemicrobescausingmosthealthcare-relatedinfectionsaretransmittedbylackoforineffectivehandwashing.4.ANS:4Somepeoplemightharborapathogenicorganism,suchasthehumanimmunodeficiencyviruswithintheirbody,andyetdonotacquirethedisease/infection.Theseindividuals,calledcarriers,havenooutwardsignofactivedisease,yettheycanpasstheinfectiontoothers.Apathogenisanorganismcapableofcausingdisease.Afomiteisacontaminatedobjectthattransfersapathogen,suchaspens,stethoscopes,andcontaminatedneedles.Avectorisanorganismthatcarriesapathogentoasusceptiblehostthroughaportalforentryintothebody.Anexampleofavectorisamosquitoortickthatbitesorstings.5.ANS:2Theorganismsresponsibleformeaslesandtuberculosis,aswellasmanyfungalinfections,arespreadthroughairbornetransmission.Neisseriameningitidis,theorganismthatcausesmeningitis,isspreadthroughdroplettransmission.Pathogensthatcausediarrhea,suchasClostridiumdifficile,arespreadbydirectcontact.Thecommoncoldcanbespreadbyindirectcontactordroplettransmission.6.ANS:1Thrushinthispatientisanexampleofanendogenous,nosocomialinfection.Thistypeofinfectionarisesfromsuppressionofthepatientsnormalfloraasaresultofsomeformoftreatment,suchasantibiotics.Normalflorausuallykeepyeastfromgrowinginthemouth.Inexogenousnosocomialinfection,thepathogenarisesfromthehealthcareenvironment.Alatentinfectioncausesnosymptomsforlongperiods.Anexampleofalatentinfectionishumanimmunodeficiencyvirusinfection.Aprimaryinfectionisthefirstinfectionthatoccursinapatient.7.ANS:3Thestageofdeclineoccurswhenthepatientsimmunedefenses,alongwithanymedicaltherapies(inthiscaseantibiotics),aresuccessfullyreducingthenumberofpathogenicmicrobes.Asaresult,thesignsandsymptomsofinfectionbegintofade.Incubationisthestagebetweentheinvasionbytheorganismandtheonsetofsymptoms.Duringtheincubationstage,thepatientdoesnotknowheisinfectedandiscapableofinfectingothers.Theprodromalstageischaracterizedbythefirstappearanceofvaguesymptoms.Convalescenceischaracterizedbytissuerepairandareturntohealastheorganismsdisappear.8.ANS:1

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Tomaintainsteriletechnique,thenurseshouldclosethepatientsdoorandlimitthenumberofpersonsenteringandexitingtheroombecauseaircurrentscancarrydustandmicroorganisms.Sterilegloves,notcleangloves,shouldbeusedtohandlesterileequipment.Placingnonsterilesyringesonthesterilefieldcontaminatesthefield.Onefoot,not6inches,isrequiredbetweenpeopleandthesterilefieldtopreventcontamination.9.ANS:3Theclassicsignsofinflammation,asecondarydefenseagainstinfection,areerythema(redness)andlocalizedheat.Thesecondarydefensesphagocytosis(processbywhichwhitebloodcellsengulfanddestroypathogens)andthecomplementcascade(processbywhichbloodproteinstriggerthereleaseofchemicalsthatattackthecellmembranesofpathogens)donotproducevisiblefindings.Immunityisatertiarydefensethatprotectsthebodyfromfutureinfection.10.ANS:2Thepatientismostlikelyexperiencinganallergicresponsetotheantibiotic.IgEistheantibodyprimarilyresponsibleforthisallergicresponse.TheantibodiesIgA,IgG,andIgMarenotinvolvedintheallergicresponse.IgAantibodiesprotectthebodyfrominfightingviralandbacterialinfections.IgGantibiotiesaretheonlytypethatcrosstheplacentainapregnantwomentoprotectherunbornbaby(fetus).IgMarethefirstantibodiesmadeinresponsetoinfection.11.ANS:2IntravenousadministrationofimmunoglobulinGprovidesthepatientwithpassiveimmunity.ImmunoglobulinGdoesnotprovidecell-mediated,humoral,oractiveimmunity.Passiveimmunityoccurswhenantibodiesaretransferredbyantibodiesfromanimmunehost,suchasfromaplacentatoafetus.Passiveimmunityisshort-lived.Activeimmunityislongerlivedandcomesfromthehostitself.Humoralimmunityoccursbysecretedantibodiesbindingtoantigens.Cell-mediatedimmunitydoesnotinvolveantibodiesbutratherfightinfectionfrommacrophagesthatkillspathogens.12.ANS:1Morethan200virusesareknowntocausethecommoncold.Thesevirusesmutatetoorapidlytodevelopavaccine.AlthoughsomeresearchersarefocusingeffortsonavaccineforHIVinfection,otherscontinuetoresearchthecommoncold.13.ANS:2Fever,acommondefenseagainstinfection,increaseswaterloss;therefore,additionalfluidisneededtosupplementthisloss.Acetaminophenandatepidbatharenotnecessaryforthislow-gradefeverbecausefeverisbeneficialinfightinginfection.Adequaterest,notnecessarilybedrest,isnecessarywithafever.14.ANS:3Nonpetroleum-basedlotionispreferredbecauseitpreventstheabsorptionoflatexproteinsthroughtheskin,whichcancauselatexallergy.Bothtypesoflotionpreventtheskinfromdryingandbecomingchafed.Neitherpreventsmicroorganismsfromadheringtotheskin.15.ANS:3Inasurgicalsetting,handsshouldbewashedfor2to6minutes,dependingonthetypeofsoapused.16.ANS:2Patientswhorequireairborneisolationareservedmealsondisposabledishesandtrays.Todisposeofthetray,thenurseinsidetheroommustwearprotectivegarbandplacethetrayandits

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contentsinsideaspecialisolationbagthatisheldbyasecondhealthcareworkeratthepatientsdoor.Theitemsmustbeplacedontheinsideofthebagwithouttouchingtheoutsideofthebag.17.ANS:2APICguidelinesdictatethat3to5mLofliquidsoapisnecessaryforeffectivehandwashing.18.ANS:4Thenurseshouldrubtheantiseptichandsolutionoverallsurfacesofthehandsuntilthesolutiondries,usually10to15seconds,toensureeffectiveness.19.ANS:2Protectiveisolationisusedtoprotectthosepatientswhoareunusuallyvulnerabletoorganismsbroughtinbyhealthcareworkers.Suchpatientsincludethosewithlowwhitebloodcellcounts,withburns,andundergoingchemotherapy.Somehospitalunits,suchasneonatalintensivecareunitsandlaboranddeliverysuites,alsouseformsofprotectiveisolation.20.ANS:2Theglovesshouldbethrownawaybecausetheglovesarelikelytobecontaminatedfromanoutsidesource.Thesuppliesdonothavetobethrownawaybecausetheyhavenotbeencontaminated.21.ANS:2TheglovesareremovedfirstbecausetheyareusuallythemostcontaminatedPPEandmustberemovedtoavoidcontaminationofcleanareasoftheotherPPEduringtheirremoval.Thegownisremovedsecond,thenthemaskorfaceshield,andfinally,thehaircovering.22.ANS:3Ifanursebecomesexposedtobodyfluid,sheshouldfirstwashthearea,tellanothernursesheisleavingthearea,contacttheinfectioncontroloremployeehealthnurseimmediately,andcompleteanincidentreport.Itismostimportanttoremovethesourceofcontamination(bodyfluid)assoonaspossibleafterexposuretohelppreventthenursesfrombecominginfected.Theotheractivitiescanwaituntilthatisdone.MULTIPLERESPONSE1.ANS:3,4Standardprecautionsshouldbeinstitutedwithallclientswheneverthereisapossibilityofcomingincontactwithblood,bodyfluids(exceptsweat),excretions,secretions,mucousmembranes,andbreaksintheskin(e.g.,whileinsertingaperipheralIV).Wheninterviewingaclient,ifthediseaseisnotspreadbyairordroplets,thereisnolikelihoodofthenursesencounteringbodyfluids.Ifthediseaseisspreadbyairordroplets,thendropletorairborneprecautionswouldbeneededinadditiontostandardprecautions.Ifgivingacompletebedbathorperformingoralhygiene,thenursewouldneedtousestandardprecautions(gloves);ifmerelyassistingaclienttoperformthoseADLs,itisnotnecessary.Noexposuretobodyfluidsislikelywhenhelpingaclienttoambulateaftersurgery.2.ANS:1,3,4Nutrition,hygiene,rest,exercise,stressreduction,andimmunizationprotectthebodyagainstinfection.Illness,injury,medicaltreatment,infancyoroldage,frequentpubliccontact,andvariouslifestylefactorscanmakethebodymoresusceptibletoinfection.3.ANS:1,3,4Handwashingrequiresatleast15secondsofwashing,whichincludeslatheringallsurfacesofthehandsandfingerstobeeffective.Thefingersshouldbeheldlowerthanthewrists.4.ANS:1,3,4

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Ifthereispotentialforcontactwithbacterialspores,handsmustbewashedwithsoapandwater;alcohol-basedsolutionsareineffectiveagainstbacterialspores.5.ANS:3,4Transportingapatientwhorequiresairborneprecautionsshouldbelimited;however,whennecessarythepatientshouldwearasurgicalmask(anN-95respiratormaskisnotrequired)thatcoversthemouthandnosetopreventthespreadofinfection.Moreover,thedepartmentwherethepatientisbeingtransportedshouldbenotifiedabouttheprecautionsbeforetransport.TRUE/FALSE1.ANS:TOrganismsthatnormallyinhabitthebody,callednormalflora,areessentialforhumanhealthandwell-being.Theykeeppathogensincheck.Intheintestine,theseflorafunctiontoaiddigestionandpromotethereleaseofvitaminK,vitaminB12,thiamine,andriboflavin.Chapter 1 Health Promotion (Part 2)____1.Aclientinformsthenursethathehasquitsmokingbecausehisfatherdiedfromlungcancer3monthsago.Basedonhismotivation,smokingcessationshouldberecognizedasanexampleofwhichofthefollowing?1)Healthyliving2)Healthpromotion3)Wellnessbehaviors4)Healthprotection____2.Apatientwithmorbidobesitywasenrolledinaweightlossprogramlastmonthandhasattendedfourweeklymeetings.Butnowhebelieveshenolongerneedstoattendmeetingsbecausehehaslearnedwhattodo.Heinformsthenursefacilitatorabouthisdecisiontoquittheprogram.Whatshouldthenursetellhim?1)Bynowyouhavesuccessfullycompletedthestepsofthechangeprocess.Youshouldbeabletosuccessfullylosetherestoftheweightonyourown.2)Althoughyouhavelearnedsomehealthyhabits,youwillneedatleastanother6weeksbeforeyoucanquittheprogramandhavesuccess.3)Youhavedonewellinthisprogram.However,itisimportanttocontinueintheprogramtolearnhowtomaintainweightloss.Otherwise,youarelikelytoreturntoyourpreviouslifestyle.4)Youhaveenteredthedeterminationstageandarereadytomakepositivechangesthatyoucankeepfortherestofyourlife.Ifyouneedadditionalhelp,youcancomebackatalatertime.____3.Theschoolnurseatalocalelementaryschoolisperformingphysicalfitnessassessmentsonthethird-gradechildren.Whenassessingstudentscardiorespiratoryfitness,themostappropriatetestistohavethestudents:1)Stepupanddownona12-inchbench.2)Performthesit-and-reachtest.3)Runamilewithoutstopping,iftheycan.4)Performrange-of-motionexercises.

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____4.IntheLeavellandClarkmodelofhealthprotection,thechiefdistinctionbetweenthelevelsofpreventionis:1)Thepointinthediseaseprocessatwhichtheyoccur.2)PlacementontheWheelsofWellness.3)Thelevelofactivityrequiredtoachievethem.4)PlacementintheModelofChange.____5.Themusclestrengthofawomanweighing132poundswhoisabletolift72poundswouldberecordedaswhichofthefollowing?1)1.832)Moderate3)0.554)18.3%____6.Whichisoneofthegreatestconcernswithheavyandchronicuseofalcoholinteensandyoungadults?1)Liverdamage2)Unintentionaldeath3)Tobaccouse4)Obesity____7.A55-year-oldmansufferedamyocardialinfarction(heartattack)threemonthsago.Duringhishospitalization,hehadstentsinsertedintwolocationsinthecoronaryarteries.Hewasalsoplacedonacholesterol-loweringagentandtwoantihypertensives.Whattypeofcareishereceiving?1)Primaryprevention2)Secondaryprevention3)Tertiaryprevention4)Healthpromotion____8.Healthscreeningactivitiesaredesignedto:1)Detectdiseaseatanearlystage.2)Determinetreatmentoptions.3)Assesslifestylehabits.4)Identifyhealthcarebeliefs.____9.Whichindividualsshouldreceiveannuallipidscreening?1)Alloverweightchildren2)Alladults20yearsandolder3)Personswithtotalcholesterolgreaterthan150mg/dL4)PersonswithHDLlessthan40mg/dL

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____10.Amotherofthreeyoungchildrenisnewlydiagnosedwithbreastcancer.Sheisintenselycommittedtofightingthecancer.Shebelievesshecancontrolhercancertosomedegreewithapositiveattitudeandfeelingsofinnerstrength.Whichofthefollowingtraitsisshedemonstratingthatislinkedtohealthandhealing?1)Invincibility2)Hardiness3)Baselinestrength4)VulnerabilityMultipleResponseIdentifyoneormorechoicesthatbestcompletethestatementoranswerthequestion.____1.TheWorldHealthOrganizationsdefinitionofhealthincludeswhichofthefollowing?Chooseallthatapply.1)Absenceofdisease2)Physicalwell-being3)Mentalwell-being4)Socialwell-being____2.AccordingtoPendershealthpromotionmodel,whichvariablesmustbeconsideredwhenplanningahealthpromotionprogramforaclient?Chooseallthatapply.1)Individualcharacteristicsandexperiences2)Levelsofprevention3)Behavioraloutcomes4)Behavior-specificcognitionsandaffect____3.GoalsforHealthyPeople2020includewhichofthefollowing?Chooseallthatapply.1)Eliminatehealthdisparitiesamongvariousgroups.2)Decreasethecostofhealthcarerelatedtotobaccouse.3)Increasethequalityandyearsofhealthylife.4)Decreasethenumberofinpatientdaysannually.____4.Thenurseisimplementingawellnessprogrambasedondatagatheredfromagroupoflow-incomeseniorslivinginahousingproject.HeisusingtheWheelsofWellnessasamodelforhisplannedinterventions.Whichofthefollowinginterventionswouldbeappropriatebasedonthismodel?Chooseallthatapply.1)Creatingaweeklydiscussiongroupfocusedoncontemporarynews2)Facilitatingarelationshipbetweenlocalpastorsandresidentsofsubsidizedhousing3)Coordinatingaseniortutorialprogramforlocalchildrenatthehousingcenter4)Establishinganon-sitehealthcareclinicoperatingonedayperweek____5.Thenurseworkinginanambulatorycareprogramasksquestionsabouttheclientslocusofcontrolasapartofhisassessmentbecauseofwhichofthefollowing?Chooseallthatapply.1)Peoplewhofeelinchargeoftheirownhealtharetheeasiesttomotivatetowardchange.

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2)Peoplewhofeelpowerlessaboutpreventingillnessareleastlikelytoengageinhealthpromotionactivities.3)Peoplewhorespondtodirectionfromrespectedauthoritiesoftenpreferahealthpromotionprogramthatissupervisedbyahealthprovider.4)Peoplewhofeelinchargeoftheirownhealtharelessmotivatedbyhealthpromotionactivities.____6.Healthpromotionprogramsassistapersontoadvancetowardoptimalhealth.Whichofthefollowingactivitiesmightsuchprogramsinclude?Chooseallthatapply.1)Disseminatinginformation2)Changinglifestyleandbehavior3)Prescribingmedicationstotreatunderlyingdisorders4)Environmentalcontrolprograms____7.Whichofthefollowingactionsdemonstratehownursespromotehealth?1)Rolemodeling2)Educatingpatientsandfamilies3)Counseling4)ProvidingsupportCompletionCompleteeachstatement.1.Amiddle-agedwomanperformsbreastself-examinationmonthly.Thisinterventionisconsideredtobe____________________prevention.2.____________________referstonursingactionsperformedtohelpclientstoachieveanoptimalstateofhealth.3.Whatisthenameofthenursingtheoristwhodefineshealthashavingthreeelements:ahighlevelofoverallphysical,mental,andsocialfunctioning;ageneraladaptive-maintenancelevelofdailyfunctioning;andtheabsenceofillness(orthepresenceofeffortsthatleadtoitsabsence)?____________________Chapter1.HealthPromotion(Part2)AnswerSectionMULTIPLECHOICE1.ANS:4Althoughhealthpromotionandhealthprotectionmayinvolvethesameactivities,theirdifferenceliesinthemotivationforaction.Healthprotectionismotivatedbyadesiretoavoidillness.Healthpromotionismotivatedbythedesiretoincreasewellness.Smokingcessationmayalsobeawellnessbehaviorandmaybeconsideredasteptowardhealthyliving;however,neitheroftheseaddressesmotivationforaction.Comprehension2.ANS:3ProchaskaandDiclementeidentifiedfourstagesofchange:thecontemplationstage,thedeterminationstage,theactionstage,andthemaintenancestage.Thispatientdemonstratesbehaviorstypicaloftheactionstage.Ifaparticipantexitsaprogrambeforetheendofthemaintenancestage,relapseislikelytooccurastheindividualresumeshispreviouslifestyle.

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3.ANS:3Fieldtestsforrunningaregoodforchildrenandcanbeutilizedwhenassessingcardiorespiratoryfitness.Thesteptestisappropriateforadults.The12-inchbenchheightistoohighforyoungchildren.Thesit-and-reachtestaswellasrange-of-motionexerciseswouldbeappropriatewhenassessingflexibility.4.ANS:1LeavellandClarkidentifiedthreelevelsofactivitiesforhealthprotection:primary,secondary,andtertiary.Interventionsareclassifiedaccordingtothepointinthediseaseprocessinwhichtheyoccur.5.ANS:3Musclestrengthmeasurestheamountofweightamuscle(orgroupofmuscles)canmoveatonetime.Thisisrecordedasaratioofweightpushed(orlifted)dividedbybodyweight.Awomanweighing132poundswhoisabletolift72poundshasaratioof72dividedby132,or0.55.6.ANS:2Heavyandchronicuseofalcoholanduseofillicitdrugsincreasetheriskofdiseaseandinjuriesandintentionaldeath(suicideandhomicide).Althoughalcoholasadepressantslowsmetabolism,chronicalcoholuseismorelikelyassociatedwithpoornutrition,whichmayormaynotleadtoobesity.Chronicalcoholusecausesdamagetolivercellsovertimeinthelateryears.Alcoholintakeisoftenassociatedwithtobaccoandrecreationaldruguse;however,theriskofunintentionalinjury,suchascaraccident,suicide,orviolence,ismoreconcerningthansmoking.7.ANS:3Primarypreventionactivitiesaredesignedtopreventorslowtheonsetofdisease.Activitiessuchaseatinghealthyfoods,exercising,wearingsunscreen,obeyingseat-beltlaws,andgettingimmunizationsareexamplesofprimarylevelinterventions.Secondarypreventionactivitiesdetectillnesssoitcanbetreatedintheearlystages.Tertiarypreventionfocusesonstoppingthediseasefromprogressingandreturningtheindividualtothepre-illnessphase.Thepatienthasanestablisheddiseaseandisreceivingcaretostopthediseasefromprogressing.8.ANS:1Healthscreeningactivitiesaredesignedtodetectdiseaseatanearlystagesothattreatmentcanbeginbeforethereisanopportunityfordiseasetospreadorbecomedebilitating.9.ANS:1TheAmericanAcademyofPediatricstakeatargetedapproach,recommendingthatoverweightchildrenreceivecholesterolscreening,regardlessoffamilyhistoryorotherriskfactorsforcardiovasculardisease.TheAmericanHeartAssociationrecommendsthatalladultsage20yearsorolderhaveafastinglipidpanelatleastonceevery5years.Iftotalcholesterolis200mg/dLorgreaterorHDLislessthan40mg/dLfrequentmonitoringisrequired.10.ANS:2Researchhasalsodemonstratedthatinthefaceofdifficultlifeevents,somepeopledevelophardinessratherthanvulnerability.Hardinessisaqualityinwhichanindividualexperienceshighlevelsofstressyetdoesnotfallill.Therearethreegeneralcharacteristicsofthehardyperson:control(beliefintheabilitytocontroltheexperience),commitment(feelingdeeplyinvolvedintheactivityproducingstress),andchallenge(theabilitytoviewthechangeasachallengetogrow).Thesetraitsareassociatedwithastrongresistancetonegativefeelingsthatoccurunderadversecircumstances.MULTIPLERESPONSE1.ANS:2,3,4

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TheWorldHealthOrganizationdefineshealthasastateofcompletephysical,mental,andsocialwell-being,notmerelytheabsenceofdiseaseofinfirmity.2.ANS:1,3,4Penderidentifiedthreevariablesthataffecthealthpromotion:individualcharacteristicsandexperiences,behavior-specificcognitionsandaffect,andbehavioraloutcomes.LevelsofpreventionwereidentifiedbyLeavellandClark;threelevelsrelatetohealthprotection.Thelevelsdifferbasedontheirtimingintheillnesscycle.3.ANS:1,3ThefouroverarchinggoalsofHealthyPeople2020areto1)increasethequalityandyearsofhealthylife,freeofdisease,injury,andprematuredeath,2)eliminatehealthdisparitiesandimprovehealthforallgroupsofpeople,3)createphysicalandsocialenvironmentsforpeopletoliveahealthylife,and4)promotehealthydevelopmentforpeopleinallstagesoflife.4.ANS:1,2,3,4TheWheelsofWellnessmodelidentifiesthefollowingdimensionsofhealth:emotional,intellectual,physical,spiritual,social/family,andoccupational.Aweeklydiscussiongroupstimulatesintellectualhealth.Arelationshipbetweenlocalpastorsandthoselivinginsubsidizedhousingcreatesaclimateforspiritualhealth.Atutorialprogramofferedbyseniorstolocalchildrenwillfacilitateoccupationalhealth.Anon-sitehealthcareclinicaddressesphysicalhealth.5.ANS:1,2,3Identifyingapersonslocusofcontrolhelpsthenursedeterminehowtoapproachaclientabouthealthpromotion.Peoplewhofeelpowerlessaboutpreventingillnessareleastlikelytoengageinhealthpromotionactivities.Peoplewhorespondtodirectionfromrespectedauthoritiesoftenpreferahealthpromotionprogramthatissupervisedbyahealthprovider.Clientswhofeelinchargeoftheirownhealtharetheeasiesttomotivatetowardpositivechange.6.ANS:1,2,4Healthpromotionprogramsmaybecategorizedintofourtypes:disseminatinginformation;programsforchanginglifestyleandbehavior;environmentalcontrolprograms;andwellnessappraisalandhealthriskassessmentprograms.Prescribingmedicationstotreatunderlyingdisordersisanactivitythatfostershealthfocusedatanindividuallevelratherthanatagroupprogramlevel.7.ANS:1,2,3,4Nursespromotehealthbyactingasrolemodels,counseling,providinghealtheducation,andprovidingandfacilitatingsupport.1.ANS:secondarySecondarypreventionactivitiesdetectillnesssothatitcanbetreatedintheearlystages.Healthactivitiessuchasmammograms,testicularexaminations,regularphysicalexaminations,bloodpressureanddiabetesscreenings,andtuberculosisskintestsareexamplesofsecondaryinterventions.Primarypreventionactivitiesaredesignedtopreventorslowtheonsetofdiseaseandpromotehealth.Activitiessuchaseatinghealthyfoods,exercising,wearingsunscreen,obeyingseat-beltlaws,andgettingimmunizationsareexamplesofprimarylevelinterventions.Tertiarypreventionfocusesonstoppingthediseasefromprogressingandreturningtheindividualtothepre-illnessphase.Chapter 2. Common Symptoms

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1.Thenurseislisteningtothebreathsoundsofapatientwithsevereasthma.Airpassingthroughnarrowedbronchioleswouldproducewhichoftheseadventitioussounds?a.Wheezesb.Bronchialsoundsc.Bronchophonyd.WhisperedpectoriloquyANS:AWheezesarecausedbyairsqueezedorcompressedthroughpassagewaysnarrowedalmosttoclosurebycollapsing,swelling,secretions,ortumors,suchaswithacuteasthmaorchronicemphysema.2.Amotherbringsher3-month-oldinfanttotheclinicforevaluationofacold.Shetellsthenursethathehashadarunnynoseforaweek.Whenperformingthephysicalassessment,thenursenotesthatthechildhasnasalflaringandsternalandintercostalretractions.Thenursesnextactionshouldbeto:a.Assurethemotherthatthesesignsarenormalsymptomsofacold.b.Recognizethattheseareserioussigns,andcontactthephysician.c.Askthemotheriftheinfanthashadtroublewithfeedings.d.Performacompletecardiacassessmentbecausethesesignsareprobablyindicativeofearlyheartfailure.ANS:BTheinfantisanobligatorynosebreatheruntiltheageof3months.Normally,noflaringofthenostrilsandnosternalorintercostalretractionoccurs.Significantretractionsofthesternumandintercostalmusclesandnasalflaringindicateincreasedinspiratoryeffort,asinpneumonia,acuteairwayobstruction,asthma,andatelectasis;therefore,immediatereferraltothephysicianiswarranted.Thesesignsdonotindicateheartfailure,andanassessmentoftheinfantsfeedingisnotapriorityatthistime.3.Ateenagepatientcomestotheemergencydepartmentwithcomplaintsofaninabilitytobreatheandasharppainintheleftsideofhischest.Theassessmentfindingsincludecyanosis,tachypnea,trachealdeviationtotheright,decreasedtactilefremitusontheleft,hyperresonanceontheleft,anddecreasedbreathsoundsontheleft.Thenurseinterpretsthattheseassessmentfindingsareconsistentwith:a.Bronchitis.b.Pneumothorax.c.Acutepneumonia.d.Asthmaticattack.ANS:BWithapneumothorax,freeairinthepleuralspacecausespartialorcompletelungcollapse.Ifthepneumothoraxislarge,thentachypneaandcyanosisareevident.Unequalchestexpansion,decreasedorabsenttactilefremitus,trachealdeviationtotheunaffectedside,decreasedchest

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expansion,hyperresonantpercussiontones,anddecreasedorabsentbreathsoundsarefoundwiththepresenceofpneumothorax.4.Thenursehasjustrecordedapositiveiliopsoastestonapatientwhohasabdominalpain.Thistestisusedtoconfirma(n):a.Inflamedliver.b.Perforatedspleen.c.Perforatedappendix.d.Enlargedgallbladder.ANS:CAninflamedorperforatedappendixirritatestheiliopsoasmuscle,producingpainintheRLQ.5.Whichstatementindicatesthatthenurseunderstandsthepainexperiencedbyanolderadult?a.Olderadultsmustlearntotoleratepain.b.Painisanormalprocessofagingandistobeexpected.c.Painindicatesapathologicconditionoraninjuryandisnotanormalprocessofaging.d.Olderindividualsperceivepaintoalesserdegreethandoyoungerindividuals.ANS:CPainindicatesapathologicconditionoraninjuryandshouldneverbeconsideredsomethingthatanolderadultshouldexpectortolerate.Painisnotanormalprocessofaging,andnoevidencesuggeststhatpainperceptionisreducedwithaging.6.Inassessingthetonsilsofa30yearold,thenursenoticesthattheyareinvoluted,granularinappearance,andappeartohavedeepcrypts.Whatiscorrectresponsetothesefindings?a.Referthepatienttoathroatspecialist.b.Noresponseisneeded;thisappearanceisnormalforthetonsils.c.Continuewiththeassessment,lookingforanyotherabnormalfindings.d.Obtainathroatcultureonthepatientforpossiblestreptococcal(strep)infection.ANS:BThetonsilsarethesamecolorasthesurroundingmucousmembrane,althoughtheylookmoregranularandtheirsurfaceshowsdeepcrypts.Tonsillartissueenlargesduringchildhooduntilpubertyandtheninvolutes.7.Thenurseisobtainingahealthhistoryona3-month-oldinfant.Duringtheinterview,themotherstates,Ithinksheisgettingherfirsttoothbecauseshehasstarteddroolingalot.Thenursesbestresponsewouldbe:a.Youreright,droolingisusuallyasignofthefirsttooth.b.Itwouldbeunusualfora3montholdtobegettingherfirsttooth.c.Thiscouldbethesignofaproblemwiththesalivaryglands.d.Sheisjuststartingtosalivateandhasntlearnedtoswallowthesaliva.

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ANS:DIntheinfant,salivationstartsat3months.Thebabywilldroolforafewmonthsbeforelearningtoswallowthesaliva.Thisdroolingdoesnotheraldtheeruptionofthefirsttooth,althoughmanyparentsthinkitdoes.8.Thenurseisassessingan80-year-oldpatient.Whichofthesefindingswouldbeexpectedforthispatient?a.Hypertrophyofthegumsb.Increasedproductionofsalivac.Decreasedabilitytoidentifyodorsd.FinerandlessprominentnasalhairANS:CThesenseofsmellmaybereducedbecauseofadecreaseinthenumberofolfactorynervefibers.Nasalhairsgrowcoarserandstifferwithaging.Thegumsmayrecedewithaging,nothypertrophy,andsalivaproductiondecreases.9.Thenurseispalpatingthesinusareas.Ifthefindingsarenormal,thenthepatientshouldreportwhichsensation?a.Nosensationb.Firmpressurec.Painduringpalpationd.PainsensationbehindeyesANS:BThepersonshouldfeelfirmpressurebutnopain.Sinusareasaretendertopalpationinpersonswithchronicallergiesoranacuteinfection(sinusitis).10.A60-year-oldmanhasjustbeentoldthathehasbenignprostatichypertrophy(BPH).Hehasafriendwhojustdiedfromcanceroftheprostate.Heisconcernedthiswillhappentohim.Howshouldthenurserespond?a.Theswellinginyourprostateisonlytemporaryandwillgoaway.b.Wewilltreatyouwithchemotherapysowecancontrolthecancer.c.Itwouldbeveryunusualforamanyouragetohavecanceroftheprostate.d.Theenlargementofyourprostateiscausedbyhormonalchanges,andnotcancer.ANS:DTheprostateglandcommonlystartstoenlargeduringthemiddleadultyears.BPHispresentin1in10menattheageof40yearsandincreaseswithage.Itisbelievedthatthehypertrophyiscausedbyhormonalimbalancethatleadstotheproliferationofbenignadenomas.Theotherresponsesarenotappropriate.11.Apatientreportsexcruciatingheadachepainononesideofhishead,especiallyaroundhiseye,forehead,andcheekthathaslastedapproximatelyto2hours,occurringonceortwiceeachday.Thenurseshouldsuspect:a.Hypertension.

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b.Clusterheadaches.c.Tensionheadaches.d.Migraineheadaches.ANS:BClusterheadachesproducepainaroundtheeye,temple,forehead,andcheekandareunilateralandalwaysonthesamesideofthehead.Theyareexcruciatingandoccuronceortwiceperdayandlastto2hourseach.12.ApatientsaysthatshehasrecentlynoticedalumpinthefrontofherneckbelowherAdamsapplethatseemstobegettingbigger.Duringtheassessment,thefindingthatleadsthenursetosuspectthatthismaynotbeacancerousthyroidnoduleisthatthelump(nodule):a.Istender.b.Ismobileandnothard.c.Disappearswhenthepatientsmiles.d.Ishardandfixedtothesurroundingstructures.ANS:BPainless,rapidlygrowingnodulesmaybecancerous,especiallytheappearanceofasinglenoduleinayoungperson.However,cancerousnodulestendtobehardandfixedtosurroundingstructures,notmobile.Chapter 3. Preoperative Evaluation & Perioperative ManagementMULTIPLECHOICE1.Thenurse is identifying diagnoses appropriate for a client scheduled for a surgical procedure.Which of the following is a diagnosis commonly used for preoperative client?

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1.Anxiety2.Sleep deprivation3.Excess fluid volume4.Disturbed body imageANS: 1The preoperative experience may be one of the most tension-producing periods ofhospitalization. The nursing diagnosis anxiety is commonly used for preoperative clients. Theother diagnoses are not commonly used as preoperative diagnoses.2.The preoperative nurse cares for the client until the client progresses into the intraoperativephase of care which begins when the client:1.signs the surgical consent form.2.arrives at the surgical suite doors.3.is transferred to the postanesthesia care unit.4.accepts that surgery is pending.ANS: 2The preoperative period ends and the intraoperative period begins when the patient and familyare at the door to the surgical suites. Intraoperative care does not begin when the client signs thesurgical consent form, is transferred to the postanesthesia care unit, or accepts that surgery ispending.3.The nurse is ensuring that a client is able to make knowledgeable decisions regarding anupcoming surgery and can provide informed consent. What isthe responsibility of the nurseregarding informed consent?1.Explain the surgical options2.Explain the operative risks

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3.Describe the operative procedure to be done4.Witness a patients signatureANS: 4The nurse may concurrently sign that hehas witnessed a patients signature. It is the physiciansresponsibility to explain the other answer choices.PTS: 1 DIF: Apply REF: Decision Strategies and Informed Consent4.A client being prepared for surgery has a pulse oximeter placed on one digit ofhis hand. Thenurse is applying this device to monitor the clients:1.oxygen level.2.heart rate.3.blood pressure.4.urine output.ANS: 1Pulse oximeters are used to precisely identify the clients peripheral tissue oxygenation. Pulseoximeters are not to measure heart rate, blood pressure, or urine output.PTS: 1 DIF: Analyze REF: Trends5.A client is scheduled for surgery in 2 weeks. Which of the following should the nurse instructthe client regarding healthy lifestyle behaviors?1.Eat nutritious meals.2.If obese, cut calories before the surgery.3.If sedentary, exercise more before the surgery.4.Stop all prescribed medications.

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ANS: 1The client should be encouraged to adopt healthy dietary, rest, and exercise habitsbefore thesurgery. A client who has not followed healthy lifestyle habits should not suddenly make thesechanges before a surgical procedure. The nurse should encourage the client to eat nutritiousmeals. A client who is obese should not be encouraged tocut calories before the surgery. Theclient who is sedentary should not be encouraged to suddenly exercise before the surgery. Theclient should not be instructed to stop prescribed medications unless a physician has prescribedthis action.PTS: 1 DIF:Apply REF: Time Frames and Tasks6.The nurse wants to reduce the stress level for a preoperative client. Which of the followingcommunication techniques can the nurse use to achieve this result?1.Allow the client to be alone before the surgery.2.Observe and ask the client if there is anything that can be done to help reduce heranxiety.3.Refer to the client by her first name.4.Make tasteful jokes or comments to help the client laugh.ANS: 2Strategies to reduce preoperative stress includeobserving and asking the client if there isanything that can be done to help reduce her anxiety. Leaving the client alone before the surgerywill not help reduce stress. Referring to the client by her first name might be consideredunprofessional and should not be done. Making jokes is also not a professional behavior andshould not be done by the nurse.PTS: 1 DIF: Apply REF: Nurse/Patient Communication7.Which of the following can the nurse do to help an elderly client scheduled for a surgicalprocedure?1.Work at a slower pace.2.Speed up the pace so the client has time to rest.3.Talk to family members and leave the client alone.

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4.Send them to the surgical holding area in advance.ANS: 1When caring for elderly clients, pace isimportant. Nurses should slow the pace. The nurseshould not ignore the client. The nurse should also not send the client to the surgical holding areain advance since this could prove to be uncomfortable for the elderly client.PTS:1DIF:ApplyREF:Age-Related Issues8.The nurse is concerned that a client scheduled for surgery will be at risk for hypothermia.Which of the following did the nurse assess in this client to determine the risk?1.Client is a vegetarian.2.Client exercises 5 days a week for 30 minutes.3.Client has a history of congestive heart failure.4.Clint is 48 years old.ANS: 3Clients at risk for hypothermia include the very young, the very old, those with a history of heartdisease, those with ableeding tendency, having complex surgery, and having surgery on a largebody area that will be exposed. Being a vegetarian or exercising does not predispose a client todeveloping hypothermia during surgery.PTS:1DIF:AnalyzeREF:Environmental Safety9.Thenurse is concerned that a client may have an undocumented allergy to latex when which ofthe following is assessed?1.Recent episode of appendicitis2.Recovered from bronchitis 3 months ago3.Allergy to specific foods4.Does not like to wearwool clothing

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ANS: 3Risk factors for latex allergy include a history of allergies, for example, food allergies or contactdermatitis (eczema). Appendicitis and bronchitis do not increase the clients risk of a latexallergy. The clients not wearing wool clothing does not increase the clients risk of a latex allergy.PTS: 1 DIF: Analyze REF: Personal Patient Safety10.The nurse is providing a medication to reduce the preoperative clients anxiety. Which of thefollowing medications is the nurse mostlikely providing to the client?1.Hydrogen ion antagonist2.Anticholinergic3.Calcium channel blocker4.OpioidANS: 4Opioids provide analgesia, decrease anxiety, and provide sedation. Calcium channel blockerstreat specific heartproblems. Hydrogen ion antagonists are used to reduce gastric secretions.Anticholinergics are used to reduce oral and respiratory tract secretions.PTS:1DIF:ApplyREFharmacology11.An elderly client scheduled for surgery is concerned that his wife is not going to be able tomanage at home alone. Which of the following can the nurse do to help this client and spouse?1.Encourage the client to not worry about his spouse.2.Ask the client if the spouse would agree to having some help while he ishospitalized.3.Encourage the spouse to come and stay with the client in the hospital.4.Suggest the spouse stay in a hotel until the client is discharged.ANS: 2When the frail elderly and spouse live together, they depend on each other for daily existence.When one is hospitalized, it places both at risk. The nurse should ask the client if the spousewould agree to having some help while the client is hospitalized. Encouraging the client not to

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worry does not take into consideration the risk to the spouse. Having the spouse stay with theclient in the hospital could cause additional health problems for both the client and spouse. Theclients finances might not support the spouse staying in a hotel until the client is discharged.PTS:1DIF:Apply12.A client needs emergency surgery after sustaining injuries from a natural gas explosion. Theclient is not attended by any family member and the surgery cannot wait. Which of the followingcan be done to ensure the best and safest care isprovided to the client?1.Hold the surgery until a family member arrives to the hospital to provide consent.2.Contact a pastor to pray with the client before the surgery.3.Instruct the client in postoperative exercises while waiting for anesthesiato take effect.4.Have a member of the nursing staff try to reach the family at home to provide consentfor the surgery.ANS: 4In the case of an unaccompanied trauma client, the team should make every effort to reach thefamily; however,preservation of life and function is a priority. A member of the nursing staffcan attempt to reach the family for consent, but the surgery should not be delayed until a familymember arrives to provide consent. Since the surgery takes precedence, the clients instruction,psychosocial, and spiritual needs will need to be addressed afterwards.PTS: 1 DIF: Apply REF: Urgent and Emergent Care13.A client who smokes one pack of cigarettes per day tells the nurse that she will need to betaken outside to have acigarette while recovering from surgery. Which of the following can thenurse respond to this client?1.That can be arranged.2.You really should stop smoking before the surgery.3.Your physician will prescribe medication to help reduce thenicotine cravings.4.I can assign someone who will be responsible for transporting you to the smokingsection.

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ANS: 3The client who smokes will have concerns about nicotine withdrawal. The nurse should respondthat medications are available and can beprescribed to help the client through this difficult time.The nurse should not support the clients smoking by saying that being taken out of doors can bearranged or that someone will be assigned to transport the client to the smoking section. Theresponse you really should stop smoking before the surgery does not address the clients concern.PTS: 1 DIF: Apply REF: Population-Based CareMULTIPLERESPONSE1.A client tells the nurse that he has been told that he needs surgery but does not know who toselect as his surgeon. Which of the following should the nurse instruct the client regardingimportant attributes to consider when choosing a surgeon? (Select all that apply.)1.Board certification2.Graduation from a reputable school3.Personality orbedside manner4.Location of office5.Word of mouth from trusted others6.The car he or she drivesANS: 1, 2, 3, 5When choosing a surgeon, a client should consider board certification, graduation from areputable school of medicine,personality and bedside manner, and the opinion of others throughword of mouth. Where the office is located and the car the physician drives are not signs of thesurgeons talent.2.A client tells the nurse that the surgeon has provided the client with a choice of severalhospitals in which to have a surgical procedure performed, but the client does not know whichone to choose. Which of the following can the nurse instruct the client to consider whenchoosing a hospital or surgical center? (Select all thatapply.)1.Does the facility have a national reputation?

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2.Is there an ICU in the hospital?3.Is it close to family?4.Will insurance pay for the stay?5.Does the hospital have magnet status?6.Does it have good food?ANS: 1, 2, 4, 5Theclient should consider the facilitys reputation, the presence of an intensive care unit, if thefacility accepts the clients health insurance coverage, and if the facility has magnet status.Proximity to family and the food served are not good reasons to choose a place to have surgery.3.A client scheduled for surgery is instructed on the use of a patient-controlled analgesic devicethat she will use after the procedure. What are the advantages this device for pain control?(Select all that apply.)1.The client controls the timing of medication delivery.2.The client does not have to wait for a nurse to provide pain medication.3.The nurse does not have to check on the client as frequently.4.The physician does not need to prescribe various painmedication after the surgery.5.The medication is delivered intravenously.6.Pain control improves client comfort after surgery.ANS: 1, 2, 5, 6Advantages to the use of a patient-controlled analgesic device for a client include client paces thetiming of medication delivery, client has control and immediate relief from medications,medications are delivered instantly, medications are delivered intravenously, client has improvedcomfort. The nurse not needing to check on the client as frequently is not an advantage for this

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type of analgesic device. The physician not needing to prescribe various pain medications is notan advantage for this type of device.PTS: 1 DIF: Analyze REF: Trends4.A client is scheduled for a same-day surgical procedure inwhich he will be dischargedafterwards, and he tells the nurse that he does not know what to bring to the hospital. Which ofthe following should the nurse instruct the client? (Select all that apply.)1.Bring identification, but send it home after it isused.2.Bring personal sleepwear to put on after the surgery.3.Bring work-related items.4.Leave important jewelry at home.5.Make a list of all medications and bring the list to the hospital.6.Books and puzzles to be entertained whilewaiting for the surgery.ANS: 1, 4, 5On the day of the surgery, the nurse should instruct the client to bring identification, but to sendit home after it is used; and a list of medications. Important jewelry should be left at home toreduce the risk ofits being lost. Personal sleepwear is most likely not going to be used since theclient will be wearing a hospital gown. Work-related items are not recreational and could beanxiety producing.Books and puzzles would be appropriate if the client is expecting to beadmitted, but they are not necessary for a same-day surgical procedure and discharge.PTS:1DIF:ApplyREFatient Playbook: What to Bring to the Hospital or Surgicenter5.The preoperative nurse has a variety of activities to complete when preparinga client forsurgery. Which of the following are activities of this nurse? (Select all that apply.)1.Awareness of safety considerations2.Assessment of vital signs during the surgery

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3.Physical assessment of the client4.Assessment of theenvironment5.Postoperative care in the recovery room6.Awareness of best practicesANS: 1, 3, 4, 6The nurses role in preparing a client for surgery includes the following activities: awareness ofsafety considerations, physical assessment of theclient, assessment of the environment, andawareness of best practices. The preoperative nurse will not assess vital signs during the surgerynor provide postoperative care in the recovery room.1.A nurse is considering additional training to become a perioperative nurse. Which of thefollowing skills are implemented by the perioperative nurse?1.Conducts telephone interviews with the preoperative client2.Applies principles of aseptic technique3.Instructs the preoperative client onexercises to use while recovering from surgery4.Plans for the postoperative clients discharge to homeANS: 2Skills of the perioperative nurse include applying principles of aseptic technique and explaininghow this knowledge applies to other areas within the operating suite. The perioperative nursedoes not conduct telephone interviews with the preoperative client, instruct the preoperativeclient in postoperative exercises, nor plan for the postoperative clients discharge to home.PTS: 1 DIF:Apply REF: The Role of the Perioperative Nurse2.Even though the nurse realizes that the ideal time period to plan for postoperative painmanagement for a pediatric client begins in the operating room, the nurse will begin theassessment process:

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1.at thetime the decision is made that the client needs surgery.2.in the familys home.3.during the admission process.4.in the operating room after anesthesia wears off.ANS: 3Pain management cannot begin before the patient is admitted, andstarting after the surgery is toolate. It begins at the admission when the type of surgery indicates which type of medication willbe needed, and medication skills will be taught to the client and the family. Planning for painmanagement cannot begin in the clients home nor at the time the decision is made that the clientneeds surgery.PTS: 1 DIF: Apply REF: Pain Management in Pediatric Patients3.The perioperative nurse realizes that the surgical environment is designed to ensure which ofthe following?1.Calming effect on the client2.Ease of use by personnel3.Control surgical asepsis4.Reduce postoperative painANS: 3The design of the intraoperative environment is to maintain surgical asepsis. The design is not tohave a calming effect onclients. Intraoperative environments are not designs for ease of use bypersonnel or to reduce postoperative pain.PTS: 1 DIF: Analyze REF: The Surgical Environment4.The scrub nurse is preparing the sterile field by opening an instrument package thatwassterilized in an autoclave with direct exposure to steam. This type of sterilization is considered tobe:

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1.high-pressure/high-temperature steam.2.cold chemical.3.dry heat.4.alcohol.ANS: 1High-pressure/high-temperature steam sterilization is the use of an autoclave to directly exposethe instruments to steam for a specified period of time. Cold chemical sterilization is thesubmersion of instruments in a sterilizing solution for a predetermined period of time. Dry heatutilizes static air or forced air to sterilize items. Alcohol is a commonly used disinfectant. It isnot an effective sterilant and, therefore, is not acceptable.5.Prior to the surgeons making an incision into a client, the clients skin is bathed with abacteriostatic solution. The nurse realizes that this solution will:1.sterilize the clients skin.2.disinfect the clients skin.3.sanitize the clients skin.4.inhibit the number of bacteria on the clients skin.ANS: 4A bacteriostatic solution is one that will inhibit the increase in the number of bacteria.Sterilization, disinfection, and sanitization are all methods to reduce or destroy microorganismson objects. These methods cannot be used on skin.6.Theoperating room personnel are applying masks and either goggles or face shields prior tobeginning a surgical procedure. The purpose of these items is to:1.facilitate vision.2.protect against splashes or sprays of blood.

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