Test Bank for CURRENT Medical Diagnosis and Treatment 2020, 59th Edition

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CURRENT Medical Diagnosis and Treatment 2020 Test BankChapter 1. Disease Prevention & Health Promotion____ 1. Which of the following behaviors indicates the highest potential for spreading infectionsamong clients? The nurse:1)disinfects dirty hands with antibacterial soap.2)3)allows alcohol-based rub to dry for 10 seconds.washes hands only after leaving each room.4)uses cold water for medical asepsis.____ 2. What is themostfrequent cause of the spread of infection among institutionalizedpatients?1)Airborne microbes from other patients2)3)Contact with contaminated equipmentHands of healthcare workers4)Exposure from family members____ 3. Which of the following nursing activities is of highest priority for maintaining medicalasepsis?1)Washing hands2)3)Donning glovesApplying sterile drapes4)Wearing a gown____ 4. A patient infected with a virus but who does not have any outward sign of the disease isconsidered a:1)pathogen.2)3)fomite.vector.4)carrier.____ 5. A patient is admitted to the hospital with tuberculosis. Which precautions must the nurseinstitute when caring for this patient?1)Droplet transmission2)3)4)Airborne transmissionDirect contactIndirect contact

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____ 6. A patient becomes infected with oral candidiasis (thrush) while receiving intravenousantibiotics to treat a systemic infection. Which type of infection has the patient developed?1)Endogenous nosocomial2)3)Exogenous nosocomialLatent4)Primary____ 7. A patient admitted to the hospital with pneumonia has been receiving antibiotics for 2days. His condition has stabilized, and his temperature has returned to normal. Which stage ofinfection is the patient most likely experiencing?1)Incubation2)3)ProdromalDecline4)Convalescence____ 8. The nurse assists a surgeon with central venous catheter insertion. Which action isnecessary to help maintain sterile technique?1)Closing the patients door to limit room traffic while preparing the sterile field2)3)Using clean procedure gloves to handle sterile equipmentPlacing the nonsterile syringes containing flush solution on the sterile field4)Remaining 6 inches away from the sterile field during the procedure____ 9. A patient develops localized heat and erythema over an area on the lower leg. Thesefindings are indicative of which secondary defense against infection?1)Phagocytosis2)3)Complement cascadeInflammation4)Immunity____ 10. The patient suddenly develops hives, shortness of breath, and wheezing after receivingan antibiotic. Which antibody is primarily responsible for this patients response?1)IgA2)3)IgEIgG4)IgM____ 11. What type of immunity is provided by intravenous (IV) administration ofimmunoglobulin G?1)Cell-mediated2)3)4)PassiveHumoralActive

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____ 12. A patient asks the nurse why there is no vaccine available for the common cold. Whichresponse by the nurse is correct?1)The virus mutates too rapidly to develop a vaccine.2)3)Vaccines are developed only for very serious illnesses.Researchers are focusing efforts on an HIV vaccine.4)The virus for the common cold has not been identified.____ 13. A patient who has a temperature of 101F (38.3C) most likely requires:1)acetaminophen (Tylenol).2)3)increased fluids.bedrest.4)tepid bath.____ 14. Why is a lotion without petroleum preferred over a petroleum-based product as a skinprotectant? It:1)Prevents microorganisms from adhering to the skin.2)3)Facilitates the absorption of latex proteins through the skin.Decreases the risk of latex allergies.4)Prevents the skin from drying and chaffing.____ 15. For which range of time must a nurse wash her hands before workingin the operatingroom?1)1 to 2 minutes2)3)2 to 4 minutes2 to 6 minutes4)6 to 10 minutes____ 16. How should the nurse dispose of the breakfast tray of a patient who requires airborneisolation?1)Place the tray in a specially marked trash can inside the patients room.Place the tray in a special isolation bag held by a second healthcare worker at the2)3)patients door.Return the tray with a note to dietary services so it can be cleaned and reused for thenext meal.Carry the tray to an isolation trash receptacle located in the dirty utility room and4)dispose of it there.____ 17. How much liquid soap should the nurse use for effective hand washing? At least:1)2 mL2)3)4)3 mL6 mL7 mL

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____ 18. To assure effectiveness, when should the nurse stop rubbing antiseptic hand solutionover all surfaces of the hands?1)Whenfingers feel sticky2)3)After 5 to 10 secondsWhen leaving the clients room4)Once fingers and hands feel dry____ 19. A patient is admitted to the hospital for chemotherapy and has a low white blood cellcount. Which precaution should the staff take with this patient?1)Contact2)3)ProtectiveDroplet4)Airborne____ 20. While donning sterile gloves, the nurse notices the edges of the glove package areslightly yellow. The yellow area is over 1 inch away from the gloves and only appears to be onthe outside of the glove package. What is the best action for the nurse to take at this point?1)Continue using the gloves inside the package because the package is intact.2)3)Remove gloves from sterile field and use a new pair of sterile gloves.Throw all supplies away that were to be used and begin again.4)Use the gloves andmake sure the yellow edges of the package do not touch the client.____ 21. The nurse is removing personal protective equipment (PPE). Which item should beremoved first?1)Gown2)3)GlovesFace shield4)Hair covering____ 22. A nurse is splashed in the face by body fluid during a procedure. Prioritize the nursesactions, listing the most important one first.A. Contact employee healthB. Complete an incident reportC. Wash the exposed areaD. Report to another nurse that she is leaving the immediate area.1)1, 2, 3, 42)3)2, 3, 4, 13, 4, 1, 24)4, 1, 2, 3Multiple ResponseIdentify one or more choices that best complete the statement or answer the question.____ 1. In which situation would using standard precautions be adequate? Select all that apply.

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1)2)3)While interviewing a client with a productive coughWhile helping a client to perform his own hygiene careWhile aiding a client to ambulate after surgery4)While insertinga peripheral intravenous catheter____ 2. Which of the following protect(s) the body against infection? Select all that apply.1)Eating a healthy well-balanced diet2)3)Being an older adult or an infantLeisure activities three times a week4)Exercising for 30 minutes 5 days a week____ 3. The nurse is teaching a group of newly hired nursing assistive personnel (NAP) aboutproper hand washing. The nurse will know that the teaching was effective if the NAPdemonstrate what? Select all that apply. The NAP:1)uses a paper towel to turn off the faucet.2)3)holds fingertips above the wrists while rinsing off the soap.removes all rings and watch before washing hands.4)cleans underneath each fingernail.____ 4. Alcohol-based solutions for hand hygiene can be used to combat which types oforganisms? Select all that apply.1)Virus2)3)Bacterial sporesYeast4)Mold____ 5. A patient with tuberculosis is scheduled for computed tomography (CT). How should thenurse proceed? Select all that apply.1)Question the order because the patient must remain in isolation.2)3)Place an N-95 respirator mask on the patient and transport him to the test.Place a surgical mask on the patient and transport him to CT lab.4)Notify the computed tomography departmentabout precautions prior to transport.True/FalseIndicate whether the statement is true or false.____ 1. Bacteria are necessary for human health and well-being.Chapter 1. Disease preventionAnswer SectionMULTIPLE CHOICE1. ANS: 3Patients acquire infection by contact with other patients, family members, and healthcareequipment. Butmostinfection among patients is spread through the hands of healthcare workers.Hand washing interrupts the transmission and should be done before and after all contact with

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patients, regardless of the diagnosis. When the hands are soiled, healthcare staff should useantibacterial soap with warm water to remove dirt and debris from the skin surface. When novisible dirt is present, an alcohol-based rub should be applied and allowed to dry for 10 to 15seconds.2. ANS: 3Patients are exposed to microbes by contact (direct contact, airborne, or otherwise) with otherpatients, family members, and contaminated healthcare equipment. Some of these are pathogenic(cause illness) and some are nonpathogenic (do not cause illness). But most microbes causinginfection among patients are spread by direct contact on the hands of healthcare workers.3. ANS: 1Scrupulous hand washing is themostimportant part of medical asepsis. Donning gloves,applying sterile drapes before procedures, and wearing a protective gown may be needed toensure asepsis, but they are not themostimportant aspect because microbes causing mosthealthcare-related infections are transmitted by lack of or ineffective hand washing.4. ANS: 4Some people might harbor a pathogenic organism, such as the human immunodeficiency viruswithin their body, and yet do not acquire the disease/infection. These individuals, called carriers,have no outward sign of active disease, yet they can pass the infection to others. A pathogen is anorganism capable of causing disease. A fomite is a contaminated object that transfers a pathogen,such as pens, stethoscopes, and contaminated needles. A vector is an organism that carries apathogen to a susceptible host through a portal for entry into the body. An example of a vector isa mosquito or tick that bites or stings.5. ANS: 2The organisms responsible for measles and tuberculosis, as well as many fungal infections, arespread through airborne transmission.Neisseria meningitidis,the organism that causesmeningitis, is spread through droplet transmission. Pathogens that cause diarrhea, suchasClostridium difficile,are spread by direct contact. The common cold can be spread by indirectcontact or droplet transmission.6. ANS: 1Thrush in this patient is an example of an endogenous, nosocomial infection. This type ofinfection arises from suppression of the patients normal flora as a result of some form oftreatment, such as antibiotics. Normal flora usually keep yeast from growing in the mouth. Inexogenous nosocomial infection, the pathogen arises from the healthcare environment. A latentinfection causes no symptoms for long periods. An example of a latent infection is humanimmunodeficiency virus infection. A primary infection is the first infection that occurs in apatient.7. ANS: 3The stage of decline occurs when the patients immune defenses, along with any medicaltherapies (in this case antibiotics), are successfully reducing the number of pathogenic microbes.As a result, the signs and symptoms of infection begin to fade. Incubation is the stage betweenthe invasion by the organism and the onset of symptoms. During the incubation stage, the patientdoes not know he is infected and is capable of infecting others. The prodromal stage ischaracterized by the first appearance of vague symptoms. Convalescence is characterized bytissue repair and a return to heal as the organisms disappear.8. ANS: 1

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To maintain sterile technique, the nurse should close the patients door and limit the number ofpersons entering and exiting the room because air currents can carry dust and microorganisms.Sterile gloves, not clean gloves, should be used to handle sterile equipment. Placing nonsterilesyringes on the sterile field contaminates the field. One foot, not 6 inches, is required betweenpeople and the sterile field to prevent contamination.9. ANS: 3The classic signs of inflammation, a secondary defense against infection, are erythema (redness)and localized heat. The secondary defenses phagocytosis (process by which white blood cellsengulf and destroy pathogens) and the complement cascade (process by which blood proteinstrigger the release of chemicals that attack the cell membranes of pathogens) do not producevisible findings. Immunity is a tertiary defense that protects the body from future infection.10. ANS: 2The patient is most likely experiencing an allergic response to the antibiotic. IgE is the antibodyprimarily responsible for this allergic response. The antibodies IgA, IgG, and IgM are notinvolved in the allergic response. IgA antibodies protect the body from in fighting viral andbacterial infections. IgG antibioties are the only type that cross the placenta in a pregnant womento protect her unborn baby (fetus). IgM are the first antibodies made in response to infection.11. ANS: 2Intravenous administration of immunoglobulin G provides the patient with passive immunity.Immunoglobulin G does not provide cell-mediated, humoral, or active immunity. Passiveimmunity occurs when antibodies are transferred by antibodies from an immune host, such asfrom a placenta to a fetus. Passive immunity is short-lived. Active immunity is longer lived andcomes from the host itself. Humoral immunity occurs by secreted antibodiesbinding to antigens.Cell-mediated immunity does not involve antibodies but rather fight infection from macrophagesthat kills pathogens.12. ANS: 1More than 200 viruses are known to cause the common cold. These viruses mutate too rapidly todevelop a vaccine. Although some researchers are focusing efforts on a vaccine for HIVinfection, others continue to research the common cold.13. ANS: 2Fever, a common defense against infection, increases water loss; therefore, additional fluid isneeded to supplement this loss. Acetaminophen and a tepid bath are not necessary for this low-grade fever because fever is beneficial in fighting infection. Adequate rest, not necessarilybedrest, is necessary with a fever.14. ANS: 3Nonpetroleum-based lotion is preferred because it prevents the absorption of latex proteinsthrough the skin, which can cause latex allergy. Both types of lotion prevent the skin from dryingand becoming chafed. Neither prevents microorganisms from adhering to the skin.15. ANS: 3In a surgical setting, hands should be washed for 2 to 6 minutes, depending on the type of soapused.16. ANS: 2Patients who require airborne isolation are served meals on disposable dishes and trays. Todispose of the tray, the nurse inside the room must wear protective garb and place the tray and its

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contents inside a special isolation bag that is held by a second healthcare worker at the patientsdoor. The items must be placed on the inside of the bag without touching the outside of the bag.17. ANS: 2APIC guidelines dictate that 3 to 5 mL of liquid soap is necessary for effective hand washing.18. ANS: 4The nurse should rub the antiseptic hand solution over all surfaces of the hands until the solutiondries, usually 10 to 15 seconds, to ensure effectiveness.19. ANS: 2Protective isolation is used to protect those patients who are unusually vulnerable to organismsbrought in by healthcare workers. Such patients include those with low white blood cell counts,with burns, and undergoing chemotherapy. Some hospital units, such as neonatal intensive careunits and labor and delivery suites, also use forms of protective isolation.20. ANS: 2The gloves should be thrown away because the gloves are likely to be contaminated from anoutside source. The supplies do not have to be thrown away because they have not beencontaminated.21. ANS: 2The gloves are removed first because they are usually the most contaminated PPE and must beremoved to avoid contamination of clean areas of the other PPE during their removal. The gownis removed second, then the mask or face shield, and finally, the hair covering.22. ANS: 3If a nurse becomes exposed to body fluid, she should first wash the area, tell another nurse she isleaving the area, contact the infection control or employee health nurse immediately, andcomplete an incident report. It is most important to remove the source of contamination (bodyfluid) as soon as possible after exposure to help prevent the nurses from becoming infected. Theother activities can wait until that is done.MULTIPLE RESPONSE1. ANS: 3, 4Standard precautions should be instituted with all clients whenever there is a possibility ofcoming in contact with blood, body fluids (except sweat), excretions, secretions, mucousmembranes, and breaks in the skin (e.g., while inserting a peripheral IV). When interviewing aclient, if the disease is not spread by air or droplets, there is no likelihood of the nursesencountering body fluids. If the disease is spread by air or droplets, then droplet or airborneprecautions would be needed in addition to standard precautions. If giving a complete bed bathor performing oral hygiene, the nurse would need to use standard precautions (gloves); if merelyassisting a client to perform those ADLs, it is not necessary. No exposure to body fluids is likelywhen helping a client to ambulate after surgery.2. ANS: 1, 3, 4Nutrition, hygiene, rest, exercise, stress reduction, and immunization protect the body againstinfection. Illness, injury, medical treatment, infancy or old age, frequent public contact, andvarious lifestyle factors can make the body more susceptible to infection.3. ANS: 1, 3, 4Hand washing requires at least 15 seconds of washing, which includes lathering all surfaces ofthe hands and fingers to be effective. The fingers should be held lower than the wrists.4. ANS: 1, 3, 4

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If there is potential for contact with bacterial spores, hands must be washed with soap and water;alcohol-based solutions are ineffective against bacterial spores.5. ANS: 3, 4Transporting a patient who requires airborne precautions should be limited; however, whennecessary the patient should wear a surgical mask (an N-95 respirator mask is not required) thatcovers the mouth and nose to prevent the spread of infection. Moreover, the department wherethe patient is being transported should be notified about the precautions before transport.TRUE/FALSE1. ANS: TOrganisms that normally inhabit the body, called normal flora, are essential for human health andwell-being. They keep pathogens in check. In the intestine, these flora function to aid digestionand promote the release of vitamin K, vitamin B12, thiamine, and riboflavin.Chapter 1 Health Promotion (Part 2)____ 1. A client informs the nurse that he has quit smoking because his father died from lungcancer 3 months ago. Based on his motivation, smoking cessation should be recognized as anexample of which of the following?1)Healthy living2)3)Health promotionWellness behaviors4)Health protection____ 2. A patient with morbid obesity was enrolled in a weight loss program last month and hasattended four weekly meetings. But now he believes he no longer needs to attend meetingsbecausehe has learned what to do. He informs the nurse facilitator about his decision to quit theprogram. What should the nurse tell him?By now you have successfully completed the steps of the change process. You should be1)able to successfully lose the rest of the weight on your own.Although you have learned some healthy habits, you will need at least another 6 weeks2)3)before you can quit the program and have success.You have done well in this program. However, it is important to continue in the programto learn how to maintain weight loss. Otherwise, you are likely to return to your previouslifestyle.You have entered the determination stage and are ready to make positive changes thatyou can keep for the rest of your life. If you need additional help, you can come back at4)a later time.____ 3. The school nurse at a local elementary school is performing physical fitness assessmentson the third-grade children. When assessing students cardiorespiratory fitness, the mostappropriate test is to have the students:1)Step up and down on a 12-inch bench.2)3)4)Perform the sit-and-reach test.Run a mile without stopping, if they can.Perform range-of-motion exercises.

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____ 4. In the Leavell and Clark model of health protection, the chief distinction between thelevels of prevention is:1)The point in the disease process at which they occur.2)3)Placement on theWheels of Wellness.The level of activity required to achieve them.4)Placement in theModel of Change.____ 5. The muscle strength of a woman weighing 132 pounds who is able to lift 72 poundswould be recorded as which of the following?1)1.832)3)Moderate0.554)18.3%____ 6. Which is one of the greatest concerns with heavy and chronic use of alcohol in teens andyoung adults?1)Liver damage2)3)Unintentional deathTobacco use4)Obesity____ 7. A 55-year-old man suffered a myocardial infarction (heart attack) three months ago.During his hospitalization, he had stents inserted in two locations in the coronary arteries. Hewas also placed on a cholesterol-lowering agent and two antihypertensives. What type of care ishe receiving?1)Primary prevention2)3)Secondary preventionTertiary prevention4)Health promotion____ 8. Health screening activities are designed to:1)Detect disease at an early stage.2)3)Determine treatment options.Assess lifestyle habits.4)Identify healthcare beliefs.____ 9. Which individuals should receive annual lipid screening?1)All overweight children2)3)4)All adults 20 years and olderPersons with total cholesterol greater than 150 mg/dLPersons with HDL less than 40 mg/dL

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____ 10. A mother of three young children is newly diagnosed with breast cancer. She isintensely committed to fighting the cancer. She believes she can control her cancer to somedegree with a positive attitude and feelings of inner strength. Which of the following traits is shedemonstrating that is linked to health and healing?1)Invincibility2)3)HardinessBaseline strength4)VulnerabilityMultiple ResponseIdentify one or more choices that best complete the statement or answer the question.____ 1. The World Health Organizations definition ofhealthincludes which of the following?Choose all that apply.1)Absence of disease2)3)Physical well-beingMental well-being4)Social well-being____ 2. According to Penders health promotion model, which variables must be considered whenplanning a health promotion program for a client? Choose all that apply.1)Individual characteristics and experiences2)3)Levels of preventionBehavioral outcomes4)Behavior-specific cognitions and affect____ 3. Goals forHealthy People 2020include which of the following? Choose all that apply.1)Eliminate health disparities among various groups.2)3)Decrease the cost of healthcare related to tobacco use.Increase the quality and years of healthy life.4)Decrease the number of inpatient days annually.____ 4. The nurse is implementing a wellness program based on data gathered from a group oflow-income seniors living in a housing project. He is using theWheels of Wellnessas a model forhis planned interventions. Which of the following interventions would be appropriate based onthis model? Choose all that apply.1)Creating a weekly discussion group focused on contemporary news2)3)Facilitating a relationship between local pastors and residents of subsidized housingCoordinating a senior tutorial program for local children at the housing center4)Establishing an on-site healthcare clinic operating one day per week____ 5. The nurse working in an ambulatory care program asks questions about the clients locusof control as a part of his assessment because of which of the following? Choose all that apply.1)People who feel in charge of their own health are the easiest to motivate toward change.

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2)3)People who feel powerless about preventing illness are least likely to engage in healthpromotion activities.People who respond to direction from respected authorities often prefer a healthpromotion program that is supervised by a health provider.People who feel in charge of their own health are less motivated by health promotion4)activities.____ 6. Health promotion programs assist a person to advance toward optimal health. Which ofthe following activities might such programs include? Choose all that apply.1)Disseminating information2)3)Changing lifestyle and behaviorPrescribing medications to treat underlying disorders4)Environmental control programs____ 7. Which of the following actions demonstrate how nurses promote health?1)Role modeling2)3)Educating patients and familiesCounseling4)Providing supportCompletionComplete each statement.1. A middle-aged woman performs breast self-examination monthly. This intervention isconsidered to be ____________________ prevention.2. ____________________ refers to nursing actions performed to help clients to achieve anoptimal state of health.3. What is the name of the nursing theorist who defines health as having three elements: a highlevel of overall physical, mental, and social functioning; a general adaptive-maintenance level ofdaily functioning; and the absence of illness (or the presence of efforts that lead to its absence)?____________________Chapter 1. Health Promotion (Part 2)Answer SectionMULTIPLE CHOICE1. ANS: 4Although health promotion and health protection may involve the same activities, theirdifference lies in the motivation for action. Health protection is motivated by a desire to avoidillness. Health promotion is motivated by the desire to increase wellness. Smoking cessation mayalso be a wellness behavior and may be considered a step toward healthy living; however, neitherof these addresses motivation for action.Comprehension2. ANS: 3Prochaska and Diclemente identified four stages of change: the contemplation stage, thedetermination stage, the action stage, and the maintenance stage. This patient demonstratesbehaviors typical of the action stage. If a participant exits a program before the end of themaintenance stage, relapse is likely to occur as the individual resumes his previous life style.

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3. ANS: 3Field tests for running are good for children and can be utilized when assessing cardiorespiratoryfitness. The step test is appropriate for adults. The 12-inch bench height is too high for youngchildren. The sit-and-reach test as well as range-of-motion exercises would be appropriate whenassessing flexibility.4. ANS: 1Leavell and Clark identified three levels of activities for health protection: primary, secondary,and tertiary. Interventions are classified according to the point in the disease process in whichthey occur.5. ANS: 3Muscle strength measures the amount of weight a muscle (or group of muscles) can move at onetime. This is recorded as a ratio of weight pushed (or lifted) divided by body weight. A womanweighing 132 pounds who is able to lift 72 pounds has a ratio of 72 divided by 132, or 0.55.6. ANS: 2Heavy and chronic use of alcohol and use of illicit drugs increase the risk of disease and injuriesand intentional death (suicide and homicide). Although alcohol as a depressant slowsmetabolism, chronic alcohol use is more likely associated with poor nutrition, which may or maynot lead to obesity. Chronic alcohol use causes damage to liver cells over time in the later years.Alcohol intake is often associated with tobacco and recreational drug use; however, the risk ofunintentional injury, such as car accident, suicide, or violence, is more concerning than smoking.7. ANS: 3Primary prevention activities are designed to prevent orslow the onset of disease. Activities suchas eating healthy foods, exercising, wearing sunscreen, obeying seat-belt laws, and gettingimmunizations are examples of primary level interventions. Secondary prevention activitiesdetect illness so it can be treated in the early stages. Tertiary prevention focuses on stopping thedisease from progressing and returning the individual to the pre-illness phase. The patient has anestablished disease and is receiving care to stop the disease from progressing.8. ANS: 1Health screening activities are designed to detect disease at an early stage so that treatment canbegin before there is an opportunity for disease to spread or become debilitating.9. ANS: 1The American Academy of Pediatrics take a targeted approach, recommending that overweightchildren receive cholesterol screening, regardless of family history or other risk factors forcardiovascular disease. The American Heart Association recommends that all adults age 20 yearsor older have a fasting lipid panel at least once every 5 years. If total cholesterol is 200 mg/dL orgreateror HDL is less than 40 mg/dLfrequent monitoring is required.10. ANS: 2Research has also demonstrated that in the face of difficult life events, some people develophardiness rather than vulnerability. Hardiness is a quality in which an individual experienceshigh levels of stress yet does not fall ill. There are three general characteristics of the hardyperson: control (belief in the ability to control the experience), commitment (feeling deeplyinvolved in the activity producing stress), and challenge (the ability to view the change as achallenge to grow). These traits are associated with a strong resistance to negative feelings thatoccur under adverse circumstances.MULTIPLE RESPONSE1. ANS: 2, 3, 4

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The World Health Organization defines health as a state of complete physical, mental, and socialwell-being, not merely the absence of disease of infirmity.2. ANS: 1, 3, 4Pender identified three variables that affect health promotion: individual characteristics andexperiences, behavior-specific cognitions and affect, and behavioral outcomes. Levels ofprevention were identified by Leavell and Clark; three levels relate to health protection. Thelevels differ based on their timing in the illness cycle.3. ANS: 1, 3The four overarching goals ofHealthy People 2020are to 1) increase the quality and years ofhealthy life, free of disease, injury, and premature death, 2) eliminate health disparities andimprove health for all groups of people, 3) create physical and social environments for people tolive a healthy life, and 4) promote healthy development for people in all stages of life.4. ANS: 1, 2, 3, 4TheWheels of Wellnessmodel identifies the following dimensions of health: emotional,intellectual, physical, spiritual, social/family, and occupational. A weekly discussion groupstimulates intellectual health. A relationship between local pastors and those living in subsidizedhousing creates a climate for spiritual health. A tutorial program offered by seniors to localchildren will facilitate occupational health. An on-site healthcare clinic addresses physicalhealth.5. ANS: 1, 2, 3Identifying a persons locus of control helps the nurse determine how to approach a client abouthealth promotion. People who feel powerless about preventing illness are least likely to engagein health promotion activities. People who respond to direction from respected authorities oftenprefer a health promotion program that is supervised by a health provider. Clients who feel incharge of their own health are the easiest to motivate toward positive change.6. ANS: 1, 2, 4Health promotion programs may be categorized into four types: disseminating information;programs for changing lifestyle and behavior; environmental control programs; and wellnessappraisal and health risk assessment programs. Prescribing medications to treat underlyingdisorders is an activity that fosters health focused at an individual level rather than at a groupprogram level.7. ANS: 1, 2, 3, 4Nurses promote health by acting as role models, counseling, providing health education, andproviding and facilitating support.1. ANS: secondarySecondary prevention activitiesdetect illness so that it can be treatedin the early stages. Healthactivities such as mammograms, testicular examinations, regular physical examinations, bloodpressure and diabetes screenings, and tuberculosis skin tests are examples of secondaryinterventions. Primary prevention activities are designed to prevent or slow the onset of diseaseand promote health. Activities such as eating healthy foods, exercising, wearing sunscreen,obeying seat-belt laws,and getting immunizations are examples of primary level interventions.Tertiary prevention focuses on stopping the disease from progressing and returning theindividual to the pre-illness phase.Chapter 2. Common Symptoms

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1. The nurse is listening to the breath sounds of a patient with severe asthma. Air passing throughnarrowed bronchioles would produce which of these adventitious sounds?a.Wheezesb.c.Bronchial soundsBronchophonyd.Whispered pectoriloquyANS: AWheezes are caused by air squeezed or compressed through passageways narrowed almost toclosure by collapsing, swelling, secretions, or tumors, such as with acute asthma or chronicemphysema.2. A mother brings her 3-month-old infant to the clinic for evaluation of a cold. She tells thenurse that he has had a runny nose for a week. When performing the physical assessment, thenurse notes that the child has nasal flaring and sternal and intercostal retractions. The nurses nextaction should be to:a.Assure the mother that these signs are normal symptoms of a cold.b.c.d.Recognize that these are serious signs, and contact the physician.Ask the mother if the infant has had trouble with feedings.Perform a complete cardiac assessment because these signs are probably indicative of early heartfailure.ANS: BThe infant is an obligatory nose breather until the age of 3 months. Normally, no flaring of thenostrils and no sternal or intercostal retraction occurs. Significant retractions of the sternum andintercostal muscles and nasal flaring indicate increased inspiratory effort, as in pneumonia, acuteairway obstruction, asthma, and atelectasis; therefore, immediate referral to the physician iswarranted. These signs do not indicate heart failure, and an assessment of the infants feeding isnot a priority at this time.3. A teenage patient comes to the emergency department with complaints of an inability tobreathe and a sharp pain in the left side of his chest. The assessment findings include cyanosis,tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonanceon the left, and decreased breath sounds on the left. The nurse interprets that these assessmentfindings are consistent with:a.Bronchitis.b.c.Pneumothorax.Acute pneumonia.d.Asthmatic attack.ANS: BWith a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If thepneumothorax is large, then tachypnea and cyanosis are evident. Unequal chest expansion,decreased or absent tactile fremitus, tracheal deviation to the unaffected side, decreased chest

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expansion, hyperresonant percussion tones, and decreased or absent breath sounds are found withthe presence of pneumothorax.4. The nurse has just recorded a positive iliopsoas test on a patient who has abdominal pain. Thistest is used to confirm a(n):a.Inflamed liver.b.c.Perforated spleen.Perforated appendix.d.Enlarged gallbladder.ANS: CAn inflamed or perforated appendix irritates the iliopsoas muscle, producing pain in the RLQ.5. Which statement indicates that the nurse understands the pain experienced by an older adult?a.Older adults must learn to tolerate pain.b.c.Pain is a normal process of aging and is to be expected.Pain indicates a pathologic condition or an injury and is not a normal process of aging.d.Older individuals perceive pain to a lesser degree than do younger individuals.ANS: CPain indicates a pathologic condition or an injury and should never be considered something thatan older adult should expect or tolerate. Pain is not a normal process of aging, and no evidencesuggests that pain perception is reduced with aging.6. In assessing the tonsils of a 30 year old, the nurse notices that they are involuted, granular inappearance, and appear to have deep crypts. What is correct response to these findings?a.Refer the patient to a throat specialist.b.c.No response is needed; this appearance is normal for the tonsils.Continue with the assessment, looking for any other abnormal findings.d.Obtain a throat culture on the patient for possible streptococcal (strep) infection.ANS: BThe tonsils are the same color as the surrounding mucous membrane, although they look moregranular and their surface shows deep crypts. Tonsillar tissue enlarges during childhood untilpuberty and then involutes.7. The nurse is obtaining a health history on a 3-month-old infant. During the interview, themother states, I think she is getting her first tooth because she has started drooling a lot. Thenurses best response would be:a.Youre right, drooling is usually a sign of the first tooth.b.c.d.It would be unusual for a 3 month old to be getting her first tooth.This could be the sign of a problem with the salivary glands.She is just starting to salivate and hasnt learned to swallow the saliva.

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ANS: DIn the infant, salivation starts at 3 months. The baby will drool for a few months before learningto swallow the saliva. This drooling does not herald the eruption of the first tooth, although manyparents think it does.8. The nurse is assessing an 80-year-old patient. Which of these findings would be expected forthis patient?a.Hypertrophy of the gumsb.c.Increased production of salivaDecreased ability to identify odorsd.Finer and less prominent nasal hairANS: CThe sense of smell may be reduced because of a decrease in the number of olfactory nerve fibers.Nasal hairs grow coarser and stiffer with aging. The gums may recede with aging, nothypertrophy, and saliva production decreases.9. The nurse is palpating the sinus areas. If the findings are normal, then the patient should reportwhich sensation?a.No sensationb.c.Firm pressurePain during palpationd.Pain sensation behind eyesANS: B The person should feel firm pressure but no pain. Sinus areas are tender to palpation inpersons with chronic allergies or an acute infection (sinusitis).10. A 60-year-old man has just been told that he has benign prostatic hypertrophy (BPH). He hasa friend who just died from cancer of the prostate. He is concerned this will happen to him. Howshould the nurse respond?a.The swelling in your prostate is only temporary and will go away.b.c.We will treat you with chemotherapy so we can control the cancer.It would be very unusual for a man your age to have cancer of the prostate.d.The enlargement of your prostate is caused by hormonal changes, and not cancer.ANS: D The prostate gland commonly starts to enlarge during the middle adult years. BPH ispresent in 1 in 10 men at the age of 40 years and increases with age. It is believed that thehypertrophy is caused by hormonal imbalance that leads to the proliferation of benign adenomas.The other responses are not appropriate.11. A patient reports excruciating headache pain on one side of his head, especially around hiseye, forehead, and cheek that has lasted approximately to 2 hours, occurring once or twice eachday. The nurse should suspect:a.Hypertension.

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b.c.Cluster headaches.Tension headaches.d.Migraine headaches.ANS: B Cluster headaches produce pain around the eye, temple, forehead, and cheek and areunilateral and always on the same side of the head. They are excruciating and occur once ortwice per day and last to 2 hours each.12. A patient says that she has recently noticed a lump in the front of her neck below her Adamsapple that seems to be getting bigger. During the assessment, the finding that leads the nurse tosuspect that this may not be a cancerous thyroid nodule is that the lump (nodule):a.Is tender.b.c.Is mobile and not hard.Disappears when the patient smiles.d.Is hard and fixed to the surrounding structures.ANS: BPainless, rapidly growing nodules may be cancerous, especially the appearance of asingle nodule in a young person. However, cancerous nodules tend to be hard and fixed tosurrounding structures, not mobile.

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Chapter 3. Preoperative Evaluation & Perioperative ManagementMULTIPLE CHOICE1.The nurse 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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1.2.3.4.AnxietySleep deprivationExcess fluid volumeDisturbed 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:1.2.3.4.signs the surgical consent form.arrives at the surgical suite doors.is transferred to the postanesthesia care unit.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 is the responsibility of the nurseregarding informed consent?1.2.Explain the surgical optionsExplain the operative risks

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3.4.Describe the operative procedure to be doneWitness a patients signatureANS: 4The nurse may concurrently sign that he has 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 of his hand. Thenurse is applying this device to monitor the clients:1.2.3.4.oxygen level.heart rate.blood pressure.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?1.2.3.4.Eat nutritious meals.If obese, cut calories before the surgery.If sedentary, exercise more before the surgery.Stop all prescribed medications.

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ANS: 1The client should be encouraged to adopt healthy dietary, rest, and exercise habits before 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 to cut 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?1.2.3.4.Allow the client to be alone before the surgery.Observe and ask the client if there is anything that can be done to help reduce heranxiety.Refer to the client by her first name.Make tasteful jokes or comments to help the client laugh.ANS: 2Strategies to reduce preoperative stress include observing 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?1.2.3.Work at a slower pace.Speed up the pace so the client has time to rest.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 is important. 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?1.2.3.4.Client is a vegetarian.Client exercises 5 days a week for 30 minutes.Client has a history of congestive heart failure.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 a bleeding 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.The nurse is concerned that a client may have an undocumented allergy to latex when which ofthe following is assessed?1.2.3.4.Recent episode of appendicitisRecovered from bronchitis 3 months agoAllergy to specific foodsDoes not like to wear wool 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 most likely providing to the client?1.2.3.4.Hydrogen ion antagonistAnticholinergicCalcium channel blockerOpioidANS: 4Opioids provide analgesia, decrease anxiety, and provide sedation. Calcium channel blockerstreat specific heart problems. 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?1.2.3.4.Encourage the client to not worry about his spouse.Ask the client if the spouse would agree to having some help while he is hospitalized.Encourage the spouse to come and stay with the client in the hospital.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 is provided to the client?1.2.3.4.Hold the surgery until a family member arrives to the hospital to provide consent.Contact a pastor to pray with the client before the surgery.Instruct the client in postoperative exercises while waiting for anesthesia to take effect.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 a cigarette while recovering from surgery. Which of the following can thenurse respond to this client?1.2.3.4.That can be arranged.You really should stop smoking before the surgery.Your physician will prescribe medication to help reduce the nicotine cravings.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 be prescribed 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 CareMULTIPLE RESPONSE1.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.)1.2.3.4.5.6.Board certificationGraduation from a reputable schoolPersonality or bedside mannerLocation of officeWord of mouth from trusted othersThe 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 that apply.)1.Does the facility have a national reputation?

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2.3.4.5.6.Is there an ICU in the hospital?Is it close to family?Will insurance pay for the stay?Does the hospital have magnet status?Does it have good food?ANS: 1, 2, 4, 5The client 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.)1.2.3.4.5.6.The client controls the timing of medication delivery.The client does not have to wait for a nurse to provide pain medication.The nurse does not have to check on the client as frequently.The physician does not need to prescribe various pain medication after the surgery.The medication is delivered intravenously.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 in which 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.)1.2.3.4.5.6.Bring identification, but send it home after it is used.Bring personal sleepwear to put on after the surgery.Bring work-related items.Leave important jewelry at home.Make a list of all medications and bring the list to the hospital.Books and puzzles to be entertained while waiting for the surgery.ANS: 1, 4, 5On the day of the surgery, the nurse should instruct theclient 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 of its 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 preparing a client forsurgery. Which of the following are activities of this nurse? (Select all that apply.)1.2.Awareness of safety considerationsAssessment of vital signs during the surgery

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3.4.5.6.Physical assessment of the clientAssessment of the environmentPostoperative care in the recovery roomAwareness 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 the client, 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?1.2.3.4.Conducts telephone interviews with the preoperative clientApplies principles of aseptic techniqueInstructs the preoperative client on exercises to use while recovering from surgeryPlans 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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1.2.3.4.at the time the decision is made that the client needs surgery.in the familys home.during the admission process.in the operating room after anesthesia wears off.ANS: 3Pain management cannot begin before the patient is admitted, and starting 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?1.2.3.4.Calming effect on the clientEase of use by personnelControl surgical asepsisReduce postoperative painANS: 3The design of the intraoperative environment is to maintain surgical asepsis. The design is not tohave a calming effect on clients. 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 that wassterilized in an autoclave with direct exposure to steam. This type of sterilization is considered tobe:

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