Chapter 1. Critical Thinking and the Nursing Process Chapter 1. Critical Thinking and the Nursing Process Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. After receiving morning report, which patient should the licensed practical nurse/licensed vocational nurse (LPN/LVN) assess first? a. A patient who needs discharge teaching b. A patient who needs assistance to ambulate c. A patient who states, “No one cares about me.” d. A patient who has a temperature of 106°F (41.1°C) ____ 2. During a class discussion, two nursing students demonstrated intellectual courage. What action did the nursing students perform? a. Considered being in the other person’s situation b. Expected proof that the use of restraints is safe c. Conducted additional research on the use of restraints in patient care d. Listened to each other’s point of view regarding the use of patient restraints ____ 3. The nursing staff is planning a celebratory dinner and cake for a newly licensed practical nurse. Which of the new nurse’s human needs is supported by these actions? a. Self-esteem b. Physiological c. Self-actualization d. Safety and security ____ 4. A patient with a newly fractured femur reports a pain level of 8/10, and analgesic medication is not due for another 50 minutes. Which actions should the nurse take? a. Reposition the patient. b. Give the medication in 30 minutes. c. Notify the registered nurse (RN) or physician. d. Tell the patient it is too early for pain medication. ____ 5. The nursing instructor is planning a teaching session on critical thinking for students. What should the instructor say when explaining critical thinking? a. “Collect data concerning the patient’s problem.” b. “Think of different ways to help relieve a patient’s problem.” c. “Determine if an action worked to eliminate a patient problem.” d. “Use knowledge and skills to make the best decision for patient care.” ____ 6. The nurse is planning care and setting goals for a newly admitted patient. Who should the nurse include when conducting these nursing actions? a. Patient b. Nurse manager c. Patient’s family members d. Patient’s health care provider (HCP) ____ 7. While caring for a patient 4 hours after a surgical procedure, the LPN/LVN notes serosanguineous dr ainage on the patient’s dressing. Which statement should the nurse use to document the finding? a. “Normal drainage noted.” b. “Moderate drainage recently noted.” c. “Scant serosanguineous drainage seen on dressing.” d. “Pale pink drainage, 2 cm by 1 cm, noted on dressing.” ____ 8. The nurse is caring for a patient who is scheduled for surgery. Which data should the nurse collect to identify safety and security needs? a. Meal patterns b. Sleep patterns c. Anxiety about surgery d. Effectiveness of pain medication ____ 9. The nurse is reviewing data collected during patient care. Which data should the nurse document as objective? a. Patient is pleasant. b. Urine output is 300 mL. c. “It has been a good day.” d. Patient’s appetite is poor. ____ 10. The nurse is determining diagnoses appropriate for a patient recovering from surgery. Which nursing diagnoses should the nurse identify as the highest priority for this patient? a. Acute pain b. Impaired mobility c. Deficient knowledge d. Impaired skin integrity ____ 11. The nurse suspects a patient is experiencing adverse effects to a newly prescribed antihypertensive medication. After being informed that the effects are expected, the nurse remains concerned and conducts an Internet search on the patient’s manifestati ons. Which critical thinking behavior did the nurse implement? a. Sense of justice b. Intellectual courage c. Intellectual empathy d. Intellectual perseverance ____ 12. The nurse is identifying outcomes for a patient with a Fluid Volume Deficit. Which outc ome should the nurse use to guide the patient’s care? a. Patient’s fluid intake will be measured daily. b. Patient’s intake will be 3000 mL daily. c. Fluids will be at the bedside for the patient. d. Fluids the patient likes will be at the bedside. ____ 13. The nurse is caring for a patient with the diagnosis of Fluid Volume Excess. Which information should the LPN/LVN use to determine if care was effective? a. Restrict the patient’s fluid intake. b. Measure the patient’s daily weight. c. Teach the patient to monitor fluid balance. d. Discuss the patient’s care plan with the RN. ____ 14. A RN delegates a patient care assignment to the LPN/LVN. Which phase of the nursing process should the LPN/LVN perform independently? a. Assessment b. Planning care c. Implementation d. Nursing diagnosis ____ 15. The nurse is caring for a patient with a painful back injury that occurred 6 months ago. Which three- part nursing diagnosis should the nurse use to guide this patient’s care? a. Pain as evidenced by herniated lumbar disk b. Acute pain related to inability to sit as evidenced by muscle spasms c. Chronic pain related to muscle spasms as evidenced by patient pain rating of 8 and difficulty walking d. Acute pain related to patient pain rating of 6 as evidenced by muscle spasms and nerve compression ____ 16. The RN implements an intervention to improve a patient’s appetite. After implementing the intervention for two meals, the LPN/LVN notes no improvement in the patient’s eating. What action should the LPN/LVN take? a. Develop a new plan of care. b. Revise the patient outcome to one that is achievable. c. Collaborate on a new nursing diagnosis with the RN. d. Provide data to the RN to assist in evaluation of the plan. ____ 17. During morning report, the LPN/LVN is assigned a group of patients. Which patient should the LPN/LVN see first? a. A patient scheduled for magnetic resonance imaging (MRI) due to back pain b. A patient reporting constipation and stomach cramps c. A 2-day postsurgical patient reporting pain at a level of 6 d. A patient with pneumonia who is short of breath and anxious ____ 18. The LPN/LVN is reviewing a patient’s list of nursing diagnoses. Which diagnoses should the LPN/LVN identify as a priority for this patient? a. Anxiety b. Constipation c. Deficient fluid volume d. Ineffective airway clearance ____ 19. The nurse is using the nursing process when caring for a patient. In which order should the nurse implement this process? a. Nursing diagnosis, intervention, rationale, evaluation, planning b. Data collection, intervention, nursing diagnosis, rationale, evaluation c. Assessment, nursing diagnosis, planning, implementation, evaluation d. Data collection, evaluation, nursing diagnosis, implementation, rationale ____ 20. The nurse is determining a patient’s problems. What step of the nursing process is the nurse performing? a. Assessment b. Outcome planning c. Nursing diagnosis d. Nursing intervention ____ 21. The nurse is preparing to determine if a patient is meeting planned outcomes. What measurable information should the nurse use to make this determination? a. P-E-S format b. Objective observations c. Subjective terminology d. Open-ended time frames ____ 22. The nurse is planning a patient’s care based on Maslow’s hierarchy of needs. Which human need should the nurse identify as requiring his or her immediate attention? a. Heart rate 38 and irregular b. Plans to return to college in a year c. Needs walker adjusted to safely ambulate d. Desire to learn how to self-inject medication ____ 23. While being taught to apply a topical medication, the patient begins to vomit. Which action should the nurse take to meet the patient’s human needs? a. Provide a clean gown before resuming the teaching. b. Position an emesis basin for patient use while teaching. c. Provide medication prescribed for nausea and vomiting. d. Wait for the vomiting to stop and begin the teaching session again. ____ 24. The nurse approaches a person in a restaurant who appears to be experiencing respiratory distress. Which action should the nurse perform first? a. Diagnose the problem. b. Help the person lie down. c. Gather data from other people. d. Collect data about the person’s condition. ____ 25. The nurse identifies the diagnosis Fluid Volume Overload as appropriate for a patient with heart failure. Which collected data should the nurse use to provide evidence for this diagnosis? a. Skin warm to the touch b. Oriented to person only c. Respiratory rate 20 and shallow d. +3 pitting edema of both feet and ankles ____ 26. After identifying nursing diagnoses, the nurse plans outcomes for a patient with gastroesophageal reflux disease. Which outcome should the nurse use to evaluate this patient’s care? a. The patient will have less heartburn. b. The patient will sleep through the night. c. The pat ient’s esophageal burning will resolve 30 minutes after taking oral antacids. d. The patient will state that burning only occurs when eating foods high in acid content. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 27. After collecting data the nurse identifies diagnoses to guide the patient’s care. Which diagnoses did the nurse document correctly? (Select all that apply.) a. Diabetes b. Acute pain c. Pancreatitis d. Activity intolerance e. Impaired physical mobility ____ 28. A patient with a family history of diabetes is experiencing high blood glucose levels, confusion, an unsteady gait, and dehydration. Which nursing diagnoses should the nurse identify as appropriate for this patient’s care? ( Select all that apply.) a. Diabetes b. Dehydration c. Risk for falls d. Hyperglycemia e. Deficient fluid volume ____ 29. The nurse identifies the diagnosis Potential for Ineffective Gas Exchange as appropriate for a patient with pneumonia. Which independent nursing actions should the nurse plan for this problem? (Select all that apply.) a. Apply oxygen, 2 liters, per nasal cannula. b. Turn and reposition in bed every 2 hours. c. Coach to deep breathe and cough every hour. d. Administer intramuscular antibiotic medication. e. Encourage to drink 240 mL of fluid every 2 hours. ____ 30. The nurse finishes collecting data on a patient with injuries from a motor vehicle crash. Which data should the nurse document as objective? (Select all that apply.) a. Patient in no acute distress b. “I can’t believe I wrecked my car.” c. Complains of pain when moving arms d. Oxygen saturation level 92% on room air e. Mid-forehead wound 3 cm long, oozing blood Other 31. A patient with a history of respiratory disease is recovering from total hip replacement surgery. In which order should the nurse address the patient’s diagnoses? (Place in order from 1 to 4.) A. _____ Acute pain related to surgery B. _____ Risk for injury related to unsteady gait C. _____ Deficient knowledge related to use of a walker D. _____ Impaired gas exchange related to compromised respiratory system 32. The nurse is caring for a patient recovering from a stroke. Use the nursing process to order the observations made or actions performed while caring for this patient (A – E). A. Hand grasp absent left hand B. Alteration in Cerebral Perfusion C. The patient flexed left thumb and index finger. D. Coached to squeeze rubber ball placed in left hand. E. The patient will be able to self-feed using left hand. Chapter 1. Critical Thinking and the Nursing Process Answer Section MULTIPLE CHOICE 1. ANS: D D. According to Maslow, humans’ basic physiological needs have the highest priority, and these patients’ health problems should be addressed first. Life -threatening needs are ranked first; health- threatening needs are second; and health-promoting needs are last. The elevated temperature has the greatest urgency. A, B, and C are not as high priority. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 2. ANS: D D. Intellectual courage is looking at other points of view. A. Intellectual empathy allows a person to consider another’s situation. B. Intellectual integrity is seeking the same level of proof fo r comparable items. C. Intellectual perseverance is continuing to search for evidence about a concern. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care| Cognitive Level: Application 3. ANS: A A. Recognizing a pe rson’s accomplishments enhances self - esteem. B. C. D. The staff’s actions are not meeting physiological, self-actualization, or safety and security needs of the new nurse. PTS: 1 DIF: Moderate KEY: Client Need: Psychosocial Integrity 4. ANS: C C. The patient should not have to wait for pain relief. The LPN should inform the RN or physician, so new pain relief orders can be obtained. A. The patient who has a fractured femur is experiencing acute pain. Repositioning a patient with a new fracture is not likely to relieve pain. B. Giving the medication before the prescribed time is beyond the nurse’s scope of practice. D. The nurse needs to do more than expect the patient to wait for pain relief. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 5. ANS: D D. Critical thinking is using knowledge and skills to make the best decisions possible in patient care situations. A. Collecting data describes assessment. B. Thinking of different ways to help a patient with a problem is planning. C. Determining if an action worked to eliminate a patient problem is evaluation. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 6. ANS: A A. Planning care and setting goals are actions performed with the patient. The patient must be in agreement with the plan for it to be successful in meeting the desired outcomes. B. The nurse manager may or may not be aware of the patient’s care needs. C. The patient’s family may or may not be aware of the patient’s care needs. D. The focus of nursing care is different from that of the HCP. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 7. ANS: D D. Objective data are pieces of factual information obtained through physical assessment and diagnostic tests observable or knowable through the five senses. The nurse should document exactly what is seen. A. B. C. These statements are interpretations of the data and use words that have vague meanings, which should be avoided when documenting. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Application 8. ANS: C C. A threat to a person’s safety and security, such as surgery, creates anxiety. The patient’s anxiety level will help the nurse plan care to meet safety and security needs. A, B, and D describe data used to support the patient’s physiological needs. PTS: 1 DIF: Moderate KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application 9. ANS: B B. Objective data are factual information such as the volume of urine output. A. This is an opinion that the nurse has about the patient’s behavior and is too vague to docum ent as objective data. C. This statement is in quotations, so it is something that the patient subjectively stated. D. This is an opinion the nurse has about the patient’s appetite and is too vague to document as objective data. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 10. ANS: A A. Using Maslow’s hierarchy, pain is the highest priority nursing diagnosis for a postoperative patient. B. D. These diagnoses would be equally im portant after the patient’s pain is addressed, because they focus on physiological needs. C. This diagnosis can be addressed at a later time once physiological needs have been met. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 11. ANS: D D. Intellectual perseverance is not giving up. A. A sense of justice examines motives when making decisions. B. Intellectual courage looks at other points of view, even when the nurse does not agree with them. C. Intellectual empathy understands how another person feels when making decisions. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 12. ANS: B B. This outcome provides objective measurable data. A. C. D. These statements are nursing actions. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Application 13. ANS: B B. To evaluate the effectiveness of the plan of care and the actions implemented, the nurse must assess the outcome for the patient’s nursing diagnosis and determine if the outcome has been achieved or if revisions are needed. For this patient, a change in weight is an objective measurement for determining if interventions to address Fluid Volume Excess have been effective. A. Restricting fluid intake is an action. Evaluation is required to determine patient outcome and effective care. C. Teaching the patient to monitor fluid balance is an intervention and will not help determine the effectiveness of care. D. Although discussing the plan of care with the RN is relevant to the patient’s care, it will not help determine effectiveness of care provided. PTS: 1 DIF: Difficult KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 14. ANS: C C. The LPN/LVN independently provides direct patient care. A. B. D. The LPN/LVN assists the RN with collecting data, formulating nursing diagnoses, determining outcomes, and planning care to meet patient needs. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 15. ANS: C C. “Chronic pain related to muscle spasms as evidenced by patient pain rating of 8 and dif ficulty walking” uses the three -part, or Problem, Etiology, and Signs/Symptoms, system with measurable data as evidence. This best guides the nurse’s care and evaluation of the outcome. A. This statement includes a medical diagnosis. B. D. There is not enough measurable evidence for these nursing diagnosis statements. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Basic Care and Comfort | Cognitive Level: Application 16. ANS: D D. The role of the LPN/LVN includes data collection and assisting in evaluating outcomes. The LPN/LVN should provide new data to the RN, so they can revise the plan of care together. A. B. This is not done independently. C. A new diagnosis may be appropriate, but is not carried out independently of the RN. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 17. ANS: D D. Using Maslow’s hierarchy of needs and considering which patient problems are life -threatening, shortness of breath is most important. A. B. C. Problems of pain, constipation, and scheduled tests are all important, but not immediately life-threatening. PTS: 1 DIF: Difficult KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Analysis 18. ANS: D D. Ineffective airway clearance is the highest priority, because it can be life-threatening. B. C. These diagnoses are important; however they are not immediately life-threatening. A. Anxiety is the lowest priority, because physiological needs must be addressed first. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Analysis 19. ANS: C C. The nurse should implement the steps of the nursing process by beginning with assessment, formulating nursing diagnoses, planning care, implementing care, and then evaluating care. A. B. D. These lists do not implement the steps of the nursing process in appropriate order. Rationale is not a step in the nursing process. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 20. ANS: C C. A nursing diagnosis is a clinical judgment about individual, family, or community response to actual or potential health problems or life processes. Nursing diagnoses are standardized labels that make an identified problem understandable to all nurses. A. Assessment is the collection of data used to identify patient problems. B. Outcome planning occurs after a patient’s problems have been identified. D. Interventions are provided after the problems, plan, and outcome have been identified. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 21. ANS: B B. Measurable means that an outcome can be observed or is objective. It should not be vague or open to interpretation. A. Problem-Etiology-Symptoms (PES) format refers to nursing diagnoses, not outcomes measurement. C. Subjective terminology is the use of patient statements to support objective data. D. Open-ended time frames do not help with measurement. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 22. ANS: A A. According to Maslow, basic needs or physiological needs must be met first. A heart rate of 38 and irregular is a physiological need. C. Safety and security needs are met after physiological needs have been satisfied. Safe ambulation would be addressed next. D. Self-esteem needs are met after safety and security needs have been addressed. The desire to be independent with medication injections can be addressed after safety and security needs. B. Planning to return to college is an example of self- actualization, which is a need that can be addressed last. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 23. ANS: C C. Basic physiological needs must be met first. Since the patient is vomiting, the nurse should provide the medication prescribed for nausea and vomiting. A. B. D. These actions do not take the patient’s physiological needs into consideration. The patient will not be able to achieve a higher level of the hierarchy before basic physiological needs are met. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 24. ANS: D D. The first step in the nursing process is to collect data, and the patient should come first. C. The nurse can collect data from other people if necessary. A. Diagnosing the problem would occur after collecting data. B. Helping the person lie down is implementing an action to address the problem. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Analysis 25. ANS: D D. Collected data that the nurse should use as evidence for the diagnosis are signs and symptoms related to the diagnosis. For Fluid Volume Overload, edema would be used as evidence that the patient’s tissue is accumulating extra fluid. A. Skin warm to the touch is an opinion. B. Oriented to person only is objective data; however, it does not apply to the nursing diagnosis. C. Respiratory rate 20 and shallow is objective data; however, it does not apply to the nursing diagnosis. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Analysis 26. ANS: C C. Outcomes should be measurable and realistic for the patient; they should include an appropriate time frame for achievement. A. Outcomes should not be vague or open to interpretation, with the use of subjective words such as “normal,” “large,” “small,” or “moderate.” B. Sleeping through the night may or may not be associated with the patient’s problem. D. Stating that the burning only occurs when eating foods high in acid content is a patient observation that could be used for subjective data collection. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Analysis MULTIPLE RESPONSE 27. ANS: B, D, E B. D. E. Acute Pain, Activity Intolerance, and Impaired Physical Mobility are nursing diagnoses. A. C. Diabetes and Pancreatitis are medical diagnoses. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 28. ANS: C, E C. E. Deficient fluid volume and Risk for falls are nursing diagnoses related to the patient’s symptoms and condition. A. B. D. Diabetes, Dehydration, and Hyperglycemia are medical problems. The nurse assists with medical diagnoses; however, the nurse does not diagnose and treat medical problems. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Application 29. ANS: B, C, E B. C. E. Independent nursing actions are those that can be implemented without an HCP’s order. A. D. Interventions that need an HCP’s order include administering oxygen and medication. These are collaborative interventions. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Application 30. ANS: D, E D. E. Data that can be observed are objective. Objective data would include an oxygen saturation level of 92% on room air and a wound on the forehead, 3 cm in length and oozing blood. A. The “patient in no acute distress” is an opinion about the patient’s status. B. A direct patient quote is subjective data. C. Complaining of pain when moving arms needs additional information to be objective such as the patient’s pain rating on a scale of 1 to 10 and the exact location of the arm pain. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application OTHER 31. ANS: D, A, B, C D. In a nursing plan of care, the patient’s most urgent problem is listed first. According to Maslow’s hierarchy of human needs, this usually involves a physiological need, such as oxygen or water, because these are life-sustaining needs. If several physiological needs are present, life-threatening needs are ranked first; health-threatening needs are second; and health-promoting needs, although important, are last. In this case, Ineffective Gas Exchange is potentially life-threatening and would be first. A. Acute Pain is the next most urgent need. B. Risk for Injury is less critical than pain, because it is a potential problem rather than an actual problem. C. Deficient Knowledge comes last, because it is health- promoting and is considered psychosocial rather than physical/physiological. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Application 32. ANS: A, B, E, D, C A. Assessed data is the absence of a left hand grasp. B. The nursing diagnosis that would be associated with the absence of a hand grasp would be Alteration in Cerebral Perfusion. E. The goal of nursing care would be for the patient to self-feed using the left hand. D. Coaching to squeeze a rubber ball in the left hand is an intervention to improve left hand function. C. The patient flexing the left thumb and index finger evaluates the success of the intervention of squeezing a rubber ball in the left hand. PTS: 1 DIF: Difficult KEY: Client Need: Physiological Integrity — Physiological Adaptation | Cognitive Level: Analysis Chapter 2. Evidence - Based Pra ctice Chapter 2. Evidence-Based Practice Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse working in a radiation oncology department wants to reduce the incidence of skin breakdown in patients who receive beam radiation. Which question should the nurse use to guide a literature search about this topic? a. How often do patients with beam radiation experience skin breakdown? b. Why do patients who get radiation beam therapy have skin breakdown? c. What nursing interventions minimize the occurrence of skin breakdown in patients receiving beam radiation? d. How does our rate of skin breakdown in patients receiving beam radiation compare to other institutions in the city? ____ 2. The nurse who works on a medical-surgical unit reads an article about a research study regarding nursing care in the intensive care unit (ICU) and decreased nosocomial infections. Which action should the nurse take in exploring this research topic?’ a. Institute a pilot study utilizing the outlined nursing care. b. Discuss the research with the chief of nursing at the institution. c. Do a journal search and look for similar studies related to non-ICU patients. d. Take the article to the nurse manger in the ICU and suggest a new policy be developed. ____ 3. A licensed practical nurse (LPN) working on the pediatric floor is interested in improving patient outcomes for children with asthma. Which clinical question would best guide the nurse’s next steps? a. How many patients with asthma have a pet dog or cat? b. What is the monthly admission rate of patients with asthma to the unit? c. What patient education materials are available to address effective management of asthma in pediatric patients? d. How has the occurrence rate of asthma in children under the age of 5 changed since the hospital instituted a no smoking policy for the hospital grounds? ____ 4. The nurse is preparing to give oral care to a patient receiving tube feedings. Which approach should the nurse use to provide care that is based on EBP? a. Use a soft toothbrush and toothpaste to brush the teeth. b. Have the patient use swish-and-swallow Nystatin twice a day. c. Increase oral suctioning to every 2 hours using toothette suction devices. d. Use mouthwash and toothettes to swab the teeth and mouth three times a day. ____ 5. The nurse is planning to review a research article for applicability to EBP. Which acronym should the nurse use to guide this review? a. RIGHT b. MYWAY c. ASKMME d. ASKWHY ____ 6. The nurse working on the burn unit is interested in understanding the rate of renal compromise with a burn. Which step should the nurse take first? a. Complete a literature review. b. Work with a medical librarian to identify key words. c. Develop a clinical question that can guide further research. d. Join the policy and procedure committee to evaluate care in the hospital. ____ 7. A nursing committee developed an evidence-based intervention that it would like to initiate institute-wide. Which step should the committee take to implement the intervention? a. Conduct a small pilot study involving the proposed change. b. Ask the charge nurse to propose the change to administration. c. Poll the nursing staff to determine its attitude toward change. d. Invite nursing experts in the city to review the proposed change. ____ 8. The nurse is researching evidence to address a clinical problem. Which evidence should the nurse focus as being the highest level supporting practice? a. Evidence obtained from quasi-experimental research studies b. Evidence from a systematic review of all relevant randomized clinical trials c. Evidence from the opinion of authorities and/or reports of expert committees d. Evidence obtained from at least one well-designed randomized controlled trial ____ 9. A nursing student asks the registered nurse (RN) preceptor why EBP is important. How should the nurse respond to the student? a. “EBP makes nursing more professional.” b. “EBP helps ensure we can demand more pay.” c. “EBP helps validate the difference nurses really make.” d. “EBP guides nursing decisions to optimize effective care.” ____ 10. The nurse is reviewing a proposal for changing the type of needleless systems currently used to administer intravenous (IV) medications in the hospital. Which part of the proposal most effectively supports the proposed change? a. A pilot study is planned. b. Two cases of staff injury related to needle sticks have occurred in the past 3 years. c. A single randomized clinical trial is cited as evidence to support the new policy. d. The supporting evidence includes research conducted at an outpatient hematology center. ____ 11. The staff development instructor is preparing a presentation on EBP for the nursing staff. Which should the instructor include as being the most important reason for using EBP? a. Saves money b. Optimizes care c. Reduces staff error d. Improves access to care ____ 12. The nurse is researching articles prior to determining the best practice for providing an aspect of patient care. On what type of article should the nurse focus when researching best practice? a. Expert opinion b. Systematic review c. Traditional practice d. Quasi-experimental studies ____ 13. The nurse wants to find research studies on infection rates as they relate to specific hand washing products. Where should the nurse search for these articles? a. Medline b. PubMed c. CINAHL d. Cochrane Reviews ____ 14. The nurse researcher is designing a study using the quasi-experimental approach. What type of data will the nurse obtain from this study design? a. Uncontrolled results b. Outcome tracking over 10 years c. Controlled comorbid conditions d. Modifiable and non-modifiable risk factors ____ 15. The nurse is planning to evaluate care provided to a patient. Which step should the nurse take to learn if the best possible care is being provided? a. Measure outcomes. b. Review the literature. c. Construct a burning clinical question. d. Determine the validity of clinical research. ____ 16. After completing all of the steps in the research process, the nurse identifies a positive response to a new intervention for foot ulcer care. Which step in EBP should the nurse perform now? a. Publish and share the results of the study. b. Complete a cost-benefit analysis of the results. c. Evaluate the validity of related research studies. d. Conduct a pilot project using the proposed intervention. ____ 17. The nurse is using Level II research when planning best practices for skin care. Which type of evidence is the nurse using? a. Cochrane Review b. A quasi-experimental study c. Joanna Briggs Best Practice Review d. A randomized controlled trial (RCT) ____ 18. While reviewing a patient care assignment with unlicensed assistive personnel (UAP), the nurse explains the reason for turning and repositioning a patient every 2 hours. Why did the nursing include this information? a. Ensures that evidence-based care is provided b. Guarantees that the patient will receive morning care c. Helps UAP focus on the action being performed d. Helps UAP with time management of tasks to complete ____ 19. Prior to administering a prescribed medication to a patient, the nurse talks with the health care provider (HCP) regarding expected effects and then contacts the pharmacist to review the guidelines for administration. Which Quality and Safety Education for Nurses (QSEN) focus is the nurse demonstrating? a. Informatics b. Patient-centered care c. Quality improvement d. Teamwork and collaboration ____ 20. The nurse identifies an intervention that has been proven to enhance patient safety. What should the nurse do before implementing this intervention? a. Analyze the intervention to determine if it is appropriate for the patient. b. Ask the charge nurse if the intervention can be implemented. c. Find out if the patient wants the intervention to be performed. d. Conduct a pilot study to see if the intervention works on the care area. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 21. The nurse is implementing dependent interventions when providing patient care. Which actions are dependent nursing interventions? (Select all that apply.) a. Low sodium soft diet b. Music therapy as desired c. Bathroom privileges as tolerated d. Give Tylenol 650 mg orally every 4 hours prn pain e. Wet-to-moist dressing changes every 6 hours while awake ____ 22. The nurse is planning a quasi- experimental study. Which criteria support the nurse’s approach? (Select all that apply.) a. 28 volunteer patients who agree to try a new type of mouthwash b. An experimental group and a control group each with 225 patients c. 14 individuals on a medical unit who complete the same questionnaire d. Tracking of pneumonia rates for all patients receiving artificial tube feedings e. Identification of oral flora in nursing home patients who receive artificial feedings ____ 23. The nurse is working with a committee to determine EBP approaches for patient care. Which steps will the committee members include when determining EBP? (Select all that apply.) a. Evaluate the change. b. Measure the outcome. c. Ask the nursing experts. d. Manipulate current practice. e. Search for the best available evidence. ____ 24. The nurse is considering the importance of safety when providing patient care. At which times should the nurse be particularly alert for safety hazards? (Select all that apply.) a. When providing patient medications b. When identifying a patient for a treatment c. When washing hands after providing care d. When stocking the supply room with linens e. When raising the side rails on a patient’s bed ____ 25. The nurse is implementing the QSEN focus of patient-centered care. Which nursing actions support this focus? (Select all that apply.) a. Individualize interventions. b. Schedule interventions to meet the patient’s needs. c. Evaluate interventions for applicability to the patient. d. Scan prescribed medications using the bar-coding system. e. Document responses to treatment in the electronic medical record. Chapter 2. Evidence-Based Practice Answer Section MULTIPLE CHOICE 1. ANS: C Asking a burning clinical question is the first step in the evidence-based practice (EBP) process. It is important to include related factors in the question and to focus on nursing interventions and care. In this situation, the nurse should focus on nursing care that may reduce the occurrence of skin breakdown for the specific patient population of interest. A. B. The frequency of skin breakdown and why patients develop skin breakdown does not help identify ways to prevent skin breakdown. D. Information on statistics from other organizations will not help the nurse identify ways to prevent skin breakdown. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 2. ANS: C Clinical reality can be very different from research situations. It could be unsafe to apply research findings in an environment that differs from the one in the study, so the next step would be to identify current research related to the current population. A. A pilot study would be premature. B. Discussing the research with the chief of nursing would not help explore the topic. D. Taking the article to the head nurse in the ICU would not help with the issue of nosocomial infections on the medical-surgical unit. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Safety and Infection Control | Cognitive Level: Application 3. ANS: C Asking a burning clinical question is the first step in the EBP process. It is important to include related factors in the question and to focus on nursing interventions and care. For this scenario, the nurse would focus on nursing care that affects patient outcomes for the specific patient population of interest. Patient education is a critical component of nursing care. A. B. D. Information about pets, admission rates of patients with asthma, and asthma occurrence since the implementation of a no smoking policy will not help improve patient outcomes for children with asthma. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 4. ANS: D Evidence-based information shows the use of toothbrushes for oral care is much more effective than foam swabs in removing plaque from the teeth. B. Swish-and swallow Nystatin is a medication that treats oral thrush and is not routinely used to provide oral care. C. Oral suctioning is not an approach to provide oral care. D. Toothettes are not an effective mechanism for providing oral care. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Basic Care and Comfort | Cognitive Level: Application 5. ANS: C An acronym that can be used to recall the steps of the evidence-based process is ASKMME: Ask, Search, Think, Measure, Make It Happen, and Evaluate. A. B. D. RIGHT, MYWAY, and ASKWHY are not acronyms used to recall the steps of the evidence-based process. PTS: 1 DIF: Easy KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 6. ANS: C Asking a burning clinical question is the first step in the EBP process. A. B. Conducting a literature search and working with a medical librarian to identify key words would be done after the clinical question is formulated. D. Evaluating the impact of care or changes in care is the last step in the EBP process. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 7. ANS: A Usually a small pilot study within the institution is done before any institute-wide change in practice is made. B. The charge nurse will not have the evidence needed to propose the change to administration. C. Polling the nursing staff is not going to help with implementing the change. D. Nursing experts might not have the information needed to determine if the change is appropriate within the organization. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 8. ANS: B Level I is the best evidence and is an analysis of many well-conducted, randomized, controlled trials. It is a systematic review of studies. D. Level II evidence is obtained from at least one well-designed randomized controlled trial. A. Level III is evidence obtained from quasi-experimental research studies. C. Level IV is evidence from the opinion of authorities and/or reports of expert committees. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 9. ANS: D Evidence-based nursing practice is much more than just evaluating research studies to determine what results to apply to nursing practice. Evidence-based nursing practice is a systematic process that utilizes current evidence to make decisions about the care of patients, including evaluation of quality and applicability of existing research, patient preferences, costs, clinical expertise, and clinical settings. A. B. EBP is not used to support professionalism in nursing or as a mechanism to increase nurses’ salaries. C. EBP also is not used to validate the importance of nursing care. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 10. ANS: A A small pilot study is typically done before an institute-wide change is made. B. This would not be a statistically significant number to support the need for change. C. More evidence or evidence of a higher level would better support the proposed change. D. It is important to consider the context in which the evidence wi ll be used, and research involving a population similar to that of the nurse’s institution is helpful. PTS: 1 DIF: Difficult KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 11. ANS: B The use of EBP allows nurses to give patients the best care possible, which is the goal of all caring nurses. It is considered the gold standard for nursing care. A. C. EBP does not necessarily save money or reduce staff errors. D. EBP does not influence access to health care. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 12. ANS: B Systematic review, or Level I evidence, is the best evidence; it is an analysis of several well- conducted, randomized, controlled trials. A. Expert opinion is Level IV evidence, which is considered the weakest evidence. C. Traditional practice is not a type of evidence for EBP analysis. D. Quasi-experimental studies are considered Level III evidence, because these studies do not control factors that could falsely change the results and are less predictive of the effectiveness of nursing care. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 13. ANS: C The only database specific to nursing is CINAHL. CINAHL is available through school libraries and hospital libraries. A. B. Medline and PubMed are the same resource and are used for medical literature. D. Cochrane Reviews focus on reviews of nursing literature. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Safety and Infection Control | Cognitive Level: Application 14. ANS: A Quasi-experimental research studies do not control for factors that could falsely change results and as such, are less predictive of the effectiveness of nursing care. B. Outcome tracking over 10 years is a longitudinal study design, however, does not explain the type of data that will be obtained. C. Control of comorbid conditions describes a Level II design study. D. Modifiable and non-modifiable risk factors would not be identified through a quasi-experimental approach, because the variables or factors are not controlled. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 15. ANS: A Nurses will know from measured outcomes that they are giving the best care possible based on the evidence available at the time. B. Reviewing the literature helps with planning care. C. Constructing a burning question is used to identify the best possible practice for care. D. Determining the validity of clinical research is used to analyze research studies for best practices. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 16. ANS: A The steps of EBP are Ask, Search, Think, Measure, Make It Happen, and Evaluate. Since the nurse completed Ask, Search, Think, and Measure, the next step is Make It Happen. B. A cost-benefit analysis should have been completed already. C. Related research studies should have been validated already. D. A pilot project should have been completed already. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Physiological Integrity | Cognitive Level: Application 17. ANS: D A randomized controlled trial is considered Level II evidence. A. C. The Cochrane Review and Joanna Briggs Best Practices Review are considered Level I evidence. B. A quasi-experimental study is considered Level III evidence. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 18. ANS: A Evidence-based care should be given at all times if possible and in all settings where nursing care is given. A way to ensure that evidence-based care is provided is to explain why the care should be given at the time the care is delegated. B. C. D. Explaining the reason for the care is not done to guarantee that the patient will receive morning care, help the UAP focus on actions, or help with time management. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 19. ANS: D Discussing expected effects of a prescribed medication with an HCP and reviewing guidelines for administration of the medication with the pharmacist demonstrate teamwork and collaboration. A. Informatics is the management of patient confidential information. B. Patient-centered care is creating an individualized plan of care for a patient. C. Quality improvement is a process to improve patient care. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 20. ANS: A It takes critical thinking to use safety interventions at the right times and in the right circumstances. Using them appropriately helps provide safer care with fewer errors. A. The nurse does not need to ask for permission to use a safety intervention. C. The patient will most likely want all safety interventions to be used. D. A pilot study does not need to be conducted before implementing a safety intervention. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application MULTIPLE RESPONSE 21. ANS: A, C, D, E Dependent nursing interventions are those delegated by a physician. B is an independent nursing intervention that does not require a physician’s order. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity — Basic Care and Comfort | Cognitive Level: Analysis 22. ANS: A, C, D, E Quasi-experimental studies do not control factors that could falsely change the results and as such, are less predictive of the effectiveness of nursing care. No control exists if there is only one group being tracked or if patients are collected on a volunteer basis. B. The use of an experimental group and a control group describes a randomized controlled trial study. PTS: 1 DIF: Difficult KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis 23. ANS: A, B The steps in the EBP process are Ask, Search, Think, Measure, Make It Happen, and Evaluate. An acronym to remember these steps is ASKMME. C. D. Asking nursing experts and manipulating current practice are not steps in the EBP process. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Application 24. ANS: A, B, C, E Safety goals increase awareness and understanding of patient safety. They address administering medications safely, identifying patients correctly, identifying operative sites correctly, improving communication, reducing fall injuries, and reducing the risk of infection. D. Safety goals would not be applicable while stocking a supply room with linens. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Safety and Infection Control | Cognitive Level: Application 25. ANS: A, B, C A. When collaborating on the development of nursing care plans, it is important to individualize interventions to provide patient-centered care. B. As nursing interventions are performed, they should meet the patient’s preferred schedules. C. Nurses should always evaluate each suggested intervention to see if it fits the patient. D. E. Scanning medication using a bar-coding system and documenting in the electronic medical record are actions that support the focus of informatics. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment — Management of Care | Cognitive Level: Analysis Chapter 3. Issues in Nursing Practice Chapter 3. Issues in Nursing Practice Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. After working a 12-hour shift, the nurse is asked to work part of the next shift due to short staffing. Which obligation to work should the nurse use to guide the response to this request? a. Justice b. Welfare c. Moral d. Legal ____ 2. The family of a patient who has been diagnosed with cancer does not want the patient to be told about the diagnosis. The patient asks the nurse, “Do I have cancer?” Which ethical principles should the nurse consider when resolving this situation? a. Autonomy and veracity b. Beneficence and justice c. Welfare rights and moral obligations d. Nonmaleficence and legal obligations ____ 3. A patient tells the nurse that the Patient’s Bill of Rights gives patients the legal right to read their medical information. Which of these responses would be appropriate for the nurse to make? a. “I’ll ask your physician if you can read the record.” b. ”Are you concerned about the care you are receiving?” c. ”I’ll stay here with you while you read it in case you have any questions.” d. ”Let me check with the charge nurse first.” ____ 4. The nurse assigned to care for a patient who has HIV accepts the patient assignment despite believing that the patient’s condition is a punishment from God. With which ethical principle is this nurse’s behavior associated? a. Justice b. Veracity c. Beneficence d. Nonmaleficence ____ 5. While planning patient care, the nurse considers what needs to be done to limit any liability. Which action should the nurse take to minimize liability when providing patient care? a. Ensure patients’ rights. b. Follow verbal orders. c. Follow directions exactly as given. d. Verify employer’s liability insurance. ____ 6. A patient is identified to participate in a new drug study, but does not understand the drug or the study. Which ethical principle should the nurse use to prevent the patient from participating in the study? a. Veracity b. Autonomy c. Nonmaleficence d. Standard of Best Interest ____ 7. The nurse educator is preparing a seminar that focuses on the impact of technology on patient care. Which effect of technology on ethical decision making should the educator include in this seminar? a. Ethical situations remain similar to what they have always been in health care. b. Nurses have fewer ethical decisions, because computers now make many decisions. c. Ethical dilemmas have become more complex owing to technologies that prolong life. d. Nurses can postpone ethical decisions, because technology allows patients to live longer. ____ 8. The nurse is concerned about a patient’s ability to make decisions about a proposed treatment plan. Which patient characteristic is causing the nurse to have this concern? a. Lower socioeconomic status b. Authoritarian family relationship c. Past experience with hospitalization d. Lack of information about treatment ____ 9. A patient has a living will and gives it t o the nurse to follow. The patient says, “Do not tell my family about the living will.” Which action should the nurse take? a. Send a copy of the living will to medical records. b. Assure the patient that the nurse will not tell anyone. c. Encourage the patient to discuss the living will with the family. d. Return the living will to the patient until the family is informed. ____ 10. The nurse is caring for an 80-year-old patient. Which statement made by the nurse conveys dignity and respect to the patient? a. “Honey, I have your medications.” b. “I have your medications for you, dear.” c. “I have your medications for you.” d. “It’s time for us to take our medications.” ____ 11. The charge nurse is concerned that an HCP is breaching a patient’s confidentialit y. What did the charge nurse observe to come to this conclusion? a. A physician asking a nurse if a friend has cancer b. Use of patient initials on nurse’s assignment worksheet c. A nurse asking an unknown physician for identification d. A nurse reviewing charts of assigned patients for orders ____ 12. The nurse is reviewing information on the state board of nursing website prior to renewing