Exam (elaborations) TEST BANK FOR BRUNNER AND SUDDARTH ’S TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION
TEST BANK FOR BRUNNER AND SUDDARTH ’S
... [Show More] TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION Contents 1. Health Care Delivery and Nursing Practice 1 2. Community-Based Nursing Practice 8 3. Critical Thinking, Ethical Decision Making, and the Nursing Process 12 4. Health Education and Health Promotion 21 5. Adult Health and Nutritional Assessment 26 6. Homeostasis, Stress, and Adaptation 31 7. Individual and Family Considerations Related to Illness 40 8. Perspectives in Transcultural Nursing 45 9. Genetics and Genomics Perspectives in Nursing 49 10. Chronic Illness and Disability 53 11. Principles and Practices of Rehabilitation 57 12. Health Care of the Older Adult 63 13. Pain Management 68 14. Fluid and Electrolytes: Balance and Disturbance 73 15. Shock and Multiple Organ Dysfunction Syndrome 85 16. Oncology: Nursing Management in Cancer Care 93 17. End-of-Life Care 101 18. Preoperative Concepts and Nursing Management 104 19. Intraoperative Nursing Management 109 20. Postoperative Nursing Management 114 21. Assessment of Respiratory Function 120 22. Management of Patients With Upper Respiratory Tract Disorders 127 23. Management of Patients With Chest and Lower Respiratory Tract Disorders 134 24. Management of Patients With Chronic Pulmonary Disease 143 25. Respiratory Care Modalities 149 26. Assessment of Cardiovascular Function 158 27. Management of Patients With Dysrhythmias and Conduction Problems 165 28. Management of Patients With Coronary Vascular Disorders 173 29. Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders 181 30. Management of Patients With Complications From Heart Disease 187 31. Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation 194 32. Assessment and Management of Patients With Hypertension 200 33. Assessment and Management of Patients With Hematologic Disorders 204 34. Assessment of Digestive and Gastrointestinal Function 212 35. Management of Patients With Oral and Esophageal Disorders 218 36. Gastrointestinal Intubation and Special Nutritional Modalities 224 37. Management of Patients With Gastric and Duodenal Disorders 230 38. Management of Patients With Intestinal and Rectal Disorders 236 39. Assessment and Management of Patients With Hepatic Disorders 243 40. Assessment and Management of Patients With Biliary Disorders 250 41. Assessment and Management of Patients With Diabetes Mellitus 254 42. Assessment and Management of Patients With Endocrine Disorders 263 43. Assessment of Renal and Urinary Tract Function 271 44. Management of Patients With Renal Disorders 274 45. Management of Patients With Urinary Disorders 281 46. Assessment and Management of Female Physiologic Processes 285 47. Management of Patients With Female Reproductive Disorders 291 48. Assessment and Management of Patients With Breast Disorders 297 49. Assessment and Management of Problems Related to Male Reproductive Processes 303 50. Assessment of Immune Function 308 51. Management of Patients With Immunodeficiency 312 52. Management of Patients With HIV Infection and AIDS 315 53. Assessment and Management of Patients With Allergic Disorders 320 54. Assessment and Management of Patients With Rheumatic Disorders 324 55. Assessment of Integumentary Function 330 56. Management of Patients With Dermatologic Problems 334 57. Management of Patients With Burn Injury 341 58. Assessment and Management of Patients With Eye and Vision Disorders 347 viii Contents 59. Assessment and Management of Patients With Hearing and Balance Disorders 353 60. Assessment of Neurologic Function 358 61. Management of Patients With Neurologic Dysfunction 363 62. Management of Patients With Cerebrovascular Disorders 368 63. Management of Patients With Neurologic Trauma 372 64. Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies 376 65. Management of Patients With Oncologic or Degenerative Neurologic Disorders 380 66. Assessment of Musculoskeletal Function 384 67. Musculoskeletal Care Modalities 388 68. Management of Patients With Musculoskeletal Disorders 394 69. Management of Patients With Musculoskeletal Trauma 398 70. Management of Patients With Infectious Diseases 404 71. Emergency Nursing 409 72. Terrorism, Mass Casualty, and Disaster Nursing 414 Answer Key 417 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. 1 Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. I. Interpretation, Completion, and Comparison MULTIPLE CHOICE Read each question carefully. Circle your answer. 1. The definition of nursing has evolved over time. According to the Social Policy Statement (2003) of the American Nurses Association (ANA), registered nurses can and should: CHAPTER 1 Health Care Delivery and Nursing Practice a. diagnose human responses to illness. b. promote optimum levels of wellness. c. prevent illness and maintain health. d. do all of the above. 2. An underlying focus in any definition of nursing is the registered nurse’s responsibility to: a. appraise and enhance an individual’s healthseeking perspective. b. coordinate a patient’s total health management with all disciplines. c. diagnose acute pathology. d. treat acute clinical reactions to chronic illness. 3. A Jewish patient who adheres to the dietary laws of his faith is in traction and confined to bed. He needs assistance with his evening meal of chicken, rice, beans, a roll, and a carton of milk. Choose the nursing approach that is most representative of promoting wellness. a. Nurse “A” removes items from the overbed table to make room for the dinner tray. b. Nurse “B” pushes the overbed table toward the bed so that it will be within the patient’s reach when the dinner tray arrives. c. Nurse “C” asks a family member to assist the patient with the tray and the overbed table while the nurse straightens the area in an attempt to provide a pleasant atmosphere for eating. d. Nurse “D” prepares the environment and the overbed table and inspects the contents of the dinner tray. The nurse asks the patient whether he would like to make any substitutions in the foods and fluids he has received. 4. Using the concept of the wellness–illness continuum, a nursing care plan for a chronically ill patient would outline steps to: a. educate the patient about every possible complication associated with the specific illness. b. encourage positive health characteristics within the limits of the specific illness. c. limit all activities because of the progressive deterioration associated with all chronic illnesses. d. recommend activity beyond the scope of tolerance to prevent early deterioration. 10. Common features that characterize managed care include all of the following except: 2 CHAPTER 1 ■ Health Care Delivery and Nursing Practice Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. 5. To be responsive to the changing health care needs of our society, registered nurses will need to: a. focus their care on the traditional diseaseoriented approach to patient care, because hospitalized patients today are more acutely ill than they were 10 years ago. b. learn how to delegate discharge planning to ancillary personnel so that registered nurses can spend their time managing the “high tech” equipment needed for patient care. c. place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness. d. stress the curative aspects of illness, especially the acute, infectious disease processes. 6. Continuous quality improvement (CQI) was mandated in health care organizations in 1992. This system focuses on all of the following processes except: a. analyzing similar clinical situations. b. assessing the impact of financial decisions on patient care delivery. c. examining processes that affect patient care. d. reviewing medication errors for individual patients. 7. Quality assurance programs created in the 1980s required that hospitals be accountable for all of the following except: a. appropriateness of care related to established standards. b. cost of services. c. staff–patient ratios for nursing care. d. quality delivery of services. 8. The primary focus of the nurse advocacy role in managing a clinical pathway is: a. continuity of care. b. cost-containment practices. c. effective utilization of services. d. a patient’s progress toward desired outcomes. 9. Nursing practice in the home and community requires competence and experience in the techniques of: a. decision making. b. health teaching. c. physical assessment. d. all of the above. a. fixed-price reimbursement. b. mandatory precertification. c. preferred provider choice. d. prenegotiated payment rates. SHORT ANSWER Read each statement carefully. Write your response in the space provided. 1. List four phenomena frequently identified by the American Nurses Association (ANA) in 2003 as the focus of nursing care and research. An example is given: Pain and discomfort (Example) __________________________________________________, __________________, ______________, and ________________. 2. List six significant changes (socioeconomic, political, scientific, and technological) that have evolved over the last hundred years that have influenced where nurses practice. _____________________________, and __________________________________________________________ _____________________________, and __________________________________________________________ _____________________________, and __________________________________________________________ 3. List four major health care concerns that practitioners are facing today with the shift from acute to chronic illnesses: ___________________________, __________________________, _____________________________, and ____________________. 4. Choose four health and illness problems and write a human response to each that would require nursing intervention. An example is provided. Health and Illness Problems Human Response Requiring Nursing Intervention Fractured right arm (Example) Self-care limitations (Example) 1. __________________________ __________________________________________ 2. __________________________ __________________________________________ 3. __________________________ __________________________________________ 4. __________________________ __________________________________________ 5. According to Hood and Leddy (2007), wellness involves proactively working toward physical, psychological, and spiritual well-being. Four major concepts supporting wellness are: ________________________________, ________________________________, ________________________________, and _________________________________. 6. List Maslow’s hierarchy of needs, and give an example for each need. The first need is provided as an example. Need Example Physiologic (Example) Food and water (Example) _________________________________ __________________________________________ _________________________________ __________________________________________ _________________________________ __________________________________________ _________________________________ __________________________________________ _________________________________ __________________________________________ _________________________________ __________________________________________ _________________________________ __________________________________________ 7. Health promotion efforts today target negative lifestyle behaviors. List six examples. __________________________________ __________________________________________ __________________________________ __________________________________________ __________________________________ __________________________________________ 8. Three infectious diseases that presently seem to be on the rise are: __________________________, ____________________________, and _________________________. 9. List four comorbidities that are associated with the major health concern of obesity: ______________, _________________, _________________, and ____________________. CHAPTER 1 ■ Health Care Delivery and Nursing Practice 3 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. 10. Define the term evidence-based practice (EBP). _________________________________________________________________________________________________________ 11. Define the term clinical pathway as it relates to the concept of managed care. _________________________________________________________________________________________________________ 12. In addition to clinical pathways, there are four other EBP tools a nurse can use. They are: ____________________, ______________________, ______________________, and ____________________. 13. Explain when “care mapping” may be more beneficial than “clinical pathways” for managing care. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 14. List five common features of managed care: ____________________, ________________________, ____________________, ____________________, and _____________________________. 15. List the purpose and goals of case management. _________________________________________________________________________________________________________ 16. List four categories of advanced practice nurses: ________________, _______________, ________________, and _______________________. II. Critical Thinking Questions and Exercises DISCUSSION AND ANALYSIS Discuss the following topics with your classmates. 1. Review the clinical pathway for acute ischemic stroke that is presented in Appendix B. Discuss the range of assessments, expected outcomes, nursing diagnoses, and treatment modalities listed in the chart. 2. Discuss the primary differences between community-based nursing and community-oriented/public health nursing. 3. Discuss the current and future role of the advanced practice nurse (APN). SUPPORTING ARGUMENTS Read the paragraph below. Fill in the space provided with the best response. Many recent changes in health care have significantly affected nursing care delivery and nursing education, including the aging population, increased cultural diversity, changing patterns of disease, the rising cost of health care, and federally legislated health care reform. Choose one factor that you believe has had the most impact on nursing care in the last 5 years, and support your argument with data. The most important factor is: ________________________________________________________________________________________________ Supporting argument: ________________________________________________________________________________________________ 4 CHAPTER 1 ■ Health Care Delivery and Nursing Practice Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. RECOGNIZING CONTRADICTIONS Rewrite each statement correctly. Underline the key concepts. 1. The majority of health problems in the United States today are of an infectious and acute nature. ______________________________________________________________________________________________ 2. A person with a chronic illness can never attain a high level of wellness, because part of his or her health potential will never be reached. _____________________________________________________________________________________________. 3. It is predicted that by the year 2030, people older than 65 years of age in the United States will constitute about 35% of the total population; racial and minority groups could approach 60% of the population. _____________________________________________________________________________________________ 4. Those individuals with infectious diseases are the largest group of health care consumers in the United States. _____________________________________________________________________________________________ 5. The largest group of health care consumers in the United States is children and the middle-aged. _____________________________________________________________________________________________ 6. Home health care nursing is a major component of public health nursing. _____________________________________________________________________________________________ EXAMINING ASSOCIATIONS Answer the following. 1. Examine the progression of Maslow’s hierarchy of needs in Figure 1-1. Consider one or more recent clinical situations where the patient’s physical symptoms prevented him or her from attending to higher level needs. _____________________________________________________________________________________________ _____________________________________________________________________________________________ 2. Using Figure 1-2 in the text, examine and explain the expected behaviors among the physician, patient, nurse, and ancillary personnel in the collaborative practice model. _____________________________________________________________________________________________ 3. Compare the two most common models of nursing care delivery in practice today: primary nursing and patient-focused or patient-centered care. _____________________________________________________________________________________________ CHAPTER 1 ■ Health Care Delivery and Nursing Practice 5 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. 6 CHAPTER 1 ■ Health Care Delivery and Nursing Practice Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. FIGURE 1-1. This scheme of Maslow’s hierarchy of human needs shows how a person moves from fulfillment of basic needs to higher levels of needs, with the ultimate goal being integrated human functioning and health. FIGURE 1-2. 2. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated in 1992 that health care organizations move toward implementation of CQI. A cause-and-effect diagram can illustrate potential causes of a process so that the cause can be examined and corrected and patient care improved. Complete the following diagram. CLINICAL SITUATIONS Complete the following flow charts. 1. Continuous quality improvement (CQI) mandates the standardization of processes that are implemented and improved on a continuous basis. Complete the blank lines on the flow chart for the process of radial pulse assessment. CHAPTER 1 ■ Health Care Delivery and Nursing Practice 7 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. 8 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. I. Interpretation, Completion, and Comparison MULTIPLE CHOICE Read each question carefully. Circle your answer. 1. The shift in health care delivery from acute care to community-based care is primarily the result of: CHAPTER 2 Community-Based Nursing Practice a. alternative health care delivery systems. b. changes in federal legislation. c. tighter insurance regulations. d. the interfacing of all three conditions. 2. Choose an alternative health care delivery system that has dramatically reduced patient-care days in acute care settings. a. Health Maintenance Organizations. b. Managed Health Care Systems. c. Preferred Provider Organizations. d. Each of the three is equally significant. 3. The most frequent users of home health services are: a. children with chronic, debilitating disorders. b. newborns who are sent home with apnea monitors. c. the frail and elderly who need skilled care. d. young adults on prolonged intravenous therapy. 4. Discharge planning from the hospital to home care begins when the: 5. Nurses working in elementary schools are trained to deal with one of the most frequent health care problems: a. discharge order is written. b. nurse receives the physician’s order for discharge. a. eating disorders. b. emotional problems. c. infections. d. drug abuse. 6. Nurses working with high school students are prepared to deal with the common health care problem of: a. influenza. b. cancer. c. alcohol and drug abuse. d. pneumonia. c. physician notifies the insurance company. d. patient is admitted to the hospital. Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. CHAPTER 2 ■ Community-Based Nursing Practice 9 SHORT ANSWER Read each statement carefully. Write your response in the space provided. 1. Name three chronic conditions that are increasing in prevalence and causing an increased need for community health services: _______________________, ________________________, and _______________________. 2. List four factors that have affected the shift of health care delivery from inpatient to outpatient settings: _________________________________, ___________________, ___________________, and _________________________. 3. List specific skills a nurse will need to function in community-based care. ____________________________________________________________________________________ 4. Community-based nursing practice focuses on three primary goals: __________________________, ______________________, and _________________________. 5. List the four primary concepts supporting community-based nursing care: _________________________, ___________________, ___________________, and ______________________________. 6. List several examples of “skilled” nursing services provided by home care. ____________________________________________________________________________________________ 7. The first step in preparing for a home visit is for the nurse to: ____________________________________________________________________________________________ 8. Explain the purpose of the initial home visit. ____________________________________________________________________________________________ ____________________________________________________________________________________________ 9. List the range of nursing responsibilities within ambulatory health care settings. ____________________________________________________________________________________________ ____________________________________________________________________________________________ 10. The homeless have high rates of health care problems such as: ____________________________________________________________________________________________ II. Critical Thinking Questions and Exercises DISCUSSION AND ANALYSIS Discuss the following topics with your classmates. 1. Distinguish among primary, secondary, and tertiary levels of preventive care and cite a clinical case example for each level. 2. Discuss one of the major financial incentives for discharging patients from acute care facilities prior to full recovery. Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. 10 CHAPTER 2 ■ Community-Based Nursing Practice 3. Explain the concept of “telehealth” and its implications for nursing care. Refer to the book, Community and Public Health Nursing, by M. Stanhope and S. Lancaster, 2008, St. Louis, Mosby. CLINICAL SITUATIONS CASE STUDY: Assessing the Need for a Home Visit Read the following case study and assess the patients’ need for a home visit. Mrs. Flynn is an 85-year-old lady who suffered a stroke on December 28. She was admitted to the emergency department and suffered another stroke on December 30. The left occipital area and the cerebellum were affected resulting in the loss of 50% of vision (right half of each eye) and loss of balance. After 2 weeks in the hospital and 10 days in a rehabilitation treatment center, Mrs. Flynn will be discharged to her one-floor home where she lives alone. Her son and daughter both live an hour away. She is capable of walking with a walker. Before the stroke, Mrs. Flynn was independent, an active member of several citizen groups, and participated in water walking at the YMCA three times a week. Her driver’s license was revoked. Using Chart 2-2 in the text, complete the outline to assess Mrs. Flynn’s need for a home visit. Create your own answers to several of the questions so you can complete the assessment. Current Health Status 1. How well is the patient progressing? 2. How serious are the present signs and symptoms? 3. Has the patient shown signs of progressing as expected, or does it seem that recovery will be delayed? Home Environment 1. Are worrisome safety factors apparent? 2. Are family or friends available to provide care, or is the patient alone? Level of Self-Care Ability 1. Is the patient capable of self-care? 2. What is the patient’s level of independence? 3. Is the patient ambulatory or bedridden? 4. Does the patient have sufficient energy or is she frail and easily fatigued? Level of Nursing Care Needed 1. What level of nursing care does the patient require? 2. Does the care require basic skills or more complex interventions? Prognosis 1. What is the expectation for recovery in this particular instance? 2. What are the chances that complications may develop if nursing care is not provided? Educational Needs 1. How well has the patient or family grasped the teaching points made? 2. Is there a need for further follow-up and retraining? 3. What level of proficiency does the patient or family show in carrying out the necessary care? Mental Status 1. How alert is the patient? 2. Are there signs of confusion or thinking difficulties? Level of Adherence 1. Is the patient following the instructions provided? 2. Does the patient seem capable of following the instructions? 3. Are the family members helpful, or are they unwilling or unable to assist in caring for the patient as expected? CHAPTER 2 ■ Community-Based Nursing Practice 11 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. 12 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition. I. Interpretation, Completion, and Comparison MULTIPLE CHOICE Read each question carefully. Circle your answer. 1. The least effective decision-making process used in critical thinking is: CHAPTER 3 Critical Thinking, Ethical Decision Making, and the Nursing Process a. analyzing data. b. establishing assumptions. c. formulating conclusions. d. synthesizing information. 2. The term metacognition refers to the critical-thinking skill of: a. consultation. b. data analysis. c. self-reasoning. d. validation. 3. Morality is defined as: a. adherence to specific codes of conduct. b. commitment to informal, personal values. c. dependence on specified principles of behavior. d. an understanding of defined rules of behavior. 4. When an ethical decision is made based on the reasoning of the “greatest good for the greatest number,” the nurse is following the: 5. Individual patient rights regarding the freedom of choice and the right to privacy are subsumed under the ethical principle of: a. deontological theory. b. formalist theory. a. autonomy. b. beneficence. c. fidelity. d. paternalism. 6. Consider the ethical situation in which a nurse moves a confused, disruptive patient to a private room at the end of the hall so that other patients can rest, even though the confused patient becomes more agitated. The nurse’s judgment is consistent with reasoning based on: a. “consequentialism,” by which good consequences for the greatest number are maximized. b. “duty of obligation,” by which an action, regardless of its results, is justified if the decision making was based on moral principles. c. “prima facie” duty, by which an action is justified if it does not conflict with a stronger duty. d. the “categorical imperative,” by which the result [Show Less]