Medical-Surgical Nursing.docx

Medical-Surgical Nursing Question 1 The nurse plans and implements care for a patient based on nursing knowledge and skills. The nurse is functioning within which role? 1. Caregiver 2. Advocate 3. Educator 4. Leader Correct Answer: 1 Rationale 1: The caregiver role for the nurse today is both independent and collaborative. Nurses independently make assessments and plan and implement patient care based on nursing knowledge and skills. Rationale 2: The nurse functioning as a patient advocate actively promotes the patient’s rights to autonomy and free choice. Rationale 3: The nurse who is functioning in the role of educator nurse assesses learning needs, plans and implements teaching methods to meet those needs, and evaluates the effectiveness of the teaching. Rationale 4: The nurse functioning in the role of leader directs, delegates, and coordinates nursing activities. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-1 Question 2 A patient tells the nurse that he does not understand the surgical procedure the physician told him he needed. What should the nurse do to advocate for this patient? 1. Contact the physician and ask that the procedure be explained to the patient. 2. Explain the procedure to the patient. 3. Document that the patient does not understand the proposed surgical procedure. 4. Instruct the patient about alternatives to the surgical procedure. Correct Answer: 1 Rationale 1: The nurse as patient advocate actively promotes the patient’s rights to autonomy and free choice. The nurse should protect the patient’s right to self-determination about the surgical procedure. Rationale 2: The nurse should not explain the procedure to the patient. This is not patient advocacy. Rationale 3: Simply documenting the patient’s lack of understanding about the procedure is not advocacy. Rationale 4: It is not the nurse’s place to discuss alternatives to a surgical procedure recommended by the physician. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-1 Question 3 The nurse, instructing a patient newly diagnosed with type 2 diabetes, reminds the patient about the need for an annual dilated retinal eye examination and annual urine tests to measure protein levels. The nurse is functioning within which role with this patient? 1. Educator 2. Researcher 3. Advocate 4. Leader Correct Answer: 1 Rationale 1: The nurse is functioning as an educator by instructing the patient on annual tests to maintain health. Rationale 2: As a researcher, the nurse would have a goal to improve the care nurses provide to patients. Rationale 3: As an advocate, the nurse actively promotes the patient’s rights to autonomy and free choice. Rationale 4: As a leader, the nurse manages time, people, and resources by delegating, directing, and coordinating nursing activities. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-1 Question 4 The nurse manager of a care area asks that a new intravenous-therapy monitoring device not be used for any patients until the entire staff has received appropriate instruction on its use. The nurse manager is demonstrating which component of caring? 1. Comportment 2. Confidence 3. Conscience 4. Commitment Correct Answer: 4 Rationale 1: Comportment is the awareness of one's conduct and behavior around others. Rationale 2: Confidence is the ability to believe in or rely on another person. Rationale 3: Conscience is defined as possessing a moral sense of right and wrong. Rationale 4: Commitment is the obligation to see something through to completion, to achieve positive outcomes, and to ensure that the organization supports the nurses in their learning needs. The nurse manager is ensuring that the nursing staff is trained in the use of the equipment before it is used. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Safety and Infection Control Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-2 Question 5 The nurse is concerned about new scheduling changes and their impact on staffing levels. If applying the component of professional comportment, in which ways should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Call a friend in another care area and discuss the changes in the unit station. 2. Request a private discussion of the proposed changes with the nurse manager. 3. Shake her head and laugh while saying, "Here we go again." 4. Discuss the changes with other staff members in the unit hallway. 5. Ask to serve on the committee that will evaluate the changes over the next 6 months. Correct Answer: 2,5 Rationale 1: Calling friends and discussing the changes in the unit station would not demonstrate professional comportment. Rationale 2: Discussing the changes calmly in a private area demonstrates professional comportment. Rationale 3: Shaking one's head, laughing, and making snide comments would not be professional or polite. Rationale 4: Talking with others about the changes within earshot of patients would not demonstrate professional comportment. Rationale 5: Working within the system to evaluate the impact of the changes demonstrates professional comportment. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-2 Question 6 A staffing issue and lack of patient care supplies cause a nurse to cancel planned evening activities and stay on the care area until all issues are resolved. The nurse’s actions are most typical of which role? 1. Administrator 2. Educator 3. Manager 4. Researcher Correct Answer: 3 Rationale 1: Nurse administrators support the organizational goals for patient care. Rationale 2: Nurse educators can either teach patients and staff, direct patient care, or deliver educational content. Rationale 3: The role of the nurse manager is to coordinate and ensure the delivery of quality care within the area of responsibility. The role includes personnel management and ensuring the availability of supplies. Nurse managers usually have 24-hour accountability for the area. Rationale 4: Nurse researchers investigate, manage data, and monitor patient responses to care. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-3 Question 7 A nurse with community-health nursing experience provides monthly blood pressure checks for fellow members of a religious congregation. The nurse is functioning within which role? 1. Parish nurse 2. Clinic nurse 3. Gerontologic nurse 4. Occupational health nurse Correct Answer: 1 Rationale 1: Parish nursing is a form of community nursing that concentrates on the health care needs of a church and members of the congregation. Many parish nurse programs provide preventive health screenings such as blood pressure checks. Rationale 2: Clinic nurses are typically found in health care provider practices. Rationale 3: Gerontologic nurses provide for the physical and psychosocial needs of the older adult population. Rationale 4: Occupational health nurses manage the health of workers and ensure compliance with OSHA standards. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-3 Question 8 A patient is admitted to a patient care area. The nurse has never provided care to a patient from this patient's culture before and is concerned. How should the nurse proceed? 1. Briefly review the patient's culture and its expectations of health care providers. 2. Have another nurse provide care to this patient. 3. Approach the care of this patient as with any other patient admitted to the care area. 4. Locate an interpreter to assist with communication. Correct Answer: 1 Rationale 1: Cultural competence is needed to provide empathy, understanding, communication, value, and caring in health care. The nurse lacks the five components of cultural awareness: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. The nurse would benefit from a brief review of the patient's culture and its expectations of health care providers. Rationale 2: There is no reason for the nurse to ask another nurse to provide care to this patient. Rationale 3: The nurse should not approach the care of this patient in the same way as any other patient because the patient's cultural norms may be different. Rationale 4: Locating an interpreter might be beneficial but does not help with the nurse's knowledge deficit. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-5 Question 9 A nurse of Hispanic descent is assigned to provide care to a patient of the same culture. How would the assignment benefit the patient? 1. The nurse will not make any cultural errors. 2. The nurse will provide expert care. 3. The nurse will make sure the patient has a timely discharge. 4. The nurse is culturally competent. Correct Answer: 4 Rationale 1: The nurse’s background will not guarantee that cultural errors will be avoided. Rationale 2: There is no evidence to support that the nurse will provide expert care. Rationale 3: There is no evidence to support that the nurse will ensure the patient has a timely discharge. Rationale 4: Cultural competence includes cultural awareness, knowledge, skill, encounters, and desire. This nurse would likely be culturally competent with a patient of the same culture. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-5 Question 10 A nurse of German descent is providing care to a patient of Asian descent. Which assets should this nurse possess to work effectively in this cross-cultural situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Understanding of the health care system 2. Motivation to engage in the care of this patient 3. Ability to self-examine 4. Patience 5. Skill in assessment based on culture Correct Answer: 2,3,5 Rationale 1: A good nurse will understand the health care system, but this quality is not specific to working in a cross-cultural situation. Rationale 2: Cultural desire is the motivation to want to engage in the process of becoming culturally aware. It is one of the components of cultural competence. Rationale 3: Cultural awareness is the ability to conduct a self-examination of personal biases toward other cultures and an exploration of personal cultural and professional background. Rationale 4: Patience is a quality of a good nurse, but is not specific to working in a cross-cultural situation. Rationale 5: The ability to conduct a cultural assessment and a culturally based physical exam reflects cultural skill. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-5 Question 11 The nurse, who is an expert at providing care to adult medical-surgical patients, is transitioning to providing care to adult intensive care patients. The nurse's skill level will most likely change to which level? 1. Competent 2. Novice 3. Advanced beginner 4. Proficient Correct Answer: 3 Rationale 1: It will take some time before the nurse is able to function at the level of competent in the new clinical setting. Rationale 2: A novice nurse is one who has little or no experiential background or understanding; the nurse is not a novice. Rationale 3: Even though the nurse is expert at providing care to the adult medical-surgical patient, the nurse is now in a new clinical setting and will need to learn subtle variations of the patients’ clinical presentations. These are characteristics of an advanced beginner. Rationale 4: It will take some time before the nurse is able to function at the level of proficient in the new clinical setting. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-6 Question 12 After receiving a report, the nurse reviews all the activities that must be completed for a group of patients. This nurse is demonstrating which characteristic of a competent nurse? 1. Matching an actual case with a textbook case 2. Planning and analyzing care needs 3. Establishing role boundaries 4. Seeing the big picture of the clinical situation Correct Answer: 2 Rationale 1: Matching an actual case with a textbook case is a characteristic of the novice nurse. Rationale 2: A characteristic of a competent nurse is taking the time to plan and analyze care priorities and needs. Rationale 3: Establishing role boundaries is a characteristic of an advanced beginning nurse. Rationale 4: Seeing the big picture of a clinical situation is a characteristic of a proficient nurse. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-6 Question 13 The nurse relates how excited she was when a patient responded to a particular intervention and how the entire situation was anxiety-producing for her. This nurse is demonstrating a characteristic of which level of nursing practice? 1. Novice 2. Advanced beginner 3. Competent 4. Expert Correct Answer: 3 Rationale 1: Demonstration of exhilaration is not characteristic of a novice nurse. Rationale 2: Demonstration of exhilaration is not characteristic of an advanced beginner. Rationale 3: Nurses at the competent stage feel exhilarated when they perform well, and anxiety is specific to a particular situation. Rationale 4: Expert nurses would not express exhilaration with performance that is considered expected at that level of performance. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-6 Question 14 The nurse observes a lack of urine output in a patient recovering from bladder surgery. Prior to notifying the health care provider, the nurse gently irrigates the tubing and dislodges a small blood clot. Immediately the urine begins to flow. This nurse's intervention demonstrates which level of clinical nursing practice? 1. Novice 2. Competent 3. Advanced beginner 4. Expert Correct Answer: 4 Rationale 1: The novice nurse would not have the experience to do this intervention. Rationale 2: The competent nurse might consult a textbook prior to implementing this intervention. Rationale 3: The advanced beginning nurse would not have the experience to do this intervention. Rationale 4: The expert nurse has the skill and experience to recognize a condition and implement activities to suit the individual patient’s needs. The nurse realized that because the patient was recovering from bladder surgery, there was a chance that a blood clot could be occluding the flow of urine. The nurse's action dislodged the clot and resumed the flow of urine. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-6 Question 15 A nurse with a high level of expertise is providing a report to the oncoming nurse about a particular patient. Which statement would exemplify this nurse's expert level of experience? 1. "I saw that the patient’s eyes changed focus, and I kept the airway open until the seizure ended." 2. "I didn't realize that 2 days of bed rest would make the patient so weak." 3. "The other nurse helping me told me that I did a good job with the patient." 4. "I learned that diuretics can cause imbalances of many electrolytes." Correct Answer: 1 Rationale 1: The expert nurse has a fine-tuned level of practice. The nurse at this level is able to discern subtle differences in the patient’s condition and acts appropriately. Rationale 2: The expert nurse would know that bed rest makes a patient weak. Rationale 3: The expert nurse also would not need validation by another nurse. Rationale 4: The expert nurse would know that diuretics cause many electrolyte imbalances. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-7 Question 16 A nurse practitioner (NP) has joined a practice focusing on family medicine. Which roles would the nurse fulfill in this practice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Developing a comprehensive education program for clinic patients 2. Working with individual patients to promote their wellness 3. Discussing how to prevent illness with patients during regular visits 4. Managing the business office of the clinic 5. Providing expert care to younger patients while the clinic physicians care for older patients Correct Answer: 1,2,3 Rationale 1: Education is a primary focus of the NP. Rationale 2: NPs focus on individualized care and wellness. Rationale 3: A primary focus of the NP is prevention. Rationale 4: The NP’s focus is on patient care, not running the clinic business office. Rationale 5: NPs provide care across the lifespan. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-4 Question 17 A patient is scheduled for surgery and will receive general anesthesia. What interaction can the patient expect with the certified registered nurse anesthetist (CRNA) assigned to the case? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse will be the patient’s primary nurse during surgery and in the postanesthesia recovery room. 2. The CRNA will conduct an assessment of the patient prior to surgery. 3. The CRNA will assist the anesthesiologist in inducing anesthesia. 4. The CRNA will teach the patient about the anesthesia process. 5. The CRNA will maintain the patient’s anesthesia level for the length of the operative procedure. Correct Answer: 2,4,5 Rationale 1: The CRNA manages the patient’s anesthesia care during this time but does not act as the primary nurse. Rationale 2: The CRNA meets the patient prior to surgery and conducts an assessment of the patient’s risks and needs relative to the application of anesthesia. Rationale 3: The CRNA is credentialed to provide anesthesia independently. Rationale 4: Preoperative teaching about anesthesia is often done by the CRNA. Rationale 5: The CRNA maintains anesthesia during the operative procedure. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-4 Question 18 A nurse would like to teach nursing in a technical school. The nurse should pursue which educational preparation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Associate degree 2. Baccalaureate degree 3. Preparation as a clinical nurse specialist 4. Master’s degree 5. Doctoral preparation Correct Answer: 4,5 Rationale 1: The nurse must have a higher level of education to be an academic nurse educator. Rationale 2: To practice as an academic nurse educator, higher-level academic preparation is necessary. Rationale 3: It is not necessary to be a clinical nurse specialist to teach in an academic setting. Rationale 4: A minimum of a master’s degree is required for teaching in an academic setting. Rationale 5: The doctoral level is the desired level of preparation for teaching in an academic setting. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-4 Question 19 A group of nurse managers wishes to develop more expert nurses in the hospital. Which activities should they plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Encourage the development of critical thinking skills. 2. Require that all nurses go back to school for an advanced degree. 3. Schedule sessions that will allow nurses to reflect on the care provided over a specific period of time. 4. Encourage examination of alternate solutions to common nursing problems. 5. Encourage strict adherence to all unit protocols. Correct Answer: 1,3,4 Rationale 1: Critical thinking is closely associated with clinical judgment and expertise in nursing. Rationale 2: While education is essential to the development of clinical judgment and critical thinking skills, a requirement to go back to school is sometimes not well received. Leaders should also consider the impact on scheduling should all nurses return to school at the same time. Rationale 3: Honest reflection is integral to the learning process and to gaining expertise. Rationale 4: The expert nurse avoids “group think.” Rationale 5: The expert nurse may diverge from protocol based on experience. The key to this variance is that the nurse understands what variance is acceptable and what variance is dangerous or unacceptable. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-7 Question 20 The nurse has decided to pursue employment as an occupational health nurse. What would this nurse anticipate as being a primary focus in this job? 1. Serving as compliance officer for the Occupational Safety and Health Act 2. Manage the company’s insurance benefit program. 3. Eliminate the employee’s need for a primary physician. 4. Make home visits to employees to provide care. Correct Answer: 1 Rationale 1: One of the primary foci of the occupational health nurse is to ensure that the employer’s practices are compliant with OSHA. Rationale 2: The benefits package is managed by the human resource department. Rationale 3: The employees still need to maintain a relationship with a primary physician for routine and emergency care. Rationale 4: Home visits are not generally within the practice of occupational health nurses. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-3