A parish nurse for a Catholic church provides a free blood pressure screening the first Sunday of every month. This is what level of prevention?
A) Tertiary prevention
B) Primary prevention
C) Secondary prevention
D) Quaternary prevention
B. Primary prevention is true prevention that precedes disease and is aimed at clients considered physically and emotionally healthy. Secondary prevention involves individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Tertiary prevention occurs when a defect or disability is permanent and irreversible, and the aim is to reduce negative impacts and complications. Quaternary prevention is not a recognized term.
A 72-year-old man diagnosed with chronic obstructive pulmonary disease 5 years ago has been participating for the last 2 years in a pulmonary rehabilitation exercise class offered by the local hospital at a fitness facility. This is what level of prevention?
A) Tertiary prevention
B) Primary prevention
C) Secondary prevention
D) Quaternary prevention
A. Tertiary prevention occurs when a defect or disability is permanent and irreversible, and the aim is to reduce negative impacts and complications. Primary prevention is true prevention that precedes disease and involves clients considered physically and emotionally healthy. Secondary prevention is aimed at individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Quaternary prevention is not a recognized term.
Based on the transtheoretical model of change, what is the most appropriate response to the following client statement: "Me, exercise? I haven't done that since Junior High gym class and I hated it then!"
A) "That's fine. Exercise is bad for you anyway."
B) "OK. I want you to walk 3 miles four times a week and I'll see you in 1 month."
C) "I understand. Can you think of one reason why being more active would be helpful for you?"
D) "I'd like you to ride your bike three times this week and eat at least four fruits and vegetables every day."
C. The transtheoretical model of change describes a series of changes that clients move through, starting with precontemplation and ending with maintenance. The first stage for this client would be to validate the client's opinion and move to the first part of precontemplation. The other options are later steps in the model.
A client says, "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the client through the stages of change toward regular exercise?
A) "Walking is OK. I really think running is better."
B) "Yes, walking is great exercise. Do you think you could go for a 5-minute walk this next week?"
C) "Yes, I want you to begin walking. Walk for 30 minutes every day and start eating more fruits and vegetables, too."
D) "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes walking if you are going to do any good."
B. This option supports the preparation stage in which the client is beginning to consider making small changes. The other options are not good ones for this client.
All of the following are examples of active strategies of health promotion except:
A) Exercise training
B) Weight reduction
C) Smoking cessation
D) Fluoridation of drinking water
D. Passive strategies of health promotion benefit individuals without any action by the individuals themselves. The fluoridation of municipal drinking water and the fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. Weight reduction is considered an active strategy of health promotion. With active strategies of health promotion, individuals are motivated to adopt specific health programs. Smoking cessation requires clients to be actively involved in measures to improve their present and future levels of wellness while decreasing the risk of disease. Exercise training meets the criteria for active strategies of health promotion because it actively involves the client in his or her own health.
A nurse routinely asks clients if they take any vitamins or herbal medications, encourages family members to bring in music that clients like to help them relax, and frequently prays with clients if that is important to them. The nurse is using which model of care?
B) Health belief
D) Health promotion
A. The holistic model attempts to create conditions that promote optimal health. The holistic model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions. The health belief model addresses the relationship between a person's beliefs and behaviors. The transtheoretical model of change discusses a series of changes through which clients move, starting with precontemplation and ending maintenance. The health promotion model defines health as a positive, dynamic state and not merely the absence of disease.
Different attitudes about illness cause people to react in different ways when illness does occur. Medical sociologists call the reaction to illness:
A) Health belief
B) Illness behavior
C) Health promotion
D) Illness prevention
B. Illness behavior is the client's reaction to illness. The other three options are models of health.
The health belief model addresses the relationship between a person's belief and behaviors, therefore:
A) A person who smokes does not follow the model.
B) This model provides a basis for caring for clients of all ages.
C) A person who does not take necessary medications does not follow the model.
D) It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care regimens.
D. The health belief model provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care regimens.
A nurse working in a special care unit for children with severe immunologic problems cares for a 3-year-old boy from Greece. The nurse is having difficulty communicating with the father. What is the appropriate action?
A) Care for the boy the same as for any other client.
B) Ask the manager to talk with the father and keep him out of the unit.
C) Have another nurse care for the boy, because maybe that nurse will communicate better with the father.
D) Search for help in interpreting and understanding the culture differences by contacting someone from the local Greek community.
D. Acquiring cultural and language assistance will help the nurse understand the needs of both the father and the son. The other three options are not culturally sensitive or helpful to the client and his father.
A nurse teaches the importance of folic acid intake to a group of pregnant women. This is considered which level of preventive care?
A) Illness behavior
B) Primary prevention
C) Tertiary prevention
D) Secondary prevention
B. Primary prevention is considered true prevention. It aims at maintaining physical and emotional health in an already healthy individual.
A person's ideas, convictions, and attitudes about health and illness can be described as:
A) Moral beliefs
B) Health beliefs
C) Holistic views
D) Negative health behaviors
B. Health beliefs are an individual's perceptions of health or illness, which may be based on factual information or misinformation, common sense or myths, or reality or false expectations. Moral beliefs are learned behaviors that are in accordance with the principles of right or wrong. Holistic views consider the emotional and spiritual well-being of the individual. Negative health behaviors include behaviors that are typically harmful to health, such as smoking, drug or alcohol abuse, poor diet, and refusal to take appropriate medications.
Which of the following models of health or illness defines health as a positive, dynamic state, not merely the absence of disease?
A) Maslow's hierarchy of needs
B) Rosenstoch's health belief model
C) Pender's health promotion model
D) The holistic health model of nursing
C. Pender's health promotion model was developed to be a "complementary counterpart to models of health protection." This model defines health as a positive, dynamic state, not merely the absence of disease. Maslow's hierarchy of needs defines what is necessary for human survival and health, such as food, water, safety, and love. Rosenstoch's health belief model addresses the relationship between a person's belief and behaviors. It predicts how clients will behave in relation to their health and how they will comply with their health regimen. The holistic health model creates conditions that promote optimal health.
All of the following are considered internal variables that influence a client's health beliefs and practices except:
A) Emotional factors
B) Developmental stage
C) Socioeconomic factors
D) Perception of functioning
C. Socioeconomic factors are considered external variables. A person seeks approval and support from neighbors, peers, and co-workers; this affects health beliefs and practices. Economic variables may affect a client's level of health. For example, a client with a fixed income who needs long-term medications may determine that food and shelter are more important than the medication; therefore, the client's health suffers. Perception of functioning is an internal variable. It is defined as the way an individual perceives his or her physical functioning and how it affects health beliefs and practices. Emotional factors are internal variables. These include a client's degree of stress, depression, or fear, which can influence health beliefs and practices. An individual's developmental stage is considered an internal variable. A client's thinking about health is dependent on his or her level of development.
Clients maintain health or enhance their health by routine exercise and proper nutrition. This is known as:
B) Health promotion
C) Control of external variables
D) Wellness education
B. Health promotion activities help clients maintain and enhance their present level of health. Wellness education instructs persons on how to care for themselves in healthy ways and includes topics such as physical awareness, stress management, and self-responsibility. Illness is defined as poor condition or disease. External variables are outside factors that influence a person's health beliefs and practices. They include family practices, socioeconomic factors, and cultural background.
The nurse in a diabetic clinic conducts monthly seminars for diabetic clients. During these seminars, the importance of taking insulin as directed to prevent diabetic complications is emphasized. This is considered which level of preventive care?
A) Illness prevention
B) Tertiary prevention
C) Primary prevention
D) Secondary prevention
D. Secondary prevention is prevention geared toward individuals who are already experiencing health problems or illness and who are at risk of experiencing complications or a worsening of their condition.
A client comes into the clinic for a complete physical examination. The nurse obtains a health history and determines that the client is at risk for heart disease. Which of the following would lead the nurse to conclude this?
A) The client is 25 years old.
B) The client lives near a chemical plant.
C) The client's father died of a heart attack at age 40.
D) The client works as a carpet salesman.
C. Genetic predisposition to specific illnesses is considered a major physical risk factor. The client's father died of a heart attack at the age of 40, which increases the client's risk of heart disease and heart attack. Age may increase or decrease a client's susceptibility to certain illnesses. Age risk factors are often closely associated with other risk factors, such as family history and personal habits. The client is 25 years old; therefore, based on age alone, risk is low for heart disease at this time. The client lives near a chemical plant; this constant exposure to chemicals may lead to health problems. The physical environment in which a person works and lives can increase the likelihood that certain illnesses will occur, but without further information the nurse cannot assess the heart disease risk related to the client's possible chemical exposure.
Which of the following statements is the World Health Organization's definition of health?
A) "Complete freedom from disease"
B) "Mental, social, and spiritual well-being"
C) "State of complete physical, mental, and social well-being, not merely the absence of disease"
D) "A state of being that people define in relation to their own values, personality, and lifestyle"
C. The World Health Organization defines health as a "state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity." There are several definitions of health. Health is a state of being that people define in relation to their own values, personality, and lifestyle. Health and illness must be defined in terms of the individual. Health can include conditions previously considered to be illness. Pender, Murdaugh, and Parsons note that views of health include mental, social, and spiritual well-being. Pender notes that not all people who are free of disease are equally healthy.
Which of the following terms is defined as a mental self-image of strengths and weaknesses in all aspects of one's personality?
A) Body image
B) Family roles
D) Emotional change
C. Self-concept is a mental self-image of strengths and weaknesses in all aspects of one's personality. Self-concept is important in relationships with other family members. When a client is ill, his or her self-concept changes and this may lead to tension and conflict. Body image is defined as a subjective concept of physical appearance. Many illnesses can cause changes in physical appearance, and clients and families react differently to these changes. Clients react differently to illness or the threat of illness. Individual behavioral and emotional reactions depend on the nature of the illness. Illness impacts family roles. When an illness occurs, parents and children try to adapt to major changes resulting from a family member's illness.
Healthy People 2010's overall goals are to:
A) Assess the health care needs of individuals, families, or communities
B) Develop and implement public health policies and improve access to care
C) Gather information on incident rates of certain diseases and social problems
D) Increase life expectancy and quality of life and eliminate health disparities
D. Healthy People 2010 was established to create ongoing health care goals, including increasing life expectancy and quality of life, and eliminate health disparities through improved delivery of health care services. Gathering information, assessing needs, and developing and implementing public health policies are steps in achieving the goals set forth by Healthy People 2010.
Substance abusers frequently avoid health care providers because of:
A) Fear of the cost of health care
B) Fear of institutions and people
C) Fear of being turned in to the criminal authorities
D) Fear of being without the recreational drug of choice
C. Substance abusers avoid health care for fear of judgmental attitudes by health care providers and concern about being turned in to the criminal authorities. Options 1, 2, and 4 are not primary concerns that result in avoidance of health care.
Vulnerable populations of clients are those who are more likely to develop health problems as a result of:
A) Chronic diseases, homelessness, and poverty
B) Poverty and limits in access to health care services
C) Lack of transportation, dependence on others for care, and homelessness
D) Excess risks, limits in access to health care services, and dependence on others for care
D. Vulnerable population are defined as clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care.
The local health department received information from the Centers for Disease Control and Prevention that the flu was expected to be very contagious this season. The nurse is asked to set up flu vaccine clinics in local churches and senior citizen centers. This activity is an example of which level of prevention?
A) Primary intervention
B) Tertiary intervention
C) Nursing intervention
D) Secondary intervention
A. Secondary intervention includes disease prevention after a health issue has been identified. Primary intervention is prevention of a health problem that has not yet occurred in the community. Tertiary intervention occurs after a problem has occurred and aims at preventing long-term negative impacts or recurrences in a population.
The local school has an increasing number of adolescent parents. The nurse works with the school district to design and teach classes about infant care, child safety, and time management. These are examples of which nursing role?
D) Case manager
A. An educator helps clients, families, and communities gain greater skills and knowledge to provide their own care. An advocate is someone who helps clients walk through the system, identifies services, and plans for accessing appropriate resources. A collaborator is an individual who engages in a combined effort with other individuals to develop a mutually acceptable plan that will achieve common goals. A case manager develops and implements a plan of care.
A nurse is practicing in an occupational health setting. There are a large number of employees who smoke, and the nurse designs an employee assistance program for smoking cessation. This is an example of which nursing role?
D) Case manager
B. A counselor helps clients identify and clarify health problems and choose appropriate courses of action to solve those problems. An educator helps the community gain greater skills, including through the presentation of educational programs. A collaborator is an individual who engages in a combined effort with other individuals to develop a mutually acceptable plan that will achieve common goals.
What are the three elements included in a community assessment?
A) Environment, families, and social systems
B) People, neighborhoods, and social systems
C) Structure or locale, people, and social systems
D) Health care systems, geographic boundaries, and people
C. The community has three components: structure or locale, people, and social systems. To develop a complete community assessment, the nurse must take a careful look at each of the three components to begin to identify needs for health policy, health programs, and health services.
The focus of community health nursing differs from that of public health nursing because the nursing care:
A) Is directed at the individual client only
B) Is provided by nurses with a graduate degree in community health nursing
C) Provides direct care to subpopulations who make up the community as a whole
D) Is administered to a collection of individuals who have in common one or more personal or environmental characteristics
C. Option 3 defines the focus of community health nursing. Community health nursing focuses on the individual, family, and community. Educational requirements for community-based nurses are not as clearly defined as those for public health nurses. An advanced degree is not always required.
In Healthy People 2010, assurance refers to the role of public health in:
A) Providing disease prevention, health protection, and health promotion
B) Making essential community-wide health services available and accessible
C) Providing leadership in developing policies that support the population's health
D) Achieving a healthy environment for each individual, family, and community
B. In Healthy People 2010, the assurance role of public health is defined as making essential community-wide health services available and accessible. In Healthy People 2010, public development and implementation refer to the role of health professionals in providing leadership in development of policies that support the population's health. Population-based public health programs focus on disease prevention, health promotion, and health protection. A healthy environment for each individual, family, and community is the overall goal of Healthy People 2010.
A home care nurse educator has repeatedly counseled a 33-year-old male diabetic client concerning the need for dietary compliance. In writing an effective teaching plan the nurse will first:
A) Reprimand the client for noncompliant behavior
B) Assess the client's learning needs and readiness to learn
C) Repeat the old teaching plan to ensure the client's comprehension
D) Provide a detailed description of complications associated with the disease process
B. Assessing the learner's needs and readiness to learn are important to increase the success of the learning process. Options A and D are negative responses and would block the learning process. Repeating the old teaching plan is nonproductive and an inefficient application of the nursing process.
Vulnerable populations are more likely to develop health problems. Which of the following is true of these populations?
A) They are specific populations with unique health care problems.
B) They are limited to the very young and older adult age groups.
C) They live in communities with similar cultures, beliefs, and values.
D) They frequently experience positive outcomes in response to community health interventions.
A. Vulnerable populations are defined as specific populations with unique health care problems. Vulnerable populations are not limited to the very young or older adults. Such individuals are those living in poverty, homeless persons, abused clients, substance abusers, and so on. Members of most vulnerable populations come from different cultures and have different beliefs and values. Vulnerable populations are at risk of experiencing poorer outcomes in response to interventions because of the multiple stressors that affect their daily lives.
A competent community-based nurse must be skilled in fulfilling a variety of roles. The ability to establish an appropriate plan of care that is based on assessment of clients and families and coordinates the provision of needed resources and services across a continuum of care defines the competency of:
B) Change agent
C) Case manager
D) Client advocate
C. A case manager's competency is defined as the ability to establish an appropriate plan of care that is based on assessment of clients and families and coordinates the provision of needed resources and services across a continuum of care. A collaborator's competency is described as engaging in a combined effort with all those involved in care delivery. A change agent's competency is to implement new and more effective approaches to problems. A client advocate presents the client's point of view so that appropriate resources can be obtained.
When completing an individual total assessment of a client, the community-based nurse will include consideration of:
A) The type of pollution present in the community
B) The amount of industrial development in the past 5 years in the community
C) The predominant cultural and religious groups found in the community
D) The community structures, the population, and the local social system in which the client lives
D. No individual client assessment should occur in isolation from the environment and conditions of the client's community. Industrial development, types of pollution, and cultural and religious groups are individual elements in the community.
During a well-baby visit, the community-based nurse observed patterned bruises and skin abrasions on the face, arms, and throat of the infant's 21-year-old mother. In questioning the mother, the nurse discovers that she is a recent victim of spousal abuse. An important principle in dealing with this client is:
A) Ensuring the protection of the mother
B) Informing the authorities of the attack
C) Educating the mother on well-baby developmental issues
D) Continuing with the well-baby examination and disregarding the mother's situation
A. When dealing with clients who are at risk for or may have suffered abuse, it is important to provide protection. Educating the mother on the developmental issues of her infant is important but provides no protection for the victim. Providing protection and eliminating the fear of retribution is a priority upon discovery of abuse. By disregarding the mother's situation, the nurse has failed to intervene for the family in crisis in the community.
A proposal written by a community-based nurse for a new, higher quality older adult care center will have increased probability of acceptance if the proposal includes:
A) All building plans and a list of contractors to complete the job
B) Compliance with the codes and building requirements of local government agencies
C) The up-front cost and managerial framework of the new older adult center
D) Description of how advantageous, realistic, compatible, and adaptable the change will be when implemented
D. Change must be perceived as advantageous, compatible with existing values, and easily adaptable to be successful and accepted. Up-front cost, managerial framework, building plans, contractors, compliance with building codes, and regulations for governmental agencies are all incorporated in proposals but do not provide convincing reasoning that leads to change.
A nurse is caring for a 64-year-old homeless woman with a chronic respiratory disease in the local community-based clinic. The nurse realizes that the client is at risk of experiencing exacerbation of the disease process related to:
A) Poor attire and cleanliness practices
B) The client's lack of education and ability to read
C) The individual's lack of concern about the disease
D) The client's lack of a storage site for medication and the inability to obtain nutritious meals
D. The homeless person's lack of a storage site for medication and inability to obtain nutritious meals are factors that contribute to poor management of chronic disease. Homeless people are often stereotyped as having a lack of concern for their situations. Poor attire and lack of hygiene are not causes of chronic illness exacerbation. They are signs of the client's status as a member of an at-risk population. It is incorrect for the nurse to assume that the client lacks education and the ability to read.
A community health nurse is caring for members of a Bosnian community. The nurse determines that the children are undervaccinated and that the community is unaware of this resource. As the nurse assesses the community, the nurse determines that there is a health clinic within 5 miles. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process for accessing the health care resources. Which of the following is the nurse doing? (Select all that apply.)
A) Improving children's health care
B) Teaching the community about illness
C) Educating about community resources
D) Promoting autonomy in decision making
A,B,C,D. In this case, all four options are correct. The community health nurse is providing information for the community and helping its members learn to access the help that is available, but not dictating the steps that need to be taken.
A nurse at the community clinic nurse cares for a 40-year-old woman who takes insulin to manage diabetes. She is having increasing difficulty controlling the disease, and the nurse wants her to try a new insulin pump to help her manage her diabetes. Which of the following change factors increase the likelihood that she will accept this new insulin pump? (Select all that apply.)
A) The innovation or change must be perceived as more advantageous than other alternatives.
B) The innovation or change must be compatible with existing needs, values, and past experiences.
C) The innovation must be tried on a limited basis.
D) Simple innovations or changes are more readily adopted than those that are complex.
A,B,C,D. All are factors that will impact the client's potential to change.
Socialization of a 6-year-old child from Mexico into the Mexican culture is best described as:
C. Enculturation is socialization into one's own culture. Acculturation is the process of adopting a new culture. Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture. Biculturalism occurs when an individual identifies equally with two or more cultures.
A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she:
A) Chose to be bicultural
B) Adapted to and adopted the American culture
C) Had an extremely negative experience with the American culture
D) Gave up part of her ethnic identity in favor of the American culture
B. Assimilation results when the individual adopts and incorporates the characteristics of the dominant culture, such as celebrating holidays of the dominant culture. There is not enough information to consider the other options.
For a nursing student to enhance cultural awareness, the student will need to make an in-depth self-examination of:
A) Motivation and commitment to caring
B) Social, cultural, and biophysical factors
C) Engagement in cross-cultural interactions.
D) Background, including recognition of biases and prejudices
D. Cultural awareness is an in-depth self-examination of one's own background, including recognizing one's biases and prejudices and assumptions about other people.
Cultural competence is the process of:
A) Learning about the large number of cultures
B) Developing motivation and commitment to caring
C) Influencing the treatment and care of clients
D) Acquiring specific knowledge, skills, and attitudes
D. Cultural competence is the process of acquiring specific knowledge, skills, and attitudes that ensure delivery of culturally congruent care. The other options are incorrect.
Ethnocentrism is the root of:
A) Cultural beliefs
B) Biases and prejudices
C) Meanings by which people make sense of their experiences
D) Individualism and self-reliance in achieving and maintaining health
B. Ethnocentrism is the cause of biases and prejudices that associate negative characteristics with people who are different from a valued group. These are individual beliefs, not cultural beliefs, and do not help people make sense of their experiences.
When action is taken on one's prejudices:
A) Discrimination occurs.
B) Effective intercultural communication develops.
C) Delivery of culturally congruent care is ensured.
D) Sufficient comparative knowledge of diverse groups is obtained.
A. Discrimination occurs when one acts on one's prejudices. These actions do not allow for the delivery of culturally competent care, and they create barriers for effective intercultural communication and the ability to learn about different groups.
Which activity would not be expected by the nurse to meet the cultural needs of the client?
A) Developing the structure and process for meeting cultural needs on a regular basis and means to avoid overlooking these needs in clients
B) Expecting the client's family to keep an interpreter present at all times day and night to assist in meeting the communication needs of the client while hospitalized
C) Promoting and supporting attitudes, behaviors, knowledge, and skills to respectfully meet the client's cultural needs despite the nurse's own beliefs and practices
D) Ensuring that the interpreter understands not only the client's language but also the feelings and attitudes behind cultural practices to make sure an ethical balance can be achieved
B. It is not the family's responsibility to assist in the communication process. Many families will leave someone to help at times, but it is the hospital's legal obligation to find an interpreter to provide continued understanding of the client and to ensure that the client is fully informed and comprehends in his or her primary language. The nurse should respect and recognize cultural needs in every client to be able to give holistic care to every client. The nurse should not use as interpreter a person who barely speaks the language, because many elements in language communication involve more than just saying the right words. Ongoing assessment and planning for incorporating cultural needs into the larger picture of health care will allow the client to feel fully cared for while in the hospital.
Culture strongly influences pain expression and need for pain medication. However, cultural pain:
A) Is not expressed verbally or physically
B) Is expressed only to others of like culture
C) Is more intense, thus necessitating more mediation
D) May be suffered by a client whose valued way of life is disregarded by practitioners
D. Clients suffer cultural pain when health care providers disregard their valued way of life. Cultural pain may or may not be intense and may or may not be expressed, and the individual and his or her culture will choose to whom the client expresses this pain.
The dominant values in American society of individual autonomy and self-determination:
A) Do not have an effect on health care
B) Rarely have an effect on those of other cultures
C) May be in direct conflict with the values of diverse groups
D) May hinder the ability to gain admission to hospice programs
C. Individual autonomy and self-determination are not societal values in all cultures, so what is valued by most Americans may not be valued in other cultures. These values do have an affect on health care, will not hinder the ability to gain admission to hospice programs, and will affect those of other cultures.
The best explanation of what Title VI of the Civil Rights Act mandates is the freedom to:
A) Pick any physician and insurance company despite one's income.
B) Enjoy equal access to all health care regardless of race and religion.
C) Receive free medical benefits as needed within the county of residence.
D) Receive basic care under a sliding scale payment plan from all health care facilities.
B. Title VI mandates that no person in the United States, regardless of race, color, or national origin, shall be excluded from participation in, denied benefits of, or be subjected to discrimination under any program receiving federal funding. The act does not say that care must be given at no charge but that the services or health care must be offered equally to all without bias. Payment guidelines are not the focus of the act; private and public organizations such as medical institutions can charge according to their own policies and are not regulated by the federal government.
The role of the nurse in planning care for a culturally diverse population can best be described as:
A) Focusing only on the needs of the client, ignoring the nurse's beliefs and practices
B) Including care that is culturally congruent with the nursing staff based on predetermined criteria
C) Providing care while remaining aware of one's own bias and focusing on the client's individual needs rather than the staff's practices
D) Blending the values of the nurse that are for the good of the client and minimizing the client's individual values and beliefs during care
C. Unless the nurse understands his or her own beliefs and values, a bias or preconceived belief of the nurse could create an unexpected conflict or an area of neglect in the plan of care for a client (who might be expecting something totally different from the care). Basing care on predetermined criteria that may or may not reflect the individual client's needs does not allow for individualization of care based on the client's culture. The nurse is still providing too much input if the plan is a blend of the nurse's and client's values. The focus of care is not to benefit the nurse but to meet specific needs of the client. The nurse in this description becomes the "guardian figure" who dictates what the "nurse believes" to be in the best interest of the client and does not include the client's own preferences or beliefs.
Which of the following statements related to cultural conflicts is an accurate definition?
A) Cultural ignorance is a refusal to accept another person's beliefs.
B) Ethnocentrism is a belief that one's own way of life is inferior to that of others.
C) Cultural blindness is the ability to see that there are differences among people.
D) Discrimination is bias against people because of age, gender, color, race, or beliefs.
D. A person who discriminates against others recognizes that there are differences among people and relies on his or her own values or beliefs about others to interpret their behaviors. Ethnocentrism is the belief that one's own value system and beliefs are superior not inferior to those of others. Cultural ignorance is failure to recognize or acknowledge that others have different values or beliefs that affect their behavior. Cultural blindness is a refusal to accept that there are differences among individuals based on beliefs, practices, and values. The culturally blind may see the difference but not give it value as a part of the focus of the individual's needs for care.
The nurse addressing cultural needs during the postpartum period knows that which of the following statements is correct?
A) Hindu mothers prefer bathing and sitz baths to feel clean after delivery and prefer liquid diets for several days after delivery.
B) In Western medicine it is common practice to perform religious rituals, such as a cleansing bath, before sexual relations are resumed after delivery.
C) Members of non-Western cultures have fewer problems with postpartum depression because attention is given to the mother's recovery for a longer period of time.
D) Eastern cultures, such as the Chinese, encourage activity and exercise by the mother soon after the delivery and a return to social involvement as soon as possible.
C. Americans are often more autonomous and have fewer friends and relatives who come for extended times to assist in the recovery period. Hindu beliefs call for bathing rituals that are performed only after bleeding has stopped, because blood is associated with pollution. Dietary practices do not call for consuming only liquids; rather, foods that are thought to balance the mother after delivery are recommended. In Eastern cultures the practice is to allow the mother to rest and be waited upon for at least a month. Ritualistic cleansing is an Eastern cultural practice, not an American or Western practice.
In reviewing topics for a cultural assessment to identify the needs of an Orthodox Jew while hospitalized, the nurse should expect which special needs?
A) Circumcision of all newborn boys
B) Cremation of the body as soon as possible after death
C) Burial of the placenta close to the home for newborn girls
D) Dietary restrictions of no meat but only vegetables and herbs for the client's diet
A. All boys are circumcised in a ritual conducted by a rabbi at a specific time after birth. Girls are not circumcised in the Jewish faith. In some Eastern religious groups, circumcision of a girl is performed. Dietary regulations include avoidance of pork; other meats are eaten. However, if a Jew follows Kosher food laws, foods must be prepared in a manner that avoids cross-contamination of milk products and meat products, including the use of separate utensils for the preparation and consumption of each. In the Jewish religion the family and gender-congruent friends cleanse the body for immediate burial. Native Americans also practice this ritual.
Which factors are least significant during assessment when gathering information about cultural practices?
A) Biocultural needs
B) Language, timing
C) Touch and eye contact
D) Pain perception and pain management expectations
A. Cultural practices do not influence biocultural needs, because biocultural needs are inborn risks that are related to a biological characteristic and not a learned cultural belief or practice. Language and timing do have an impact on how practices are shared with the health care provider. Touch and eye contact can be interpreted differently in other cultures. Pain is interpreted as having a variety of causes depending on culture. Pain can be perceived as punishment from God, a consequence of a past life, or something to be endured with or without the aid of certain behaviors.
Transcultural nursing involves:
A) Working in another culture to practice nursing within the limitations of that culture
B) Ignoring all cultural differences to provide the best generalized care to all clients
C) Combining all cultural beliefs into a practice that takes a nonthreatening approach to minimize cultural barriers and achieve equality of care for all clients
D) Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate
D. Transcultural care means that the nurse understands and learns about specific cultural practices so that the nurse can integrate these practices into the plan of care for a client who adheres to these beliefs or practices in order to meet the client's needs in a holistic way. Transcultural nursing can be practiced anywhere; the nurse does not have to work within the given country under its practice limitations. Even if the nurse combines all cultural beliefs, the nurse still may not meet the belief needs of a specific client. The nurse cannot ignore needs and expect the plan of care to be satisfying or beneficial for an individual client. Taking a holistic approach to health care means meeting all of the physical, social, psychological, and spiritual needs of the client.
According to the Nurse Practice Act (NPA), how are cultural needs addressed?
A) There are no references to culture or ethnicity of clients in the NPA.
B) Knowledge of cultural aspects is to be incorporated into the plan of care to meet each client's unique needs.
C) Cultural needs can be ignored when the client is very ill and about to die, because physical needs are more important at this time.
D) Only scientifically based methods of treatment are to be used in nursing; use of other methods or therapies is not the role of the nurse.
B. Assessment and implementation of care must consider the total needs of the client, and cultural needs are one of the major areas of assessment. In the Standards of Professional Practice, the nurse is directed to follow all federal, state, and local laws governing the practice of registered nurses, and to provide nursing services without discrimination, regardless of the national origin, race, religion, or health problems of the client served. Cultural needs are incorporated, especially at the time of death, when many religious beliefs and practices of the client and family affect what care is expected from the health care team. A care activity does not have to have a scientific basis for it to be performed. If the client believes that a certain practice will help him or her get better and no harm is expected from the practice, the nurse is expected to support it for the betterment of the client.
Which of the following statements about culture is correct?
A) Subcultures are cultures that are inferior to others.
B) Culture is not inherited but is a result of socialization.
C) Cultural needs are the same as racial needs because they originate from biological traits that are unique to that group.
D) Cultural conflict is the inability of a person to decide which cultural pathway to follow when exposed to multiple cultures.
B. The process of gaining culture is a process of learning through exposure and incorporation of cultural elements into one's own belief system. Racial traits are genetically passed on and include such things as bone structure, tendencies to develop various disorders, and recognizable characteristics (texture of hair, shape of nose, etc.). Cultural concepts are not genetic but are learned and do not depend on biological traits. Subcultures are smaller recognizable groups within a larger societal group that have their own unique characteristics. Cultural conflict is the conflict between two values or beliefs that a person might have.
Which of the following should the nurse do when planning nursing care for a client with a different cultural background?
A) Identify how these cultural variables affect the health problem.
B) Speak slowly and show pictures to make sure the client always understands.
C) Allow the family to provide care during the hospital stay so that all rituals or customs are carried out.
D) Explain how the client must adapt to hospital routines to be effectively cared for while in the hospital.
A. Without assessment and identification of the client's cultural needs, the nurse cannot begin to understand how these might influence the health problem or health care management. Although the family can assist if they desire to do so, the nurse is legally responsible for giving care based on current assessments, for documenting problems, and for following current physician orders.
A nurse hears a colleague tell a student nurse that it is best not to touch the clients unless performing a procedure or an assessment. Why is this not the best practice?
A) She does not touch the clients either.
B) Touch is a type of verbal communication.
C) There is never a problem with using touch.
D) Touch forms a connection between nurse and client.
D. Touch is relational and helps create a connection between the nurse and the client. Touch is best used when there is a caring connection between nurse and client.
The nurse demonstrates the concept of "knowing the client" when he or she:
A) Gathers pertinent data about the client's condition
B) Predicts the need for certain interventions based on the disease process
C) Encourages the client to depend on the nurse to make important decisions
D) Is able to detect changes in the client's condition based on shared information and bonding
D. The nurse who knows the client can predict responses, capacity, and endurance because the two have a mutual sense of bonding. Truly knowing the client is much more than gathering data; a relationship is necessary. The nurse must avoid assumptions based on knowledge of the disease process and rely on information revealed by the client. The client should make decisions, and the nurse should work with the client to help so that it is a mutual process.
A client is fearful of upcoming surgery and a possible cancer diagnosis. The client has discussed a love of the Bible with the nurse, who then recommends a favorite Bible verse. The nurse is reprimanded and told that there is no place in nursing for spiritual caring. Which of the following would be an appropriate response?
A) "It is true that spiritual care should be left to a professional."
B) "You are correct, religion is a personal decision."
C) "Spiritual, mind, and body connections can affect health."
D) "I will be more careful not to share my religious beliefs with clients."
C. Research shows a link between spirit, mind, and body, and an individual's beliefs and expectations do have effects on the person's well-being. Nurses should not force their beliefs on clients, but sharing is a part of caring.
A number of strategies have the potential for creating work environments that enable nurses to demonstrate more caring behaviors. Some of these include:
A) Increasing working hours
B) Raising monetary compensation
C) Providing flexibility, autonomy, and improved staffing
D) Increasing input from physicians concerning nursing functions
C. Strategies to create work environments that allow nurses to demonstrate more caring behaviors include introducing greater flexibility in the work in environment structure, rewarding more experienced nurses in non-monetary ways, improving nurse staffing, and providing nurses with autonomy over their practices.
Listening includes not only taking in what a client says but also:
A) Incorporating the views of the physician
B) Correcting any errors in the client's understanding
C) Injecting the nurse's personal views and statements
D) Interpreting and understanding what the client means
D. Listening includes taking in what a client says as well as interpreting and understanding what the client is saying and communicating that understanding back to the person talking.
"Presence" involves a person-to-person encounter that:
A) Enables the client to care for the self
B) Provides personal care to the client
C) Conveys closeness and a sense of caring
D) Puts the nurse in close physical contact with a client
C. Presence involves "being there" and "being with" a client, including communication and understanding. It includes a sense of closeness and caring.
Clients' perceptions are important because health care organizations are:
A) Required always to act in the best interest of the client
B) Placing greater emphasis on client satisfaction
C) Under investigation for misappropriation of funds
D) Carefully watched and regulated by the federal government
B. A study of clients' perceptions is important because health care organizations are placing greater emphasis on client satisfaction.
The caring aspect of nursing may be negatively affected in clinical practice today primarily because of:
A) Lack of time constraints in nursing care
B) Increased emphasis on the nurse-client relationship
C) Prevalence of chronic conditions that slow the pace of nursing
D) Rise in technology that takes nurses' attention away from clients
D. Increased technology tends to take the nurse away from the bedside. The prevalence of chronic conditions has a positive, not a negative, impact. The trend is toward greater acuity in clients' conditions. There are more time constraints because of disease acuity and technology.
The nurse demonstrates caring behavior when he or she:
A) Leaves the light off in the client's room
B) Pats the client's arm when approaching the bed
C) Asks the client if he or she needs anything while exiting the room
D) Traces the intravenous (IV) tubing from the arm to the fluid bag while checking for kinks
B. Physical contact is a means of expressing caring. Leaving the lights off interferes with eye contact and clear communication. Caring for the IV shows attention to technology and details rather than to the client. Although asking if the client needs anything is kind, if the nurse does not wait for an answer and is not offering presence, this is not a caring behavior.
According to Watson's transpersonal caring theory, the nurse should understand which of the following?
A) The act of caring is personal and cannot be shared.
B) Caring can increase healing and promote well-being.
C) Expressions of human caring are the same for all individuals.
D) Nurses must use caring behaviors specific to their own cultures.
B. Conscious caring by the nurse can promote healing and is complementary to conventional nursing practice. Caring can be shared and is a powerful connection between individuals. It is important for the nurse to appreciate the culture of the client and incorporate this into the care. Caring is individual and is different for all.
Because clients and nurses may differ in their perceptions of caring, it is important that the nurse:
A) Focus on keeping the relationship on a business level.
B) Follow his or her own beliefs about what is appropriate.
C) Seek information regarding what is important to the client.
D) Allow a more experienced nurse to establish the nurse-client relationship.
C. It is important to assess the client's needs and expectations of care. Clients relate to nurses on a personal level. The client's beliefs must be considered. Personnel at all levels of nursing should have effective relationships with clients.
Which of the following nurses is showing behavior that indicates that the nurse is providing presence in a caring relationship?
A) The clinic nurse who pats the client on the back for reassurance
B) The newly licensed nurse who braces the client as he or she gets out of bed
C) The home care nurse who focuses attention on the older adult client sharing a story
D) The staff nurse who stays with a client who is undergoing an unfamiliar procedure
D. Coaching a client through an experience is an example of presence, as is sitting by a client's bedside. The nurse is providing safety while helping the client get out of bed. In option 3, the nurse is listening.
The nurse demonstrates listening skills by:
A) Blocking nonverbal communication so that the verbal communication is more defined
B) Waiting until mealtimes so that the conversation can be more sociable
C) Surrounding the client with family and friends to make him or her comfortable
D) Paying attention to the tone of voice in addition to the client's words so the meaning is clear
D. The client's tone of voice supplies cues that allow the nurse to better understand the client's frame of reference. Nonverbal cues add meaning to the verbal communication and increase understanding. Surrounding the client with family and friends serves as a distraction to communication between client and nurse. A client's hunger, pain, or other distractions can hinder communication.
The nurse can best demonstrate caring to a client who has recently suffered a loss through miscarriage by:
A) Sitting with the client in silence
B) Sharing a personal account of a similar loss
C) Offering some literature on the grieving process
D) Asking the hospital chaplain to visit the client
A. Offering self is a powerful demonstration of caring and allows the client to trust and feel the presence of a caring person. Therapeutic communication should focus on the client, not the nurse. Offering literature may be helpful at some point when the client indicates she is ready and asks for information. Chaplain visits may be helpful but do not replace the need for a caring relationship with the nurse.
A nurse who normally uses touch when caring for clients might consider this inappropriate for which of the following clients?
A) A client of the opposite sex
B) A client from a different culture than that of the nurse
C) A psychiatric client who is displaying suspicion and fear
D) A client who has many family members present in the room
C. A psychiatric client may interpret a gesture as a threat, and further assessment is required. There is no contraindication to touching a client of the opposite sex or to touching a client when family members are present unless the client indicates that he or she is uncomfortable.
Family members make the following comments about the nursing care being received. Which one should be investigated further?
A) "The nurses showed us how to keep Mother's arm propped on a pillow."
B) "Our nurses don't seem too optimistic about the outcome of Dad's stroke."
C) "The night nurse tells us to wait and ask the doctor the questions we have."
D) "The nurses have written down the turn schedule and taped it above the bed."
C. A caring nurse should show interest in answering questions and giving clear explanations. The comment in option 3 indicates that the nurse is shirking responsibility. Teaching the family is important and gives the family the feeling of being useful. Keeping the family informed and included in care is a sign of good nursing. Honesty is a quality of caring. False reassurance is dishonest and is not helpful.
In caring for a client, the nurse would describe learning about the client's family as:
C) A waste of time
D) Okay to do when one has the time
A. Each individual experiences life through their relationships with others, so learning about the client's family is essential in learning about the client.
Regarding a request for organ and tissue donation at the time of death, the nurse should be aware that:
A) Specially educated personnel make these requests.
B) These requests are usually made by the nurse caring for the client at the time of death.
C) Professionals should be very selective in whom they ask for organ and tissue donation.
D) Only clients who have given prior instruction regarding donation can become donors.
A. A specially trained professional makes requests for organ and tissue donation at the time of death. The person requesting organ or tissue donation provides information about who can legally give consent, which organs or tissues can be donated, associated costs, and how donations will affect burial or cremation. If the deceased did not leave behind instructions for organ and tissue donation, the family may give consent at the time of death.
A home health nurse is asked by a family member what he should do if the client's serious chronic illness continues to worsen even with increased medical interventions. The nurse recognizes that the family member is posing a question about goals of care at the end of life. The nurse should:
A) Encourage the family to think more positively about the client's new therapy.
B) Avoid the discussion because it has to do with medical, not nursing, diagnoses.
C) Begin the discussion by asking the family member what he believes the goals should be.
D) Initiate a discussion about advance directives with the client, family, and health care team.
C. The nurse must first assess the family's goals before any further discussions can take place. Then, with the appropriate knowledge, the nurse can continue discussions regarding options for future care, either disease treatment or end-of-life care, based on the family's needs and wishes.
A client's family member remarks to the nurse, "The doctor said he will provide palliative care. What does that mean?" Which of the following is the nurse's best response?
A) "Palliative care aims to relieve or reduce the symptoms of a disease."
B) "Palliative care is given to those who have less than 6 months to live."
C) "The goal of palliative care is to cure a serious illness or disease."
D) "Palliative care means that the client and family take a more passive role and the doctor focuses on the physiological needs of the client. Death will most likely occur in the hospital."
A. The goal of palliative care is the prevention, relief, reduction, or soothing of symptoms of disease or disorders without effecting a cure. Palliative care is for clients of any age, with any diagnosis, and at any time, and not just during the last few months of life. Generally clients accepted into a hospice program have less than 6 months to live. Palliative care aims to relieve pain and other distressing symptoms, not cure the disease. Palliative care is a philosophy of total care. Care options encompass the physical, psychological, social, spiritual, and existential aspects of the client's illness. Care is provided by an interdisciplinary team, and the client and family take an active role in decision making. The location of death may or may not be the hospital.
woman experiences the loss of a very early term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. The type of grief the woman may be experiencing is:
D. Disenfranchised grief is experienced when a person's relationship to the deceased is not socially sanctioned, the loss cannot be openly acknowledged or publicly shared, or the loss seems of lesser significance to others. A person experiences anticipatory grief, the unconscious process of disengaging or letting go, before the actual loss or death occurs. Exaggerated grief, in which the individual exhibits bizarre behaviors, usually is seen in individuals with underlying mental illness. Delayed grief occurs when a person avoids the pain of a loss by suppressing or postponing normal grief responses.
A family member of a recently deceased client talks casually with the nurse at the time of the client's death and expresses relief that she will not have to visit at the hospital anymore. Which of the following may apply to this family member in terms of her grief?
B) Anticipatory grief
C) Dysfunctional grief
D) Yearning and searching
A. In the denial stage, a person acts as though nothing has happened and refuses to accept the fact of a loss. This is a normal stage and is a self-protective mechanism. In dysfunctional grief, the grieving person has a prolonged or significantly difficult time moving forward after a loss. Emotional outbursts of tearful sobbing and acute distress characterize Bowlby's second stage of grief, termed yearning and searching. A person experiences anticipatory grief, the unconscious process of disengaging or letting go, before the actual loss or death occurs, especially in situations of prolonged or predicted loss.
A self-care goal for the nurse who cares for dying and grieving clients might be to:
A) Learn not to take the loss so seriously.
B) Limit involvement with clients who are grieving.
C) Maintain life balance and reflect on the meaning of one's work.
D) Admit that one is not well suited to care for grieving clients and families.
C. For nurses who work with dying and grieving clients, the maintenance of life balance and reflection on the purpose for the work is the key to longevity in the career. Loss is serious, and nurses do take loss seriously. Involvement with grieving clients can be healthy for the nurse. Nurses need to determine what discipline in nursing works for them.
During postmortem care, the nurse should give priority to:
A) Locating the client's clothing
B) Providing culturally and religiously sensitive care in body preparation
C) Transporting the body to the morgue as soon as possible to prevent body decomposition
D) Providing all postmortem care to protecting the deceased's family from having to see the body
B. Providing the integrity of rituals and mourning practice gives families a sense of fulfilled obligations and promotes acceptance of death. If the family wants to provide postmortem care, then the nurse should be sensitive to their needs. The body should be transported to the morgue when the family is ready. Locating the client's clothing is not a priority; it can be done after the other tasks are completed.
A client has recently been told he has terminal cancer. As the nurse enters the room, he yells, "My eggs are cold, and I'm tired of having my sleep interrupted by noisy nurses!" The nurse may interpret the client's behavior as:
A) The result of previous losses
B) The result of maturational loss
C) An expression of disenfranchised grief
D) An expression of the anger stage of dying
D. In the anger stage of Kübler-Ross's stages of dying, the individual resists the loss and may strike out at everyone and everything—in this case, the nurse. Disenfranchised grief occurs when a person experiences a loss that cannot be openly acknowledged, is not socially sanctioned, or cannot be publicly shared. A maturational loss is any life change that occurs in the developmental process and is normally expected during a lifetime. Previous losses may compound the feeling of loss and influence the individual's reaction when an additional loss occurs, but this question did not mention previous losses by the client.
When helping a person through grief work, the nurse knows that:
A) Most clients want to be left alone.
B) A person's perception of a loss has little to do with the grieving process.
C) The stages of grief may occur in the standard order, they may be skipped, or they may reoccur.
D) Coping mechanisms that were effective in the past are often disregarded in response to the pain of a loss.
C. Grief is manifested in a variety of ways that are unique to the individual and based on personal experiences, cultural expectations, and spiritual beliefs. The coping mechanisms that were effective in the past are repeated as a first response to the pain of a loss. When older coping strategies are unsuccessful, new coping mechanisms are attempted. The type of loss and the perception of the loss influence the depth and duration of grief a person experiences. The nurse must not assume that clients want to be left alone. If a client chooses not to share feelings or concerns, the nurse should convey a willingness to be available when needed. Sometimes clients need to begin resolving their grief before they can discuss their loss.
It is 1 day after the client underwent a mastectomy for the treatment of her breast cancer. The client is crying when the nurse enters the room. Which of the following is the nurse's best response?
A) "Let me get you something for pain."
B) "You seem upset. Would you like to tell me about what is bothering you?"
C) "Cheer up. The worst is behind you now, and you'll start feeling better soon."
D) "You shouldn't be crying now. Just wait until you go home and you're all alone without us to help you."
B. The nurse should use therapeutic communication skills to clarify the feelings of the client. The nurse should use open-ended questions, attentive listening, and presence to allow the clients to freely share her thoughts and concerns.
A client in the end stage of terminal cancer is hospitalized. His family members are sitting at his bedside. What can the nurse do to best aid the family at this time?
A) Find simple and appropriate care activities for the family to perform.
B) Limit the time visitors may stay so they do not become overwhelmed by the situation.
C) Avoid telling family members about the client's actual condition so they will not lose hope.
D) Discourage spiritual practices because this will have little meaning for the client at this time.
A. It is helpful for the nurse to find simple care activities for the family to perform, such as feeding the client, washing the client's face, combing the hair, and filling out the client's menu card. This helps the family demonstrate their caring for the client and enables the client to feel their closeness and concern. Older adults often become particularly lonely at night and may feel more secure if a family member stays at the bedside during the night. The nurse should allow visitors to remain with dying clients at any time if the client wants them there. It is up to the family members to determine if they are feeling overwhelmed, not the nurse. The nurse should keep the family informed so the family can anticipate the type of symptoms the client will likely experience and the implications for care. Facilitating connections to a spiritual practice or community and supporting the expression of culturally held beliefs can provide comfort for many clients, especially at this time.
When the nurse is caring for a terminally ill client, it is important for the nurse to maintain the client's dignity. This can be facilitated by:
A) Spending time to let the client share his or her life experiences
B) Making decisions for the client so the client does not have to make them
C) Placing the client in a private room to provide privacy at all times
D) Decreasing emphasis on attending to the client's appearance because such personal care only increases the client's fatigue
A. Spending time to let the client share his or her life experiences enables the nurse to know the client better. Knowing the client then facilitates choosing therapies that promote client decision making and autonomy, and thus promote the client's self-esteem and dignity. Basic to promoting a client's self-esteem and dignity is attending to the client's appearance and surroundings. Cleanliness, absence of body odors, wearing of attractive clothing, and personal grooming all contribute to a sense of worth. Helping the client make his or her own decisions helps maintain autonomy. Being autonomous plays a vital role in maintaining the client's dignity. The client should not be placed in a private room unless family members visit and plan to stay around the clock.
What are the stages of dying defined by Elisabeth Kübler-Ross?
A) Denial, anger, bargaining, depression, and acceptance
B) Anticipatory grief, perceived loss, actual loss, and renewal
C) Numbing, yearning and searching, disorganization and despair, and reorganization
D) Accepting the reality of loss, working through the pain of grief, adjusting to the environment without the deceased, and emotionally relocating the deceased and moving on with life
A. Denial, anger, bargaining, depression, and acceptance are the five behavior-oriented stages of dying according to Elisabeth Kübler-Ross.
Bereavement may be defined as:
A) The emotional response to loss
B) The outward, social expression of loss
C) Postponement of the awareness of the reality of the loss
D) The inner feelings and outward reactions of the survivor
D. Bereavement includes grief and mourning. Option 1 is the definition of grief. Option 2 is the definition of mourning. Postponement of the awareness of the reality of loss describes what may occur during the bargaining stage of dying according to Kübler-Ross.
A client for whom there is a "Do Not Resuscitate" order passes away. After verifying that there is no pulse or respirations, the nurse should next:
A) Call the transplant team to retrieve vital organs.
B) Call the funeral director to come and get the body.
C) Have family members say goodbye to the deceased.
D) Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position the body appropriately.
D. The body of the deceased should be prepared before the family comes in to view and say their goodbyes. This includes removing all equipment, tubes, supplies, and dirty linens according to protocol; bathing the client; applying clean sheets; and removing trash from the room. The body should be cleaned and positioned before the family is given the option to view or not to view the body. Organ transplant and donation would first have to be discussed with the family. The funeral home is not called until after family members have had the opportunity to say their goodbyes.
A nurse should assess the client's and family's wishes for end-of-life care. It is important for the nurse to remember to:
A) Keep what is learned about a client's preferences to him or herself.
B) Avoid self-reflection because it may interfere with caring for dying clients.
C) Have family members follow hospital routines rather than engage in their specific cultural or spiritual practices in end-of-life care.
D) Find a health care provider who is experienced in discussing end-of-life issues if the nurse feels uncomfortable doing so.
D. A nurse must assess the client's and family's wishes for end-of-life care, including the preferred place for death, the level of life-sustaining measures to employ, and expectations regarding pain and symptom management. If the nurse feels uncomfortable in assessing a client's wishes, then the nurse must find a health care provider who is experienced in discussing end-of-life issues and can assist in communicating a client's preferences to the total health care team. A nurse cannot keep what is learned about a client's preferences private. Good interdisciplinary teamwork is essential to provide quality end-of-life care. Self-reflection is a valuable tool in maintaining professionalism and knowing when to get away from a situation and take care of oneself. Facilitating connections to preferred spiritual practices and supporting the expression of culturally held beliefs is very important and can provide comfort to the client and family.
The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, says she does not believe the treatments will make any difference, does not ask about her progress, and has missed two chemotherapy sessions. Based on these assessment data, the nurse would gather more information to consider making which of the following nursing diagnoses?
C) Spiritual distress
D) Anticipatory grieving
B. The area to consider with this client is powerlessness (she doesn't believe the treatments will help anyway). This client does not show signs of the other areas based on the information given.
The nurse suggests that a client receive a palliative care consultation for symptom management because of anxiety and increasing pain. A family member asks the nurse if this means the client is dying and is now "in hospice." The nurse explains which of the following?
A) Hospice (end-of-life care) and palliative care are the same thing.
B) Palliative care is for any client, at any time, for any disease, in any setting.
C) Palliative care strategies are primarily designed to treat the client's illness.
D) Palliative care interventions relieve the symptoms of illness and treatment.
B. Palliative care is the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness. It is appropriate for clients of any age, in any setting, and for any disease. Hospice care focuses specifically on individuals with a limited life expectancy of less than 6 months, whereas palliative care does not need to focus on end-of-life issues. Palliative care focuses on symptoms, not the disease process.
The nurse discovers an electrical fire in a client's room. The nurse's first action would be to:
A) Activate the fire alarm.
B) Confine the fire by closing all doors and windows.
C) Evacuate any clients or visitors in immediate danger.
D) Extinguish the fire by using the nearest fire extinguisher.
C. The nurse's first step when a fire is discovered is to evacuate any clients or visitors in immediate danger. Then the nurse should activate the fire alarm, confine the fire, and then extinguish it.
A parent calls the pediatrician's office frantic because her 2-year-old son drank a bottle of cleaner. Which of the following is the most important instruction the nurse can give to this parent?
A) Give the child milk.
B) Call the poison control center.
C) Give the child syrup of ipecac.
D) Take the child to the emergency department.
B. The poison control center will direct all care given to a child who has ingested a substance. Based on the description of the poison, poison control center staff will tell the parent whether the child needs to go to the emergency department and what substances should be given to the child.
A couple has brought in their adolescent daughter for a school physical. The parents tell the nurse that they are worried about all the safety risks for this age group. As the nurse plans to teach the parents about these risks, the nurse remembers that adolescents are at a greater risk for injury from:
A) Home accidents
B) Poisoning and child abduction
C) Physiological changes of aging
D) Automobile accidents, suicide, and substance abuse
D. Adolescents are more likely to be involved in automobile accidents, commit suicide, and engage in substance abuse than are those in other age groups. Children are more susceptible to poisoning and child abduction, and older adults are more susceptible to home accidents and the physiological changes of aging.
During the night shift a client is found wandering the hospital halls looking for a bathroom. The nurse's initial intervention would be to:
A) Insert a urinary catheter.
B) Ask the physician to order a restraint.
C) Assign a staff member to stay with the client.
D) Provide scheduled toileting during the night shift.
D. Providing scheduled toileting during the night makes it less likely that a client will wander while being confused and ensures staff presence to decrease confusion at the times when the client is away from bed. Inserting a urinary catheter is not necessary. Assigning a staff member to stay with the client might not be necessary if the scheduled toileting is successful. Restraints are unnecessary in this case..
Lisa, a nurse assistant, is working with the nurse during the nurse's shift. One of the nurse's clients has upper limb restraints. In delegating care of this client to Lisa, the nurse would tell her to:
A) Secure the restraints to the side rails.
B) Check to see if the client can have a medication for sleep.
C) Call the physician if the client becomes more agitated with the restraint.
D) Report any signs of redness, excoriation, or constriction of circulation under the restraint.
D. The restraint sites much be checked regularly for signs of redness, excoriation, or constriction, and this task may be delegated. Calling the physician and performing medication assessments are nursing responsibilities. Restraints should never be secured to the side rails.
The family of the nurse's confused, ambulatory client insists that all four side rails be up when the client is alone. The best way to handle this situation is to:
A) Ask them to stay with the client at all times.
B) Inform them of the risks associated with side rail use.
C) Thank them for being conscientious and put the four rails up.
D) Provide the client with a one-to-one sitter while the side rails are up.
B. The use of side rails when a client is disoriented will cause more confusion and further injury. A confused client who is determined to get out of bed may attempt to climb over the side rail or climb out at the foot of the bed, and may fall or experience other injury. After the nurse has this discussion with the family, then the nurse should perform a thorough nursing assessment and develop a plan to ensure the client's safety.
During the nurse's assessment of a 56-year-old man, he reports increased alcohol consumption because of stress at work. One of the expected outcomes for this client will be to:
A) Decrease stress in his life.
B) Teach him ways to promote sleep.
C) Decrease his alcohol intake during times of stress.
D) Provide the client with information about stress management classes.
D. Resources for stress management and sleep promotion can help accomplish reduced alcohol intake during times of stress in the client's life. Management of stress is the expectation, but decreasing stress may not be possible.
A child for which the nurse is caring in the hospital starts to have a grand mal seizure while playing in the playroom. What is the most important intervention the nurse can do during this situation?
A) Begin cardiopulmonary resuscitation.
B) Restrain the child to prevent injury.
C) Place a tongue blade over the tongue to prevent aspiration.
D) Clear the area around the child to protect the child from injury
D. An area around the child should be cleared to prevent injury. Restraining the child or placing a tongue blade in the child's mouth may actually be a cause of injury. Cardiopulmonary resuscitation is required only if heart function stops after the seizure.
When providing health maintenance teaching to new employees in the food-handling department, the nurse emphasizes the need to perform hand hygiene after using the bathroom to prevent:
A) Food poisoning
B) Spread of hepatitis A
C) Bacterial food infections
D) Salmonella contamination
B. The hepatitis A virus is spread via fecal contamination of food, water, or milk. It is essential that food handlers wash their hands anytime they use the bathroom. Food poisoning can be due to bacterial contamination of food from a variety of sources, but not usually feces. Salmonella contamination usually arises from uncooked eggs.
A student nurse is designing a health fair project aimed at reducing motor vehicle accidents. For which group of clients would this subject be most appropriate?
B) Older adults
C) Middle-aged adults
D) School-aged children
A. The risk of motor vehicle accidents is higher among teen drivers than in any other age group.
As a member of the hospital's bioterrorism team, the nurse understands the importance of knowing how an organism is transmitted. Smallpox has the potential to spread quickly because it is transmitted via which route?
A. Organisms with an airborne route of transmission can claim many victims and spread very quickly. Smallpox is not spread via blood. There is no such thing as an absorption or ingestion route of transmission.
After the nurse assists a client with a history of seizures to a recliner chair, the client begins to have a seizure. The nurse should immediately:
A) Turn the client onto his or her stomach.
B) Recline the client's chair all the way back.
C) Return the client to the bed and place the client on his or her side.
D) Slide the client to the floor and cradle the client's head in the nurse's lap.
D. The nurse's lap is the safest position for the client's head, and the client is less likely to sustain an injury if the client is already on the floor. Attempting to move the client laterally by oneself could result in injury to the client and/or nurse. Placement in a reclining position could cause excess secretions to accumulate in the oral pharynx and obstruct the airway. Turning the client onto his or her stomach would decrease access to the airway.
The nurse delegates to an unlicensed assistant the task of removing the restraints from the client's wrists every ________ hours and reporting any abnormalities.
A. Removal of restraints and inspection of the contact area every 2 hours is a requirement of The Joint Commission. The time periods in the other options are too long. The client could experience a serious complication if restraints are not removed and the area under the restraints inspected frequently.
Health care workers who have direct contact with individuals suspected of being contaminated with anthrax should do which of the following? (Choose all that apply.)
A) Wear an isolation gown, gloves, and high-efficiency particle arrestor (HEPA) mask
B) Prepare the client for transfer to the radiology department for chest radiography
C) Instruct the client to wash the hands and exposed areas with soap and water
D) Have the client remove clothing and place it in a sealed biohazard bag
A,D.Anthrax is caused by a spore-forming, gram-positive bacillus. Humans become infected through skin contact, ingestion, and inhalation. The nurse should wear an isolation gown, gloves, and a high-efficiency particle arrestor (HEPA) mask. The client should remove potentially contaminated clothing for testing and decontamination. The client should remain in isolation until it is certain that the bacteria have been contained, not transferred to radiology. The client should shower thoroughly with soap and water, not just wash hands and exposed areas.
While the nurse is administering flu immunizations in November to a group of older adults at a community senior citizens' center, one of the seniors expresses a fear of contracting the flu from the injection. The nurse reassures the senior that this is not possible because the vaccine contains a dead virus and explains that this injection will produce _________ immunity, in which the senior's body will make antibodies to the virus.
As defined by the World Health Organization, this is a "state of complete physical, mental and social well-being, not merely the absence of disease or infirmity".
Activities related to maintaining, attaining, or regaing good health and preventing illness.
Positive Health Behaviors
Attempts to create conditions that promote optimal health, and consider clients the ultimate expert on their own health.
Holistic Health Model
Activites, such as routine exercise and good nutrition, that help clients maintain or enhance their present levels of health.
Teaches people how to care for themselves in a healthy way, such as stress management or physical awareness.
Activites, such as immunizations programs, that protect clients from actual or potential threats to health.
Individuals gain from the activites of others without acting themselves
Passive Strategies of Health Promotion
True prevention, precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy.
Focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions.
Occurs when a defect or disability is permanent and irreversible, and involves minimizing effects of long-term disease or disability.
Any situation, habit, social or environmental condition, physiological pr physiological condition, developmental or intellectual condtion, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident.
Is a state in which a person's physical, emotional, intellectual, social, developlmental, or spiritual functioning is diminished or impaired compaired with previous experience.
This involved how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system.
These represent various ethnic, religious, and other groups with distinct characteristics from the dominant culture.
This refers to a shared identity related to social and cultural hertage, such as values, language, geographical space, and racial characteristics.
Thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
This results when an individual gradually adopts and incorporates the characteristics of the dominant culture.
This occurs when an individual rejects a new culture because experience with a new or different culture is extremely negative.
A comparative study of cultures to understand similarities and differences across human groups.
Transcultural Nursing, Leininger
Care that fits the person's valued life patterns and set of meanings.
Culturally Congruent Care, or goal of transcultural nursing.
Ability of a nurse to bridge cultural gaps in caring, work with cultural differences, and enable clients and families to achieve meaningful and supportive caring.
Culturally Competent Care
Use of own values and lifestyles as the absolute guide in dealing with clients and interpreting their behaviors.
These groups of people believe that epilepsy or seizure disorders are caused by the wandering of the soul, and requires intervention by a shaman, who performs a ritual to retrieve the child's soul.
Attributes illness to natural, impersonal, and biological forces that cause alteration in the equilibirium of the human body.
Believes that an external agent, which can be human (sorcerer), or non-human (ghosts, evil, deity), causes health and illness.
When Jewish clients refrain from using electrical appliances, and requires creative accomodations by the staff.
This type of food, that includes meat, fish, fresh fruit, vegatables, eggs, milk, and cheese, are permissible for Muslims.
Prohibited foods, such as non-halal meat, animals with fangs, pork products, gelatine products, and alcohol, for Muslims are known as...
A diet that avoids meat from carnivores, pork products, and fish without scales or fins, and permissible animals must be slaughtered with the least amount of suffering.
This focus requires understanding the needs of a population. (High Risk Infants)
Public Health Nursing
A collection of individuals who have in common one or more personal or environmental characterisitics.
This focuses on the health of individuals, families, and groups in a community. (Think Village of Schaumburg)
Community Health Nursing
Care that takes place in community settings, where focus is on the needs of the individual or family.
Clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care.
Includes all of the many physical and psychosocial factors that influence or affect the life and survival of the client.
Colorless, odorless, poisounous gas produced by the combustion of of carbon or organic fuels.
The amount of water vapor in the air compared with the maximum amount of water vapor that the air could contain at the same temperature.
This occurs when the noise level in an environment becomes uncomfortable to the inhabitants of the environment.
The hyperexcitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions.
Any substance that impairs health or destroys life when ingested, inhaled, or otherwise absorbed by the body.
This is concerned with relationships between people and with a nurses's character and attitude towards others.
Ethics of Care
A form of necessary loss that includes all normally expected life changes across the life span, such as the loss a mother feels on her child's first day of school.
This occurs when a person can no longer feel, hear, or know a person or object. Such as the loss of a body part, or loss of a job.
Uniquely defined by the person experiencing the loss and are less obvious to other people, such as rejection by a friend.
This term captures both grief and mourning, and includes the emotional responses and outward behaviors of a person experiencing loss.
This is the most common reaction to death, and is the ability to make sense of loss, and to find benefit in the loss.
The unconscious process of disengaging or "letting go" before the actual loss or death occurs.
Marginal or unsupported friend, when their relationship to the deceased person is not socially sanctioned, cannot be openly acknowledged or publicly shared, or seems of lesser significance, such as the loss of a loved pet or gay partner.
A person expresses resistance and sometimes feel instense anger at God, other people, or the situation.
Occurs when an individual comes to terms with his or her life and puts life's pieces together in a way consistent with one's entire life.
The prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness.
The surgical dissection of a body after death to determine the exact cause and circumstances of death or to discover the pathway of a disease.