Test Bank Of Brunner and Suddarth’s Medical Surgical Nursing 12e by Suzanne C.

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Brunner and Suddarth’s Medical Surgical Nursing 12e by Suzanne C. Smeltzer RNC EdD FAAN

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Chapter: Chapter 03: Critical Thinking, Ethical Decision Making, and the Nursing Process

 

 

 

 

Multiple Choice

 

 

 

 

  1. A nurse is offered a position at a clinic that offers therapeutic abortions. This procedure contradicts the nurse’s personal beliefs. The nurse knows that she is unable to care for these patients objectively. What is the nurse’s ethical obligation to these patients?
  2. A) The nurse is required by law to continue service to these patients.
  3. B) The nurse should make the choice to decline this position.
  4. C) The nurse may discriminate between patients and refuse to care for the patient.
  5. D) The nurse may express his or her opinion and provide another option to terminating the pregnancy.

 

Ans:  B

Chapter:  3

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  5

Page and Header:  28, Ethical Nursing Care

 

Feedback:  To avoid facing ethical dilemmas, nurses can follow certain strategies. For example, when applying for a job, a nurse should ask questions regarding the patient population. If a nurse is uncomfortable with a particular situation, then not accepting the position would be an option. The other answers would be incorrect because the nurse is only required by law to provide care to the patients the clinic accepts, the nurse may not discriminate between patients, and the nurse expressing her own opinion and providing another option is inappropriate.

 

 

 

 

  1. A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large dose of narcotic via intravenous infusion. You know that one of the side effects of this medicine is respiratory depression. When you assess your patient’s respiratory status, you find that the rate has decreased from 16 breaths per minute to 10 breaths per minute. What action should you take?
  2. A) Decrease the IV infusion
  3. B) Stimulate the patient
  4. C) Report the decreased respiratory rate to the physician
  5. D) Allow the patient to rest comfortably

 

Ans:  C

Chapter:  3

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  28, Ethical Nursing Care

 

Feedback:  End-of life issues that often involve ethical dilemmas include pain control, “do not resuscitate” orders, life-support measures, and administration of food and fluids. The risk of respiratory depression is not the intent of the action of pain control. Respiratory depression should not be used as an excuse to withhold pain medication for a terminally ill patient. The patient’s respiratory status should be carefully monitored and any changes should be reported to the physician.

 

 

 

 

  1. When a terminally ill patient has requested a “do not resuscitate” (DNR) order and the family of the patient is strongly opposed to the patient’s request, what is the responsibility of the nurse?
  2. A) Perform a “slow code” until a decision is made
  3. B) Honor the request of the patient
  4. C) Contact a lawyer to intervene
  5. D) Terminate nursing care until the physician talks to the family

 

Ans:  B

Chapter:  3

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  4

Page and Header:  28, Ethical Nursing Care

 

Feedback:  Discussing the matter with the physician may lead to further communication with the family, during which the family may reconsider their decision. The nurse must also honor the patient’s wishes and continue to provide required nursing care. It is not appropriate for the nurse to seek the assistance of a lawyer or to perform a “slow code” in this situation.

 

 

 

 

  1. A new patient comes to your unit. During admission the patient states, “I have a living will.” What is the correct definition of a living will?
  2. A) A legal document that is always honored
  3. B) A legal document that specifies the patient’s wishes before hospitalization
  4. C) A legal document that is binding for the duration of the patient’s life
  5. D) A legal document drawn by the patient’s family to determine DNR status

 

Ans:  B

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  5

Page and Header:  29, Ethical Nursing Care

 

Feedback:  A living will is one type of advance directive. In most situations, living wills are limited to situations in which the patient’s medical condition is deemed terminal. The other answers are incorrect because living wills are not always honored, they are not binding for the duration of the patient’s life, and they are not drawn by the patient’s family.

 

 

 

 

  1. A nurse has a duty of nonmaleficence. Which of the following would be considered a contradiction to that duty?
  2. A) Provide comfort measures for a terminally ill patient
  3. B) Assist the patient with ADLs
  4. C) Refuse to administer pain medication as ordered
  5. D) Provide all information related to procedures

 

Ans:  C

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  25, Ethical Nursing Care

 

Feedback:  The duty not to inflict as well as prevent and remove harm is termed nonmaleficence. Providing comfort measures for a terminally ill patient, assisting a patient with ADLs, and providing information related to procedures would not be considered a contradiction to the nurse’s duty of nonmaleficence.

 

 

 

 

  1. You have just taken report for your shift and you are doing your initial assessment of your patients. One of your patients asks you if there has been an error made in her medication. Which of the following principles would apply if you give an accurate response?
  2. A) Veracity
  3. B) Confidentiality
  4. C) Respect
  5. D) Justice

 

Ans:  A

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  3

Page and Header:  26, Ethical Nursing Care

 

Feedback:  The obligation to tell the truth and not deceive others is termed veracity. The other answers are incorrect because they are not the obligation to tell the truth.

 

 

 

 

  1. It is important that the wording of a nursing diagnosis falls within the taxonomy of nursing. Which organization is responsible for developing the taxonomy of a nursing diagnosis?
  2. A) American Nurses Association (ANA)
  3. B) North American Nursing Diagnosis Association (NANDA)
  4. C) National League for Nursing (NLN)
  5. D) Joint Commission

 

Ans:  B

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  32, The Nursing Process

 

Feedback:  North American Nursing Diagnosis Association (NANDA) International is the official organization responsible for developing the taxonomy of nursing diagnoses and formulating nursing diagnoses acceptable for study. The ANA, NLN, and Joint Commission are not charged with the task of developing the taxonomy of nursing diagnoses.

 

 

 

 

  1. What phase of the nursing process is the nurse in when he determines a medication is effective and documents this in the patient’s record?
  2. A) Analysis
  3. B) Evaluation
  4. C) Assessment
  5. D) Data collection

 

Ans:  B

Chapter:  3

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  30, The Nursing Process

 

Feedback:  Evaluation, the final step of the nursing process, allows the nurse to determine the patient’s response to the nursing interventions and the extent to which the objectives have been achieved. The other answers are incorrect because they are not the correct phase of the nursing process.

 

 

 

 

  1. After the health history and admission assessment are completed, the nurse establishes a care plan for the patient. What is the rationale for documenting and planning the patient’s care?
  2. A) It provides continuity of care.
  3. B) It creates a teaching log for family.
  4. C) It verifies staffing.
  5. D) It provides the patient with information about treatments.

 

Ans:  A

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  6

Page and Header:  32, The Nursing Process

 

Feedback:  This record provides a means of communication among members of the health care team and facilitates coordinated planning and continuity of care. It serves as the legal and business record for a health care agency and for the professional staff members who are responsible for the patient’s care. A care plan is not a teaching log, it does not verify staffing, and it is not intended to provide the patient with information about treatments.

 

 

 

 

  1. The nurse is caring for a patient who is combative and confused. The patient has a fractured hip and is trying to get out of bed. What is the most appropriate action for the nurse to take?
  2. A) Leave the patient and get help
  3. B) Obtain a physician’s order to restrain the patient
  4. C) Read the facility’s policy on restraints
  5. D) Order soft restraints from the storeroom

 

Ans:  B

Chapter:  3

Client Needs:  A-2

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  28, Ethical Nursing Care

 

Feedback:  It is mandatory in most settings to have a physician’s order before restraining a patient. Before restraints are used, other strategies, such as asking family members to sit with the patient, or utilizing a specially trained sitter, should be tried. The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO) and the Centers for Medicare and Medicaid Services (CMS) have designated standards for the use of restraints. A patient should never be left alone while the nurse summons assistance. All staff members require annual instruction on the use of restraints, and the nurse should be familiar with the facility’s policy. This makes all other answers incorrect.

 

 

 

 

  1. A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility. The nurse notes that the patient’s leg is pain-free, without redness or edema. Which step of the nursing process does this reflect?
  2. A) Assessment
  3. B) Analysis
  4. C) Implementation
  5. D) Evaluation

 

Ans:  D

Chapter:  3

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  30, The Nursing Process

 

Feedback:  The nursing actions described constitute evaluation of the expected outcomes. The findings show that the expected outcomes have been achieved. Assessment consists of the patient’s history, physical examination, and laboratory studies. Analysis consists of considering assessment information to derive the appropriate nursing diagnosis. Implementation is the phase of the nursing process where the nurse puts the care plan into action.

 

 

 

 

  1. During report, a nurse finds that she has been assigned to care for a patient with AIDS. She is refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which legal premise?
  2. A) Good Samaritan Act
  3. B) Nursing Interventions Classification (NIC)
  4. C) Patient Self-Determination Act
  5. D) ANA Code of Ethics

 

Ans:  D

Chapter:  3

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  28, Ethical Nursing Care

 

Feedback:  The ethical obligation to care for all patients is clearly identified in the first statement of the ANA Code of Ethics for Nurses. The Good Samaritan Act relates to lay people helping others in need. The NIC is a standardized classification of nursing treatment that includes independent and collaborative interventions. The Patient Self-Determination Act encourages people to prepare advance directives in which they indicate their wishes concerning the degree of supportive care to be provided if they become incapacitated.

 

 

 

 

  1. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. The patient is to have a lumbar puncture performed, and the nurse is doing postprocedure teaching with the child and the mother. The nurse’s action is an example of which therapeutic communication technique?
  2. A) Informing
  3. B) Suggesting
  4. C) Humor
  5. D) Broad openings

 

Ans:  A

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Page and Header:  28, Ethical Nursing Care

 

Feedback:  Informing involves providing information to the patient regarding his care. Suggesting is the presentation alternative idea for the patient’s consideration relative to problem solving. Humor is the discharge of energy through the comic enjoyment of the imperfect. Broad openings encourage the patient to select topics for discussion.

 

 

 

 

  1. The nurse, in collaboration with the patient’s family, is assigning priorities related to the care of the patient. The nurse explains that when setting priorities it is important to look at the urgency of specific problems. What provides the best framework for prioritizing patient problems?
  2. A) Availability of hospital resources
  3. B) Family member statements
  4. C) Maslow’s hierarchy of needs
  5. D) Nursing skill

 

Ans:  C

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  34, The Nursing Process

 

Feedback:  Maslow’s hierarchy of needs provides a useful framework for prioritizing problems, with the first level given to meeting physical needs of the patient. Availability of hospital resources, family member statements, and nursing skill do not provide a framework for prioritization of patient problems.

 

 

 

 

  1. Which of the following would be an example of the nurse practicing fidelity? The nurse
  2. A) regulates visitors.
  3. B) stays with the patient during his or her death as promised.
  4. C) withholds information as requested.
  5. D) provides continuity of care.

 

Ans:  B

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Caring

Objective:  3

Page and Header:  26, Ethical Nursing Care

 

Feedback:  Fidelity requires the nurse to keep promises made and to be faithful to one’s commitments.

 

 

 

 

  1. You work in a long-term care facility. One of your patients is an elderly man who is very confused. What ethical dilemma is posed when using restraints in a long-term care setting?
  2. A) It limits personal safety.
  3. B) It increases confusion.
  4. C) It threatens autonomy.
  5. D) It prevents self-directed care.

 

Ans:  C

Chapter:  3

Client Needs:  A-2

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  28, Ethical Nursing Care

 

Feedback:  Because there are safety risks involved when using restraints on elderly confused patients, this is a common ethical problem in long-term care settings, as well as other health care settings. Restraints limit the individual’s autonomy because they are perceived as imprisonment. Restraints should not limit personal safety. Often restraints increase confusion, and they prevent self-directed care.

 

 

 

 

  1. While receiving report on her patients, the nurse learns that a patient with terminal cancer has granted medical power of attorney to her brother. What applies to the power of attorney?
  2. A) Another individual has been identified to make decisions on behalf of the patient.
  3. B) It is binding even if the patient changes his or her mind.
  4. C) The named individual is in charge of the patient’s finances.
  5. D) It is a legal document delegating custody of children to other than the spouse.

 

Ans:  A

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  5

Page and Header:  29, Ethical Nursing Care

 

Feedback:  A power of attorney is said to be in effect when a patient has identified another individual to make decisions on the patient’s behalf. The patient has the right to change her mind. A medical power-of-attorney does not give anyone the right to make financial decisions for the patient nor does it delegate custody of minor children.

 

 

 

 

  1. Before making a nursing diagnosis, what must a nurse do?
  2. A) Establish a plan.
  3. B) Assign a positive value to each consequence.
  4. C) Collect and analyze data.
  5. D) Evaluate the plan of care.

 

Ans:  C

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  29, The Nursing Process

 

Feedback:  In the diagnostic phase of the nursing process, the patient’s nursing problems are defined through analysis of patient data. Establishing a plan comes after collecting and analyzing data, evaluating a plan is the last step of the nursing process, and assigning a positive value to each consequence is not done.

 

 

 

 

  1. You are writing a care plan for a patient newly admitted to your unit. Which of these would be considered a nursing implementation?
  2. A) The patient will ambulate twice a day.
  3. B) The patient appears diaphoretic.
  4. C) The patient is at risk for aspiration.
  5. D) Monitor for peripheral edema twice a day.

 

Ans:  D

Chapter:  3

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  29, The Nursing Process

 

Feedback:  Implementation refers to carrying out the plan of nursing care.

 

 

 

 

  1. The physician has recommended an amniocentesis for an 18-year-old woman. The patient is 34 weeks’ gestation and does not want this procedure. The physician is insistent the patient have the procedure. The physician arranges for the amniocentesis to be done. What is this would be an example of?
  2. A) Veracity
  3. B) Beneficence
  4. C) Paternalism
  5. D) Autonomy

 

Ans:  C

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  3

Page and Header:  25, Ethical Nursing Care

 

Feedback:  Paternalism is the intentional limitation of another’s autonomy. Paternalism exists when the physician decides what is best for the patient rather than providing the patient with options and allowing the patient to make an informed decision related to care.

 

 

 

 

  1. You are admitting a patient to your unit who has just come back from surgery. The patient’s husband is providing the information you need. During the discussion with the patient’s husband, you discover that the patient has a living will. What applies to a living will?
  2. A) The patient is legally unable to refuse basic life support.
  3. B) The physician may disagree with the patient’s desires for treatment.
  4. C) The patient may nullify the living will during the illness.
  5. D) Power-of-attorney may change while the patient is hospitalized.

 

Ans:  C

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  5

Page and Header:  29, Ethical Nursing Care

 

Feedback:  Because living wills are often written when the person is in good health, it is not unusual for the patient to nullify the living will during illness. A living will does not make a patient legally unable to refuse basic life support. The physician may disagree with the patient’s wishes, but he is ethically bound to carry out those wishes. A power-of-attorney is not a living will.

 

 

 

 

  1. Your patient has a diagnosis of rheumatoid arthritis. While making the patient’s plan of care, which nursing diagnosis would be most applicable to this patient?
  2. A) Self-care deficit related to fatigue and joint stiffness
  3. B) Ineffective airway clearance related to chronic pain
  4. C) Risk for depression related to body image disturbance
  5. D) Urinary retention related to chronic pain

 

Ans:  A

Chapter:  3

Client Needs:  D-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  29, The Nursing Process

 

Feedback:  Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. All of the other answers are possibly correct; the self-care deficit would be most applicable.

 

 

 

 

  1. You are writing a care plan for a 65-year-old patient you have just admitted to the hospital. The patient has pneumonia and you note decreased air entry to bilateral lung bases. What is the most appropriate nursing diagnosis for this patient?
  2. A) Ineffective airway clearance related to copious tracheobronchial secretions
  3. B) Pneumonia related to disease process
  4. C) Poor ventilation related to infection
  5. D) Immobility related to fatigue

 

Ans:  A

Chapter:  3

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  29, The Nursing Process

 

Feedback:  Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis for this patient is “ineffective airway clearance related to copious tracheobronchial secretions.”

 

 

 

 

  1. Your patient has a diagnosis of pneumonia. Which of these would be classified as part of the planning phase of the nursing process for a patient diagnosed with pneumonia?
  2. A) Improve airway patency
  3. B) Promote fluid intake
  4. C) Administer fluids
  5. D) Avoid overexertion

 

Ans:  A

Chapter:  3

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  29, The Nursing Process

 

Feedback:  The planning phase entails specifying the immediate, intermediate, and long-term goals of nursing action. The other answers are incorrect because they are part of the implementation phase of the nursing process.

 

 

 

 

  1. You are the nurse who is caring for a patient with an allergy to peanuts. What would be an immediate goal with a nursing diagnosis of “knowledge deficit related to the patient’s administration of an Epi-pen”?
  2. A) The patient will demonstrate correct injection technique with today’s teaching session.
  3. B) The patient will observe the nurse demonstrating the injection.
  4. C) The nurse will teach the patient’s family member to administer the injection.
  5. D) The patient will return to the clinic in 2 weeks to demonstrate the injection.

 

Ans:  A

Chapter:  3

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  35, The Nursing Process

 

Feedback:  Immediate goals are those that can be reached in a short period of time. An appropriate immediate goal for this patient is that the patient will demonstrate correct administration of the medication on a specified date of today. Answers B and C are incorrect because the goal should specify that the patient administer the Epi-pen. Answer D is not an immediate goal.

 

 

 

 

  1. Many nursing actions are independent while others are interdependent. A nurse is performing an interdependent nursing intervention when he
  2. A) provides a back rub to a restless patient to help her sleep.
  3. B) provides mouth care.
  4. C) administers IV fluid.
  5. D) elevates the head of the bed.

 

Ans:  C

Chapter:  3

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  36, The Nursing Process

 

Feedback:  Although many nursing actions are independent, others are interdependent, such as carrying out prescribed treatments, administering medications and therapies, and collaborating with other health care team members to accomplish specific expected outcomes and to monitor and manage potential complications. Irrigating a wound, administering pain medication, and administering IV fluids are interdependent nursing actions and require a physician’s order. An independent nursing action occurs when the nurse provides a back rub, elevates the head of the bed, or provides mouth care.

 

 

 

 

  1. What should the nurse do during the evaluation phase of the nursing process?
  2. A) Have patient provide input on quality of care
  3. B) Discontinue surgical sutures
  4. C) Provide follow-up appointment for postoperative patient
  5. D) Document improved gas exchange with incentive spirometry use

 

Ans:  D

Chapter:  3

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  36, The Nursing Process

 

Feedback:  During the evaluation phase of the nursing process, the nurse determines the patient’s response to nursing interventions. An example of this is when the nurse documents whether the patient’s spirometry use has improved his or her condition. Answer A is incorrect because the patient does not do the evaluation. Answers B and C are incorrect because they are not evaluations.

 

 

 

 

  1. You are the charge nurse for this shift. Upon completing his rounds, a physician prescribes restraints for four on the floor. Upon reviewing the orders, you know that it is inappropriate to apply restraints to which of the following patients?
  2. A) A postlaryngectomy patient attempting to pull out his tracheostomy tube
  3. B) A patient in hypovolemic shock trying to pull out his IV catheter
  4. C) A patient with urosepsis who is often ringing the call bell to use the bedside commode
  5. D) A paranoid patient who has just tried to commit suicide and is refusing restraints

 

Ans:  C

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