Test Bank Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper |Test Bank Chapter 1-52|

Rationale: Grain intake should include at least six servings daily. To maintain a healthy weight and reduce incidence of cardiovascular disease, fat intake should not exceed 30% of the daily intake. Folic acid intake should be at 400 mg daily. Iron is a vital ingredient in the daily diet. 18 mg daily is reflective of the desired amount. Constipation should be managed by an adequate fluid and fiber intake. Nursing Process Step: Planning Client Needs Category: Health Promotion and Maintenance Client Needs Subcategory: Prevention and/or Detection of Early Health Problems Cognitive Level: Application 5. During a routine physical examination for a 52-year-old Caucasian male, the client declines to have his prostate gland examined. He states he does not have a family history and does not feel he is at risk. What initial response by the nurse is most appropriate? a. “You may refuse any screening test you wish.” b. “I will need to tell the physician about your refusal.” c. “Your risk factors increase with aging.” Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper d. “You are right, Caucasian men have less incidence of prostate cancer.” Answer: c Rationale: The need for prostate screening begins at age 50. Individuals with risk factors should begin screening at age 45. The client’s age places him at an increased risk, so he should begin the screening process. While the client may refuse any testing, this does not allow the client to engage in secondary levels of prevention. The client’s refusal should be recorded in the medical record but not used as a means to coerce the client. Nursing Process Step: Implementation Client Needs Category: Health Promotion and Maintenance Client Needs Subcategory: Growth and Development through the Lifespan Cognitive Level: Analysis 6. The nurse is preparing to teach a class for a group of new parents. The nurse is attempting to determine what topic would be of the greatest interest to the audience. What selection would be most appropriate? a. Safety b. Chronic illness prevention c. Problem-solving skills d. Interventions to manage depression Answer: a Rationale: The parents of small children are interested in information geared toward keeping them safe. Household safety is a priority for children of all ages. The families attending the session likely will have limited interest in preventing illness, as they typically represent a healthy segment of the population. Depression is a greater concern for older adults. Nursing Process Step: Assessment Client Needs Category: Health Promotion and Maintenance Client Needs Subcategory: Growth and Development through the Lifespan Cognitive Level: Analysis 7. An African-American male is discussing his dietary intake with the nurse. The nurse encourages the client to keep sodium intake below 1,500 mg per day. The client reports he does not have any known risk for the development of hypertension and feels this is too restrictive. How should the nurse respond? a. “African-Americans typically have higher sodium levels than their Caucasian counterparts.” b. “This is the amount of sodium intake recommended for everyone.” c. “This is what will be best for you.” d. “Do you eat a great deal of salt?” Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper Answer: a Rationale: After generations of conditioning, African-Americans frequently have higher sodium levels. The recommended sodium intake for African-Americans is slightly lower than are the levels for their Caucasian peers. Simply telling the client the recommendation is “best” does not provide an adequate level of information. The amount of salt ingested by the client should be recorded, but this is not the best response. Nursing Process Step: Implementation Client Needs Category: Physiological Integrity Client Needs Subcategory: Physiological Adaptation Cognitive Level: Analysis 8. A 45-year-old woman presents to the ambulatory clinic for a gynecological examination. The health history reveals no significant personal or family medical history. What information concerning health-promotion behaviors should be presented to the client? a. It is time to begin having mammograms every other year. b. If the client is in a monogamous relationship, Pap smears will not be needed. c. Bone density examinations are indicated every year. d. Recommended calcium intake is at least 1,200 mg per day. Answer: d Rationale: The recommended calcium intake is at least 1,200 mg per day. This will be beneficial in the prevention of osteoporosis. Women should begin having annual mammograms by age 40. Pap smears are continued for women in monogamous relationships. For women with no significant risk for the development of osteoporosis, bone density examinations should be done every other year. Nursing Process Step: Implementation Client Needs Category: Health Promotion and Maintenance Client Needs Subcategory: Prevention and/or Early Detection of Health Problems Cognitive Level: Analysis 9. A 75-year-old client seeks care at an ambulatory clinic. The client reports having experienced extreme drowsiness after recently taking dosages of an over-the-counter cold medication. When collecting data, the nurse notes the client reports taking only the prescribed amount of the preparation. What inferences can be made by the nurse concerning the events? a. The client likely has taken more of the preparation than stated. b. The client likely has experienced a reaction between the cold medication and other routine medications. c. The client’s age has influenced his response to the medication. d. The client is allergic to the cold medication. Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper Answer: c Rationale: Older clients often experience altered responses to medications. These changes are in response to age-related developments in the kidneys and liver. There is no evidence the client has taken too much medication. There is no information provided to indicate the client is taking other medications. Allergic reactions typically manifest with integumentary- or respiratory-related symptoms. Nursing Process Step: Evaluation Client Needs Category: Physiological Integrity Client Needs Subcategory: Pharmacological and Parental Therapies Cognitive Level: Analysis Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper Chapter 3 1. A nursing student is reading about the concept of parish nursing. Which of the following statements indicates understanding of the key concepts of parish nursing? 1. “You must practice a certain faith to be involved in parish nursing.” 2. “Parish nurses are independent practitioners providing care to members of a selected church.” 3. “Parish nursing is reserved for nurse practitioners.” 4. “Parish nurses may be employed by a hospital.” Answer: 4 Rationale: Parish nursing seeks to provide health care to traditionally underserved populations. Involvement in parish nursing is not limited to select faiths. The parish nurse may work directly for the church involved or be contracted by the church to provide nursing services and perform referrals. Parish nursing is not limited to nurse practitioners. Nursing Process Step: Evaluation Client Needs Category: Health Promotion and Maintenance Client Needs Subcategory: Prevention and/or Early Detection of Health Problems Cognitive Level: Application 2. The mother of a severely handicapped child states she is exhausted and voices the need to “take a break” to the nurse. What type of referral would best benefit the client? 1. A respite care provider 2. Hospice care agency 3. Home care 4. Ambulatory clinic Answer: 1 Rationale: Individuals who are faced with caring for ill or handicapped family members might need to have a “break.” The best option would be for a respite care provider. Respite care offers short in-home services in which the care provider would be freed from her duties for a short time. Hospice care is designed to assist the dying client and family members. Home health care is best for clients who are unable to leave their home for care services. Ambulatory clinics are used for clients who are in need of limited point-of-care medical services. Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper Nursing Process Step: Implementation Clients Needs Category: Psychological Integrity Client Needs Subcategory: Coping and Adaptation Cognitive Level: Application 3. The client who lives alone indicates concerns about their ability to perform the necessary dressing changes after discharge. Which action by the nurse is indicated at this time? 1. Explain to the client that she will need to seek the assistance of a friend or neighbor to help as needed. 2. Make a referral to the home healthcare agency preferred by the client. 3. Contact the hospital social worker. 4. Discuss the client’s anticipated needs with the physician. Answer: 4 Rationale: The client will likely need home health care. Home care requires a physician’s order. The nurse will need to initiate the referral process. In some facilities, a discharge planner might be involved. The services of the hospital social worker are not indicated by the information provided. The client has already indicated the absence of assistance. If the client lacks the social resources for it, it will be up to the healthcare team to locate community-based resources. Nursing Process Step: Implementation Client Needs Category: Safe, Effective Care Environment Client Needs Subcategory: Management of Care Cognitive Level: Application 4. The nurse is evaluating a group of clients for referral to a home health agency. Each of the clients is on the Medicare program. Which client is most likely to qualify for home health services? 1. The postoperative client needing reevaluated by the physician six weeks postoperatively 2. The client having a moderate-sized stage III pressure ulcer requiring daily dressing changes 3. The bedridden client who’s physician has prescribed oral antibiotic therapy for two weeks 4. The client having large stage I pressure ulcer Answer: 2 Rationale: Home care is indicated for clients for whom travel to the healthcare provider would be impossible or quite difficult. A large stage III pressure ulcer would be painful for the client during travel. Daily dressing changes would not be a typical function of the physician’s office, and would ideally be completed in the home. The client requiring a Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper postoperative assessment in six weeks does not appear to have any limitations presented. Oral antibiotic therapy does not present challenges to the client that signal the need for home care. The stage I pressure ulcer does not have skin breakdown or require professional healthcare services. Nursing Process Step: Planning Client Needs Category: Safe, Effective Care Environment Client Needs Subcategory: Management of Care Cognitive Level: Analysis 5. During a home care visit, the nurse notices the client’s dressing supplies are not being kept in a readily assessable environment. The nurse has discussed this with the client and family in previous visits. What action by the nurse is indicated? 1. Document the activities relating to the situation. 2. Continue to discuss the issues each visit. 3. Notify the physician. 4. Take the supplies and arrange to bring them back with each visit. Answer: 1 Rationale: The nurse has attempted to address the concerns with the client and family. The client’s failures to make changes in routine indicate a lack of intent to change. Continued discussion likely will prove futile. There is no need to notify the physician at this time. Taking custody of the supplies, carrying them around and bringing them back each time, is not feasible for the nurse. Goals of the nurse are not necessarily shared by the client. Nursing Process Step: Planning Client Needs Category: Psychological Integrity Client Needs Subcategory: Coping and Adaptation Cognitive Level: Application 6. While conducting a home health care visit, the nurse is asked to administer insulin to the client’s ailing husband. What action by the nurse is indicated? 1. The nurse should refuse to administer the medication. 2. The nurse may agree to assist with the administration of the insulin this time only but should caution the client and family that this is not the purpose for their visit. 3. The nurse should contact the physician for the husband for an order for the medication. 4. The nurse should contact his supervisor to obtain permission to administer the medication. Answer: 1 Test Bank for Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper Rationale: The home healthcare nurse is there to care for the client. Providing nursing services for the other members of the household is not appropriate. Legal issues would preclude the nurse from providing care without an order. Making contact with the physician is not appropriate, as the client’s husband is not a client of the home health agency. Nursing Process Step: Implementation Client Needs Category: Safe, Effective Care Environment Client Needs Subcategory: Management of Care Cognitive Level: Analysis 7. The home health nurse observes several small, round bruises on the back side of an elderly client’s arms. What action by the nurse is indicated first? 1. Question the client about the cause of the bruises. 2. Discuss the bruises with the client’s spouse. 3. Document the bruises, with plans to review them for changes on the next visit. 4. Contact the home health supervisor to report the findings. Answer: 1 Rationale: The client should be asked about the cause of the bruises. Nurses suspecting abuse are legally required to report it. Pending the client’s response, the supervisor will likely require notification. The client’s spouse should not be the first contact concerning the bruises, as he might be the source of the injury. Documentation about the findings is indicated. Delaying action until the next visit does not meet the legal responsibilities of the nurse. Nursing Process Step: Assessment Client Needs Category: Safe, Effective Care Environment Client Needs Subcategory: Safety and Infection Control Cognitive Level: Analysis 8. A home health nurse is preparing to begin a series of visits with a client. Based upon the client’s condition, the client is expected to require home care visits weekly for the next two months. Which of the following tasks should take place first? 1. Set priorities. 2. Assess the home environment. 3. Establish trust and rapport. 4. Promote learning.