Test bank for medical surgical nursing critical thinking in patient care 5th edition by lemone

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.. Cognitive Level:

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LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

Chapter 1

Question 1

Type: MCSA

The nurse is instructing a patient on the role of diet, exercise, and medication to control type 2 diabetes The nurse

is practicing which of the following core competencies for healthcare professionals?

1 provide patient-centered care

2 work in interdisciplinary teams

3 use evidence-based practice

4 apply quality improvement

Correct Answer: 1

Rationale 1: The nurse instructing the patient is an example of the competency provide patient-centered care

Rationale 2: The core competency work in interdisciplinary teams involves collaboration between disciplines to

provide continuous and reliable care

Rationale 3: Using best research when providing patient care is an example of the core competency use

evidence-based practice

Rationale 4: Identifying safety hazards and measuring quality is an example of the core competency apply

quality improvement

Global Rationale: In 2003, the National Academy of Sciences proposed a set of five core competencies that all

healthcare professionals should possess to meet the needs of the twenty-first century The nurse instructing the

patient is an example of the competency providing patient-centered care Collaboration between disciplines to provide continuous and reliable care is an example of the core competency work in interdisciplinary teams Using best research when providing patient care is an example of the core competency use evidence-based practice Identifying safety hazards and measuring quality are examples of the core competency apply quality

improvement

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Describe the core competencies for healthcare professionals: provide patient-centered

care, work in interdisciplinary teams, use evidence-based practice, apply quality improvement, and use

informatics.

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Question 2

Type: MCSA

Which of the following is an example of the nurse who is utilizing the core competency use informatics when

providing patient care?

1 searching through a database of articles to find current research on wound care

2 documenting the effectiveness of pain medication for a patient

3 discussing the effectiveness of bedside physical therapy with the therapist

4 changing the sharps container in a patient’s room

Rationale 4: Changing the sharp’s container is an example of applying quality improvement.

Global Rationale: Examples of the nurse using the core competency of using informatics include the use of

technology to communicate, manage knowledge, decrease errors, and support critical thinking activities The activity of searching through a database of articles to find current research on wound care is an example of the use

of informatics Documenting the effectiveness of pain medication for a patient is an example of providing centered care Discussing the effectiveness of bedside physical therapy with the therapist is an example of

patient-working in interdisciplinary teams Changing the sharps container in a patient’s room is an example of applying quality improvement.

Nursing/Integrated Concepts: Nursing Process: Evaluation

informatics.

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The nurse who plans to implement evidence-based practice when providing patient care would include which of

the following activities?

Standard Text: Select all that apply.

1 Participate in education and research activities when possible.

2 Integrate research findings with clinical care to maximize patient outcomes.

3 Serve on the committee to create critical pathways for patient care.

4 Reinforce hand hygiene techniques with unlicensed assistive personnel.

5 Contact Environmental Services to inform of a malfunctioning infusion pump.

Correct Answer: 1,2

Rationale 1: Participate in education and research activities when possible This is an example of an activity

when implementing evidence-based practice in the provision of patient care.

Rationale 2: Integrate research findings with clinical care to maximize patient outcomes This is an example of an

activity when implementing evidence-based practice in the provision of patient care.

Rationale 3: Serve on the committee to create critical pathways for patient care This is an example of work in

interdisciplinary teams.

Rationale 4: Reinforce hand hygiene techniques with unlicensed assistive personnel This is an example of

applying quality improvement.

Rationale 5: Contact Environmental Services to inform of a malfunctioning infusion pump This is an example of

applying quality improvement.

Global Rationale:

Cognitive Level: Applying

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Describe the core competencies for healthcare professionals: patient-centered care,

interdisciplinary teams, evidence-based practice, quality improvement, and informatics

Question 4

Type: MCSA

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Which of the following activities would the community health nurse implement to exemplify the core competency

provide patient-centered care?

1 smoking cessation classes and literature for members in the community

2 increasing the hours for the physician to see patients in the community

3 attending a continuing education program on clean water initiatives

4 evaluating the effectiveness of weight reduction strategies for community members

Rationale 1: Smoking cessation classes and literature for members in the community is an example of an activity

to provide patient-centered care.

Rationale 2: Increasing the hours for the physician to see patients in the community is an activity to support the

competency of working in interdisciplinary teams.

Rationale 3: Attending a continuing education program on clean water initiatives is an activity to support the

competency of using evidence-based practice.

Rationale 4: Evaluating the effectiveness of weight reduction strategies for community members is an activity to

support the competency of applying quality improvement.

Global Rationale: Activities to exemplify the core competency provide patient-centered care should be focused

on disease prevention, wellness, and promotion of healthy lifestyles The activity “smoking cessation classes and

literature for members in the community” is an example of an activity to provide patient-centered care Increasing the hours for the physician to see patients in the community is an activity to support the competency of working in interdisciplinary teams Attending a continuing education program on clean water initiatives is an activity to support the competency of using evidence-based practice Evaluating the effectiveness of weight reduction strategies for community members is an activity to support the competency of applying quality improvement.

informatics.

Question 5

Type: MCSA

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The nurse, instructing a patient on weight reduction and smoking cessation, is implementing which of the

following codes of nursing practice?

1 International Council of Nurses Code for Nurses

2 American Nurses Association Standards of Professional Practice

3 American Nurses Association Code of Ethics for Nurses

4 State Board of Nursing

Rationale 1: The nurse who instructs a patient on weight reduction and smoking cessation is promoting health

and preventing illness which exemplifies the International Council of Nurses Code for Nursing

Rationale 2: The American Nurses Association Standards of Professional Practice are standards, not a code, and

focus on specific behaviors to address quality practice, practice evaluation, education, collegiality, collaboration, ethics, research, resource utilization, and leadership

Rationale 3: The American Nurses Association Code of Ethics for Nurses has nine statements which address the

nurse’s professional relationships, commitment to patients, patient rights, nursing practice, competency,

conditions of employment, and contributions to the science of nursing, collaboration, and nursing values

Rationale 4: The state boards of nursing do not publish codes for nursing.

Global Rationale: The International Council of Nurses Code for Nurses specifies what nurses are accountable for

in terms of people, practice, society, coworkers, and the profession The philosophical base for this code is that the nurse who instructs a patient on weight reduction and smoking cessation is promoting health and preventing illness, which exemplifies the International Council of Nurses Code for Nursing The American Nurses

Association Standards of Professional Practice are standards, not a code, and focus on specific behaviors to address quality practice, practice evaluation, education, collegiality, collaboration, ethics, research, resource utilization, and leadership The American Nurses Association Code of Ethics for Nurses has nine statements which address the nurse’s professional relationships, commitment to patients, patient rights, nursing practice, competency, conditions of employment, and contributions to the science of nursing, collaboration, and nursing values The state boards of nursing do not publish codes for nursing

Learning Outcome: 2 Explain the importance of nursing codes and standards as guidelines for clinical nursing

practice

Question 6

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Type: MCSA

To practice within the American Nurses Association Standards of Professional Practice, the nurse would

implement which of the following activities?

1 Integrate research findings into practice.

2 Implement a patient’s plan of care.

3 Evaluate patient progress toward identified outcomes.

4 Analyze assessment data to determine issues.

Rationale 1: The nurse who is practicing within the American Nurses Association Standards of Professional

Practice would integrate research findings into practice The standards focus on behaviors to address quality practice, practice evaluation, education, collegiality, collaboration, ethics, research, resource utilization, and leadership

Rationale 2: Implementing a patient’s plan of care is an example of adhering to the American Nurses Association

Standards of Practice

Rationale 3: Evaluating patient progress toward identified outcomes is an example of adhering to the American

Nurses Association Standards of Practice

Rationale 4: Analyzing assessment data to determine issues is an example of adhering to the American Nurses

Association Standards of Practice

Global Rationale: The American Nurses Association Standards of Professional Practice focus on behaviors to

address quality practice, practice evaluation, education, collegiality, collaboration, ethics, research, resource utilization, and leadership The nurse who is practicing within these standards would integrate research findings into practice The other activities would be implemented when the nurse is adhering to the American Nurses Association Standards of Practice

practice

Question 7

Type: MCSA

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The nurse who prescribes strategies and alternatives to assist a patient achieve expected outcomes is practicing within which of the American Nurses Association Standards of Practice?

Rationale 1: The American Nurses Association Standards of Practice follow the nursing process The nurse who

prescribes strategies and alternatives to assist a patient achieve expected outcomes is practicing within the

planning of the standards

Rationale 2: Assessment activities include data collection.

Rationale 3: Diagnosis activities include the analyzing of data to determine issues.

Rationale 4: Implementation activities include implementation of the plan of care and coordination of care

delivery

Global Rationale: The American Nurses Association Standards of Practice follow the nursing process The nurse

who prescribes strategies and alternatives to assist a patient achieve expected outcomes is practicing within the planning of the standards Assessment activities include data collection Diagnosis activities include the analyzing

of data to determine issues Implementation activities include implementation of the plan of care and coordination

of care delivery

practice

Question 8

Type: MCSA

A terminally ill patient says that the only thing he fears about dying is the pain The nurse, following the

International Council of Nurses Code for Nurses, would plan which of the following for the patient?

1 measures to alleviate suffering

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2 modified activities of daily living

3 enforcement of strict bed rest

4 dietary interventions to maximize strength

Rationale 1: Since the philosophical base for the International Council of Nurses Code for Nurses is the

responsibility to promote health, prevent illness, and alleviate suffering, the nurse should plan measures to

alleviate the patient’s suffering

Rationale 2: Modified activities of daily living may not reduce the pain the terminally ill patient fears and would

be incorrect

Rationale 3: Enforcement of strict bed rest may not reduce the pain the terminally ill patient fears and would be

incorrect

Rationale 4: Dietary interventions to maximize strength may not reduce the pain the terminally ill patient fears

and would be incorrect

Global Rationale: Since the philosophical base for the International Council of Nurses Code for Nurses is the

responsibility to promote health, prevent illness, and alleviate suffering, the nurse should plan measures to

alleviate the patient’s suffering Modified activities of daily living, enforcement of strict bed rest, and dietary interventions to maximize strength may not reduce the pain the terminally ill patient fears and would be incorrect

1 “I understand your anger and am sorry for the delay I have your pain medication now.”

2 “I had other patients who needed my attention first so I did a few things before getting the pain medication.”

3 “I needed to find out what your medication is and if you can have more when you asked.”

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4 “It seems that you always ask for pain medication when I am trying to do other things.”

Rationale 1: One behavior associated with critical thinking is having empathy and understanding why the patient

is angry when having to wait for pain medication The best response for the nurse to make to the patient is “I understand your anger and am sorry for the delay I have your pain medication now.”

Rationale 2: “I had other patients who needed my attention first so I did a few things before getting the pain

medication” is not an example of a critical thinking behavior and would be incorrect or inappropriate for the nurse

to respond to the patient

Rationale 3: “I needed to find out what your medication is and if you can have more when you asked” is not an

example of a critical thinking behavior and would be incorrect or inappropriate for the nurse to respond to the patient

Rationale 4: “It seems that you always ask for pain medication when I am trying to do other things” is not an

example of a critical thinking behavior and would be incorrect or inappropriate for the nurse to respond to the patient

Global Rationale: One behavior associated with critical thinking is having empathy and understanding why the

patient is angry when having to wait for pain medication The best response for the nurse to make to the patient is

“I understand your anger and am sorry for the delay I have your pain medication now.” The other choices are not examples of critical thinking behaviors and would be incorrect or inappropriate for the nurse to respond to the patient

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Apply the attitudes, mental habits, and skills necessary for critical thinking when using

the nursing process in patient care

Question 10

Type: MCSA

Which of the following should the nurse do with patient admission assessment data that would demonstrate divergent thinking?

1 Identify abnormal data for further analyzing.

2 Focus on normal data to rule out health problems

3 Discriminate information as facts or guesses

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4 Think about the information to determine solutions

Rationale 1: Divergent thinking, a critical-thinking skill, means having the ability to weigh the importance of

information The nurse should sort out the data that are relevant from data that are irrelevant for the patient and abnormal data are usually considered relevant

Rationale 2: Normal data are helpful but may not change the care to provide to the patient This is not divergent

thinking because it does not weigh the importance of the information

Rationale 3: Discriminating information as facts or guesses describes the critical-thinking skill of reasoning.

Rationale 4: Thinking about the information to determine solutions describes the critical- thinking skill of

reflection

Global Rationale: Divergent thinking, a critical-thinking skill, means having the ability to weigh the importance

of information The nurse should sort out the data that are relevant from data that are irrelevant for the patient Abnormal data are usually considered relevant; normal data are helpful but may not change the care to provide to the patient Discriminating information as facts or guesses describes the critical-thinking skill of reasoning Thinking about the information to determine solutions describes the critical- thinking skill of reflection

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5 find easy answers to problems

2 effective communication techniques

3 identify outcome criteria

4 set priorities

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Rationale 1: Making a diagnosis is a complex process and the nurse uses diagnostic reasoning to choose nursing

diagnoses that best define the individual patient’s health problems Diagnostic reasoning is a form of clinical judgment used to make decisions about which label, or diagnosis, best describes the patterns of data Elements of the clinical judgment process include data gathering and validation, data categorization, intuition, and prior clinical experience

Rationale 2: Effective communication techniques would be needed when conducting the assessment of the

patient

Rationale 3: Identification of outcome criteria is a part of the planning phase of the nursing process.

Rationale 4: Setting priority is an activity conducted during the implementation phase of the nursing process.

Global Rationale: Making a diagnosis is a complex process and the nurse uses diagnostic reasoning to choose

nursing diagnoses that best define the individual patient’s health problems Diagnostic reasoning is a form of clinical judgment used to make decisions about which label, or diagnosis, best describes the patterns of data Elements of the clinical judgment process include data gathering and validation, data categorization, intuition, andprior clinical experience Effective communication techniques would be needed when conducting the assessment

of the patient Identification of outcome criteria is a part of the planning phase of the nursing process Setting priority is an activity conducted during the implementation phase of the nursing process

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Question 13

Type: MCSA

The nurse plans and implements care for a patient based upon nursing knowledge and skills The nurse is

functioning within which of the following roles?

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Rationale 1: The caregiver role for the nurse today is both independent and collaborative Nurses independently

make assessments and plan and implement patient care based on nursing knowledge and skills

Rationale 2: The nurse functioning as a patient advocate actively promotes the patient’s rights to autonomy and

free choice

Rationale 3: The nurse who is functioning in the role of educator nurse assesses learning needs, plans and

implements teaching methods to meet those needs, and evaluates the effectiveness of the teaching

Rationale 4: The nurse functioning in the role of leader directs, delegates, and coordinates nursing activities.

Global Rationale: The caregiver role for the nurse today is both independent and collaborative Nurses

independently make assessments and plan and implement patient care based on nursing knowledge and skills Thenurse functioning as a patient advocate actively promotes the patient’s rights to autonomy and free choice The nurse who is functioning in the role of educator nurse assesses learning needs, plans and implements teaching methods to meet those needs, and evaluates the effectiveness of the teaching The nurse functioning in the role of leader directs, delegates, and coordinates nursing activities

Learning Outcome: 4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate,

leader and manager, and researcher

Question 14

Type: MCSA

A patient tells the nurse that he does not understand the surgical procedure the physician told him he needed Which of the following should the nurse do to advocate for this patient?

1 Contact the physician and ask that the procedure be explained to the patient.

2 Explain the procedure to the patient.

3 Document that the patient does not understand the proposed surgical procedure.

4 Instruct the patient in alternatives to the surgical procedure.

Rationale 1: The nurse as patient advocate actively promotes the patient’s rights to autonomy and free choice

The nurse should protect the patient’s right to self-determination about the surgical procedure

Rationale 2: The nurse should not explain the procedure to the patient This is not patient advocacy.

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Rationale 3: The nurse should not do anything beyond documenting the patient’s lack of understanding about the

procedure

Rationale 4: The nurse should not provide alternatives to the surgical procedure.

Global Rationale: The nurse as patient advocate actively promotes the patient’s rights to autonomy and free

choice The nurse should protect the patient’s right to self-determination about the surgical procedure The nurse should not explain the procedure to the patient The nurse should not do anything beyond documenting the

patient’s lack of understanding about the procedure The nurse should not provide alternatives to the surgical procedure

Question 15

Type: MCSA

The nurse, instructing a patient newly diagnosed with type 2 diabetes, reminds the patient about an annual dilated retinal eye examination in addition to annual urine tests to measure protein levels The nurse is functioning within which of the following roles with this patient?

Rationale 3: As an advocate, the nurse actively promotes the patient’s rights to autonomy and free choice.

Rationale 4: As a leader, the nurse manages time, people, and resources by delegating, directing, and

coordinating nursing activities

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Global Rationale: The nurse is functioning as an educator by instructing the patient on annual tests to maintain

health As a researcher, the nurse would have a goal to improve the care nurses provide to patients As an

advocate, the nurse actively promotes the patient’s rights to autonomy and free choice As a leader, the nurse manages time, people, and resources by delegating, directing, and coordinating nursing activities

Client Need: Health Promotion and Maintenance

Question 16

Type: MCSA

Which of the following leadership activities would the nurse perform when providing care within the primary nursing care delivery model?

1 Communicate with patients, families, other care providers, and plans patient discharge.

2 Serve as the team leader by making assignments and being responsible for all care provided.

3 Make referrals and manages the quality of care to include timeliness and cost.

4 Manage a caseload of patients and the health team members providing care to the patients.

Rationale 1: When providing care to patients within the primary nursing care delivery model, leadership activities

of the nurse include communicating with patients, families, and other care providers, and planning the discharge

of the patients

Rationale 2: In the team nursing care delivery model, leadership activities of the nurse include serving as the

team leader, making assignments, and being responsible for all care provider

Rationale 3: In the case management care delivery model, leadership activities of the nurse include making

referrals and managing the quality of care to include timeliness and cost

Rationale 4: In the case management care delivery model, leadership activities of the nurse include managing a

caseload of patients and managing the health team members providing care to the patients

Global Rationale: When providing care to patients within the primary nursing care delivery model, leadership

activities of the nurse include communicating with patients, families, and other care providers, and planning the discharge of the patients In the team nursing care delivery model, leadership activities of the nurse include serving as the team leader, making assignments, and being responsible for all care provider In the case

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management care delivery model, leadership activities of the nurse include making referrals, managing the quality

of care to include timeliness and cost, managing a caseload of patients, and managing the health team members providing care to the patients

Rationale 1: The nursing process is a series of critical-thinking activities that nurses use to provide care to

patients The purpose of care may be to promote wellness, restore health, or facilitate coping with a disability or death

Rationale 2: The use of critical pathways is primarily used to manage disease conditions.

Rationale 3: The use of evidence-based practice is primarily used to manage disease conditions.

Rationale 4: The use of variance analyzing implies the use of statistical-based research.

Global Rationale: The nursing process is a series of critical-thinking activities that nurses use to provide care to

patients The purpose of care may be to promote wellness, restore health, or facilitate coping with a disability or death The use of critical pathways and evidence-based practice are primarily used to manage disease conditions The use of variance analyzing implies the use of statistical-based research

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Question 18

Type: MCSA

Which of the following best demonstrates a nurse using critical thinking when providing patient care?

1 A nurse lists alternative interventions available to provide patient care.

2 A nurse checks a laboratory manual before providing care.

3 A nurse is confused when the only planned intervention fails to help a patient.

4 A nurse checks every intervention with the charge nurse before providing care.

Rationale 1: Critical thinking is thinking about one’s own thinking It is self-directed thinking that involves

attitudes and skills The purpose of the thinking, level of knowledge, prejudices, information sources, option identification, and personal values should all be considered with critical thinking

Rationale 2: Although the nurse may use a laboratory manual when planning or providing care, it is not the best

selection

Rationale 3: The nurse who is unable to employ alternative interventions lacks some of the basic characteristics

associated with critical thinking

Rationale 4: The nurse who is unable to make independent decisions lacks some of the basic characteristics

associated with critical thinking

Global Rationale: Critical thinking is thinking about one’s own thinking It is self-directed thinking that involves

attitudes and skills The purpose of the thinking, level of knowledge, prejudices, information sources, option identification, and personal values should all be considered with critical thinking Although the nurse may use a laboratory manual when planning or providing care, it is not the best selection The nurse who is unable to make independent decisions or employ alternative interventions lacks some of the basic characteristics associated with critical thinking

Question 19

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Type: MCSA

A new nurse tells her mentor, “You always seem so poised when you interact with the patient It is as if you always know what to do Can you teach me how to do that?” What characteristic does this mentor possess in relation to critical thinking?

Rationale 1: Confidence in one’s own decisions is gained through the use of critical thinking.

Rationale 2: Independent thinking is demonstrated by the ability to make decisions with minimal input from

others

Rationale 3: Empathy involves being able to relate in an understanding manner with others.

Rationale 4: Discipline involves self-control.

Global Rationale: Confidence in one’s own decisions is gained through the use of critical thinking Independent

thinking is demonstrated by the ability to make decisions with minimal input from others Empathy involves being able to relate in an understanding manner with others Discipline involves self-control

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Rationale 2: Divergent thinking involves thinking about multiple items simultaneously.

Rationale 3: Reasoning allows the nurse to use the powers of deduction.

Rationale 4: Clarifying is the use of thinking skills to enhance clarity and reduce confusion.

Global Rationale: Reflection occurs when time is taken to think about a situation and compare it to other similar

situations Divergent thinking involves thinking about multiple items simultaneously Reasoning allows the nurse

to use the powers of deduction Clarifying is the use of thinking skills to enhance clarity and reduce confusion

Question 21

Type: MCSA

The nurse working on a quality improvement study wants to evaluate a patient care process Which of the

following can the nurse use to evaluate this process?

Rationale 1: The nursing process can serve as a framework for the evaluation of quality care.

Rationale 2: The use of critical pathways would not provide the best, recommended means to evaluate a patient

care process

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Rationale 3: The use of variance analyzing would not provide the best, recommended means to evaluate a patient

care process

Rationale 4: The use of evidence-based practice would not provide the best, recommended means to evaluate a

patient care process

Global Rationale: The nursing process can serve as a framework for the evaluation of quality care The use of

critical pathways, variance analyzing, and evidence-based practice would not provide the best, recommended means to evaluate a patient care process

Rationale 1: The data gained during the evaluation of provided patient care serves as the assessment The nurse

can then proceed to create a nursing diagnosis based upon this information The steps in the nursing process are interrelated, interdependent, and used cyclically

Rationale 2: During the assessment phase, the nurse is actively collecting data.

Rationale 3: Implementation is the phase of the nursing process during which the nurse performs interventions Rationale 4: Determining the needs of patient and devising a plan of action take place during the planning phase Global Rationale: The data gained during the evaluation of provided patient care serves as the assessment The

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are interrelated, interdependent, and used cyclically During the assessment phase, the nurse is actively collecting data Implementation is the phase of the nursing process during which the nurse performs interventions

Determining the needs of patient and devising a plan of action take place during the planning phase

Rationale 1: Information that is perceived only by the person experiencing it is called subjective data.

Rationale 2: Evaluative data is used to assess responses to care that are delivered.

Rationale 3: Qualitative data refers to the presence or absence of a factor.

Rationale 4: Objective data can be measured by someone or something other than the patient.

Global Rationale: Information that is perceived only by the person experiencing it is called subjective data

Evaluative data is used to assess responses to care that are delivered Qualitative data refers to the presence or absence of a factor Objective data can be measured by someone or something other than the patient

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