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Chapter 03: Critical Thinking, Ethical Decision Making and the Nursing
1. A nurse has been offered a position on an obstetric unit and has learned that the unit offers therapeutic
abortions, a procedure which contradicts the nurses personal beliefs. What is the nurses ethical
obligation to these patients?
A) The nurse should adhere to professional standards of practice and offer service to these patients.
B) The nurse should make the choice to decline this position and pursue a different nursing role.
C) The nurse should decline to care for the patients considering abortion.
D) The nurse should express alternatives to women considering terminating their pregnancy.
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 the best option. The nurse is only required
by law (and practice standards) to provide care to the patients the clinic accepts; the nurse may not
discriminate between patients and the nurse expressing his or her own opinion and providing another
option is inappropriate.
2. A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large dose
of intravenous opioids by continuous infusion. You know that one of the adverse effects of this medicine
is respiratory depression. When you assess your patients respiratory status, you find that the rate has
decreased from 16 breaths per minute to 10 breaths per minute. What action should you take?
A) Decrease the rate of IV infusion.
B) Stimulate the patient in order to increase respiratory rate.
C) Report the decreased respiratory rate to the physician.
D) Allow the patient to rest comfortably.
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 patients respiratory status should be carefully monitored
and any changes should be reported to the physician.
3. An adult patient has requested a do not resuscitate (DNR) order in light of his recent diagnosis with late
stage pancreatic cancer. The patients son and daughter-in-law are strongly opposed to the patients
request. What is the primary responsibility of the nurse in this situation?
A) Perform a slow code until a decision is made.
B) Honor the request of the patient.
C) Contact a social worker or mediator to intervene.
D) Temporarily withhold nursing care until the physician talks to the family.
The nurse must honor the patients wishes and continue to provide required nursing care. Discussing the
matter with the physician may lead to further communication with the family, during which the family
may reconsider their decision. It is not normally appropriate for the nurse to seek the assistance of a
social worker or mediator. A slow code is considered unethical.
4. An elderly patient is admitted to your unit with a diagnosis of community-acquired pneumonia. During
admission the patient states, I have a living will. What implication of this should the nurse recognize?
A) This document is always honored, regardless of circumstances.
B) This document specifies the patients wishes before hospitalization.
C) This document that is binding for the duration of the patients life.
D) This document has been drawn up by the patients family to determine DNR status.
A living will is one type of advance directive. In most situations, living wills are limited to situations in
which the patients 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 patients life, and they are not
drawn up by the patients family.5. A nurse has been providing ethical care for many years and is aware of the need to maintain the ethical
principle of nonmaleficence. Which of the following actions would be considered a contradiction of this
A) Discussing a DNR order with a terminally ill patient
B) Assisting a semi-independent patient with ADLs
C) Refusing to administer pain medication as ordered
D) Providing more care for one patient than for another
The duty not to inflict as well as prevent and remove harm is termed nonmaleficence. Discussing a DNR
order with a terminally ill patient and assisting a patient with ADLs would not be considered
contradictions to the nurses duty of nonmaleficence. Some patients justifiably require more care than
6. 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 an error has been made in her medication. You know that an incident report
was filed yesterday after a nurse inadvertently missed a scheduled dose of the patients antibiotic. Which
of the following principles would apply if you give an accurate response?
The obligation to tell the truth and not deceive others is termed veracity. The other answers are incorrect
because they are not obligations to tell the truth.
7. A nurse has begun creating a patients plan of care shortly after the patients admission. It is important that
the wording of the chosen nursing diagnoses falls within the taxonomy of nursing. Which organization is
responsible for developing the taxonomy of a nursing diagnosis?
A) American Nurses Association (ANA)B) NANDA
C) National League for Nursing (NLN)
D) Joint Commission
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.
8. In response to a patients complaint of pain, the nurse administered a PRN dose of hydromorphone
(Dilaudid). In what phase of the nursing process will the nurse determine whether this medication has
had the desired effect?
D) Data collection
Evaluation, the final step of the nursing process, allows the nurse to determine the patients response to
nursing interventions and the extent to which the objectives have been achieved.
9. A medical nurse has obtained a new patients health history and completed the admission assessment.
The nurse has followed this by documenting the results and creating a care plan for the patient. Which of
the following is the most important rationale for documenting the patients care?
A) It provides continuity of care.
B) It creates a teaching log for the family.
C) It verifies appropriate staffing levels.
D) It keeps the patient fully informed.Ans: A
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 patients care. Documentation
is not primarily a teaching log; it does not verify staffing; and it is not intended to provide the patient
with information about treatments.
10. The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequently
combative and confused, despite the administration of benzodiazepines. The patient has a fractured hip
that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate
action for the nurse to take?
A) Leave the patient and get help.
B) Obtain a physicians order to restrain the patient.
C) Read the facilitys policy on restraints.
D) Order soft restraints from the storeroom.
It is mandatory in most settings to have a physicians 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. A patient should never be left alone while the nurse summons assistance.
11. A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility.
Following treatment with a heparin infusion, the nurse notes that the patients leg is pain-free, without
redness or edema. Which step of the nursing process does this reflect?
The nursing actions described constitute evaluation of the expected outcomes. The findings show that
the expected outcomes have been achieved. 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. This nurses actions do not constitute diagnosis.
12. During report, a nurse finds that she has been assigned to care for a patient admitted with an
opportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she is
refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which
A) Good Samaritan Act
B) Nursing Interventions Classification (NIC)
C) Patient Self-Determination Act
D) ANA Code of Ethics
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
13. 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 preprocedure teaching with the
child and the mother. The nurses action is an example of which therapeutic communication technique?
Feedback:Informing involves providing information to the patient regarding his or her care. Suggesting is the
presentation of an alternative idea for the patients consideration relative to problem solving. This action
is not characterized as expectation-setting or enlightening.
14. The nurse, in collaboration with the patients family, is determining priorities related to the care of the
patient. The nurse explains that it is important to consider the urgency of specific problems when setting
priorities. What provides the best framework for prioritizing patient problems?
A) Availability of hospital resources
B) Family member statements
C) Maslows hierarchy of needs
D) The nurses skill set
Maslows 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, though
each may be considered.
15. A medical nurse is caring for a patient who is palliative following metastasis. The nurse is aware of the
need to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle in
the care of this patient?
A) The nurse tactfully regulates the number and timing of visitors as per the patients wishes.
B) The nurse stays with the patient during his or her death.
C) The nurse ensures that all members of the care team are aware of the patients DNR order.
D) The nurse liaises with members of the care team to ensure continuity of care.
Beneficence is the duty to do good and the active promotion of benevolent acts. Enacting the patients
wishes around visitors is an example of this. Each of the other nursing actions is consistent with ethical
practice, but none directly exemplifies the principle of beneficence.16. The care team has deemed the occasional use of restraints necessary in the care of a patient with
Alzheimers disease. What ethical violation is most often posed when using restraints in a long-term care
A) It limits the patients personal safety.
B) It exacerbates the patients disease process.
C) It threatens the patients autonomy.
D) It is not normally legal.
Because safety risks are involved when using restraints on elderly confused patients, this is a common
ethical problem, especially in long-term care settings. By definition, restraints limit the individuals
autonomy. Restraints are not without risks, but they should not normally limit a patients safety.
Restraints will not affect the course of the patients underlying disease process, though they may
exacerbate confusion. The use of restraints is closely legislated, but they are not illegal.
17. While receiving report on a group of patients, the nurse learns that a patient with terminal cancer has
granted power of attorney for health care to her brother. How does this affect the course of the patients
A) Another individual has been identified to make decisions on behalf of the patient.
B) There are binding parameters for care even if the patient changes her mind.
C) The named individual is in charge of the patients finances.
D) There is a document delegating custody of children to other than her spouse.
A power of attorney is said to be in effect when a patient has identified another individual to make
decisions on her behalf. The patient has the right to change her mind. A power-of-attorney for health
care does not give anyone the right to make financial decisions for the patient nor does it delegate
custody of minor children.
18. In the process of planning a patients care, the nurse has identified a nursing diagnosis of Ineffective
Health Maintenance related to alcohol use. What must precede the determination of this nursing
diagnosis?A) Establishment of a plan to address the underlying problem
B) Assigning a positive value to each consequence of the diagnosis
C) Collecting and analyzing data that corroborates the diagnosis
D) Evaluating the patients chances of recovery
In the diagnostic phase of the nursing process, the patients 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.
19. You are following the care plan that was created for a patient newly admitted to your unit. Which of the
following aspects of the care plan would be considered a nursing implementation?
A) The patient will express an understanding of her diagnosis.
B) The patient appears diaphoretic.
C) The patient is at risk for aspiration.
D) Ambulate the patient twice per day with partial assistance.
Implementation refers to carrying out the plan of nursing care. The other listed options exemplify goals,
assessment findings, and diagnoses.
20. The physician has recommended an amniocentesis for an 18-year-old primiparous 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 performed. The nurse should recognize
that the physician is in violation of what ethical principle?
C) NonmaleficenceD) Autonomy
The principle of autonomy specifies that individuals have the ability to make a choice free from external
constraints. The physicians actions in this case violate this principle. This action may or may not violate
the principle of beneficence. Veracity centers on truth-telling and nonmaleficence is avoiding the
infliction of harm.
21. During discussion with the patient and the patients husband, you discover that the patient has a living
will. How does the presence of a living will influence the patients care?
A) The patient is legally unable to refuse basic life support.
B) The physician can override the patients desires for treatment if desires are not evidence-based.
C) The patient may nullify the living will during her hospitalization if she chooses to do so.
D) Power-of-attorney may change while the patient is hospitalized.
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 patients wishes, but he or she is ethically bound
to carry out those wishes. A power-of-attorney is not synonymous with a living will.
22. Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving only
modest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When
creating this patients plan of care, which nursing diagnosis would most likely be appropriate?
A) Self-care deficit related to fatigue and joint stiffness
B) Ineffective airway clearance related to chronic pain
C) Risk for hopelessness related to body image disturbance
D) Anxiety related to chronic joint pain
Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions.
Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness
are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely.
Ineffective airway clearance is unlikely.
23. You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and you
note decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate
nursing diagnosis for this patient?
A) Ineffective airway clearance related to tracheobronchial secretions
B) Pneumonia related to progression of disease process
C) Poor ventilation related to acute lung infection
D) Immobility related to fatigue
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. Pneumonia
and poor ventilation are not nursing diagnoses. Immobility is likely, but is less directly related to the
patients admitting medical diagnosis and the nurses assessment finding.
24. You are providing care for a patient who has a diagnosis of pneumonia attributed toStreptococcus
pneumonia infection. Which of the following aspects of nursing care would constitute part of the
planning phase of the nursing process?
Achieve SaO2 92% at all times.
B) Auscultate chest q4h.
C) Administer oral fluids q1h and PRN.
D) Avoid overexertion at all times.
The planning phase entails specifying the immediate, intermediate, and long-term goals of nursing
action, such as maintaining a certain level of oxygen saturation in a patient with pneumonia. Providingfluids and avoiding overexertion are parts of the implementation phase of the nursing process. Chest
auscultation is an assessment.
25. You are the nurse who is caring for a patient with a newly diagnosed allergy to peanuts. Which of the
following is an immediate goal that is most relevant to a nursing diagnosis of deficient knowledge
related to appropriate use of an EpiPen?
A) The patient will demonstrate correct injection technique with todays teaching session.
B) The patient will closely observe the nurse demonstrating the injection.
C) The nurse will teach the patients family member to administer the injection.
D) The patient will return to the clinic within 2 weeks to demonstrate the injection.
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 today. The
goal should specify that the patient administer the EpiPen. A 2-week time frame is inconsistent with an
26. A recent nursing graduate is aware of the differences between nursing actions that are independent and
nursing actions that are interdependent. A nurse performs an interdependent nursing intervention when
performing which of the following actions?
A) Auscultating a patients apical heart rate during an admission assessment
B) Providing mouth care to a patient who is unconscious following a cerebrovascular accident
C) Administering an IV bolus of normal saline to a patient with hypotension
D) Providing discharge teaching to a postsurgical patient about the rationale for a course of oral
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 physicians order. An independent nursing action occurs
when the nurse assesses a patients heart rate, provides discharge education, or provides mouth care.27. A nurse has been using the nursing process as a framework for planning and providing patient care.
What action would the nurse do during the evaluation phase of the nursing process?
A) Have a patient provide input on the quality of care received.
B) Remove a patients surgical staples on the scheduled postoperative day.
C) Provide information on a follow-up appointment for a postoperative patient.
D) Document a patients improved air entry with incentive spirometric use.
During the evaluation phase of the nursing process, the nurse determines the patients response to nursing
interventions. An example of this is when the nurse documents whether the patients spirometry use has
improved his or her condition. A patient does not do the evaluation. Removing staples and providing
information on follow-up appointments are interventions, not evaluations.
28. An audit of a large, university medical center reveals that four patients in the hospital have current
orders for restraints. You know that restraints are an intervention of last resort, and that it is
inappropriate to apply restraints to which of the following patients?
A) A postlaryngectomy patient who is attempting to pull out his tracheostomy tube
B) A patient in hypovolemic shock trying to remove the dressing over his central venous catheter
C) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode
D) A patient with depression who has just tried to commit suicide and whose medications are not
achieving adequate symptom control
Restraints should never be applied for staff convenience. The patient with urosepsis who is frequently
ringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior that
will not result in patient harm. The other described situations could plausibly result in patient harm;
therefore, it is more likely appropriate to apply restraints in these instances.
29. A patient has been diagnosed with small-cell lung cancer. He has met with the oncologist and is now
weighing the relative risks and benefits of chemotherapy and radiotherapy as his treatment. This patient
is demonstrating which ethical principle in making his decision?A) Beneficence
Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to
do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy.
Justice states that cases should be treated equitably.
30. A patient with migraines does not know whether she is receiving a placebo for pain management or the
new drug that is undergoing clinical trials. Upon discussing the patients distress, it becomes evident to
the nurse that the patient did not fully understand the informed consent document that she signed. Which
ethical principle is most likely involved in this situation?
A) Sanctity of life
Telling the truth (veracity) is one of the basic principles of our culture. Three ethical dilemmas in
clinical practice that can directly conflict with this principle are the use of placebos (nonactive
substances used for treatment), not revealing a diagnosis to a patient, and revealing a diagnosis to
persons other than the patient with the diagnosis. All involve the issue of trust, which is an essential
element in the nursepatient relationship. Sanctity of life is the perspective that life is the highest good.
Confidentiality deals with privacy of the patient. Fidelity is promise-keeping and the duty to be faithful
to ones commitments.
31. The nursing instructor is explaining critical thinking to a class of first-semester nursing students. When
promoting critical thinking skills in these students, the instructor should encourage them to do which of
the following actions?A) Disregard input from people who do not have to make the particular decision.
B) Set aside all prejudices and personal experiences when making decisions.
C) Weigh each of the potential negative outcomes in a situation.
D) Examine and analyze all available information.
Critical thinking involves reasoning and purposeful, systematic, reflective, rational, outcome-directed
thinking based on a body of knowledge, as well as examination and analysis of all available information
and ideas. A full disregard of ones own experiences is not possible. Critical thinking does not denote a
focus on potential negative outcomes. Input from others is a valuable resource that should not be
32. A care conference has been organized for a patient with complex medical and psychosocial needs. When
applying the principles of critical thinking to this patients care planning, the nurse should most
exemplify what characteristic?
A) Willingness to observe behaviors
B) A desire to utilize the nursing scope of practice fully
C) An ability to base decisions on what has happened in the past
D) Openness to various viewpoints
Willingness and openness to various viewpoints are inherent in critical thinking; these allow the nurse to
reflect on the current situation. An emphasis on the past, willingness to observe behaviors, and a desire
to utilize the nursing scope of practice fully are not central characteristics of critical thinkers.
33. Achieving adequate pain management for a postoperative patient will require sophisticated critical
thinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all that
A) Enhancing the nurses clinical decision making
B) Identifying the patients individual preferencesC) Planning the best nursing actions to assist the patient
D) Increasing the accuracy of the nurses judgments
E) Helping identify the patients priority needs
Ans: A, C, D, E
Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize
information within the context in which it is presented. Critical thinking enhances clinical decision
making, helping to identify patient needs and the best nursing actions that will assist patients in meeting
those needs. Critical thinking does not normally focus on identify patient desires; these would be
identified by asking the patient.
34. A nurse is unsure how best to respond to a patients vague complaint of feeling off. The nurse is
attempting to apply the principles of critical thinking, including metacognition. How can the nurse best
A) By eliciting input from a variety of trusted colleagues
B) By examining the way that she thinks and applies reason
C) By evaluating her responses to similar situations in the past
D) By thinking about the way that an ideal nurse would respond in this situation
Critical thinking includes metacognition, the examination of ones own reasoning or thought processes,
to help refine thinking skills. Metacognition is not characterized by eliciting input from others or
evaluating previous responses.
35. The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse
should describe skills in which of the following domains? Select all that apply.
C) InferenceD) Autonomy
Ans: B, C, E
Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and
self-regulation. Self-esteem and autonomy would not be on the list because they are not skills.
36. The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The
nurses most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking
is determining the significance of data that have been gathered. What characteristic of critical thinking is
used in determining the best response to this assessment finding?
Nurses use interpretation to determine the significance of data that are gathered. This specific process is
not described as extrapolation, inference, or characterization.
37. A nurse is admitting a new patient to the medical unit. During the initial nursing assessment, the nurse
has asked many supplementary open-ended questions while gathering information about the new patient.
What is the nurse achieving through this approach?
A) Interpreting what the patient has said
B) Evaluating what the patient has said
C) Assessing what the patient has said
D) Validating what the patient has said
Critical thinkers validate the information presented to make sure that it is accurate (not just supposition
or opinion), that it makes sense, and that it is based on fact and evidence. The nurse is not interpreting,
evaluating, or assessing the information the patient has given.
38. A nurse uses critical thinking every day when going through the nursing process. Which of the following
is an outcome of critical thinking in nursing practice?
A) A comprehensive plan of care with a high potential for success
B) Identification of the nurses preferred goals for the patient
C) A collaborative basis for assigning care
D) Increased cost efficiency in health care
Critical thinking in nursing practice results in a comprehensive plan of care with maximized potential for
success. Critical thinking does not identify the nurses goal for the patient or provide a collaborative basis
for assigning care. Critical thinking may or may not lead to increased cost efficiency; the patients
outcomes are paramount.
39. A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status
post knee replacement. What would be the best explanation why their care plans may be different from
A) Patients may have different insurers, or one may qualify for Medicare.
B) Individual patients are seen as unique and dynamic, with individual needs.
C) Nursing care may be coordinated by members of two different health disciplines.
D) Patients are viewed as dissimilar according to their attitude toward surgery.
Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences in
insurance coverage and attitude may be relevant, but these should not fundamentally explain the
differences in their nursing care. Nursing care should be planned by nurses, not by members of other
disciplines.40. A class of nursing students is in their first semester of nursing school. The instructor explains that one of
the changes they will undergo while in nursing school is learning to think like a nurse. What is the most
current model of this thinking process?
A) Critical-thinking Model
B) Nursing Process Model
C) Clinical Judgment Model
D) Active Practice Model
To depict the process of thinking like a nurse, Tanner (2006) developed a model known as the clinical
41. Critical thinking and decision-making skills are essential parts of nursing in all venues. What are
examples of the use of critical thinking in the venue of genetics-related nursing? Select all that apply.
A) Notifying individuals and family members of the results of genetic testing
B) Providing a written report on genetic testing to an insurance company
C) Assessing and analyzing family history data for genetic risk factors
D) Identifying individuals and families in need of referral for genetic testing
E) Ensuring privacy and confidentiality of genetic information
Ans: C, D, E
Nurses use critical thinking and decision-making skills in providing genetics-related nursing care when
they assess and analyze family history data for genetic risk factors, identify those individuals and
families in need of referral for genetic testing or counseling, and ensure the privacy and confidentiality
of genetic information. Nurses who work in the venue of genetics-related nursing do not notify family
members of the results of an individuals genetic testing, and they do not provide written reports to
insurance companies concerning the results of genetic testing.
42. A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDSTestrelated pneumonia. The student tells the instructor that she is unwilling to care for this patient. What key
component of critical thinking is most likely missing from this students practice?
A) Compliance with direction
B) Respect for authority
C) Analyzing information and situations
D) Withholding judgment
Key components of critical thinking behavior are withholding judgment and being open to options and
explanations from one patient to another in similar circumstances. The other listed options are incorrect
because they are not components of critical thinking.
43. A group of students have been challenged to prioritize ethical practice when working with a
marginalized population. How should the students best understand the concept of ethics?
A) The formal, systematic study of moral beliefs
B) The informal study of patterns of ideal behavior
C) The adherence to culturally rooted, behavioral norms
D) The adherence to informal personal values
In essence, ethics is the formal, systematic study of moral beliefs, whereas morality is the adherence to
informal personal values.
44. Your patient has been admitted for a liver biopsy because the physician believes the patient may have
liver cancer. The family has told both you and the physician that if the patient is terminal, the family
does not want the patient to know. The biopsy results are positive for an aggressive form of liver cancer
and the patient asks you repeatedly what the results of the biopsy show. What strategy can you use to
give ethical care to this patient?
A) Obtain the results of the biopsy and provide them to the patient.B) Tell the patient that only the physician knows the results of the biopsy.
C) Promptly communicate the patients request for information to the family and the physician.
D) Tell the patient that the biopsy results are not back yet in order temporarily to appease him.
Strategies nurses could consider include the following: not lying to the patient, providing all information
related to nursing procedures and diagnoses, and communicating the patients requests for information to
the family and physician. Ethically, you cannot tell the patient the results of the biopsy and you cannot
lie to the patient.
45. The nurse admits a patient to an oncology unit that is a site for a study on the efficacy of a new
chemotherapeutic drug. The patient knows that placebos are going to be used for some participants in
the study but does not know that he is receiving a placebo. When is it ethically acceptable to use
A) Whenever the potential benefits of a study are applicable to the larger population
B) When the patient is unaware of it and it is deemed unlikely that it would cause harm
C) Whenever the placebo replaces an active drug
D) When the patient knows placebos are being used and is involved in the decision-making process
Placebos may be used in experimental research in which a patient is involved in the decision-making
process and is aware that placebos are being used in the treatment regimen. Placebos may not ethically
be used solely when there is a potential benefit, when the patient is unaware, or when a placebo replaces
an active drug.
46. The nurse caring for a patient who is two days post hip replacement notifies the physician that the
patients incision is red around the edges, warm to the touch, and seeping a white liquid with a foul odor.
What type of problem is the nurse dealing with?
A) Collaborative problem
B) Nursing problem
C) Medical problemD) Administrative problem
In addition to nursing diagnoses and their related nursing interventions, nursing practice involves certain
situations and interventions that do not fall within the definition of nursing diagnoses. These activities
pertain to potential problems or complications that are medical in origin and require collaborative
interventions with the physician and other members of the health care team. The other answers are
incorrect because the signs and symptoms of infection are a medical complication that requires
interventions by the nurse.
47. While developing the plan of care for a new patient on the unit, the nurse must identify expected
outcomes that are appropriate for the new patient. What resource should the nurse prioritize for
identifying these appropriate outcomes?
A) Community Specific Outcomes Classification (CSO)
B) Nursing-Sensitive Outcomes Classification (NOC)
C) State Specific Nursing Outcomes Classification (SSNOC)
D) Department of Health and Human Services Outcomes Classification (DHHSOC)
Resources for identifying appropriate expected outcomes include the NOC and standard outcome criteria
established by health care agencies for people with specific health problems. The other options are
incorrect because they do not exist.
The nurse has just taken report on a newly admitted patient who is a 15year-old girl who is a recent
immigrant to the United States. When planning interventions for this patient, the nurse knows the
interventions must be which of the following? Select all that apply.
A) Appropriate to the nurses preferences
B) Appropriate to the patients age
D) Appropriate to the patients culture
E) Applicable to others with the same diagnosis
Ans: B, C, D
Planned interventions should be ethical and appropriate to the patients culture, age, and gender. Planned
interventions do not have to be in alignment with the nurses preferences nor do they have to be shared by
everyone with the same diagnosis.
Chapter 04: Health Education and Promotion
1. A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1
diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had several
admissions to the hospital medical unit, and the nurse has often carried out health promotion
interventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health?
A) The medical nurse
B) The community health nurse who has also worked with Mrs. Griffin
C) Mrs. Griffins primary care provider
D) Mrs. Griffin
American society places a great importance on health and the responsibility that each of us has to
maintain and promote our own health. Therefore, the other options are incorrect.
2. An elderly female patient has come to the clinic for a scheduled follow-up appointment. The nurse
learns from the patients daughter that the patient is not following the instructions she received upon
discharge from the hospital last month. What is the most likely factor causing the patient not to adhere to
her therapeutic regimen?
A) Ethnic background of health care provider
B) Costs of the prescribed regimen
C) Presence of a learning disability
D) Personality of the physician
Variables that appear to influence the degree of adherence to a prescribed therapeutic regimen include
gender, race, education, illness, complexity of the regimen, and the cost of treatments. The ethnic
background of the health care provider and the personality of the physician are not considered variables
that appear to influence the degree of adherence to a prescribed therapeutic regimen. A learning
disability could greatly affect adherence, but cost is a more likely barrier.
3. A gerontologic nurse has observed that patients often fail to adhere to a therapeutic regimen. What
strategy should the nurse adopt to best assist an older adult in adhering to a therapeutic regimen
involving wound care?
A) Demonstrate a dressing change and allow the patient to practice.
B) Provide a detailed pamphlet on a dressing change.
C) Verbally instruct the patient how to change a dressing and check for comprehension.
D) Delegate the dressing change to a trusted family member.
The nurse must consider that older adults may have deficits in the ability to draw inferences, apply
information, or understand major teaching points. Demonstration and practice are essential in meeting
their learning needs. The other options are incorrect because the elderly may have problems reading
and/or understanding a written pamphlet or verbal instructions. Having a family member change the
dressing when the patient is capable of doing it impedes self-care and independence.
4. A 20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin.
When planning the appropriate educational interventions and considering variables that will affect his
learning, the nurse should prioritize which of the following factors?
A) Patients expected lifespan
B) Patients gender
C) Patients occupation
D) Patients culture
One of the major variables that influences a patients readiness to learn is the patients culture, because it
affects how a person learns and what information is learned. Other variables include illness states,
values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables that
are usually less salient.
5. The nurse is planning to teach a 75-year-old patient with coronary artery disease about administering her
prescribed antiplatelet medication. How can the nurse best enhance the patients ability to learn?
A) Provide links to Web sites that contain evidence-based information.
B) Exclude family members from the session to prevent distraction.
C) Use color-coded materials that are succinct and engaging.
D) Make the information directly relevant to the patients condition.
Studies have shown that older adults can learn and remember if the information is paced appropriately,
relevant, and followed by appropriate feedback. Family members should be included in health education.
The nurse should not assume that the patients color vision is intact or that the patient possesses adequate
6. A nurse is planning care for an older adult who lives with a number of chronic health problems. For
which of the following nursing diagnoses would education of the patient be the nurses highest priority?
A) Risk for impaired physical mobility related to joint pain
B) Functional urinary incontinence related decreased mobility
C) Activity intolerance related to contractures
D) Risk for ineffective health maintenance related to nonadherence to therapeutic regimen
For some nursing diagnoses, education is a primary nursing intervention. These diagnoses include risk
for ineffective management of therapeutic regimen, risk for impaired home management, health-seeking
behaviors, and decisional conflict. The other options do not have patient education as the highest
priority, though each necessitates a certain degree of education.
7. The nursing instructor has given an assignment to a group of certified nurse practitioner (CNP) students.
They are to break into groups of four and complete a health-promotion teaching project and present a
report to their fellow students. What project most clearly demonstrates the principles of healthpromotion
A) Demonstrating an injection technique to a patient for anticoagulant therapy
B) Explaining the side effects of a medication to an adult patient
C) Discussing the importance of preventing sexually transmitted infections (STI) to a group of high
D) Instructing an adolescent patient about safe and nutritious food preparation
Health promotion encourages people to live a healthy lifestyle and to achieve a high level of wellness.
Discussing the importance of STI prevention to a group of high school students is the best example of a
health-promotion teaching project. This proactive intervention is a more precise example of health
promotion than the other cited examples.
Health promotion ranks high on the list of health-related concerns of the American public. Based on
current knowledge, what factor should the nurse prioritize in an effort to promote health, longevity, and
weight control in patients?
A) Good nutrition
B) Stress reduction
C) Use of vitamins
D) Screening for health risks
It has been suggested that good nutrition is the single most significant factor in determining health status,
longevity, and weight control. A balanced diet that uses few artificial ingredients and is low in fat,
caffeine, and sodium constitutes a healthy diet. Stress reduction and screening for health risks are correct
answers, just not the most significant factors. Vitamin use is not normally necessary when an individual
eats a healthy diet, except in specific circumstances.
9. The nursing profession and nurses as individuals have a responsibility to promote activities that foster
well-being. What factor has most influenced nurses abilities to play this vital role?
A) Nurses are seen as nurturing professionals.
B) Nurses possess a baccalaureate degree as the entry to practice.
C) Nurses possess an authentic desire to help others.
D) Nurses have long-established credibility with the public.
Nurses, by virtue of their expertise in health and health care and their long-established credibility with
consumers, play a vital role in health promotion. The other options are incorrect because they are not the
most influential when it comes to health promotion by nursing and nurses.
10. The nurse is teaching a local community group about the importance of disease prevention. Why is the
nurse justified in emphasizing disease prevention as a component of health promotion?
A) Prevention is emphasized as the link between personal behavior and health.
B) Most Americans die of preventable causes.
C) Health maintenance organizations (HMOs) now emphasize prevention as the main criterion of
D) External environment affects the outcome of most disease processes.
Healthy People 2020 defines the current national health-promotion and disease-prevention initiative for
the nation. The overall goals are to (1) increase the quality and years of healthy life for people and (2)
eliminate health disparities among various segments of the population. Most deaths are not classified as
being preventable. HMO priorities do not underlie this emphasis. The external environment affects many
disease processes, but the course of illness is primarily determined by factors intrinsic to the patient.
11. The nurse is preparing discharge teaching for a 51-year-old woman diagnosed with urinary retention
secondary to multiple sclerosis. The nurse will teach the patient to self-catheterize at home upon
discharge. What teaching method is most likely to be effective for this patient?
A) A list of clear instructions written at a sixth-grade level
B) A short video providing useful information and demonstrations
C) An audio-recorded version of discharge instructions that can be accessed at home
D) A discussion and demonstration between the nurse and the patient
Demonstration and practice are essential ingredients of a teaching program, especially when teaching
skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. When
special equipment is involved, such as urinary catheters, it is important to teach with the same equipment
that will be used in the home setting. A list of instructions, a video, and an audio recording are effective
methods of reinforcing teaching after the discussion and demonstration have taken place.
12. You are the nurse planning to teach tracheostomy care to a patient who will be discharged home
following a spinal cord injury. When preparing your teaching, which of the following is the most
important component of your teaching plan?
A) Citing the evidence that underlies each of your teaching points
B) Alleviating the patients guilt associated with not knowing appropriate self-care
C) Determining the patients readiness to learn new information
D) Including your nursing colleagues in the planning process
Assessment in the teachinglearning process is directed toward the systematic collection of data about the
person and familys learning needs and readiness to learn. Patient readiness is critical to accepting and
integrating new information. Unless the patient is ready to accept new information, patient teaching will
be ineffective. Citing the evidence base will not likely enhance learning. Patient guilt cannot be
alleviated until the patient understands the intricacies of the condition and his physiologic response to
the disease. Inclusion of colleagues can be beneficial, but this does not determine the success or failure
13. A public health nurse is preparing to hold a series of health-promotion classes for middle-aged adults
that will address a variety of topics. Which site would best meet the learning needs of this population?
A) A well-respected physicians office
B) A large, local workplace
C) The local hospital
D) An ambulatory clinic
The workplace has become a center for health-promotion activity. Health-promotion programs can
generally be offered almost anywhere in the community, but the workplace is often more convenient for
the adult, working population. This makes this option preferable to a hospital, doctors office, or
14. A nurse has been studying research that examines the association between stress levels and negative
health outcomes. Which relationship should underlie the educational interventions that the nurse chooses
A) Stress impairs sleep patterns.
B) Stress decreases immune function.
C) Stress increases weight.
D) Stress decreases concentration.
Studies have shown the negative effects of stress on health and a cause-and-effect relationship between
stress and infectious diseases, traumatic injuries (e.g., motor vehicle crashes), and some chronic
illnesses. It is well known that stress decreases the immune response, thereby making individuals more
susceptible to infectious diseases. The other options can also be correct in certain individuals, but they
are not those that best support stress-reduction initiatives.
15. A public health nurse understands that health promotion should continue across the lifespan. When
planning health promotion initiatives, when in the lifespan should health promotion begin?
B) School age
D) Before birth
Health promotion should begin prior to birth because the health practices of a mother prior to the birth of
her child can be influenced positively or negatively. This makes the other options incorrect.
16. A nurse is working with a teenage boy who was recently diagnosed with asthma. During the current
session, the nurse has taught the boy how to administer his bronchodilator by metered-dose inhaler. How
should the nurse evaluate the teachinglearning process?
A) Ask the boy specific questions about his medication.
B) Ask the boy whether he now understands how to use his inhaler.
C) Directly observe the boy using his inhaler to give himself a dose.
D) Assess the boys respiratory health at the next scheduled visit.
Demonstration and practice are essential ingredients of a teaching program, especially when teaching
skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. By
observing the patient using the inhaler, the nurse may identify what learning needs to be enhanced or
reinforced. Asking questions is not as an accurate gauge of learning. Respiratory assessment is a
relevant, but indirect, indicator of learning. Delaying the appraisal of the patients technique until a later
clinic visit is inappropriate because health problems could occur in the interval.
17. A team of public health nurses are doing strategic planning and are discussing health promotion
activities for the next year. Which of the following initiatives best exemplifies the principles of health
A) A blood pressure clinic at a local factory
B) A family planning clinic at a community center
C) An immunization clinic at the largest local mall
D) A workplace safety seminar
Health promotion may be defined as those activities that assist people in developing resources that
maintain or enhance well-being and improve their quality of life. A family planning clinic meets these
criteria most closely. Workplace health and safety would be considered a protection service. A blood
pressure clinic and immunization clinic would fall under the category of preventive services.
18. You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of your
patients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior best
demonstrates this patients willingness to learn?
A) The patient requests a visit from the hospitals diabetic educator.
B) The patient sets aside a dessert brought in by a family member.
C) The patient wants a family member to meet with the dietician to discuss meals.
D) The patient readily allows the nurse to measure his blood glucose level.
Emotional readiness also affects the motivation to learn. A person who has not accepted an existing
illness or the threat of illness is not motivated to learn. The patients wiliness to learn is expressed
through the action of seeking information on his or her own accord. Seeking information shows an
emotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn.
19. A nurse is planning an educational event for a local group of citizens who live with a variety of physical
and cognitive disabilities. What variable should the nurse prioritize when planning this event?
A) Health-promotion needs of the group
B) Relationships between participants and caregivers
C) Wellness state of each individual
D) Learning needs of caregivers
The nurse must be aware of the participants specific health-promotion needs when teaching specific
groups of people with physical and mental disabilities. This is a priority over the relationships between
participants and caregivers, each persons wellness state, or caregivers learning needs.
20. A public health nurse is planning educational interventions that are based on Beckers Health Belief
Model. When identifying the variables that affect local residents health promotion behaviors, what
question should the nurse seek to answer?
A) Do residents believe that they have ready access to health promotion resources?
B) Why have previous attempts at health promotion failed?
C) How much funding is available for health promotion in the community?
D) Who is available to provide health promotion education in the local area?
Barriers, Beckers second variable, are defined as factors leading to unavailability or difficulty in gaining
access to a specific health promotion alternative. The other listed questions do not directly relate to the
four variables that Becker specified.
21. A nursing student is collaborating with a public health nurse on a local health promotion initiative and
they recognize the need for a common understanding of health. How should the student and the nurse
best define health?
A) Health is an outcome systematically maximizing wellness.
B) Health is a state that is characterized by a lack of disease.
C) Health is a condition that enables people to function at their optimal potential.
D) Health is deliberate attempt to mitigate the effects of disease.
Health is viewed as a dynamic, ever-changing condition that enables people to function at an optimal
potential at any given time. Health does not necessarily denote the absence of disease, an effort to
maximize wellness, or mitigate the effects of disease.
22. A parish nurse is describing the relationships between health and physical fitness to a group of older
adults who all attend the same church. What potential benefits of a regular exercise program should the
nurse describe? Select all that apply.
A) Decreased cholesterol levels
B) Delayed degenerative changes
C) Improved sensory function
D) Improved overall muscle strength
E) Increased blood sugar levels
Ans: A, B, D
Clinicians and researchers who have examined the relationship between health and physical fitness have
found that a regular exercise program can promote health in the following ways: by decreasing
cholesterol and low-density lipoprotein levels; delaying degenerative changes, such as osteoporosis; and
improving flexibility and overall muscle strength and endurance. Physical fitness does not improve the
senses or increase blood sugar.
23. An occupational health nurse is in the planning stages of a new health promotion campaign in the
workplace. When appraising the potential benefits of the program, the nurse should consider that success
depends primarily on what quality in the participants?
A) Desire to expand knowledge
C) Adequate time- and task-management
D) Taking responsibility for oneself
Taking responsibility for oneself is the key to successful health promotion, superseding the importance
of desire to learn information, self-awareness, or time-management.
24. A public health nurse is assessing the nutritional awareness of a group of women who are participating
in a prenatal health class. What outcome would most clearly demonstrate that the women possess
A) The women demonstrate an understanding of the importance of a healthy diet.
B) The women are able to describe the importance of vitamin supplements during pregnancy.
C) The women can list the minerals nutrients that should be consumed daily.
D) The women can interpret the nutrition facts listed on food packaging.
Nutritional awareness involves an understanding of the importance of a healthy diet that supplies all of
the essential nutrients. The other options are incorrect because vitamin supplements are not necessary for
a healthy diet, a certain amount of all minerals need to be eaten daily, and understanding what
constitutes the recommended daily nutrients is not necessary for nutritional awareness.
25. A nurse has planned a teachinglearning interaction that is aimed at middle school-aged students. To
foster successful health education, the nurses planning should prioritize which of the following
B) Social and cultural patterns
C) Patient awareness
D) Measurable interventions
A patients social and cultural patterns must be appropriately incorporated into the teachinglearning
interaction. Pretesting may or may not be used; patient awareness is a phrase that has many meanings,
none of which make the teachinglearning interaction successful. Interventions are not measured; goals
and outcomes are.
26. Positive patient outcomes are the ultimate goal of nursepatient interactions, regardless of the particular
setting. Which of the following factors has the most direct influence on positive patient-care outcomes?
A) Patients age
B) Patients ethnic heritage
C) Health education
D) Outcome evaluation
Health education is an influential factor directly related to positive patient-care outcomes. The other
options are incorrect because ethnicity, the patients age, and outcome evaluation are less influential
factors related to positive patient-care outcomes, though each factor should be considered when planning
27. A school nurse is facilitating a health screening program among junior high school students. What
purpose of health screening should the nurse prioritize when planning this program?
A) To teach students about health risks that they can expect as they grow and develop
B) To evaluate the treatment of students current health problems
C) To identify the presence of infectious diseases
D) To detect health problems at an early age so they can be treated promptly
The goal of health screening in the adolescent population has been to detect health problems at an early
age so that they can be treated at this time. An additional goal includes efforts to promote positive health
practices at an early age. The focus is not on anticipatory guidance or evaluation of treatment. Health
screening includes infectious diseases, but is not limited to these.
28. A nurse recognizes that individuals of different ages have specific health promotion needs. When
planning to promote health among young adults, what subject is most likely to meet this demographic
groups learning needs?
A) Family planning
B) Management of risky behaviors
C) Physical fitness
D) Relationship skills training
Because of the nationwide emphasis on health during the reproductive years, young adults actively seek
programs that address prenatal health, parenting, family planning, and womens health issues. The other
options are incorrect because they are not health promotion classes typically sought out by young adults.
29. Middle-aged adults are part of an age group that is known to be interested in health and health
promotion, and the nurse is planning health promotion activities accordingly. To what suggestions do
members of this age group usually respond with enthusiasm? Select all that apply.
A) How lifestyle practices can improve health
B) How to eat healthier
C) How exercise can improve your life
D) Strategies for adhering to prescribed therapy
E) Exercise for the aging
Ans: A, B, C
Young and middle-aged adults represent an age group that not only expresses an interest in health and
health promotion but also responds enthusiastically to suggestions that show how lifestyle practices can
improve health; these lifestyle practices include nutrition and exercise. Middle-aged adults may not
respond positively to teaching aimed at the aging. Adherence is not noted to be a desired focus in this
30. A community health nurse has been asked to participate in a health fair that is being sponsored by the
local senior center. The nurse should select educational focuses in the knowledge that older adults
benefit most from what kind of activities?
A) Those that help them eat well
B) Those that help them maintain independence
C) Those that preserve their social interactions
D) Those that promote financial stability
Although their chronic illnesses and disabilities cannot be eliminated, the elderly can benefit most from
activities that help them maintain independence and achieve an optimal level of health. For many older
adults, this is a priority over social interaction, finances, or eating well, even though each of these
subjects is important.
31. A recent nursing graduate is aware that the nursing scope of practice goes far beyond what is
characterized as bedside care. Which of the following is a nurses primary responsibility?
A) To promote activities that enhance community cohesion
B) To encourage individuals self-awareness
C) To promote activities that foster well-being
D) To influence individuals social interactions
As health care professionals, nurses have a responsibility to promote activities that foster well-being,
self-actualization, and personal fulfillment. Nurses often promote activities that enhance the community
and encourage self-awareness; however, they are not a nurses central responsibility. As professionals,
nurses do not actively seek to influence social interactions.
32. A nurse who provides care at the campus medical clinic of a large university focuses many of her efforts
on health promotion. What purpose of health promotion should guide the nurses efforts?
A) To teach people how to act within the limitations of their health
B) To teach people how to grow in a holistic manner
C) To change the environment in ways that enhance cultural expectations
D) To influence peoples behaviors in ways that reduce risks
The purpose of health promotion is to focus on the persons potential for wellness and to encourage
appropriate alterations in personal habits, lifestyle, and environment in ways that reduce risks and
enhance health and well-being. The other options are incorrect because the purpose of health promotion
is not to teach people how to grow in a holistic manner, to accommodate their limitations, or to change
the environment in ways that enhances cultural expectations.
33. Health care professionals are involved in the promotion of health as much as in the treatment of disease.
Health promotion has evolved as a part of health care for many reasons. Which of the following factors
has most influenced the growing emphasis on health promotion?
A) A changing definition of health
B) An awareness that wellness exists
C) An expanded definition of chronic illness
D) A belief that disease is preventable
The concept of health promotion has evolved because of a changing definition of health and an
awareness that wellness exists at many levels of functioning. The other options are incorrect because
health promotion has not evolved because we know that wellness exists or a belief that disease is
preventable. No expanded definition of chronic illness has caused the concept of health promotion to
34. A nurse is working with a male patient who has recently received a diagnosis of human
immunodeficiency virus (HIV). When performing patient education during discharge planning, what
goal should the nurse emphasize most strongly?
A) Encourage the patient to exercise within his limitations.
B) Encourage the patient to adhere to his therapeutic regimen.
C) Appraise the patients level of nutritional awareness.
D) Encourage a disease-free state,
One of the goals of patient education is to encourage people to adhere to their therapeutic regimen. This
is a very important goal because if patients do not adhere to their therapeutic regimen, they will not
attain their optimal level of wellness. In this patients circumstances, this is likely a priority over exercise
or nutrition, though these are important considerations. A disease-free state is not obtainable.
35. Research has shown that patient adherence to prescribed regimens is generally low, especially when the
patient will have to follow the regimen for a long time. Which of the following individuals would most
likely benefit from health education that emphasizes adherence?
A) An older adult who is colonized with methicillin-resistant Staphylococcus aureus (MRSA)
B) An 80-year-old man who has a small bowel obstruction
C) A 52-year-old woman who has a new diagnosis of multiple sclerosis
D) A child who fractured her humerus in a playground accident
when the regimens are complex or of long duration (e.g., therapy for tuberculosis, multiple sclerosis, and
HIV infection and hemodialysis). This is less likely in a person with MRSA, an arm fracture, or a bowel
36. You are the clinic nurse providing patient education to a teenage girl who was diagnosed 6 months ago
with type 1 diabetes. Her hemoglobin A1C results suggest she has not been adhering to her prescribed
treatment regimen. As the nurse, what variables do you need to assess to help this patient better adhere
to her treatment regimen? Select all that apply.
A) Variables that affect the patients ability to obtain resources
B) Variables that affect the patients ability to teach her friends about diabetes
C) Variables that affect the patients ability to cure her disease
D) Variables that affect the patients ability to maintain a healthy social environment
E) Variables that affect the patients ability to adopt specific behaviors
Ans: A, D, E
Nurses success with health education is determined by ongoing assessment of the variables that affect a
patients ability to adopt specific behaviors, to obtain resources, and to maintain a healthy social
environment. The patients ability to teach her friends about her condition is not a variable that the nurse
would likely assess when educating the patient about her treatment regimen. Type 1 diabetes is not
37. Nurses who are providing patient education often use motivators for learning with patients who are
struggling with behavioral changes necessary to adhere to a treatment regimen. When working with a
15-year-old boy who has diabetes, which of the following motivators is most likely to be effective?
A) A learning contract
B) A star chart
C) A point system
D) A food-reward system
Using a learning contract or agreement can also be a motivator for learning. Such a contract is based on
assessment of patient needs; health care data; and specific, measurable goals. Young adults would not
respond well to the use of star charts, point systems, or food as reward for behavioral change. These
types of motivators would work better with children.
38. As the nurse working in a gerontology clinic, you know that some elderly people do not adhere to
therapeutic regimens because of chronic illnesses that require long-term treatment by several health care
providers. What is the most important consideration when dealing with this segment of the population?
A) Health care professionals must know all the dietary supplements the patient is taking.
B) Health care professionals must work together to provide coordinated care.
C) Health care professionals may negate the efforts of another health care provider.
D) Health care professionals must have a peer witness their interactions with the patient.
Above all, health care professionals must work together to provide continuous, coordinated care;
otherwise, the efforts of one health care professional may be negated by those of another. Interactions do
not necessarily need to be witnessed. The care team should be aware of the patients use of supplements,
but this is not a priority principle that guides overall care.
39. An adult patient will be receiving outpatient intravenous antibiotic therapy for the treatment of
endocarditis. The nurse is preparing to perform health education to ensure the patients adherence to the
course of treatment. Which of the following assessments should be the nurses immediate priority?
A) Patients understanding of the teaching plan
B) Quality of the patients relationships
C) Patients previous medical history
D) Characteristics of the patients culture
Before beginning health teaching, nurses must conduct an individual cultural assessment instead of
relying only on generalized assumptions about a particular culture. This is likely a priority over previous
medical history and relationships, though these are relevant variables. The teaching plan would not be
created at this early stage in the teaching process.
40. The nurse is working with a male patient who has diagnoses of coronary artery disease and angina
pectoris. During a clinic visit, the nurse learns that he has only been taking his prescribed antiplatelet
medication when he experiences chest pain and fatigue. What nursing diagnosis is most relevant to this
A) Acute pain related to myocardial ischemia
B) Confusion related to mismanagement of drug regimen
C) Ineffective health maintenance related to inappropriate medication use
D) Ineffective role performance related to inability to manage medications
This patients actions suggest that by taking his medications incorrectly he is not adequately maintaining
his health. Role performance is not directly applicable to the patients actions and confusion suggests a
cognitive deficit. Pain is not central to the essence of the problem.