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Essentials for Nursing Practice, 8th Edition by Patricia A. Potter, Anne Griffin Perry, Patricia Stockert, Amy Hall – Test Bank
Sample Questions
Chapter 06: Ethics
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
- A 73-year-old patient with hypertension is awaiting a triple cardiac bypass surgery. The patient is hard of hearing and did not understand what the surgeon said regarding the surgery. The daughter is concerned that the patient does not understand the risks of the surgery. If not clarified, this would be a violation of what principle?
| a. | Autonomy |
| b. | Justice |
| c. | Fidelity |
| d. | Nonmaleficence |
ANS: A
Autonomy refers to a person’s independence. As a principle in bioethics, autonomy represents an agreement to respect a patient’s right to determine a course of action. Justice refers to the principle of fairness: fair treatment and fair distribution of health care resources. Fidelity refers to the agreement to keep promises and is based on the virtue of caring. Nonmaleficence is actively seeking to do no harm.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 77 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A 45-year-old mother of two children has cirrhosis of the liver and is on a waiting list for a liver transplant. She had to meet certain criteria to be eligible to receive a liver. She understands that she is next on the list for a donor liver that matches. This is an example of which ethical principle?
| a. | Autonomy |
| b. | Justice |
| c. | Fidelity |
| d. | Nonmaleficence |
ANS: B
Justice refers to the principle of fairness. In health care, the term is used to reflect a commitment to fair treatment and fair distribution of health care resources. You may find reference to this principle during discussion about issues of access to care. It is not always clear just how to achieve a fair distribution of resources. Autonomy refers to independence and self-determination. Fidelity refers to the agreement to keep promises and is based on the virtue of caring. Nonmaleficence refers to the fundamental agreement to do no harm.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 78 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A registered nurse who works on an oncology unit discussed pain control options that the primary health care provider had ordered with a patient undergoing treatment for pancreatic cancer. The patient requested that the intravenous (IV) pain medication be given on a regular basis. The nurse agreed to provide the IV pain medication as requested and continued to reevaluate the pain levels. The nurse is following which ethical principle?
| a. | Autonomy |
| b. | Justice |
| c. | Fidelity |
| d. | Nonmaleficence |
ANS: C
Fidelity refers to the agreement to keep promises. The principle of fidelity also promotes the obligation of a nurse to follow through with the care offered to patients. Autonomy refers to independence and self-determination, which is what the patient followed, but the question asked for which principle the nurse followed. Justice refers to fairness or equity of health care resources. Nonmaleficence refers to the fundamental agreement to do no harm.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 78 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A registered nurse knows that an oncology patient undergoing a bone marrow transplant will spend weeks in isolation in the hospital. During that time the patient will be at an increased risk for infection and other complications and may not recover. The nurse ensures that the patient has been given information regarding the risks and potential benefits of the procedure. The nurse is following which ethical principle?
| a. | Autonomy |
| b. | Justice |
| c. | Fidelity |
| d. | Nonmaleficence |
ANS: D
The principle of nonmaleficence (do no harm) promotes a continuing effort to consider the potential for harm even when it is necessary to promote health. It is helpful in guiding your discussions about new or controversial technologies. Autonomy deals with independence and self-determination. Justice refers to fairness or equity of health care resources. Fidelity refers to maintaining promises and faithfulness.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 78 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A registered nurse is working on a pediatric oncology unit and caring for four children undergoing chemotherapy. Today a new nursing assistive personnel (NAP) who has passed a competency examination is assigned to the team. The nurse will delegate a portion of the fundamental nursing tasks to the NAP during the shift, but realizes that he or she is still responsible for his or her own actions and is accountable for the care. The nurse is following which principle of behavior?
| a. | Ethical dilemma |
| b. | Code of ethics |
| c. | Bioethics |
| d. | Feminist ethics |
ANS: B
The code of ethics reflects underlying principles that include responsibility, accountability, respect for confidentiality, competency, judgment, and advocacy. An ethical dilemma exists when the right thing to do is not clear or when members of the health care team cannot agree on the right thing to do. The study of bioethics represents a particular branch of ethics (i.e., the study of ethics within the field of health care). Feminist ethics proposes that we routinely ask how ethical decisions will affect women as a way to repair a history of inequality (Lindeman, 2005).
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 78 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- The mother of a 45-year-old patient is a retired physician and requests to discuss the patient’s plan of care with the nurse caring for the patient. What is the nurse’s best response to this request?
| a. | “I will need to ask permission from my supervisor before I can share that information.” |
| b. | “I will show you the chart, just follow me and we can discuss your questions and concerns.” |
| c. | “I would suggest that you leave me out of your family problems. I am here to care for the patient.” |
| d. | “I will have to get the patient’s permission before I can share that information.” |
ANS: D
Even family members or friends of the patient are not permitted access to the patient’s personal health information without the patient’s consent. Federal legislation known as HIPAA (Health Insurance Portability and Accountability Act of 1996) requires that those with access to personal health information not disclose the information to a third party without patient consent. The nurse does not need to ask permission from the supervisor because HIPAA laws state what the nurse can do. “I would suggest that you leave me out of your family problems” is inappropriate because it ignores the request of the family member. Showing the chart and discussing the care is a violation of HIPAA.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 80 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- A nurse bases ethical decisions on the effect, or consequences, an act will have and uses the following guidelines: the greatest good for the greatest number of people. Which ethical system is the nurse using?
| a. | Legal |
| b. | Deontology |
| c. | Utilitarianism |
| d. | Ethics of care |
ANS: C
Utilitarianism guides us to measure the effect, or consequences, that an act will have. The greatest good for the greatest number of people is the guiding principle for action in this system. By comparison, deontology focuses less on consequences and looks to the presence of pure principles of autonomy, justice, fidelity, beneficence, and nonmaleficence. Ethical issues differ from legal issues. Legal issues are resolved by reference to laws that tend to be concrete and publicly determined. Ethics of care suggest that health care workers resolve ethical dilemmas by paying attention to relationships and stories of the participants and by promoting a fundamental act of caring.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 81
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A registered nurse has recently been reassigned to the gynecology unit at the hospital. The nurse is strongly against abortion because of religious beliefs and contacts the nursing supervisor regarding the assignment because the unit cares for women who are undergoing abortions. The nurse is having a conflict in which area?
| a. | Confidentiality |
| b. | Values |
| c. | Social networking |
| d. | Culture |
ANS: B
The nurse is having a conflict in values because of religious beliefs and abortion. A value is a personal belief about the worth of an idea, a custom, or an object. Confidentiality is not the issue because no confidences have been broken. Social networking is online communication, which is not the issue in this scenario, values are the issue. The nurse is not having a conflict in culture, but in beliefs and values.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 77
OBJ: Describe the process for recognizing and resolving an ethical dilemma.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A 9-year-old patient was severely burned and has been undergoing whirlpool treatments to debride the wounds. The patient is crying and does not want to go to the physical therapy department for treatment. The registered nurse caring for the patient knows that, even though it is uncomfortable, the patient needs to have the therapy for the wounds to heal properly. The nurse is demonstrating which ethical principle?
| a. | Autonomy |
| b. | Bioethics |
| c. | Justice |
| d. | Beneficence |
ANS: D
The principle of beneficence promotes taking positive, active steps to help others. It encourages a nurse to do good for the patient. Beneficence guides decisions in which the benefits of a treatment pose a risk to the patient’s well-being or dignity. Autonomy refers to independence and self-determination. The study of bioethics represents a particular branch of ethics (i.e., the study of ethics within the field of health care). Justice refers to the principle of fairness. In health care the term is used to reflect a commitment to fair treatment and fair distribution of health care resources.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 78 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- Although a registered nurse has been working for several years as a staff nurse on an adult oncology unit, the nurse recently transferred to a pediatric unit in the hospital. The nurse will be in orientation for several days to learn about the different systems and will need to demonstrate proficiency in various pediatric areas such as medication administration. Which behavior is the nurse demonstrating?
| a. | Competency |
| b. | Judgment |
| c. | Advocacy |
| d. | Utilitarianism |
ANS: A
In the practice of nursing, competence ensures the provision of safe nursing care (proficiency in pediatric medication administration). The agreement to practice with competence is a common denominator for all state regulations and is in the nursing code of ethics. Judgment refers to the ability to form an opinion or draw sound conclusions. Advocacy involves speaking up for patient care issues from your unique perspective and advocating for humane and dignified care. You use a utilitarian ethic when determining the value of something based primarily on its usefulness and effects or consequences. The greatest good for the greatest number of people is the guiding principle for action in this system (utilitarian).
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 79
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- Which behavior best indicates that the nurse is fulfilling ethical responsibilities?
| a. | Delivers competent care |
| b. | Applies the scientific process |
| c. | Forms interpersonal relationships |
| d. | Evaluates new computerized technologies |
ANS: A
Delivers competent care is the best example because the American Nurses Association (ANA) and the International Council of Nurses (ICN) publish codes of ethics for nurses that set principles of behavior for nurses to embrace. They reflect common underlying principles that shape professional nursing practice, including responsibility, accountability, respect for confidentiality, competency, judgment, and advocacy. The scientific process, interpersonal relationships, and new technologies do not indicate ethical behavior like competent care.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 78
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A nurse decides to withhold a medication because it will further lower a patient’s respiratory rate. In this case, the nurse is practicing what principle?
| a. | Responsibility |
| b. | Privacy |
| c. | Ethics |
| d. | Moral behavior |
ANS: A
Responsibility refers to the execution of duties associated with a nurse’s role. For example, when administering a medication, you are responsible for assessing the patient’s need for the medication, giving it safely and correctly, and evaluating the patient’s response to it. Moral behavior refers to judgment about right and wrong behavior. Ethics refers to the consideration of standards of conduct, particularly the study of right and wrong behavior. A fundamental right of patients is the right to privacy. Privacy becomes a focus of increasing interest as health care becomes digitized, but it is not a focus of this scenario.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 78
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A patient is about to undergo a new, controversial bone marrow transplant procedure. The procedure may cause periods of pain and suffering. Although nurses agree to do no harm, this procedure may be necessary to promote health. This is an example of which ethnical principle?
| a. | Autonomy |
| b. | Justice |
| c. | Fidelity |
| d. | Nonmaleficence |
ANS: D
Nonmaleficence refers to the fundamental agreement to do no harm. The principle of nonmaleficence promotes a continuing effort to consider the potential for harm even when it is necessary to promote health. Autonomy refers to a person’s independence. Justice refers to the principles of fairness. Fidelity refers to the agreement to keep promises.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 78 OBJ: Describe and defend patient advocacy and the nurse’s role.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A community health nurse states, “I wish we had just a portion of the dollars spent repairing atherosclerotic hearts to teach the community about cardiovascular risk factors.” The nurse’s statement stems from what philosophy?
| a. | Deontology |
| b. | Feminist ethic |
| c. | Utilitarianism |
| d. | Ethics of care |
ANS: C
Utilitarianism determines the value of something based primarily on its usefulness. Deontology defines actions as right or wrong according to principles. The feminist ethic asks how ethical decisions will affect women. The ethics of care suggests that health care workers solve ethical dilemmas by the promotion of the fundamental act of caring.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 81
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A nurse is teaching the staff about the International Council of Nurses Code of Ethics. Which major element of the Code should the nurse include in the teaching session?
| a. | People |
| b. | Pride |
| c. | Power |
| d. | Problems |
ANS: A
The major elements of the Code include: Nurses and People; Nurses and Practice; Nurses and the Profession; and Nurses and Co-workers. It does not include pride, power, and problems.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 80
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- The code of ethics for nursing sets forth ideals of nursing conduct and was developed by what organization?
| a. | The Board of Nursing |
| b. | The American Medical Association |
| c. | The National League for Nursing |
| d. | The American Nurses Association |
ANS: D
The American Nurses Association (ANA) and the International Council of Nurses (ICN) publish codes of ethics for nurses that set principles of behavior for them to embrace. The Board of Nursing regulates nursing programs and nursing practice. The American Medical Association deals with physicians. The National League for Nursing is an agency concerned with nursing education.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 78
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A nurse is processing an ethical dilemma by focusing on relationships and stories of the participants. Which ethical system is the nurse using?
| a. | Deontology |
| b. | Utilitarianism |
| c. | Feminist ethics |
| d. | Ethics of care |
ANS: D
Ethics of care suggest that health care workers resolve ethical dilemmas by paying attention to relationships and stories of the participants and by promoting a fundamental act of caring. Attention to relationships distinguishes the ethics of care from other ethical viewpoints because it does not necessarily apply universal principles that are intellectual or analytical. Deontology defines actions as right or wrong based on “right-making characteristics” such as truth and justice. You use utilitarian ethics when determining the value of something based primarily on its usefulness and effects or consequences. Feminist ethics proposes that we routinely ask how ethical decisions will affect women as a way to repair a history of inequality.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 81
OBJ: Discuss the foundations of ethics and ethical practice in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A nurse is teaching the staff about how to process an ethical dilemma. Which order should the nurse use to present the steps?
- Evaluate the action.
- Negotiate the outcome.
- State the problem clearly.
- Gather all relevant information.
- Examine own values and opinions.
- Consider possible courses of action.
| a. | d, e, c, f, a, b |
| b. | d, e, c, f, b, a |
| c. | d, c, e, f, a, b |
| d. | d, e, c, b, f, a |
ANS: B
The steps to process an ethical dilemma include the following: (1) Is this an ethical dilemma? (2) Gather all information relevant to the case. (3) Examine and determine your own values and opinions about the issues. (4) State the problem clearly. (5) Consider possible courses of action. (6) Negotiate the outcome. (7) Evaluate the action.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 82
OBJ: Describe the process for recognizing and resolving an ethical dilemma.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
MULTIPLE RESPONSE
- A nurse is working with the parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. To help the parents resolve this conflict, which steps should the nurse take to process the ethical dilemma? (Select all that apply.)
| a. | Identifying people who can solve this dilemma |
| b. | Gathering all relevant information surrounding this dilemma |
| c. | Clarifying own values and opinions about the issues |
| d. | Consulting a professional ethicist regarding how to proceed with this dilemma |
| e. | Considering possible courses of action |
ANS: B, C, E
The nurse should gather all relevant information, clarify own values and opinions about the issue, and consider possible courses of action. Seven steps are used when solving an ethical dilemma: (1) Asking “is it an ethical dilemma?”, (2) gathering all information, (3) examining and determining one’s own values and opinions about the issue, (4) stating the problem clearly, (5) considering possible courses of action, (6) negotiating an outcome, and (7) evaluating the action. Identifying people who can solve this dilemma and consulting a professional ethicist are not steps of the process.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 82
OBJ: Describe the process for recognizing and resolving an ethical dilemma.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
Chapter 07: Evidence-Based Practice
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
- Which organization is preparing future nurses to have the knowledge, skills, and attitudes (KSAs) of evidence-based practices necessary to continuously improve the quality and safety of the health care systems within which they work?
| a. | The Joint Commission |
| b. | Quality and Safety Education for Nurses’ (QSEN) |
| c. | The National Database of Nursing Quality Improvement (NDNQI) |
| d. | The Agency for Health care Research and Quality (AHRQ) |
ANS: B
Evidence-based practice is also one of the Quality and Safety Education for Nurses’ (QSEN) competencies, with the overall goal for the QSEN project being to meet the challenge of preparing future nurses to have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work (QSEN, 2012). The Joint Commission provides Patient Safety Goals. All magnet-designated hospitals maintain the National Database of Nursing Quality Improvement (NDNQI). The database has information on falls, pressure ulcer incidence, and nurse satisfaction. The AHRQ is a national agency that provides important sources of new scientific information that include standards and practice guidelines.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 91 OBJ: Discuss the QSEN competencies for evidence-based practice.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A registered nurse questioned the nurses on the neonatal intensive care unit about the practice of kangaroo care for neonates. The nurse had read literature supporting the practice, but the nurses that work on the neonatal unit stated that they had never done anything like that at their institution. The nurse continued to ask questions and began a literature review. Which behavior was the nurse demonstrating?
| a. | Variables |
| b. | Peer review |
| c. | Evidence-based practice |
| d. | Process measurement |
ANS: C
Evidence-based practices (EBP) guide nurses and other health care providers in making effective, timely, and appropriate clinical decisions. Nurses and other health care providers can no longer accept and practice the status quo. Greater attention must be given to why certain health care approaches are used, which ones work, and which ones do not. Hypotheses are predictions made about the relationship among study variables (e.g., characteristics or traits that vary among subjects). An example of a research question is: Does the use of chlorhexidine 2% compared with povidone-iodine reduce CLABSI in patients with CVCs? Within that question the author is studying the variables (independent) of chlorhexidine and povidone-iodine solutions as they affect the outcome (dependent variable) of CLABSI in patients. Peer review is the practice of nurses evaluating nurses. A peer-reviewed article is one submitted for publication and reviewed by a panel of experts familiar with the topic or subject matter of the article. When you implement a practice change, you sometimes want to monitor whether or not the process or protocol was implemented. This requires a process measurement. The nurse has not implemented kangaroo care (only reviewed literature), so there is no need for a process measurement.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 89-90 OBJ: Discuss ways to apply evidence in nursing practice.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A registered nurse wants to review the latest information regarding prevention of a health care acquired infection. Where is the best place for the nurse to obtain this information?
| a. | Online information |
| b. | Peer-reviewed nursing journal |
| c. | Latest edition of a nursing textbook |
| d. | Most recent edition of a popular magazine |
ANS: C
The best scientific evidence comes from well-designed, systematically conducted research studies, usually found in peer-reviewed scientific journals. A good textbook incorporates current evidence into the practice guidelines and procedures it describes. However, a textbook relies on the scientific literature, and sometimes information on a particular topic is outdated by the time a book is published. Peer-reviewed material is better than online information or recent popular magazines.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 91 OBJ: Discuss the levels of evidence in the literature.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A 15-year-old patient was admitted to the hospital with a bowel obstruction. The patient underwent surgery and was experiencing postoperative pain. The nurse caring for the patient had recently read a research article in which a study had been done with neonatal (infant) patients and the use of therapeutic touch to assist with pain control. Which factor is most important for the nurse to consider in this case when applying research to clinical practice?
| a. | The patient’s gender |
| b. | The patient’s preference |
| c. | The patient’s allergies |
| d. | The patient’s roommate |
ANS: B
Using clinical expertise and considering patients’ values and preferences ensures that a nurse will apply the available evidence to practice both safely and appropriately. Even when you use the best evidence available, application and outcomes differ based on your patients’ values, state of health, preferences, concerns, and/or expectations. Patient’s allergies, gender, and roommate are not important in this scenario as it does not affect therapeutic touch.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 91
OBJ: Explain how critiquing the scientific literature leads to best evidence for practice changes. TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
- A nurse is using evidence-based practice (EBP) to provide care. Which action should the nurse take first?
| a. | Collect the most relevant and best evidence. |
| b. | Integrate evidence with one’s clinical expertise. |
| c. | Critically appraise the evidence gathered. |
| d. | Ask a clinical question. |
ANS: D
EBP is a systematic approach to determine the most current and relevant evidence on which to base patient care decisions. Melnyk and Fineout-Overholt recommend a six-step process for EBP: (1) Ask a clinical question; (2) Collect the most relevant and best evidence; (3) Critically review and evaluate/appraise the evidence gathered; (4) Combine/Integrate evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change; (5) Evaluate the practice decision or change; (6) Communicate results of the change. Collecting the best evidence is step 2. Integrating evidence is step 4. Critically appraising the evidence is step 3.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 91 OBJ: Describe the steps of evidence-based practice.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- The nurse manager of a 30-bed medical surgical unit has noticed that the fall rate of postoperative patients has increased in the past 2 months. The nurse manager wants to address this situation using evidence-based practice. Which type of trigger did the nurse manager use?
| a. | Literature-focused trigger |
| b. | Problem-focused trigger |
| c. | Knowledge-focused trigger |
| d. | Expectations-focused trigger |
ANS: B
A problem-focused trigger is one you face while caring for patients or a trend you see on a nursing unit. A knowledge-focused trigger is a question that arises as a result of new information available on a topic, such as current information in literature. Titler et al. (2001) suggest using problem- and knowledge-focused triggers to think critically about clinical and operational nursing-unit issues. It does not include literature or an expectations trigger.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 91-92 OBJ: Describe the steps of evidence-based practice.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A registered nurse who works for a surgical intensive care unit (ICU) has recently read several articles in professional nursing journals about the use of quiet time in the ICU to enhance patient outcomes. The nurse would like to apply the research findings to the unit. How did the nurse formulate the clinical question?
| a. | Measurement-focused trigger |
| b. | Problem-focused trigger |
| c. | Knowledge-focused trigger |
| d. | Expectations-focused trigger |
ANS: C
A knowledge-focused trigger is a question that arises as a result of new information available on the topic. For example, “What is the current evidence for the best way to educate patients with low health literacy?” A problem-focused trigger is one you face while caring for patients or a trend you see on a nursing unit. Titler et al. (2001) suggest using problem- and knowledge-focused triggers to think critically about clinical and operational nursing-unit issues. It does not include measurement or expectation focuses.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 91-92 OBJ: Describe the steps of evidence-based practice.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A nurse’s manager has suggested that a nurse formulate a PICO question to clarify the topic before doing a literature review. When the nurse asks what the acronym PICO stands for, how should the nurse manager respond?
| a. | Policy, information, comparison, outcome |
| b. | Patient, information, collection, outcome |
| c. | Patient, intervention, comparison, outcome |
| d. | Policy, intervention, communication, outcome |
ANS: C
P: Patient population of interest. Identify patients by age, gender, ethnicity, disease, or health problem.
I: Intervention of interest. Which intervention do you want to use in practice (e.g., a treatment, diagnostic test, educational approach)?
C: Comparison of interest. What is the usual standard of care or current intervention that you now use in practice?
O: Outcome. What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, patient perception)?
Policy, information, comparison, collection, and communication are not included in PICO.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 92 OBJ: Develop a PICO or PICOT question.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- A nurse working on a PICO question has found a large amount of literature available on the topic with multiple studies that have been published. Which type of study should have the best evidence?
| a. | Meta-analysis of randomized control trials |
| b. | Opinion of an expert committee |
| c. | One well-designed randomized control trial |
| d. | Systematic review of descriptive and qualitative studies |
ANS: A
Systematic reviews or meta-analyses are state-of-the-science summaries from an individual researcher or panel of experts and are on the highest level of the hierarchy. These research summaries are the perfect answers to PICO(T) questions because the researchers have rigorously summarized all current evidence on the question. A single RCT is not as conclusive as a review of several RCTs on the same question. Opinion of an expert committee is on the lowest level of the hierarchy of evidence. Systematic review is above opinions but is below meta-analysis on the hierarchy of evidence.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 93-94 OBJ: Discuss the levels of evidence in the literature.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A registered nurse is concerned about the patients’ perceptions and feelings about the quality of life that they experience after a diagnosis of liver cancer. Which is the most appropriate type of research study the nurse should use to gather information about this situation?
| a. | Quantitative study |
| b. | Randomized trial |
| c. | Qualitative study |
| d. | Case controlled study |
ANS: C
Qualitative research offers analysis of interviews, observations, and/or surveys to measure people’s perceptions, feelings, or views of phenomena about which little is known. Randomized trial has participants divided into groups to test for the same outcome to determine if there is a difference in the effect of a treatment or intervention compared with a standard of care. A case control study compares patients who have a disease or outcome of interest with patients who do not have the disease or outcome. The researcher looks back to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and disease. If quantitative data such as physical measurements and scores on surveys are collected, statistical results from the study are explained. Quantitative data do not focus on perceptions and feelings.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 94
OBJ: Explain how critiquing the scientific literature leads to best evidence for practice changes. TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
- A nurse works for a facility in which the facility sends information to The National Data Base for Nursing Quality Improvement (NDNQI) regarding patient falls, pressure ulcer incidence, and nursing satisfaction. The nurse works at which facility?
| a. | The Joint Commission |
| b. | A magnet-designated hospital |
| c. | The Centers for Disease Control and Prevention |
| d. | The American Association of Critical Care Nurses |
ANS: B
All magnet-designated hospitals maintain the National Database of Nursing Quality Improvement (NDNQI). The database includes information from Magnet hospitals on falls, pressure ulcer incidence, and nurse satisfaction. The Joint Commission produces patient safety goals. The Centers for Disease Control and Prevention help produce guidelines for clinical practice. American Association of Critical Care Nurses provides standards and practice guidelines for critical care nurses.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 92
OBJ: Explain the relationship among nursing research, evidence-based practice, and quality improvement. TOP: Nursing Process: Evaluation
MSC: NCLEX: Management of Care
- A student nurse is looking for research articles that can be used to complete a research paper. Where can the nursing student look to quickly find out if an article is research or clinically based?
| a. | p value |
| b. | Abstract |
| c. | Analysis |
| d. | Literature review |
ANS: B
An abstract is a brief summary of the article that quickly shows whether the article is research or clinically based. An abstract summarizes the purpose of the study or clinical review, the major themes or findings, and the implications for nursing practice. A good author offers a detailed background of previous studies and the level of evidence or clinical information that exists about the topic of the article, which is called the literature review. Analysis is the section that explains how the data collected in a study are analyzed. The p value (usually set at 0.05) is a probability level that tells you whether the difference between two groups was likely related to the intervention or if it was simply a difference by chance.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 95
OBJ: Explain how critiquing the scientific literature leads to best evidence for practice changes. TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
- A nurse working in an acute care setting wanted to determine the most accurate way to take patients temperatures. The nurse noticed that the tympanic thermometers used by the unit were often not accurate. The nurse found that the literature showed tympanic thermometers were not the most accurate method of obtaining a temperature. The nurse wants to change the nursing practice of the unit. What is the nurse’s most logical next step?
| a. | Discuss the findings with a patient to gain support. |
| b. | Tell the aides to stop taking temperatures. |
| c. | Share the findings with the nursing policy and procedure committee. |
| d. | Write an editorial in the public newspaper to bring the community into the process. |
ANS: C
A key feature of a practice environment that supports the use of best evidence is requiring clinical practice policies and procedures to be evidence based. Many organizations involve staff nurses and research-prepared advanced practice nurses in reviewing scientific articles relevant to policies and procedures and then making appropriate revisions. Policies and procedures are important tools for supporting hospital-based nurses in using evidence in their everyday practice and promoting positive patient outcomes. Discussing results with the patient will not get the procedure changed. Telling the aides to stop taking the temperatures is dangerous. Writing an editorial in the public newspaper is inappropriate to effect change on the unit. First follow policies and procedures of the agency in which one works.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 97 OBJ: Identify ways to sustain knowledge in evidence-based practice.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- After a practice change has taken place in an organization because of a nurse following evidence-based practice in a task force, which final step should the nurse take?
| a. | Evaluate |
| b. | Encourage |
| c. | Engage |
| d. | Execute |
ANS: A
After applying evidence in practice, the next step is to evaluate the effect. Newhouse and White (2011) recommend that to be successful in changing practice within an organization, it is essential to Engage, Educate, Execute, and Evaluate. Engage and execute have already occurred because the change has taken place. Encourage is not a step in the evidence-based process.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 96-97 OBJ: Identify ways to sustain knowledge in evidence-based practice.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- The nursing unit staff has used evidence-based practice to implement a practice change. What is the next step in the process the nursing staff should implement?
| a. | Review literature. |
| b. | Engage companies. |
| c. | Measure outcomes. |
| d. | Ask a clinical question. |
ANS: C
After implementing the change, the practice decision or change should be evaluated by using outcome or process measurements. Remember the “O” in your PICO(T) question. It represents the outcomes you choose to measure as you integrate the evidence. These outcomes tell you how well the evidence-based intervention works. Reviewing literature and asking a clinical question occurred before the change. Companies are not a part of this process.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 91 | 97 OBJ: Describe the steps of evidence-based practice.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- At a health care organization, patients are turned every 2 hours to help prevent pressure ulcers. Because of this nursing intervention, patients exhibit far fewer pressure ulcers than the national average. Which term should the nurse use to describe this finding?
| a. | Sentinel event |
| b. | Qualitative research |
| c. | Manuscript narrative |
| d. | Nursing-sensitive outcome |
ANS: D
A nursing-sensitive outcome focuses on how patients and their health care problems are affected by nursing interventions (ONS, 2012). Nursing-sensitive outcomes look at the effects of interventions within the scope of nursing practice. Sometimes a problem is presented to a committee in the form of a sentinel event, an unexpected occurrence involving death or serious physical or psychological injury of a patient. Qualitative research is analysis of interviews, observations, and/or surveys to measure people’s perceptions, feelings, or views of phenomena about which little is known. Manuscript narrative is the “middle section” or narrative of a manuscript that differs according to the type of evidence-based article it is.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 98
OBJ: Discuss ways to measure outcomes for an evidence-based practice change.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- The quality improvement or performance improvement (QI/PI) process should begin at which level of nursing?
| a. | Staff nurse |
| b. | Nurse manager |
| c. | Nurse administrator |
| d. | Advanced practice registered nurse |
ANS: A
The QI/PI process begins at the staff level, where all disciplines become involved in identifying quality problems. Although all those listed can do QI/PI, the process begins at the staff level.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 100
OBJ: Explain the relationship among nursing research, evidence-based practice, and quality improvement. TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
MULTIPLE RESPONSE
- The nurse is investigating an area of practice in which no research evidence is available. What types of non-research information should the nurse consider? (Select all that apply.)
| a. | Performance improvement and risk management data |
| b. | International, national and local standards of care |
| c. | Study with pre- and post-test design |
| d. | Benchmarking |
| e. | Retrospective or concurrent chart reviews |
ANS: A, B, D, E
Other sources of information from non-research evidence include: performance improvement and risk management data, international, national and local standards of care, infection control data, benchmarking, clinicians’ expertise, and retrospective or concurrent chart reviews. Study with a pre- and post-test design is a research study. The question asked for non-research information.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 91 OBJ: Discuss the levels of evidence in the literature.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- A nurse is describing types of performance improvement models. Which information should the nurse include? (Select all that apply.)
| a. | Six Sigma |
| b. | Balanced scorecard |
| c. | Plan-Do-Study-Act |
| d. | Root cause analysis |
| e. | Human subjects committee |
ANS: A, B, C, D
Performance improvement models include Six Sigma, balanced scorecard, Plan-Do-Study-Act, and root cause analysis. Research studies must be approved by an institutional review board (IRB), also called a human subjects committee, which is not involved with performance improvement models but with research.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 101
OBJ: Discuss the relationship between evidence-based practice and the improvement of the safety and quality of nursing practice. TOP: Nursing Process: Implementation
MSC: NCLEX: Management of Care
Chapter 11: Communication
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
- A nurse who works for an oncology unit is preparing to bathe a patient who recently underwent surgery to remove an abdominal tumor. Before beginning the bath, the nurse explains the procedure. Which of the following best describes the nurse’s communication role?
| a. | Channel |
| b. | Receiver |
| c. | Message |
| d. | Sender |
ANS: D
The nurse is the sender in this scenario. The sender is the person who delivers the message. The roles of sender and receiver change back and forth as two persons interact. The message is sent to a receiver, in this case the patient. The message is the content of the conversation; in this scenario explaining what will happen is the message. The channel is the means of conveying and receiving messages through visual, auditory, and tactile senses, the nurse’s spoken words in this scenario.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 185 OBJ: Describe the elements of the communication process.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
- A patient is being cared for by a nurse. The patient has questions regarding what time the surgery is scheduled. When the nurse responds to the question, the nurse is assuming which communication role?
| a. | Channel |
| b. | Receiver |
| c. | Message |
| d. | Sender |
ANS: D
The nurse is the sender in this scenario because the nurse responds by speaking and sending a message, rather than just receiving the message. The sender is the person who delivers the message. The roles of sender and receiver change back and forth as two persons interact. The message is sent to a receiver, in this case the patient. The message is the content of the conversation; in this scenario the time of the surgery is the message. The channel is the means of conveying and receiving messages through visual, auditory, and tactile senses, the nurse’s spoken words in this scenario.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 185 OBJ: Describe the elements of the communication process.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
- A registered nurse is a new nurse manager who needs to council an employee regarding attendance. Because the nurse manager is new to the position, the nurse is rehearsing what is planning to say to the employee before the meeting. The nurse is using which form of communication?
| a. | Interpersonal |
| b. | Intrapersonal |
| c. | Public |
| d. | Private |
ANS: B
Intrapersonal communication, also called self-talk, is a powerful form of communication that occurs within an individual. People “talk to themselves” by forming thoughts internally that strongly influence perceptions, feelings, behavior, self-concept, and performance. Self-talk is a mental rehearsal for difficult tasks or situations so that individuals deal with them more effectively. Interpersonal communication is interaction that occurs between two people or within a small group. When the nurse actually talks to the employee, it is called interpersonal communication. Public communication is the interaction of one individual with large groups of people. Private is not a level of communication.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 186
OBJ: Describe the levels of communication and their uses in nursing.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- A nurse is working in a busy emergency department of an urban hospital. The family of a patient brought in by ambulance asks the nurse what the doctor meant when he or she said that the patient was coding. In this situation, the word coding is an example of which of the following?
| a. | Denotative meaning |
| b. | Connotative meaning |
| c. | Intonation |
| d. | Pacing |
ANS: A
Coding in this instance is a denotative meaning. A single word sometimes has several meanings. Individuals who use a common language share the denotative meaning of a word. The word baseball has the same meaning for all individuals who speak English, but the word code denotes cardiac arrest primarily to health care providers. The connotative meaning is the shade or interpretation of the meaning of a word, which is influenced by the thoughts, feelings, or ideas that people have about the word. Tone of voice and volume dramatically affect the meaning of a message, and emotions directly influence tone of voice, which is intonation. Pacing can involve talking rapidly, using awkward pauses, or speaking extremely slowly and deliberately, conveying different meanings.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 186
OBJ: Describe the levels of communication and their uses in nursing.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- A patient asked a nurse when the primary health care provider would make rounds. The nurse was taking another patient for a stat test and replied very quickly, “I have no idea.” The patient most likely interpreted the nurse as uncaring because of which factor?
| a. | Vocabulary |
| b. | Pacing |
| c. | Timing |
| d. | Personal appearance |
ANS: B
Because the nurse replied very quickly it is pacing. Talking rapidly, using awkward pauses, or speaking extremely slowly and deliberately conveys an unintended message. Vocabulary is the sender’s words and phrases. “I have no idea” is vocabulary that is understandable. Timing is critical in communication. The nurse used timing appropriately by answering the patient’s question. Personal appearance is not an issue in this scenario.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 186 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
- A 9-year-old patient who is hospitalized for bowel surgery appears very frightened. To appear less threatening to the child, which action should the nurse take?
| a. | Stand over the bed when talking to the patient. |
| b. | Sit in a chair next to the bed when talking to the patient. |
| c. | Maintain constant eye contact with the patient at all times. |
| d. | Stay within 12 inches of the patient when talking to the patient. |
ANS: B
The nurse should sit in a chair next to the bed. A nurse appears less dominant and less threatening when interacting at the patient’s eye level. Looking down on a person (standing by the bed) establishes authority, but interacting at the same eye level indicates equality in the relationship. Constant eye contact can be intrusive or threatening to some people. Twelve inches is within the intimate zone and can be threatening.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 188 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A nurse went into a patient’s room at 0900, shortly after the patient was told that he or she had liver cancer. The patient asked the nurse to stay because he or she did not want to be alone. The nurse stood very close to the patient, held the patient’s hand, and told the patient that he or she had plenty of time. A few minutes later, the nurse thought to check the time on the wristwatch because the nurse was supposed to take another patient for a test at 0945. The patient saw the nurse look at the wrist watch and told the nurse it was now okay to be alone. What was the most likely reason the patient said it was okay for the nurse to leave?
| a. | Invasion of personal space |
| b. | Verbal communication |
| c. | Nurse’s gesture |
| d. | Intonation |
ANS: C
The nurse’s gesture of looking at the wrist watch most likely caused the request. Gestures alone carry specific meanings, or they may create messages with other communication cues. There was no invasion of personal space because the patient allowed the nurse to sit very close and hold hands. There was no inappropriate verbal communication (words or phrases), nor was there any inappropriate intonation (tone of voice).
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 188 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- A registered nurse is caring for a postoperative patient who is experiencing respiratory distress after the administration of pain medication. The nurse called the patient’s primary health care provider immediately. The information regarding the patient was conveyed using the SBAR format. Which information did the nurse convey to the primary health care provider?
| a. | Situation, background, assessment, recommendation |
| b. | STAT, background, assessment, requirement |
| c. | Status, background, analysis, recommendation |
| d. | Setting, belief, assessment, requirement |
ANS: A
SBAR stands for situation, background, assessment, and recommendation. Use of common language when communicating critical information helps prevent misunderstandings. SBAR has become a best practice for standardizing communication between health care providers. SBAR does not contain STAT, status, setting, analysis, belief, or requirement.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 190 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- Which behavior by the nurse would be considered most professional?
| a. | Addressing a patient by “dear” |
| b. | Wearing small earrings |
| c. | Being task oriented |
| d. | Avoiding troublesome patients |
ANS: B
Wearing small earrings is the most professional. The patient’s acceptance of a nurse as a professional often depends on the manner in which he or she presents a professional and caring image. Verbal and nonverbal behaviors influence the helping relationship. Professional appearance, demeanor, and behavior are important in establishing trustworthiness and competence. Calling a patient “honey,” “dear,” “grandpa,” or “sweetheart” rather than by a personal name is inappropriate. Being task oriented, or making a technical procedure (e.g., administration of a medicine) your priority, is another way of not being emotionally available. Do not avoid patients whose behavior is troublesome.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 192
OBJ: Identify features and expected outcomes of the nurse-patient relationship.
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
- When caring for a patient from another culture, what is the best strategy for the nurse to use in communicating with the patient?
| a. | Using a cultural joke to break the ice |
| b. | Stereotyping the patient within his or her culture |
| c. | Considering the context of the patient’s background |
| d. | Assuming the patient or the family member speaks English |
ANS: C
When a patient is from another culture, the nurse should consider the context of the patient’s background. Accept patients’ rights to adhere to cultural customs and norms. Persons of different cultures use different types of verbal and nonverbal cues to convey meaning. A nurse should make a conscious effort not to interpret messages through his or her own cultural perspective; instead, a nurse considers the context of the other individual’s background. Avoid stereotyping persons from other cultures or making jokes about them. With patients from another culture, the nurse cannot assume the patient or family members can speak English.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 194
OBJ: Explain the focus of communication within each phase of the nursing process.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A patient had a stroke that left the patient aphasic. A nurse is working on a plan of care. Which nursing diagnosis should the nurse use to describe the patient’s aphasia?
| a. | Impaired Verbal Communication |
| b. | Anxiety |
| c. | Impaired Social Interaction |
| d. | Ineffective Coping |
ANS: A
Impaired Verbal Communication is the nursing diagnostic label to describe a patient who has limited or no ability to communicate verbally. This diagnosis is useful for a wide variety of patients with special problems and needs related to communication. It is defined as difficulty or inability to use or understand language in interpersonal reactions. Anxiety is not the same thing as aphasia. Although impaired social interactions could be used, based upon the question (diagnosis for patient’s aphasia), impaired verbal communication is most appropriate. There are no data in the scenario to say the patient is not interacting with others. There are no data to support ineffective coping; it just says the patient is aphasic but no data address coping.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 195
OBJ: Explain the focus of communication within each phase of the nursing process.
TOP: Nursing Process: Diagnosis MSC: NCLEX: Management of Care
- A patient is aphasic from a recent stroke. The nurse is taking a multidisciplinary approach to this patient’s care. Who would be most appropriate for the nurse to collaborate with regarding the patient’s aphasia?
| a. | Interpreter |
| b. | Speech therapist |
| c. | Physical therapist |
| d. | Mental health nurse specialist |
ANS: B
Speech therapists help patients with aphasia. The nurse should collaborate with other health care providers who have expertise in communication strategies. Interpreters are invaluable when a patient speaks a foreign language. Mental health advanced practice nurses help in communicating with angry or highly anxious patients. Physical therapist would help with mobility issues.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 195
OBJ: Explain the focus of communication within each phase of the nursing process.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A nurse is spending time with a patient, who has recently been diagnosed with breast cancer. The patient states that he or she is frightened about the diagnosis and feels overwhelmed. The nurse responds, “It sounds to me like you are feeling very scared right now.” Which communication technique did the nurse use?
| a. | Sympathy |
| b. | Empathy |
| c. | Focusing |
| d. | Self-disclosure |
ANS: B
Empathy is the ability to understand and accept another person’s perspective. Although no one can ever totally know another’s experiences, a nurse can try to understand what the person is experiencing. Focusing directs conversation to a specific topic or issue when a discussion becomes unclear. Self-disclosures are personal statements intentionally revealed to the other person. Sympathy is the concern, sorrow, or pity that you feel for a patient when you personally identify with his or her needs. Unlike empathy, which tries to understand a patient’s experience, sympathy takes a subjective look at the patient’s world (“Oh, I know just what you mean. I hate feeling that way.”).
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 195 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A patient has just been admitted to the hospital with a broken hip from a fall in the home. The nurse admitting the patient is practicing active listening. Which behavior best conveys to the patient that the nurse is using active listening?
| a. | Keeping arms crossed |
| b. | Sitting facing the patient |
| c. | Standing facing the patient |
| d. | Leaning away from the patient |
ANS: B
The best behavior is sitting facing the patient. Active listening enhances trust because the nurse communicates acceptance and respect for the patient. Several nonverbal skills facilitate attentive listening, which are identified by the acronym SOLER:
Sit facing the patient.
Observe an open posture.
Lean toward the patient.
Establish and maintain eye contact.
Relax.
Keeping arms crossed is a closed posture. Leaning toward, not away, from the patient is active listening. Sitting, not standing, is best.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 196 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A nurse is caring for a patient who is having abdominal pain and is experiencing difficulty sleeping. The nurse sits at the bedside of the patient and takes the patient’s hand. The patient quickly pulls back. How should the nurse interpret this patient’s behavior?
| a. | The patient is uncomfortable with being touched. |
| b. | The patient is unable to express feelings. |
| c. | The patient has impaired social skills with others. |
| d. | The patient has difficulty with nonverbal communication. |
ANS: A
Nurses need to remain sensitive to his or her responses as well as the patient’s feelings. If a patient refuses to hold a nurse’s hand while in pain or pulls away from physical contact, this signals that the patient is uncomfortable with being touched by the nurse. It does not imply impaired social skills, inability to express feelings, or difficulty with nonverbal communication.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 199 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
- A nurse is assisting in the admission of a patient to the orthopedic unit of the hospital and is obtaining information for the database. Which technique is the best way for the nurse to obtain information from the patient?
| a. | Ask personal questions so as to show interest. |
| b. | Use medical vocabulary to appear competent. |
| c. | Ask why the patient waited so long to get treatment. |
| d. | Use silence while the patient collects his or her thoughts. |
ANS: D
Most people have a natural tendency to fill empty spaces with words, but sometimes silence is useful when they face decisions that require much thought. Nontherapeutic techniques discourage further expression of feelings and ideas and engender negative responses or behaviors in others. Asking irrelevant personal questions simply to satisfy your curiosity is inappropriate and invasive and nontherapeutic. Limit questions to health-related information. Health care professionals have their own culture and language. Using technical words in discussions with patients can cause confusion and anxiety. Avoid excessive use of such terms or translate them into lay terms. Sometimes asking “why” implies an accusation and results in resentment, insecurity, and mistrust.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 196 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A nurse gives a hand-off report to the oncoming staff nurse. Which type of communication does this illustrate?
| a. | Gossip |
| b. | Validation |
| c. | Interpersonal |
| d. | Intrapersonal |
ANS: C
Interpersonal communication is interaction that occurs between two people or within a small group. Gossiping violates confidentiality. The act of validation requires comparing data with another source. Intrapersonal communication occurs within the individual, consisting of self-talk, self-verbalization, or inner thoughts.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 186
OBJ: Describe the levels of communication and their uses in nursing.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
- A nurse is caring for a patient who is visually impaired. Which technique should the nurse use to facilitate communication?
| a. | Touch the patient before speaking. |
| b. | Identify self when entering the room. |
| c. | Quietly leave the room when finished. |
| d. | Keep the room dimly lit for calmness. |
ANS: B
For a visually impaired patient, identify yourself when entering the room. The nurse should communicate verbally before touching the patient who is visually impaired. Notify the patient when leaving the room; do not quietly leave the room when finished as the patient will think you are still in the room. Ensure that lighting is adequate for the patient to see the speaker; do not keep it dimly lit.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 200
OBJ: Explain techniques used to assist patients with special communication needs.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A nurse is caring for a patient who cannot speak clearly. Which technique should the nurse use to enhance conversation with this patient?
| a. | Speak loudly. |
| b. | Finish the patient’s sentences. |
| c. | Ask question that require “yes” or “no” answers. |
| d. | Avoid communication aids to prevent embarrassment. |
ANS: C
For patients who are mute, unable to speak, or cannot speak clearly, ask simple questions that require “yes” or “no” answers. Use normal volume and do not shout or speak too loudly. Do not finish the patient’s sentences. Use communication aids as needed; do not avoid them.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 200
OBJ: Explain techniques used to assist patients with special communication needs.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A nurse forms a contract with the patient to specify roles during a therapeutic helping relationship. The nurse is in which phase of the therapeutic relationship?
| a. | Working |
| b. | Termination |
| c. | Pre-interaction |
| d. | Orientation |
ANS: D
During the orientation phase when you and the patient meet and get to know one another is the time when the contract is formed. During the working phase the nurse and patient work together to solve problems and accomplish goals. During the termination phase the helping relationship is ended. In the pre-interaction stage the nurse gathers information from various sources about the patient.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 190
OBJ: Describe a nurse’s focus within each phase of a therapeutic nurse-patient relationship. TOP: Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity
- A nurse enters a patient’s room and sees the patient grimacing with each movement. When the nurse asks in a normal tone of voice how the patient is feeling, the patient states that he or she “feels fine.” Which finding will the nurse classify as nonverbal communication?
| a. | The nurse’s tone of voice is normal. |
| b. | The patient states that he or she “feels fine.” |
| c. | The nurse asks how the patient is feeling. |
| d. | The patient grimaces with each movement. |
ANS: D
The patient grimacing with each movement is nonverbal communication. Nonverbal communication includes messages sent through the language of the body, without the use of words. Nonverbal forms of communication include use of facial expressions, eyes, gestures, posture, and physical appearance. Nonverbal communication often reveals physical feelings. Tone of voice, asking questions, and saying that he or she feels fine are examples of verbal communication. Verbal communication involves the use of words or phrases and includes intonation, pacing, denotative and connotative meanings, volume, clarity, brevity, timing and relevance.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 187 OBJ: Differentiate aspects of verbal and nonverbal communication.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- While a patent is being interviewed by the nurse, a family member states, “What my father really means is that he doesn’t know for sure what the physician meant about the medical diagnosis.” Which communication technique did the family member use?
| a. | Focusing |
| b. | Clarifying |
| c. | Summarizing |
| d. | Sharing observations |
ANS: B
The family member’s statement is clarifying. Clarifying validates whether the person interpreted the message correctly. Focusing directs conversation to a specific topic or issues when a discussion becomes unclear. Summarizing provides a concise review of main ideas. Sharing observations is commenting on a patient’s appearance and how he or she sounds and acts such as, “I see you didn’t eat any breakfast.”
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 196 OBJ: Describe behaviors and techniques that affect communication.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
- Which technique should the nurse use when providing information to a patient with a health literacy level of fifth grade?
| a. | Use the passive voice of language. |
| b. | Present the most important information first. |
| c. | Shift from subject to subject until the patient responds. |
| d. | Explain using jargon so the patient will understand others on the health care team. |
ANS: B
To promote understanding in a patient with a health literacy level of fifth grade is to present the most important information first. Use the active voice instead of passive. Break complex information into understandable chunks; do not shift from subject to subject. Use simple language, avoid medical jargon.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 189
OBJ: Discuss the principles of plain language for promoting health literacy.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
- Which technique by the nurse will facilitate communication with an older adult?
| a. | Have the TV play lightly in the background. |
| b. | Ask several questions in a row. |
| c. | Allow reminiscing. |
| d. | Use long sentences. |
ANS: C
Allow older adults the opportunity to reminisce. Reminiscing has therapeutic properties that increase the sense of well-being. During conversation maintain a quiet environment that is free from background noise (turn off the TV). Allow time for conversation; do not ask several questions in a row. Avoid long sentences to explain the subject. Try to keep it short, simple, and to the point.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 201
OBJ: Discuss effective communication for patients of varying developmental levels.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
- A nurse has just admitted a 5-year-old child for suspected appendicitis. Which therapeutic communication techniques should the nurse use while communicating with this child? (Select all that apply.)
| a. | Avoid sudden movements or gestures. |
| b. | Use simple, direct language. |
| c. | Sit at the child’s eye level. |
| d. | Tell the child exactly what can do. |
| e. | Use drawing or toys as needed. |
ANS: A, B, C, E
Sudden movements or gestures can be frightening so they need to be avoided. When giving explanations or directions, use simple, direct language and be honest. Meet a child at eye level. Drawing and playing with young children allows them to communicate nonverbally (making the drawing) and verbally (explaining the picture). Telling the child exactly what can do is inappropriate. Remain calm and gentle and, if possible, let a child make the first move.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 201
OBJ: Discuss effective communication for patients of varying developmental levels.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
Chapter 21: Spiritual Health
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
- An elderly patient is dying, and begins talking to loved ones who have died before him. The nurse feels a sense of inner peace as his patient quietly dies. What is the best term for this feeling of peace?
| a. | Self-transcendence |
| b. | Intrapersonal connectedness |
| c. | Interpersonal connectedness |
| d. | Transpersonal connectedness |
ANS: A
Self-transcendence refers to connecting to your inner self, which allows you to go beyond yourself to understand the meanings of experiences, whereas transcendence is the belief that there is a positive force outside of and greater than oneself that allows you to develop new perspectives that are beyond physical boundaries. Examples of transcendent moments include the feelings of awe when holding a new baby or watching the sun rise over the mountains. Spirituality offers a sense of connectedness intrapersonally (connected with oneself), interpersonally (connected with others and the environment), and transpersonally (connected with God, the unseen, or a higher power).
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 548
OBJ: Describe the relationship among faith, hope, and spiritual well-being.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- The nurse is caring for a patient who states that he does not believe in the existence of God. The nurse realizes that this person:
| a. | is not a spiritual person. |
| b. | is an agnostic. |
| c. | believes that people bring meaning into the world. |
| d. | finds meaning in life through work and relationships. |
ANS: D
Atheists search for meaning in life through their work and relationships with others. Spirituality exists in all people regardless of their religious beliefs and it gives people the energy needed to maintain health and cope with difficult situations. Spirituality is an important concept for individuals who either do not believe in the existence of God (atheist) or who believe that any ultimate reality is unknown or unknowable (agnostic). It is important for agnostics to discover meaning in what they do or how they live because they find no ultimate meaning for the way things are. They believe that we, as people, bring meaning to what we do.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: 549
OBJ: Describe the relationship among faith, hope, and spiritual well-being.
TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity
- A nurse is caring for a patient with a debilitating chronic illness. The patient mentions several times that faith would guide her healing. The nurse knows that faith can best be defined as a:
| a. | system of organized beliefs and worship. |
| b. | relationship with a higher power, authority, or spirit. |
| c. | source of energy needed to cope with difficult situations. |
| d. | multidimensional concept that gives comfort while a person endures hardship. |
ANS: B
Faith is a relationship with a divinity, higher power, authority, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action). Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. Spirituality exists in all people regardless of their religious beliefs and it gives people the energy needed to maintain health and cope with difficult situations. Hope is multidimensional and gives comfort while a person endures hardship and personal challenges.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 549
OBJ: Describe the relationship among faith, hope, and spiritual well-being.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- A patient has been diagnosed with a terminal disease. Hope may be used effectively with this type of patient. Nurses can support a patient’s use of hope because hope provides a:
| a. | system of organized beliefs and worship. |
| b. | belief in a higher power, spirit guide, God, or Allah. |
| c. | cultural connectedness, structure, and guidance in difficult times. |
| d. | motivation to achieve and the resources to use toward that achievement. |
ANS: D
Hope is energizing, giving individuals a motivation to achieve and the resources to use toward that achievement. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. Faith involves a belief in a higher power, spirit guide, God, or Allah. Spirituality offers a sense of connectedness. Spirituality is unique for each person. It is a unifying theme in life and a state of being.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 550
OBJ: Describe the relationship among faith, hope, and spiritual well-being.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- When caring for patients, a nurse must understand the difference between religion and spirituality. Religious care helps patients maintain their faithfulness to:
| a. | their belief systems and worship practices. |
| b. | a relationship to a higher being or life force. |
| c. | a sense of connectedness. |
| d. | the awareness of one’s inner self. |
ANS: A
Religious care helps patients follow their belief systems and worship practices. Spirituality is an awareness of one’s inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself. Spirituality offers a sense of connectedness. Spirituality is unique for each person. It is a unifying theme in life and a state of being.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 550 OBJ: Compare and contrast the concepts of religion and spirituality.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- A patient who has been diagnosed with terminal liver cancer states that he does not believe in God, but he has had a meaningful life by contributing to the lives of those around him. This person is most likely which of the following?
| a. | Buddhist |
| b. | Christian |
| c. | Agnostic |
| d. | Atheist |
ANS: D
Atheists search for meaning in life through their work and relationships with others. It is important for agnostics to discover meaning in what they do or how they live because they find no ultimate meaning for the way things are. They believe that we, as people, bring meaning to what we do. A Buddhist turns inward, valuing self-control, whereas a Christian looks to the love of God to provide enlightenment and direction in life.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 549 OBJ: Compare and contrast the concepts of religion and spirituality.
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
- A nurse is caring for a 64-year-old patient who has survived cardiopulmonary resuscitation after a triple coronary artery bypass graft surgery. To help this patient cope with this experience, what is the best thing for the nurse to do?
| a. | Recommend that the patient not discuss the experience with family. |
| b. | Assume that the near death experience was a positive experience. |
| c. | Explain that people who have not had that experience will not understand. |
| d. | Explore what happened with the patient. |
ANS: D
After patients have survived a near death experience (NDE), promote spiritual well-being by remaining open, giving patients a chance to explore what happened, and supporting patients as they share the experience with significant others. Patients who have an NDE are often reluctant to discuss it, thinking family or caregivers will not understand. Isolation and depression often occur. Furthermore, not all NDEs are positive experiences. However, individuals experiencing an NDE who discuss it openly with family or caregivers find acceptance and meaning from this powerful experience.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 552
OBJ: Discuss the relationship of spirituality to an individual’s total being.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A nurse who works in a neonatal intensive care unit is caring for a critically ill infant with a poor prognosis. She is Christian and feels responsible to care for both the physical and spiritual needs of the infant and his parents. What is the best statement for the nurse to make to the parents of the infant?
| a. | “You should have the child baptized so that its soul will be saved.” |
| b. | “Would you like me to call the chaplain to christen your child at the bedside?” |
| c. | “What can I do to support your spiritual needs?” |
| d. | “I have asked my pastor to stop by and talk to you.” |
ANS: C
Differentiate your personal spirituality from that of the patient. Your role is not to solve the spiritual problems of patients, but to provide an environment for your patients to express their spirituality. Having the child baptized or asking your pastor to come talk to the patient is applying your spiritual values on the patient. Asking permission to call the chaplain is assuming that the patient has value regarding that religious denomination.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 552
OBJ: Discuss the relationship of spirituality to an individual’s total being.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A patient refuses to remove a specific spiritual garment for daily bathing. The most appropriate action for the nurse would be to:
| a. | remove the article anyway because the garment hinders daily care delivery. |
| b. | respect the patient’s wishes and work around it. |
| c. | explain to the patient that the garment has no real spiritual value. |
| d. | identify the refusal as a sign of spiritual distress. |
ANS: B
To care for and meet the spiritual needs of your patients, it is essential to respect each patient’s personal beliefs. People experience the world and find meaning in life in different ways and the spiritual garment has meaning for the patient. Caring for your patients’ spiritual needs requires you to be compassionate and remove any personal biases or misconceptions. You need to recognize that not all patients have spiritual problems. Patients bring certain spiritual resources that help them assume healthier lives, recover from illness, or face impending death.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 554
OBJ: Discuss the relationship of spirituality to an individual’s total being.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- To assess, evaluate, and support a patient’s spirituality the best action a nurse should take includes:
| a. | recognizing that spirituality does not enhance therapeutic relationships. |
| b. | performing a definitive spiritual assessment once because spirituality does not vary. |
| c. | focusing the assessment on religious doctrine and faith. |
| d. | remembering that spirituality is very subjective. |
ANS: D
Remember that spirituality is very subjective and has different meanings for different people. You are able to gather an accurate assessment of your patients’ spirituality when you take time to build therapeutic relationships with them. Conduct an ongoing spiritual assessment the entire time you care for a patient. Focus your assessment on aspects of spirituality most likely to be influenced by life experiences, events, and questions in the case of illness and hospitalization.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 554 OBJ: Compare and contrast the concepts of religion and spirituality.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
- Interventions a nurse can use to establish presence with a patient include which of the following? (Select all that apply.)
| a. | Giving attention |
| b. | Answering questions |
| c. | Listening |
| d. | Administering medication |
| e. | Speaking with the family |
ANS: A, B, C
Behaviors that establish your presence include giving attention, answering questions, listening, and having a positive and encouraging (but realistic) attitude. Presence is part of the art of nursing that involves “being with” a patient versus “doing for” a patient, as in administering medication and speaking with the family. Presence is being able to offer closeness with the patient, which helps to prevent emotional and environmental isolation.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: 561 OBJ: Establish presence with patients.
TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity
