Critical Care Nursing 8th Edition Urden - TEST BANK

Critical Care Nursing 8th Edition Urden – TEST BANK

 

Instant Download – Complete Test Bank With Answers

 

 

Sample Questions Are Posted Below

 

Chapter 05: Patient and Family Education

Urden: Critical Care Nursing, 8th Edition

 

MULTIPLE CHOICE

 

1. A patient is scheduled for a cardiac catheterization this afternoon. The nurse wants to provide her with some basic information before going in the room to talk about her specific procedure. Which teaching strategy is most appropriate for this situation?

a.	Discussion
b.	Demonstration and practice
c.	Audiovisual media
d.	Written

 

 

ANS:  C

Media are used to educate patients on a variety of educational needs, such as medications, disease processes, procedures, symptom management, weight monitoring, laboratory tests, diet, surgery, and health maintenance issues. Patient education videos require the patient’s attention for only a few minutes and supply the learner with “nice-to-know” and “need-to-know” information. Demonstration and practice is not appropriate for this procedure because the patient is not performing the cardiac catheterization. Discussion and written material will help enhance the learning with the audiovisual media; however, this is not an interactive media.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 67

OBJ:   Nursing Process Step: Intervention   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

2. A nurse has been progressively working with a patient on the exercises he needs to do at home when he is discharged. The nurse wants to ensure he will remember what to do when he is at home. Which teaching strategy is most appropriate for this situation?

a.	Discussion
b.	Demonstration and practice
c.	Audiovisual media
d.	Written

 

 

ANS:  D

Written media, such as brochures, pamphlets, patient pathways, and booklets, are common in outpatient and inpatient areas of health care. Demonstration and practice would be useful throughout the hospitalization to make sure the patient is performing the exercises correctly. Discussion and audiovisual media would be appropriate in the assessment and intervention portion of learning; however, written material may be reviewed by the patient after returning home.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 68

OBJ:   Nursing Process Step: Intervention   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

3. What does the first step of the teaching–learning process involve?

a.	Gathering data to assist in the assessment of learning needs
b.	Identifying major learning needs for the patient
c.	Identifying learning needs related to medical diagnosis
d.	Evaluating the effects of prior teaching

 

 

ANS:  A

The first step of the teaching–learning process is assessment, which involves gathering a database to assist the nurse in meeting the patient’s and family’s needs. Learning needs can be defined as gaps between what the learner knows and what the learner needs to know, such as survival skills, coping skills, and ability to make care decisions.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 59

OBJ:   Nursing Process Step: N/A              TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

4. Which educational content area is appropriate during the first hours of hospitalization?

a.	Pathophysiology of the admitting diagnosis
b.	Dietary modifications
c.	Purpose of bedside equipment
d.	Medication side effects

 

 

ANS:  C

Initial interventions are targeted to promote comfort and familiarity with the environment and surroundings. The plan should focus on survival skills, orientation to the environment and equipment, communication of prognosis, procedure explanations, and the immediate plan of care. Information regarding diagnosis, dietary modifications, and medication will be addressed after the patient is through the initial contact phase and is in the continuous care phase of education.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 72|Table 5-2

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

5. How should a nurse respond when a patient asks if he or she is going to die?

a.	Avoid the question by leaving the room.
b.	Defer the question to the physician.
c.	Answer honestly and sensitively with information that is understandable and in simple terms.
d.	Speak with the family first before answering the patient.

 

 

ANS:  C

During this time of elevated stress, the nurse may have to refocus the patient or family to help concentrate efforts on coping with the present instead of dwelling on possibilities of the future. Not addressing these immediate concerns could result in further anxiety, affect their ability to cope, and prevent open and honest communication.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   p. 63|p. 65

OBJ:   Nursing Process Step: Intervention   TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

6. Which intervention can support a learning environment in the critical care unit?

a.	Providing a variety of caregivers to enhance the availability of different information
b.	Allowing frequent uninterrupted rest periods to enhance obtaining structured sleep
c.	Providing the patient lists of facts that can enhance understanding of the disease
d.	Teaching according to a structured plan to enhance comprehension

 

 

ANS:  B

Sleep cycle alterations caused by sleep deprivation or sensory overload related to continuous noise from machines or people affect the patient’s ability to concentrate and comprehend information. Allowing frequent uninterrupted rest periods assists the patient in obtaining structured sleep. Assignment of multiple caregivers may negatively affect the ability of the patient and family to form a trusting relationship with the nursing staff. Teach whatever the patient wants to learn and avoid lists of facts.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 63|Table 5-1

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

7. A patient is admitted to the critical care unit with the onset of tuberculosis. He was diagnosed with HIV/AIDS 1 year ago. When talking to the patient about preventing the spread of tuberculosis, the patient tells the nurse that he has not followed precautions regarding tuberculosis for patients with HIV. Which educational objective is BEST stated for this patient?

a.	Patient will know at least two ways to prevent the spread of tuberculosis within 1 week.
b.	Patient will understand how HIV is spread within 3 days.
c.	Patient will realize that improper precautions will spread his disease to others.
d.	Patient will verbalize two methods of transmission for tuberculosis within 2 days.

 

 

ANS:  D

Terms such as know, understand, realize, and appreciate are open to many interpretations and are difficult to measure. Active verbs such as identify, state, list, and demonstrate should be used. The three components in the outcomes statement are (1) the individual who will meet the objective, (2) a measurable or observable verb, and (3) the content to be evaluated or learned.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 66

OBJ:   Nursing Process Step: Planning        TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

8. When writing goals and outcomes, what should be incorporated in the outcome statement?

a.	An action oriented intervention list
b.	An observable verb
c.	The objectives for the nurse
d.	The length of the education session

 

 

ANS:  B

The three components in the outcomes statement are (1) the individual who will meet the objective, (2) a measurable or observable verb, and (3) the content to be evaluated or learned. When goals or expected outcomes of the education encounter are clearly stated, the teacher and the learner understand the expectations and will do their best to achieve them. These statements differ from interventions in that they reflect what the learner is to accomplish, not what the nurse is to teach. The length of the education session is not part of the outcome statement.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   p. 66

OBJ:   Nursing Process Step: Planning        TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

9. In which situation are group discussions most effective as a patient teaching strategy?

a.	Patients have a variety of medical diagnoses.
b.	Patients are in the acute phase of their illness.
c.	Patients are in the hospital only 3 days or less.
d.	Patients are at similar stages of adaptation.

 

 

ANS:  D

Hospitalized patients with similar problems and at similar stages of adaptation can benefit from discussion groups. The patient and each member of the family may be experiencing different stages in the adaptation process at the same time. The education encounter may need to be modified to meet the needs of the patient and family.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 63|Table 5-1

OBJ:   Nursing Process Step: Planning        TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

10. According to Maslow’s hierarchy of needs, the need to know and understand information is considered what type of need?

a.	High-level
b.	Low-level
c.	Physiologic
d.	Critical

 

 

ANS:  A

Experiencing the stress of a physiologic need requires immediate attention and is considered a lower level, immediate need. The need to know and understand is a high-level need and can only be met if no lower level needs require attention.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 61

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

11. The patient is asked to complete an admission form. The patient hands the form to his spouse and asks her to complete the form, stating, “I forgot my glasses.” What might be inferred from the patient’s actions?

a.	Patient has functional health literacy.
b.	Patient needs a word recognition test.
c.	Patient has low health literacy.
d.	Patient needs a reading comprehension test.

 

 

ANS:  C

Behaviors such as handing a form to a family member to complete, claiming to be too tired, or “forgetting” one’s glasses are a few behaviors that may be used by individuals to hide their limitations or low health literacy. Word recognition tests consist of lists of health care terms that patients are asked to read. Reading comprehension tests assess understanding of health care information presented but do not demonstrate the individual’s ability to apply this information. Functional health literacy tests assess the individual’s level of comprehension and ability to put into action what he or she has learned.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 61|pp. 64-65|Box 5-2

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

12. What are the three learning domains to be considered when developing an individualized education plan?

a.	Knowledge, ability, and willingness to learn
b.	Psychologic, skills, and knowledge
c.	Knowledge, skills, and attitude
d.	Skills, attitude, and psychologic

 

 

ANS:  C

Three learning domains are considered when developing an individualized education plan: knowledge, attitude, and skills.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 65

OBJ:   Nursing Process Step: N/A              TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

13. Information on what topic should be included in the educational plan of a patient who is unconscious?

a.	Sensations
b.	Pathophysiology
c.	Rehabilitation
d.	Attitudes

 

 

ANS:  A

Providing information regarding environment, procedures, sensations, and time of day is benevolent and may help decrease immediate physiologic stress.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 70

OBJ:   Nursing Process Step: Intervention   TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

14. What topic should be included in the education of a patient’s family members during their first visit?

a.	When to call the practitioner
b.	Availability of support groups
c.	Expectations about self-care
d.	What the patient may look like

 

 

ANS:  D

The focus of the any education during the first visit should include what the patient may look like. When to call the practitioner, availability of support groups, and expectation for self-care should be included into later teaching sessions.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   p. 64|Table 5-2

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

15. A patient has been in the critical care unit for 20 days with a diagnosis of sepsis and acute respiratory distress syndrome. The patient is ready for transfer to the step-down unit but is apprehensive. The patient has communicated to the nurse that he does not want to leave the ICU because he is afraid that his needs will not be met on the step-down unit. Which educational objective would be best to use in this situation?

a.	The patient will state two reasons why he is being transferred by the end of the day.
b.	The patient will confront his fears and deal with them within 1 day of transfer.
c.	The patient will state the name of his “new” nurse by the end of the day.
d.	The patient will be introduced to at least two of his “new” caregivers by the time of transfer.

 

 

ANS:  D

The patient needs to trust the new caregivers on the step-down unit. Introducing the new caregivers will help decrease his anxiety about an unfamiliar environment. Objectives must be realistic in expectation and timeline. Anxiety and fear of change will decrease the patient’s cognitive level.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 64|Table 5-2

OBJ:   Nursing Process Step: Planning        TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

16. A 79-year-old patient received a liver transplant 3 days ago. The patient is extubated and hemodynamically stable. His spouse is coming for a visit, and the nurse has some time to discuss immune suppression drug therapy with both of them. The patient is hearing and sight impaired. The spouse brought the patient’s hearing aids 2 days ago and will bring the patient’s glasses today. Which of the following teaching strategies would be least effective in the critical care unit setting?

a.	Patient education channel
b.	Written materials
c.	Lecture
d.	Discussion

 

 

ANS:  C

Lecture is not the strategy of choice for this situation; it does not work well in the critical care unit. Teaching must be done at the bedside by using as many of the senses as possible. Written material, discussion, demonstration, and use of media are common teaching strategies used in the critical care unit.

 

PTS:   1                    DIF:    Cognitive Level: Evaluating             REF:   p. 60

OBJ:   Nursing Process Step: Intervention   TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

17. During which phase do Health Insurance Portability and Accountability Act (HIPAA), advance directives, and visitation policies occur for the patient or family members?

a.	Transfer to a different level of care
b.	End-of-life care
c.	Initial contact or first visit
d.	Continuous care

 

 

ANS:  C

During preparation for the first visit, the nurse would instruct the patient or family on Health Insurance Portability and Accountability Act (HIPAA), advance directives, and visitation policy. Transfer to a different level of care includes orientation to the receiving unit. Continuous care includes discussion of day-to-day routines, procedures, and treatment process. End-of-life care includes discussion of palliative care or hospice.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 64|Table 5-2

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Safe and Effective Care Environment

 

18. Which of the following statements best describes the teaching–learning process?

a.	It follows the distinct order of the nursing process, with each step of the process separate and without repetition.
b.	It requires formal blocks of learning time that are planned during the shift.
c.	It is a continuous activity that occurs during hospitalization and beyond.
d.	It ends at the point of discharge.

 

 

ANS:  C

In the teaching–learning process, the steps of the nursing process (assessment, diagnosis, goals, interventions, and evaluation) may occur simultaneously and repetitively. The teaching–learning process is a dynamic, continuous activity that occurs throughout the entire hospitalization and may continue after the patient has been discharged.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 59

OBJ:   Nursing Process Step: N/A              TOP:   Patient and Family Education

MSC:  NCLEX: Psychosocial Integrity

 

19. Which statement best describes the efficacy of group discussion as a patient teaching strategy for educating both a patient newly diagnosed with diabetes and a patient who has had the disease for years?

a.	It is an efficient use of the nurse’s time.
b.	It is an efficient use of the patient’s time.
c.	It is an effective strategy as both patients have identical goals.
d.	It is not an appropriate teaching strategy.

 

 

ANS:  D

Educational needs between the two patients will differ. Group discussion is only effective when the goals of the education plan are the same for all patients involved. A patient newly diagnosed with diabetes will require education on topics that are potentially well known to a patient diagnosed years ago.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 63

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

20. A mechanically ventilated patient is being weaned off sedation. The patient begins to wake up and becomes increasingly agitated, pulling at the gown, kicking, and grimacing. What action should the nurse take next?

a.	Administer additional sedation until the patient stops kicking
b.	Initiate wrist restraints to prevent the patient from pulling
c.	Tell the patient to stop moving around to avoid accidental extubation
d.	Provide the patient with simple facts to assist with understanding of the situation

 

 

ANS:  D

The need for oxygen and survival predominates over all other human needs. According to Maslow’s hierarchy of human needs, lower-level, physiologic needs must be satisfied before an individual can move on to higher-level issues. Experiencing a significant physiologic stressor may completely consume all the patient’s available energy and thoughts, affecting his or her ability to interact, comprehend, and respond.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 65

OBJ:   Nursing Process Step: Implementation

TOP:   Patient and Family Education           MSC:  NCLEX: Safe and Effective Care Environment

 

21. A lack of true understanding can often be misread by the nurse as noncompliance. Which of the following statements demonstrate effective questioning methods to assess a patient’s understanding?

a.	“Do you take your heart medication every morning?”
b.	“Can you tell me what you know about your different heart medications?”
c.	“Do you take all of your medications?”
d.	“Do you ever miss taking your medication?”

 

 

ANS:  B

Open-ended questions provide the nurse an opportunity to assess actual knowledge gaps rather than assume knowledge by obtaining a “yes” or “no” response. These types of questions also assist the patient and family to tell their story of the illness and communicate their perceptions of the experience. Questions that elicit only a “yes” or “no” response close off communication and do not provide for an interactive teaching–learning session.

 

PTS:   1                    DIF:    Cognitive Level: Applying               REF:   p. 70

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

1. Acute illness disrupts the patient’s and family’s normal routines and is extremely stressful. What coping mechanisms might the nurse expect the patient and/or family to display? (Select all that apply.)

a.	Denial
b.	Adaptation
c.	Values
d.	Anger
e.	Disbelief

 

 

ANS:  A, D, E

Denial, disbelief, and anger are all examples of coping mechanisms that patients use to help in stressful situations. Adaptation is the ability to break down emotional barriers that affect willingness and readiness for learning. Values are considered sociocultural factors for coping with stress.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 60

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

2. What are sources of physiologic stress in the acutely ill patient? (Select all that apply.)

a.	Hypotension
b.	Hypoxemia
c.	Fever
d.	Neurologic deficits
e.	Eupnea

 

 

ANS:  A, B, C, D

Physiologic alterations in heart rate and blood pressure can be measured and taken into consideration during the teaching–learning encounter. Sources of physiologic stress in acutely ill patients include medications, pain, hypoxemia, decreased cerebral and peripheral perfusion, hypotension, fluid and electrolyte imbalances, infection, sensory alterations, fever, and neurologic deficits.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   p. 61

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

3. According to Malcolm Knowles’ andragogy, what are characteristics of the adult learner? (Select all that apply.)

a.	Autonomy
b.	Experience
c.	Instructor-driven assessments
d.	Peer-directed motivation
e.	Individualism

 

 

ANS:  A, B, E

Malcolm Knowles described these principles of adult learning in a model known as andragogy. Adult learning theory stresses concepts of individualism, self-assessment, self-direction, motivation, experience, and autonomy.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 60

OBJ:   Nursing Process Step: N/A              TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance

 

4. Which questions can a nurse use to obtain assessment information to determine the immediate need for education? (Select all that apply.)

a.	“How can we help you today?”
b.	“Can you tell me why you take each medication?”
c.	“Are you in pain?”
d.	“Are these people your main support system?”
e.	“How well do you understand the directions?”

 

 

ANS:  A, B, E

Generally, with practice and effort, it can be determined what educational information is needed in a brief period without much disruption in the routine care of the patient. Questions that elicit a “yes” or “no” response close off communication and do not provide an interactive teaching–learning session.

 

PTS:   1                    DIF:    Cognitive Level: Remembering        REF:   p. 60|Box 5-1

OBJ:   Nursing Process Step: Assessment   TOP:   Patient and Family Education

MSC:  NCLEX: Health Promotion and Maintenance