Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank Chapter 4: Theoretical Foundations of Nursing Practice MULTIPLE CHOICE 1. In preparing to review different theories, the nurse reviews basic information to assist in understanding the material. Theories are defined as: 1. Mental formulations of objects or events 2. Aspects of reality that can be consciously sensed 3. Statements that describe concepts or connect concepts 4. Concepts or propositions that project a systematic view of phenomena ANS: 4 A theory is a set of concepts, definitions, relationships, and assumptions that project a systematic view of phenomena. Mental formulations of objects or events are called concepts. Aspects of reality that can be consciously sensed are called phenomena. Statements that describe concepts or connect concepts are called assumptions. DIF: A REF: 46 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 2. There are different types of theories that may be used by nurses seeking to study the basis of nursing practice. When the goal of a theory is to speculate on why phenomena occur, it is termed a: 1. Grand theory 2. Prescriptive theory 3. Descriptive theory 4. Middle range theory ANS: 3 Descriptive theories describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena. Grand theories provide the structural framework for broad, abstract ideas about nursing. Prescriptive theories address nursing interventions and predict the consequence of a specific nursing intervention. Middle range theories address specific phenomena or concepts and reflect practice. DIF: A REF: 47 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance

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Test Bank 3. Which one of the four linkages of interest in the nursing paradigm refers to factors in the home or school? 1. Person 2. Health 3. Nursing care 4. Environment

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ANS: 4 Environment/situation includes all possible conditions affecting the client and the setting in which health care needs occur, such as the home, school, workplace, or community. Person refers to the recipient of nursing care, including individual clients, families, and the community. Health is the goal of nursing care. Nursing care refers to the diagnosis and treatment of human responses to actual or potential health problems (ANA, 1995). DIF: A REF: 45 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 4. The nurse is working within a health care system that employs Neumans theory. A client is having difficulty breathing and requires oxygen and medication. Within Neumans theory, the nurse approaches the client to: 1. Achieve the 14 basic needs 2. Promote attainment of biological self-care requisites 3. Assist in physiological adaptation to internal changes 4. Strengthen the line of defenses at the secondary level of prevention ANS: 4 Neumans framework for practice included nursing actions as primary, secondary, or tertiary levels of prevention in caring for clients holistically. Secondary prevention strengthens internal defenses and resources by establishing priorities and treatment plans for identified symptoms. In Hendersons theory, nurses help the client to perform 14 basic needs. The goal of Orems theory is to promote attainment of self-care. Roys theory focuses on adaptation. DIF: A REF: 49 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 5. Although there are similarities in the different nursing theories, there are key elements that distinguish one from another. The emphasis of Jean Watsons conceptual model is that: 1. Self-care maintains wholeness 2. Stimuli disrupt an adaptive system 3. Subsystems exist in dynamic stability 4. Caring is central to the essence of nursing

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Test Bank ANS: 4 Like Benner and Wrubels theory, Watson emphasized caring in her theory. Watsons model is designed around the caring process, assisting clients in attaining or maintaining health or in dying peacefully. The key emphasis of her theory is that caring is the moral ideal: mind-body-soul engagement with another. Self-care is central to Orems theory. The key emphasis of Roys theory is that stimuli disrupt an adaptive system. The key emphasis of Johnsons theory is that subsystems exist in dynamic stability. DIF: A REF: 50-51 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance

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6. A community health nurse is working with a variety of clients and decides to use a systems theory approach to assist them to meet their health care needs. In using this approach, the nurse focuses on the: 1. Hierarchy of the clients human needs 2. Clients interaction with the environment 3. Clients attitudes toward health behaviors 4. Response of the client to the process of growth and development ANS: 2 According to systems theory, a system is made up of parts that rely on one another, are interrelated, share a common purpose, and together form a whole. A clients interaction with the environment is an example of an open system. The nurse understands factors that change the environment can also have an impact on the system. Maslows hierarchy of human needs is an interdisciplinary theory useful in planning individualized care. Determining a clients attitudes toward health behaviors follows a health-and-wellness theoretical model. Focusing on the response of a client to the process of growth and development is consistent with developmental theories. DIF: A REF: 47 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 7. While working on a postoperative unit, the nurse is applying the elements of the self-care theory. The nurse who assists the client to manage or attain self-care in wound management is using the theory developed by: 1. Imogene King 2. Dorothea Orem 3. Virginia Henderson 4. Florence Nightingale ANS: 2 The goal of Orems theory is to help the client perform self-care.

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The goal of Kings theory is to use communication to help the client reestablish positive adaptation to the environment. The goal of Hendersons theory is to work independently with other health care workers assisting the client to gain independence as quickly as possible. The goal of Nightingales theory is to facilitate the bodys reparative processes by manipulating the clients environment. DIF: A REF: 50 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 8. Martha Rogers theory has a framework for practice that includes the: 1. Manipulation of the clients environment 2. 21 nursing problems within 4 major client needs 3. Seven categories of behavior and behavioral balance 4. Unitary human being in continuous interaction with the environment ANS: 4 The framework for practice according to Martha Rogers theory is the unitary human continuously changing and coexisting with the environment. Nightingales theory includes manipulation of the clients environment (i.e., appropriate noise, nutrition, hygiene, light, comfort, socialization, and hope) in the framework for practice. Abdellahs nursing theory includes 21 nursing problems within 4 major client needs in the framework for practice. Johnsons theory includes seven categories of behavior and behavioral balance in the framework for practice. DIF: A REF: 50 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 9. The nurse plans to apply a theory that focused on stress reduction. A theory proposed by which one of the following individuals should be selected? 1. Parse 2. Peplau 3. Neuman 4. Orlando ANS: 3 Stress reduction is the goal of the systems model of nursing practice according to Neumans theory. Parses theory focuses on indivisible beings and the environment co-creating health. Peplaus theory focuses on the interpersonal process as the maturing force for personality. Orlandos theory focuses on the interpersonal process to alleviate distress. DIF: A REF: 49 OBJ: Comprehension

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Test Bank TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 10. A similarity between the theories of Leininger and of Benner and Wrubel is: 1. Caring as a central focus 2. The clients adaptation to demands 3. An emphasis on the maximum level of wellness 4. Dynamic interpersonal communication

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ANS: 1 Leininger states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. Caring is also central to the theory of Benner and Wrubel, depicting personal concern as an inherent feature of nursing practice. The theories of Roy and Johnson focused on the clients adaptation to demands. Neumans theory places emphasis on achieving a maximum level of wellness. Abdellahs theory also addressed the person as a whole. Kings theory and Peplaus theory share a similarity with a focus on interpersonal communication. DIF: A REF: 50-51 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 11. The nurse is working with a client diagnosed with multiple sclerosis. The goal is that the client will be capable of living independently. The nursing theory that best supports this clients situation is: 1. Orems theory 2. Neumans theory 3. Abdellahs theory 4. Hendersons theory ANS: 1 According to Orem, the goal of nursing is to increase the clients ability to independently meet biological, psychological, developmental, or social needs. Neumans theory is concerned with the whole person. According to Neuman, the focus of nursing is on the variables affecting the clients response to a stressor. Abdellahs theory emphasizes the delivery of nursing care for the whole person. According to Henderson, nurses help clients to perform 14 basic needs. DIF: A REF: 50 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 12. While the nurse realizes that the definition of health is unique to the client, the most universal factor is that health is: 1. Dynamic and ever-changing 2. Affected and managed by the nurse

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Test Bank 3. Determined by internal and external forces 4. Perceived and defined by the individual

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ANS: 1 Health has different meanings for each client, the clinical setting, and the health care profession (see Chapter 6). Health is dynamic and continuously changing. Your challenge is to provide the best possible care based on the clients level of health and health care needs at the time of care delivery. While the other options may be true, they are not universally true to all individuals because not everyone is involved in a nurse-client relationship, wellness can be affected by internal factors, external factors, or a combination of both, and not everyone is capable of perceiving and defining their own wellness. DIF: C REF: 45 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 13. Which of the following statements by the nurse best defines nursing diagnoses for a client? 1. It is the basis for a clients care plan. 2. It is what we nurses use to plan your care. 3. It is one of a set of standardized client oriented problems. 4. It is the way nurses identify what specific needs a client has. ANS: 4 In medicine, physicians diagnose and treat disease. In contrast, nursing is the diagnosis and treatment of human responses to actual or potential health problems (ANA, 2003). The scope of nursing is broad. For example, a nurse does not medically diagnose the clients heart condition but instead assesses the clients response to the disease and may develop nursing diagnoses of fatigue, change in body image, and altered coping. From these nursing diagnoses, the nurse creates an individualized plan of care for each of the clients health problems. Although the other statements are correct, they are not the best options available because they do not fully explain the function of a nursing diagnosis. DIF: C REF: 45 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 14. The nurse is caring for a client newly diagnosed with type 2 diabetes mellitus. Which of the following nursing interventions best reflects Orems nursing theory? 1. Arranging for a consult with a certified diabetic nurse educator 2. Demonstrating proper documentation of glucose testing results 3. Explaining the role of A1C values in the management of glucose levels 4. Preparing discharge teaching to reinforce proper finger-stick technique ANS: 4

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If a nurse uses Orems theory in practice, the nurse assesses and interprets the data to determine the clients self-care needs, self-care deficits, and self-care abilities in the management of a disease. The theory then guides the design of individualized nursing interventions. While the other interventions are appropriate and will ultimately affect effective client selfcare/management of the diabetes, they are not the correct option because they are not directly involved in determining client self-care needs. DIF: C REF: 50 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 15. Swansons theory of caring is best demonstrated when the nurse: 1. Demonstrates efficiency when performing ordered treatments 2. Offers to stay with the client during a painful bedside procedure 3. Administers the clients pain medication promptly when requested 4. Frequently updates a family regarding a clients status during surgery ANS: 2 Swansons theory of caring defines five components of caring: knowing, being with, doing for, enabling, and maintaining belief (see Chapter 8). These components provide a foundation of knowledge for the direction and delivery of caring nursing practice. This theory provides a basis for identifying and testing nurse caring behaviors to determine if caring improves client health outcomes. Offering to stay with the client is an intervention directly reflected of being with the client. Efficiency is a component of caring but it is not the best option available because it is not exclusively directed toward Swansons theory. Administering pain medication promptly reflects effective nursing care as well as a clients right. It is a component of caring but it is not the best option available because it is not exclusively directed towards Swansons theory. Effective nursing care and caring for the family is important, but it is not the best option available because it is not directed towards the client. DIF: C REF: 46 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 16. Which of the following responses observed in a client recently diagnosed with lung cancer is most directly addressed by the Neuman System Model? 1. The client asks for a consult with the hospital clergy. 2. The client is observed crying after his family has left for the day. 3. The client asks for pictures of his children to be brought to him in the hospital. 4. The client is heard saying, I trust my health team, and Ill do what they suggest. ANS: 2 Examples of phenomena of nursing include caring, self-care, and client responses to stress. In the Neuman Systems Model (1995), phenomena include all client responses, environmental factors, and nursing actions. Crying is reflective of a clients response to stress to a second level need (Maslows) and so is directly related to Neumans model.

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While consulting with clergy is reflective of a client need, it is higher on Maslows hierarchy and so not the best option available. While requesting family photos is reflective of a client need, it is higher on Maslows hierarchy and so not the best option available. The client stating that he/she will trust the health team is reflective of a client response, it is less reflective of a need and so not the best option available. DIF: C REF: 49 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 17. A client diagnosed with type 2 diabetes mellitus reports poor glucose control since starting her new stressful job. The nurse uses Neumans theory to focus on the: 1. Identification of new stressors and improve dietary choices 2. Acquisition of appropriate interpersonal communication skills 3. Learning of effective coping methods and relaxation techniques 4. Implementation of both aerobic and anaerobic exercise routines ANS: 1 The Neuman Systems Model uses a systems approach to describe how clients deal with stressors in their internal or external environments. Nurses using Neumans theory in practice focus their care on client responses to the stressors (Meleis, 2006). For example, when a client takes on a new role within their employment, they may react to the stress by eating an improper diet. In this situation the nurse focuses on the client response to the stressors and designs interventions related to improving nutritional intake, both actions directed towards improving glucose control. While acquiring good interpersonal communication skills may help minimize the stress the client is currently experiencing, it does not address identifying the source of the stress or the management of the type 2 diabetes. While acquiring effective coping and relaxation skills may help manage the stress the client is currently experiencing, it does not address identifying the source of the stress or the management of the type 2 diabetes. While implementing effective exercise routines may help in the management of the type 2 diabetes, it does not address identifying the source of the stress or the thorough management of the type 2 diabetes. DIF: C REF: 46 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 18. The best example of an appropriate nursing assumption is: 1. Clients will make their needs and wants known to the staff 2. Clients require a quiet, darkened environment in which to sleep 3. Prompt administration of pain medication is an expectation of a postoperative client 4. A client recently diagnosed with cancer will want family present when discussing treatment options

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ANS: 3 Assumptions are the taken for granted statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory (Meleis, 2006; Chinn and Kramer, 2004). It is a reasonable assumption that a client who recently underwent surgery would require and expect prompt administration of medications to manage that pain. Not all clients will openly communicate their needs/wants to the staff so this option is not the best example offered. While most clients will rest effectively in a quiet, darken environment, it is not required by all clients so this option is not the best example offered. While many clients will want family present in this situation, not all will. Therefore this option is not the best example offered because an incorrect assumption would result in a violation of a clients right to privacy. DIF: C REF: 46 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 19. An example of a nursing activity directed towards providing input to the nursing process is: 1. Assessing a client who has just reported being nauseated 2. Discussing various ways to increase calcium intake with a client 3. Asking the client to identify when she would like to be ambulated 4. Documenting a clients pain level 30 minutes after being medicated ANS: 1 Input for the nursing process is the data or information that comes from a clients assessment (i.e., how the client interacts with the environment and the clients physiological function). This is an example of the nursing process content: the information about the nursing care for clients with specific health care problems. Feedback serves to inform a system about how it functions: how the client responds to the intervention. Output is the end product of a system and in the case of the nursing process it is whether the clients health status improves or remains stable as a result of nursing care. DIF: C REF: 47 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 20. The nurse realizes that which of the following stated client needs has the highest priority? 1. A clients reaction to facial scarring after an automobile accident 2. A client who is crying hysterically upon hearing of her sons death 3. A homeless clients fear that his belongings will be stolen while he is hospitalized 4. An asthmatic clients concern regarding the lack of insurance to pay for her medications ANS: 4

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The second level of Maslows hierarchy includes safety and security needs, which involve physical and psychological security. The clients concern about securing the medication needed to minimize the potential for breathing problems has the highest priority of the options available. The fourth level encompasses esteem and self-esteem needs, which involve self-confidence, usefulness, achievement, and self-worth. Although important, a clients concern regarding her appearance would not have priority over the other options available. The third level contains love and belonging needs, including friendship, social relationships, and sexual love. Although important, a clients reaction to the loss of a loved one does not have priority over the other options available. The second level of Maslows hierarchy includes safety and security needs, which involve physical and psychological security. While the clients concern for the safety of his belongs is on the same level, it does not take priority over the client whose concern relates to potential breathing problems. DIF: C REF: Chapter 6, 72 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 21. Which of the following statements best expresses the primary goal of nursing practice? 1. To identify client needs in order to facilitate improved health and wellness 2. To tend to the physical and psychosocial needs of both the client and his family 3. To provide effective, research-based nursing care specifically tailored to each clients needs 4. To perform the required treatments and interventions directed towards client recovery from illness ANS: 3 Providing excellent, evidenced-based nursing care is an expectation for all nurses and the care they provide. Although other options are reflective of an appropriate nursing outcome, they are not the best descriptions of nursings primary goal. DIF: C REF: 45 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.