Title: ASN 210 Week 5 Post Quiz (Remotely Proctored)
Course: 16SP-ASN-210-GH1A1-ADV NUR THROUGH LIFESPAN I > Section: Week 5

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Q: A research nurse meets with the nurse manager to discuss plans for the development of evidence-based practice (EBP) guidelines using the Reavy and Tavernier model. Which statement should the nurse include in the discussion?
- “Our efforts should focus on forming a team to develop an EBP initiative.”
- “I will assist staff nurses with literature reviews and the synthesis of evidence.”
- “You should identify barriers to evidence-based implementation.”
- “I will develop a PICOT question and share it with the staff nurses.”
A: “I will assist staff nurses with literature reviews and the synthesis of evidence.”
If right: The Reavy and Tavernier model views the staff nurse as the clinical expert and believes that the expertise of a nurse researcher should facilitate the EBP process by supporting nursing staff in identifying areas for improvement, assisting staff with literature reviews and synthesis of evidence, and helping with the implementation and evaluation of EBP projects. Team forming is a component of the Iowa model. Identification of strengths and barriers to EBP implementation is a component of the ARCC model. Staff nurses should identify their own PICOT questions from “burning” clinical questions.
If wrong: The Reavy and Tavernier model views the staff nurse as the clinical expert and believes that the expertise of a nurse researcher should facilitate the EBP process by supporting nursing staff in identifying areas for improvement, assisting staff with literature reviews and synthesis of evidence, and helping with the implementation and evaluation of EBP projects. Team forming is a component of the Iowa model. Identification of strengths and barriers to EBP implementation is a component of the ARCC model. Staff nurses should identify their own PICOT questions from “burning” clinical questions.

Q: A nurse who wants to incorporate evidence-based practices into client care on a medical unit is meeting resistance. Which barrier does the nurse identify as preventing nurses from engaging in evidence-based practices?
- Difficulty accessing research materials
- Lack of value for client preferences
- Trouble understanding client needs
- Inadequate nurse-client ratios
A: Difficulty accessing research materials
If right: Major barriers that prevent nurses from engaging in evidence-based practice include lack of time, lack of value for research in practice, lack of understanding of organization or structure of electronic databases, difficulty accessing research materials, lack of computer skills, and difficulty understanding research articles.
If wrong: Major barriers that prevent nurses from engaging in evidence-based practice include lack of time, lack of value for research in practice, lack of understanding of organization or structure of electronic databases, difficulty accessing research materials, lack of computer skills, and difficulty understanding research articles.

Q: A nurse wants to explore why clients who receive patient-controlled analgesia (PCA) after abdominal surgery ambulate sooner than clients who receive nurse-administered pain medications. Which action should the nurse take first?
- Contact the medical center’s clinical pharmacist.
- Search the medical library for the best evidence.
- Recommend PCA for all clients.
- Appraise data obtained through client chart audits.
A: Search the medical library for the best evidence.
If right: After asking the “burning” question, the nurse should find the very best evidence to try to answer it. The clinical pharmacist may be knowledgeable, but this is not the best evidence available. Information from client chart audits may demonstrate better outcomes with PCA, but this again is not the best evidence. The nurse should wait and recommend clinical practice changes until best evidence is found, appraised, and synthesized.
If wrong: After asking the “burning” question, the nurse should find the very best evidence to try to answer it. The clinical pharmacist may be knowledgeable, but this is not the best evidence available. Information from client chart audits may demonstrate better outcomes with PCA, but this again is not the best evidence. The nurse should wait and recommend clinical practice changes until best evidence is found, appraised, and synthesized.

Q: A nurse researcher is evaluating clinical questions. Which is a quantitative question?
- “What are the effects of hourly rounding on client fall rates?”
- “How do middle-aged men respond to premature balding?”
- “What are the lived experiences of postoperative clients with pain?”
- “What is the experience of having breast cancer like for young women?”
A: “What are the effects of hourly rounding on client fall rates?”
If right: Quantitative questions ask about the relationship between or among defined, measurable phenomena and include statistical analysis of information that is collected to answer a question. Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people, and usually analyze the content of what a person says during an interview or what a researcher observes.
If wrong: Quantitative questions ask about the relationship between or among defined, measurable phenomena and include statistical analysis of information that is collected to answer a question. Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people, and usually analyze the content of what a person says during an interview or what a researcher observes.

Q: A nurse plans evidence-based care for a client on a medical-surgical unit. Which elements should the nurse assess when developing this plan of care? <b>(Select all that apply.)</b>
- Client values
- Nurse’s experiences
- Organizational budget
- Staffing ratios
- Best available evidence
A: Client values; Nurse’s experiences; Best available evidence
If right: Evidence-based practice incorporates best current evidence with the expertise of the clinician and the client’s values.
If wrong: Evidence-based practice incorporates best current evidence with the expertise of the clinician and the client’s values.

Q: A nurse manager educates staff nurses in the use of clinical practice guidelines. Which statement should the nurse include in this teaching?
- “Clinical practice guidelines are implemented by The Joint Commission.”
- “Practice guidelines are based on hospital management staff’s expertise.”
- “Clinical practice guidelines are official recommendations based on evidence.”
- “Practice guidelines allow for greater reimbursement from insurance companies.”
A: “Clinical practice guidelines are official recommendations based on evidence.”
If right: Clinical practice guidelines are based on evidence and provide an official recommendation for the diagnosis and/or management of health problems. These are usually developed from high-quality evidence. Although The Joint Commission publishes guidelines, clinical practice guidelines are not implemented by The Joint Commission. The hospital’s management staff may be involved in the development and implementation of clinical practice guidelines, but these guidelines should not be based solely on management expertise. Clinical guidelines provide for better client outcomes. These guidelines are not focused on reimbursement.
If wrong: Clinical practice guidelines are based on evidence and provide an official recommendation for the diagnosis and/or management of health problems. These are usually developed from high-quality evidence. Although The Joint Commission publishes guidelines, clinical practice guidelines are not implemented by The Joint Commission. The hospital’s management staff may be involved in the development and implementation of clinical practice guidelines, but these guidelines should not be based solely on management expertise. Clinical guidelines provide for better client outcomes. These guidelines are not focused on reimbursement.

Q: A nurse teaches clients about patterns of inheritance for genetic disorders among adults. Which disorders have an autosomal dominant pattern of inheritance? <b>(Select all that apply.)</b>
- Breast cancer
- Alzheimer’s disease
- Hemophilia
- Huntington disease
- Marfan syndrome
- Cystic fibrosis
A: Breast cancer; Huntington disease; Marfan syndrome
If right: Breast cancer, Huntington disease, and Marfan syndrome have an autosomal dominant pattern of inheritance. Alzheimer’s disease is a complex disorder with familial clustering, hemophilia is a sex-linked recessive disorder, and cystic fibrosis has an autosomal recessive pattern of inheritance.
If wrong: Breast cancer, Huntington disease, and Marfan syndrome have an autosomal dominant pattern of inheritance. Alzheimer’s disease is a complex disorder with familial clustering, hemophilia is a sex-linked recessive disorder, and cystic fibrosis has an autosomal recessive pattern of inheritance.

Q: A nurse obtains health histories when admitting clients to a medical-surgical unit. With which client should the nurse discuss predisposition genetic testing?
- Middle-aged woman whose mother died at age 48 of breast cancer
- Young man who has all the symptoms of rheumatoid arthritis
- Pregnant woman whose father has sickle cell disease
- Middle-aged man of Eastern European Jewish ancestry
A: Middle-aged woman whose mother died at age 48 of breast cancer
If right: A client with a family history of breast cancer should be provided information about predisposition testing. Predisposition testing should be discussed with clients who are at high risk of hereditary breast, ovarian, and colorectal cancers so that the client can engage in heightened screening activities or interventions that reduce risk. The client with symptoms of rheumatoid arthritis should be given information about symptomatic diagnostic testing. The client with a familial history of sickle cell disease and the client who is of Eastern European Jewish ancestry should be given information about carrier genetic testing.
If wrong: A client with a family history of breast cancer should be provided information about predisposition testing. Predisposition testing should be discussed with clients who are at high risk of hereditary breast, ovarian, and colorectal cancers so that the client can engage in heightened screening activities or interventions that reduce risk. The client with symptoms of rheumatoid arthritis should be given information about symptomatic diagnostic testing. The client with a familial history of sickle cell disease and the client who is of Eastern European Jewish ancestry should be given information about carrier genetic testing.

Q: A nurse is educating a client about genetic screening. The client asks why red-green color blindness, an X-linked recessive disorder noted in some of her family members, is expressed more frequently in males than females. How should the nurse respond?
- “Females have a decreased penetrance rate for this gene mutation and are therefore less likely to express the trait.”
- “Females have two X chromosomes and one is always inactive. This inactivity decreases the effect of the gene.”
- “The incidence of X-linked recessive disorders is higher in males because they do not have a second X chromosome to balance expression of the gene.”
- “Males have only one X chromosome, which allows the X-linked recessive disorder to be transmitted from father to son.”
A: “The incidence of X-linked recessive disorders is higher in males because they do not have a second X chromosome to balance expression of the gene.”
If right: Because the number of X chromosomes in males and females is not the same (1:2), the number of X-linked chromosome genes in the two genders is also unequal. Males have only one X chromosome, a condition called hemizygosity, for any gene on the X chromosome. As a result, X-linked recessive genes have a dominant expressive pattern of inheritance in males and a recessive expressive pattern of inheritance in females. This difference in expression occurs because males do not have a second X chromosome to balance the expression of any recessive gene on the first X chromosome. It is incorrect to say that one X chromosome of a pair is always inactive in females, or that females have a decreased penetrance rate for this gene mutation. X-linked recessive disorders cannot be transmitted from father to son, but the trait is transmitted from father to all daughters who will be carriers.
If wrong: Because the number of X chromosomes in males and females is not the same (1:2), the number of X-linked chromosome genes in the two genders is also unequal. Males have only one X chromosome, a condition called hemizygosity, for any gene on the X chromosome. As a result, X-linked recessive genes have a dominant expressive pattern of inheritance in males and a recessive expressive pattern of inheritance in females. This difference in expression occurs because males do not have a second X chromosome to balance the expression of any recessive gene on the first X chromosome. It is incorrect to say that one X chromosome of a pair is always inactive in females, or that females have a decreased penetrance rate for this gene mutation. X-linked recessive disorders cannot be transmitted from father to son, but the trait is transmitted from father to all daughters who will be carriers.

Q: A nurse consults a genetic counselor for a client whose mother has Huntington disease and is considering genetic testing. The client states, “I know I want this test. Why do I need to see a counselor?” How should the nurse respond?
- “The advanced practice nurse will advise you on whether you should have children or adopt.”
- “Genetic testing can be a stressful experience. Counseling can provide support and education throughout the process.”
- “There is no cure for this disease. The counselor will determine if there is any benefit to genetic testing.”
- “Genetic testing is expensive. The counselor will advocate for you and help you obtain financial support.”
A: “Genetic testing can be a stressful experience. Counseling can provide support and education throughout the process.”
If right: Genetic testing is a stressful experience, and clients should be provided with support, education, and assistance with coping. Genetic testing should be performed only after genetic counseling has occurred. The client has the right to decide whether to have children or to participate in genetic testing. Nursing staff should provide both benefits and risks to genetic testing so that the client can make an informed decision. Financial support is not part of genetic counseling.
If wrong: Genetic testing is a stressful experience, and clients should be provided with support, education, and assistance with coping. Genetic testing should be performed only after genetic counseling has occurred. The client has the right to decide whether to have children or to participate in genetic testing. Nursing staff should provide both benefits and risks to genetic testing so that the client can make an informed decision. Financial support is not part of genetic counseling.

Q: A nurse completes pedigree charts for clients at a community health center. Which diagnosis should the nurse refer for carrier genetic testing? <b>(Select all that apply.)</b>
- Huntington disease
- Breast cancer
- Hemophilia
- Colorectal cancer
- Sickle cell disease
- Cystic fibrosis
A: Hemophilia; Sickle cell disease; Cystic fibrosis
If right: Of the disease processes listed, the ones that would make the client a candidate for carrier genetic testing would be hemophilia, sickle cell disease, and cystic fibrosis. Although Huntington disease, breast cancer, and colorectal cancer all have genetic components, there is no evidence that carrier genetic testing would be beneficial in diseases such as these.
If wrong: Of the disease processes listed, the ones that would make the client a candidate for carrier genetic testing would be hemophilia, sickle cell disease, and cystic fibrosis. Although Huntington disease, breast cancer, and colorectal cancer all have genetic components, there is no evidence that carrier genetic testing would be beneficial in diseases such as these.

Q: A nurse cares for an adult client who has received genetic testing. The client’s mother asks to receive the results of her daughter’s genetic tests. Which action should the nurse take?
- Obtain a signed consent from the client allowing test results to be released to the mother.
- Invite the mother and other family members to participate in genetic counseling with the client.
- Encourage the mother to undergo genetic testing to determine if she has the same risks as her child.
- Direct the mother to speak with the client and support the client’s decision to share or not share the results.
A: Direct the mother to speak with the client and support the client’s decision to share or not share the results.
If right: All conversations and test results must be kept confidential. The client has the right to determine who may be involved in discussions related to diagnosis and genetic testing, who may participate in genetic counseling with the client, and what information may be disclosed to family members. It is the nurse’s responsibility to provide a private environment for discussions and protect the client’s information from improper disclosure. The nurse should support the client’s right to disclose or not disclose information.
If wrong: All conversations and test results must be kept confidential. The client has the right to determine who may be involved in discussions related to diagnosis and genetic testing, who may participate in genetic counseling with the client, and what information may be disclosed to family members. It is the nurse’s responsibility to provide a private environment for discussions and protect the client’s information from improper disclosure. The nurse should support the client’s right to disclose or not disclose information.

Q: The nurse receives a hand-off report. One client is described as a drug seeker who is obsessed with even tiny changes in physical condition and is “on the light constantly” asking for more pain medication. When assessing this client’s pain, what statement or question by the nurse is most appropriate?
- “Help me understand how pain is affecting you right now.”
- “I wish I could do more; is there anything I can get for you?”
- “You cannot have more pain medication for 3 hours.”
- “Why do you think the medication is not helping your pain?”
A: “Help me understand how pain is affecting you right now.”
If right: This is an example of therapeutic communication. A client who is preoccupied with physical symptoms and is “demanding” may have some psychosocial impact from the pain that is not being addressed. The nurse is providing the client the chance to explain the emotional effects of pain in addition to the physical ones. Saying the nurse wishes he or she could do more is very empathetic, but this response does not attempt to learn more about the pain. Simply telling the client when the next medication is due also does not help the nurse understand the client’s situation. “Why” questions are probing and often make clients defensive, plus the client may not have an answer for this question.
If wrong: This is an example of therapeutic communication. A client who is preoccupied with physical symptoms and is “demanding” may have some psychosocial impact from the pain that is not being addressed. The nurse is providing the client the chance to explain the emotional effects of pain in addition to the physical ones. Saying the nurse wishes he or she could do more is very empathetic, but this response does not attempt to learn more about the pain. Simply telling the client when the next medication is due also does not help the nurse understand the client’s situation. “Why” questions are probing and often make clients defensive, plus the client may not have an answer for this question.

Q: The nurse is assessing a client’s pain and has elicited information on the location, quality, intensity, effect on functioning, aggravating and relieving factors, and onset and duration. What question by the nurse would be best to ask the client for completing a comprehensive pain assessment?
- “Are you worried about addiction to pain pills?”
- “Do you attach any spiritual meaning to pain?”
- “How high would you say your pain tolerance is?”
- “What pain rating would be acceptable to you?”
A: “What pain rating would be acceptable to you?”
If right: A comprehensive pain assessment includes the items listed in the question plus the client’s opinion on a functional goal, such as what pain rating would be acceptable to him or her. Asking about addiction is not warranted in an initial pain assessment. Asking about spiritual meanings for pain may give the nurse important information, but getting the basics first is more important. Asking about pain tolerance may give the client the idea that pain tolerance is being judged.
If wrong: A comprehensive pain assessment includes the items listed in the question plus the client’s opinion on a functional goal, such as what pain rating would be acceptable to him or her. Asking about addiction is not warranted in an initial pain assessment. Asking about spiritual meanings for pain may give the nurse important information, but getting the basics first is more important. Asking about pain tolerance may give the client the idea that pain tolerance is being judged.

Q: The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client. What information provided by the nurse is most appropriate for the client’s long-term outcome?
- “At least you know that the pain after surgery will diminish quickly.”
- “Discuss acceptable pain control after your operation with the surgeon.”
- “Opioids often cause nausea but you won’t have to take them for long.”
- “The nursing staff will give you pain medication when you ask them for it.”
A: “Discuss acceptable pain control after your operation with the surgeon.”
If right: The best outcome after a surgical procedure is timely and satisfactory pain control, which diminishes the likelihood of chronic pain afterward. The nurse suggests that the client advocate for himself and discuss acceptable pain control with the surgeon. Stating that pain after surgery is usually short lived does not provide the client with options to have personalized pain control. To prevent or reduce nausea and other side effects from opioids, a multimodal pain approach is desired. For acute pain after surgery, giving pain medications around the clock instead of waiting until the client requests it is a better approach.
If wrong: The best outcome after a surgical procedure is timely and satisfactory pain control, which diminishes the likelihood of chronic pain afterward. The nurse suggests that the client advocate for himself and discuss acceptable pain control with the surgeon. Stating that pain after surgery is usually short lived does not provide the client with options to have personalized pain control. To prevent or reduce nausea and other side effects from opioids, a multimodal pain approach is desired. For acute pain after surgery, giving pain medications around the clock instead of waiting until the client requests it is a better approach.

Q: An older client who lives alone is being discharged on opioid analgesics. What action by the nurse is most important?
- Discuss the need for home health care.
- Give the client follow-up information.
- Provide written discharge instructions.
- Request a home safety assessment.
A: Request a home safety assessment.
If right: All these activities are appropriate when discharging a client whose needs will continue after discharge. A home safety assessment would be most important to ensure the safety of this older client.
If wrong: All these activities are appropriate when discharging a client whose needs will continue after discharge. A home safety assessment would be most important to ensure the safety of this older client.

Q: An older adult has diabetic neuropathy and often reports unbearable foot pain. About which medication would the nurse plan to educate the client?
- Desipramine (Norpramin)
- Duloxetine (Cymbalta)
- Morphine sulfate
- Nortriptyline (Pamelor)
A: Duloxetine (Cymbalta)
If right: Antidepressants and anticonvulsants often are used for neuropathic pain relief. Morphine would not be used for this client. However, older adults do not tolerate tricyclic antidepressants very well, which eliminates desipramine and nortriptyline. Duloxetine would be the best choice for this older client.
If wrong: Antidepressants and anticonvulsants often are used for neuropathic pain relief. Morphine would not be used for this client. However, older adults do not tolerate tricyclic antidepressants very well, which eliminates desipramine and nortriptyline. Duloxetine would be the best choice for this older client.

Q: An emergency department (ED) manager wishes to start offering clients nonpharmacologic pain control methodologies as an adjunct to medication. Which strategy would be most successful with this client population?
- Listening to music on a headset
- Participating in biofeedback
- Playing video games
- Using guided imagery
A: Listening to music on a headset
If right: Listening to music on a headset would be the most successful cognitive-behavioral pain control method for several reasons. First, in the ED, the nurse does not have time to teach clients complex modalities such as guided imagery or biofeedback. Second, clients who are anxious and in pain may not have good concentration, limiting the usefulness of video games. Playing music on a headset only requires the client to wear the headset and can be beneficial without strong concentration. A wide selection of music will make this appealing to more people.
If wrong: Listening to music on a headset would be the most successful cognitive-behavioral pain control method for several reasons. First, in the ED, the nurse does not have time to teach clients complex modalities such as guided imagery or biofeedback. Second, clients who are anxious and in pain may not have good concentration, limiting the usefulness of video games. Playing music on a headset only requires the client to wear the headset and can be beneficial without strong concentration. A wide selection of music will make this appealing to more people.

Q: A student nurse learns that there are physical consequences to unrelieved pain. Which factors are included in this problem? <b>(Select all that apply.)</b>
- Decreased immune response
- Development of chronic pain
- Increased gastrointestinal (GI) motility
- Possible immobility
- Slower healing
A: Decreased immune response; Development of chronic pain; Possible immobility; Slower healing
If right: There are many physiologic impacts of unrelieved pain, including decreased immune response; development of chronic pain; decreased GI motility; immobility; slower healing; prolonged stress response; and increased heart rate, blood pressure, and oxygen demand.
If wrong: There are many physiologic impacts of unrelieved pain, including decreased immune response; development of chronic pain; decreased GI motility; immobility; slower healing; prolonged stress response; and increased heart rate, blood pressure, and oxygen demand.

Q: A student nurse asks why several clients are getting more than one type of pain medication instead of very high doses of one medication. What response by the registered nurse is best?
- “A multimodal approach is the preferred method of control.”
- “Doctors are much more liberal with pain medications now.”
- “Pain is so complex it takes different approaches to control it.”
- “Clients are consumers and they demand lots of pain medicine.”
A: “Pain is so complex it takes different approaches to control it.”
If right: Pain is a complex phenomenon and often responds best to a regimen that uses different types of analgesia. This is called a multimodal approach. Using this terminology, however, may not be clear to the student if the terminology is not understood. Doctors may be more liberal with pain medications, but that is not the best reason for this approach. Saying that clients are consumers who demand medications sounds as if the nurse is discounting their pain experiences.
If wrong: Pain is a complex phenomenon and often responds best to a regimen that uses different types of analgesia. This is called a multimodal approach. Using this terminology, however, may not be clear to the student if the terminology is not understood. Doctors may be more liberal with pain medications, but that is not the best reason for this approach. Saying that clients are consumers who demand medications sounds as if the nurse is discounting their pain experiences.