Medical-Surgical Nursing I Student Chapter 1-2

Chapter 1
The Nurse’s Role in Adult Health

Nursing
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Defined
• The profession that “[assists] the individual, sick or well,

in the performance of those activities contributing to
health or its recovery (or to peaceful death) that he
would perform unaided if he had the necessary strength,
will or knowledge” (Henderson, 1996)
• “The diagnosis and treatment of human responses to
health and illness” (ANA, 2003)

The Nursing Profession
• 2.5 million nurses as of 2008

• Ruled by a code of ethics
• Roles are specified by “scope of practice” legislation

Question
• Is the following statement true or false?

• The scope of practice specifies particular interventions
that are appropriate for patients who have specific
medical and nursing diagnoses.

Answer
Scope of practice is used to delineate actions that are
legally permitted for a particular profession based on
specific educational qualifications. It does not specify
particular interventions that are appropriate for particular
clinical situations

Nursing Roles
• Advanced practitioner
• Nursing leader
• Nurse researcher

The Patient
• The nurse’s primary function is to obtain an

understanding of the patient’s situation and identify the
patient’s immediate needs in order to address them

Maslow’s Hierarchy of Needs

Question
• The nurse is helping a patient and her family in planning

the patients’ return to work after a surgery. Which level
of Maslow’s hierarchy of basic needs does the patient’s
need for self-fulfillment fit on?
A. Physiologic
B. Safety and security
C. Love and belonging
D. Self-actualization

Answer
Rationale: Maslow’s highest level of human needs is self-
actualization, which includes self-fulfillment, the desire to
know and understand, and aesthetic needs

Health and Wellness
• Health: The “state of complete physical, mental, and

social well-being and not merely the absence of disease
and infirmity” (WHO, 1948)
• Wellness: Implies a proactive process toward a goal of
physical, psychological, and spiritual well-being in which
people of any age and in various stages of health are
willing to “work hard” (Kiefer, 2008)
– Increasing emphasis is placed on health, health
promotion, wellness, and self-care

Models of Nursing Care
• Patient- and family-centered care

– A model in which the patient and family are cared for
by an interdisciplinary group of health care
professionals, with the active participation of the
patient and family and their collaboration in
informed decision making

Influences on Health Care Delivery
• Immigration
• Aging population
• Changing patterns of disease
• Advances in technology

Influences on Health Care Delivery
(cont’d)
• Regulatory bodies
– Occupational Health and Safety Administration
– The Joint Commission
– Centers for Medicare and Medicaid Services
– Department of Public Health
• Professional societies and associations
• Hospitals and institutions
• Individual employees
• Economics

Question
• The Occupational Health and Safety Administration is

responsible for:
A.Ensuring safe working environments
B.Establishing treatment standards to guide nursing
practice
C.Promoting health in the American population
D.Defining health goals and outcomes

Answer
Rationale: The role of the Occupational Health and Safety
Administration (OSHA) is to promote the safety and health
of working people by setting and enforcing standards,
providing training, outreach, and education, establishing
partnerships, and encouraging continual process
improvement in workplace safety and health

Economics
• Hospitals are placing a greater emphasis on reducing
costs, monitoring utilization of services, and limiting length
of stay
– Diagnosis-related groups (DRGs) – Medicare has a
fixed-rate reimbursement payment for hospital
services based on the patient’s admitting diagnosis
• If patient costs are less than the payment, the
hospital makes a profit
• If patient costs are more than the payment, the
hospital incurs a loss

Nursing Care
• Nurses in hospitals care for patients who are older and
sicker and require more nursing services
• Community nurses care for patients who have been
discharged earlier and need high-technology acute care
services as well as long-term care
• Discharge planning, along with utilization review and
quality improvement is important
• Nurses in acute care settings must work with other health
care team members to maintain quality care while facing
pressures to discharge patients earlier and decrease costs

NCLEX-Style Review Questions
Under the Occupational Safety and Health Act (OSHA) of
1970, employers are responsible for providing a safe and
healthy workplace for their employees. Which of the following
would be inconsistent with the role of OSHA?
a.Financial assistance
b.Outreach
c.Education
d.Establishing partnerships

Rationale: The role of the Occupational Health and Safety
Administration (OSHA) is to promote the safety and health
of working people by setting and enforcing standards,
providing training, outreach, and education, establishing
partnerships, and encouraging continual process
improvement in workplace safety and health.

Nursing has evolved from the hospital or home care of the
individual during illness to caring for individuals,
communities, and populations across the health care
continuum. Which of the following necessitated changes in
models of nursing care?
a.Less individuals with chronic disease
b.Increased aging population
c.Less inpatient settings
d.Lengthened hospital stays

Rationale: Shortened hospital stays combined with
economic constraints, an aging population, and a greater
number of individuals with chronic disease have
necessitated changes in models of nursing care to those
best suited to a particular population or setting.

Which of the following entities is charged with the
protection of health and well-being of the state’s population
and environment?
a.Joint Commission
b.Occupational Health and Safety Administration
c.Department of Public Health
d.Centers of Medicare and Medicaid Services

Rationale: The Department of Public Health (DPH) is generally
charged with the protection of the health and well-being of the state’s
population and environment. The Joint Commission is a nonprofit
organization whose mission is to “continuously improve the safety and
quality of care provided to the public through the provision of health
care accreditation and related services that support performance
improvement in health care organizations.” The role of the
Occupational Health and Safety Administration (OSHA) is to provide a
safe and healthy workplace for their employees. The Centers of
Medicare and Medicaid Services (CMS) is the federal agency that
manages Medicare, which is the health insurance program for people
over 65 years of age, people with certain disabilities under age 65,
and those with end-stage renal disease (ESRD).

Based on DRGs, prospective payment sets the rates of reimbursement
for hospital services for Medicare patients. Which of the following is an
accurate statement regarding the use of DRGs?
a.If the cost of the patient’s care is lower than the payment, the
hospital takes a loss.
b.If the cost of the patient’s care is higher than the payment, the
hospital takes a loss.
c.Hospitals receive various payments for every patient with a given
diagnosis.
d.If the cost of the patient’s care is higher than the payment, the
hospital makes a profit.

Rationale: Hospitals receive the same payment for every
patient with a given diagnosis, or who falls within a given
DRG. If the cost of the patient’s care is lower than the
payment, the hospital makes a profit; if the cost is higher,
the hospital incurs a loss. As a result, hospitals are placing
greater emphasis on reducing costs, monitoring utilization
of services, and limiting length of patient stay.

Nurses should consider their own cultural orientation when
interacting with patients. Which of the following is a
technique that can be used to overcome a language barrier
when interacting with a patient?
a.Talk loudly so that the patient will understand.
b.Give the patient a substantial amount of information.
c.Give instructions in proper sequence.
d.Talk directly to the person that accompanied the patient.

Rationale: Give the patient instructions in proper
sequence. Speak in a low, moderate voice. Avoid talking
loudly. Discuss one topic at a time, and avoid giving too
much information in a single conversation. Talk directly to
the patient rather than to the person who accompanied him
or her.

Chapter 2
Health Education and Health

Promotion

Health Education
• An independent function of nursing practice and a

primary nursing responsibility
• Nurses must use opportunities in all health care settings
to promote wellness.

Trends in Health Education
• Patients are being encouraged to play an active role in

the care and information they receive
• Supported by numerous programs
• Goal of patient and family education is to improve patient
outcomes
– Often through encouraging adherence
– Especially important for those with chronic health
problems

Readiness to Learn
• This must be assessed prior to teaching
• Health literacy: “a complex group of reading, listening,
analytical, and decision-making skills, and the ability to apply
these to health situations” (NNLM, 2010)
• As many as 90 million people in the United States lack these
skills
– Especially among older adults, immigrants, low-income
individuals, those with chronic diseases
– See Box 2-1 for strategies to implement with older adults.

Therapeutic Regimen
• One of the goals of patient education is to encourage people to adhere to
their therapeutic regimen.
• Adherence to treatment usually requires that a person make one or more
lifestyle changes to carry out specific activities that promote and
maintain health.
– Taking prescribed medications
– Maintaining a healthy diet
– Increasing daily activities
– Practicing specific hygiene measures
– Seeking recommended health evaluations and screenings
– Performing other therapeutic and preventive measures

Question
• Older adults often do not adhere to a therapeutic

regimen. What strategy is most likely to promote
adherence to an older patient’s therapeutic regimen after
surgery?
A.Demonstrate a dressing change and allow the patient to
practice
B.Provide a pamphlet on a dressing change
C.Verbally instruct the patient how to change a dressing
D.Have a family member change the dressing

Answer
Rationale: Health education that includes visual, tactile and
interactive elements is most likely to result in learning,
especially among older adults. Engaging the patient himself
or herself is more beneficial than deferring to a family
member.

Nursing Process: Patient Teaching
• The health education process utilizes the nursing process:
1.Begin by assessing learning readiness
– Identify any potential barriers to communication
2.Identify relevant nursing diagnoses
3.Planning
– Identify goals, strategies, and desired outcomes.
– Choose an appropriate setting and appropriate timing.

Nursing Process: Implementation
4. Utilize a variety of techniques to maximize learning:
– Lecture
– Discussion
– Group learning
– Multimedia
– Written material
– Demonstration

Question
• The nurse is planning to teach a patient about administering
her new asthma medication. How can the nurse enhance the
patient's ability to learn?
A.Provide a list of websites that contain information related to
the medication
B.Exclude family members from the session to minimize
distractions
C.Use color-coded materials
D.Make the information relevant to the patient’s condition and
needs

Answer
Rationale: Identifying a link between the patient’s interests
and the material to be taught enhances learning. Family
members should not normally be excluded from health
education. Websites can be a useful source of information,
but providing a list of these does not enhance learning.

5. Evaluation
– It cannot be assumed that patients have learned just
because teaching has occurred
– Apply measurements—ideally more than one

• Patients remember information in the following ratios:
– 10% of what they read
– 25% of what they hear
– 45% of what they see
– 65% of what they hear and see
– 70% of what they say and write
– 90% of what they say as they perform a task

Question
• Is the following statement true or false?

• The most accurate way to evaluate whether learning has
taken place is to observe for a change in the patient’s
behavior.

Answer
Rationale: An observable change in a patient’s behavior is
often the most clear indication that the patient has learned
and integrated new information.

Health Promotion
• Defined as “the process of enabling people to increase

control over their health and its determinants thereby
improving their health” (WHO, 2009)
• The concept has evolved because of a changing definition
of health and an awareness that wellness exists at many
levels of functioning
• Includes an element of self-responsibility
• Health promotion occurs throughout the lifespan and
activities should be planned accordingly

Question
• Which of the following is the best example of health
promotion teaching?
A.Demonstrating an injection technique to a patient for
anticoagulant therapy
B.Explaining the side effects of a medication to an adult
patient
C.Discussing the importance of preventing sexually
transmitted infections to a group of high school students
D.Instructing an adolescent patient about her allergies

Answer
Rationale: Disease prevention through lifestyle changes is a
key focus of health promotion. Education about
medications and diagnoses is important for many
individuals, but this does not clearly demonstrate the
proactive focus of health promotion.

A nurse is providing discharge teaching for an elderly patient
who is fully dressed, watching television, and waiting for
family. The nurse sits in a chair facing the patient and shows
the patient a handout. The patient squints while reading and
periodically looks at the television. The nurse is about to
review the information and determine the patient’s
understanding of the material when the family enters the
room. The nurse determines the need for further education
due to learning barriers. Which barriers affected the patient’s
ability to comprehend the information? Select all that apply.

a. The patient is elderly.
b. The patient squints while reading.
c. The family entered the room while teaching.
d. The patient is fully dressed.

Rationale: The patient’s attention is distracted by the
television and the arrival of family. The patient is also
giving a visual queue that they are having trouble reading
the material. It is important to remember that age alone is
not an intrinsic barrier.

The nurse is to provide discharge teaching to a patient with newly diagnosed
coronary artery disease. In what order should the following steps be prioritized
and completed?
a.Implement teaching plan.
b.Collect and analyze data regarding the patient’s knowledge of coronary artery
disease.
c.Form education nursing diagnoses.
d.Reassess patient’s knowledge as needed.
e.Develop teaching plan.
f.Identify learning needs.
g.Update and change plan.

Rationale: This follows the order of the nursing process,
assessment, diagnosis, planning, implementation and
evaluation, remembering that it is an iterative process.

The nurse is discussing postoperative discharge instructions
with an Asian American patient. The patient looks at the
floor, smiles, and then nods his head. The nurse interprets
this behavior as which of the following?
a.Acceptance of the instructions
b.Understanding of the material
c.A reflection of cultural values
d.The patient’s ability to follow through on the instructions

Rationale: Each culture has a basic response to authority
and stress.

When constructing a teaching plan, steps of the nursing
process are utilized. In which step are teaching strategies
identified?
a.Assessment
b.Planning
c.Implementation
d.Evaluation

Rationale: In the planning phase, teaching strategies for
goal attainment are identified. During assessment, the
readiness to learn is identified. In the implementation
phase, the teaching plan is put into action. Behavioral
responses are compared to expected outcomes during the
evaluation phase.

Which of the following is an accurate statement with
regards to adult learner readiness?
a.Learning readiness is based solely on past life
experiences.
b.Physical skills play little role in learner readiness.
c.Experimental readiness is not related to emotional
readiness.
d.It is based on culture, attitude, and personal values.

Rationale: For adults, readiness is based on culture,
attitude, personal values, physical and emotional status,
and past experiences in learning. Many behaviors required
for reaching maximal health potential require knowledge,
physical skills, and positive attitudes. Experimental
readiness is closely related to emotional readiness, because
motivation tends to be stimulated by an appreciation for
the need to learn.

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Chapter 1

The Nurse’s Role in Adult Health

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The profession that “[assists] the individual, sick or well,

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• 2.5 million nurses as of 2008

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Is the following statement true or false?

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The nurse’s primary function is to obtain an

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The nurse is helping a patient and her family in planning

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Health: The “state of complete physical, mental, and

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Patient- and family-centered care

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The Occupational Health and Safety Administration is

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Education and Health

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• An independent function of nursing practice and a

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Patients are being encouraged to play an active role in

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Older adults often do not adhere to a therapeutic

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Is the following statement true or false?

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Defined as “the process of enabling people to increase

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins