3. Turning patients every 2 hours prevents pressure ulcers because:
1. Relieving weight on the capillaries allows oxygen to reach body cells 2. Moving promotes muscle contractions that increase the basal metabolic rate 3. Keeping the extremities dependent allows blood to flow to distal cells by gravity 4. Dropping of the abdominal organs by gravity relieves pressure against the
diaphragm
20 FUNDAMENTALSSUCCESS: A Q & A REVIEWAPPLYINGCRITICALTHINKING TOTESTTAKING
CRITICAL-THINKING STRATEGY
Recognize keywords.
Recognize who the client is.
Ask what the question is asking.
Critically analyze options in relation to the question.
Eliminate incorrect options.
Turningpatients every 2 hours prevents pressure ulcers because:
The patient is the client.
How does turning a patient prevent a pressure ulcer?
The word in the stem that indicates that this is a comprehension-level question is prevents.
What is the consequence of turning patients every 2 hours?
You need to scrutinize each option to identify whether the description in the option correctly explains how turning a patient relieves pressure and prevents a pressure ulcer.
Rationales:
1. Capillary beds are compressed and blood flow is obliterated with excessive external pressure (12 to 32 mm Hg). Changing position removes the weight of the body off dependent areas, permitting blood to flow through the capillaries and supporting gaseous exchange at the cellular level.
2. Muscle contraction expends energy that raises the basal metabolic rate; however, this is unrelated to the development of pressure ulcers.
3. Blood flow to the extremities will increase when they are kept below the level of the heart; however, this is unrelated to the development of pressure ulcers.
4. Relieving pressure against the diaphragm by abdominal organs allows for greater thoracic expansion; however, this is unrelated to the development of pressure ulcers.
Options 2, 3, and 4 do not accurately explain how turning relieves pressure thereby preventing a pressure ulcer and can be eliminated.
are parts of your day that are routine, every day you are exposed to new, challenging experi- ences. The same concept holds true for application questions. With application questions you will be confronted by situations that you learned about in a book, experienced personally, re- lived through other students’ experiences, or never heard about or experienced before. This will happen throughout your entire nursing career. The challenge of answering application questions is going beyond rules and regulations and using information in a unique, creative way. See TEST SUCCESS: Test-Taking Techniques for Beginning Nursing Students for specific study techniques related to application-level questions.
U
SE AC
RITICAL-T
HINKINGS
TRATEGY TOA
NSWERA
PPLICATION- L
EVELQ
UESTIONS1. A patient complains about not having had a bowel movement in 3 days. Which classification of drugs is most helpful in relieving this problem?
1. Stool softener 2. Cardiac glycoside 3. Histamine H2antagonist 4. Calcium channel blocker
CHAPTER1 FUNDAMENTALS OFCRITICALTHINKINGRELATED TOTESTTAKING 21
CRITICAL-THINKING STRATEGY
Recognize keywords.
Recognize who the client is.
Ask what the question is asking.
Critically analyze options in relation to the question.
Eliminate incorrect options.
A patient complains about not having a bowel move- ment in 3 days.Which classificationof drugis most helpfulin relievingthis problem?
The patient is the client.
Which classification of drugs is most helpful in facilitating defecation?
The words in the stem that indicate that this is an application question are most helpful in relieving.
To choose which classification of drugs will be most helpful in relieving this patient’s problem, you must know that a patient who has not had a bowel move- ment in 3 days may be constipated, the therapeutic action and outcome of various classifications of drugs, and which classification of drugs would be helpful in relieving constipation.
Rationales:
1. Docusate sodium (Colace) is a stool softener. It increases water and fat penetration of feces, which softens the stool.
2. Cardiac glycosides increase the force of cardiac contractions which increases the cardiac output (positive inotropic effect) and decrease electrical conduction in the heart, which decreases the heart rate (positive dromotropic effect). Docusate sodium (Colace) is not a cardiac glycoside.
3. Histamine-2 (H2) antagonists inhibit histamine at H2 receptor sites in parietal cells, which inhibits gastric acid secretion. Docusate sodium (Colace) is not an H2antagonist.
4. Calcium channel blockers inhibit calcium ion influx across cell membranes during cardiac depolarization.
They relax coronary vascular smooth muscles, dilate coronary and peripheral arteries, and slow sinoatrial/
atrioventricular node conduction times. Docusate sodium (Colace) is not a calcium channel blocker.
Because options 2, 3, and 4 are not the name of the classification of docusate sodium (Colace) they can 2779_Ch01_001-028.qxd 8/10/11 5:33 PM Page 21
2. A patient scheduled for major surgery, who is perspiring and nervously picking at the bed linen, says, “I don’t know if I can go through with this surgery.” The nurse re- sponds, “You’d rather not have surgery now?” Which interviewing technique was used by the nurse?
1. Focusing 2. Reflection 3. Paraphrasing 4. Clarification
22 FUNDAMENTALSSUCCESS: A Q & A REVIEWAPPLYINGCRITICALTHINKING TOTESTTAKING
CRITICAL-THINKING STRATEGY
Recognize keywords.
Recognize who the client is.
Ask what the question is asking.
Critically analyze options in relation to the question.
Eliminate incorrect options.
A patient scheduled for major surgery, who is perspir- ing and nervously picking at the bed linen, says, “I don’t know if I can go through with this surgery.”
The nurse responds, “You’d rather not have surgery now?” Which interviewing technique was usedby the nurse?
The patient is the client.
What interviewing technique is being used by the nurse when the nurse says in response to the pa- tient, “You’d rather not have surgery now?”
The words in the stem that indicate that this is an ap- plication question are was used.
To identify which technique was used by the nurse you have to understand the elements of a paraphras- ing statement and you need to be able to recognize a paraphrasing statement when it is used. Although it is helpful to understand the elements of the other interviewing techniques because it will help you eliminate incorrect options, it is not necessary to understand this information to answer the question.
Rationales:
1. The example in the stem is not using focusing because the patient’s statement was short and contained one message that was reiterated by the nurse. Focusing is used to explore one concern among many statements made by the patient.
2. The example in the stem is not using reflection be- cause the nurse’s statement is concerned with the content, not the underlying feeling, of the patient’s statement. An example of reflection used by the nurse is, “You seem anxious about having major surgery.”
3. The nurse used paraphrasing because the patient’s and nurse’s statements contain the same message but they are expressed with different words.
4. The example in the stem is not using clarification.
When clarification is used, the nurse is asking the patient to further explain what is meant by the pa- tient’s statement. An example of clarification used by the nurse is, “I am not quite sure that I know what you mean when you say you would rather not have surgery now.”
Options 1, 2, and 4 can be eliminated because these techniques are different from the technique portrayed in the nurse’s response in the stem.
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3. The nurse identifies that a patient on prolonged bed rest may be developing a pres- sure ulcer when the skin over a bony prominence appears:
1. Red 2. Blue 3. Black 4. Yellow
CHAPTER1 FUNDAMENTALS OFCRITICALTHINKINGRELATED TOTESTTAKING 23
CRITICAL-THINKING STRATEGY
Recognize keywords.
Recognize who the client is.
Ask what the question is asking.
Critically analyze options in relation to the question.
Eliminate incorrect options.
The nurse identifies that a patient may be developing a pressure ulcerwhen the skinover a bony prominenceappears:
The patient is the client.
Which early sign indicates a pressure ulcer caused by immobility?
The words in the stem that indicate this is an applica- tion question are identifiesand developing pressure ulcer.
To answer this question you have to understand how and why pressure can cause a pressure ulcer and know the common early sign that indicates the for- mation of a pressure ulcer.
Although it is helpful to know what is happening when the skin reflects each of the colors indicated so that you can eliminate incorrect answers, it is not neces- sary to comprehend this information to answer the question.
Rationales:
1. Erythema is a red discoloration generally caused by local vasodilation in an attempt to bring more oxygen to the area.
2. Cyanosis is a bluish color caused by an increased amount of deoxygenated hemoglobin associated with hypoxia not pressure.
3. Eschar generally appears black and is the scab or dry crust that results from death of tissue.
4. Jaundice is a yellow-orange color caused by increased deposits of bilirubin in tissue, not a response to pressure.
Options 2, 3, and 4 are not early signs of a pressure ulcer and are incorrect answers. They can be eliminated.