Chapter 4: Theoretical Foundations of Nursing Practice

Test Bank
MULTIPLE C!ICE
1. The nursing instructor is teaching a class on nursing theory. One of the students asks, Why
do we need to know this stuff? It doesnt really affect patients. The instructors est response
would e
a
.
!ou are correct, ut we ha"e to learn it anyway.

.
#$posure to theories will help you later in graduate school.
c
.
Theories help keep the focus of nursing narrow.
d
.
Theories help e$plain why nurses do what they do.
%&'( )
Theories offer well*grounded rationales or reasons for how and why nurses perfor+ specific
inter"entions. ,earning aout theories is i+portant ecause these theories help to descrie,
e$plain, predict, and-or prescrie nursing care +easures. %lthough nursing theory will help the
nurse in graduate school, it is also an i+portant asis for the nurses approach to daily patient
care, and it e$pands scientific knowledge of the profession.
)I.( /nderstand 0#.( 12
O34( #$plain the influence of nursing theory on a nurses approach to practice.
TO5( #"aluation 6'7( Teaching-,earning
8. The nurse is caring for a patient who is known as a fre9uent flyer, and who has een laeled
as nonco+pliant y +ost of the staff ecause she does not follow her prescried regi+en for
diaetes +anage+ent. %s a prescrier to Ore+s theory, the nurse inter"iews the patient in an
atte+pt to identify the cause of the patients nonco+pliance. This is ecause Ore+s theory
a
.
Is useful in designing inter"entions to pro+ote self*care.

.
)oes not allow for en"iron+ental influences on care.
c
.
%llows for de"elop+ent of a plan of care that the patient +ust follow.
d
.
Is not useful in pro+oting self*care regi+ens.
%&'( %
Ore+s theory e$plains the factors within a patients li"ing situation that support or interfere
with the patients self*care aility. This theory has "alue in helping nursing design
inter"entions with the patient that will help to pro+ote the patients self*care in +anaging an
illness, such as diaetes or arthritis.
)I.( /nderstand 0#.( 11
O34( #$plain the influence of nursing theory on a nurses approach to practice.
TO5( I+ple+entation 6'7( 7aring
:. The type of theory that is used to de"elop and test specific nursing inter"entions is known as
;;;;; theory.
a
.
<rand

.
5rescripti"e
c
.
)escripti"e
d
.
6iddle*range
%&'( 3
5rescripti"e theories are action oriented and test the "alidity and predictaility of a nursing
inter"ention. These theories guide nursing research to de"elop and test specific nursing
inter"entions. <rand theories are road in scope and co+ple$, and re9uire further
specification through research. )escripti"e theories do not direct specific nursing acti"ities ut
help to e$plain patient assess+ent. The pheno+ena within +iddle*range theories tend to cross
different nursing fields and reflect a wide "ariety of nursing care situations.
)I.( =nowledge 0#.( 18 O34( )escrie types of nursing theories.
TO5( I+ple+entation 6'7( 7aring
1. The nurse researcher is e"aluating whether holding pressure at an in>ection site after in>ecting
the anticoagulant eno$aparin ?,o"eno$@ will reduce ruising at the in>ection site. This study
in"ol"es a prescripti"e theory ecause it
a
.
Tests a specific nursing inter"ention.

.
#$plains why ruising occurs.
c
.
Is road in scope and co+ple$.
d
.
0eflects a wide "ariety of nursing care situations.
%&'( %
5rescripti"e theories guide nursing research to de"elop and test specific nursing inter"entions.
<rand theories are road in scope and co+ple$, and re9uire further specification through
research. )escripti"e theories do not direct specific nursing acti"ities ut help to e$plain
patient assess+ent. The pheno+ena within +iddle*range theories tend to cross different
nursing fields and reflect a wide "ariety of nursing care situations.
)I.( /nderstand 0#.( 18 O34( )escrie types of nursing theories.
TO5( I+ple+entation 6'7( 7aring
A. The student nurse is learning nursing theories ut fails to see how they relate to the nursing
process. The professional nurse realiBes that nursing theory
a
.
Cas a +inor role in professional nursing.

.
0e9uires the nursing process to de"elop knowledge.
c
.
7an direct how a nurse uses the nursing process.
d
.
is specific to certain patients only.
%&'( 7
&ursing theory can direct how a nurse uses the nursing process. Integration of theory into
practice ser"es as the asis for professional nursing. The nursing process pro"ides a
syste+atic process for the deli"ery of care, not the knowledge co+ponent of the discipline.
/seful theories are adaptale to different patients and to all care settings.
)I.( /nderstand 0#.( 1:
O34( )escrie the relationship etween theory, the nursing process, and patient needs.
TO5( I+ple+entation 6'7( 7aring
D. % syste+ is +ade up of separate co+ponents. % closed syste+
a
.
Interacts with the en"iron+ent.

.
Is e$e+plified y the hu+an organis+.
c
.
)oes not interact with the en"iron+ent.
d
.
Is e$e+plified y the nursing process.
%&'( 7
Two types of syste+s ha"e een identified( open and closed. %n open syste+, such as a
hu+an organis+ or processes like the nursing process, interacts with the en"iron+ent. %
closed syste+ does not interact with the en"iron+ent.
)I.( =nowledge 0#.( 1: O34( )iscuss selected theories fro+ other disciplines.
TO5( %ssess+ent 6'7( &ursing 5rocess
E. The nurse is caring for a patient diagnosed with essential hypertension. The physician orders
lood pressure +edication that the nurse ad+inisters. The nurse then +onitors the patients
lood pressure for se"eral days to help deter+ine the effecti"eness of the ad+inistration. In
doing so, the nurse e"aluates which of the following syste+ co+ponents?
a
.
Input

.
Output
c
.
.eedack
d
.
7ontent
%&'( 3
Output is the end product of a syste+ and, in the case of the nursing process, it is defined as
whether the patients health status i+pro"es or re+ains stale as a result of nursing care. Input
consists of the data that co+e fro+ a patients assess+ent. .eedack ser"es to infor+ a syste+
aout how it functions. 7ontent is the product and infor+ation otained fro+ the syste+.
)I.( /nderstand 0#.( 1: O34( )iscuss selected theories fro+ other disciplines.
TO5( I+ple+entation 6'7( 7aring
F. The patient is ad+itted to the I7/ to rule out a +yocardial infarction ?6I@. )uring the
ad+ission process, the patient is noted to ha"e a history of +ethicillin*resistant
Staphylococcus aureus ?60'%@ and is placed in isolation until cultures can e otained and
the patient declared noninfectious. )uring the isolation process, the nurse encourages fa+ily
"isits, realiBing that which le"el of 6aslows hierarchy of needs is at risk?
a
.
.irst le"el

.
'econd le"el
c
.
Third le"el
d
.
.ourth le"el
e
.
.ifth le"el
%&'( 7
The third le"el contains lo"e and elonging needs, including friendship, social relationships,
and se$ual lo"e. The first le"el includes physiological needs. The second le"el includes safety
and security needs. The fourth le"el enco+passes estee+ and self*estee+ needs. The fifth and
final le"el is the need for self*actualiBation.
)I.( /nderstand 0#.( 1: O34( )iscuss selected theories fro+ other disciplines.
TO5( I+ple+entation 6'7( 7aring
G. 6any aspects of nursing theory are ased on de"elop+ental theories ecause hu+an growth
and de"elop+ent is elie"ed to e
a
.
#rratic and difficult to predict.

.
%n orderly predicti"e process.
c
.
%n orderly process until adulthood.
d
.
/npredictale during childhood.
%&'( 3
Cu+an growth and de"elop+ent is an orderly predicti"e process that egins with conception
and continues through death. It is not erratic or difficult to predict. It does not stop at
adulthood and is not unpredictale during childhood.
)I.( /nderstand 0#.( 11 O34( )iscuss selected theories fro+ other disciplines.
TO5( I+ple+entation 6'7( 7aring
12. The nurse is +aking rounds and finds her older adult patient soing and o"iously upset. 'he
states that her doctor told her that she has cancer, and she does not want to die. Whats the
sense? she says. I +ight as well die. I+ going to anyway. I guess that shows how useless I
really a+. &oody wants an old lady around. The nurse notices that the patients respirations
ha"e increased, and the tip of her nose and ear loes are eco+ing cyanotic. The nurse
assesses the patient and finds that the patients pulse rate is o"er 1A2 eats per +inute.
%ccording to 6aslows hierarchy of needs, the nurse should first
a
.
7all the physician to re9uest a psychiatric consult.

.
0eassure the patient that she has "alue as a hu+an eing.
c
.
5lace the patient on o$ygen and try to cal+ her.
d
.
7all the patients fa+ily to help her realiBe that she is wanted.
%&'( 7
6aslows hierarchy is useful in setting patient priorities. 3asic physiological and safety needs
are usually the first priority. These include physiological needs such as air, water, and food.
7yanosis and fast heart rate are indicators of physiological stress and +ust e dealt with first,
or the patient +ay not sur"i"e. The second le"el includes psychological security. % psychiatric
consult would co+e after physiological stailiBation. The third le"el includes lo"e and
elonging needs that would also need to e addressed, and the fa+ily +ay e helpful in
dealing with this, once the patient is stailiBed. The fourth le"el in"ol"es self*estee+, which
would also need to e addressed.
)I.( %pply 0#.( 1: O34( )iscuss selected theories fro+ other disciplines.
TO5( I+ple+entation 6'7( 7aring
11. %s the initial +odel for nursing, &ightingales descripti"e theory encouraged nurses to
a
.
=now all aout the disease processes affecting their patient.

.
Think aout their patients and patients en"iron+ent.
c
.
7o+ine nursing knowledge with +edicine.
d
.
.ocus on +edication ad+inistration and treat+ents.
%&'( 3
&ightingales descripti"e theory pro"ides nurses with a way to think aout patients and their
en"iron+ent. &ightingales concept of the en"iron+ent was the focus of nursing care, and her
suggestion that nurses need not know all aout the disease process represents early atte+pts to
differentiate etween nursing and +edicine. &ightingale did not "iew nursing as li+ited to the
ad+inistration of +edications and treat+ents.
)I.( /nderstand 0#.( 11 O34( )iscuss selected nursing theories.
TO5( I+ple+entation 6'7( 7aring
18. The nurse is "isiting a patient at ho+e after he was discharged fro+ the hospital following a
heart attack. 'he listens to the patients concerns aout eing an in"alid for the rest of his life
ecause of his ad heart, ut he is afraid of ha"ing open heart surgery. The nurse e$plains
the different surgical procedures that are a"ailale to the patient, as well as other options such
as cardiac rehailitation. %fter se"eral such "isits, the patient states that he elie"es that
cardiac rehailitation therapy would e est for hi+, and asks the nurse how he can get in.
The nurse calls the patients physician and sets up a referral for cardiac rehailitation. This
action +ost closely fits which of the following theories?
a
.
5eplaus theory

.
Cendersons theory
c
.
&ightingales theory
d
.
Ore+s self*care deficit theory
%&'( %
5eplaus theory focuses on the indi"idual, the nurse, and the interacti"e process or nurse*
patient relationship. <oals are to educate the patient and fa+ily and to help the patient define
the prole+ and solutions. Cendersons theory focuses on helping the patient with acti"ities
that the patient would perfor+ unaided if he or she were ale. &ightingale "iewed nursing not
as li+ited to the ad+inistration of +edications and treat+ents, ut rather as oriented toward
pro"iding fresh air, light, war+th, cleanliness, 9uiet, and ade9uate nutrition. The goal of
Ore+s theory is to help the patient perfor+ self*care.
)I.( %pply 0#.( 11 O34( )iscuss selected nursing theories.
TO5( I+ple+entation 6'7( &ursing 5rocess
1:. The nurse is caring for a patient who is acti"ely leeding. The physician orders lood
transfusions. The nurse notes in the chart that the patient is a 4eho"ahs Witness and infor+s
the patient of the physicians order. The patient states that she is a 4eho"ahs Witness and does
not want lood products. The nurse contacts the physician to tell hi+ that lood cannot e
gi"en to this patient and re9uests alternati"e treat+ent. In doing so, the nurse is operating
within which of the following theories?
a
.
,einingers cultural care di"ersity and uni"ersality theory

.
0oys adaptation theory
c
.
Watsons philosophy of transpersonal caring
d
.
Ore+s self*care deficit theory
%&'( %
The goal of ,einingers theory is to pro"ide the patient with culturally specific nursing care
that integrates the patients cultural traditions, "alues, and eliefs into the plan of care. The
goal of 0oys +odel is to help the person adapt to changes in physiological needs, self*
concept, role function, and relations. Watsons theory elie"es that the purpose of nursing
action is to understand the interrelationship etween health, illness, and hu+an eha"ior. The
goal of Ore+s theory is to help the patient perfor+ self*care.
)I.( /nderstand 0#.( 11*1D O34( )iscuss selected nursing theories.
TO5( I+ple+entation 6'7( &ursing 5rocess
11. The patient is ter+inally ill and is under hospice care. The nurse cares for the patient y
athing, sha"ing, and repositioning hi+. The fa+ily elie"es that the end is "ery near and
would like a 7atholic priest called to pro"ide the patient with the 'acra+ent of the 'ick. The
nurse places a call to the 7atholic 7hurch the patient attended and arranges for the priests
"isit. /nder which of the following theories does the nurses care fall?
a
.
0oys adaptation theory

.
Watsons philosophy of transpersonal caring
c
.
Cendersons theory
d
.
Ore+s self*care deficit theory
%&'( 7
Cenderson defines nursing as assisting the indi"idual, sick or well, in the perfor+ance of
those acti"ities that will contriute to health, reco"ery, or a peaceful death, and that the
indi"idual would perfor+ unaided if he or she had the necessary strength, will, or
knowledge. 0oys +odel is to help the person adapt to changes in physiological needs, self*
concept, role function, and relations. Watsons theory elie"es that the purpose of nursing
action is to understand the interrelationship etween health, illness, and hu+an eha"ior. The
goal of Ore+s theory is to help the patient perfor+ self*care.
)I.( /nderstand 0#.( 11*1D O34( )iscuss selected nursing theories.
TO5( I+ple+entation 6'7( &ursing 5rocess
1A. The patient is newly diagnosed with diaetes and will e discharged in the ne$t day or so. The
nurse is teaching the patient how to draw up and self*ad+inister his insulin. Which nursing
theory is the nurse utiliBing?
a
.
Watsons philosophy of transpersonal caring

.
Ore+s self*care deficit theory
c
.
0ogers theory
d
.
Cendersons theory
%&'( 3
The goal of Ore+s theory is to help the patient perfor+ self*care. In Watsons theory, the
nurse is concerned with pro+oting and restoring health and pre"enting illness. 0ogers theory
considers the indi"idual as an energy field coe$isting within the uni"erse. Cenderson defines
nursing as assisting the indi"idual, sick or well, in the perfor+ance of those acti"ities that
will contriute to health, reco"ery, or a peaceful death, and that the indi"idual would perfor+
unaided if he or she had the necessary strength, will, or knowledge.
)I.( %pply 0#.( 11*1D O34( )iscuss selected nursing theories.
TO5( I+ple+entation 6'7( &ursing 5rocess
1D. The prospecti"e nursing student is trying to decide on which nursing progra+ to attend. 'he is
e$a+ining the nursing philosophies of each progra+. 'he elie"es that the essence of nursing
is 7aring. Which of the following theories would +ost likely +eet her needs?
a
.
3enner and Wruels theory of nursing

.
0oys adaptation theory
c
.
Ore+s self*care deficit theory
d
.
0ogers theory
%&'( %
The pri+acy of caring is a +odel proposed y 5atricia 3enner and 4udith Wruel. 7aring is
central. 0oys +odel is to help the person adapt to changes in physiological needs, self*
concept, role function, and relations. The goal of Ore+s theory is to help the patient perfor+
self*care. 0ogers theory considers the indi"idual as an energy field coe$isting within the
uni"erse.
)I.( #"aluate 0#.( 11*1D O34( )iscuss selected nursing theories.
TO5( I+ple+entation 6'7( &ursing 5rocess
1E. The nursing process is
a
.
The generation of nursing knowledge for use in practice.

.
% syste+atic "iew of a pheno+enon specific to in9uiry.
c
.
% +ethod used to infor+ a syste+ aout how it functions.
d
.
% syste+atic process for the deli"ery of nursing care.
%&'( )
%lthough the nursing process is central to nursing, it is not a theory. It pro"ides a syste+atic
process for the deli"ery of nursing care. Theory generates nursing knowledge for use in
practice. %n interdisciplinary theory e$plains a syste+atic "iew of a pheno+enon specific to
the discipline of in9uiry. .eedack ser"es to infor+ a syste+ aout how it functions.
)I.( =nowledge 0#.( 1: O34( )escrie theory*ased nursing practice.
TO5( %ssess+ent 6'7( &ursing 5rocess
1F. &ursing has its own ody of knowledge that is oth theoretical and practical. Which of the
following is an e$a+ple of theoretical knowledge?
a
.
0eflection on care e$periences

.
'ynthesis and integration of the art and science of nursing
c
.
0eflection on asic "alues and principles
d
.
7reating a narrow understanding of nursing practice
%&'( 7
Theoretical knowledge includes and reflects on the asic "alues, guiding principles, ele+ents,
and phases of nursing. The goals of theoretical knowledge are to sti+ulate thinking and create
a road understanding of the science and practices of the nursing discipline. 5ractical
knowledge is achie"ed through personal knowing gained through reflection on care
e$periences, synthesis, and integration of the art and science of nursing.
)I.( /nderstand 0#.( 1D O34( )escrie theory*ased nursing practice.
TO5( %ssess+ent 6'7( &ursing 5rocess
MULTIPLE "E#P!N#E
1. % paradig+ is useful in descriing the do+ain of a discipline. &ursings paradig+ includes
which of the following? (Select all that apply.)
a
.
5erson

.
)isease
c
.
Cealth
d
.
#n"iron+ent
e
.
&ursing
%&'( %, 7, ), #
&ursings paradig+ includes four linkages( the person, health, en"iron+ent-situation, and
nursing. )isease is not part of nursings paradig+.
)I.( =nowledge 0#.( 12*11
O34( #$plain the influence of nursing theory on a nurses approach to practice.
TO5( )iagnosis 6'7( Teaching-,earning
8. 5sychosocial theories are needed in nursing ecause nursing is a di"erse discipline that stri"es
to +eet which criteria? (Select all that apply.)
a
.
5hysiological needs of the patient

.
5sychological needs of the patient
c
.
'ociocultural needs of the patient
d
.
'piritual needs of the patient
e
.
The nurse*patient relationship
%&'( %, 3, 7, )
&ursing is a di"erse discipline that stri"es to +eet the physiologic, psychological,
sociocultural, de"elop+ental, and spiritual needs of patients. The nurse*patient relationship
for+s the asis for Cildegard 5eplaus theory of nursing.
)I.( /nderstand 0#.( 11 O34( )iscuss selected theories fro+ other disciplines.
TO5( I+ple+entation 6'7( 7aring