Nursing Theories And Nursing Practice 4th Edition By Smith – Test Bank

 

 

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Sample Questions

 

King is a strong advocate of documenting patient transactions. Divide the class into small
groups and have them discuss this documentation process. Questions to consider might
include whether documenting goals on the chart is feasible and appropriate, what
advantages are obtained from this documentation process, how the patient’s privacy can
be maintained (e.g., if the patient’s spouse is abusive and intrusive, is it appropriate to
document the patient’s goal of filing for divorce where the spouse can see it?)
3. King provides a methodology for developing concepts. Divide the students into small
groups and have them explore a concept development on a simple subject. Give them
about 10 or 15 minutes and let them know they are not required to do literature research
in this short time. Instead, have them use King’s steps of defining the attributes of the
concept and then using the concepts to write a brief conceptual definition. Besides using
medical concepts, include something whimsical that will add a humorous dimension to
the discussions.

Chapter 10
Multiple-Choice Questions
(Answers appear in bold)
1. According to King, a concept is:
A. A fixed idea
B. An organization of reference points
C. A group of ideas relating to the same subject
D. A plan for treatment

2. King’s Transaction Process Model is, among other things:
A. A human interaction process
B. A way of organizing medical procedures
C. An exchange of theoretical concepts
D. A theory-building model

3. King says nurses should document their interactions with patients:
A. In their diaries
B. On a special form
C. On the patients’ charts
D. With the nursing supervisor

4. According to King, the goal of nursing practice is to:
A. Assist the patient in building a Transaction Process Model.

B. Collaborate in setting patient goals.
C. Research the health care literature for insights into systems operation.
D. Help individuals maintain or regain health.

5. An advantage of King’s documentation system is:
A. The nurse knows if the patient achieved the goal or not.
B. It includes the patient in the goal setting process.
C. It includes the doctor in the goal-setting process.
D. It provides a path for recovery of health.

6. King suggests that the central idea in the nature of nursing is:
A. The nature of humanity
B. Clinical proficiency
C. Ability to interact well with patients
D. Achieving goals

7. A conceptual system provides:
A. A basis for communication
B. Reasonable limits for goal setting
C. Boundaries for communication
D. Structure of a discipline

8. King tells us that if the patient and nurse agree to goals, the goals will be attained:

A. 99% of the time
B. 90% of the time
C. 76% of the time
D. 50% of the time

9. What is a transaction, according to King?
A. An interaction between members of a system
B. A sharing of information between nurse and patient
C. Exchanging information and setting a goal with the patient
D. Dispensing medications

10. If a patient does not achieve a goal, the nurse should
A. Report the failure to the doctor.
B. Report the failure to a family member.
C. Ask the patient why.
D. Start the process over.

Chapter 10: King’s Theory of Goal Attainment
Instructions: Read the case study and answer the questions that follow.
The Brown family is gathered at the bedside of the family matriarch, who was recently
transferred to hospice after her lapse into a coma while being cared for in her home. The family
is struggling with the decision to move their mother to the hospice in-patient facility, which is
not in keeping with her desire to die at home surrounded by family.
1. What is the phenomenon of concern to the client?
2. How are the concepts of person, health, environment, and nursing viewed in this situation
using King’s theory?
3. Describe strategies that would enhance the family in attaining their mother’s goal.
Guided Response (Answer) for Instructors:
1. Engage students in a discussion of the phenomenon of concern: dying at home surrounded by
family. (A) How might the nurse facilitate the attainment of this goal? For example; what is most
important, dying at home or being surrounded by family?
(B) Who is the client in this situation, the family or the matriarch?
(C) What was the meaning of being at home for the matriarch?
(D) How could the hospice setting be made more homelike?

Chapter 11
Statement of Intent
The intent of this chapter is to describe the use of the Roy Adaptation Model for developing
knowledge for practice. A summary of research directed by the model is provided. The chapter
presents a research exemplar with the hearing impaired elderly.

Chapter 11
Key Terms
Humanism

Adaptive modes

Veritivity

Cognator–Regulator Subsystems

Cosmic unity

Stabilizer-Innovator Subsystems

Clinical Science of Nursing

Human Adaptive System

General Systems Theory

Integration Level

Environment

Integrated

Health

Compensatory

Holistic adaptive systems

Compromised

Coping processes

Self-consistency

Adaptation

Cognitive adaptation processing

Adaptation level

Chapter 11
Objectives
On completion of this chapter, students will be able to:
1. Identify the central belief of the Roy Adaptation Model.
2. Discuss the scientific assumptions and principles of the Roy Adaptation Model.
3. Identify four categories for assessing behavior using the Roy Adaptation Model.
4. Describe the functions of coping adaptation processes.
5. Discuss Roy’s view of the clinical science of nursing.
6. Explain the applicability of coping adaptation processing and self-consistency to a specific
nursing situation.
7. Describe the development of Roy’s research program over time.

Chapter 11
Outline
Introducing the Theory
Applications: Research Framework
Assumptions
Major Concepts
Uses in Research
Knowledge Development Strategies
Structure of Knowledge
Clinical Nursing Science
Coping and Adaptation Processing
Conceptual Development
Instrument Development
Self-Consistency
Conceptual Development
Instrument Development
Application of the Model: Research Exemplar Elderly with Hearing Impairment
Problem and Significance
Study Design
Study Design
Research Hypothesis
Sample
Major Variables

Data Collection
Findings
Model in Practice
Nursing Practice Implications of the Research
Coping Process of Clear Focus
Coping Process of Knowing Awareness
Coping Process of Self-Perception
Self-Awareness
Self-Analysis and Emotions
Self-Consciousness
Summary
References

Chapter 11
Questions for Classroom Discussion
1. Roy’s principle of “cosmic unity” shifts the emphasis of system actions from system
maintenance, as outlined in General Systems Theory, to purposefulness of human existence.
How might this conceptual change influence the practice of nursing? [Students may want to refer
to the Roy and Andrews (1999) text and/or basic readings on General Systems Theory.] What
other nursing models are based on General Systems Theory?
2. After reviewing the research exemplar provided by Roy, discuss what you learned about the
importance and function of research in testing theoretical models. Identify a research hypothesis
based on the model and the exemplar that would extend Roy’s study.

Chapter 11
Multiple-Choice Questions
(Answers appear in bold)
1. A central belief of the Roy Adaptation Model is that adaptive responses support
health.
A. True
B. False

2. Scientific assumptions of the Roy Adaptation Model are based on:
A. General Systems Theory and Developmental Theory
B. Adaptation-Level Theory and Developmental Theory
C. General Systems Theory and Adaptation-Level Theory
D. Adaptation-Level Theory and Cosmic Theory

3. Concept analysis, synthesis, and derivation of proposition statements have been used
by Roy for:
A. Instrument development
B. Theory development
C. Research studies
D. All of the above

4. Self-consistency falls under which of Roy’s following adaptive modes?
A. Physiological–physical

B. Role function
C. Interdependence
D. Self-concept—group identity

5. Hearing loss in the elderly was conceptualized by Roy as loss of a:
A. Contextual stimuli
B. Focal stimuli
C. Coping effort
D. All of the above

6. The findings of the research exemplar presented by Roy indicated that the hypothesis
of the study was supported because there was no relationship between coping and
adaptive processes and self-consistency in older persons with hearing loss.
A. True
B. False

7. According to Roy, the coping process of self-awareness
A. Signals the need for adaptive efforts.
B. Interrupts ongoing behavior patterns.
C. Restores sense of self.
D. All of the above

8. According to Roy, the coping process of self-analysis and emotions

A. Signals the need for adaptive efforts.
B. Interrupts ongoing behavior patterns.
C. Restores sense of self.
D. All of the above

9. According to Roy, the coping process of self-consciousness and self-analysis
A. Signals the need for adaptive efforts.
B. Interrupts ongoing behavior patterns.
C. Restores sense of self.
D. All of the above

10. The principle that people and Earth have common patterns and integral relationships
is defined by Roy as:
A. Veritivity
B. Cosmic unity
C. Unitary being
D. Cosmic principle

Chapter 11: Sister Callista Roy’s Adaptation Theory
Instructions: Read the case study and answer the questions that follow.
Sgt. Eddie Johns leaned back against the chair in the outpatient orthopedic clinic. His head
was killing him! He wasn’t sure which was worse, the “morning after” headache or not being
able to sleep at night. At least when he had a few beers under his belt he could catch a few hours
of sleep. It had been like this since he was air evacuated back stateside from Afghanistan after
the roadside bomb went off. He was thankful that he had only broken his leg in a couple of
places and gotten a bad bump on the head. They called that traumatic brain injury but he didn’t
know what that was and really didn’t believe them anyway. He was still thinking just fine. His
friend Joe wasn’t so lucky! How was Joe going to learn to walk on those artificial legs? He was
still in the hospital in Washington, DC. That was pretty far from his home. Eddie wished he
could visit Joe. They had been in the same platoon for 9 months. But, Eddie was glad that he had
been able to come back to his own home town for outpatient treatment. It took an hour to get
here but at least he could see his girl almost every day. Sure he had moved back in with his mom
but it was easier to have someone to help him get around and cook for him. It was a bummer that
he couldn’t work right now. He guessed it didn’t matter much since he really didn’t have a job to
go back to. He had been replaced at the plant. They said they would find something for him to do
once he could get around more easily. Eddie sure hoped the doc would take the pins out of his
leg today and give him a clearance to work.
1. How would the use of the Roy Adaptation Model assist the nurse in planning the continuation
of care for Sgt. Johns?
2. Describe the influence of Roy’s Theory in guiding the nurse’s actions in promoting Sgt. Johns
adjusted self-concept.

3. From the perspective of the Roy Adaptation Model, why is it important for the nurse to listen
to Sgt. Johns’ “story” in his own words and not just base her interactions on information from the
chart, fellow colleagues, or his family?
Guided Response (Answer) for Instructors:
1. Roy views humans as holistic adaptive systems, who have coping processes that act to
maintain adaptation and promote person and environment transformations. By using these coping
processes, the person as a holistic adaptive system can interact with both his or her internal and
external environment to transform his or her environment and him- or herself. The modes of
change have been identified as physiology–physical, self-concept identity, role function, and
interdependence. Sgt. Johns appears to be facing challenges in all of these areas. The nurse
should work with Sgt. Johns to identify his priorities.
2. Self-concept is viewed as one mode of the individual with two subareas: the physical self and
the personal self. Physical self is described as both body image and body sensation while
personal self comprises self-consistency, self-ideal, and moral–ethical–spiritual self.

Chapter 12
Statement of Intent
The intent of this chapter is to explain the Neuman systems model, share global applications of
the model, and provide a bibliography to facilitate further study.

Chapter 12
Key Terms
Client

System

Complete whole

Interrelationship

Negentropy

Wellness state

Entropy

Stressors

Lines of resistance

Lines of defense

Basic structure

Primary prevention

Client wholeness

Chapter 12
Objectives
On completion of this chapter, students will be able to:
1.

Differentiate among primary, secondary, and tertiary prevention as discussed in
Neuman’s theory.

2. Explain Neuman’s five client variables.
3. Discuss Neuman’s view of environment as it relates to wellness or illness.
4. Demonstrate how Lines of Defense fit into Neuman’s theory and how they contribute to
the patient’s health or illness.
5. Explain the basic components of Neuman’s Systems Model.
6. Discuss the importance of networking to enhance applications of the Model.

Chapter 12
Outline
Introducing the Theorist
Overview of the Neuman Systems Model
Unique Perspective of the Neuman Systems Model
Propositions
The Conceptual Model
Client–Client System
Flexible Line of Defense
Normal Line of Defense
Lines of Resistance
Basic Structure
Five Client Variables
Environment
Health
Nursing
Prevention as Intervention
Nursing Tools for Model Implementation
Applications of the Model
Application of the Neuman Systems Model to Nursing Practice
Application of the Neuman Systems Model to Nursing Education
Nursing Administration and the Neuman Systems Model
Networking to Enhance Application of the Model

Summary
References

Chapter 12
Questions for Classroom Discussion
1. Divide the class into small groups and assign each group one of Neuman’s five client
variables. Ask the groups to determine how a nurse could investigate or identify portions of the
variable as they apply to the patient. Then have each group provide their results and discuss them
with the group in light of the other groups’ findings.
2. Neuman posits that the human system is dynamic and moves toward negentrophy, or wellness.
Ask students to do a quick writing exercise and brainstorm on how they have witnessed this
move toward negentropy. After the exercise (no more than 10 minutes), ask students to share
their ideas in an open discussion.
3. Neuman talks about the flexible line of defense and the normal line of defense. Divide the
students into small discussion groups and ask them to take 10 minutes to list what they believe to
be the components of these two lines of defense. Have the groups share their findings and
discuss them with the class, soliciting comments from other groups regarding their results.
4. Much has been written about the spiritual variable. Ask students to do a 10-minute quick
writing about this variable. They may wish to consider whether the spiritual variable exists at all,
whether it has as wide-ranging results as Neuman claims, and whether it is appropriate for a
nurse to participate in or work with the patient’s spiritual dimension. After the writing exercise,
invite the students to share their results with the class for discussion.
5. Neuman states that each person has three environments: Internal, External, and Created.
Divide the students into small groups and ask them to review a case history you’ve generated,
from which they can determine factors of each environment. Bring the class together to discuss

each group’s findings. Did they agree? Why or why not? Can they resolve any differences? How
would they offer help to the patient “on the floor?”

Chapter 12
Multiple-Choice Questions
(Answers appear in bold)
1. Neuman’s theory includes an accordion-like mechanism that protects the normal line of
defense. This mechanism is called:
A. The Accordion Line of Defense
B. The Defense Line Buffer
C. The Flexible Line of Defense
D. The Stressor Defense Line

2. Neuman defines the client’s usual state of wellness as:
A. The Flexible Line of Defense
B. The Normal Line of Defense
C. The Stressor Defense Line
D. The Accordion Defense Line

3. Neuman’s system suggests that __________________ are activated after the normal line of
defense is penetrated by stressors.
A. The Flexible Line of Defense
B. The Accordion Line of Defense
C. Client Resistance Factors
D. Lines of Resistance

4. Neuman identifies ___________ client variables.
A. Three
B. Six
C. Five
D. Nine

5. Neuman calls the process whereby energy moves toward evolution as a system absorbs energy
to increase its organization, complexity, and development when it moves toward a steady or
wellness state:
A. Negentropy
B. Hypertrophy
C. Entropy
D. Dynatrophy

6. Neuman calls the process whereby energy moves toward extinction by gradual
disorganization, increasing randomness, and energy dissipation::
A. Negentropy
B. Hypertrophy
C. Entropy
D. Dynatrophy

7. Neuman states that the _________ variable is on a continuum of development that penetrates
all other client system variables and supports the client’s optimal wellness.

A. Physiological
B. Psychological
C. Developmental
D. Spiritual

8. Neuman defined ________ broadly as “all internal and external factors or influences
surrounding the identified client or client system.
A. Ecosystem
B. Environment
C. Wellness
D. Nursing

9. _______________ penetrate(s) the lines of defense to cause illness.
A. Stressors
B. Lines of Resistance
C. Negentropy
D. Pathogens

10. The ______________________ offers a protective coping shield that helps the client to
function and stimulate the client’s health.
A. Created environment
B. Spiritual variable
C. Extrapersonal environment

D. Physiological variable

Chapter 12: Betty Neuman’s Systems Model
Instructions: Read the case study and answer the questions that follow.
During final exams, Eugenia, a 17-year-old high school junior, reports to the school health
office complaining of a headache, nausea, and feeling “shaky” and “dizzy.” The school nurse
notices the she is pale with dark circles under her eyes. Eugenia’s temperature is normal but her
heart rate is 110 bpm and her BP is slightly elevated. She tells the nurse “I am so tired I don’t
think I can stand up anymore.” When the school nurse asks her if she has eaten today, Eugenia
replies, “I was so anxious about my exams this morning I couldn’t eat. If I don’t do well on my
chemistry exam I won’t get into college and my parents will take my car for the summer.” In
reviewing her chart, the nurse notes that Eugenia takes Ritalin for attention-deficit/hyperactivity
disorder (ADHD), inattentive type. The nurse asks her when was the last time she had a good
night’s sleep and how often she had been taking her Ritalin. Eugenia tells the nurse that though
she knows she should take her Ritalin only in the morning, she has been using the Ritalin to stay
awake at night and study for the past 3 days. Eugenia attends a Christian high school and worries
that her misuse of a prescription drug is a violation of the school and her personal anti-drug
values.
1. What are the effects of short-term loss of sleep and misuse of Ritalin on Eugenia’s normal
state of wellness?
2. What are the internal and external environmental stressors that have an influencing effect on
Eugenia’s behavior and wellness?
3. Use Neuman’s concepts of primary, secondary, and tertiary prevention as intervention in
developing a plan of care for Eugenia.

Guided Response (Answer) for Instructors:
1. The philosophic base of the Neuman Systems Model encompasses wholism, a wellness
orientation, client perception and motivation, and a dynamic systems perspective of energy and
variable interaction with the environment to mitigate possible harm from internal and external
stressors, while caregivers and clients form a partnership relationship to negotiated desired
outcome goals for optimal health retention, restoration, and maintenance. —Betty Neuman
(2002c, p. 12)
2. Encourage students to explore the effects of loss of sleep and misuse of Ritalin in the
literature.
Internal stressors: Physiological [physical effects of loss of sleep and misuse of Ritalin];
Psychological and sociocultural [wanting to do well in chemistry, social expectations of going to
college]; Developmental [normal development of a 17-year-old girl, effect of having ADHD on
development] and Spiritual [value conflict over misuse of prescription drugs] variables
External stressors: Relationships and resources of family, friends, or caregivers, education,
finances, etc. [concerns about getting into college, relationship with her parents if she doesn’t
test well, effect on summer social life if she loses her care privileges]
Primary prevention: General knowledge that is applied in client assessment and intervention in
identification and reduction or mitigation of possible or actual risk factors associated with
environmental stressors to prevent possible reaction [health promotion education, side effects
of Ritalin, and the effects of loss on sleep on energy levels and mental functioning]. Work
with Eugenia to develop healthier study habits.
Secondary prevention: Symptomatology following a reaction to stressors, appropriate ranking of
intervention priorities, and treatment to reduce their noxious effects [elevated BP and heart

rate, loss of sleep, symptoms of loss of appetite, head ache, feeling shaky and dizzy].
Tertiary prevention: Relates to the adaptive processes taking place as reconstitution begins and
maintenance factors move the client back in a circular manner toward primary prevention.
[limit complications and disabilities and restore functionality and self-sufficiency by
encouraging Eugenia to tell her parents about the stressors are in her life and how she has
been managing them, address safety concerns by having parents pick Eugenia up from school
rather than allowing her to drive in her current state of wellness, encourage time to rest and
recover, monitor her Ritalin use.]

Chapter 13
Statement of Intent
The intent of this chapter is to provide an overview of Erickson, Tomlin, and Swain’s Theory of
Modeling and Role Modeling (MRM). The overall objective of the MRM Theory is to help
people find meaning in their experiences and to enhance their sense of well-being. Practice
exemplars are provided.

Chapter 13
Key Terms
Modeling

Role-modeling

Intervention aims

Intervention goals

Worldview

Nursing actions

Objective actions

Artistic actions

Outcomes

Person

Environments

Health

Nursing

Social justice

Holistic

Innate instinct

Cope

Innate drive

Stimuli

Feedback loops

Responses

Intuitive

Self-care knowledge

Self-care resources

Self-care actions

Social beings

Needs

Affiliated-individuation

Spiritual beings

Eudemonistic health

Nurturance

Facilitation

Sense of well-being

Adaptation

Adaptive potential

Basic needs

Social needs

Growth needs

Needs satisfaction

Object attachment process

Grieving response

Attachment

Morbid grief

Life orientation

Being orientation

Deficit orientation

Self-actualization

Developmental tasks

Life tasks

Chapter 13
Objectives
On completion of this chapter, students will be able to:
1. Describe Erickson, Tomlin, and Swain’s Modeling and Role Modeling (MRM) Theory.
2. Discuss the relationship between Erickson, Tomlin, and Swain’s MRM Theory and
Maslow’s Hierarchy of Needs.
3. Define Erickson, Tomlin, and Swain’s use of the term eudemonistic health in the context
of MRM Theory.
4. Compare and contrast Erickson, Tomlin, and Swain’s use of the concepts “intervention
aims and intervention goals.”
5. Describe global applications of Erickson, Tomlin, and Swain’s MRM Theory.