foundations final ati

how can one prepare the mind and body before beginning an imagery session?

using a relaxation technique

when is the imaginary situatiuon more likely to take place?

when all senses are involved because the imagery situation is fully encoded in the body

A nurse is preparing for a teaching session with a client. Which of the following actions should the nurse take to provide the client with unbiased care? (Select all that apply.)

Assessment Analysis Planning Implementation Evaluation

A nurse is conducting a cultural assessment. Which of the following factors are incorporated in Leininger's Sunrise Enabler? (Select all that apply.)

Kinship and social factors Biological factors Economic factors Political and legal factors

A nurse is describing to another nurse how to use social media in client care. Which of the following examples should the nurse include as an acceptable use of social media?

Reviewing the use of a fitness application with a client

A nurse is caring for a client who asks, "Why do I have to talk to so many people before I can go home? Don't these people communicate?" Which of the following statements should the nurse make?

"Your health care team works together so you can safely go home."

General documentation tips

-Document with CARE C=clarity A=accuracy R=relevance E=exceptions

kava and comfrey

linked to serious liver damage

A nurse is teaching guided imagery to a prenatal class. Which technique did the nurse describe?

Using sensory peaceful words

A nurse truthfully answers a client's questions about their laboratory results. The nurse is demonstrating which of the following ethical principles?

Veracity

A nurse is reviewing the impact low health literacy has for clients with a newly licensed nurse. Which of the following information should the nurse include?

Increase in mortality rate

A nurse is caring for a client who was born in India but has lived in the U.S. for 30 years. The client speaks English and has family members at the bedside. Which of the following actions should the nurse take?

Inquire about any special cultural beliefs or practices.

A nurse at a clinic is providing free blood pressure screenings for clients. Which of the following levels of health prevention is the nurse demonstrating?

Secondary prevention

A nurse is reviewing the use of electronic documentation with a newly licensed nurse. Which of the following statements should the nurse make?

"Electronic documentation provides evidence of care provided."

Accuracy

-Chronological order -Follow institutional guidelines -Be careful distinguishing what is observation and what is interpretation

G codes

-Medicare part B -Outpatient

A nurse educator is planning a presentation for nurses about the opioid epidemic. Which of the following is a strategy promoted by the U.S. Department of Health and Human Services to address this epidemic?

Educate nurses and other health care personnel about naloxone.

A nurse is caring for a client for who recently lost their job. Which of the following actions should the nurse take during the assessment step of the nursing process? (Select all that apply.)

Identify whether the client is experiencing feelings of grief. Check the client for physical manifestations of grief. Ask the client about their support system.

A nurse is admitting a client who has hypertension. Using the nursing process, which of the following actions should the nurse take first?

Perform a physical assessment

A nurse is caring for a client who has dementia. Which of the following communication strategies should the nurse implement to communicate with the client?

Speak to the client clearly and at a slow pace. The nurse should speak to the client who has cognitive or developmental delays clearly and at a slower pace. The nurse should also avoid the use of complicated terms or medical terminology.

A nurse is assessing a school-age child whose friend recently died. Which of the following findings should the nurse expect?

The child holds back their feelings.

A nurse is assigned to care for a client. The client's provider is known to become angry and yell at the nurse. Which of the following actions by the nurse demonstrates the use of cognitive rehearsal?

The nurse mentally practices in advance what to say to the provider.

what are echinacea and goldenseal (separate or in combo) commonly used for?

respiratory infections

A nurse is discussing the Dual Process Model of Grief with a newly licensed nurse. Which of the following statements should the nurse make?

"A client's grief will oscillate between loss-oriented grief and restoration-oriented grief."

Clarity

Consider language being used. -Abbreviations and jargon -Grammer and spelling

A charge nurse is providing teaching to a group of nurses about the collaborative teamwork skill of situation monitoring. Which of the following statements by a nurse indicates an understanding of the teaching?

"Situation monitoring focuses on the awareness of the team's performance on client outcomes."

A charge nurse is discussing Worden's Four Tasks of Mourning with a newly licensed nurse. Which of the following statements should the charge nurse include?

"The pain of grief is experienced during the second task."

A nurse is teaching a client about the Affordable Care Act (ACA). Which of the following information should the nurse include?

A focus of the ACA is disease prevention.

A nurse is reviewing standards of care with a group of newly hired nurses. The nurse should include which of the following incidents as an example of breach of standards of care?

A nurse did not read back a verbal medication prescription to a provider

A nurse is preparing a discharge plan for a client following a bilateral below-the-knee amputation. Which of the following interventions is the priority?

Determine whether the client's home is wheelchair accessible.

A nurse is preparing for an initial visit with a client who is experiencing grief. Which of the following tasks should the nurse plan to complete first?

Develop a relationship with the client.

A nurse is caring for a client whose partner recently died. In which step of the nursing process should the nurse and client identify the goals for the client's care?

Planning

A nurse in a provider's office is calling a client's insurance company to obtain permission prior to scheduling a magnetic resonance imaging (MRI) test. Which of the following is the nurse obtaining?

Precertification

A preadolescent patient is experiencing maturational stress. Which area will the nurse focus on when planning care?

Self-esteem issues

A nurse in an emergency department overhears a provider say they will not accept any more clients who do not have health insurance. Which of the following is the provider violating?

The Emergency Medical Treatment and Labor Act (EMTALA)

A nurse is preparing to educate a client about the proper procedure for a dressing change. Which of the following indicates an understanding of Knowles's fundamental principles of client readiness?

The client is engaged and alert.

A nurse is teaching a newly licensed nurse about Medicare reimbursement. Which of the following should the nurse include in the teaching?

Reimbursement amounts will be adjusted for clients who contract HACs.

A charge nurse is preparing an in-service for staff members about spiritual influences on grief. Which of the following information should the nurse include?

Religion can provide comfort during the grieving process.

A nurse is reviewing the HIPAA regulatory rules. Which of the following rules is restricted to electronic protected health information (e-PHI)?

The Security Rule

A nurse is caring for a client who is nearing the end of life. Which of the following responses by the nurse supports the client's dignity? (Select all that apply.)

"What would you like to know about your medications?" "What can I do to help you feel more independent?"

A nurse in a clinic is caring for a client who is going to require 7 days of IV antibiotics and dressing changes for cellulitis. Which of the following care facilities should the nurse anticipate the client be admitted to?

Acute care hospital

Part A of medicare

Inpatient hospitalization -Have to spend 3 days in hospital and 100 days in skilled nursing facility -Also covers home health and hospice

A nurse is discussing palliative care with a client who has colon cancer. Which of the following information should the nurse include?

Palliative care uses a holistic approach.

A nurse is teaching a client who has a new prescription for an antihypertensive medication.

Tertiary prevention

A nurse in a long-term care facility took a picture of a client and posted it on the internet. This action by the nurse is an example of which of the following?

Violating the code of ethics for nurses.

A patient in a motor vehicle accident states, "I did not run the red light," despite very clear evidence on the street surveillance tape. Which defense mechanism is the patient using?

Denial

A nurse is discussing hospice care with a newly licensed nurse. Which of the following should the nurse identify as the goal of hospice care?

Provide care for a client who has less than 6 mos to live.

A nurse is discussing the nurse's role in client education with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of a nurse's role?

"Nurses make up the greatest percentage of members on a health care team."

After a natural disaster occurred, an emergency worker referred a family for crisis intervention services. One family member refused to attend the services, stating, "No way, I'm not crazy." What is the nurse's best response?

"Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique."

A nurse is teaching a client about hospice care. Which of the following information should the nurse include? (Select all that apply.)

"You must have a terminal illness." "You accept palliative care for comfort." "The health care provider must officially state that you are terminally ill."

A young male patient is diagnosed with testicular cancer. Which action will the nurse take first?

Ask about the patient's priority needs.

A nurse is providing teaching to a client who has a new prescription for eye drops. Which of the following teaching strategies is an example of using the psychomotor domain of learning?

Ask the client to teach-back about how to use the medication.

A nurse is teaching a client about how to perform daily blood pressure readings at home. Which of the following statements by the client is an example of the teach-back method of learning?

Let me show you how I will take my blood pressure at home each day.

A nurse enters a client's room and stands near the client to ask them if they need anything. The client continues to watch the television, which is at a loud volume. Which of the following actions should the nurse take?

Lower the volume on the television. The nurse should minimize the noise in the environment by decreasing the volume on the television when communicating with the client. Auditory communication is what the receiver hears when the sender speaks a message. It can be affected by environmental noise. The loud television presents a barrier to communication and the nurse should reduce the environmental noise.

An adult male reports new-onset, seizure-like activity. An EEG and a neurology consultant's report rule out a seizure disorder. It is determined the patient is using conversion. Which action should the nurse take next?

Obtain history of any recent life stressors.

A nurse is reviewing the contributions made by various nursing organizations that have impacted the nursing profession. The nurse should identify that which of the following are contributions made by The American Nurses Association (ANA)? (Select all that apply.)

Providing a definition of nursing is correct. Lobbying for whistle blower protection is correct. Providing all registered nurses with competency expectations is correct.

A nurse is planning a smoking cessation program for a client. Which of the following actions is a component of SMART outcome goals?

Providing a time frame to accomplish the outcome.

A nurse is caring for a patient with stress and is in the evaluation stage of the critical thinking model. Which actions will the nurse take?

Reassess patient's stress-related symptoms and compare with expected outcomes.

A nurse who completed their shift realized they forgot to take a client's vital signs as frequently as prescribed. Which of the following actions should the nurse take to uphold the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements?

Report this omission to the charge nurse and the nurse on the next shift.

A nurse is preparing a low-stimulus environment for an educational session on smoking cessation. Which of the following should the nurse implement?

Set the thermostat to a comfortable temperature.

A nurse is discussing the Healthy People initiative with a newly licensed nurse. Which of the following information should nurse include?

The program focuses on providing goals and data for improved public health.

A nurse is teaching a class about barriers to interprofessional collaboration between health care professionals. The nurse should include that which of the following is a barrier?

Unresolved conflicts between team members

addressed a person's qi -- Qi or chi in Japanese -- is believed to flow vertically in the body through an intricate structure of 12 primary meridians, energy circuits that nourish and support all cells and organs of the body

acupuncture

either increases or decreases the flow of qu along the meridian, restoring the balance of yin and yang -- change in flow contiributes to healing

acupuncture

A trauma survivor is requesting sleep medication because of "bad dreams." The nurse is concerned that the patient may be experiencing post-traumatic stress disorder (PTSD). Which question is a priority for the nurse to ask the patient?

"Are you reliving your trauma?"

A nurse is orienting a newly licensed nurse to the unit. Which of the following statements by the newly licensed nurse indicates an understanding of the importance of documentation of client education?

"Client documentation can increase staffing and services."

A nurse and an assistive personnel (AP) disagree about how to move a client from the bed to a stretcher. Which of the following statements should the nurse make to promote conflict resolution?

"Let's discuss how we can work together."

A charge nurse is teaching a newly licensed nurse about the concept of team nursing. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

"Nurses will pair together to care for an assigned group of clients." Team nursing is the concept of nursing that pairs two or more nurses together to provide care for a group of clients. Team nursing provides support for novice nurses and others that are not as skilled in performing more complex tasks. A positive outcome of team nursing is the team works together. No one is expected to perform tasks that they are uncomfortable with or not competent to perform.

A nurse is providing education on priority setting frameworks to a group of newly licensed nurses. Which of the following statements should the nurse make regarding the safety and risk reduction priority setting framework?

"This framework assigns the highest priority to the situation that poses a threat to the client's physical well-being."

A nurse is discussing culturally competent care with another nurse. Which of the following statements should the nurse include?

"Use a medical interpreter for a client who does not speak the same language."

A nurse is teaching about change-of-shift report with a newly licensed nurse. Which of the following statements should the nurse make?

"Using I-SBAR-R during change-of-shift report decreases the risk of missing information."

A nurse is teaching about Medicaid to a client who is concerned about paying for health care. Which of the following statements should the nurse make?

"Your income will determine if you are eligible for Medicaid."

A nurse is caring for a client who is postoperative and requests spiritual support. Which of the following statements should the nurse make?

'Tell me what I can do to help fulfill your need for support."

A nurse has received change-of-shift report on four clients. Which of the following clients should the nurse plan to see first?

A client who has audible wheezing during respirations

A nurse has received change-of-shift report for a group of clients. Which of the following clients should the nurse plan to see first?

A client who is receiving a blood transfusion and reports urticaria

A nurse is teaching a newly licensed nurse about ethical principles. The nurse should include that which of the following situations is an example of fidelity?

A nurse keeps a promise to a client not to tell their family about their diagnosis

A nurse in a provider's office is speaking with a client who needs a refill for a prescription that has expired. The nurse should identify that which of the following team members can assist the client with the refill? (Select all that apply.)

APRN PA Physician

A nurse is caring for a client who was recently diagnosed with chronic kidney disease. The client asks the nurse, "Why me? This is not fair." The nurse should identify the client's statement as an expression of which of the following stages of grief?

Anger

A nurse is caring for a client who has a terminal illness and reports feeling isolated from family and friends. Which of the following actions should the nurse take?

Assist in scheduling friends and family to visit.

A nurse is assisting with teaching a class about evidence-based protocols established by the CDC to prevent healthcare-associated infections (HAIs). Which of the following infections should the nurse include? (Select all that apply.)

Catheter-associated urinary tract infection Central line-associated bloodstream infection Surgical site infection

A nurse is discussing the Model of Professionalism with another nurse. Which of the following concepts should the nurse include as an outer process? Trustworthiness Clear communication Self-awareness Capacity for reflection

Clear communication Clear communication is an outer process because it is a behavior or action that the nurse performs.

A nurse is discussing clinical pathways with a newly licensed nurse. Which of the following information should the nurse include?

Clinical pathways use evidence-based practice guidelines for health care delivery.

A nurse is participating in a question-and-answer session with a client. Which of the following domains of learning uses this type of client education?

Cognitive domain

A nurse is preparing a poster about fire safety for a community health fair. The nurse should include on the poster that which of the following components contains needed elements for fire to occur? (Select all that apply.)

Cooking oil Oxygen Heat

A nurse is instructing a client regarding heart-healthy activities. This action represents which of the following phases of the nurse-client relationship?

Exploitation The nurse is actively coaching the client toward a healthier lifestyle.

A nurse is preparing to conduct a fall risk screening on a client. Which of the following variables will the nurse use to evaluate the client? (Select all that apply.)

Fall history Medical diagnosis Use of assistive devices Mental status

A charge nurse is overseeing an assistive personnel (AP) who has been assigned care for a group of clients. Which of the following actions by the charge nurse demonstrates accountability? assigns the AP to provide care for clients who are in rooms next to each other Files an incident report when the AP performs a task that is outside their scope of practice Promises to write a letter of recommendation for the AP if they complete all their assigned tasks Discusses advancing their education with the AP

Files an incident report when the AP performs a task that is outside their scope of practice An incident report is a risk assessment tool that identifies an unusual occurrence. By filing the report, the charge nurse is demonstrating accountability and ensuring safety standards are met, thus protecting the client from potential harm.

A nurse is teaching a client about the benefits of a healthy diet and regular exercise to achieve weight loss. Which of the following topics is the nurse teaching to the client?

Health Promotion

A nurse is preparing to use a video-enabled device to communicate with a client who is at home. Which of the following actions should the nurse plan to take?

Instruct the client to use a computer for the video conference.

A nurse is caring for a client who asks about healthy choices to lose weight. The nurse shares information from Healthy People 2030 to address the client's questions. Which of the following describes the Healthy People initiative?

It is a set of objectives for improving the health of Americans.

A nurse is discussing culturally competent care with another nurse. Which of the following information should the nurse include?

It is culturally insensitive to talk about impending death in some cultures.

A nurse is preparing a poster describing leadership styles for a unit in-service. Which of the following terms should the nurse use to describe a nurse manager who exerts little control over the decisions made by the charge nurse? Bureaucratic Transactional Transformational Laissez-faire

Laissez-faire Under a laissez-faire style of leadership, nurses are given the freedom to work independently to accomplish goals with little control asserted by the nurse manager.

A home health nurse is visiting a client who lives in an older home and is concerned about their child's exposure to lead paint in the house. The nurse should identify that which of the following is a potential health risk from exposure to lead paint?

Learning disabilities

A nurse is assisting with teaching a newly licensed nurse about using a lift device to transfer a client. Which of the following actions by the nurse indicates an understanding of the teaching? (Select all that apply.)

Locks the brakes on the client's bed Checks the maximum weight of the lift before using it Performs a safety check before lifting the client

A nurse is assessing a client who is getting divorced and reports feelings of loss associated with no longer being in the role of a spouse. The nurse should identify that the loss of a previously held role is which of the following types of losses?

Loss of identity

In a natural disaster relief facility, the nurse observes that an older-adult male has a recovery plan, while a 25-year-old male is still overwhelmed by the disaster situation. A nurse is planning care for both patients. Which factors will the nurse consider about the different coping reactions?

Maturational and situational factors

A nurse is caring for a client who is actively dying and notes the client's feet are purple and marbled. Which of the following findings should the nurse expect?

Mottling is visible on the client's legs.

A nurse is assessing a client using the ABCDE priority-setting approach. Which of the following actions should the nurse take when completing the exposure component of this priority setting method? (Select all that apply.)

Observe the client's lower extremities for indications of deep vein thrombosis. Measure the client's temperature. Check the client for bruising.

Part B of medicare

Outpatient/individual -Have to pay 20% out of pocket

A nurse is reviewing discharge instructions with a client who has low health literacy. Which of the following actions should the nurse take?

Provide examples.

A nurse is planning a 30-min group education class. Which of the following actions should the nurse plan to take to address various learning styles related to the domains of learning?

Provide games, discussion, and question-and-answer.

A nurse is teaching a newly licensed nurse about receiving and transcribing verbal prescriptions. Which of the following instructions should the nurse include?

Read back the prescription to the provider after transcribing.

A nurse learns that a coworker has died unexpectedly. Which of the following actions should the nurse take?

Recognize their feelings of grief.

A nurse is caring for a client who is experiencing a seizure. Which of the following actions should the nurse take?

Record the time and length of the seizure.

A nurse is assisting with emergency care of a client who has been exposed to a chemical toxin. Which of the following actions should the nurse take?

Rinse the client's skin with water.

A nurse is assisting with teaching a newly licensed nurse about the use of electronic health records (EHRs). Which of the following is an outcome associated with the use of EHRs that the nurse should include?

Saves time

A nurse is assessing a 16-year-old client whose parent recently died. Which of the following findings should the nurse expect?

The client displays high-risk behaviors.

A nurse is using a question-and-answer session to teach a client about a diabetic diet. Which of the following outcomes is an example of cognitive learning?

The client understands a diabetic meal plan.

A nurse is teaching a client about modifiable risk factors to their health. Which of the following should the nurse include as an example of a modifiable risk factor?

Tobacco use

consists of placing very thin, short, sterile needles at particular acupoints, believe to be centers of nerver and vascular tissue, along a meridian.

acupuncture

why are some consumers and practitioners attracts to herbs?

because they are "natural" plant products which are perceived as more compatiable with the body than manufactured phamaceutical agents.

believe that when symptoms are suppressed by medication, the condition "goes deeper" into the body, making it ultimately more difficult to cure.

homeopathics

Documentation must include

-Who -What -When -Where -Why

A nurse enters a client's room and finds the client crying. The nurse sits beside the bed in silence. Which of Swanson's five categories of caring behaviors is the nurse demonstrating?

Being with

A nurse is preparing to administer a premixed medication to a client. The nurse should check the label for which of the following information? (Select all that apply.)

The date the medication was mixed The dose of the mixed medication The time the medication was mixed

A senior college student visits the college health clinic about a freshman student living on the same dormitory floor. The senior student reports that the freshman is crying and is not adjusting to college life. The clinic nurse recognizes this as a combination of situational and maturational stress factors. Which is the best response by the nurse?

"Give the freshman student this list of university and community resources."

A newly licensed nurse is talking about their day with another nurse. Which statement by the newly licensed nurse demonstrates incivility?

"The charge nurse called me stupid in front of the team."

A nurse is teaching a client who is newly diagnosed with diabetes mellitus. The client tells the nurse, "Thank you. I never really knew what caused diabetes." Using the Schramm model of communication, the nurse should recognize the client's statement as an example of which of following components of the model?

Feedback In the Schramm model, one of the three components is feedback. Feedback is demonstrated when the receiver is allowed to let the sender know that the message was properly received.

A nurse is assisting with teaching a class about warning signs from a co-worker that might indicate future workplace violence. Which of the following behaviors should the nurse include?

Frequent reports of not being treated fairly

A nurse stops at the side of the road to provide care to a person involved in a motor-vehicle crash. Which of the following protects the nurse from liability when administering care at the scene of an accident?

Good Samaritan Laws

A newly licensed nurse is reviewing the client assignments for a shift and determining tasks to complete. Which of the following is a time management strategy the nurse should use?

Make a list and prioritize a plan. Managing multiple clients can be difficult for a new nurse. Making a list of all tasks to accomplish and then prioritizing a plan can help the nurse stay organized and efficient.

A nurse is caring for a client who is actively dying. The client's caregivers state they are interested in donating the client's organs. Which of the following actions should the nurse take?

Make a referral to an organ procurement organization.

A nurse is providing discharge instructions to a client during a follow-up telephone call. Based on the Shannon-Weaver communication model, which of the following components of the model is the nurse demonstrating?

Sender The nurse is initiating the message; therefore, the nurse is the sender.

chemical compounds that are ingested with the hope of achieving a therapeutic goal

botanical agents (herbs) and nutritional supplements

A nurse is teaching a group of newly licensed nurses about professional values. Which of the following statements by a newly licensed nurse demonstrates an understanding of social justice?

"Health care should be a right for everyone."

A nurse is admitting a client for surgery. Which of the following questions should the nurse ask to determine the client's health literacy level and learning needs?

"How comfortable are you with filling out medical forms by yourself?"

A nurse receives a phone call from a client who was discharged yesterday. The client asks the nurse to email them a copy of their discharge instructions. Which of the following responses should the nurse make?

"I am unable to send your discharge instructions via email due to the HIPAA Privacy Act." The HIPPA Privacy Act consists of rules that govern the protection of the client's protected health information (PHI). The use of emails, texting, and faxing must occur with equipment and communication lines that are secure and encrypted. All electronic communication of PHI must have these safeguards in place. Sending the discharge instructions to a personal email outside the facility would breach this law.

A nurse is using the introduction, situation, background, assessment, recommendation, and readback (I-SBAR-R) communication tool when contacting a provider about a client who has COPD. Which of the following statements by the nurse should be included in the assessment component?

"The client has a respiratory rate of 38/min."

A nurse is using the introduction, situation, background, assessment, recommendation, and readback (I-SBAR-R) communication tool when contacting a provider about a client who has Parkinson's disease. Which of the following statements by the nurse should be included in the situation component?

"The client is coughing while eating."

A nurse is teaching a client who has end-stage kidney disease and a new sacral pressure injury. The client's provider has requested a plastic surgery consultation. Which of the following statements by the client indicates an understanding of the consultation?

"The plastic surgeon might change my wound care treatment."

Documentation

-Occupation based documentation supports requirements set forth by 3rd party payers

Things to consider

-Voice: Use active -ex: begins with the person rather than action, then person -Be non-discriminnatory

Red flag words

-Words that will cause the reader to stop and not read any further ex: maintained instead of progressing; client was seen implies they didn't do anything

two unconvential theorys of homeopathy:

1. "like cures like" -- the notion that adisease can be cured by a substance that produces similar symptoms in helathy people 2. "law of minimum dose" -- the notion that the lower the dose of meds, the greater its effectiveness. many homeopathic remedies are so diluted that no molecules of the original substance remain.

A nurse at a provider's office is reviewing the records of several clients. Which of the following clients should the nurse recommend as the priority for treatment?

A client who reports new chest pain

A nurse is discussing leadership styles with a newly licensed nurse. The nurse should include that which of the following is a characteristic of situational leadership? Follows leadership directives exactly as stated Controls situations by paying attention to details Adjusts quickly to different circumstances Refuses to allow staff to make exceptions to established guidelines

Adjusts quickly to different circumstances A situational leader looks at each situation quickly and adjusts strategies based on the circumstances. The situational leader aligns their style to assist in the development and growth of others and the overall effectiveness of the organization. This leader communicates, problem-solves, organizes, and prepares with their employees to accomplish tasks and improve overall efficiencies.

A nurse is assisting with teaching a newly licensed nurse about using barcode technology in client care. The nurse should include that barcode technology is used to reduce errors during which of the following phases of the medication process?

Administering

A nurse is assisting with teaching a class about hospital-acquired injuries. The nurse should include that which of the following is a hospital-acquired injury? (Select all that apply.)

Blood transfusion incompatibility Wrong site surgery Ineffective insulin usage

A nurse is caring for a client who is emotionally distraught. Which of the following uses of touch should the nurse implement to convey caring?

Briefly holding the clients hand.

A nurse is teaching an in-service about zero-tolerance for bullying and incivility in the health care facility. Which of the following information should the nurse include?

Bullying can result in an increase in nursing turnover.

A nurse is teaching a group of newly licensed nurses about client education. Which of the following information should the nurse include in the teaching?

Client education can improve self-care at home.

A nurse is planning care for a client who uses culturally based folk- care for medical treatments. Which of the following actions should the nurse take?

Coordinate folk care treatments with modern medical treatments.

A nurse is caring for a client who has Parkinson's disease and needs assistance with ADLs. Which of the following referrals should the nurse anticipate the provider to prescribe?

Dietitian Physical therapist Occupational therapist

A nurse is caring for a client who has impaired cognition and has begun taking a new medication. Which of the following actions should the nurse take during client education?

Direct the education to the caregivers as well as the client.

A nurse is providing postmortem care for a client. Which of the following actions should the nurse take? (Select all that apply.)

Document where the body is being moved. Include the name of anyone notified in the medical record. Document the date and time of death. Ensure the client's belongings are accounted for.

A nurse is caring for a client who reports that they have recently lost their job and do not have insurance coverage. Which of the following social determinants of health is challenging for this client?

Economic stability

A nurse is caring for a client who is actively dying. Which of the following actions should the nurse take for alterations in breathing pattern?

Educate the family about the expected respiratory changes.

A nurse in a provider's office is speaking with a client about a Press Ganey survey. The nurse should inform the client that this survey will be conducted by which of the following methods?

Email

A nurse is reviewing information about client education with a newly licensed nurse. Which of the following information should the nurse include as the focus of client education?

Empowering clients to be accountable for self-care.

A nurse is checking a client's allergy bracelet before administering a medication and finds the client is allergic to that medication. The nurse does not administer the medication to the client. This is an example of which of the following unexpected events?

Near-miss event

A nurse is teaching the staff about a nursing theory that views a person, family, or community developing a normal line of defense. Which theory is the nurse describing?

Neuman Systems Model

A nurse is caring for a client who is at risk for suicide. Which of the following actions should the nurse take? (Select all that apply.)

Place the client on round-the-clock surveillance. Remove objects from the room that the client could use to harm themselves. Search items brought into the client's room by visitors. Screen the client for suicidal ideation.

Part D Medicare

Prescriptions

A nurse is planning to reconcile medications for a client who speaks a different language than the nurse. Which of the following actions should the nurse take?

Request assistance from the facility's interpreter. The nurse should request a facility-approved interpreter to assist with the communication barrier. This would also ensure that the information is correct and gives both the nurse and client an opportunity to ask questions.

A nurse is caring for a client who reports feeling inferior and states that they are not good enough. The nurse should recognize that these feelings fall under which of the following categories of Maslow's Hierarchy of Needs?

Self-esteem

Despite working in a highly stressful nursing unit and accepting additional shifts, a new nurse has a strategy to prevent burnout. Which strategy will be best for the nurse to use?

Strengthen friendships outside the workplace.

A nurse is discussing chain of command with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the discussion? "The use of the chain of command is reserved for natural disasters or acts of terrorism." "The steps for the chain of command consist of notifying my superiors starting from the top to the bottom." "I will wait to document the communication I used while following the chain of command until the end of the process." "The chain of command clarifies the steps I need to take when I have a concern about a client's care."

The chain of command clarifies the steps I need to take when I have a concern about a client's care." The chain of command is the process of making an immediate supervisor aware of a client concern or situation. The nurse should report concerns to the charge nurse on the unit initially and move up the chain of command only if the charge nurse does not address the concern.

A nurse is preparing to administer medications to a client. Which of the following information should the nurse use to identify the client? (Select all that apply.)

The client's full name The client's date of birth The client's telephone number

A nurse is planning to use the identity, situation, background, assessment, recommendation, read back (ISBARR) tool to communicate with a provider about a client. Which of the following information is included in the assessment component of ISBARR?

The client's laboratory test results

A nurse is assisting with conducting a home hazard assessment for a client who has dementia. Which of the following findings indicates an understanding of home safety?

The edges of stairs are marked with brightly colored tape.

A graduate nurse notes that a hospital with Pathway to Excellence® recognition is hiring staff. Which of the following should the nurse expect from this facility? (Select all that apply.)

The facility has practices in place that lead to a healthy workplace environment. The facility emphasizes shared governance. The facility emphasizes practices that positively affect a nurse's well-being.

A nurse has accepted a position at a hospital in the state where they live. The nurse should identify that which of the following regulates the nurse's actions when they begin working?

The state Nurse Practice Act

A nurse is planning care for a patient that uses displacement. Which information should the nurse consider when planning interventions?

This protects against feelings of worthlessness and anxiety.

A nurse is reviewing a client's plan of care. "The client will ambulate 20 feet using a walker" is the desired outcome. Which of the following aspects of the SMART goal should the nurse identify as missing from the outcome?

Timed

A nurse is planning to implement the Transforming Care at the Beside plan on a medical-surgical unit. Which of the following interventions should the nurse include in the plan?

Use a standardized communication tool.

A nurse is planning care for a client who is terminally ill and speaks a different language than the nurse. Which of the following actions should the nurse take?

Use the health care facility's interpreter services.

what is ginko biloba frequently used for?

dilation of cerebral blood vessels and reduce symptoms of memory loss and mental confusion. interferes with platelet function: do not take with warfarin or aspirin - increased bleeding

A nurse is teaching a client about advance directives. Which of the following client statements indicates an understanding of the teaching?

"My health care surrogate will make health care decisions for me if I am unable."

A nurse is preparing for a presentation on professional identity in nursing. Which of the following statements should the nurse use to describe professional identity? Professional identity is how one describes themselves as a professional." "Professional identity refers to public image about the role of nurses." "Professional identity is a term describing the belief and acceptance of the standards and values of the profession." "Professional identity begins with licensure and training within a health care setting."

"Professional identity is how one describes themselves as a professional." Professional identity is a personal interpretation of how one sees themselves within a professional role. It is often described as the self-image, self-concept, or personal view an individual has of themselves in their professional role.

A charge nurse is reviewing Kübler-Ross's five stages of grief with a newly licensed nurse. Which of the following statements should the nurse make? (Select all that apply.)

Clients might not go through all five stages of grief. Clients can return to a stage of grief after moving into one of the other stages. Client who are grieving might attempt to bargain with a higher power.

A nurse is preparing to administer an influenza vaccine to a client. The client states that they understand being immunized will help protect them against the influenza virus. Which of the following concepts is the nurse demonstrating by administering the vaccine?

Disease prevention

A nurse is assisting with teaching a class about HIPAA. Which of the following information should the nurse include? (Select all that apply.)

HIPAA protects the unauthorized release of a client's protected health information is correct. The loss of a provider's cell phone that contains a client's protected health information is considered a data breach is correct. A breach in HIPAA should be reported within 60 days after the breach is discovered is correct.

A nurse is providing privacy for a client who has incontience. The nurse is demonstrating which of the following professional values?

Human dignity

Which sociocultural finding in the history of a patient will alert the nurse to a possible developmental problem?

Prolonged poverty

A nurse is conducting a preoperative assessment of a client. Which of the following statements is an example of the nurse using motivational interviewing?

"You said that you're sad. What is making you feel sad?" Motivational interviewing uses OARS (open-ended questions, affirmations, reflective listening, summarizing), which includes open-ended questions. This is an example of an open-ended question because it requires more than a yes or no answer.

Relevence

-Need to demonstrate the need for skilled therapy throughout beginning to end -Disclose precautions or contraindications related to activities or interventions provided -Document what is relevant to the goals and objectives

A nurse is teaching a class about using smart infusion pumps to administer intravenous medications. Which of the following information should the nurse include?

Nurses enter client information into the smart infusion pump.

A nurse is caring for a client who has an indwelling urinary catheter in place. Which of the following actions is the priority for the nurse to take to reduce the client's risk of developing a healthcare-associated infection?

Perform hand hygiene.

A nurse is caring for a client who has a prescription for wrist restraints. Which of the following actions should the nurse take?

Remove the restraints with each vital sign check.

A nurse is providing teaching to a client who speaks a different language than the nurse. Which of the following actions should the nurse take?

Request a medical interpreter to be present.

A home health nurse is caring for a client who is receiving hospice care. The client's partner reports feeling overwhelmed from caring for the client. Which of the following types of facilities should the nurse recommend?

Respite care

A nurse is teaching a class about the Hospital-Acquired Condition Reduction Program (HACRP). Which of the following information should the nurse include?

The HACRP links Medicare payments to health care quality.

A nurse is reviewing the health history of a client during a routine office visit. Which of the following observations by the nurse is an example of the client demonstrating health literacy?

The client states they understand their health care information and treatments,

A nurse in the PACU is determining if a client has pain. The client is drowsy and opens their eyes to verbal stimuli but is unable to communicate their pain level. Which of the following actions should the nurse take?

Use an alternative method for determining the client's pain level. Medications such as general anesthesia can cause cognitive deficits that could make it difficult for the client to communicate their needs. The nurse should use an alternative method for determining the client's pain level by observing facial expressions (grimacing or clenching of the teeth); body movements, including restlessness, muscle tension, or resisting movement; and vocalizing discomfort by moaning, grunting, or crying.

A nurse is preparing for a teaching session with a client who has pernicious anemia. Which of the following should the nurse identify as part of the implementation step of the teaching process?

Use demonstration to teach the client about vitamin B12 injections.

A nurse is exploring leadership styles of nurse managers as a part of a quality improvement project. Which of the following statements by a nurse manager should the nurse identify as an example of transactional leadership? "You are a smart and highly competent team. I will let you do what you do best." "We've agreed to provide excellent client care and brainstormed the steps we will take to meet our objectives." "I appreciate your suggestion, but each of you will wash your hands before exiting a client's room." "The staff members who complete their online learning courses before the deadline will receive a gift card."

"The staff members who complete their online learning courses before the deadline will receive a gift card." Transactional leaders use rewards or punishments to encourage compliance for an established goal. They communicate specific expectations, focusing on tasks and completion of short-term goals.

A nurse is caring for a client who is actively dying and is discussing pain management with the client's caregiver. Which of the following information should the nurse include?

A combination of approaches is suggested to manage pain symptoms.

A nurse follows the six rights of medication administration when caring for a client. Which of the following concepts is the nurse demonstrating? Laissez-faire Advocacy Professional identity Accountability

Accountability The nurse is demonstrating accountability because they are administering medications in a way that reduces errors and harm to the client.

A nurse discovers a small fire in a client's room. After removing the client to safety, which of the following actions should the nurse take next?

Activate the fire alarm.

A nurse is teaching a newly licensed nurse about professional competence. Which of the following examples should the nurse include in the teaching? Documenting client care before it is completed Reviewing the charts of clients not assigned to the nurse Presenting a summary of an evidence-based journal Performing a surgical procedure under the direction of a surgeon

Presenting a summary of an evidence-based journal A component of maintaining professional competence is to seek out and implement improved evidence-based practices. This ensures the nurse's practice remains current, evidence-based, and promotes safe and competent care.

A nurse is discussing the concept of spirituality with a newly licensed nurse. Which of the following information should the nurse include?

Spirituality focuses on the significance and purpose of life.

A nurse is teaching a newly licensed nurse about The Joint Commission (TJC). Which of the following information should the nurse include?

TJC ensures organizations remain up-to-date with state guidelines.

A nurse is preparing to provide education to a group of newly licensed nurses about methods to enhance communication with clients. Which of the following statements should the nurse include? (Select all that apply.)

"Respect the client during the conversation" is correct. The nurse should respect the client during the conversation to enhance communication. "Allow time for reflection during the conversation with the client" is correct. The nurse should allow time for reflection. This would enhance communication with the client. "Show empathy during the conversation with the client" is correct. Showing empathy during the conversation enhances communication with the client.

A nurse is reviewing a report by the Institute of Medicine (IOM). Which of the following competencies should the nurse identify health care professionals need in order to reduce errors? (Select all that apply.)

Cooperation Communication Coordination

A nurse is caring for a client who is postoperative and has sanguineous drainage on their dressing. The nurse is unable to reach the client's provider. Which of the following members of the chain of command should the nurse contact next? The charge nurse The nursing supervisor The divisional director The chief medical officer

The charge nurse According to evidence-based practice, the first person in the chain of command that the nurse should contact is the charge nurse. The nurse should initiate the chain of command to make the charge nurse aware of the situation and to ensure the client receives safe and effective care.

A nurse is assisting with teaching a client about remote patient monitoring (RPM) devices. Which of the following information should the nurse include? (Select all that apply.)

The transfer of data is accomplished using wireless devices. Clients can participant in their health by using RPM. A client's heart rhythm can be transferred using RPM.

how does the FDA in the US classify herbs?

food, not a drug (important because herbs are not regulated for quality and potency as drugs are and herbal formulas can be sold without being studied to see if they are helpful or harmful)

dervived from substnaces that come from plants, minerals, or animals, such as red onion, arnica (mountain herb), crushed whole bees, white arsenic, poision ivy, belladonna (deadly nightshade) and stinging nettle. often formulated as sugar pellets to be placed under the tongue but may be in other forms such as ointments, gels, drops, creams, and tablets

homeopathic remedies

A nurse is discussing types of grief with a group of clients who have a serious illness. Which of the following information should the nurse include?

Anticipatory grief occurs prior to the actual loss of someone or something.

A nurse is reviewing hospice care services with a group of newly hired nurses. Which of the following information should the nurse include?

Hospice care is an interdisciplinary team effort.

A nurse who has been working 12-hr shifts on a busy unit is experiencing nurse fatigue. Which of the following effects can result from nurse fatigue?

Increase in medication error

A nurse is helping parents who have a child with attention-deficit/hyperactivity disorder. Which strategy will the nurse share with the parents to reduce stress regarding homework assignments?

Time-management skills

A nurse is caring for a client who is experiencing unexpected manifestations with several body systems. Which of the following priority setting frameworks should the nurse use to prioritize client assessment?

ABCDE

what is acupuncture used for?

reducing pain, promoting adherence to substance abuse programs, and minimizing nausea and vomiting due to chemotherapy and pregnancy

A hospice nurse is caring for a client who is hallucinating and talking to someone who is not there. Which of the following actions should the nurse take?

Ensure client safety and prevent injury.

A nurse suspects their coworker might be under the influence of a chemical substance. Which of the following actions should the nurse take?

Tell the charge nurse that the coworker might be impaired

A nurse is assessing a client's health literacy prior to providing education. Which of the following actions should the nurse take? (Select all that apply.)

Ask questions regarding the client's health care needs and concerns. Obtain a health history. Assess the client's education level.

A female teen with celiac disease continues to eat food she knows will make her ill several hours after ingestion. While planning care, the nurse considers maturational and tertiary-level interventions. Which intervention will the nurse add to the care plan?

Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.

A nurse is reviewing the medial record of an adolescent who is a lesbian. The nurse should identify that which of the following findings are likely caused by the client being marginalized by others? (Select all that apply.)

Being bullied @ school. Depression Using illicit drugs.

A nurse manager is planning an in-service about culturally competent care. Which of the following cultural competencies should the manager describe as enabling a nurse to interact with clients from other cultures?

Cultural encounters

A hospice nurse is caring for a client who states that they want to have their last rites before they die. The nurse recognizes that which of the following factors is influencing the client's request?

Cultural factor Death-related rituals might be very closely tied to cultural factors such as religion. The nurse should recognize that this client is expressing a death ritual of the last rites, which is associated with Catholicism.

A nurse is reviewing information about culture with a group of newly hired nurses. Which of the following statements by a newly hired nurse should the nurse identify as an understanding of culture?

Culture can include language and communication preferences.

A nurse is planning teaching for a client about wound care. Which of the following actions should the nurse take?

Ensure the client is wearing their glasses during teaching. The nurse should take steps to facilitate learning, such as ensuring the client's assistive devices, including eyeglasses or hearing aids, are being used.

A nurse is reviewing the role of health information technology in client care with a newly licensed nurse. Which of the following information should the nurse include? (Select all that apply.)

Facilitates care coordination is correct. Improves practice efficiencies is correct. Is capable of being overridden by a nurse is correct. Improves clinical outcomes is correct.

A nurse is caring for a client who tells the nurse they want to quit smoking. The nurse provides the client with information about smoking cessation and other ways to improve their health. Which of the following nursing roles is the nurse demonstrating? (Select all that apply.)

Health Promoter Nurse educator

A nurse is providing information to a client who is from the Baby Boomer generation about a newly prescribed medication. Using information about generational preferences, which of the following methods of teaching should the nurse use?

Talk w/ the client in person.

A nurse is caring for a client whose spouse recently died. The client is from a different culture than the nurse. Which of the following information should the nurse consider when caring for the client? (Select all that apply.)

Cultural-based rituals can assist clients in handling the death of a loved one. Culture may determine how a client expresses their grief. Rituals regarding death direct what procedures are performed on the body after death.

A nurse is caring for an adult client who is mourning the death of a sibling. Which of the following information should the nurse consider when caring for the client?

Grief differs for adults due to their full understanding of death and memories of the deceased.

how can nurses assist with imagery?

see if recorded imagery material is available on the nursing unit or assist pt with writing own script and record it use "outcome imagery" -- might consist of using a picture of photgraph to visualize the desired outcome in a body part or in a situation. pts can add to the visual cue and develop a total image during a painful stressful event (i.e IV line being started) the pt can "go to a favorite place" and imagine being there with all the pleasant experiences related to that space

A palliative care nurse is preparing an in-service for newly hired staff members about common grief reactions. Which of the following information should the nurse include? (Select all that apply.)

A client who is grieving often experiences a wide range of emotions. A client may feel a sense of relief if the death of a loved one was expected. A client may experience difficulty concentrating and hallucinations as a psychological response to loss. Behavioral responses to grief can include the refusal to eat or participate in social activities.

A nurse is caring for a client who is confused and trying to remove their peripheral IV. Using the least restrictive/least invasive priority setting framework, which of the following actions should the nurse take first?

Cover the IV site with an elastic bandage.

A nurse is speaking to a client who smokes tobacco and has a child living in the home. The nurse should identify that the child's exposure to second-hand smoke is an example of which of the following types of risk factors?

Environmental

A nurse is assessing a postoperative client prior to a teaching session. The nurse notes that the client is grimacing and restless. Which of the following barriers to learning is the client exhibiting?

Physical discomfort

A nurse is caring for a client who has diabetes mellitus and does not adhere to the prescribed diet. Which of the following interventions by the nurse demonstrates collaborative health care?

Requesting a referral to a dietitian to work with the client

A nurse is discussing shared governance with a newly licensed nurse. Which of the following components should the nurse include in the discussion? (Select all that apply.) Guides decisions toward accountability Improves client outcomes Assures money is being used for its intended purpose Promotes professional development Monitors activities of directors

Guides decisions toward accountability is correct. Guiding decisions toward accountability is a function of shared governance. Improves client outcomes is correct. Improving client outcomes is a function of shared governance. Promotes professional development is correct. Promoting professional development is a function of shared governance.

A nurse is caring for a client who has a new diagnosis of cancer. The client states, "I don't understand what my treatment options are." Which of the following statements by the nurse demonstrates advocacy? "I will contact your provider to review your treatment options." "Why don't you understand your options?" "Your provider thinks you need an operation." "You will need to cut living costs so you can pay for the treatment."

"I will contact your provider to review your treatment options." The nurse is demonstrating advocacy by contacting the provider to communicate the client's concerns so that the client can make an informed decision regarding their health care.

A nurse is caring for a client who is alone & has just received a serious diagnosis. The client asks the nurse if they can pray together, & the nurse agrees. The nurse is demonstrating which of the following ethical principles?

Beneficence

A nurse is giving change-of-shift report to an oncoming nurse using SBAR reporting. Which of the following entries by the nurse demonstrates the correct use of SBAR?

The client in room 1 has been experiencing breakthrough pain following an exploratory surgery yesterday. Vital signs are stable. Recommend calling the provider for a breakthrough dose if pain continues. The nurse is providing relevant and needed information for SBAR reporting: situation, background, assessment, and recommendation.

A nurse is assisting with teaching a newly licensed nurse about electrical safety. Which of the following actions by the newly licensed nurse indicates an understanding of the teaching?

The nurse holds onto the plug to unplug a client's electronic blood pressure machine.

A nurse educator is planning an in-service for staff nurses about psychomotor client teaching strategies. Which of the following activities requires the use of gross motor skills? (Select all that apply.)

A client walking with crutches. A client using a manual wheelchair.

An adult who was in a motor vehicle accident is brought into the emergency department by paramedics, who report the following in-transit vital signs: Oral temperature: 99.0° F Pulse: 102 beats/min Respiratory rate: 26 breaths/min Blood pressure: 140/106 Which hormones should the nurse consider as the most likely causes of the abnormal vital signs?

Epinephrine and norepinephrine

A nurse calls the unit to tell say that they will be late for their shift. The charge nurse responds, "Don't worry, take your time and be safe." After hanging up the phone, the charge nurse then says to staff at the nurses' station, "I'm tired of that nurse always being late. I wish someone would do something about their tardiness." Which of the following communication styles is the charge nurse demonstrating?

Passive-aggressive During the phone call while talking with the oncoming nurse, the charge nurse was pleasant and accepting that the nurse would be late. However, once the phone call ended, the charge nurse then complained about the nurse always being late to the other staff. The charge nurse exhibited a passive-aggressive style of communication.

A charge nurse is teaching a group of nurses about protecting themselves from an abusive client. Which of the following statements by a nurse within the group demonstrates an understanding of the teaching?

"I should try to escape or put a barrier between myself and the client." The nurse should always try to escape a dangerous situation. If escape is not possible, creating a barrier where the client cannot reach them until help arrives is the next acceptable action.

A nurse is precepting a newly licensed nurse and suggests using the IDEAL method to structure the client's discharge planning. The client's caregiver is also in the room. Which of the following statements made by the newly licensed nurse demonstrates the correct the use of the IDEAL method?

"I will include the client and caregivers in the discharge discussion." "I" stands for "include" in this model. The nurse should include the client and caregivers to review the discharge instructions. Research shows including caregivers in the discharge instructions with the client leads to a safer transition.

A nurse is assisting with teaching a class about events that require an occurrence report. Which of the following events should the nurse include? (Select all that apply.)

A client's visitor falls in the hallway is correct. A client develops an unexpected reaction to a medication is correct. A client's dentures are lost is correct.

A nurse is caring for a client who is scheduled for surgery. Before the client has signed the informed consent form, the client states, "I didn't really understand what the doctor said." Which of the following actions should the nurse take?

Ask the provider to discuss the procedure with the client

A nurse is discussing responsibility with a newly licensed nurse. Which of the following actions should the nurse include as an example of responsibility? Informs a social worker that a client will require financial assistance with prescriptions at discharge Supports a client's decision to stop chemotherapy Checks a client to determine how well a pain medication worked Ensures a client understands their treatment options

Checks a client to determine how well a pain medication worked This action by the nurse represents responsibility because the nurse identified a client need, intervened, and is now determining the outcome of the intervention.

A nurse is caring for a client who is actively dying. The client's caregiver asks the nurse about the client's noisy respirations. Which of the following information should the nurse include? (Select all that apply.)

They can be an indication of approaching death. Turning the client's head to the side can assist with drainage. Medications can be administered to help dry up the secretions. The client is unable to clear the secretions themselves.

Jargin and slang

-Avoid Jargon: OT talk; other ppl don't understand -Avoid buzzwords: evidence based practice -Avoid contractions -Write in 3rd person -Use longer and more complex paragraphs

A nurse is teaching the staff about the general adaptation syndrome. In which order will the nurse list the stages, beginning with the first stage? 1. Resistance 2. Exhaustion 3. Alarm

3, 1, 2

A nurse is caring for a client who has a new prescription for dialysis three times a week. The client avoids eye contact while talking to the nurse and explains that they work two jobs to support their partner and two children. The client also states, "I don't know how I am going to have time for dialysis." Which of the following factors are influencing the client's communication? (Select all that apply.)

Psychosocial factors is correct. The nurse should recognize that psychosocial factors are influencing communication with the client. Psychosocial factors include the client's financial situation. The client is working two jobs and going to dialysis appointments twice a week, which might require them to miss work time and pay. Furthermore, the client is the only income for this household. Situational factors is correct. The nurse should recognize situational factors, such as the new prescription for dialysis, influencing the communication with the client. Situational factors that can affect communication cause emotions including fatigue, anxiety, grief, and fear. This client's verbal and nonverbal communication are indicators of worry, anxiety, sadness, and grief.

A nurse is planning to teach new assistive personnel (AP) how to use a bedside glucose monitor to check a client's blood glucose level. The nurse will include a 30-min face-to-face lecture and a written copy of the step-by-step procedure. Which of the following modes of communication is the nurse using in the teaching plan? (Select all that apply.)

Verbal is correct. The nurse planned on teaching in a face-to-face presentation of the information. The verbal mode of communication occurs during face-to-face communication between the sender (the nurse) and the receiver (the APs). It can also occur during a telephone call. Written is correct. The written mode of communication is any form of communication in which the receiver reads the message from the sender. The nurse plans to use both face-to-face verbal communication and a written mode of communication. Nonverbal is correct. The nonverbal mode of communication is comprised of body language. Actions such as eye contact, facial gestures, posture, and overall appearance all send messages to the receiver in addition to what the sender is saying. The nurse will be sending and receiving messages with the AP as they deliver the verbal information in a face-to-face environment.

A nurse is discussing social determinants of health with a newly licensed nurse. The nurse should include that which of the following factors contribute to the neighborhood and built environment determinant category? (Select all that apply.)

Access to foods that support healthy eating patterns. Crime and violence Environmental conditions

A nurse is preparing for a teaching session with a client. Which of the following actions should the nurse take to provide the client with unbiased care? (Select all that apply.)

Avoid assumptions about the client. Control personal thoughts about the client. Collaborate with another nurse to develop teaching strategies.

A nurse is planning a presentation about skin care for a group of older adult clients at a senior center. Which of the following actions should the nurse take to enhance client learning?

Ensure the room is well lit. The nurse should identify that a well-lit room can allow the participants to better see the presentation as well as the nurse during the teaching.

ICD10

Diagnosis codes

focuses on evoking pleasant images to replace negative or stressful feelings and to promote relaxation

guided imagery

involves using all 5 senses to imagine an event or body process unfolding according to a plan

guided imagery

A nurse is assisting with client triage at the scene of a mass casualty event. Which of the following clients should the nurse recommend for transport first?

A client who has an abdominal wound that is actively bleeding

A nurse is providing teaching to a client who has a recent diagnosis of pancreatic cancer. The nurse is using strategies in the affective domain of learning. Which of the following client statements is part of the affective domain?

"I have been crying a lot since I learned about my diagnosis. I'm worries about everything."

A nurse is teaching the SMART goal method to a client who has diabetes mellitus and is setting nutrition and weight loss goals. Which of the following client statements should indicate to the nurse an understanding the teaching?

"I will reduce my sugar intake by 10 grams each week for one month until I reach the desired level." This response indicates the client understands and is using the SMART goal method: creating goals that are specific (S), measurable (M), attainable (A), realistic (R), and timely (T).

A nurse in a provider's office is caring for a client who has hypertension during a follow-up appointment and is focusing on the client's ability to make healthy behavior changes. Which of the following statements by the nurse is an example of the use of affirmations?

"I'm glad you decided to continue your fitness routine." This statement by the nurse builds the client's confidence and acknowledges the client's efforts to make positive changes. It is an example of the use of affirmations to acknowledge the client's efforts to make healthy behavior changes.

A nurse is using the NURSE mnemonic while speaking with a client who is experiencing grief. Which of the following responses by the nurse demonstrates the concept represented by the "U" in the NURSE mnemonic?

"There is a lot going on right now, how can I be of help to you?"

Reimbursement/legal and ethical issues

-Denials -Billing fraud and abuse -Malpractice and other legal claims -Ethical dilemmas (wrong abbreviations, spelling errors, illegible writing)

Exceptions

-Document unusual circumstances or events like noncompliance or deviation from plan

4 principles that guide OT practice

1. Client centered 2. Occupation centered 3. Evidence based 4. Culturally relevent

A nurse is planning a presentation about shared governance. Which of the following examples should the nurse plan to include? A supervisor at a home health agency makes a unilateral decision to cut staff. Two assistant directors at an ambulatory care center write the policy manuals for the center. A group of staff nurses in a clinic work together to recommend new equipment purchases for the unit. Nurses on a medical-surgical floor follow instructions made by the charge nur

A group of staff nurses in a clinic work together to recommend new equipment purchases for the unit. Shared governance is a leadership structure that encourages group collaboration to make shared decisions. Being a contributing partner in decisions promotes interprofessional collaboration, professional development and accountability, and improves client outcomes.

A nurse is teaching a newly licensed nurse about professional values. The nurse should include that which of the following is an example of autonomy?

A nurse respects a client's which to discontinue a treatment

A nurse in an emergency department is caring for four clients. Which of the following clients requires mandatory reporting?

A young adult client who is positive for tuberculosis

A nurse is caring for a client who asks why they chose the nursing profession. The nurse states that it was because they wanted to help others. The nurse is referring to which of the following professional values?

Altruism

A nurse is providing teaching about performing blood glucose checks to a client who has a new diagnosis of diabetes mellitus. Which of the following actions indicates the nurse is using the affective domain of learning?

Ask the client how they feel about checking their blood glucose levels.

A nurse is caring for a group of clients. Which of the following actions by the nurse demonstrates professionalism? Asks a client for their name, date of birth, and scans their medical identification bracelet before administering medications Determines that a client's rash is a response to being overly stressed about a new diagnosis Suggests a client's family member translate medical information for a client who speaks a different language than the nurse Documents that a client's medication was administered when retrieving the medication from the pharmacy

Asks a client for their name, date of birth, and scans their medical identification bracelet before administering medications The nurse demonstrates professionalism by practicing the rights of medication administration to promote client safety.

A nurse is teaching a newly licensed nurse about ethical principles. The nurse should include that client who has chosen to sign a blood product refusal form is an example of which of the following ethical principles?

Autonomy

A nurse is discussing nursing roles with a newly licensed nurse. The nurse should include that which of the following is a role of the nurse? (Select all that apply.)

Caregiver is correct. The role of the nurse includes providing care to clients with respect and empathy, engaging in therapeutic communication, and providing physical, mental and emotional support. Advocate is correct. The role of the nurse includes advocating for client needs and assisting clients to make informed decisions regarding their care. Change agent is correct. The role of the nurse includes guiding a client to recognize the need for change, engage in the plan, and take a proactive role in their health status.

A charge nurse uses a transformational leadership style when working with other staff on the unit. Which of the following actions by the charge nurse demonstrates transformational leadership? Tells assistive personnel if the morning care for a group of clients is completed by noon they will receive a free lunch Challenges a nurse to investigate evidence-based approaches to reduce the client fall rate on the unit Provides a nurse with the written protocol for changing a dressing and encourages them to work independently Adjusts direction to nursing staff based on the nurses' experience and client needs

Challenges a nurse to investigate evidence-based approaches to reduce the client fall rate on the unit A transformational leader focuses on a person's willingness to change and stimulates them to review current structures and come up with fresh new ways to improve them, such as finding a way to decrease client falls.

A nurse is caring for a client who is being transferred to another unit, but the receiving nurse is unavailable to take report. Which of the following concepts is being violated that could place the client at risk?

Continuity of care The nurse should understand that continuity of care can cause a safety risk of a client when there are numerous hand-off reports completed during a transfer to another unit. The nurse should wait until the other nurse is available for report.

A nurse is completing a medication reconciliation on a newly admitted client. Which of the following information should the nurse include? (Select all that apply.)

Current prescribed medications is correct. Nutritional supplements the client takes is correct. Over-the-counter medications the client uses is correct.

A nurse is discussing leadership styles with a newly licensed nurse. Which of the following characteristics should the nurse identify as describing a bureaucratic leader? (Select all that apply.)

Decisions are controlled by policies is correct. A bureaucratic leader bases their decisions on policies and strictly follows the rules. Enforces the rules is correct. A bureaucratic leader strictly follows and enforces the rules. Inflexible to creative suggestions is correct. Bureaucratic leaders abide by the specific policy and procedures and are not open to creativity, suggestions, or ideas.

A nurse is reviewing Kübler-Ross's five stages of grief. The nurse should identify that Kübler-Ross placed the stages in which original order? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Denial Anger Bargaining Depression Acceptance

A nurse is reviewing the goals of client education with a newly licensed nurse. Which of the following information should the nurse include? (Select all that apply.)

Determine if different nursing interventions are required.

A nurse is caring for a client who has a terminal illness and states that they want to experience a "good death." Which of the following actions should the nurse take?

Determine the client's definition of a "good death."

A nurse is advocating for a client who is seeking treatment for an eating disorder. In which order should the nurse take the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) Assist the client in establishing goals for treatment. Determine the client's level of understanding regarding their eating disorder. Review the client's weight prior to each treatment session. Encourage the client to communicate their preferences during the team meeting to establish the steps of treatment.

Determine the client's level of understanding regarding their eating disorder is the first step. The nurse should collect data regarding the client's level of understanding, interests, personal values, mental function, and awareness of rights in order to advocate for the client. Assist the client in establishing goals for treatment is the second step. The nurse should assist the client in identifying the goals for treatment, which are based on the client's needs and beliefs, in order to advocate for the client .Encourage the client to communicate their preferences during the team meeting to establish the steps of treatment is the third step. The nurse should next assist the client in communicating their preferences to the rest of the health care team to implement the advocacy plan. Review the client's weight prior to each treatment session is the fourth step. The nurse should monitor the outcomes of the plan and make adjustments as needed to advocate for the client.

A nurse is preparing to administer a PRN pain medication to a client but withholds the medication because the client is sleeping. Which of the following actions should the nurse take to provide the expected standard of care?

Document that the medication was not administered

A nurse manager is observing a newly licensed nurse provide care for a client. Which of the following actions by the newly licensed nurse should the manager identify as unprofessional behavior? (Select all that apply.) Documents in advance to save time Stays logged into the client's electronic health record while obtaining supplies from the supply room Contacts a client on social media to become friends Informs a provider that a requested action is outside the nurse's scope of practice Provides a certified medical translator for a client who speaks a different language than the nurse

Documents in advance to save time is correct. This is falsification of documentation. The nurse should document during or after providing care to ensure accurate documentation. Stays logged into the client's electronic health record while obtaining supplies from the supply room is correct. The nurse should log off the computer to reduce the risk of another person accessing the client's personal health information. Leaving a computer unattended while still logged in places the nurse at risk for a HIPAA or confidentiality violation. Contacts a client on social media to become friends is correct. Contacting a client on social media oversteps professional boundaries between the nurse and the client and is considered inappropriate conduct.

A nurse at the end of their shift realizes they forgot to give a client their scheduled vitamins. The nurse decides to document that the vitamins were administered. Which of the following describes the nurse's action?

Falsification of records

Part C medicare

Have to buy into -Includes outside costs

A nurse is reviewing the goals of client education with a newly licensed nurse. Which of the following information should the nurse include? (Select all that apply.)

Improvement of health. Provide knowledge about an illness or injury. Health promotion.

A nurse is teaching a newly licensed nurse about what to include in a medication reconciliation form for a client who is being transferred to a new facility. Which of the following instructions should the nurse include?

Include medications the client took at home.

A nurse notifies their supervisor that they accidentally administered the wrong medication to a client. The nurse is demonstrating which of the following professional values?

Integrity

A nurse is providing equal care to a group of clients who have varying economic statuses. Which of the following ethical principles is the nurse demonstrating?

Justice

A nurse is reviewing information to enhance their own cultural awareness. The nurse should identify the need to examine which of the following?

Self-bias

A nurse is preparing a poster about professional accountability for an in-service. Which of the following examples should the nurse include? (Select all that apply.) --nforms a client's family that the assistive personnel (AP) failed to get the client out of bed during the day -Lowers a client's bed to the lowest position after assisting the client to lie down -Administers pain medication to a client 30 min before the client is scheduled for physical therapy -Provides instructions to assistive personnel (AP) on how to provide culturally competent care to a client -Documents a dressing change on a client's wound prior to completing it

Lowers a client's bed to the lowest position after assisting the client to lie down is correct. A nurse is accountable to the client as well as the facility to take actions to ensure a client's safety. This includes lowering the client's bed to reduce the risk of falls if the client tries to get out of bed. Administers pain medication to a client 30 min before the client is scheduled for physical therapy is correct. Planning actions, such as providing pain medication to a client prior to physical therapy, demonstrates planning and accountability for ensuring the client receives quality care. This action allows the medication time to take effect prior to the client having to perform physical activities, allowing for a more effective physical therapy session and decreasing the risk of client injury and discomfort. Provides instructions to assistive personnel (AP) on how to provide culturally competent care to a client is correct. Professional accountability involves not only ensuring the safety and quality of nursing care, but also delivering it in a culturally competent manner.

A nurse is assessing a client who came to the emergency department reporting chest pain. The client tells the nurse they have hearing loss and forgot to bring their hearing aid with them. Which of the following actions should the nurse take to improve communication with the client? (Select all that apply.)

Move the client to a quiet area or private room is correct. The nurse should reduce environmental noise as much as possible to enhance communication with this client. Speak at a slower pace is correct. Speaking at a slower pace might help the client to be able to better understand and communicate with the nurse. Avoid using medical terminology is correct. The nurse should avoid using medical terminology. These words are unfamiliar and can impede communication with all clients.

A nurse is obtaining a health history from a client who is newly admitted. The nurse notices that the client does not make eye contact and that their arms are folded across their chest. The nurse should recognize that the client is using which of the following forms of communication?

Nonverbal The nurse should recognize the client is exhibiting nonverbal communication through their physical gestures. Nonverbal communication, also known as body language, plays an important role in interactions among nurses, clients, and their families. For instance, not making eye contact, not being engaged in the conversation, or having closed posture (folded arms, slouching) can portray a negative message.

A nurse is preparing a presentation on the regulation of nursing practice. Place the hierarchy of the regulation of practice in the correct order beginning with the highest level (step one) and proceeding to the lowest level (step four). (Move the steps into the box on the right, placing them in the order of hierarchy. Use all the steps.) -Individual self regulation -nursing practice act -organization policies and procedures -nursing regulatory board

Nursing regulatory board is the highest level in the hierarchy of regulation (step one). Each state has a board of nursing that reports to the National Council of State Board who oversees the standards for educational programs, license requirements, scope of practice, and grounds for disciplinary action, remediation, or violations. Nurse practice act is the second highest level in the hierarchy of regulation (step two). Each board of nursing determines the laws of practice or the Nurse Practice Act (NPA) for licensed nurses within that state. The NPA defines the nursing activities and ensures nurses practice within the defined laws, rules, and regulations. Nurses are responsible for knowing the details and abiding by the NPA. Nurses can be held liable when they, even in error, violate the standards of the NPA. Organization policies and procedures is the third highest level in the hierarchy of regulation (step three). Organizations establish policies and procedures that regulate and guide nursing practice within their establishments. These policies define the standards of care and responsibilities of individual nurses from assistive personal, nursing students, graduate nurses, the newly licensed, and the experienced nurse. Individual self-regulation is the lowest level in the hierarchy of regulation (step four). Each nurse is in control of their individual competence, decisions, and actions while providing client care. This is the duty to self-regulate. Nurses must use their knowledge and expertise to be prepared for all eventualities.

A nurse is discussing hospice care services with the caregiver of a client who is terminally ill. Which of the following information should the nurse include?

Nursing support will be provided in meeting the client's daily needs, including the administration of medications.

A nurse is discussing the benefits of palliative care with a newly licensed nurse. Which of the following information should the nurse include?

Palliative care improves the client's quality of life.

A nurse is grieving following the death of a client who had a terminal illness and is having difficulty sleeping and concentrating. Which of the following actions should the nurse take?

Participate in an exercise program.

A nurse is caring for a newly admitted client. Which of the following actions should the nurse take first?

Perform a cultural health assessment.

A woman who was sexually assaulted a month ago presents to the emergency department with reports of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. Which medical problem will the nurse expect to see documented in the chart?

Post-traumatic stress disorder

A nurse is caring for a client who has refused to have a biopsy. The client states, "I don't need the biopsy; I wouldn't do anything about it anyways if it's cancer." The nurse replies, "You don't want to have the biopsy because you would not seek treatment if it was cancer. Is that correct?" Which of the following therapeutic communication techniques is the nurse using?

Restating The nurse is summarizing, paraphrasing, or restating the client's thoughts to confirm the nurse understands what the client is attempting to communicate.

A nurse manager is planning to introduce a new scheduling policy to the unit staff. Which of the following methods of communication should the nurse manager use?

Schedule a face-to-face unit staff meeting. In-person communication of this important policy would permit for both verbal and nonverbal modes of communication between the sender (the nurse manager) and the receiver (the unit staff).

A nurse is assessing a client who is experiencing disenfranchised grief. Which of the following findings should the nurse expect?

Social isolation

The nurse teaches stress-reduction and relaxation training to a health education group of patients after cardiac bypass surgery. Which level of intervention is the nurse using?

Tertiary

A nurse is discussing professional commitment with their supervisor during an annual performance review. Which of the following actions by the nurse demonstrates professional commitment? -The nurse attends an educational course to learn about the treatment and prevention of pressure ulcers. -The nurse tries to improve their skills by starting an unnecessary IV on a client who has dementia. -The nurse covers for another nurse who the nurse suspects is chemically impaired. -The nurse withholds information from a client to reduce the client's at

The nurse attends an educational course to learn about the treatment and prevention of pressure ulcers. Professional commitment includes a motivation to improve oneself in the domain of their profession. Attending a course that expands current knowledge contributes to promoting one's professional commitment.

A nurse is assisting with teaching a class about using simulation for clinical education. Which of the following information should the nurse include?

The use of simulation improves communication skills.

A nurse is assisting with teaching a class about using health information technology for client care. Which of the following examples should the nurse include?

Using a barcode to verify a client's medication

CPT

What we'll have to use

although sometimes ssumed that all homeopathic redeies are highly diluted and therefore unlikely to cause harm, some products labeled as homeopathic contain substanial amounts of:

active ingredients, thus could cause side effects and drug interactions. **little evidence supports homeopathy as an effective treatment

what can herbs be used for?

herbs can be used for treatment fo disease or reduction of symptoms

A nurse is teaching a client about hospice care. Which of the following statements by the client indicates an understanding of the teaching?

"I understand that services provided will include just what is needed to keep me comfortable."

A nurse is caring for a client who has a prescription for opioid analgesia. The client tells the nurse, "I don't want to take that medication because it makes me sleepy." Which of the following responses should the nurse make?

"I will speak to your provider to see if there is a different medication to treat your pain."

A nurse is caring for a client whose religious belief prohibits them from receiving blood products. The client states, "My adult children don't agree with my beliefs and want me to receive a transfusion." Which of the following responses should the nurse make?

"You have the right to choose what treatments are best for you."

A nurse is reviewing the medical records of four clients. Which of the following clients should the nurse identify as the priority for care?

A client who received digoxin and has a heart rate of 48/min

A nurse is teaching a newly licensed nurse about health literacy. Which of the following information should the nurse include?

A client's comprehension of education can be affected by low health literacy.

A nurse is talking with a client who arrived at the clinic over an hour ago and states, "Doesn't anyone care that I am sick? Why do I have to wait so long?" The nurse listens to the client and notifies the provider, relaying the needs of the client. In which of the following roles is the nurse performing?

Advocate

A nurse in a community clinic sees clients experiencing health disparities within vulnerable populations. The nurse should consider which of the following clients as belonging to a vulnerable population? (Select all that apply.)

An African American adolescent who is pregnant. A low-income family. A female who is Latina and has type 2 diabetes mellitus.

A nurse is assessing a client using the ABCDE approach. The nurse has already assessed the client's airway and breathing status. Which of the following assessments should the nurse perform next?

Blood pressure

A newly licensed nurse is reviewing Benner's Novice to Expert Model for nursing competence. At which of the following stages does the nurse first develop the ability to prioritize tasks by drawing on experience?

Competent

A nurse is caring for a client who is from a different culture. To provide the best possible client care, which of the following actions should the nurse take first?

Conduct a self-assessment.

A nurse is performing the role of case manager for a client. Which of the following actions demonstrates this nursing role?

Coordinating and overseeing the care the client is receiving

A nurse helping to develop an in-service about cultural competence is reviewing a list of health beliefs provided by members of a local cultural group. The nurse should recognize that this list provides which of the following types of information?

Emic knowledge

A nurse is planning an in-service for a group of staff nurses about spiritual care. Which of the following situations should the nurse identify as appropriate for a consultation with pastoral staff? (Select all that apply.)

Ethical dilemma Terminal illness Death of a client Hardship

A nurse is caring for a client who reports experiencing chills and not feeling well. The nurse informs the client that they will need to have their temperature taken to monitor the manifestations. Which of the following terms describes that the nurse's action is grounded in research?

Evidence-based practice

A nurse is hired to be a case manager in a facility. Which of the following services should the nurse expect to perform?

Facilitate transfer of clients to meet the req'd level of care.

A nurse is reviewing historical nursing data and how it has impacted nursing care. The nurse should identify that which of the following nursing pioneers is credited with first using evidence-based practice in caring for clients?

Florence Nightingale

A nurse is talking with a group of clients in a community setting. Which of the following statements by the nurse describes how culture affects a client's definition of health and illness?

Health and illness can be defined differently by individual clients.

A nurse is reviewing a client's medical record for factors that could impact accessibility to health care services. For which of the following factors should the nurse monitor?

Health disparities

A nurse is teaching a client about the International Self-Care Foundation's seven pillars of self-care. Which of the following client statements indicates an understanding of the teaching?

I will perform moderate exercise several times each week.

A nurse at a community health center is providing an in-service for a group of residents about the Healthy People program. Which of the following information should the nurse include? (Select all that apply.)

Initiatives to reduce health care disparities. Activities to improve social determinants of health. Improving access to health care.

A nurse is completing the Minimum Data Set (MDS) assessment for a resident in a skilled-nursing facility. Which of the following information should the nurse include in the assessment? (Select all that apply.)

Input from team members of the client's Interdisciplinary team. The client's cognitive status. Each physical therapy visit. The client's need for assistance with ADLs.

A nurse is explaining to a newly licensed nurse that caring for clients involves lifelong learning by the nurse. The nurse should include which of the following as examples of learning opportunities for nurses? (Select all that apply)

Online continuing education journals Nursing skill refresher Continuing education presentation Participating in healthcare research

A nurse is caring for a client who states the health care provider recommends treatment to provide comfort because a cure is not possible. To which of the following concepts is the provider referring?

Palliative care

A nurse is prioritizing care for a client. Identify the priority order of client needs using Maslow's Hierarchy of Needs. (Move the levels into the box on the right, placing them in the order of priority. Use all the levels.)

Physiological Safety Love/Belonging Esteem Self-actualization

A community health nurse is teaching a newly licensed nurse about social determinants of health. Which of the following should the newly licensed nurse identify as a physical determinant of health?

Poor air quality

A charge nurse is reviewing client acuities and tasks to make the nursing staff's daily assignments. When using the Five Rights of Delegation, which of the following should the charge nurse use to ensure client safety?

Right task The charge nurse should delegate an assignment or task that is safe for a health care worker to carry out. Safety includes right training, competency, or within the health care worker's scope of practice.

A nurse is caring for a client who tells the nurse, "Something is wrong. I feel like God is so far away from me and I don't know what to do." Which of the following is the client experiencing?

Spiritual distress

A nurse is teaching a group of guardians about primary prevention techniques. Which of the following topics should the nurse include as an example of primary prevention?

Taking measures to decrease the risk of childhood injuries within the home.

A nurse is reviewing the contributions of various nursing organizations that provide support in caring for clients. The nurse should identify that which of the following agencies provides The Nursing Scope and Standards of Practice?

The American Nurses Association (ANA)

A nurse manager is providing education to a group of newly licensed nurses about various nursing organizations. Which of the following information should the nurse manager include?

The American Nurses Association's The Code of Ethics for Nurses with Interpretive Statements guides nurses through difficult decisions.

A nurse is teaching a newly licensed nurse about the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) tool. Which of the following information should the nurse include?

The HCAHPS tool is issued to measure client satisfaction with the health care service.

A nurse is reviewing the Institute of Medicine (IOM) Future of Nursing report to better understand proposed educational requirements of nurses. Which of the following organizations is responsible for publishing this report?

The National Academy of Medicine

A nursing student expresses a desire to become more involved with the nursing profession on a national level. Which of the following organizations should the student join?

The National Student Nurses' Association

A nurse is planning care for a client who is a veteran. Which of the following information should the nurse consider?

The client is at an increased risk for poor health outcomes.

A nurse is caring for a client who reports new onset of abdominal pain. The nurse should assign the client's condition to which of the following categories when prioritizing care?

Urgent

A nurse is caring for a client who speaks a different language than the nurse. Which of the following actions should the nurse take?

Use a certified medical interpreter.

A nurse is caring for a client who reports an improved diet, exercising 30 min a day for 5 days a week, and an overall sense of improved health. The nurse should identify that the client is describing a positive state of health known as which of the following?

Wellness

A nurse is speaking with a client who is non-compliant in performing a daily blood glucose testing regimen. Which of the following responses should the nurse make?

What is preventing your consistency with your daily blood glucose checks?" The nurse is using an open-ended question to encourage the client to talk more about what is hindering them from the process for daily blood glucose testing.

A nurse working in an acute care facility is caring for a client who has a total brain injury and is receiving mechanical ventilation. Which of the following facilities should the nurse anticipate the client to be transferred to for further treatment?

LTCH

A nurse at a hospital is interviewing a newly admitted client. The client tells the nurse they would like to adhere to their cultural beliefs during their hospitalization. Which of the following actions should the nurse take to provide the client with culturally competent care? (Select all that apply.)

Listen to the client's request with respect and compassion. Reassure the client that they can practice their cultural beliefs if safe to self and others. Provide resources to meet the client's culture needs.

A nurse is interviewing a client who states that they are transgender, although they have a biological sex of male listed in their records. Which of the following information should the nurse plan to incorporate when assisting with the client's plan of care?

The client associates their identity to something different from their biological sex.

A nurse is performing an admission assessment on a client. Using the safety and risk reduction priority setting framework, which of the following findings should the nurse identify as the priority?

The client reports dizziness when standing