Lifespan III
An otherwise healthy 33-year-old woman experienced debilitating and persistent fatigue over a period of several weeks and was subsequently diagnosed with acute myeloid leukemia (AML). The woman has been admitted to the hospital for treatment. The nurse who is providing care for this patient should prioritize which of the following assessments? A) Assessing the woman for thrombosis and embolism B) Assessing the woman for signs and symptoms of infection C) Assessing the woman's heart rate, rhythm, and circulation D) Assessing the woman for signs and symptoms of fluid volume overload
B
The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (PRBCs) has begun, the patient is having difficulty breathing and is experiencing chest tightness. What is the most appropriate initial action for the nurse to take? A) Notify the patient's health care provider. B) Stop the transfusion immediately. C) Remove the patient's IV access. D) Assess the patient's chest sounds and vital signs.
B
The nurse has been monitoring a patient's vital signs closely after initiating a transfusion of packed red blood cells (PRBCs). The nurse has observed that the patient's temperature is trending upward, and the patient is complaining of chills. The nurse has stopped the transfusion and informed the patient's health care provider, who believes that the patient is experiencing a febrile nonhemolytic transfusion reaction (FNHTR). A) Administering a bolus of normal saline B) Monitoring the patient closely and administering antipyretics C) Initiating apheresis and administering IV antihistamines D) Performing a stat cross-match and beginning a transfusion of the correct blood type
B
A 44-year-old homeless man presented to the emergency department with hemoptysis. The patient was diagnosed with tuberculosis (TB) after diagnostic testing and has just begun treatment with INH, pyrazinamide, and rifampin (Rifater). When providing patient education, what should the nurse emphasize? A) The rationale and technique for using incentive spirometry B) The correct use of a metered-dose inhaler (MDI) for bronchodilators C) The need to maintain good nutrition and adequate hydration D) The importance of adhering to the prescribed treatment regimen
D
A 72-year-old patient is status post right knee replacement, and the nurse recognizes the patient's risk of hospital-acquired pneumonia (HAP). What is a priority nursing measure for the prevention of HAP? A) Providing emotional support B) Giving antibiotics as ordered C) Providing extra nutrition for the elderly patient D) Providing anticipatory interventions
D
A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and her condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include what? A) Hepatectomy B) Vitamin K administration C) Platelet transfusion D) Splenectomy
D
What kind of standard provide processes for evaluation (includes consumer input) and determines best practice by evidence, consumer, and employees.
Process Standards ( also called performance standards)
Name 5 aspects of Quality Improvement Program
1. Safe 2. Effective 3. Patient Centered Care 4. Timely 5. Efficient
A patient, newly diagnosed with thrombocytopenia, is admitted to the medical unit. After the admission assessment the patient asks the nurse to explain the disease. What should the nurse explain to the patient about this condition? A) There could be an attack on the platelets by the antibodies B) There could be decreased production of platelets C) There could be elevated platelet production. D) There could be decreased white blood cell production.
B
A 60-year-old woman has begun a course of oral antibiotics for the treatment of a urinary tract infection (UTI). The patient's nurse should recognize that the causative microorganisms most likely originated from: A) Fecal contamination from the patient's perineum B) Colonization of the patient's urethra from bloodborne pathogens C) Proliferation of normal microbiotic flora D) Ingested microorganisms
A
A nurse who provides care in a long-term care facility has observed a sharp decline in an 88-year-old man's level of consciousness and activity over the past 36 hours. The nurse recognizes the high incidence of pneumonia among older adults. How does pneumonia present differently among the elderly than among younger patients? A) Older adults often lack a fever when they develop pneumonia. B) Oxygen saturation levels remain stable among older adults despite increased sputum production. C) Pneumonia is usually intensely painful for older adults but lacks an increase in white blood cells (WBCs). D) Older adults who have pneumonia are usually asymptomatic.
A
A patient with megaloblastic anemia is being treated in an inpatient setting and has daily blood work ordered. This morning's blood work has become available, and the patient's hemoglobin and hematocrit are continuing to trend downward. The nurse has contacted the patient's health care provider to determine whether the health care provider wants to order a transfusion of packed red blood cells (PRBCs). When considering the efficacy of this treatment the nurse should understand that: A) A transfusion of PRBCs may have the potential to create fluid volume overload and pulmonary edema. B) The patient's body is likely to destroy the transfused red cells soon after they are transfused. C) The patient is deficient in oxygen-carrying capacity more than in the absolute number of RBCs. D) The patient will require multiple transfusions over several days to achieve an increase in Hgb and Hct.
A
A woman's routine complete blood count (CBC) revealed a highly elevated platelet level, and subsequent diagnostic testing has resulted in a diagnosis of primary thrombocythemia. The nurse has begun the relevant health education with the patient. What should the nurse teach this woman about her health problem? A) "Primary thrombocythemia creates potential problems at both ends of the clotting spectrum: inappropriate clotting or inappropriate bleeding." B) "Your doctor will likely order a series of blood transfusions for you over the next several months." C) "It's very important that you try to adopt a diet that's high in organ meats and leafy green vegetables." D) "Primary thrombocythemia makes you quite vulnerable to hemorrhage, so you'll need regular injections of some important clotting factors."
A
The nurse educator is discussing aspiration with new nursing graduates. Which patient would the educator tell the nurses is at the greatest risk for aspiration? A) A stroke patient with dysarthria B) An ambulatory patient with Alzheimer's disease C) A 92-year-old patient who needs help with activities of daily living (ADLs) D) A patient with severe, deforming rheumatoid arthritis
A
The nurse is caring for a patient with a diagnosis of hypoproliferative anemia. When planning this patient's care, the nurse should be aware that this type of anemia is due to what? A) Lack of production of red blood cells (RBCs) B) Loss of RBCs C) Injury to the RBCs in circulation D) Abnormality of RBCs
A
A nurse decides to hold a patients medication of Metoprolol because their systolic BP was <90. What kind of action did the nurse use?
Critical Thinking * Critical thinking discourages quick judgements
A 30-year-old woman has presented for care, stating, "I'm pretty sure that I've got a UTI, so I think I'll need some antibiotics." In the presence of a UTI, the nurse would expect the woman to have which of the following signs and symptoms? Select all that apply. A) Pain on urination B) Excessively dilute urine C) Urinary frequency D) Urgency E) Copper-colored urine
A,C,D
Note two patient populations that require particular attention for protection in regard to nursing research
A. Older adult B. Children
A 50-year-old woman recently sought care from her primary care provider and was diagnosed with hypoproliferative anemia following a diagnostic workup. The nurse at the clinic has been charged with the responsibility for organizing the woman's care and is consequently creating a nursing care plan. When planning this woman's care, what nursing diagnosis should the nurse prioritize? A) Decreased cardiac output B) Risk for fatigue C) Acute pain D) Risk for hypothermia
B
A 72-year-old patient who was admitted to the hospital for a total hip arthroplasty has developed increasing dyspnea and leukocytosis over the past 48 hours and has been diagnosed with hospital-acquired pneumonia (HAP). The choice of antibiotic therapy for this patient will be primarily based on which of the nurse's assessments? A) Auscultation and percussion of the patient's thorax B) Collection of a sputum sample for submission to the hospital laboratory C) Analysis of the patient's leukocytosis and the white blood cell (WBC) differential D) Assessment of the patient's activities of daily living
B
A gerontological nurse is aware of the high incidence and prevalence of urinary tract infections (UTIs) among older adults. Consequently, the nurse is implementing plans of care that attempt to reduce this risk. Which of the following actions present the greatest risk of UTIs for older adults? A) The use of antibiotics for respiratory infections B) The use of indwelling urinary catheters C) Restricting older adults' mobility and levels of activity D) Restricting fluid in older adults with congestive heart failure (CHF) or renal disease
B
A patient with renal failure is experiencing decreased erythropoietin production. Upon analysis of the patient's complete blood count (CBC), the nurse will expect which of the following results? A) An increased hemoglobin and hematocrit B) A decreased hemoglobin and hematocrit C) A decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) D) An increased MCV and MCHC
B
The nurse notices a red, soft spot on a patient's sacrum and decides to turn the patient Q2. What kind of action is this?
Independent Action Without an order, assessment findings
The clinic nurse is teaching a young woman about preventing recurrent urinary tract infections. What information should the nurse include? A) Bathe daily. B) Avoid voiding immediately after sexual intercourse. C) Drink liberal amounts of fluids. D) Void every 6 to 8 hours.
C
The nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What statement should the nurse include in patient education? A) "Take the iron with dairy products to enhance your body's absorption of it." B) "You should increase your intake of vitamin E while you're taking iron." C) "Iron will likely cause your stools to darken in color." D) "Limit foods high in fiber due to the risk for diarrhea."
C
The triage nurse in the emergency department (ED) is assessing a patient who presents complaining of pain and swelling in her right lower leg beginning last night along with fever, chills, and sweating. The patient states that she hit her leg on the car door 4 or 5 days ago, and it has been sore ever since. The patient has a history of chronic venous insufficiency. The nurse should suspect that this patient might have: A) Thrombocytopenia B) Arterial insufficiency C) Cellulitis D) Phlebothrombosis
C
A nurse enters the room of a client who is on contact precautions and finds the client lying on the floor. Which of the following actions should the nurse take first? A. Call the provider B. Ask a staff member for assistance getting the client back to bed C. Inspect the client for injuries D. Instruct the client to ask for help if he needs to get out of bed
C. Inspect the client for injuries
A PN ending her shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. Complete an incident report B. Delegate this take to the PN C. Ask the AP if she needs assistance D. Notify the nurse manager
C.Ask the AP if she needs assistance
A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPPA C. Patient Self-Determination Act D. Patient Care Partnership
D. Patient Care Partnership
A nurse received an order to discontinue a clients PICC line, what kind of action would the nurse be performing?
Dependent Action Orders, responsibility of the nurse within their scope of practice
Clinical Decision Making
Evidenced based nursing practice is clinical decision making based on the best available scientific evidence combined with nursing expertise and considering patient preferences and available resources
A nurse is participating in a quality improvement study of a procedure frequently on the unit. Which of the following information will provide data regarding the efficacy of the procedure? A. Frequency with which procedure is performed B. Client satisfaction with performance of procedure C. Incidence of complications related to procedure D. Accurate documentation of how procedure was performed
Incidence of complications related to procedureA
A nurse works with a physical therapist to help the client learn how to use a walker, what kind of action is this?
Interdependent Actions Teamwork w/ RN,PT,OT
What is foundational thinking in nursing?
Knowledge of S/S of patients illness, expected reference ranges of the patients diagnostic testing, risk factors for an alteration in health, expected S.E of a medication or treatment
What kind of standard evaluate results of actions and processes, patient outcomes.
Outcome Standards used for evaluating internal processes
What are defined actions by nurses that are legally permitted, based upon educational qualifications?
Scope of Practice
What kind of standard establish guidelines for organizational patterns and support structures for providing health care, equipment, personnel, and polices that guides actions?
Structural Standards