MS 1
Prior to planning health promotion interventions in the local community, the nurse is appraising the key health care indicators in the local region and comparing them with those in the nation as a whole. What do these key indicators reveal?
A significant gap in health status between the overall population and people of specific ethnic backgrounds
A team of community health nurses is planning to draft a proposal for a program that will increase the community's alignment with the principles of the Healthy People 2020 report. What activity would best demonstrate the priorities identified in this report?
Addressing determinants of health such as clean environment
A public health nurse has been commissioned to draft a health promotion program that meets the health care needs and expectations of the community. What factor is most likely to influence the nurse's choice of interventions?
Management of chronic conditions and disability
The nurse has just received report on a client who is coming to the unit from the emergency department with a torn meniscus. The nurse reviews the PRN medications and sees that an NSAID (ibuprofen) is prescribed every 6 hours. How should the nurse best implement preventive pain measures?
Check for allergies, use a pain scale to assess the clients pain, and offer the ibuprofen every 6 hours until the client is discharged
The nurse is admitting a client who is a recent immigrant from China and who has a diagnosis of adenocarcinoma. During the client's admission assessment, the client speaks of her beliefs related to health care and indirectly references the yin/yang theory. Based on her cancer diagnosis and her yin/yang beliefs, which meal will the client most likely order for lunch?
Chicken noodle soup with crackers, fruit crisp, and hot tea
The nurse is caring for a client who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the client's death is imminent?
Mottling of the lower limbs
The nurse is accepting care of an adult client who has been expediting severe and intractable pain. When reviewing the client's medication administration record, the nurse notes the presence of gabapentin. The nurse is justified in suspecting what phenomenon in the etiology of the client's pain?
Neuropathy
A woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply
Reinvesting in new relationships at the appropriate time Reminiscing about the relationship she had with her husband Relinquishing old attachments to her husband at the appropriate time
A terminally ill client the nurse is caring for is reporting pain. The physician has prescribed a large dose of intravenous opioids by continuous infusion. When the nurse assesses the client's respiratory status, the rate has decreased from 16 to 10 breaths per minute. What action should the nurse take?
Report the descreased respiratory rate to the physician
The nurse is caring for a client admitted to the medical-surgical unit after an injury. The client states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the client's care, what variables should the nurse consider? Select all that apply.
Resources that can assist the client with pain management The advantages and disadvantages How the presence of pain affects clients and families
An older adult client has returned to the community following knee replacement surgery. The community health nurse recognizes that the client has prescriptions for nine different medications for the treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses?
Risk for falls related to poly pharmacy and impaired balance
A nurse is providing care for a client who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement?
A critically appraising the outcomes of care that is provided
A nurse has been using the nursing process as a framework for planning and providing client care. What action would the nurse do during the evaluation phase of the nursing process?
Document a client's improved air entry with incentive spirometric use
The nurse is admitting a client with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment?
Does she have a sense of peace of mind and a purpose to her life?
A home health nurse makes a home visit to a 90-year-old client who has cardiovascular disease. During the visit the nurse observes that the client has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do?
Arrange for the client to see his primary care provider.
A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller's Functional Consequences Theory. To put this theory into practice, the nurse should prioritize what task?
Differentiating between age-related change and modifiable risk factors
A nurse is auditing the care of a recently discharged client and is appraising the client's care in light of Leininger theory of Culture Care Diversity and Universality. Specifically, the nurse is looking for evidence that caregivers implemented professional actions and decisions that helped the client achieve a beneficial or satisfying health outcome. What aspect of Leininger theory is the nurse addressing?
Culture care restructuring
A client with chronic back pain says that he is having problems at work and has been absent from work about once every 2 weeks. He says that he is short-tempered with other workers, feels tired all the time, and is worried about losing his job. In the plan of care, what should the goals for the plan of care focus on?
Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.
A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.
Financial pressures on health care providers Client reluctance to accept this type of care Advances in "curative" treatment in late-stage illness Explanation: Physicians are reluctant to refer clients to hospice, and clients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those clients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible clients.
A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?
Helping the patient to achieve specific outcomes
An adult client has requested a "do not resuscitate" (DNR) order in light of his recent diagnosis with late-stage pancreatic cancer. The client's son and daughter-in-law are strongly opposed to the client's request. What is the primary responsibility of the nurse in this situation?
Honor request of the client
A client was diagnosed with rheumatoid arthritis one year ago, but has achieved adequate symptom control with celecoxib (Celebrex), a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain?
Inhibiting transduction by blocking the formation of prostaglandins in the periphery.
The nurse is providing care for a client with chronic obstructive pulmonary disease (COPD). The nurse's most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking is determining the significance of data that have been gathered. What characteristic of critical thinking is used in determining the best response to this assessment finding?
Interpretation
The nurse is providing client teaching to a client with early stage Alzheimer disease (AD) and her family. The client has been prescribed donepezil hydrochloride. What should the nurse explain to the client and family about this drug?
It slows the progression of AD.
The home health nurse is caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the client at your visit today. The family members will be taking care of the client. What would your priority nursing interventions be for this visit?
Provide client and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
A hospital has reaffirmed its commitment to meeting National Patient Safety Goals (NPSGs). The hospital is most likely to meet these goals by:
Reducing the incidence of hospital-acquired infections.
A nurse has been providing ethical care for many years and is aware of the need to maintain the ethical principle of nonmaleficence. Which of the following actions would be considered a violation of this principle?
Refusing to administer pain medication as prescribed
The nurse is caring for a client with late-stage Alzheimer disease. The client's wife states that the client has now become completely dependent and that she feels guilty if she takes any time for herself. What outcomes would be appropriate for the nurse to develop in order to assist the client's wife?
The caregiver distinguishes essential obligations from those that can be controlled or limited.
During discussion with the client and the client's husband, the nurse discovers that the client has a living will. How does the presence of a living will influence the client's care?
The client may nullify the living will during her hospitalization if she so chooses to do so
The nurse is receiving an older adult client from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that the client has been agitated in the past following opioid administration. What principle should guide the nurse's management of the client's pain?
The elderly may require lower doses of medication and are easily confused with new medications
A medical nurse is caring for a client who is palliative following metastasis. The nurse is aware of the need to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle in the care of this client?
The nurse stays with the client during their death
The nurse is caring for a client in the emergency department and is implementing evidence-based practice (EBP). What considerations should inform the nurse's evidence-based care? Select all that apply
The nurses expertise and judgement The client's preferences Valid and reliable research
The nurse has observed that an older adult client with a diagnosis of end-stage kidney disease seems to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the client explains that this is a cultural practice and very important to him. How should the nurse best respond?
Work with the team to negotiate informed consent.
A parent informs the nurse that immunizations are contrary to her religious beliefs, and she does not want her child to receive them. The nurse proceeds to inform the parent that the child will be in grave danger of illness all her life and will not be allowed to start school unless she is immunized. The nurse also informs the parent that she had all of her own children vaccinated with no adverse effects. The nurse's behavior is an example of what?
cultural imposition
Achieving adequate pain management for a postoperative client will require sophisticated critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all that apply.
-Enhacing the nurse's clinical design making - planning the best nursing actions to assist the client - helping indenting the client's priority needs -increasing the accuracy of the nurse judgement
A nurse on a medical-surgical unit has asked to represent the unit on the hospital's quality committee. When describing quality improvement programs to nursing colleagues and members of other health disciplines, what characteristic should the nurse cite?
These programs emphasize the need for evidence-based practice.
The nurse is creating a nursing care plan for a client with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who live with chronic pain should be integrated into care planning?
They can experience acute pain in addition to chronic pain
The nurse is caring for a client who is withdrawing from heavy alcohol use and who is consequently combative and confused, despite the administration of benzodiazepines. The client has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate action for the nurse to take?
Obtain a physician's order to restrain the client
The nurse is caring for a 91-year-old client who reports urge incontinence and says that he sometimes falls when he tries to get to the bathroom in his home. The nurse identifies the nursing diagnosis of Risk for Falls related to impaired mobility and urinary incontinence. The older adult's risk for falls is considered to be which of the following?
A geriatric syndrome
A nurse is caring for recently-immigrated client who is in end-stage kidney disease. The physician offers to discharge the client home to hospice care, but the client and family refuse. After the physician leaves, the client's daughter approaches the nurse and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?
A language barrier to hospice care for this client
A nurse uses critical thinking every day when going through the nursing process. Which of the following is an outcome of critical thinking in nursing practice?
A) A comprehensive plan of care with a high potential for success
An infant with pyelonephritis is receiving care on the pediatric unit and the nurse's review of the child's electronic health record reveals that the infant has not received any of her scheduled immunizations. The mother informs the nurse that immunizations are absolutely against her cultural beliefs, and she does not want her child to receive immunizations. In this scenario, what do the mother's views on immunizations represent?
A cultural taboo
The nurse is providing care for a client who has a diagnosis of pneumonia due to Streptococcus pneumonia infection. What aspect of nursing care would constitute part of the planning phase of the nursing process?
Achieve SaO2 > 92% at all times
The nurse in a pediatric ICU is caring for a child who is dying of sickle cell disease. The child's mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the child's pain and suffering. What intervention has the highest priority?
Allowing the client go express her feeling with out judging her
The nurse is caring for a client diagnosed with multiple myeloma who has just been told that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should the nurse do first?
Ask if he would like you sit with him while he collects his thoughts
A pediatric nurse is emotionally distraught by the death of a 9-year-old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief?
Attend the patients memorial service.
The nurse is planning an educational inservice for nursing colleagues with the goal of fostering culturally competent care. What outcome should the nurse prioritize when planning this education?
Participants will acknowledge and adapt to diversity among their colleagues.
A client is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the client's pain in the plan of nursing care, the nurse should consider what characteristic of cancer pain?
Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
Giger and Davidhizar created an assessment model to guide nurses in exploring cultural phenomena that might affect nursing care. When using this model in the care of a client who has had a transurethral prostate resection (TUPR), what area of care would be influenced most directly?
Explaining the rationale for continuous bladder irrigation (CBI)
One of the functions of nursing care of the terminally ill is to support the client and their family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply.
Try to appreciate and understand the illness from the client's perspective. Assist clients with performing a life review. Describe their personal experiences in dealing with end-of-life issues.