Nursing I: Exam I

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

Durable power of attorney for health care

Under which of the following circumstances should a nurse consider providing health education?

During each contact that the nurse has with a health care consumer

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?

Early detection and treatment of diseases

health-illness continuum

"A person can be both healthy and ill at the same time."

A young female client smokes two packs of cigarettes and drinks a six-pack of beer each day. The nurse is attempting to teach the client about smoking cessation and decreasing alcohol intake. The client states, "My grandmother lived to be in her 90s, and she smoked and drank. I come from good genes." What is the most apropriate statement the nurse can make in response?

"Certain illnesses can be traced to common risk factors and can be prevented."

The nurse is educating the client about management of diabetes. Which statement by the student would indicate to the nurse that further teaching is necessary?

"Checks of blood glucose level are to be done ac and hs."

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

"It will enable the patient to remain home if that is what is desired."

A nurse is teaching a client on the proper technique of using a metered dose inhaler. In the middle of the teaching the client states, "This is so hard! I'm nervous I'm going to do this wrong!" To facilitate learning for the client, what statement will the nurse use in response to the client's concern?

"Let me break it down in smaller steps."

primary focus of the nurse advocacy role in managing a clinical pathway

A patient's progress toward desired outcomes

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges the client's achievement when she walks to the bedside commode with her walker

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in?

Acute

Priority based on Maslow's hierarchy of needs (physiologic need)

Administering pain medication

A nurse can best implement the principles of collaborative practice by

Adopting an attitude of "teachability" when planning and performing patient care

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

Encourage the family members to express their feelings and listen to them in their frank communication

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

Allows for the nurse to facilitate the grieving process

Which one of the following individuals likely has the greatest need for health education?

An elderly woman who has just been diagnosed with congestive heart failure (|CHF)

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

Anger

Although nurse practice acts may vary state by state, all recognize several basic principles supporting the legal parameters for all registered nurses. Select the activity that falls under the scope of nursing practice.

Appraising and enhancing an individual's health-seeking perspective

Goal of case management

Appropriateness of services

A health care provider asked a nurse to teach a patient how to self-administer subcutaneous insulin. After collecting her assessment data and drafting her plan, the nurse selected the teaching strategy that research has indicated has the highest chance of reinforcing knowledge. Which of the following strategies did the nurse select?

Assisting the patient to perform the skill in a simulated setting

Which is an example of a direct measurement technique used to evaluate the teaching-learning process?

Behavioral observation

Which statement is a misconception about chronic disease?

Chronic illnesses cannot be prevented

The nurse assesses that client most likely to be nonadherent with treatment is the one who

Has tuberculosis and is taking multiple antitubercular medications

Which initiative is targeted with improving the health of all Americans?

Healthy People 2020

The Healthy People 2020 initiative targets the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of this plan?

Increasing the quality and length of a healthy life

What has nursing identified leadership as?

Inherent to all nursing positions

what regulatory body oversees the process of accreditation in order to enhance the credibility and status of a hospital?

Joint Commission

A patient with a visual impairment would benefit from which of the following teaching strategies?

Magnifying lenses

Which of the following is an example of adherence to treatment? Select all

Maintaining a healthy diet Self-monitoring for signs and symptoms of illness Taking prescribed medications Increasing daily activities

The nurse is planning to teach a 75-year-old patient about administering his medication. How can the nurse best enhance the patient's ability to learn?

Making the information relevant to the patient's condition

Which statement provides accurate information related to chronic illness?

Most people with chronic conditions do not consider themselves sick or ill.

A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival.

Palliative care

collaborative practice model

Participation in decision making that is shared by all involved

What legislation supports the focus on chronic disease prevention, health promotion, and quality, affordable health care for everyone?

Patient Protection and Affordable Care Act

A nursing student observes the home care nurse provide education to a client with congestive heart failure (CHF). The nurse teaches the client how to read food labels and calculate sodium content. The nursing student recognizes that the home care nurse is aware of which basic principle of patient education?

Patient instruction related to self-care activities promotes patient independence

What is a model for the delivery of nursing care in today's health care arena?

Patient-centered care

An example of evidence-based practice would be

Patients on bed rest are turned every 2 hours to prevent the formation of bedsores.

Health education is important for all patients and families. Of the four groups listed below, which group is most in need of health teaching?

Patients with chronic illnesses, because life-long interventions and adjustments can improve the quality of life

Maslow's lowest level need

Physiologic needs

Which phase of the nursing process encompasses the establishment of expected outcomes?

Planning

A nurse is discussing the need for a client to increase activity level and eat a heart-healthy diet. The client tells the nurse, "I eat just fine and I'm not that fond of exercising." The nurse would identify this client at which stage of change?

Precontemplation

Nurse functioning in the practitioner role

Providing direct care Educating the patient and family Coordinating with other disciplines

The hospice nurse understands that many factors directly or indirectly affect how a person dies. Which of the following is a changeable factor that can be influenced by the nurse when dealing with the dying patient?

Relationship with the health care providers

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care

A nurse is preparing teaching for a client with an auditory perceptual disorder. Which educational strategy will be most effective?

Repeat and reinforce words frequently.

A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?

Respect the client's and family members' choices

The client has been diagnosed with terminal COPD. The client and the client's family have not yet agreed on the final arrangements and are discussing options. How can the nurse best intervene in these final decisions?

Respect the client's autonomy and right to determine how to spend the rest of his or her life.

The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness?

The client gradually returns back to an acceptable way of life within the limits imposed by the illness

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness:

The client stops taking some medications due to side effects that are disturbing to the client.

When providing discharge instructions, the nurse recognizes that which client is most likely to comply with the therapeutic treatment regimen?

The client with pneumonia who requires 1 week of oral antibiotics

"I plan to recover from my stroke to the best of my ability. I know I will always have some limitations; however, I will not let the limitations slow me down." Which description of health does the patient exemplify with this statement?

The concept of health wellness-illness continuum

A diabetes nurse is performing health education with a 44-year-old woman who has recently learned that she has type 2 diabetes. The nurse is teaching the patient the importance of adhering to her prescribed treatment regimen. When providing this health education, the nurse should emphasize:

The fact that adherence to a prescribed treatment regimen usually requires careful planning

Based on the nurse's knowledge of nonadherence to therapeutic regimens, which nurse needs to place extra emphasis on adherence to the treatment plan?

The nurse planning to teach adults aged 65 about congestive heart failure management

The nurse develops outcome criteria for a patient with chronic obstructive pulmonary disease. Which outcome criteria are appropriate for this patient?

The patient will have the ability to climb a flight of stairs without experiencing difficulty in breathing.

The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

The principle of autonomy

What is the goal of health screening in adolescent population?

To detect health problems at an early age, so that they can be treated at this time

A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying?

Trajectory onset

Which phase in the trajectory model of chronic illness is characterized by the reactivation of an illness in remission?

Unstable

Which action would be incorporated in a teaching strategy for a hearing-impaired client?

Use of slow, directed, and deliberate speech

What is the most appropriate application of the evidence that nurse researchers generate?

Using it to formulate guidelines for nursing practice

Which of the following nursing action exemplifies the evaluation of the teaching-learning process to determines how effectively the patient has responded to teaching?

Watching a return demonstration of insulin administration from a client newly diagnosed with diabetes

Centers for Disease Control and Prevention and U.S. Preventive Services Task Force recommendation for prostate screening frequency?

Yearly

Clinical nurse specialist (CNS)

a role that included clinical practice, education, management, consultation, and research

Future healthcare policy in the United States will be significanly affected by a population that is:

aging and becoming more culturally diverse

A 90-year-old home care client's son has been designated to make decisions regarding the client's medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son's decision-making designation?

durable power of attorney for health care

focus of the quality assurance programs developed in the 1980s

focus on processes used to provide care and improving those processes

Continuous Quality Improvement (CQI) programs

focus on the process used to provide care Critically examining the processes through which care is provided

primary tasks of a nurse researcher

generate evidence

A nurse is a member of which entity within the larger healthcare environment?

healthcare team

A cause related to the increasing number of people with chronic conditions is

improved screening and diagnostic procedures.

A nurse is providing feedback to a client who demonstrates how to use an incentive spirometer. What primary role does feedback have in the adult learning process?

motivates learning

The home health nurse is planning teaching for a client with COPD and a history of noncompliance to the medication regimen. Which factor does the nurse recognize as having the most influence to enabling complete adherence of a health regimen?

motivation

primary purpose of nursing research

Nursing research contributes to the scientific base of nursing practice

Prevalent chronic illness in the US

Diabetes mellitus

Which is also known as a proxy directive?

Durable power of attorney for health care

On which level of Maslow's hierarchy of basic needs does the patient's need for self-fulfillment fit?

Self-actualization

A 71-year-old woman with a longstanding diagnosis of emphysema developed community-acquired pneumonia 3 weeks ago and was admitted to the hospital for treatment. A combination of respiratory therapy and IV antibiotics has resolved the woman's infection and she is now preparing to return to the home she shares with her husband. What phase in the trajectory model of chronic illness is this patient currently experiencing?

Comeback

Which stage of the transtheoretical model occurs when the patient has serious consideration of change, but it is sometime in the future?

Contemplation

A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns?

Obesity along with conditions associated with it has become a major health concern

What characteristic of the hospital would be indicated by Magnet status?

The hospital attracts and retains high-functioning nursing staff

culture

The learned patterns of behavior, beliefs, and values that can be attributed to a particular group of people

focus of the nursing researcher role

Establishment of a scientific basis for action

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs.

Which tool is often used by case managers?

Standards of care

A nurse is planning a smoking-cessation program for a client and incorporates stages from the Transtheoretical Model of Change in the program. For the client to be successful, the client follows the stages in this order from steps 1 to 5:

Thinks about smoking cessation Makes a plan to cease smoking Takes steps to stop smoking Works to prevent relapse of smoking Resists relapsing into smoking