PNC 1- Exam 3: Collaboration, Leadership, and Health Promotion

A nurse at an assisted living facility is planning workshops for the residents. Which of the following would be considered health promotion activities? (Select all that apply.) A. Preventive health services B. Diabetes management C. Nutrition and aging D. Drug abuse E. Hip replacement recovery

Answer: A and C Rationale: Health protection activities are illness specific, such as those that address the consequences of chronic conditions, surgery, and drug abuse. Health promotion is not disease oriented. Health promotion activities seek to expand positive potential for health.

A client returns to the clinic one week after a skin biopsy of a suspicious lesion. The biopsy report indicates that the lesion is melanoma and further surgery is indicated. The nurse explains that this type of lesion has which characteristic? A. Characterized by invasion of local tissues B. Highly metastatic C. Rarely metastatic D. Encapsulated

Answer: Rationale: Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic and a person's survival depends on early detection and treatment. Basal cell carcinoma arising in the basal cell layer is rarely metastatic. Squamous cell carcinomas invade local tissue and may metastasize if left untreated. Malignant lesions are not encapsulated.

The nurse caring for a client who is scheduled for a mastectomy finds the client is crying. What is the most appropriate nursing diagnosis for this client? A. Anticipatory Grieving B. Fatigue C. Risk for Injury D. Disturbed Body Image

Answer: A Rationale: Anticipatory grieving is the most appropriate at this time as the client is crying in anticipation of surgery and losing a part of her body. Disturbed body image would be the priority after surgery when the client sees herself without the breast. Fatigue and risk for injury are possible, but not priorities.

The nurse is conducting a seminar about breast cancer at a community center for women from diverse backgrounds. Which would the nurse include about cultural risks of breast cancer to encourage breast self-exam? A. Asian, Hispanic, and Native American women have a lower incidence of breast cancer. B. Breast cancer is more prevalent in Caucasian women under 40. C. Caucasian women are more likely to die from breast cancer because they are often diagnosed in advanced stages. D. African American women are more at risk for breast cancer than any other group.

Answer: A Rationale: Asian, Hispanic, and Native American women have a lower risk for developing breast cancer. Breast cancer is more prevalent in Caucasian women over 40. Breast cancer is more prevalent in African American women under 40. African American women are more likely to die from breast cancer because diagnosis often occurs at an advanced stage.

When performing collaborative health care, the nurse must implement which of the following? A. Rely on the expertise of other health care team members. B. Assume a leadership role in directing the health care team. C. Delegate decision-making authority to each health care provider. D. Be physically present for the implementation of all aspects of the care plan.

Answer: A Rationale: In collaboration, each member of the team, including the client, participates in sharing ideas and reaching consensus on the best plan of care. The team is generally led by the health care professional most skilled in the client's specific areas of need. Once the plan is established, it may be implemented by any member of the team or a designate at an appropriate time or place. It is not necessarily delegated by the nurse.

A 73-year-old client is in the hospital for pneumonia for the third time in 6 months. During the nursing history, the nurse discovers that the client has few financial resources, lives alone, and has not received needed immunizations. To provide excellence in care, the nurse should: A. Request consultations with other disciplines. B. Tell the client of the need to move to long-term care. C. Recommend that the client remain in the hospital until well. D. Request an order from the physician for long-term care.

Answer: A Rationale: Many older adults choose to remain in their own homes to care for themselves. In today's world, the nurse recognizes that with the proper resources, this is a possibility. The nurse might request a social worker and a nutritionist to help the client with home care resources, and might also ask the physician for the appropriate immunizations. Considering the cost of health care, the client can recuperate at home with the appropriate resources. The client may not want or need long-term care and should be consulted prior to making that decision. The nurse might discuss the advantages of long-term care with the client, but would not tell the client to move to it.

The nurse is caring for a client who is being treated with radiation to shrink a tumor before undergoing surgery. The nurse anticipates monitoring which of the following priority results during radiation therapy? A. Platelet count and WBC B. Platelet count and electrolyte panel C. Cardiac enzymes and electrolyte panel D. White blood cell count (WBC) and electrolyte panel

Answer: A Rationale: Radiation therapy can cause decreases in the white blood cell count and the platelet count, putting the client at risk for infection and bleeding. The electrolyte panel and cardiac enzymes are not priority tests.

The nurse is caring for a client who has an ileostomy due to colorectal cancer. When planning care, which of the following outcomes would the nurse consider for this client? A. Demonstrates a willingness to discuss changes in sexual function B. Performs care on colostomy C. Resumes previous diet habits D. Will be pain-free

Answer: A Rationale: The client needs to be able to discuss sexual needs and changes openly with the partner and healthcare professional. The client has an ileostomy, not a colostomy. The client should reach a tolerable level of pain, but will likely still feel some discomfort. The client with an ileostomy will likely have a new diet prescribed by the physician.

A client who has had a prostatectomy following a diagnosis of prostate cancer is ready to be discharged. When initiating discharge, which should the nurse include in her teaching plan? A. Avoid lifting heavy objects for 4-6 weeks. B. Avoid driving for 1 week. C. Decrease fluid intake to decrease incontinence. D. Notify the physician for any blood in the urine.

Answer: A Rationale: The client should avoid lifting heavy objects for 4-6 weeks after surgery. Small amounts of bleeding and clots are normal for up to 2 weeks after surgery. Driving should be avoided for a minimum of 3 weeks postoperatively. Fluid intake should be increased to at least 2 L per day to limit clot formation and prevent infection.

A nurse practicing culturally competent care to a prenatal patient demonstrates which action? (Select all that apply) A. Has information printed in the language of the client's choice. B. Asks the woman if there are certain practices she expects to follow while she is pregnant. C. Encourages clients to keep their religious preferences a secret as these are not an important aspect of reproductive health. D. Requires clients to reveal what place of worship they attend.

Answer: A and B Rationale: A nurse demonstrating culturally competent care would ask the client if there are certain practices that they expect to follow and would have information printed in the language of the client's choice. It is never appropriate for the nurse to require a client to reveal their place of worship or to discourage religious preferences.

The nurse is caring for a client who has been placed on a critical pathway for care following hip surgery. The client asks the nurse why there is a need for this type of care model. The best response by the nurse is: A. "Critical pathways give direction to the team caring for you." B. "Critical pathway is just a new term for the nursing care plan." C. "Critical pathways ensure that you will get well." D. "Critical pathways make you adhere to the program of care."

Answer: A Rationale: There are many disciplines who will participate in the care of a postoperative hip client. Critical pathways provide direction for the management of the client's care. Critical pathways have similarities to a nursing care plan; they are not a care plan, but are an outcome of goals that are directed at all disciplines caring for the client. Critical pathways do not force the client to do anything. They are individualized to meet each client's needs. Critical pathways are fluid and modified depending on the progress of the client. They are geared to facilitate healing, but do not guarantee it, since many variables may affect the progress of the client.

When conducting an interview with a client who has had surgery for prostate cancer, which statement by the nurse would most likely elicit information about the client's sexual concerns? A. "Tell me about your experience with sexual function since you were diagnosed with cancer." B. "Do you miss having sex?" C. "Following your prostate surgery, when did you first notice you had problems with sexual intercourse?" D. "Why do you think you should be sexually active at your age?"

Answer: A Rationale: This statement is stated in a way that allows the client to feel free to ask questions and express feelings about his sexual concerns. The other statements assume problems or contain judgmental attitudes.

Which of the findings would the nurse be concerned with to know that a client is at risk for exposure to cytomegalovirus? A. Working in a day-care center B. Caring for a cat litter box C. Use of IV drugs in the past D. Giving blood twice a year

Answer: A Rationale: Day-care workers are frequently exposed to this virus. Exposure to cat litter poses a risk for toxoplasmosis. IV drug abuse risks exposure to HIV and other blood borne pathogens. A history of giving blood poses no risk to the client or fetus.

The nurse teaches the client about which normal changes that occur in the reproductive system during pregnancy? A. Vaginal secretions will increase and thicken. B. The uterus will grow by adding many new cells. C. The breasts will become red and hard. D. The cervix will begin to dilate in the second trimester.

Answer: A Rationale: During pregnancy, increased estrogen production results in an increase and thickening of vaginal secretions. The uterus grows by cell hypertrophy, or cell enlargement, not by adding many new cells. Breasts that are red and hard, or dilation of the cervix in the second trimester, are abnormal findings.

Which would indicate the need for delivery by cesarean section if found by the nurse during a prenatal care visit? A. History of genital herpes lesions; prodromal symptoms but no lesions at delivery B. Positive herpes culture at first visit; asymptomatic at delivery C. Genital herpes lesion 1 month prior to delivery but no lesions at delivery D. Oral fever blisters at the time of delivery

Answer: A Rationale: Indications for cesarean delivery are the presence of herpes lesions or prodromal symptoms. If there are no genital herpes lesions and no symptoms, a vaginal delivery is recommended. Oral fever blisters do not necessitate cesarean section.

The nurse is providing education on isoimmune hemolytic disease of the newborn to a group of prenatal clients. Which statement will the nurse include? A. "Pregnant women who are Rh negative will have the Indirect Coombs test done at 28 weeks gestation." B. "If Rh antibodies are present, Rh immune globulin is given." C. "When Rh antibodies are present, the mother is considered unsensitized." D. "The Indirect Coombs test is performed on the baby of a mother who tests positive for Rh antibodies."

Answer: A Rationale: Isoimmune hemolytic disease of the newborn occurs when the newborn's RBC's are attacked by antibodies from the mother. In order to help prevent this disease, pregnant women who are Rh negative will have the Indirect Coombs test done at 28 weeks gestation. If Rh antibodies are present, Rh immune globulin is not given. When Rh antibodies are present, the mother is considered sensitized. The Direct Coombs test is performed on babies, not the Indirect Coombs test.

A client consuming a diet appropriate for weight reduction lost 12 pounds within 30 days. What possible outcome related to this rapid weight loss would the nurse discuss with this client? A. Loss of lean muscle mass, especially if there is no exercise regimen in place B. Inability to maintain weight loss C. Depression D. Resolution of joint pain

Answer: A Rationale: The recommended weight loss is 1-2 pounds per week. When weight loss exceeds this rate, a client risks losing lean tissue and developing a nutrient deficiency. Maintenance of weight loss is related to sustained lifestyle changes. Weight loss can improve joint health and discomfort, but there is not enough data presented to know if this client had joint pain and, if so, reasons for the discomfort. Depression may result in weight loss, but it is more often the case that individuals who are obese are depressed. Instead, weight loss tends to boost self-worth.

The nurse is educating the pregnant client about the prevention of supine hypotensive syndrome. Which statement will the nurse include? A. "The condition occurs when you are lying flat and your enlarging uterus presses on a major vein, causing a drop in your blood pressure." B. "The condition occurs when you are on your stomach and your diaphragm is contracted, causing a drop in your blood pressure." C. "You can prevent this by placing a pillow or wedge under your left hip when you are lying down." D. "The condition can be corrected by lying on your right side."

Answer: A Rationale: When the pregnant woman lies supine, the enlarging uterus may press on the vena cava. This reduces blood flow to the right atrium; lowers blood pressure; and causes dizziness, pallor, and clamminess. It can be corrected by having the woman lie on her left side or by placing a pillow or wedge under her right hip as she lies in a supine position.

What are some of the benefits of interdisciplinary teams? (Select all that apply.) A. Fewer omissions B. Greater effectiveness C. Redundancy D. Physician satisfaction E. Greater emphasis on individual expertise

Answer: A and B Rationale: Less redundancy is a benefit of interdisciplinary teams. Some physicians may be opposed to interdisciplinary collaboration and prefer physician led treatment. Interdisciplinary teams emphasize each individual's contribution to the joint planning and accomplishment of client goals, as opposed to placing emphasis on each individual team member's area of professional expertise. Studies suggest that interdisciplinary teams can manage care with less redundancy, more efficiency, and fewer omissions.

A nurse is a member of a community team formed to support and treat individuals with serious mental illnesses. Who might also be part of this team? (Select all that apply.) A. Psychiatrist B. Speech therapist C. Physical therapist D. Employment specialist E. Paralegal

Answer: A and D Rationale: Although some individuals may require speech services, physical therapy, or paralegal consultation, these are not services expected as a regular part of a community support team for clients with mental illness. Employment specialists can provide vocational guidance and placement services. A psychiatrist can provide medication management to the team's efforts.

Which diagnostic test is used to differentiate benign prostatic hypertrophy (BPH) from prostate cancer? (Select all that apply.) A. Digital rectal examination B. Pelvic ultrasound C. Urinary elimination D. Skin integrity E. Prostate-specific antigen (PSA) level

Answer: A and E Rationale: In a digital rectal exam for BPH, the prostate is asymmetrical and enlarged; while in prostate cancer the exam shows nodules and a fixed position. PSA is specific to the prostate gland and is released by both benign and malignant cells; however, in BPH the amounts of the free form of PSA and complex PSA would be different. The other tests are not helpful in differentiating prostate cancer from BPH.

A nurse educator is explaining the difference between groups and teams. What are some of the specific characteristics of teams that the nurse identifies. (Select all that apply.) A. Teams have a flexible hierarchy. B. Team members have a variety of goals C. Team members are only individually accountable. D. Task completion is delegated to individuals. E. A team is a specialized type of group.

Answer: A and E Rationale: In a team, task completion and product creation are collaborative in nature, as opposed to being delegated to individuals. A team comprises individuals who agree to work in tandem to accomplish a common goal. Accountability among team members is both individual and mutual in nature. A team's hierarchy is more flexible than that of a group; members of a team often share the leadership role. In simplest terms, a team comprises individuals who agree to work in tandem to accomplish a common goal.

What is the nurse's role when a client is experiencing mobility changes as a result of a recent diagnosis of multiple sclerosis? (Select all that apply.) A. Provide the client with explanations about necessary adjustments. B. Insist that the client immediately accept the need for a wheelchair. C. Make a referral for a long-term care facility. D. Discuss the client's issues privately with family members. E. Suggest ways to make the client's home more accessible.

Answer: A and E Rationale: The nurse should always respect the client's autonomy. Clients need sufficient information to participate in decision-making processes and to maintain a feeling of being in control. Nurses must support clients' right to self-determination. The nurse should function as an educator when lifestyle changes are indicated. The nurse should help in making arrangements wherever possible to accommodate the client's lifestyle. Stress management skills are an important emotional component of wellness. Emotional wellness requires the ability to accept limitations.

A client who has different types of skin lesions inquires if any of them indicate a risk for developing skin cancer. The nurse explains that which is a risk factor for skin cancer? A. Angiomas B. Nevi C. Skin tags D. Keloids

Answer: B Rationale: Nevi are the skin lesions that should be monitored for changes as they can become malignant. Angiomas, skin tags, and keloids do not develop into malignant lesions.

The nurse is instructing a group of elders about non-melanoma skin cancer. A client asks what attributes make a person more prone to develop that type of skin cancer. The nurse responds with which of the following? A. Alopecia, thin hair, itching B. Blond hair, freckles, fair skin C. Dark hair, dark skin, dry skin D. Tanned skin, dark hair, edema

Answer: B Rationale: People with fair skin are more likely to develop non-melanoma cancer and should have a yearly total body check for lesions. The other attributes are not strongly associated with the disease, but people with these characteristics still should have lesions checked that change color or shape.

The nurse is planning care for a woman who has had a mastectomy. Which of the following outcomes would the nurse plan interventions for as a priority? A. Will experience normal swelling B. Will remain free of infection C. Will experience fear D. Will experience pain

Answer: B Rationale: Remaining free of infection is a priority outcome for the client who has had breast surgery. Other appropriate outcomes would include "will experience minimal pain," "will experience no edema," and "will recognize sources of fear."

The home health nurse has made a visit to a client who is receiving several therapies by health team members in the home for arthritis and postoperative care. Upon return to the home health office, the nurse plans to: A. Review the cases for the next day. B. Communicate the client's status to the rest of the team. C. Report to the manager. D. Call the client to reinforce teaching.

Answer: B Rationale: Since the client is receiving several therapies, the nurse would communicate with team members regarding the client's current status and progress in collaboration. Reviewing the cases for the next day may or may not be necessary. It is not necessary to report to the manager unless there is a system problem. Calling the client is probably not necessary since the nurse would evaluate client understanding of teaching before leaving the home.

A client of Scandinavian descent is in the clinic for an annual physical examination. Which nursing assessment is most significant to the development of malignant melanoma? A. Inadequate knowledge regarding infection prevention B. A change in the size of a nevus C. Sexual contact with a person who has herpes infection DA dietary intake of high-calorie foods

Answer: B Rationale: The amount of melanin pigment in the skin protects against the development of nonmelanoma skin cancer. People who have fair complexions and tend to freckle or sunburn easily, such as people of Irish, Scandinavian, or English ancestry, have a low amount of melanin, thus lowering their protection against the damage produced by the suns' UV rays. The change in the color or size of a nevus is a manifestation of melanoma. The other options, while possible risks for cancer, are not the most significant manifestation of melanoma.

The nurse is administering Tamoxifen (Nolvadex) to a client who has had a lumpectomy. Which side effect will the nurse prepare the client to experience? A. Chilling episodes B. Pain when walking C. Swelling in the breasts D. Edema of the ankles

Answer: B Rationale: The client taking Tamoxifen is at risk for developing deep vein thrombosis (DVT), and pain while walking is one of the classic symptoms of DVT. Breast swelling, chilling episodes, and edema of the ankles are not side effects associated with the use of this medication.

A charge nurse has made client assignments for the shift and learns that two of the nurses are arguing over who is really going to care for one particular client. One nurse was directed by the nurse manager to care for the client because the client's family requested that nurse. The other nurse was assigned care of the client by the charge nurse. The cause of this conflict is: A. Receiving directions from two or more "bosses." B. Inadequate communication C. Lack of trust D. Inadequate action plan

Answer: B Rationale: The ultimate cause of this conflict is the lack of communication between the nurse manager and the charge nurse. Receiving directions from two bosses would create an individual conflict. Inadequate action plan is not relevant to this situation because there is no plan in place. Lack of trust implies that the nurses do not trust the charge nurse, which is not in evidence here.

The nursing students are introduced to the staff, the relief charge nurse, the unit educator, and the physicians. The students identify which person as the formal leader in the group? A. The staff nurses B. The unit educator C. The physicians D. The relief charge nurse

Answer: B Rationale: The unit educator holds the formal position designated by the agency. Physicians are not considered formal leaders. The staff nurses may be informal leaders but do not have a leadership position chosen by the organization. Relief charge nurse is usually not a formal position but rather one appointed for a shift as a designee by the manager.

The nurse is initiating teaching for a client with a colostomy and the family regarding foods that affect the consistency of stools in the client's colostomy. Which of the following foods will the nurse tell the family will help the stool solidify? A. Dried beans B. Yogurt C. Fried foods D. Spicy foods

Answer: B Rationale: Yogurt has a tendency to thicken stools. The other foods listed tend to cause the stool to be looser.

Which action is both an independent and a collaborative intervention for the client with an ectopic pregnancy? A. The nurse administers the ordered IV solution and analgesic to the patient. B. The nurse assists in pain management by re-positioning the client and administering the ordered analgesic. C. The nurse provides tissue to the client and allows the client to have her privacy. D. There are no interventions that are both independent and collaborative.

Answer: B Rationale: An independent intervention is one in which the nurse may provide without a physician order while a collaborative intervention involves both the nurse and another member of the healthcare team. The nurse assisting in pain management, by repositioning the client and administering the ordered analgesic, is the only option that is both an independent and a collaborative intervention.

The nurse is teaching a group of pregnant women about normal body changes during pregnancy. Which would the nurse include regarding normal cardiovascular changes? A. The pulse rate will decrease. B. There may be dizziness when lying on the back. C. There may be a feeling of fullness in the chest. D. There is a decrease in red blood cells.

Answer: B Rationale: Pressure on the vena cava from the gravid uterus may cause a decrease in blood flow to the right atrium and result in a decreased blood pressure, causing dizziness when the client is lying on her back. The pulse rate should stay the same or slightly increase due to the increased workload on the heart. There is an increased number of red blood cells to meet physiological demands. Fullness in the chest is not a normal finding, although abdominal fullness increases as the pregnancy progresses.

During the first prenatal exam, the nurse discovers that a client has not had a second vaccination for measles, mumps, and rubella (MMR). Which will the nurse anticipate the obstetrical provider to do? A. Administer the vaccine before the client leaves. B. Administer the vaccine following delivery. C. Wait until the third trimester to administer the vaccine. D. Omit the vaccine as these are childhood diseases.

Answer: B Rationale: The MMR vaccine is a live, attenuated virus and could cause disease to the mother and fetus. The vaccine is given after delivery with instructions to the client to avoid pregnancy for 3 months following vaccination. Adults are susceptible to these diseases as is the fetus.

A client is in the clinic for a first prenatal visit and tells the nurse that she is a vegetarian. How should the nurse respond? A. Advise the patient to increase her consumption of incomplete proteins, such as legumes and nuts. B. Advise the patient to consume approximately 1200—1500mg/day of calcium. C. Advise the patient that she will harm her baby if she continues be vegetarian. D. Advise the patient to eat meat for proper iron consumption during her pregnancy.

Answer: B Rationale: The client who does not eat meat requires approximately 1200-1500mg/day of calcium, more than a client who is an omnivore. It is not appropriate for the nurse to tell the client that she will harm her baby if she continues being vegetarian. Legumes and nuts are complete proteins, not incomplete. Though a vegetarian may need iron supplementation during pregnancy to meet their dietary needs, a client does not need to eat meat to achieve adequate dietary iron

What are some biological factors involved in health? (Select all that apply.) A. Mind-body interactions B. Gender C. Age D. Health beliefs E. Lifestyle choices

Answer: B and C Rationale: Mind-body interactions are part of the psychological dimension of health. Lifestyle choices and health beliefs are part of the cognitive dimension of health. Certain acquired and genetic diseases are more common in one sex than in the other. Age is a significant factor in the distribution of disease.

A nursing student asks his mentor to outline the components of emotional wellness. What are some of the characteristics the mentor might describe? (Select all that apply.) A. Striving for continued growth and learning B. The ability to manage stress C. The ability to accept one's limitations. D. The belief in a force that provides meaning to life E. The ability to interact successfully with other individuals

Answer: B and C Rationale: The belief in a force that provides meaning to life is a spiritual component of wellness. Striving for continued growth and learning is an intellectual component of wellness. The ability to interact successfully with other individuals is a social component of wellness.

A nurse is reviewing with a client methods to prevent reproductive illnesses. The nurse knows that teaching has been effective when the client states: (Select all that apply) A. "Pap smears are not necessary for the average woman of reproductive age." B. "If I become pregnant I will have my husband change our cat's litter box." C. "I will practice safe sex to prevent sexually transmitted infections." D. "I will make sure to receive the MMR vaccine while I am currently pregnant."

Answer: B and C Rationale: The client who has effective teaching regarding the management of reproductive health and prevention of reproductive illness understands to practice safe sex to avoid STI's and to avoid cat litter boxes while pregnant to prevent toxoplasmosis infection. Pap smears are a vital test in detecting cervical cancer in women of reproductive age, and pregnant clients cannot have the MMR vaccine because it is a live attenuated vaccine.

The nurse is educating a prenatal client on the glucose tolerance test ordered by the obstetrical provider. Which statement would the nurse include? (Select all that apply). A. "This test is not standard, you do not need to have it done." B. "This screening test is a standard part of prenatal care." C. "You should remain seated during the test." D. "A fasting plasma glucose level equal or greater than 85 mg/dl indicates gestational diabetes."

Answer: B and C Rationale: The glucose tolerance test is a standard screening test for all prenatal clients. A fasting plasma glucose level equal or greater than 92 mg/dl indicates gestational diabetes. The client should remain seated during the test as activity can alter the test results. It is inappropriate for a nurse to tell a client not to have an ordered test done.

A nurse educator is explaining some of the characteristics of chronic illness. What is included in the nurse's description? (Select all that apply.) A. Chronic illnesses have severe symptoms of short duration. B. Chronic illnesses often have periods of remission and exacerbation. C. After chronic illness, most individuals return to their normal level of wellness. D. Chronic illness rarely requires lifestyle changes. E. A chronic illness is one that lasts for an extended period.

Answer: B and D Rationale: Acute illnesses have severe symptoms of short duration. After acute illness, most individuals return to their normal level of wellness. Chronic illness often requires lifestyle changes. Chronic illness is usually 6 months or longer. During periods of remission the symptoms disappear, and during exacerbation the symptoms reappear.

The nurse is presenting a program at a community center about colorectal cancer to promote the new cancer screening center at the hospital. For which of the following participants will the nurse advise a screening colonoscopy? (Select all that apply.) A. The client with celiac disease B. The client with Crohn's disease C. The client with diverticulosis D. The client with a family history of polyps E. The female client who is 48 years old

Answer: B and D Rationale: Inflammatory bowel disease (Crohn's) and a family history of polyps indicate a higher risk for developing colorectal cancer. Females are not more prone to experience colorectal cancer than males, and the risk age is 50. Celiac disease and diverticulosis do not present a higher risk for colorectal cancer.

A nurse is preparing education programs for new parents. Which of the following are appropriate health promotion topics for this group? (Select all that apply.) A. Peer group influences B. Playful activity to stimulate development C. Self-concept and body image D. Dental checkups E. Immunizations

Answer: B and E Rationale: Peer group influences, self-concept and body image, and dental checkups are appropriate topics for parents of older children and adolescents. Stimulating activities are important to infants. Immunization information is critical to new parents.

The nurse who is teaching a client about sibutramine (Meridia) includes which of the following instructions? (Select all that apply.) A. Be aware that taking this drug will allow you more leeway when deciding to "cheat" on the diet. B. Continue to follow the prescribed diet while taking this drug. C. People taking this drug tend to have a slower heart rate while they are taking this drug. D. Do not drive while taking this drug because the drug increases sleepiness. E. Pay careful attention to maintaining lifestyle changes once the drug is stopped to avoid rebound weight gain.

Answer: B and E Rationale: Sibutramine is an appetite suppressant that increases both pulse rate and blood pressure. The drug is intended as an adjunct to a low-calorie diet plan with exercise and is not intended to allow the individual to not follow the prescribed diet regimen. As a stimulant, which acts on the central nervous system, the drug increases heart rate, does not cause sleepiness, and may interfere with sleep. Careful adherence to maintaining a diet and exercise plan is important once the drug is stopped because there is a tendency for rebound weight gain to occur.

The nurse has selected a nursing diagnosis of anxiety for a client diagnosed with basal cell carcinoma of the skin based on which behavior by the client? (Select all that apply.) A. Client asks about treatment. B. Client is agitated. C. Client states that it probably is not cancer. D. Client is angry. E. Client requests information about prevention.

Answer: B, C, and D Rationale: Signs of anxiety can include denial, agitation, and anger. The client who is requesting to know about treatment and wants more information about prevention may have anxiety, but that behavior is not indicative of anxiety.

A nurse is forming a team responsible for school based care. Identify some of the disciplines that might be appropriate for this team. (Select all that apply.) A. School secretary B. Social worker C. Teacher D. School bus driver E.Nurse F. Cafeteria supervisor

Answer: B, C, and E Rationale: Although information provided by those who have regular contact with students, such as school secretaries, cafeteria supervisors and bus drivers, may be useful in team planning, they do not bring expertise that contributes to a team's planning and treatment process. Social workers can contribute case management and mental health skills to the interdisciplinary team. Teachers can contribute perspective and knowledge about a student's cognitive and social functioning. School nurses can contribute knowledge and skills on physical and mental health issues.

A nurse manager has the reputation of being an autocratic leader. Which statement by this manager would support that reputation? A. "I'd like to hear from you (addressing the staff) what your ideas are for promoting better morale in this unit." B. "I'm putting a suggestion box in the break room if anyone has ideas that would be helpful to the unit." C. "The new work schedule is posted for the next 6 weeks." D. "I put the new procedure manual out. Please add your comments to the blank sheet of paper attached to the front."

Answer: C Rationale: An autocratic leader makes decisions for the group and is likened to a dictator in that the autocratic leader gives orders and directions to the group, determines policies, and solves problems without input from the group. Creativity, autonomy, and self-motivation are group attributes that are not met with this type of leadership style. The other options would be more reflective of a democratic leader.

Risk for urinary incontinence is a common nursing diagnosis following prostatectomy. Which assessment data would the nurse need to consider when planning for appropriate interventions with this diagnosis? A. Client had a Foley catheter in the past B. Type of surgery being performed C. Client's previous urinary patterns D. Client's pain tolerance

Answer: C Rationale: Before the nurse can plan interventions for this diagnosis, the nurse would need to know what the client's previous urinary patterns were. Having a Foley catheter in the past does not affect this diagnosis. Any type of prostate surgery will impact urinary continence. Pain is not associated with incontinence in this surgery.

The nurse works in a gastrointestinal clinic with clients who have various bowel disorders and cancer. The nurse considers prevention of colorectal cancer a significant nursing care issue. Which of the following statements by a client indicate to the nurse that teaching has been effective? A. "I'm down to 25 pounds over my ideal weight." B. "I have increased my intake of fluids significantly." C. "I have increased my intake of calcium and folic acid." D. "I have reduced my smoking to one pack a day."

Answer: C Rationale: Calcium and folic acid supplements are one measure that can help prevent colon cancer. Intake of increased fluids is not considered a preventive measure for colorectal cancer. The client should cease smoking totally and should continue to take measures for weight loss to help prevent colon cancer.

The nurse is assessing a client in the clinic who has vague complaints of changes in bowel habits. Which of the following will be the nurse's next action? A. Ask the client about eating disorders. B. Assess the client's mental status. C. Ask the client about rectal bleeding. D. Assess the client's fluid status.

Answer: C Rationale: Colorectal cancer is usually very slow growing and manifestations do not appear until the cancer is advanced. The nurse must be aware that changes in bowel elimination habits and bleeding may be the only early symptoms. Eating disorders and fluid status will not give the nurse information about possible colon cancer. Altered mental status in a client with colorectal cancer would not be evident until the cancer has metastasized.

A client who has had a mastectomy and her spouse are asking the nurse questions about reconstructive surgery. What is the best response by the nurse? A. "Reconstructed breasts do not look normal." B. "Reconstructive surgery must be completed within 3 weeks of the mastectomy." C. "Reconstructive surgery may require multiple surgeries." D. "Silicone is known to be safe when used as an implant."

Answer: C Rationale: Depending on the type of mastectomy, reconstructive surgery may require multiple surgeries, thereby increasing such risks as reaction to anesthesia and infection. Controversy still exists about the health risks of silicone use. Reconstructed breasts do look normal and the surgery may be performed immediately after mastectomy or later on.

A nurse is providing a program for older men in a senior community about measures that can be taken to reduce the risk for prostate cancer. Which would the nurse include in the program? A. Avoid foods high in sodium. B. Decrease lycopene intake. C. Decrease red meat and fat intake. D. Increase fiber intake.

Answer: C Rationale: Some studies have shown an increase of prostate cancer in societies with diets high in red meats and fats. The other options have not been shown to impact the incidence of prostate cancer.

The nurse is discharging the client after a biopsy for possible skin cancer. What is the nurse's initiative to prevent infection? A. Make the first dressing change to teach dressing change techniques. B. Instruct the client to clean the wound with hydrogen peroxide. C. Request that the client perform a return demonstration of wound care. D. Instruct the client to keep the wound covered for 3 days.

Answer: C Rationale: The best way to ensure that the client understands teaching in this case is to have the client perform a return demonstration of care of the wound. The nurse can teach wound care, but must be able to evaluate its effectiveness by requesting a demonstration. Hydrogen peroxide is too caustic and may cause further skin breakdown if used. The wound is covered for a minimum of 8 hours and then the dressing is removed.

A client with prostate cancer is having the urinary catheter removed by the nurse. The nurse will evaluate which outcome goal for this client? A. Client will have no bleeding or clots in the urine. B. Client will verbalize less pain. C. Client will regain urinary continence. D. Client will verbalize that follow-up care is not needed.

Answer: C Rationale: The client who has had a prostatectomy will very likely experience some form of incontinence after the urinary catheter is removed. The outcome goal after removal of the catheter is to regain continence of urine. Pain does not affect incontinence. Bleeding and clots are expected for 2 weeks after surgery. The client should verbalize the need for follow-up care.

The nurse caring for an older client with a colostomy selects disturbed body image as a nursing diagnosis based on which of the following client behaviors? A. Client attempts to use the bathroom for bowel movement. B. Client inspects colostomy. C. Client requests nurse to teach the family to change appliance. D. Client requests frequent pain medication.

Answer: C Rationale: The client who will not participate in the care of the colostomy is likely in denial and is likely to have disturbed body image. The client who inspects the colostomy is showing signs of acceptance. The client who attempts to use the bathroom has a knowledge deficit. Requesting pain medication does not indicate that the client denies the existence of the colostomy.

The primary care physician has recommended to the nurse that the client be discharged to a rehabilitation center for further care. The nurse discusses the recommendation with the family and client, who decide that this is not what they want to do. The nurse's next action is to: A. Tell the family that this is the physician's order. B. Notify the case manager that the family is noncompliant. C. Discuss available acceptable options with the family. D. Notify the physician about the family's decision.

Answer: C Rationale: The family and client are a part of the collaborative team. If the family does not favor a recommendation, the nurse explores other options open to the client, such as home health care, and then communicates the client's wishes to the team. It is not appropriate to tell the family that this is the doctor's order because clients have a voice in care decisions. The case manager can be notified to help the nurse present other options but not that the family is noncompliant. The physician may be notified of the need for other options as part of the team.

The nurse is providing discharge teaching for a 74-year-old client with prostate cancer that has metastasized to other areas of the body. His family will be providing care to the client at home. Which is a priority teaching point for this family? A. Administer pain medication when the client states that the pain is severe. B. Assess the client's pain level using the pain scale. C. Administer pain medication at ordered frequency. D. Call the doctor before giving narcotics.

Answer: C Rationale: The family is taught to give the medication at ordered intervals whether or not the client states that there is pain. Since the cancer has spread, pain control is a priority; waiting until the level is severe will make control more difficult. The family would be told to call the physician if the medication is given appropriately and the pain continues to be severe. The family is not taught how to use the hospital pain assessment tool.

A nurse is caring for three clients who all demand that the nurse meet expectations immediately. The charge nurse asks the nurse to set up a room and take a new admission from the emergency department. The nurse is experiencing: A. Intergroup conflict B. Organizational conflict C. Role conflict D. Interpersonal conflict

Answer: C Rationale: The nurse who is overwhelmed on a tour of duty by many obligations that are due simultaneously is experiencing individual or role conflict. Interpersonal conflict is conflict between people. Organizational conflict refers to conflicts that may occur between departments or perhaps agencies. Intergroup conflict is another name for organizational conflict

The home health nurse is visiting an 86-year-old client who weighs 96 pounds to assess the client's postoperative progress. The nurse observes the aide giving a bath and notes that the aide puts powder in the folds of the perineal area. To promote a collaborative setting, the nurse would: A. Report the aide to the agency. B. Ask the family to request another aide. C. Take the aide aside and teach the appropriate skin care. D. Report the aide to the physician.

Answer: C Rationale: The role of the nurse in this instance is one of a teacher. The nurse cannot assume that the aide was or was not taught appropriately, and would take the aide aside and gently explain appropriate care for this client. This action puts the client in the center of the team and promotes collaboration. Telling the family to request another aide is not appropriate and could decrease the family's trust level; it also victimizes the family. If the aide continues with inappropriate care, the nurse would report the aide after informing the aide of the nurse's intentions. There is no reason to involve other team members, including the physician.

A staff member suggests a change in how the unit delivers care. The unit manager uses transformational leadership skills by responding: A. "It might upset the clients if we make a change in care delivery." B. "I think what we are doing works well enough." C. "Perhaps you could form a committee and submit a proposal." D. "Why would you want to change our system?"

Answer: C Rationale: The successful manager would respond by asking the staff to submit a proposal for changing delivery of care since this may speak to not only staff satisfaction, but also client satisfaction. Being open to change is a hallmark of an effective leader. Telling the staff that the current system is fine will breed dissatisfaction by the staff and may reduce the staff's trust in the manager. Stating that the clients might not like a change is excuse-making and not an effective trait. Questioning the staff about wanting a change is a challenge and will not be received well by the staff.

A 68-year-old client has prostate cancer that has metastasized. When assessing pain levels with this client, the nurse is aware of which of the following? A. Pain levels in elders are elevated. B. Elders experience pain the same as younger people. C. Pain levels may be exacerbated by pre-existing conditions. D. Elders are not as sensitive to pain as younger people.

Answer: C Rationale: When assessing pain levels in this client, the nurse is aware that the client's pain from metastasis may be augmented by pre-existing conditions such as osteoarthritis, which can make pain relief more challenging for the healthcare team. Pain is an individual experience, so it is not accurate to state that one group experiences pain more than another. However, due to poor circulation or peripheral neuropathy, pain sensations may be diminished in elders. The client's perception of pain is paramount when determining pain levels.

The nurse is told by a pregnant client that she does not like to eat dairy products and does not eat a balanced diet. What nursing diagnosis is the client at risk for? A. Altered metabolism due to increased levels of serum calcium B. Pain related to joint disturbances C. Risk for injury due to seizures from decreased calcium intake D. Risk for injury due to respiratory depression from increased calcium intake

Answer: C Rationale: A client who does not eat dairy and does not have a well-balanced diet is at risk for hypocalcemia. A hypocalcemic patient may have seizures if the condition is severe enough.

The nurse is teaching the student nurse about the role of the pelvis in childbearing. The nurse knows that the teaching has been effective when the student nurse states the bones in the pelvis include: A. One innominate bone, sacrum, and coccyx B. Sacrum, femur, coccyx C. Two innominate bones, sacrum, and coccyx D. Greater trochanter, sacrum, coccyx

Answer: C Rationale: The female pelvis is made up of four bones: two innominate bones, the sacrum, and the coccyx. All other choices are incorrect.

The nurse informs a very obese client that a sustained daily exercise regimen is critical to weight loss and to improving cardiovascular health. After the client has received medical clearance to begin a program of exercise, the first step the nurse would take is to: A. Assess why the client is consuming excess carbohydrates. B. Consult an exercise physiologist. C. Assess the client's current activity level and tolerance of that activity. D. Get the client to list obstacles to exercise.

Answer: C Rationale: The first action in planning an exercise regimen with a client is to assess the client's current activity level and response to that activity. This establishes a baseline from which to develop a realistic, workable exercise regimen, where the client can achieve success. Consulting an exercise physiologist is helpful, but first determining current level of activity and performance can provide useful information if or when consultation is sought. Having the client list obstacles to exercise and then developing a plan to counter these obstacles should follow the baseline assessment. Exploring with the client reasons for excess carbohydrate consumption focuses on dietary awareness rather than on exercise.

Nursing assessment of a 14-year-old reveals a BMI in the 90th percentile and a lifestyle that includes spending 4 hours a day playing video games and eating supper while watching television. The priority nursing diagnosis is: A. Fatigue related to malnutrition. B. Disturbed Body Image related to distorted perception of body size and shape. C. Imbalanced Nutrition: More Than Body Requirements related to excessive intake and sedentary lifestyle. D. Delayed Growth and Development related to inappropriate intake.

Answer: C Rationale: The most appropriate nursing diagnosis is the one that focuses on the core of the problem. The child is overweight because of poor eating habits and a sedentary lifestyle. Fatigue and altered development would be more appropriate with a child who is not receiving enough calories. While the teen might have altered body image, there is no information given that supports a diagnosis of Disturbed Body Image, a nursing diagnosis that would be more appropriate with a diagnosis of Anorexia Nervosa.

A middle-aged female client's waist-to-hip ratio is 1:1, her high-density lipoprotein (HDL) is above normal, and her low-density lipoprotein (LDL) is relatively high. The nurse is most likely to teach which of the following lifestyle modifications to reduce risk of obesity-related illnesses? A. Lifestyle modifications are not needed, as waist-to-hip ratio is not a marker for health problems. B. Modify diet and exercise to obtain lower levels of high-density lipoprotein (HDL). C. Include a healthful diet, effective weight management, and regular exercise. D. Modify diet and exercise to obtain higher levels of low-density lipoprotein (LDL).

Answer: C Rationale: Waist-to-hip ratio is useful as a health risk marker and identifies upper body obesity. Adult females with a waist-to-hip ratio greater than 0.8 are at a higher risk for cardiovascular disease, stroke, and elevated insulin levels. Therefore, instruction about client lifestyle modification, including eating a healthful diet, effective weight management, and getting regular exercise, is indicated. To lower her risk for cardiovascular disease, the client would benefit from modifying her diet and exercise regimen with the goal of elevating (not lowering) her levels of high-density lipoprotein (HDL) and lowering (not raising) her levels of low-density lipoprotein (LDL).

What are some of the philosophical concepts that are essential to health promotion? (Select all that apply.) A. Autonomy B. Specialization C. Wholeness D. Wellness E. Beneficence

Answer: C and D Rationale: Autonomy and beneficence are principals of nursing ethics. Specialization in health is the focus on a particular area or topic. Wholeness encompasses all aspects of a person's life. Health promotion is motivated by personal, positive approach to wellness.

Which of the following rationales supports the premise that activity intolerance is an appropriate nursing diagnosis for many obese individuals? (Select all that apply.) A. Blood glucose is elevated. B. They tend to suffer from depression. C. Joint pain is common. D. Respirations increase with exertion. E. Tachycardia is common.

Answer: C, D, and E Rationale: Obese individuals may find activity difficult due to fatigue, tachycardia, joint pain, or shortness of breath upon exertion. Gradual increases in activities that are acceptable to the client are planned. Depression and elevated blood glucose levels do not affect activity tolerance.

The nurse is instructing the family of a child regarding the care of a biopsy site performed to diagnose skin cancer. Which statement by the family indicates a need for further instruction? A. "I will bring the child back in 7 days to remove the sutures." B. "I will use the antibiotic ointment as ordered." C. "I will call the physician if there is any drainage from the wound." D. "I will remove the dressing when I get home and cleanse the site with tap water."

Answer: D Rationale: Following a skin biopsy, the nurse instructs the family to keep the dressing dry for 8 hours and then remove the dressing and cleanse the area with tap water daily to remove dry blood or crusts. The physician is notified if there is drainage or continued bleeding. Sutures are removed in 7-10 days after the biopsy. The physician may order an antibiotic ointment for the wound.

The nurse is caring for a client who has had a modified radical mastectomy. Which symptom, if noted by the nurse, would indicate that the client is experiencing complications from surgery? A. Numbness and tingling in the affected arm B. Serous drainage C. Pain D. Swelling in the affected arm

Answer: D Rationale: Lymphedema or arm edema is a complication of mastectomy that can occur at any time, including years after the surgery. Pain is an expected outcome of surgery as is serous drainage. Numbness and tingling are not associated with mastectomy.

The nurse teaches a group of obese clients that which of the following is the initial criterion before bariatric surgery is performed? A. The client has no other co-morbid illnesses. B. The client can show a strong family history of obesity. C. The client has a good support system. D. The client has a BMI > 40.

Answer: D Rationale: Surgical treatment of obesity is usually reserved for those with a BMI > 40 (or, 200% of body weight) who are unable to lose weight through diet and exercise or have serious obesity-related problems like metabolic syndrome, hypertension, or heart disease. The surgery carries substantial risk, and following surgery the client will need to undergo dietary modification and make lifestyle changes for the surgery to be successful. A thorough psychological evaluation is performed prior to surgery; a good support system is beneficial but is not a requirement for surgery. A family history of obesity may be present but is not a requirement for surgery.

The nurse is working in a busy pediatric ICU. Several of the nurses on the unit are interested, at the request of parents, in changing the rules to allow families to be present in a code situation for their child. The nurses are afraid to speak their minds openly because some of the doctors do not support the change and the nurses do not want to cause hard feelings. The nurse manager suggests a meeting of all concerned and might use which of the following to help with decision making? A. Ask the members to be open minded. B. Present both sides of the argument to the group members. C. Ask the nurses to present their changes. D. Have group members present concerns and questions on paper.

Answer: D Rationale: Nurses and doctors have to function as a team for the benefit of the client. Using the nominal group technique has the benefit of members submitting their ideas privately, which can help decrease friction in the group as a whole. The nurse manager would not want to take over the meeting since this would discourage dialogue within the group. If the nurses present their changes themselves, there is the chance that those nurses may be subject to the censorship of the group as a whole. This issue is an emotional one and asking group members to be open-minded may not happen since emotions may be high. It is best, to begin with, present concerns anonymously.

A nurse is having difficulty with a particular product that is needed to care for a client. The nurse asks a more experienced colleague to suggest ways to use the product appropriately. This is an example of: A. Line authority B. Chain of command C. Nursing responsibility D. Staff authority

Answer: D Rationale: Staff authority is an advisory authority. In this case, the more experienced nurse offers advice to the nurse who is having difficulty with a product. Chain of command refers to the hierarchy of authority within an organization. Line authority is supervisory in nature. Nursing responsibility does not enter into chain of command.

The nurse is planning care for a client who has just undergone a radical mastectomy. Which would the nurse include in the client's plan? A. Start intravenous lines on the affected side in the antecubital area B. Wait for the fifth postoperative day to start exercises. C. Use warm, moist compresses on the arm to alleviate pain. D. Keep the affected arm above the level of the heart.

Answer: D Rationale: The arm is kept elevated after a mastectomy to reduce edema. Warm compresses encourage the inflammatory response, causing more edema. IV lines, lab draws, and, blood pressures are performed in the opposite arm because the lymph nodes have been removed. Gentle range of motion may be started immediately after surgery.

A nurse is reported to the charge nurse by a physician for ignoring an order that the physician gave regarding patient care. The charge nurse investigates the issue and finds that it appears as if the nurse did ignore the order. The charge nurse would: A. Ask another nurse to go get the nurse in question. B. Ask the client if the task was performed. C. Go to the nurse and request an explanation. D. Discuss the situation with the nurse in an office.

Answer: D Rationale: The best approach would be to ask the nurse in question to describe the conflict in the privacy of the office. It is entirely possible that there is an easy solution to the problem, but the discussion should take place in private. The request for an explanation should not be conducted in the client care setting. The charge nurse would not ask the client about the incident unless there is a complaint by the client. The charge nurse does not involve another nurse in the conflict since this would be a breach of the first nurse's right to confidentiality.

The nurse is working with a client who will be discharged home in the next few days. The nurse notes that the client has orders for home health and physical therapy after discharge. The nurse plans to notify: A. The physical therapy department B. The home health agency C. The nurse manager D. The case manager

Answer: D Rationale: The case manager is responsible for coordinating the care of the client from admission through discharge. When the client has orders for services beyond the hospital setting, the case manager arranges the care so that continuity of care is maintained. The nurse is no longer responsible for notifying the home health agency or physical therapy, but is responsible for collaborating with the case manager to assure that the services will be in place when the client is discharged. The nurse manager does not need to be notified unless a situation arises that would need a manager's expertise.

The nurse is performing a focused assessment on a client a week after a skin biopsy was performed. The nurse concludes that the client has met the outcome goals as demonstrated by which of the following? A. Client is uncommunicative. B. Client is anxious about further episodes of cancer. C. Incision is slightly red with edema. D. Client verbalizes the absence of pain.

Answer: D Rationale: The goals following biopsy are that there will be no pain, the biopsy site is healed without signs of infection, and the client's anxiety regarding cancer is reduced. A client who is uncommunicative is likely harboring fears that are not verbalized.

The nurse is caring for an 83-year-old client who had a colostomy for colorectal cancer. Which of the following interventions is the priority when teaching this client colostomy care at home? A. Importance of exercise twice a day B. Inclusion of high-fiber foods such as cabbage in the diet C. Yearly screening colonoscopy D. Skin care

Answer: D Rationale: The older client's skin is more fragile, which can increase the risk for infection with breaks in the skin, making this a high-priority intervention. Foods such as cabbage often produce gas, which can cause embarrassment for the client with a colostomy. Colonoscopy is not done on a yearly basis. Exercising is important, but a lower priority than skin care.

The nurse is counseling a client who has had an ectopic pregnancy. Which risk factor is associated with an increased chance of this condition? A. Diabetes B. Multiple Sclerosis C. Asthma D. Pelvic Inflammatory Disease (PID)

Answer: D Rationale: An ectopic pregnancy is the implantation of the fertilized ovum outside of the uterus. Pelvic Inflammatory Disease (PID) increases the chance of this condition. Clients with asthma, diabetes, or Multiple Sclerosis do not have an increased risk for an ectopic pregnancy.

The obstetrical provider examining a client at the first prenatal care appointment indicates the client's vaginal mucosa has a bluish tint. The nurse understands that this finding is called: A. Goodell's sign B. Hegar's sign C. McDonald's sign D. Chadwick's sign

Answer: D Rationale: Beginning about the fourth week of pregnancy, vasocongestion in the pelvic area results in a bluish color to the vulva called Chadwick's sign. Hegar's sign is softening of the lower uterine segment; Goodell's sign is a softening of the cervix; and McDonald's sign is an ease in flexing the body of the uterus against the cervix.

Which statement indicates that an obese client with a BMI of 25 needs further teaching about the effective management of weight problems? A. "When I find myself feeling stressed, I'll try walking for 10 minutes." B. "I need to find some physical activities I can do." C. "I'm going to try to limit intake of sweets to a small portion once each day." D. "I think we should consider pharmacotherapy to start."

Answer: D Rationale: Weight management for obese individuals is complex due to a number of contributing factors. Pharmacotherapy is recommended only as an adjunct when traditional therapies have not been successful; it is not typically an initial strategy for weight management, particularly in a client with a BMI less than 27. Clients need to reduce caloric intake and increase physical activity, as well as learn about the factors that may trigger eating at times when they may not be physically hungry.

The nurse in the OB/GYN clinic recognizes that which of the following women is most at risk for breast cancer? A. Age 33, never pregnant B. Age 45, very thin C. Age 23, two children D. Age 64, positive family history

Answer: D Rationale: The risk factors are double for this client due to age and family history. The other clients are not at increased risk for breast cancer

A nurse is forming an intradisciplinary team to help implement electronic records. Who might be requested to join the team? (Select all that apply.) A. A hospital records supervisor B. An orthopedic surgeon C. A hospital administrator D. A nurse anesthesiologist E. A nurse supervisor

Answer: D and E Rationale: Intradisciplinary teams are formed by members of the same profession who work toward achieving a common goal. Only nurses would be part of an intra disciplinary nursing team. A nurse anesthesiologist might be requested to join an intradisciplinary nursing team. A nurse supervisor might be requested to join an intradisciplinary nursing team.

A 73 year old client is being discharged following knee replacement surgery. The home health care nurse is forming an interdisciplinary collaborative team to provide care for the client. What would be some characteristics of this team? (Select all that apply.) A. The physical therapist would be the leader. B. A physician will make all the treatment decisions. C. There is limited communication among team members. D. Individual members of the team participate in the overall treatment planning. E. Decisions are made by the treatment team.

Answer: D and E Rationale: Members of the multidisciplinary team set goals and develop client treatment plans in a more autonomous fashion. In a multidisciplinary team approach, a single team member-usually a physician-makes the treatment decisions. While the physician interacts with each member of the multidisciplinary team, there is little communication between the other individual professionals on the team. As opposed to placing emphasis on each individual team member's area of professional expertise, interdisciplinary collaboration emphasizes each individual's contribution to the joint planning. On an interdisciplinary or interprofessional team, decisions are made by the group.