test 3

The nurse is preparing to administer a hemodialysis treatment for a client diagnosed with chronic kidney disease (CKD). Which laboratory values should the nurse anticipate prior to the client's treatment? Select all that apply. A) Increased blood urea nitrogen (BUN) B) Decreased potassium C) Decreased phosphorus D) Increased urine osmolality E) Increased creatinine

A, E) The damaged kidney is unable to excrete waste products, including creatinine, so creatinine levels will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.

A client tells the nurse, "My mother spent many years in a mental institution, and my father would abuse me when my mother was not around." Based on this information, the client is at greatest risk for developing which of the following conditions? A) A personality disorder B) Poor relationships with individuals of the opposite sex C) An eating disorder D) Substance abuse

A) Risk factors for the development of personality disorders include a family history of mental illness, a history of abuse, instability in family life, and a personal history of other mental illnesses. The client's statement mentions several of these risk factors. Based on the information presented, this client is not necessarily at high risk for an eating disorder, poor relationships with individuals of the opposite sex, or substance abuse.

After reviewing the population demographics for an urban community, the community health nurse determines that community members would benefit from teaching on type 2 diabetes mellitus in children. What findings support this nurse's conclusion? Select all that apply. A) 60% of community families have both parents diagnosed with type 2 diabetes mellitus. B) 35% of school-age children do not routinely receive the annual flu vaccination. C) 50% of children between the ages of 10 and 19 are African American. D) 25% of children between the ages of 10 and 19 are Hispanic. E) 75% of school-age children are raised in families where both parents are unemployed.

A, C, D) The risk factors for diabetes include race, ethnicity, and family history. Type 2 diabetes mellitus rates are greater among youth ages 10 to 19 with higher rates among U.S. minority populations than in non-Hispanic Whites. Frequency of obtaining the annual flu vaccination and socioeconomic status are not risk factors for the development of type 2 diabetes in children.

Which action by the nurse will help minimize the risk of eyestrain when engaging in computerized documentation? A) Use a firm board to rest the palm. B) Use an antiglare screen cover. C) Obtain a paper chart for nursing documentation. D) Use a lumbar support.

B) An antiglare screen cover may decrease the eyestrain that the nurse is experiencing. The nurse will not be allowed to chart on paper because the nursing documentation is electronic. A firm, flat board or hard surface to rest the palm is the best way to protect the wrist from injury. A lumbar support helps with appropriate body posture for the back.

Advances in technology have made what information available to healthcare providers at the client's bedside? A) Vital signs B) Radiologic images C) Allergy alerts D) Dietary restrictions

B) Even before many advances in technology, nurses and other healthcare providers had access to the client's current vital signs, allergy alerts, and dietary restrictions by viewing the client's paper chart at the client's bedside. However, they usually could not view radiologic images at the bedside. Now, with advances in technology, results from laboratory and radiologic exams can often be viewed at the client's bedside.

A clinic nurse is providing care for several clients. Which client is at the highest risk for anorexia nervosa? A) A 16-year-old Hispanic female client B) A 21-year-old Hispanic male client C) A 16-year-old non-Hispanic White female client D) A 22-year-old non-Hispanic White male client

C) Although eating disorders can impact individuals at any age, adolescents and young adults are most often diagnosed with these disorders. In the United States, among adolescents and teens between the ages of 13 and 17, an estimated 2.7% have an eating disorder. Anorexia nervosa is most prevalent among non-Hispanic White adolescents. Bulimia nervosa is most prevalent among Hispanic adolescents. Compared to boys, girls are more than twice as likely to develop an eating disorder.

The nurse on the hospital research committee is assigned the task of compiling information related to the therapeutic and side effects of a specific drug. Which best describes how the nurse can use informatics to gain information about this topic? A) Search for articles about the drug in the hospital's library. B) Email other research committees to find out what they know about the drug. C) Query electronic health records (EHRs) to determine client responses to the drug. D) Look up the drug facts in the latest pharmacology textbook

C) Using computers, nurses can now query EHRs to research client responses to drug administration. Searching for articles in the library or looking up drug facts in a textbook does not require the use of informatics. Although emailing does use computers, emailing another research committee for information about a drug is not best practice for nursing research.

Which administrative function related to medical records management may be made easier by the use of informatics? A) Tracking client outcomes B) Making sure charts are coded correctly C) Ordering materials and supplies D) Assigning a client to a hospital room

D) All of these tasks are made easier through the use of informatics, but only assigning a client to a hospital room is related to medical records management. Tracking client outcomes is part of quality assurance, making sure charts are coded correctly is the job of the billing department, and ordering materials and supplies is related to facilities management.

The nurse is caring for a client who has a condition that is not responding to standard interventions. How could accessing the clinical decision support system (CDSS) help with this client's care? A) Provides evidence-based recommendations for care B) Decreases the need to use critical thinking skills C) Tells the nurse what the next step should be D) Supports the nurse's "gut" instinct when providing care

A) A CDSS uses a knowledge base and programmed rules, protocols, and guidelines developed using evidence-based guidelines to match against client data in the electronic health record (EHR) to deliver alerts or recommendations to the provider. The system will not provide a definitive next step for care, and the nurse still needs to use critical thinking skills to determine the best approach for the individual client. The CDSS may or may not support the nurse's "gut" instinct.

The nurse is providing care to a client who is receiving treatment for diabetic ketoacidosis (DKA). Which possible pathophysiologic cause should the nurse identify for the altered metabolism the client is experiencing? A) Insulin deficiency B) Decreased gluconeogenesis C) Excess production of bicarbonate D) Hypo-osmolarity

A) A client who is diagnosed with DKA will experience alterations in metabolism due to an insulin deficiency. Within the pathophysiology of diabetic ketoacidosis, the client will experience increased gluconeogenesis, a loss of bicarbonate, and hyperosmolarity.

What function might be made easier for healthcare organizations through the use of a computerized contract management system? A) Tracking changes in reimbursement rates B) Sharing information between billing systems C) Managing material and supply inventories D) Planning organizational budgets

A) A computerized contract management system helps facilities track rates of reimbursement and real-time changes in policies for different health insurance plans. Financial systems help share information between billing systems, manage material and supply inventories, and plan organizational budgets.

The medication clopidogrel (Plavix) is most commonly given during which stage of treatment for a stroke? A) Stroke prevention B) Acute care immediately after a stroke C) Recovery care after a stroke D) Rehabilitation after a stroke

A) Antiplatelet and anticoagulant drugs, including aspirin, clopidogrel, dipyridamole, and ticlopidine, are often used as preventive drugs in clients with a history of previous transient ischemic attacks or stroke. Recombinant tissue plasminogen activator alteplase is the gold standard for the treatment of acute ischemic stroke. The rehabilitation phase of treatment usually involves physical, occupational, and/or speech therapy rather than medication.

The nurse, teaching a class to a group of community members about the importance of weight loss in decreasing the risk of type 2 diabetes mellitus, is asked why weight loss reduces the risk associated with the development of this health problem. Which response by the nurse is most appropriate? A) "Excess body weight impairs the body's release of insulin." B) "The amount of food taken in by those who are overweight requires more insulin to adequately metabolize, resulting in diabetes." C) "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin." D) "Thin people are less likely to become diabetic."

A) Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food taken in is not the issue as much as the excess body weight. The body does require more insulin with a greater food intake, but that does not necessarily result in diabetes. While obesity is a risk factor for the development of diabetes, this does not meet the question posed by the client. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin.

A nurse is teaching the father of a 2-year-old client about steps he can take to foster his child's self-esteem. Which statement by the father indicates that more education is needed? A) "At this stage, my most important job as a parent is to ensure that my child does not fail at completing new tasks." B) "I should provide my child with an environment that is safe yet still allows for active exploration." C) "My child needs to be permitted to learn from her mistakes." D) "Toddlers who feel confident about their ability to act independently are more likely to develop healthy self-esteem."

A) Between the ages of 1 and 3, children will begin to assert their independence, develop skills, and engage in activities that promote growing independence and autonomy. Parents need to allow toddlers active exploration within an encouraging environment that is tolerant of failure; thus, the father's statement that he must not allow his child to fail at new tasks indicates a need for further education. The nurse should emphasize that the primary parental task at this stage is to foster independence while avoiding criticism of failures. By bolstering toddlers' self-esteem, parents will help children be supported in acquiring increased independence, thus becoming more confident and secure in their own ability to navigate in the world.

Which organization specifically focuses on improving healthcare quality, safety, and outcomes through improving the use of information technology (IT) and systems? A) Healthcare Information and Management Systems Society (HIMSS) B) American Medical Informatics Association (AMIA) C) Alliance for Nursing Informatics (ANI) D) Technology Informatics Guiding Educational Reform (TIGER)

A) HIMSS works to improve healthcare quality, safety, and outcomes through improving the use of IT and systems. AMIA is dedicated to developing health informatics that support client care and teaching. ANI supports information leadership, practice, education, policy, and research. TIGER integrates technology and informatics competencies into nursing education and practice

Why is development of Kussmaul respirations problematic in a client with chronic kidney disease (CKD)? A) It suggests the client is experiencing metabolic acidosis. B) It suggests the client is dehydrated. C) It suggests the client is hypotensive. D) It suggests the client is experiencing proteinuria

A) Kussmaul respirations involve an increase in respiratory rate and depth. Clients with CKD may exhibit these respirations when they are experiencing metabolic acidosis related to impaired hydrogen ion excretion and buffer production. Clients with CKD typically experience fluid retention and hypertension rather than dehydration and hypotension. Proteinuria is common among clients with CKD and does not contribute to Kussmaul respirations.

Which statement regarding the term "point of care" is correct? A) "Point of care" refers to the use of a portable device to provide care near the client. B) "Point of care" refers to the location that nurses document care of the client. C) "Point of care" refers to care that takes place away from the client. D) "Point of care" refers to care that takes place in the client's home.

A) One of the selling points of an electronic health record is that charting at point of care is possible, which helps to increase efficiency. Point of care refers to interventions or testing that takes place using a transportable, portable, or handheld device near the client. Point of care does not refer to the location where documentation takes place or to care that takes place away from the client or specifically in the client's home

A client who was admitted for treatment of a personality disorder is observed pulling another client's hair and pushing clients out of their chairs. What is the priority nursing intervention for this client? A) Removing the client from the room and addressing the behavior privately B) Establishing a therapeutic nurse-client relationship C) Placing the client in a jacket restraint D) Asking the client what purpose is served by disrupting others

A) Priorities of care for a client with a personality disorder include safety, managing crisis, setting limits, and improving socialization. Because of the nature of personality disorders, it may be difficult to form a therapeutic nurse-client relationship, so this should not be the nurse's main focus at this time. The nurse should not confront the client by asking what purpose is served by disrupting others. Placing the client in a jacket restraint is not indicated in response to this behavior. The best intervention would be for the nurse to remove the disruptive client from the room and address the behavior privately.

During a 6-month well-baby check up, the mother mentions to the nurse that her infant seems to be sleeping just as much as she did as a newborn, and she seems to do everything with her left hand. The nurse recognizes that these are warning signs of stroke that occurred early in life. What other question should the nurse ask to assess for signs of stroke? A) "Have you noticed your baby jerking any muscles of the face, arms, or legs?" B) "Have you noticed your baby having trouble forming words?" C) "Does your baby vomit frequently after feeding?" D) "Does your baby frequently seem to lose her balance?"

A) Stroke warning signs in infants include seizures, extreme sleepiness, and favoring the use of only one side of the body. Signs of seizure in neonates include repetitive facial movements, staring, apnea, and jerking of the muscles of the face, arms, or legs. Questions related to balance or forming words are not age appropriate, as most normal 6-month-old infants do not have steady balance or the ability to form words. The question related to vomiting is also not appropriate, as vomiting at this age is more frequently related to food intolerances/allergies or gastrointestinal problems rather than stroke.

While completing a health history with an older adult client, the nurse learns that the client experienced a transient ischemic attack (TIA) several months ago. The nurse should recognize that: A) the client is at risk for an ischemic thrombotic stroke. B) the client will have minimal symptoms should a stroke occur. C) the client will not experience a stroke in the future. D) the client is at high risk for a hemorrhagic stroke.

A) TIAs are often warning signs of an ischemic thrombotic stroke. There is no way to predict the symptoms the client will experience after a stroke. One or many TIAs may precede a stroke, with the time between the attack and the stroke ranging from hours to months. A hemorrhagic stroke is caused by the rupture of a cerebral blood vessel and is not related to a TIA.

Which test is commonly used to screen for type 2 diabetes in the general population? A) Fasting plasma glucose B) Oral glucose tolerance test C) Urine ketone levels D) Serum cholesterol levels

A) Tests used to screen for type 2 diabetes in the general population include fasting plasma glucose and glycated hemoglobin (A1C). Oral glucose tolerance tests are primary used for screening for gestational diabetes in pregnant women, although they can also be used for clients with suspected diabetes. Urine ketone levels and serum cholesterol levels are not used for screening. Urine ketone levels are used primarily to monitor clients with type 1 diabetes. Serum cholesterol levels are measured to assess the risk for cardiovascular disease, which may or may not be related to diabetes.

A client tells the nurse that he feels pressure to spend every Sunday with his parents. However, the client's wife does not participate and stays at home waiting for the client to return. Which of the following elements is determining the client's self-concept? A) Family and culture B) History of successes and failures C) Stressors D) Resources

A) The client is conflicted because the client's parents have one set of expectations and the spouse has another. This conflict will adversely affect the client's self-concept. Stressors are events that cause an individual to either become stronger or respond in a maladaptive way. Resources can be internal or external. Internal resources include confidence and values; external resources include support networks, finances, and organizations. A history of successes and failures can impact self-concept. People with a history of failures tend to see themselves as failures and view life in a negative way. Those with a history of successes often have a positive self-concept and view their lives as successful.

The nurse is preparing to discharge a client diagnosed with chronic kidney disease (CKD). The nurse is teaching the client and family about administering calcium acetate tablets by mouth with each meal at home. Which explanation about this medication is most appropriate for the nurse to include? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps neutralize your gastric acids." C) "The calcium acetate will help stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."

A) The client with CKD has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with CKD. This medication has no effect on appetite stimulation.

The client with diabetes mellitus reports having difficulty trimming the toenails because they are thick and ingrown. What should the nurse recommend to this client? A) Make an appointment with a podiatrist. B) Offer to file the tops of the nails to reduce thickness after cutting. C) Cut the nails straight across with a clipper after the bath. D) Make an appointment with a nail shop for a pedicure.

A) The toenails of the client with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails across after the bath is correct for toenails that do not demonstrate the complications listed. The client with diabetes is at an increased risk for infection and should avoid situations in which this risk is increased, such as the nail shop pedicure. The nurse should not file the client's toenails to reduce thickness.

The nurse is planning care for a client admitted with a stroke. Which intervention would support the client's sensorimotor needs? A) Encourage use of nonaffected arm to feed self, bathe, and dress. B) Speak in normal conversational pattern and tones. C) Provide complete care. D) Talk loudly and distinctly.

A) To address the client's alteration in sensory and motor statuses, the nurse should encourage the client to use the nonaffected arm to feed self, bathe, and dress. The nurse should not provide all care for the client. The nurse should not talk loudly to the client but should articulate slower and face the client when speaking. Speaking in normal conversational patterns and tones may not be adequate when communicating with the client.

While teaching a wellness class on the warning signs of stroke, a participant asks the nurse, "What's the most important thing for me to remember?" What is an appropriate response by the nurse? A) "Be alert for sudden weakness or numbness." B) "Know your family history." C) "Keep a list of your medications." D) "Call 911 if you notice a gradual onset of paralysis or confusion."

A) Warning signs of stroke include sudden weakness, numbness, paralysis, loss of speech, confusion, dizziness, unsteadiness, and loss of balance—the key word is sudden. Family history and past medical history can be indicators for risk, but they are not warning signs of stroke. Gradual onset of symptoms is not indicative of a stroke.

The nurse is facing a problem with a long-term care client that is different from anything encountered by the nurse in the past. What nursing action is appropriate prior to taking the problem to the research committee? A) Perform a review of the literature. B) Ask the client's family if this is a recurring issue. C) Bring the problem up for discussion in the next staff meeting. D) Ask the physician for assistance.

A) When encountering a problem, the nurse can conduct a literature review to find applicable information. Asking the client's family if the problem is recurring will not help the nurse determine the course of care. The physician is not consulted for nursing problems. A staff meeting may provide some other opinions but will not give the nurse information regarding studies related to the client's problem.

A nurse working on the behavioral health unit is caring for a client with histrionic personality disorder. Which types of behaviors should the nurse anticipate when assessing this client? Select all that apply. A) Flamboyant behaviors B) Dramatic behaviors C) Competitive behaviors D) Arrogant behaviors E) Manipulative behaviors

A, B) Clients with histrionic personality disorder tend to be flamboyant and dramatic, and they seek to be the center of attention. Competitiveness, arrogance, and manipulative behaviors are more commonly associated with narcissistic personality disorder.

The nurse is planning care for a client who has been diagnosed with antisocial personality disorder. Which goals address the client's antisocial behavior? Select all that apply. A) The client will share meals with others in the community dining area. B) The client will interact socially with others. C) The client will engage in individual therapy without disruptions. D) The client will take all medications as prescribed. E) The client will refrain from attention-seeking behavior.

A, B) This client is demonstrating antisocial behavior. Goals that address antisocial behavior are for the client to interact socially with others and to share meals in the community dining area. The other goals would not specifically measure the effectiveness of interventions to address the client's antisocial behavior.

The nurse is providing care to an adolescent client who has a history of vomiting after eating. Which diagnostic tests should the nurse anticipate when providing care to this client? Select all that apply. A) Complete blood count B) Serum electrolytes C) Blood urea nitrogen (BUN) and creatinine D) Urine drug screen E) Barium enema

A, B, C) A history of vomiting after eating is a clinical manifestation of an eating disorder. When caring for a client who is suspected of having an eating disorder, the nurse should anticipate the need for a complete blood count, as well as serum electrolyte, BUN, and creatinine levels. These tests can provide insight regarding the client's nutritional status and kidney function, both of which may be compromised. A urine drug screen and barium enema would not be part of standard care for a client with a suspected eating disorder.

The nurse is providing care to a client who has been diagnosed with a personality disorder. Which treatment options should the nurse anticipate for this client? Select all that apply. A) Antipsychotic medication B) Antidepressant medication C) Cognitive-behavioral therapy D) Nutritional counseling E) Weight management program

A, B, C) For a client who has been diagnosed with a personality disorder, the nurse would anticipate antipsychotic medication, antidepressant medication, and cognitive-behavioral therapy. Nutritional counseling and a weight management program would be more appropriate for a client with an eating disorder.

A student nurse is asked to recall the questions included in the SCOFF questionnaire. Which questions identified by the student nurse are appropriate? Select all that apply. A) Do you believe yourself to be fat when others say you are too thin? B) Would you say that food dominates your life? C) Do you worry you have lost control over how much you eat? D) Do you make yourself sick because you feel uncomfortably full? E) Have you recently lost more than 1 pound in a 3-month period?

A, B, C, D) "Have you recently lost more than 1 pound in a 3-month period?" is not a question included in the SCOFF questionnaire. Rather, the SCOFF questionnaire consists of the other four questions in the student nurse's response, along with one additional question: "Have you recently lost more than one stone (14 pounds) in a 3-month period?"

The nurse is preparing an educational brochure to teach clients how to determine the validity of content obtained from health-related internet websites. Which information should the nurse plan to include in this teaching tool? Select all that apply. A) Source for the information B) Sponsor of the website C) Ways to identify if the site is selling a product D) Number of visitors to the website E) Date the content was last reviewed

A, B, C, E) When analyzing online information, the source of the information should be validated. The sponsor of the website should be clearly identified. The site should be studied to see if a product is being sold. A date when the data was last reviewed or updated should be visible. It is not necessary to locate the number of visitors to the website.

The nurse administrator of a local hospital is attending training on the new informatics system the hospital will be implementing. Which information should the nurse administrator be able to manage from the dashboard? Select all that apply. A) Staffing B) Budgets C) Clients D) Quality initiatives E) Plans of care

A, B, D) Many electronic health records give administrators tools to manage budgets, staffing, quality initiatives, and productivity information. The use of dashboards puts all of this information at the administrator's fingertips. The dashboard does not include client-specific or identifying information, such as plans of care.

The nurse is part of the clinical information system committee at a major healthcare organization. When designing a plan to ensure the protection of client information, which approaches should the nurse suggest this committee include in the implementation plan? Select all that apply. A) Design policies to address password protection and login information. B) Determine how to handle clients who desire to "friend" staff through social media. C) Identify applications that interface with smartphones. D) Create interfaces so that health data can be inputted by the client. E) Teach users to not leave protected health information unattended.

A, B, E) The committee is creating a plan to ensure the protection of client information. The committee needs to design polices for password protection and login information, determine mechanisms to handle clients and staff who communicate through social media, and teach users to not leave protected health information unattended. Identifying applications that interface with smartphones and creating interfaces so that clients can input health data are not approaches to ensure the protection of client information.

During a home visit, the nurse is concerned that an older adult client is developing chronic kidney disease (CKD). The client has no history of cardiovascular disease. Which data in the client's assessment caused the nurse to have this concern? Select all that apply. A) Progressive edema B) Complaints of hip joint pain C) New onset of hypertension D) Recent increase in hunger and thirst E) Warm moist skin

A, C) The manifestations of chronic kidney disease (CKD) often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of CKD in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not CKD in the older client. A client with CKD will have pale dry skin with poor turgor.

The nurse is planning care for a client with type 2 diabetes mellitus. Which nursing diagnosis would be most appropriate for this client? A) Self Neglect B) Risk for Infection C) Risk for Decreased Cardiac Tissue Perfusion D) Impaired Tissue Integrity

B) A client with diabetes mellitus is at the greatest risk for infection. No other information is given in the question with regard to risk for self neglect, ineffective tissue perfusion, or impaired tissue integrity as potential nursing diagnoses.

Rejection of a donor kidney that begins months to years after transplant surgery and does not respond to increased immunosuppression would be categorized as which type of rejection? A) Acute rejection B) Chronic rejection C) Delayed rejection D) Nonimmune rejection

B) Acute rejection develops within months of the transplant. It is caused by a cellular immune response and may be managed with methylprednisolone and OKT3 monoclonal antibody. Chronic rejection, which may develop months to years following the transplant, is a major cause of graft loss. Both humoral and cellular immune responses are involved in chronic rejection. Chronic rejection does not respond to increased immunosuppression.

The community nurse is teaching a class at the community center regarding the cultural and ethnic risk factors for stroke. Which statement should nurse include in this presentation? A) Caucasians have an increased incidence of intracerebral hemorrhage. B) African Americans have almost twice the number of first-ever strokes compared with Whites. C) Asian Americans are more likely to die following a stroke than Whites. D) The prevalence of hypertension among Hispanics is the highest in the world.

B) African Americans have almost twice the number of first-ever strokes compared with Caucasians and have the highest rate of hypertension compared to other races/ethnicities. Hispanics have an increased incidence of intracerebral hemorrhage. Individuals living in the Southeastern United States have the highest stroke mortality rate.

An adolescent client tells the nurse that she plans to fight recent charges of shoplifting because she was just taking what was rightfully hers. Which trait associated with personality disorders is this client exhibiting? A) Lying B) Narcissism C) Projection D) Manipulation

B) Clinical manifestations commonly seen in individuals with personality disorders include narcissism, manipulation, and impulsiveness. A client who states that she was only taking what was rightfully hers is demonstrating narcissism, which is the belief that one is the superior to others and therefore entitled to certain things. Manipulation is controlling behavior that exploits others for personal gain. Although this client may engage in manipulative behavior, she is not demonstrating manipulation in this statement. The client may be lying to the nurse, but lying is not a key trait associated with personality disorders. The client's statement does not indicate projection, nor is projection a common characteristic in individuals with personality disorders.

Health promotion and prevention related to type 1 diabetes should include A) teaching clients at high risk how to prevent type 1 diabetes. B) teaching clients with type 1 diabetes how to prevent complications. C) providing clients with vaccinations against viruses that cause type 1 diabetes. D) referring clients to a nutritionist and exercise therapist.

B) Currently, there is no known way to prevent type 1 diabetes. Therefore, prevention related to type 1 diabetes is related to preventing the short- and long-term complications of the disease process. Although vaccinations are available against some viruses that may trigger type 1 diabetes, vaccinations against all viruses are not available, and many other triggers exist that may cause type 1 diabetes in susceptible individuals. Nurses may refer clients to a nutritionist or exercise therapist after diagnosis, but proper nutrition or exercise will not prevent type 1 diabetes.

Which of the following personality disorders is characterized by an inability to trust others; a rigid worldview that often conspiratorial in nature; and the belief that other people's actions are based on ulterior motives? A) Obsessive-compulsive personality disorder B) Paranoid personality disorder C) Schizoid personality disorder D) Schizotypal personality disorder

B) Individuals with paranoid personality disorder (PPD) tend to demonstrate an inability to trust others. Actions and intentions of others are perceived as having an underlying theme of malevolence. From the suspicious, mistrusting vantage point of the individual with PPD, others are viewed as being deceptive and disloyal. Individuals with PPD often maintain rigid, inflexible worldviews and will reject logic or proof that contradicts their beliefs. Hypervigilance combined with certainty that others' actions are prompted by hidden motives can lead to isolation.

While caring for a client diagnosed with end-stage renal disease (ESRD), the nurse tracks the client's serum albumin level. For which nursing diagnosis is this action most indicated? A) Excess Fluid Volume B) Imbalanced Nutrition: Less than Body Requirements C) Risk for Ineffective Perfusion D) Risk for Infection

B) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.

Which laboratory finding is suggestive of chronic kidney disease? A) Increase in creatinine clearance B) Decrease in serum sodium C) Increase in hematocrit D) Decrease in BUN

B) Laboratory findings associated with chronic kidney disease include decreased creatinine clearance due to a decrease in the glomerular filtration rate; decreased serum sodium because of water retention; decreased hematocrit due to decreased red blood cell production, and increased BUN due to inability of the kidneys to eliminate nitrogenous waste products.

Which best describes how the use of a clinical decision support system can help the nurse plan care for a client with a particular condition? A) It can help the nurse find out what was done on the previous admission. B) It can help the nurse identify evidence-based guidelines for this client's condition. C) It can help the nurse use standardized nursing language during documentation. D) It can help the nurse search the internet for information about surgical procedures.

B) Nursing care should always be based on evidence-based guidelines, which the nurse can access through a clinical decision support system. Although informatics can help the nurse find out what was done on the previous admission, use standardized language for documentation, and search the internet for information about the surgical procedure, none of these will help the nurse plan evidence-based care

The nurse is documenting in the electronic medical record (EMR) after providing care in the client's room. The client asks the nurse why a computer is being used. Which response by the nurse is appropriate? A) "The information that is uploaded is available for anyone to view." B) "Computers improve client care because information is readily available." C) "The computer decreases documentation time for nurses." D) "Computers allow you access to your medical record."

B) Nursing informatics is the science of using computers in nursing practice to improve client care by making client information easily accessible for the client and other healthcare workers who are participating in the client's care. Documenting client information by computer does not necessarily reduce charting time, depending on the system used. The client's information is protected by privacy laws. Clients have the right to access their medical records regardless of whether they are paper or electronic.

The nurse is caring for a 76-year-old client with type 2 diabetes who is recovering from surgery following a hip fracture. In addition to blood glucose level, what should the nurse recognize as a sign of hyperosmolar hyperglycemic state (HHS)? A) Excessive sweating B) Increased urine output C) Insomnia D) Edema

B) Older adults with type 2 diabetes who have undergone a major surgery are at high risk for developing hyperosmolar hyperglycemic state (HHS). Symptoms of HHS include greatly elevated blood glucose levels, high plasma osmolarity, and altered level of consciousness. Other symptoms include increased urine output, dry skin and mucous membranes (not excessive sweating), extreme thirst, and lethargy (not insomnia). HHS leads to dehydration and fluid loss, not edema.

To evaluate a client's personal identity, the nurse should consider what three aspects of the client's self? A) Ideal self, private self, and public self B) Ideal self, real self, and public self C) Authentic self, presented self, and perceived self D) Real self, goal self, and private self

B) Personal identity can be evaluated from the standpoint of three aspects of self: the ideal self, the real self, and the public self. The ideal self reflects the qualities an individual believes he or she should possess, as well as those he or she aspires to develop. The real self represents an individual's perceived true self; it may include observations about self or self-perceived qualities that the individual hides from others or does not readily share. The public self is formed on the basis of how the individual wishes to be perceived by others.

A nurse working on the behavioral health unit is developing a plan of care for a client. The client does not interact with others, refuses to attend group sessions, and has a history of throwing things at other clients. Which of the following is the priority nursing diagnosis for this client? A) Ineffective Coping B) Risk for Other-Directed Violence C) Social Isolation D) Impaired Social Interaction

B) Risk for Other-Directed Violence would be the priority nursing diagnosis, because ensuring the safety of others is imperative. Although the other diagnoses may also be appropriate, they are not the priority.

After a stroke, sensory-perceptual changes increase the client's risk for what? A) Aspiration B) Injury C) Bleeding D) Infection

B) Strokes often alter the ability to integrate, interpret, and attend to sensory data. The client may experience deficits in vision, hearing, equilibrium, taste, and smell. The ability to perceive vibration, pain, warmth, cold, and pressure may be impaired, as may proprioception (the body's sense of its position). The loss of these sensory abilities increases the risk for injury. Sensory-perceptual changes do not increase the risk for aspiration, bleeding, or infection, although stroke may cause these other complications.

The destruction of which types of cells in the islets of Langerhans cause type 1 diabetes mellitus? A) Alpha cells B) Beta cells C) Delta cells D) Gamma cells

B) The beta cells of the islets of Langerhans in the pancreas are the only cells in the body that produce insulin. Destruction of these cells cause type 1 diabetes mellitus. Alpha cells are responsible for the production of glucagon, and delta cells produce somatostatin. Gamma cells produce pancreatic polypeptide.

What is the primary advantage of electronic reminders in the electronic health record? A) They help nurses decrease the length of stay. B) They help nurses increase client safety. C) They help nurses document assessments. D) They help nurses track quality metrics.

B) The primary direct advantage of electronic reminders is that they help improve client safety, often by reminding nurses to use certain screening tools or complete certain assessments. By increasing safety, these reminders can indirectly reduce length of stay. Note, however, that electronic reminders don't actually help nurses document assessments, nor do they track quality metrics.

A rural home health nurse is caring for a client recovering from a myocardial infarction. The client is concerned that the community clinic does not have the ability to provide the necessary monitoring for the health problem. Which response by the nurse supports the use of informatics to meet client needs? A) "It is not necessary for you to be monitored after a myocardial infarction." B) "We can send your information to the cardiologist using telehealth." C) "You are right. We will be sending you to the city every month." D) "We use an intranet in this facility."

B) Through telehealth advances, clients who live in remote areas can have their information monitored by specialists using computers. Because of this technology, clients do not need to make frequent visits to specialists for monitoring and evaluation of progress. A client who has experienced a myocardial infarction does require monitoring. The intranet is used within an agency or system and is not a tool that can be accessed from the outside.

An adult client tells the nurse, "No matter what I do, I never can make my parents happy." Which action by the nurse may enhance the client's self-concept? A) Suggesting that the client reduce the amount of time spent with her parents B) Reminding the client that she is educated and has a great career and good marriage C) Suggesting that the client turn the tables by expressing the same dissatisfaction with her parents D) Telling the client that she is too old to be listening to her parents

B) To improve or support the client's self-concept, the nurse needs to help the client identify strengths. Reminding the client about education, career, and marriage will help identify those strengths. Suggesting the client reduce the amount of time spent with parents, telling the client that she is too old to be listening to her parents, or suggesting the client express dissatisfaction with her parents are all inappropriate responses and will not help the client identify strengths.

Type 2 diabetes mellitus is characterized by which underlying pathophysiology? A) Excessive insulin production B) Insulin resistance C) Inability of the pancreas to produce insulin D) Impaired insulin uptake

B) Type 2 diabetes occurs despite the availability of endogenous insulin, because insulin's functioning is impaired by insulin resistance. The level of insulin produced in type 2 diabetes varies; production could be increased or decreased, depending on the client. The pancreas is able to produce insulin, but the insulin cannot work properly due to insulin resistance. Glucose uptake, not insulin uptake, is impaired in type 2 diabetes.

A group of staff nurses is discussing the importance of uniform language within healthcare documentation. Which statement made by the one of the nurses indicates an understanding of uniform language in healthcare documentation? A) "Uniform language is useful only when communicating with other staff nurses." B) "Uniform language is the consistent use of the same terminology among all providers." C) "Uniform language decreases the value of nursing interventions in the eyes of other providers." D) "HIPAA and HITECH are examples of uniform languages used by nurses."

B) Uniform language is the consistent use of the same terminology among providers, facilities, institutions, and organizations. It is useful when communicating both with nurses and with providers from other disciplines. Uniform language can increase the visibility of nursing interventions and thus increase their value in the eyes of other providers. NANDA, NIC, and NOC are examples of uniform languages used by nurses, not HIPAA and HITECH

The nurse is planning care for a 4-year-old child newly diagnosed with type 1 diabetes mellitus. The child's mother appears unconcerned with the diagnosis and is complaining about the cost of medication, as three additional children in the family have needs. On which nursing diagnoses should the nurse focus when planning this client's care? Select all that apply. A) Chronic Pain B) Deficient Knowledge C) Compromised Family Coping D) Risk for Unstable Blood Glucose Level E) Disturbed Body Image

B, C, D) Because the child is only 4 years old, the mother will need to learn how to provide the insulin injections; however, the mother is unconcerned with the diagnosis, likely due to Deficient Knowledge. The mother's complaint about the cost of medication and lack of concern about the diagnosis would cause the client to have a Risk for Unstable Blood Glucose Level, as it is unknown whether the mother is going to ensure the child has the required medication. The family has a total of four children and the mother is concerned with money for medication, as there are three additional children with needs. This could lead to Compromised Family Coping. There is no evidence to support the diagnoses of Chronic Pain or Disturbed Body Image with this client.

Several nurses are discussing the use of electronic medical records when providing client care. Which statements by the nurses indicate that they understand the advantages of electronic health records (EHRs)? Select all that apply. A) "The record reduces the cost of healthcare." B) "The record allows trending of client progress." C) "Client education can be documented in the system." D) "Quality metrics can be observed to reduce readmission rates." E) "Coordination of care is improved."

B, C, D, E) Electronic health records can assist the nurse by allowing trending of client progress, documentation of client education, and observation of quality metrics to help decrease readmission rates. Electronic health records also allow improved coordination of care between providers because they are all working off one chart. The use of the electronic health record does not directly reduce the cost of healthcare.

The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease (CKD). Which topics should the nurse include in the seminar? Select all that apply. A) Avoid eating red meat. B) Control blood glucose levels in diabetes mellitus. C) Adhere to medication regimen to control hypertension. D) Participate in regular exercise. E) Avoid smoking.

B, C, D, E) Prevention of CKD should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of CKD.

A client diagnosed with cancer is receiving care through a facility that is 100 miles from the client's home. After the nurse explains how telehealth will be used to enhance this client's care, which client statements indicate that teaching about telehealth has been effective? Select all that apply. A) "I will have to move closer to the provider." B) "My health record can stay where I am." C) "I can participate in the videoconference." D) "I will have to change doctors." E) "This will help lower some costs of care."

B, C, E) Using telehealth, the client can live and stay in the home and does not need to move closer to the treatment or monitoring facility. The client will not be required to change healthcare providers. Telehealth allows for the client to participate in a videoconference, keep health records in the home agency, and lower many of the costs that could be incurred with frequent travel.

The nurse is finalizing a plan of care for a school-age client newly diagnosed with type 1 diabetes mellitus. Which areas should the plan prioritize to achieve the maximum outcomes for this client? Select all that apply. A) Ways to minimize the number of school days missed B) Identification and referral to community resources C) Physical activities that limit exposure to injuries D) Self-management of glucose monitoring and medications E) Signs and symptoms of hypoglycemia and actions to take

B, D, E) Planning should prepare the child and the family for self-management of glucose monitoring and medications, signs and symptoms of hypoglycemia, and actions to take. Before discharge, the child and the family should be linked to the resources in the community that will support care of the child with diabetes. Minimizing the number of school days missed and activities that limit exposure to injuries are not immediate priorities for this client's plan.

What collaborative interventions are likely to improve outcomes for an 11-year-old client diagnosed with type 2 diabetes mellitus? Select all that apply. A) Weaning off oral medications B) Food intake based on age, sex, and physical activity C) Obtaining adequate rest and sleep D) Physical activity to be at least 30 to 60 minutes per day most days of the week E) Family participation in the lifestyle change

B, D, E) The child with type 2 diabetes mellitus will most likely be treated with oral hypoglycemic agents. Weaning off of these medications will not improve the client's long-term prognosis. The child with type 2 diabetes mellitus does not have a need for adequate rest and sleep to improve the long-term prognosis. Plans to improve the client's long-term prognosis should focus on food intake that is based on the client's age, sex, and physical activity, obtaining the required physical activity that is recommended for most days of the week, and family support to comply with lifestyle changes that the client needs.

A client who has been diagnosed with a personality disorder tells the nurse, "Sometimes I daydream that I go home and kill my family." Which of the following is the priority nursing diagnosis for this client? A) Ineffective Coping B) Deficient Knowledge C) Risk for Other-Directed Violence D) Dysfunctional Family Processes

C) A client who has been diagnosed with a personality disorder and admits to daydreaming about killing his family is at risk for violence toward others. To protect the client and family, the priority nursing diagnosis should be Risk for Other-Directed Violence. Dysfunctional Family Processes, Deficient Knowledge, and Ineffective Coping may also be appropriate nursing diagnoses, but the nurse's first priority should be to address the client's risk for violence toward others.

The healthcare provider prescribes sitagliptin (Januvia) for a client with type 2 diabetes mellitus. For which potential side effect should the nurse monitor in this client? A) Elevated blood lipid levels B) Hyperglycemia C) Pancreatitis D) Renal insufficiency

C) A potential side effect of sitagliptin (Januvia) is pancreatitis, and the client must be monitored for this. Sitagliptin (Januvia) does not cause elevated blood lipids, hyperglycemia, or renal insufficiency.

The nurse is caring for a client diagnosed with chronic kidney disease (CKD) who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to CKD. The client's spouse asks why the client is anemic. Which response by the nurse is the most appropriate? A) "Your spouse has a genetic tendency for the development of anemia." B) "The increased metabolic waste products in your spouse's body depress the bone marrow and cause anemia." C) "Your spouse's kidneys are producing reduced amounts of the hormone erythropoietin, and this is the cause of the anemia." D) "Your spouse is not eating enough iron-rich foods, and this has led to anemia."

C) Anemia is common in clients with chronic kidney disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in stimulating the bone marrow to produce RBCs. Metabolic wastes do not suppress bone marrow, and diet and heredity do not factor into the production of erythropoietin.

A client with a suspected transient ischemic attack (TIA) presents to the emergency department with aphasia. Based on this data, the nurse plans care based on ischemia to which portion of the brain? A) Anterior cerebral artery B) Vertebral artery C) Left hemisphere of the brain D) Right hemisphere of the brain

C) Aphasia occurs due to ischemia of the left hemisphere. The other choices may be involved in a TIA, but are not the causative pathology of aphasia.

Which of the following manifestations would the nurse least likely observe in a client with a Cluster B personality disorder? A) Dramatic behavior B) Erratic behavior C) Extreme fearfulness D) Extremely emotionality

C) Clients with Cluster A traits, which include paranoid, schizoid, and schizotypal personality disorders, may appear odd or eccentric. Clients with Cluster B traits, which include antisocial, borderline, histrionic, and narcissistic personality disorders, may display dramatic, emotional, and erratic behaviors. Finally, clients with Cluster C traits, which include avoidant, dependent, and obsessive-disorder personality disorders, may appear as anxious or fearful. Thus, extreme fearfulness would be more likely observed in clients with Cluster C disorders than in clients with Cluster B disorders.

Which of the following questions would best help the nurse assess a client's global self-esteem? A) "What do you consider your greatest personal strength?" B) "What do you like least about yourself?" C) "How satisfied are you with yourself and your life so far?" D) "Do you consider yourself a hard-working person?"

C) Global self-esteem is the degree to which an individual likes himself or herself overall, as a whole being. Of the questions listed here, only "How satisfied are you with yourself and your life so far?" would help the nurse assess a client's global self-esteem. The remaining questions would help the nurse gauge the client's specific self-esteem, or his or her positive regard for certain aspects of himself or herself.

An experienced nurse is teaching a student nurse about personality disorders in the older adult population. Which of the following statements by the student nurse would indicate a need for further education? A) "In some older adults, borderline personality disorder remits with age." B) "In older adults, loss of a significant support person sometimes exacerbates symptoms and leads individuals to seek treatment." C) "Antisocial personality disorder tends to worsen as a person moves from middle age into older adulthood." D) "Among older adults with personality disorders, the risk of suicide tends to decline with age."

C) In some individuals, antisocial and borderline personality disorders become less evident or remit with age; thus, the student nurse's statement about antisocial personality disorder indicates a need for further education. All of the other statements are correct.

A client with a history of hypertension is diagnosed with chronic kidney disease (CKD). When the client asks the nurse how this disease developed, which response by the nurse is the most appropriate? A) "Thickening of the kidney structures and gradual death of nephrons has led to this diagnosis." B) "Cysts have compressed your renal tissue and destroyed your kidneys, causing this diagnosis." C) "High blood pressure has reduced your renal blood flow, harming the kidney tissue and causing this diagnosis." D) "Immune complexes have formed in your kidney tissue, causing inflammation that has led to this diagnosis."

C) Long-standing hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. In contrast, diabetic nephropathy causes chronic kidney disease (CKD) by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes CKD by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Finally, systemic lupus erythematosus causes CKD by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.

Which factor increases nurses' use of clinical decision support systems (CDSS)? A) Out-of-the-way workstations B) Nursing experience C) Caring for a new client D) Reminder pop-ups

C) Nurses tend to use CDSS more frequently when they are caring for a client with which they are unfamiliar. However, nurses tend to decrease use of a CDSS when they have more nursing experience, when there are too many reminders, or when the workstation is not conveniently located.

In preparation for the next quality improvement committee meeting, the nurse accesses the clinical decision support system to run an outcomes report. How should the nurse anticipate the committee using this report? A) To eliminate unnecessary care B) To measure the length of hospital stays C) To assist in modifying policies and procedures D) To validate appropriate place of treatment

C) Outcome tracking helps identify faulty processes and assists in modifying policies and procedures to improve client outcomes for a particular diagnosis or department within a health organization. Utilization review is designed to eliminate inappropriate or unnecessary medical care, length of stay, and place of treatment.

The nurse is counseling a couple who is planning a pregnancy. The woman was diagnosed with type 1 diabetes when she was 14 years old. She is now 27. Which examination should the nurse prepare the woman to have before, during, and after the pregnancy? A) Gastrointestinal examination for gastric hypotony B) Neural examination for diabetic peripheral neuropathy C) Eye examination for diabetic retinopathy D) Renal examination for urinary incontinence

C) Pregnant women with type 1 diabetes are at an increased risk for diabetic retinopathy. Women with type 1 diabetes who are planning a pregnancy should have eye examinations before the pregnancy, during each trimester, and for 1 year postpartum. Older adults, not pregnant women, are at increased risk for gastric hypotony and urinary incontinence related to type 1 diabetes. Pregnant women with type 1 diabetes are not at increased risk for diabetic peripheral neuropathy compared to other clients with type 1 diabetes.

A client who is newly diagnosed with type 1 diabetes has smoked for 30 years. When teaching the client on ways to optimize health outcomes, what should the nurse explain about the effects of smoking and diabetes? A) Smoking is a major factor in the development of diabetic neuropathy. B) Smoking increases insulin resistance. C) Smoking accelerates atherosclerotic changes in blood vessels. D) Smoking promotes weight gain.

C) Smoking is especially unhealthy for diabetic clients because smoking accelerates the atherosclerotic effects that occur in blood vessels from elevated levels of blood glucose. Smoking is not associated with weight gain; in fact, people use weight gain as an excuse not to quit smoking. Poor glycemic control in diabetics is associated with the development of complications including diabetic neuropathy. Smoking does not affect insulin resistance.

What is one advantage of the standardization of health records in relation to client education? A) It allows the nurse to print information for the client rather than reviewing the information in person. B) Families can receive education rather than clients in order to ensure that the client receives proper care at home. C) Clients can receive the same education about their condition regardless of where they receive treatment. D) Clients can look up their health information at home after discharge.

C) Standardization of the health record allows clients to receive the same education about their condition regardless of where they receive treatment. Standardization does not negate the nurse's responsibility to review the information in person with the patient or family. Both families and client should receive education as appropriate, regardless of standardization. Clients looking up their health information at home does not depend on standardization of health records.

During an assessment, a client tells the nurse that she "can't stand her mother." The client also says she does "whatever Mom wants me to do" because the client "can't do anything right anyway." The nurse should use this information when determining which of the following items during the client assessment? A) Personal identity B) Role performance C) Self-esteem D) Body image

C) The client is critical of her mother, verbalizes feelings of helplessness by saying she does whatever her mother wants her to do, and is critical of herself, as evidenced by the statement that she cannot do anything right. These findings should all contribute to the nurse's assessment of the client's self-esteem. Role performance would be assessed by asking the client about the different roles she has and her satisfaction with each of these roles. Body image would be assessed by asking the client how she feels about her appearance. Personal identity would be assessed by asking the client to describe her personal characteristics and self-concept.

The nurse is planning care for a client diagnosed with chronic kidney disease (CKD) and osteoporosis. Based on this information, which should be the nurse's priority diagnosis for this client? A) Anxiety B) Disturbed Body Image C) Risk for Injury D) Risk for Bleeding

C) The client with CKD and osteoporosis is at high risk for fractures; therefore, preventing injury should be the priority nursing diagnosis. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, the client is not undergoing hemodialysis. Anxiety is not related to osteoporosis.

The nurse is administering peritoneal dialysis to a client with a diagnosis of chronic kidney disease (CKD). The nurse notes the presence of a cloudy dialysate return. After notifying the healthcare provider, which action by the nurse is the most appropriate and of highest priority? A) Measure the client's abdominal girth. B) Document the cloudy dialysate. C) Culture the dialysate return. D) Increase dialysate instillation.

C) The client's dialysate return should be clear. The presence of cloudy drainage might indicate peritonitis, so the nurse should culture the return in order to help identify the presence and type of organism that could be causing the infection. Documenting the cloudy dialysate would be a necessary nursing action, but is not the next-priority action. Measurement of abdominal girth is performed prior to the dialysis procedure, and even though increased girth could indicate peritonitis, culturing the return is more important. The instillation part of the procedure is completed prior to the collection of the dialysate return, and the rate of the instillation has no relationship to the development of an infection.

Which type of infection has been implicated in destruction of pancreatic beta cells and thus causes type 1 diabetes? A) Fungal B) Parasitic C) Viral D) Bacterial

C) Triggers for the development of type 1 diabetes include genetic predisposition, environmental factors, viral infections, or chemical toxins. Fungal, parasitic, and bacterial infections have not been linked to the development of type 1 diabetes.

A client explains that she is experiencing high stress levels because her mornings are so hectic. She tells the nurse that before she arrives at work each morning, she needs to dress and feed her children, drop them off at daycare, and begin preparations for that evening's dinner. Based on this information, the nurse should anticipate that the client will require care related to which of the following issues? A) Self-esteem B) Role mastery C) Role conflict D) Role ambiguity

C) When role-related expectations clash or are incongruent, role conflict may occur. This client is expected to be at work, care for her children, and make dinner, all within a limited window of time—a situation that could contribute to role conflict. Role mastery occurs when an individual's behaviors within a role meet or exceed predetermined expectations. Role ambiguity occurs when an individual lacks clarity regarding the expectations, behaviors, or demands associated with fulfilling a given role. Self-esteem is the degree to which an individual approves of, values, or likes himself or herself.

The nurse is planning care for a client admitted with diabetic ketoacidosis (DKA). On what should the nurse focus for this client's care? Select all that apply. A) Administration of oral glucose B) Monitoring for fluid volume overload C) Frequent blood glucose monitoring D) Intravenous fluid infusions E) Insulin infusion

C, D, E) For the client experiencing diabetic ketoacidosis, frequent blood sugar monitoring, IV fluids, and insulin drips for treatment mandate that the client be cared for in an intensive care environment until stabilized. The client will be dehydrated and most likely will not need treatment for fluid volume overload. Oral glucose should not be administered to the client with diabetic ketoacidosis.

Under which circumstance would the use of a geographic information system (GIS) be beneficial for healthcare workers? A) When sharing a traveling client's electronic health record (EHR) with an out-of-state provider B) During a mass casualty incident C) When tracking the sleep pattern of a client D) During an influenza outbreak

D) A GIS is used to map where infectious diseases are most likely to spread next so that adequate care can be provided. Although sleep patterns can be tracked using GIS, GIS is more beneficial when comparing sleep patterns in different geographic regions rather than tracking sleep patterns of one individual client. GIS is not typically used when sharing a traveling client's EHR with an out-of-state provider or during a mass casualty incident

The parents of an adolescent client tell the nurse that their daughter is very shy, exhibits intense anxiety about new people and situations, and tends to internalize negative comments from her peers. They ask the nurse whether they should be concerned about this behavior. What is the nurse's best response? A) "All of these behaviors are strongly associated with avoidant personality disorder. I'd suggest you take your daughter to a psychologist as soon possible." B) "Your daughter may be exhibiting signs of dependent personality disorder, but this condition can't be formally diagnosed until she is an adult." C) "This behavior is normal for adolescents, and your daughter will eventually grow out of it." D) "A lot of these behaviors are developmentally appropriate to some degree, but if they persist or severely impair your daughter's ability to function, they may be suggestive of a personality disorder."

D) All of the behaviors described here are associated with avoidant personality disorder, which cannot be accurately diagnosed until a client has reached adulthood. Some individuals who are later diagnosed with Cluster C personality disorders (avoidant personality disorder and dependent personality disorder) will become increasingly shy during adolescence and early adulthood and avoid developing the social relationships characteristic of that developmental stage. However, these behaviors may actually be developmentally appropriate, so the nurse should not prematurely or inappropriately suggest that the client has a Cluster C disorder.

Which stage of chronic kidney disease is characterized by hypertension, anemia, malnutrition, altered bone metabolism, metabolic acidosis, and a severely decreased glomerular filtration rate? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

D) Clients in stage 1 of chronic kidney disease (CKD) are asymptomatic and have a normal or increased glomerular filtration rate (GFR). During stage 2, the GFR mildly decreases and hypertension may develop. In stage 3, there is a moderate GFR decrease, as well as hypertension, possible anemia and fatigue, anorexia, possible malnutrition, and bone pain. Stage 4 involves a severely decreased GFR as well as hypertension, anemia, malnutrition, altered bone metabolism, edema, metabolic acidosis, hypercalcemia, possible uremia, and azotemia.

Which goal would be most appropriate to include in the nursing care plan of a client with type 2 diabetes? A) The client will record daily fat intake. B) The client will use hand hygiene when toileting. C) The client will monitor fasting glucose levels. D) The client will inspect feet at least once daily.

D) Clients with type 2 diabetes are at high risk for foot problems related to diabetic peripheral neuropathy. Therefore, an appropriate goal for clients with type 2 diabetes includes inspecting feet at least once daily. Clients with type 2 diabetes should record carbohydrate intake, not fat intake. Although fasting glucose levels are important, postprandial blood glucose levels provide the most useful information for evaluating glycemic control in clients with type 2 diabetes. Teaching proper hand hygiene may be appropriate when teaching clients with diabetes about insulin injections, but teaching hand hygiene when toileting is not specific for clients with type 2 diabetes.

The nurse is providing community health teaching on stroke in children and adolescents. Which risk factors for this population should the nurse identify? A) Hypertension B) Dysrhythmias C) Arteriosclerosis D) Head trauma

D) Common causes of adult strokes such as hypertension, dysrhythmias, and arteriosclerosis are rare in children, whose risk factors for stroke include congenital heart defects, sickle-cell disease, immune disorders, arterial diseases, abnormal blood clotting, trauma to the head or neck, and maternal history of infertility.

The nurse is caring for an older adult client diagnosed with chronic kidney disease (CKD). The client reports no bowel movements in the past 2 days. Based on this data, which condition is the client at risk for developing? A) Metabolic acidosis B) Hypercalcemia C) Increased serum creatinine levels D) Hyperkalemia

D) Constipation exacerbates hyperkalemia, so it is important to monitor clients with CKD who already have elevated potassium levels. Hypercalcemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.

A client is admitted with behavior consistent with borderline personality disorder. Which of the following interventions should the nurse anticipate for this client? A) Exercise therapy B) Vitamin B12 injections C) Occupational therapy D) Dialectical behavior therapy

D) Dialectical behavior therapy (DBT) is a cognitive and behavioral therapy used in the treatment of borderline personality disorder. DBT has been shown to decrease suicidal behavior, hospitalization, and treatment dropout while improving interpersonal functioning and anger management. This is the intervention most likely to be used with this client. Exercise therapy and occupational therapy are not known to improve borderline personality disorder. Vitamin B12 injections might be indicated if the client demonstrates depressive episodes.

A client with a diagnosis of chronic kidney disease (CKD) is experiencing manifestations of anemia. Based on this data, which treatment should the nurse anticipate for this client? A) Begin fluid restriction. B) Administer intravenous glucose and insulin. C) Begin a low-sodium diet. D) Administer epoetin injections.

D) Epoetin injections are used in the treatment of anemia caused by CKD. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In CKD, production of this hormone will be reduced. Fluid restriction would be indicated for uremia caused by CKD. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by CKD. A low-sodium diet is used to help reduce fluid volume excess that is caused by CKD.

The nurse is completing an assessment interview with an older adult client being seen for a yearly physical examination. Which client statement would indicate a possible diagnosis of diabetes mellitus? A) "I'm slightly winded when I walk up a flight of stairs, but it passes quickly." B) "I feel a bit tired by mid-afternoon and take a 30-minute nap most days." C) "I sometimes have muscle aches in my upper legs at night." D) "I've been experiencing increased thirst during the past several months."

D) Excessive thirst can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus. Fatigue that responds to a short nap, having some muscle aches at night, and being slightly short of breath after walking up a flight of stairs with a quick recovery may be within the normal functioning of a healthy older client.

The nurse is providing care to a client who has been diagnosed with a personality disorder. Which finding indicates that the treatment plan has been beneficial for this client? A) The client has ceased self-mutilating behavior and bathes once a week. B) The client eats sporadically and reports being told she does not deserve to eat. C) The client asks others for money because the client's money was stolen. D) The client sits with others in the lounge area conversing about current affairs.

D) For clients with personality disorders, improvement will be achieved slowly. The client who is observed sitting with others in the lounge area conversing about current affairs is showing indications that treatment has been beneficial. The other observed behaviors would all indicate that treatment needs to be continued.

The nurse instructs a client diagnosed with chronic kidney disease (CKD) regarding the prescribed medication furosemide (Lasix). Which client statement indicates that the teaching has been effective? A) "I will take this medication to keep my calcium balance normal." B) "This medication will make sure I have enough red blood cells in my body." C) "I will take this pill to keep my protein level in my body stable." D) "This pill will reduce the swelling in my body and get rid of the extra potassium."

D) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with CKD that is used to stabilize protein levels in the body.

How does the clinical decision support system support human resource functions? A) Determining if staff are correctly coding client care procedures B) Identifying staff who are incorrectly charging for resources used for client care C) Recognizing staff who are not discharging clients according to identified lengths of stay D) Evaluating the number of staff with licensure due to expire

D) Human resource departments can benefit from computerization by tracking personnel within the healthcare system. Professional licenses and credentials expire and must be renewed. It would be a daunting task to keep track of this information manually for a large facility that employs thousands of healthcare professionals. A computerized system can monitor license expiration and when recredentialing of a provider is required. Coding and charging for resources would be used by the billing department. Information about client discharges according to identified lengths of stay would be used in a utilization review.

Which potential cause of type 2 diabetes influences insulin's ability to regulate glucose metabolism and uptake by the liver, skeletal muscles, and adipose tissue? A) Viral infection B) Exposure to toxins C) Young age D) Obesity

D) In obesity, insulin has a decreased ability to influence glucose metabolism and uptake by the liver, skeletal muscles, and adipose tissue. Viral infections and chemical toxins are known triggers for type 1 diabetes, not type 2 diabetes. Older age, not young age, can increase cellular resistance to the effects of insulin and increase the risk of developing type 2 diabetes.

The nurse is caring for a client from another country who was admitted to the hospital with a diagnosis of hypertension and chronic kidney disease. The client is receiving hemodialysis three times a week. When the nurse inquires about diet, the client reports the use of salt substitutes. Why should the nurse teach the client to avoid these products? A) They will increase the risk of AV fistula infection. B) They will cause the client to retain fluid. C) They will interact with the client's antihypertensive medications. D) They can contribute to hyperkalemia.

D) Many salt substitutes contain high levels of potassium chloride. Potassium intake must be carefully regulated in clients with chronic kidney disease, and use of salt substitutes can worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitutes should be avoided. Control of hypertension is essential in the management of a client with kidney disease, but salt substitutes are not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection, but this is unrelated to use of salt substitutes.

The nurse is providing discharge instructions about medications and exercise to a client who was hospitalized with a serious medical condition. Which action by the nurse ensures that the client is fully informed? A) Make sure a relative attends the discharge teaching session. B) Repeat the discharge teaching sessions twice. C) Ask the physician to reinforce teaching prior to discharging the client. D) Print the discharge instructions and hand them to the client prior to discharge.

D) Most hospitals and agencies have computer-generated discharge instructions that the nurse can print to give the client to refer to when at home. This not only prevents calls, but gives the client confidence. Repeating the instructions does not help the client at home. Relatives can forget as easily as the client. It is not the physician's place to reinforce teaching.

What type of stroke occurs when the blood supply to a part of the brain is cut off by a thrombus, embolus, or stenosis? A) Intracerebral stroke B) Subarachnoid stroke C) Hemorrhagic stroke D) Ischemic stroke

D) Strokes may be ischemic, occurring when the blood supply to a part of the brain is suddenly interrupted by a thrombus (blood clot), embolus (foreign matter traveling through the circulation), or stenosis (narrowing); or they may be hemorrhagic, occurring when a blood vessel breaks open and spills blood into spaces surrounding neurons. Intracerebral and subarachnoid are two types of hemorrhagic stroke.

A nurse is evaluating whether the drug sodium polystyrene sulfonate (Kayexalate) is exerting the desired therapeutic effect for a client diagnosed with chronic kidney disease (CKD). Which therapeutic effect should the nurse anticipate from this medication? A) Increased serum sodium B) Increased stool excretion C) Decreased urine specific gravity D) Decreased serum potassium

D) The client with CKD is unable to excrete potassium. Therefore, the drug sodium polystyrene sulfonate (Kayexalate) is used in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the serum sodium level or the urine specific gravity.

The nurse is preparing discharge instructions for a client with a foot wound. How will the clinical information system support this client's learning needs? A) Improves documentation about the client's status B) Summarizes the list of charges that will appear on the client's bill C) Provides a record of all medications received while hospitalized D) Prints discharge instructions to use for teaching

D) The clinical information system provides access to client information and provides data to help the nurse execute the nursing process. This includes printing discharge instructions to use in client teaching. Although different information systems can do all of these things, only printing discharge instructions will support the client's learning needs.

A client newly diagnosed with type 1 diabetes mellitus tells the nurse that the diagnosis must be wrong because the client is not overweight, eats all of the time, and is thin. Which response by the nurse is most appropriate? A) "Thin people can be diabetic, too." B) "Your condition makes it impossible for you to gain weight." C) "Your lab tests indicate the presence of diabetes." D) "You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in."

D) The diabetic client is unable to obtain the needed glucose for the body's cells due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin. While the statement about diabetics being thin is correct, it does not answer the client. It is not impossible for diabetics to gain weight. Although the laboratory tests might indicate the presence of diabetes, this does not meet the client's needs for teaching.

An older adult client recognizes the need for help with personal care at home yet does not want to move to a nursing home or assisted living facility. Which action by the nurse would best assist this client? A) Reminding the client that his physical strength will grow weaker at home until a nursing home is required B) Suggesting that the client move in with his adult children C) Recommending to the physician that the client be admitted to a nursing home immediately D) Referring the client to a personal care assistant who can help with activities of daily living

D) The nurse needs to help strengthen this client's self-esteem. To best do this, the nurse should recommend a personal care assistant to help the client with activities of daily living. Suggesting that the client move in with children or be admitted to a nursing home does not strengthen the client's feelings of self-worth or promote a healthy self-concept. Telling the client that progressive weakness will eventually make nursing home care inevitable will harm this client's already damaged self-esteem.

The nurse is instructing the spouse of a client with a stroke on how to do passive range-of-motion exercises to the affected limbs. Which rationale for this intervention will the nurse include in the teaching session? A) Improve muscle strength B) Maintain cardiopulmonary function C) Improve endurance D) Maintain joint flexibility

D) The nurse should instruct the spouse that the exercises will help with joint flexibility. Passive range-of-motion exercises help maintain joint flexibility. Active range-of-motion exercises improve muscle strength, can help maintain cardiopulmonary functioning. And improve endurance.

The nurse is preparing to teach a client who is newly diagnosed with type 1 diabetes mellitus on the preferred area to self-inject insulin. On which area should the nurse focus, based on insulin absorption rates? A) Deltoid B) Thigh C) Hip D) Abdomen

D) The rate of absorption and peak of action of insulin differ according to the site. The site that allows the most rapid absorption is the abdomen, followed by the deltoid muscle, then the thigh, and then the hip. Because of the rapid absorption, the abdomen is the recommended site.

A client diagnosed with a stroke is going to receive treatment with fibrinolytic therapy using the recombinant tissue plasminogen activator alteplase (rt-PA). Which information should the nurse include when performing medication teaching for the client's family? A) Used to treat thrombotic and hemorrhagic strokes B) Not associated with serious complications C) Indicated if the stroke symptoms have occurred within the last 6 hours D) Administered to break up existing clots and increase cerebral blood flow

D) Thrombolytic therapy using rt-PA is used to dissolve the clot formed with a thrombotic stroke. Dissolving the clot reestablishes cerebral circulation. The treatment is only used with ischemic strokes. Bleeding is a complication associated with the treatment, which may result in cerebral hemorrhage, causing extensive brain damage and disability. The treatment can be used if the symptoms have occurred within the last 3 hours.