Vsim questions advanced fund final
A nurse is preparing to admit a patient with cystic fibrosis and altered nutrition status. The nurse plans to implement which precautions to be used in the patient's care? a. Standard precautions b. Contact precautions c. Droplet precautions d. Airborne precautions
a
A patient is concerned about a medication the nurse is administering. The patient states that the medication is not normally something that is administered. What is the best response by the nurse? a. I will hold the medication and find out for you b. It is probably a genera medication for something you normally get c. The provider has ordered it for you d. We should probably update your medication reconciliation forms
a
The nurse is providing education to Ms. Morrow and her daughter on nutrition. What is the best dietary choice to promote wound healing? a. Baked chicken b. Baked potato c. Whole grain bread d. Green leafy vegetables
a
What assessment data will the nurse expect to find to support the assumption that Mr. Hayes's surgical incision is in the inflammatory phase of wound healing? (SATA) a. Incisional site pain b. Signs of scabbing are noted at the incision site c. Redness surrounding the incision d. Increased white blood cell count e. Incision is slightly edematous
a c d e
A patient with newly diagnosed pneumonia has an oxygen saturation of 94% on room air, an increased respiratory rate, and an increased pulse. The patient is pale and anxious. The nurse questions the oxygen saturation results and looks up which of the following test results? a. WBC count b. Hemoglobin c. Gram stain d. Chest X-ray
b
The nurse is irrigating a patient's wound when the patient complains of pain. What is the appropriate action by the nurse? a. Discontinue the irrigation and notify the provider b. Stop the procedure and administer the ordered analgesic c. Administer the ordered analgesic when the procedure is finished d. Complete a pan assessment and finish the procedure
b
In preparation for calculating the infusion rate for a newly ordered IV solution, the nurse must first secure what information? a. Patient's history of allergies b. When the IV is to be started c. The status of the patient's IV site d. The infusion set's drop factor
d
The need for a sigmoid colostomy is generally a result of cancer at what point in the intestinal tract? a. Anywhere in the descending colon b. Near the ileocecal valve c. Anywhere in the transverse colon d. Near the rectum
d
Which physical finding poses the greatest safety risk for a patient diagnosed with hyponatremia? a. Cold, clammy skin b. Anxiety c. Dry mucous membranes d. Orthostatic hypotension
d
Which statement concerning fluid balance demonstrates a need for additional instruction concerning fluid intake and output? a. Fluid output is comprised of feces, sweat, and exhaled air b. A desirable amount of fluid intake and output in adults ranges from 1,500 to 3,500mL daily c. It is recommended that a healthy adult consume 1 ½ quarts of water daily d. The balance between fluid intake and output must be achieved each day to maintain homeostasis
d
The nurse is conducting a skin assessment using the Braden Scale. How would the nurse interpret a score of 12? a. High risk b. Not a risk c. Moderate risk d. Low risk
a
What determines the acidity of a substance like body fluids? a. The amount of available HCO3 b. The number of existing H+ ions c. The body's ability to trigger chemical reactions d. The fluid's pH measurements
b
Expected assessment findings of a patient with pneumonia may include which of the following? (SATA) a. Use of accessory muscles b. Fever c. Malaise d. Tachypnea e. Enuresis
a b c d
The nurse is preparing to irrigate a patient's wound. Upon assessment, the wound appears be healing and the wound bed is beefy red. Which solution should the nurse select for this procedure? a. Dakin's solution b. Tap water c. Normal saline d. Isopropyl alcohol
c
In addition to regular monitoring of serum potassium level, which intervention will the nurse implement to address the safety needs of a patient intravenous potassium chloride? a. Monitoring for hyperactivity b. Delivering the mediation by slow IV push c. Shading windows to minimize sun exposure d. Securing ECG regularly
d
The nurse is caring for a patient admitted with bilateral lower extremity edema. What questions should the nurse ask when completing a health history?
When did the edema start? Can you describe the edema? What were you doing just before you noticed the edema? Do you have any recent history of surgery or illness? What are your usual daily activities? Do you stand a lot? What medications do you take? Do you have heart disease or blood vessel disease?
A nurse is teaching a patient with cystic fibrosis about nutrition in the high-fat, high-protein, high-carbohydrate diet that has been recommended. Which of the following should be included in this education? a. It is important to select a variety of nutrient-dense foods b. It is important to only eat high-fat, high-protein, high-carbohydrate foods c. It is not necessary to monitor dietary intake d. It is important to focus on eating calorie-dense foods
a
A nurse rounding on a patient with pneumonia notices the patient is more confused than at the beginning of the shift. What is the best response by the nurse? a. Check oxygen saturation level b. Ensure a sitter is available to watch the patient c. Document findings in the medical record d. Notify the provider
a
As the nurse administers Mona Hernandez's prescribed medication, guaifenesin, the patient states: "I don't like this medication. it makes me cough too much." How should the nurse respond? a. When you cough out secretions, oxygenation is more effective b. I will let your provider know you have questions about your medications c. This medication is given to you because of your pneumonia d. This mediation will help make your breathing easier
a
Mona Hernandez's laboratory work indicates an elevated WBC count with a left shift in the differential. The nurse interprets this to mean which of the following? a. There is a high number of WBCs and immature WBCs present to fight the infection b. There is a high number of WBCs to fight the infection, and the RBCs are compensating. c. A left shift in the differential means that there is no infection present d. There is a high number of WBCs, but not immature WBCs, present in the circulation
a
Which intervention takes priority when the nurse determines that a postoperative patient has hypoactive bowel sounds? a. Assess the abdomen for signs of distention b. Advance the patient's diet to soft, solid food c. Assess the patient for indications of hypotension d. Notify the surgeon of this assessment finding
a
Which statement by the nurse indicates a thorough understanding of the purpose of postoperative nursing care? a. The goal is to ensure uneventful recovery from surgery b. The goal is frequent assessment of the surgical incision site c. The goal is to prevent infection d. The goal is well-managed postoperative pain
a
While completing discharge instructions with a patient, the nurse notices the patient is SOB. What is the priority nursing action at this time? a. Listen to the patient's lungs b. Ask if the patient has support at home c. Reassure the patient d. Determine if the patient has any questions
a
Calculate the IV infusion rate using the following provider's order: 1000mL of NS over 8 hours. Infusion set has a drop rate of 10 drops/mL. a. 21 drops/minute b. 10 drops/minute c. 41 drops/minute d. 30 drops/minute
a Formula: 1000mL/480 min X 10 drops/mL= 20.83333
The nurse is completing an admission assessment on a patient admitted for an infection, non-healing wound. Which factors in the patient's history may contribute to this condition? (SATA). a. Poor circulation b. Diabetes mellitus c. Obesity d. Poor hygiene e. Hypertension
a b c d
The nurse is performing an assessment of Ms. Morrow's wound. What should be included in the documentation? (SATA). a. Drainage b. Tunneling c. Odor d. Location e. Turgor
a b c d
A patient with a low BMI is found to have low albumin and prealbumin levels. Which of the following nursing actions should be considered? (SATA). a. Request a nutrition consult b. Assess GI function c. Monitor input and output for the patient d. Assess for signs and symptoms of infection e. Encourage oral intake of foods and fluids as ordered
a b c e
What information should the nurse include in the documentation associated with the changing of a patient's colostomy pouch? (SATA) a. Characteristics of the fecal matter b. Description of the stoma c. Patient's response to the process d. How often the process will be done e. Condition of the skin around the stoma
a b c e
Which interventions will the nurse implement to help minimize a postoperative patient's risk for surgical site complications? (SATA) a. Advancing diet as appropriate to provide adequate nutrition b. Monitoring for elevation in body temperature c. Following strict aseptic techniques when changing surgical dressing d. Encouraging deep, sustained breathing and supported coughing e. Providing sufficient fluids to maintain hydration
a b c e
Mona Hernandez's blood gas results indicate respiratory acidosis. Her oxygen saturation is 95% per the pulse oximeter. Which interventions should the nurse provide? (SATA) a. Ensure the patient is well hydrated b. Assist the patient with adequate ventilation c. None; the patient has a 95% oxygenation d. Provide supplemental oxygen as ordered e. Promote voluntary coughing activities to clear secretions
a b d e
Which statements best support the nurse's evaluation that a patient who recently experienced a sigmoid colostomy has begun to accept the body change? (SATA) a. My ostomy nurse always has helpful suggestions about daily care routine b. My stoma continues to be red and moist c. I really hope no one else I know has to ever deal with a colostomy d. I'm anxious to get a bathing suit that accommodates my colostomy e. Having a colostomy is a small price to pay for being healthy
a b d e
The nurse titrates the patient's oxygen to 3L per nasal cannula in order to maintain an oxygen saturation of at least 94%, per the provider's orders. What is the rationale for this order? (SATA) a. Promotes a decrease in myocardial workload b. Prevents atelectasis in a patient with pneumonia c. Promotes a decrease in respiratory effort d. Allows the body to meet metabolic demands e. Allows the patient to receive 100% oxygen
a c d
What information will the nurse include when providing education for a patient who is scheduled for a sigmoid colostomy? (SATA) a. When an ostomy is needed, intestinal mucosa is brought through the abdominal wall b. The fecal matter that will pass through the stoma will be liquid in form c. The term ostomy refers to an opening from the inside of an organ to the outside of the body d. A stoma is the portion of intestinal mucosa that is secured to the skin of the abdomen
a c d
A nurse is creating a care plan for a young adult patient with chronic illness. Which of the following nursing diagnoses might be included in the care plan? (SATA) a. Activity intolerance b. Caregiver role strain c. Risk-prone health behavior d. Ineffective health maintenance e. Social isolation
a c d e
The nurse is caring for a patient with lower extremity edema resulting from chronic venous insufficiency. What should the nurse include in the plan of care for this patient? (SATA). a. Monitor patient for signs for skin breakdown b. Maintain strict bed rest c. Assist with range of motion exercises to lower extremities d. Perform neurovascular checks to look for changes e. Provide meticulous skin care
a c d e
The nurse is completing an admission assessment on a patient admitted for impaired skin integrity. Which questions would be appropriate for the nurse to ask the patient? (SATA_ a. do you have any sores on your body? b. What kind of activities cause you to be fatigued? c. Have you used pads or special pants because you can't control your urine? d. Do some areas of your skin seem warmer or colder than others? e. Have you noticed any swelling on your feet, ankles, or fingers?
a c d e
What information should be included when documenting a change in the infusion rate for an IV solution? (SATA). a. Patient's response to IV therapy b. Original flow rate c. Change made to flow rate d. Date and time change was made e. Nurse's initials
a c d e
Which statements indicate that a patient who recently required a colostomy has achieved the outcomes set for regular bowel elimination? (SATA) a. I've learned to implement the techniques I learned in stress management b. Getting a short nap each afternoon makes me feel so much better c. I've gotten accustomed to drinking at least two quarts of water a day d. My routine includes about 30 minutes of exercise daily e. I know that what I eat has a large impact on my bowel function
a c d e
The nurse is preparing discharge education for a patient with a permanent colostomy. What information concerning diet and nutrition will the nurse include? (SATA) a. Avoid foods that previously caused diarrhea b. Be aware that colostomies are prone to develop food blockages c. Avoid high fiber foods for eight weeks after surgery d. Drink at least two quarts of water daily e. Gradually add new foods into the diet
a e
A nurse is assessing an adolescent patient. Which of the following questions best represents therapeutic communication techniques? a. You don't smoke, do you? b. What do you hope happens here today? c. Do you know what to do to stay healthy? d. Are you feeling well?
b
A patient demonstrates correct use of the incentive spirometer when the patient places the mouthpiece in the mouth and does which of the following? a. Inhales quickly and forcefully b. Inhales slowly and deeply c. Exhales slowly and deeply d. Exhales quickly and forcefully
b
A patient has just completed a tube feeding that has run throughout the night. What is the best education the nurse can provide to the patient at this time? a. You should lie down to get some sleep b. You should remain upright for the next hour c. You should wear your pneumatic compression device when you are in bed d. It is important that you ambulate three times today
b
A patient states he does not want to use the incentive spirometer because it makes the patient cough up too much sputum, and it is difficult to breathe. What is the correct information to teach the patient about the incentive spirometer? a. You should wait to use your incentive spirometer until you are not coughing up so much sputum b. The incentive spirometer helps you to maximize lung function and minimize the risk of atelectasis c. You have to use your incentive spirometer because your provider has ordered it for you d. The incentive spirometer will cause you to cough less because you are moving more air through your lungs
b
A patient with cystic fibrosis has five capsules of pancrelipase (amylase, lipase, and protease) ordered to be administered now with his breakfast. The patient is currently experiencing nausea and intermittent vomiting. What should the nurse do with the medication? a. Call the provider immediately b. Hold the medication until the patient is able to eat again c. Administer the medication as ordered d. Crush the medication to administer to the patient
b
During her hospitalization for pneumonia, the provider order's arterial blood gases for Mona Hernandez. What is the best explanation for why this is ordered? a. Patient has a productive cough with rust colored sputum b. Patient has shallow, ineffective breathing c. Patient has fever and malaise d. Patient has a history of smoking ½ pack of cigarettes per day
b
Mona Hernandez complains of SOB with activity and does not want to exacerbate her condition by moving to the chair or ambulating three times a day as ordered. How should the nurse respond? a. You should wait until your breathing improves to try to get out of bed again, because it makes you SOB b. Even short activities such as moving to the chair will help you cough mucus out of your lungs c. Pneumonia causes thick secretions in your lungs, making it difficult to breathe d. You really need to walk as much as possible in order to prevent your pneumonia from getting worse
b
The nurse assesses a wound and documents it as stage III. What did the nurse observe when the wound was assessed? a. Partial-thickness loss of dermis presenting as a shallow open ulcer with a red/pink wound bed b. Full-thickness tissue loss, possibly with visible subcutaneous fat c. Full-thickness tissue loss with exposed bone, tendon, or muscle d. Intact skin with nonblanchable redness of a localized area
b
The nurse has received an order to apply a hydrocolloid dressing to Ms. Morrow's right lower extremity. Which statement, if made by the nurse, would indicate the need for further education? a. It will help protect the wound from contamination b. This dressing will need to be held in place by surgical tape c. Hydrocolloid dressings help to maintain a moist wound environment d. I can leave this dressing in place for three to seven days
b
The nurse is caring for an adolescent patient who appears withdrawn and isolated. What strategy should the nurse use to work with this patient? a. Tell the patient what the patient needs to do in order to get better b. Develop a therapeutic, trusting relationship with the patient c. Leave the patient alone as much as possible d. Talk to the patient's parents about what is going on with the patient.
b
The nurse is performing a sterile dressing change. After donning sterile gloves, the nurse drops the dressing on the bed and does not have a replacement. What is the appropriate action at this time? a. Pick up the dressing and use the side that did not touch the bed b. Ask the patient to press the call bell to summon a co-worker to obtain another dressing c. Remove gloves and go to the supply room to obtain more supplies d. Reapply the original dressing until a new one can be obtained
b
The nurse is providing education to Ms. Morrow and her daughter on management of venous stasis in the lower extremities. What would be appropriate for the nurse to include in the teaching session? a. Avoid ambulating as this may aggravate your condition b. Put on antiembolism stockings as soon as you get up in the morning and wear them all day c. Sit with your legs in the dependent position so that blood will drain to lower extremities d. Keep skin surrounding the wound dry and inspect it at least once a week
b
Upon entering the room, the nurse observes Mona Hernandez slumped over in a semi-Fowler's position, struggling to catch her breath. What is the priority nursing action at this time? a. Obtain vital signs b. Assist the patient into a high Fowler's position c. Titrate her oxygen so that her oxygen is greater than or equal to 95% d. Obtain an oxygen saturation level
b
What is the initial step in assessing a patient for orthostatic hypotension a. After having the patient sit upright with legs dangling for 1-3 minutes, take and record bp and pulse b. After having the patient lie in a supine position for 3-10 minutes, take and record the bp and pulse c. Assist patient into a standing position lasting 2-3 minutes, then take and record bp and pulse d. Encourage the patient to drink 8 eight ounces of fluid, then take and record bp and pulse
b
Which statement by Mr. Ahmed best reflects his ability to assume some responsibility in tracking his urinary output? a. I listened as you discussed the instructions about the calibrated urinal b. I will always use the calibrated urinal to measure my urine c. I understand that it's important to measure my urine with the calibrated urinal d. I will notify staff when I need to use the calibrated urinal
b
Which statement concerning the measurement of intake and output is true? a. Liquid medications are not considered when calculating intake b. When possible, intake and output should be measured rather than estimated c. Only foods that are consumed as liquids are included in intake calculations d. Health care agencies have adopted standard volumes for common beverage containers
b
Which statement made by the patient indicates an understanding of diet progression after surgery? a. I know it is important to get my strength back, so I will ask for a milkshake after surgery b. I'll start drinking water as soon this nausea subsides c. I love coffee, so ill have some as soon as I get back from surgery d. I can't tolerate a soft diet, so I'll simply go back to drinking clear liquids
b
Identify the following potential problems or actual problems that the nurse should include when planning care for the patient diagnosed with pneumonia? (SATA) a. Metabolic acidosis b. Not able to tolerate activity c. Ineffective respiratory gas exchange d. Acute pain e. Difficulty breathing
b c d e
The nurse is preparing to discharge Mona Hernandez from the hospital. Which of the following instructions should the nurse include in the discharge education? (SATA). a. Stop taking your antibiotics once you are feeling better b. Take your antibiotics as directed, even if you are feeling better c. Continue to focus on ambulating several times per day d. Quitting smoking will improve your recovery e. Use the incentive spirometer every one to two hours to move secretions out of your lungs
b c d e
Which statements will guide the nurse when preparing to educate a patient whose condition requires a permanent colostomy? (SATA) a. Help the patient get accustomed to looking at the ostomy b. Assess the patient for signs of depression c. Schedule the teaching two to three days after the surgery d. Encourage the patient to take part in the care process e. If the patient is accepting, include family members in the teaching
b d e
A nurse is assessing a patient with cystic fibrosis. Based on a diagnosis of cystic fibrosis, the nurse expects to find which of the following common physical symptoms upon assessment? a. Nausea, vomiting, headache b. SOB, headache, and vision changes c. Cyanosis or pallor, dyspnea, and arrhythmias d. Increased activity, diaphoresis, and tachycardia
c
A nurse is caring for an 18-year-old patient who has recently started living on his own and has experienced a greater than 5% weight loss over two weeks. He has a low body mass index and complains of feeling fatigued. According to Maslow's hierarchy of needs, the nurse identifies which of the following as the patient's priority need at this time? a. Love and belonging needs b. Self-esteem needs c. Physiologic needs d. Safety and security needs
c
A nurse is planning patient education about a prescribed medication for a patient. What should the nurse do first? a. Educate the patient about potential drug interactions b. Educate the patient about potential allergic reactions to the medication c. Find out what the patient already knows about the medication d. Review the signs and symptoms of drug toxicity with the patient
c
A postoperative patient is receiving enoxaparin sodium therapy. Which assessment data would the nurse report immediately to the patient's health care provider? a. Patient reports no bowel movements for two days b. A platelet reading of 360,000 per mcL c. Patient has reported self-medicating with aspirin three times since surgery d. Small amount of gum bleeding after completing oral hygiene
c
Christopher Parrish has a low body mass index and has lost 12 pounds over the past two weeks. Which method could the nurse use to assess his overall dietary intake in order to provide nutrition education? a. Ask the patient to keep a food diary log b. Track the percentage of food eaten at each meal while in the hospital c. Obtain a food frequency assessment d. Ask the patient if he has a healthy diet
c
Considering Mr. Ahmed's diagnosis of dehydration and the possibility of neurological impairment, which nursing intervention is directed toward minimizing his risk for possible injury? a. Administrating ondansetron with a full glass of water b. Educating the patient on the use of a calibrated urinal c. Implementing falls precaution d. Assessing for orthostatic hypertension daily
c
Mona Hernandez asks the nurse why it is necessary to use the incentive spirometer when she is already having difficulty breathing. What is the best response by the nurse? a. It decreases cardiac workload during inspiration b. It increases the oxygen taken in by the lungs when you inhale c. It helps prevent atelectasis or collapsing of the alveoli in the lungs d. It was ordered by your provider
c
Ms. Morrow's daughter asks the nurse why it is necessary to irrigate to irrigate her mother's wound. What is the appropriate response by the nurse? a. Irrigation helps to sterilize the wound b. The irrigation fluid contains medication for the wound c. The procedure helps remove drainage and debris from the wound d. The application of fluid helps hydrate the surrounding tissue
c
The nurse plans on assessing the patient's GI system. Which statement below reflects the best prioritization of this assessment? a. The nurse should percuss and then auscultate the abdomen b. The nurse should percuss and then inspect the abdomen c. The nurse should auscultate and then palpate the abdomen d. The nurse should palpate and then auscultate the abdomen
c
What pathology is responsible for metabolic acidosis? a. A decrease of carbonic acid b. An increase of CO2 c. A decrease in bicarbonate or an increase in hydrogen icons d. An excess of HCO3 and/or decrease in H+ ions
c
Which diagnostic test is used as a screening tool for the possible diagnosis of colon cancer? a. Timed stool specimen b. Stool pinworms c. Occult blood d. Stool culture
c
Which of Mr. Ahmed's lab results best supports his diagnosis of dehydration? a. Creatinine: 1.1 ng/dL b. White blood cells: 2.1x10^9 c. Sodium: 130 mEq/L d. Hemoglobin: 16.7 g/dL
c
Which statement by the nurse indicates a need for further education on the role of water as a body fluid? a. Waste products are removed from the cells by water b. Tissue lubrication is facilitated by water c. Water is transported to cells when it is attached to electrolytes d. Water helps maintain normal body temperature
c
A nurse has just finished placing a nasogastric tube into a patient for the purposes of administering feedings. What should the nurse do first? a. Administer the tube feeding as ordered b. Assess how much of the tube was inserted into the patient to verify placement c. Irrigate the nasogastric tube with 30-60mL water d. Confirm the placement of the nasogastric tube per facility policy
d
A nurse is planning on administering a tube feeding to a patient with a nasogastric tube. The patient appears asleep flat in bed. What should the nurse do first? a. Carefully connect the nasogastric tube to the tube feeding b. Administer the feeding quietly without waking the patient c. Flush the nasogastric tube with 30 to 60 mL water d. Assist the patient to a semi-Fowler's position or higher
d
A patient complains of nausea after a tube feeding. What is the priority action of the nurse at this time? a. Position the patient on the left side b. Aspirate the tube feeding contents from the patient's stomach c. Flush the tube with 30-60mL water d. Ensure the head of the bed remains elevated
d
A provider orders a high-fat, high-protein, high-carbohydrate diet for a patient with cystic fibrosis. What is the best rationale for this diet order? a. Cystic fibrosis is a chronic disease characterized by altered electrolytes b. Thickened mucus secretions predispose the patient to anemia c. The diet was ordered according to the patient's preferred food intake d. Cystic fibrosis interferes with the digestion of food and absorption of nutrients
d
The nurse is assessing a patient admitted with a venous stasis ulcer on the right lower extremity. What would the nurse expect to find when assessing the leg? a. Scaly rash between the toes with itchiness b. Pale, white toes with decreased sensations c. Shiny skin with hair loss over legs, feet, and toes d. Dark discoloration of the skin surrounding the wound site
d
The nurse is preparing to irrigate a wound. Which statement, if made by the nurse, indicates am understanding of the procedure? a. In order to debride the wound, I will use a moderate amount of force to instill the solution b. I will make sure the tip of the syringe touches the wound bed while performing the irrigation c. I will use a sterile specimen cup to slowly pour irrigation solution over the entire wound bed d. I will gently direct a stream of fluid into the wound, keeping the syringe tip at least one inch from the upper tip of the wound.
d
The nurse is reviewing the patient's laboratory results. Which lab test most accurately represents current nutritional status? a. Albumin b. Iron c. Calcium d. Prealbumin
d
What information will the nurse provide to a patient to best assure the risk of side effects associated with sulfamethoxazole-trimethoprim therapy? a. Arrange for a yearly flu vaccination b. Notify health care provider immediately if experiencing palpitations c. Increase dietary consumption of dairy products d. Increase fluid intake in order to remain well hydrated
d
What instruction should the nurse provide to a patient concerning how often the colostomy pouch should be emptied? (SATA) a. At least four to five times daily b. When the pouch isn't well attached to the skin c. After each meal d. Whenever the pouch is one-third full of fecal drainage
d
A patient is placed on omeprazole 20mg daily. When will the nurse administer the mediation? a. At bedtime b. One hour before breakfast c. One hour after any meal d. With breakfast
b
A patient in semi-Fowler's position is having difficulty breathing. What is the priority action of the nurse? a. Raise the HOB. b. Auscultate the lungs c. Call respiratory therapy d. Conduct a pain assessment
a
1. Which patients have an increased risk for developing colorectal cancer? (SATA) a. A 50-year-old whose diet includes red meat daily b. A 70-year-oldwho has been diagnosed as obese c. A 40-year-old with a history of lupus d. A 63-year-old who is healthy e. A 30-year-old with a 13-year history of Crohn's disease
a b d e
Which nursing interventions are implemented primarily to prevent respiratory complications in a patient after abdominal surgery? (SATA) a. Encouraging deep breathing b. Education on incentive spirometer use c. Prompting to cough d. Providing pain medication as required e. Assisting in early ambulation
a e
The nurse removes a dressing and assesses a yellow, foul smelling drainage. How would the nurse document this finding? a. Serous b. Serosanguinous c. Sanguineous d. Purulent
d
What information will the nurse include when providing education for a patient scheduled for a colostomy as treatment for rectal cancer? a. The surgeon will determine whether the ostomy can be temporary once surgery has begun b. Permanency will depend on how much colon function has been affected by the surgery c. Once the inflammation in the colon subsides, the ostomy will be reversed d. The ostomy will be permanent because of the nature of the illness
d
When should the nurse caring for a patient with a new colostomy plan to change the pouching system? a. After any meal b. Right before bed c. Before the patient showers d. Before breakfast
d