FN 161 Test 3

A client made a formal request to review their medical records. With review, the client believes there are errors within the medical record. What is the most appropriate nursing response? a) "According to HIPAA legislation, you have a right to request changes to inaccurate information." b) "HIPAA legislation allows for you to change any information." c) "According to HIPAA, medical records cannot be changed." d) "HIPAA legislation only allows access to review the medical record."

"According to HIPAA legislation, you have a right to request changes to inaccurate information."

A nursing student is making notes that include client data on a clipboard. Which statement by the nursing instructor is most appropriate? a) "Any papers with client data should not leave the unit." b) "Be sure to write down specific information for your clinical paperwork." c) "You can get an electronic print out of client lab data to take with you." d) "Be sure to put the client's name and room number on all paperwork."

"Any papers with client data should not leave the unit."

A nurse is caring for an older adult client who has just died in a hospice unit. The child of the client arrives and asks, "Can I please stay and sit at the bedside? I really wanted to be here so they did not die alone." Which statement made by the nurse best demonstrates the use of empathy? a) I lost my dad last year, so I know how you feel." b) "You are too late for that, but you can stay for a while if you would like." c) "I tried to contact you earlier, but you did not answer your phone." d) "I will close the door so you can spend some quiet time at the bedside."

"I will close the door so you can spend some quiet time at the bedside."

Nurses at a health care facility maintain client records using a method of documentation known as charting by exception (CBE). What is a benefit of this method of documentation? a) It provides and refers to a client's problem by a number. b) It documents assessments on separate forms. c) It list expected normal parameters and provided quick access to abnormal findings. d) It records progress under problems, intervention, and evaluation.

It list expected normal parameters and provided quick access to abnormal findings.

When recording data regarding the client's health record, the nurse mentions the analysis of the subjective and objective data, assessment findings, in addition to detailing the plan for care of the client. Which of the following styles of documentation is the nurse implementing? a) PIE charting b) charting by exception c) Narrative charting d) SOAP charting

SOAP charting

The nurse observes that a client responds better to health education when the nurse motivates him and assures him about the benefits of the teaching. In which of the following learning domains does the client's learning style fall? a) Psychomotor domain b) Affective domain c) Cognitive domain d) Interpersonal domain

affective domain

The nurse is caring for a client with hypertension and only documents a blood pressure of 170/100 Hg when all other vital signs are normal. This reflects what type of documentation? a) narrative b) Focus Charting c) SOAP d) Charting by Exception

charting by exception

When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which of the following learning domains does the client's learning style fall? a) Affective domain b)Cognitive domain c) Interpersonal domain d) Psychomotor domain

cognitive domain

The nurse is preparing discharge teaching for a client with diabetes. Which information will the nurse include? (Select all that apply.) *ways to pay for hospitalization and outpatient care charges *community resources for diabetic individuals *appropriate use of glucometer *instructions to follow-up with the healthcare provider *meal planning

community resources for diabetic individuals appropriate use of glucometer instructions to follow-up with the healthcare provider meal planning

A nurse is manually documenting information related to a client's condition. When documenting this information, the nurse makes an error on the manual record sheet. What is the best technique for recording the error made in documentation? a) Erase the incorrect statement and write the correct one. b) Cross out the wrong statement in a way that is not readable. c) Use correction fluid to obliterate what has been written. d) Cross out the incorrect statement with a single line and place nurse's initials above it.

cross out the incorrect statement with a single line and place nurse's initials above it.

When conducting health teaching for a client, the nurse uses the client's name frequently throughout the instructional period. Which learning barrier is the nurse trying to resolve? a) Functional illiteracy b) Cultural differences c) Sensory deficits d) Shortened attention span

shortened attention span

The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety? a) "I will start an IV so I can administer fluids directly into your vascular system." b) "I will start an IV, which should not cause you too much pain." c) "I will start an IV with an 18 gauge catheter." d) "I will start an IV, which should not take much time."

"I will start an IV so I can administer fluids directly into your vascular system."

A client asks the nurse how cortisol works. What is the appropriate nursing response? a) It increases capillary permeability to prevent tissue swelling." b) "It raises blood glucose and inhibits insulin along with suppressing the immune response." c) "It strengthens lymphoid tissue." d) "It causes release of proinflammatory mediators that lower heart rate"

"It raises blood glucose and inhibits insulin along with suppressing the immune response."

A female client reports to her primary care physician with aggravated chest pain. The physician orders a stress test. The client tells the nurse that she does not want to take the test and feels she should instead continue with the medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse? a) Most people tolerate the procedure quite well." b) "Tell me more about how you are feeling." c) "Don't you want to improve your health?" d) "Emergency equipment is always kept ready."

"Tell me more about how you are feeling."

A nurse visits a female victim of sexual assault for the fourth visit. The client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse? a) "Can you do something to alleviate the fear of being assaulted again?" b) "In reality, the rape did not occur yesterday; it has been over one month now." c) "Tell me more about the aspects that make you feel as if it happened yesterday." d) "We should move on from the strong feelings associated with this incident."

"Tell me more about the aspects that make you feel as if it happened yesterday."

A client who is bedridden is scheduled to receive subcutaneous injections of heparin at 8:00 a.m. and 8:00 p.m. each day. The client's medication administration record would present these times as: a) 0800 and 1800 b) 0800 and 2000 c) 800 and 2200 d) 0800 and 2200

0800 and 2000

The nurse is caring for four clients. Which client does the nurse identify as the highest risk for social readjustment concerns? a) 54-year old who is undergoing marital separation b) 32-year old who has recently been incarcerated c) 77-year old whose spouse just died d) 40-year old who was fired from work last month

77-year old whose spouse just died

The nurse is preparing to teach four clients. Which client will the nurse plan to teach using principles associated with gerogogy? a) 56-year old who likes to take notes on paper b) 4-year old who likes to play with blocks c) 31-year old who continuously used the internet d) 79-year old who has slight cognitive changes

79-year old who has slight cognitive changes

A nurse caring for a client with depression. The nurse finds that the client is withdrawn and does not communicate with others. What is the most appropriate response by the nurse? Is that a new shirt you're wearing? a)Is that a new shirt you're wearing b) Did you like your dinner? c) Did you sleep well last night? d) Do you feel like talking?

Did you like your dinner?

A nurse needs to complete an assessment and vital signs on a client who has Alzheimer's disease. How should the nurse approach this client to gain cooperation? (Select all that apply.) *Smile and maintain eye contact. *Focus on the nursing tasks. Speak loudly and clearly. *Approach the client from the front. *Use the client's name.

Smile and maintain eye contact. Approach the client from the front. Use the client's name

The nurse is caring for a client who has been admitted for a new diagnosis of hypertension. When does the nurse begin client teaching? a) before the first blood draw b) immediately prior to discharge c) during the admission process d) as soon as possible after admission

as soon as possible after admission

A nurse is providing care for client who experienced a stroke and has expressive aphasia (the person knows what he or she wants to say, yet has difficulty communicating it to others). Which nursing intervention reflects tertiary level of prevention? a) Conduct mental status assessment every 2 hours. b) Discuss family history of hypertension. c) Assess blood pressure every 4 hours. d) Provide care transition at discharge for speech therapy.

provide care transition at discharge for speech therapy.

When documenting information in a client's medical record, what should the nurse do consistently for each entry? a) Report each observation to the physician. b) Sign each entry by name and title. c) Provide just the day of the week on the entry. d) Obtain a signature from the physician.

sign each entry by name and title.

A general contractor is discussing a problem with the nurse, he tells the nurse that he is always doing small, petty jobs for everyone and he is not happy about this and it is not fulfilling. Because of this, he is feeling stressed and has been getting into fights with his wife. What should the nurse suggest to help the client overcome this problem? a) Avoid people who dump tasks on him. b) Take control of the situation by changing his work options. c) Change jobs. d) Avoid doing petty jobs

take control of the situation by changing his work options.

A client is admitted to the health center with chronic diarrhea which might be related to diet therapy. It has been determined that special dietary instruction is needed. When should the nurse initiate instruction about the benefits of this special diet to the client so that the risk of diarrhea is minimized? a) When performing follow up care b) When discharging the client c) When providing treatment d) When admitting the client

when admitting the client

The nurse is caring for a client who is a physician in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms as well as exhaustion. At what stage of stress is the client? a) Exhaustion stage b) Alarm stage c) Resistance stage d) Secondary stage

exhaustion stage

A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? a) "The needle causes discomfort upon insertion, but I will be by your side throughout and will help you hold your position." b) "I will be by your side throughout the procedure; the procedure will be painless if you don't move." c) "You might feel a little bit uncomfortable when the needle goes in, but if I were you I would breathe rhythmically; I will be here to coach you with breathing." d) "The procedure may take only 2 to 3 minutes, so you might get through it by mentally counting up to 120."

"The needle causes discomfort upon insertion, but I will be by your side throughout and will help you hold your position."

A nurse is collecting a health history on a client. When asked about alcohol, tobacco, and drug use, the client states, "I quit smoking 10 years ago." However, the nurse observes an open package of cigarettes in the client's shirt pocket. What is the most appropriate response by the nurse? a) "You said that you do not smoke, but you have an open package of cigarettes in your pocket. Let's discuss. b) "Why did you tell me you quit smoking?" c) "Are you having difficulty quitting smoking?" d) "I know that you are lying about not smoking, so tell me how much you smoke each day."

"You said that you do not smoke, but you have an open package of cigarettes in your pocket. Let's discuss.

While covering a colleague's lunch break, a nurse on an orthopedic unit has responded to a client's call light. The client has requested assistance in transferring from the bed to the bathroom. The nurse has not previously provided care for this client and is unsure of the client's current activity orders. The client's current level of activity can be most easily verified by consulting what written source? a) Education plan b) Active Orders c) Nursing supervisor d) Vital sign Flow sheet

active orders

A client who tends to volunteer to complete major assignments (but forgets to complete his own work) is stressed because of this. The nurse suggests that the client prioritize his work, complete the difficult part of his work first, and delegate the rest of the work to colleagues. In this case, what technique is the nurse asking the client to follow? a) Alternative coping b) Alternative behaviors c) Negative technique d) Alternative lifestyle

alternative behaviors

The nurse is planning to provide teaching to a client who is recovering from abdominal surgery. When in the most appropriate time to teach the client? a) when the meal tray arrives b) as the client is sitting quietly, reading a book c) immediately before discharge to home d) at the time of pain medication administration

as the client is sitting quietly, reading a book

The nurse is caring for a 70-year-old client with a fractured wrist and is in need of instruction regarding medication therapy. Which of the following is the best method to determine if the client has retained the information taught? a) Observe the change in client's behavior one month after teaching b) Ask the client to recall the information after approximately 15 minutes. c) Ask the client "do you understand" d) Test the client on the health education and information imparted.

ask the client to recall the information after approximately 15 minutes.

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate? a) Assess for cultural differences. b) Delegate the health education to a colleague. c) Replace one-on-one teaching with written materials. d) Boost the morale of the client.

assess for cultural differences

The nurse notes that a diabetic client has been readmitted to the health care facility with a high blood sugar level as the client had not followed the proper diet. The client is unable to read and speak English properly and can only sign their name. Which category does the client fall into? a) Literate b) Moderately illiterate c) Illiterate d) Functionally illiterate

functionally illiterate

A Spanish-speaking client is admitted to the Emergency Department with a urinary tract infection and is experiencing a stress response from hospitalization. What is the priority nursing intervention? a) Administer broad-spectrum antibiotic. b) Contact a translator. c) Begin taking a client history. d) Collect a urine specimen.

contact a translator

The nurse is required to provide formal education to a client admitted to the health care facility. Which of the following should the nurse consider first when providing formal education? a) Showing enthusiasm b) Creating a plan c) Using diagrams d) Teaching spontaneously

creating a plan

A client experienced a fight or flight response immediately following a car accident. What clinical symptoms would the nurse expect? (Select all that apply.) *decreased digestion *pupil constriction *heightened awareness *Pale appearance *increased heart rate *relaxed muscle tone

decreased digestion heightened awareness pale appearance increased heart rate

A nurse is teaching the importance of personal hygiene and proper bowel movement to a group of clients using gerogogy. Which client is the nurse addressing? a) Pregnant women b) Elderly people c) Infants d) Adults

elderly people

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? a) Pity b) Indifference c) Sympathy d) Empathy

empathy

A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. Which intervention is most appropriate? a) Tell the family to leave the client alone. b) Remain with the family but maintain silence. c) Make decisions for the family in difficult situations. d) Encourage family discussions of feelings when appropriate.

encourage family discussions of feelings when appropriate.

When maintaining medical records for a client, the nurse knows that a medical record also serves as a legal document of evidence. What is one important aspect of legal defensible charting? a) Ensure that the client's name appears on all pages. b) Leave spaces between entries and signature. c) Record all facts and subjective interpretations. d) Use abbreviations wherever possible, especially those that could have two different meanings

ensure that the client's name appears on all pages.

The nurse is caring for a client who is prescribed an antibiotic by mouth every 4 hours. When will the nurse document that the antibiotic has been given? a) immediately following administration b) during administration c) at the end of the shift d) immediately prior to administration

immediately following administration

A nurse has received change-of-shift report and is briefly reviewing the documentation about a client in the client's medical record. A recent entry reads, "Client was upset throughout the morning." To improve this entry regarding detailed charting, it should: a) list the specific reasons that the client was upset. b) specify the subsequent interventions that were performed. c) avoid mentioning cognitive or psychosocial issues. d) include clearer descriptions of the client's mood and behavior.

include clearer descriptions of the client's mood and behavior.

A nurse is planning the care of a client who will soon begin radiotherapy for the treatment of breast cancer. The nurse has been identifying interventions that are rooted in the notion of holism, which states that: a) Most physical illnesses do not require pharmacologic interventions or surgery. b) A client's illness affects friends and family in the same way that the client is affected. c) An individual's medical diagnosis has local, but not systemic, effects. d) Interactions between the mind and the body can profoundly influence health.

interactions between the mind and the body can profoundly influence health.

A client who is a drug addict visits a health care facility for treatment. During counseling, he discloses that he took to drugs because it helped him deal with stressful situations. The nurse explains that he is not using the correct coping strategy to overcome his stress-related problems. What kind of strategy has the client used in this case? a) Nontherapeutic coping strategy b) Therapeutic coping strategy c) Antidepressant strategy d) Stress-reduction strategy

nontherapeutic coping strategy

A nurse is working with a client who is in postoperative day 2 following a total knee replacement. The client has briefly mobilized using a wheeled walker and with the assistance of the physical therapist. However, the client is reluctant to progress further with mobilization for fear of injuring herself. In response to this, the nurse converses with the physical therapist to create a plan of care that creates specific goals for the client's mobility. In doing so, this nurse has exemplified what role? a) Nurse as caregiver b) Nurse as delegator c) Nurse as collaborator d) Nurse as educator

nurse as collaborator

A nurse is providing health education to a client who has been admitted to the health care facility. How can the nurse best determine that the education standards have been met? a) Document teaching and learning in the client's medical record. b) Ask the client's opinion about the quality of education. c) Ask the client's primary care provider about the teaching standards followed. d) Observe changes in the client's behavior after teaching.

observe changes in the client's behavior after teaching.

The nurse has provided teaching for a client with a sinus infection who has been prescribed antibiotics and a decongestant. What is the appropriate nursing response when the client states, "I'm not sure how many days I'm supposed to take this antibiotic." a) Re-teach the length of time to take the prescription. b) Ask the client to restate the teaching that was provided. c) Proceed with teaching about the decongestant. d) Tell the client to take the antibiotic until symptoms subside.

re-teach the length of time to take the prescription.

The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach will the nurse plan to implement? a) Ask family member to do meal planning to alleviate burden for the client. b) Provide brochures about low sodium foods. c) Refer to the American Heart Association website, Demonstrate FoodPyramid phone app, to show the best food choices on a lunch tray. d) Have client repetitively choose appropriate foods from various menus.

refer to the American Heart Association website, Demonstrate MyFoodPyramid phone app, to show the best food choices on a lunch tray.

A nurse is caring for a client with myasthenia gravis. The client is having difficulty forming words and his tone is nasal. Which communication strategy is an effective one for this client? a) Encourage the client to speak quickly while talking. b) Nod continuously when the client is talking. c) Repeat what the client has said to verify the meaning of what was said and to avoid misunderstanding. d) Engage the client in a lengthy discussion to strengthen his voice.

repeat what the client has said to verify the meaning of what was said and to avoid misunderstanding.

A nurse is working with a client whose quality of life is impacted by the presence of numerous health problems. The nurse is aware that the client's body is attempting to maintain homeostasis, a process that primarily involves: a) minimizing the body's exposure to external influences. b) ensuring a stable level of blood glucose. c) maximizing the serum levels of hormones. d) responding appropriately to internal and external influences.

responding appropriately to internal and external influences.

A client visits the medical unit with the client's father for a scheduled checkup. The client's father has been recently diagnosed with hypertension. The nurse suggests that the client get his blood pressure regularly checked to avoid possible problems. What level of prevention is the nurse following in this case? a) Primary level b) General guidance level c) Tertiary level d) Secondary level

secondary level

A client visits a health care facility reporting work-related stress that alters his mood when he comes home. The nurse suggests that the client make changes to his home décor to include vibrant colors and bright lighting, and listen to soothing music when he returns home. Which stress-reducing technique is the nurse following in this case? a) Nontherapeutic technique b) Sensory manipulation technique c) Alternative thinking technique d) Alternative behavior technique

sensory manipulation technique

A client with persistent nausea is diagnosed with somatization. What is the appropriate nursing action when the client reports nausea? a) Explain that the physical symptoms are all in their head. b) Contact the primary care provider c) Sit with the client and ask them about their feelings. d) Immediately administer an antiemetic.

sit with the client and ask them about their feelings.

A child has been admitted to the medical center with severe depression and stress, and has been avoiding going to school for these reasons. What would be the most beneficial action by the nurse? a) Teach the child the importance of being happy and unstressed. b) Talk with the child and try to discover what has caused stress and depression c) Administer antidepressants to counter stress. d) Ensure the child goes to group therapy and talks about their feelings

talk with the child and try to discover what has caused stress and depression

A client has been admitted to the health care facility and a plan of nursing care has been created. The nursing care plan specifies that client education should begin as soon as possible and a nurse has begun an assessment in preparation for this education. What assessment parameter should the nurse prioritize during this assessment? a) The client's coping skills b) The client's occupation c) The client's social support network d) The client's motivation to learn

the client's motivation to learn

A 7-year-old child is admitted to a health care facility. His parents explain that the child is not able to interpret what they say and so is not able to speak clearly. The child is also not able to remember anything he is taught in school. What should the nurse conclude about the part of the brain that is affected in this case? a) The cortex is affected. b) The mid-brain is affected. c) The brainstem is affected. d) The subcortex is affected.

the cortex is affected

A nurse is working with an adult client who has been admitted with hyperglycemia following a period of poor glycemic control. The nurse has many similarities to the client with regard to age, gender, and socioeconomic status but is careful to utilize therapeutic communication techniques rather than social communication. How does therapeutic communication differ from social communication? a) Therapeutic communication focuses primarily on problems while social communication addresses positive aspects of the client's life. b) Therapeutic communication focuses on what the nurses' goals while social communication is about the client's goals c) Therapeutic communication is focused on a particular goal while social communication is more superficial in content. d) Therapeutic communication relies heavily on technical medical vocabulary while social communication uses colloquialisms.

therapeutic communication is focused on a particular goal while social communication is more superficial in content.

A nurse caring for a client at a health care facility has to maintain a medical record for the client. Which of the following is a use of the medical record? a) to release the entire health record for research b) to inform family and others concerned about the client's care c) to document the quality of care the agency provided d) to transmit health records to the government

to document the quality of care the agency provided

When caring for a client at a health care facility, the nurse discovers that the client is unable to read or write. Which of the following teaching approaches is most useful for the client? a) Provide all the needed education at one time rather than breaking it up. b) Keep the education session short because if the client cannot read they are most likely developmentally delayed c) Read all of the information very slowly to the client, and provide written instructions. d) Use verbal and visual modes of communication.

use verbal and visual modes of communication.