Foundations Exam 6
What are the physical changes that occur as death approaches? 1. Unresponsiveness 2. Erythema 3. Mottling 4. Restlessness 5. Increased Urine Output 6. Weakness 7. Incontinence
1 3 4 6 7
A family member of a dying patient talks casually with the nurse and expresses relief that she will not have to visit at the hospital anymore. Which theoretical description of grief best applies to this family member? 1. Denial 2. Anticipatory Grief 3. Yearning and Searching 4. Dysfunctional Grief
2
A grieving patient complains of confusion, inability to concentrate, and insomnia. What do these symptoms indicate? 1. These are normal symptoms of grief 2. There is a need for pharmacological support for insomnia 3. The patient is experiencing complicated grief 4. These are common complaints of the admitted patient.
1
A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care? 1. Patient will be able to walk 200 feet without shortness of breath. 2. Wound will heal without signs of infection. 3. Patient will express concerns related to return to home. 4. Patient will identify strategies to improve sleep habits.
1
A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area? 1. Quality improvement (QI) 2. Health care patient system 3. Nursing informatics 4. Computerized nursing network
1
A year after her husband's death, a widow visits the unit on which he died. She talks about the anniversary and how much she misses him. Which type of giref is she experiencing? 1. Normal 2. Complicated 3. Chronic 4. Disenfranchised
1
Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? 1. Patient safety 2. Evidence-based practice 3. Patient satisfaction 4. Maintenance of competency
1
To best assist a patient in the grieving process, which of the following is most helpful to determine? 1. Previous experiences with grief and loss 2. Religious affiliation and denomination 3. Ethnic background and cultural practices 4. Current financial status
1
A family has decided to care for a grandparent with terminal cancer in the daughter's home. Family care-giving is new to the family. When helping this family as they begin to plan for their cargiving roles, what are the two top priority assessments to best learn about family functioning? (Select all that apply) 1. Communication 2. Decision making 3. Development 4. Economic status 5. Family structure
1 2
A family is facing job loss of the father, who is the major wage earner, and relocation to a new city where there is a new job. The children will have to switch schools, and his wife will have to resign from the job she likes. Which of the following contribute to this family's hardiness? (Select all that apply) 1. Family meetings 2. Established family roles 3. New neighborhood 4. Willingness to change in time of stress 5. Passive orientation to life
1 2 4
The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.) 1. Use of physical restraints 2. Pain assessment, intervention, and reassessment 3. Patient satisfaction with food preparation 4. Registered nurse (RN) education and certification 5. Number of outpatient surgical cases per year
1 2 4
When planning care for the dying patient, which interventions promote the patient's dignity? 1. Providing respect 2. Viewing patients as a whole 3. Providing symptom management 4. Showing interest 5. Being present 6. Using a preferred name
1 2 4 5 6
Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.) 1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 3. Working with patients in a cardiac rehabilitation program 4. Providing home wound care to a patient 5. Teaching a class to parents at the local grade school about the importance of immunizations
1 2 5
Which of the following are possible outcomes with clear family communication? (Select all that apply) 1. Family goals 2. Increased socialization 3. Decision making 4. Methods of discipline 5. Improved education 6. Impaired coping
1 3 4
Which factors influence a person's approach to death? (Select all that apply) 1. Culture 2. Age 3. Spirituality 4. Personal Beliefs 5. Previous experiences with death 6. Gender 7. Level of education 8. Degree of social support
1 3 4 5 8
You are caring for a family that consists of a father and 3-year-old boy who has well-managed asthma but misses care infrequently. They live in state-supported housing. The father is in school studying to be an information technology professional. His income and time are limited, and he admits to going to fast-food restaurants frequently for dinner. However he and his son spend a lot of time together. The family receives state-supported health care for his son, but he does not have health insurance or a personal physician. He has his son enrolled in a government-assisted day care program. Which of the following are risks to this family's level of health? (Select all the apply) 1. Economic Status 2. Chronic illness 3. Underinsured 4. Government-assisted day care 5. Frequency of fast-food dinners 6. State-supported housing
1 3 5
A family is undergoing a major change. Just as twins graduate from college and leave home to begin their careers, the husband loses his executive well-paying job. Because the family had two children in college at the same time, they did not save for retirement. They planned to save aggressively after the children left college. In this situation, which of the following demonstrate family resiliency? (Select all that apply) 1. Resuming full-time work when spouse loses job 2. Increasing problems among siblings 3. Developing hobbies when children leave home 4. Placing blame on family members 5. Expecting children to help financially 6. Consulting a financial planner
1 3 6
A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are your major concerns for this patient? (Select all that apply.) 1 The loss of his work role 2 The risk of social isolation 3 A determination if the wife will need to start working 4 How the wife expects household tasks to be divided in the home in retirement 5 The age the patient chose to retire
1 4
A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable around 130/70. The patient does not exercise regularly and complains of weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.) 1. Impaired vision 2. Residence design 3. Blood pressure 4. Leg weakness 5. Exercise history
1 4 5
Which of the following are characteristics of managed care systems? (Select all that apply.) 1. Provider receives a predetermined payment for each patient in the program. 2. Payment is based on a set fee for each service provided. 3. System includes a voluntary prescription drug program for an additional cost. 4. System tries to reduce costs while keeping patients healthy. 5. Focus of care is on prevention and early intervention.
1 4 5
A community center is presenting a nurse-led program on the Patient Protection and Affordable Care Act. Which statement made by a participant indicates a need for further teaching? 1. "My small company will now have to offer the 75 employees health insurance or pay a penalty." 2. "As long as my son is a full-time student in college, I will be able to keep him on my health insurance until he is 26 years old." 3. "I signed up for the state health insurance exchange before the designated deadline to make sure I had health insurance." 4. "Since I have now been diagnosed with diabetes, my health insurance plan cannot charge me higher premiums."
2
A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: 1 Dementia. 2 Depression. 3 Delirium. 4 Disengagement.
2
A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. She notes that the patient is very thin and unkempt, has a stage 3 pressure ulcer to her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver sin who accompanied her to the hospital. The nurse's next step is to: 1. Call social services to begin nursing home placement 2. Ask the son to step out of the room so she can complete her assessment 3. Call adult protective services because you suspect elder mistreatment 4. Assess patient's cognitive status
2
A nurse is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information to the class on which topic? 1. Prospective payment system 2. Pay for performance 3. Capitation payment system 4. Managed care systems
2
What is the most common reason for calling grandparents to raise their grandchildren? 1. Single parenthood 2. Legal interventions 3. Dual-income families 4. Increased divorce rate
2
When providing postmortem care, which action is a priority for the nurse? 1. Locating the patient's clothing 2. Providing culturally and religiously sensitive care in body preparation 3. Transporting the body to the morgue as soon as possible 4. Providing postmortem care to protect the family of the deceased from having to view the body
2
Which of the following is the best intervention to help a hospitalized patient maintain some autonomy? 1. Use therapeutic techniques when communicating with the patient 2. Allow the patient to determine timing and scheduling of interventions 3. Encourage family to only visit for short periods of time 4. Provide the patient with a private room close to the nurse's station.
2
A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before discharge. What can you do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.) 1 Speak loudly so the patient can hear you. 2 Sit facing the patient so he is able to watch your lip movements and facial expressions. 3 Present one idea or concept at a time. 4 Send a written copy of the instructions home with him and tell him to have the family review them. 5 Include the family caregiver in the teaching session.
2 3 5
A nurse is participating in a health and wellness event at the local community center. A woman approaches and relates that she is worried that her widowed father is becoming more functionally impaired and may need to move in with her. The nurse inquires about his ability to complete activities of daily living (ADLs). ADLs include independence with: (select all that apply) 1. Driving 2. Toileting 3. Bathing 4. Daily exercise 5. Eating
2 3 5
A patient's family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.) 1 The center should be clean, and rooms should look like a hospital room. 2 There should be adequate staffing on all shifts. 3 Social activities should be available for all residents. 4 Three meals should be served daily with a set menu and serving schedule. 5 Family involvement in care planning and assisting with physical care is necessary.
2 3 5
A patient is receiving palliative care for symptom management related to anxiety and pain. A family member asks if the patient is dying and now in "hospice." What does the nurse tell the family about palliative care? (Sata) 1. Palliative care and hospice are the same thing 2. Palliative care is for any patient, any time, any disease in any setting 3. Palliative care strategies are primarily designed to treat the patient's illness 4. Palliative care relieves the symptoms of illness and treatment. 5. Palliative care selects home health care services
2 4
During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? (Select all that apply.) 1 Taking two medications for hypertension 2 Taking a total of eight different medications during the day. 3 Having one physician who reviews all medications 4 Patient's health history 5 Involvement of the caregiver in assisting with medication administration
2 4
A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? 1. PDSA 2. Six Sigma 3. Rapid-improvement event (RIE) 4. A randomized controlled trial
3
A major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis could precipitate: 1 Dementia. 2 Delirium. 3 Depression. 4 Stroke.
3
A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? 1. This health plan is for people who cannot afford their own health insurance. 2. This health plan is operated by the government to provide health care to older adults. 3. This health plan gives you a list of physicians and hospitals from which you can choose. 4. This is a fee-for-service plan in which you can choose any physician or hospital.
3
A young mother is dying of breast cancer with bone mestastasis and tells the nurse, "My body hurts so much. I can hardly move. Why is God making me suffer when I have done nothing bad in my life? I feel like giving up. How can I care for my children when I can't even care for myself?" What is the most appropriate nursing diagnosis for this patient? 1. Spiritual distress related to questioning God 2. Hopelessness related to terminal diagnosis 3. Pain related to disease process 4. Anticipatory grief related to impending death
3
The Collins family includes a mother; stepfather, two teenage biological daughters of the mother; and a 25-year old biological daughter of the father. The father's daughter just moved home following the loss of her job in another city. The family is converting a study into Stacey's bedroom and is in the progress of distributing household chores. When you talk to members of the family, they all think that their family can adjust to lifestyle changes. This is an example of family: 1. Diversity 2. Durability 3. Resiliency 4. Configuration
3
What is the palliative care team's primary obligation for the patient with severe pain? 1. Postmortem care 2. Teaching about grief stages 3. Enhancing the patient's quality of life 4. Supporting the family after the death
3
Which comment to a patient by a new nurse regarding palliative care needs to be corrected? 1. "Even though you're continuing treatment, palliative care is something we might want to talk about." 2. "Palliative care is appropriate for people with any diagnosis." 3. "Only people who are dying receive palliative care." 4. "Children are able to receive palliative care."
3
You are working with an older adult after an acute hospitalization. Your goal is to help this person be more in touch with time, place, and person. What might you try? 1 Reminiscence 2 Validation therapy 3 Reality orientation 4 Body image interventions
3
You see a 76-year-old woman in the outpatient clinic. Her chief complaint is vision. She states she has really noticed glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. You suspect that she may have: 1 Presbyopia. 2 Disengagement. 3 Cataract(s). 4 Depression.
3
A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. Place the steps in the correct sequence for PDSA. 1. Bedside change of shift report is piloted on two medical-surgical units. 2. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change. 3. The nursing council develops a strategy for bedside change of shift report. 4. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units.
3 1 2 4
Which of the following nursing activities is provided in a secondary health care environment? (SATA) 1. Conducting blood pressure screenings for older adults at the Senior Center 2. Teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques 3. Changing the postoperative dressing for a patient on a medical-surgical unit 4. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit
3 4
Which of the following family assessments are most important for successful family care-giving? (Select all that apply) 1. Educational level of family members 2. Cultural food preferences 3. Collaboration between family memers 4. Social support 5. Conflict resolution practices
3 4 5
A student nurse is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature was 37.1° C (98.8° F). The student reports her recent assessment to the registered nurse (RN): the patient's temperature is 37.2° C (99° F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend first? 1 Tell the student that temporary confusion is normal and simply requires reorientation 2 Tell the student to increase the patient's fluid intake since the urine is concentrated 3 Tell the student that her assessment findings are normal for an older adult 4 Tell the student that he will notify the physician of the findings
4
In viewing the family as context, what is the primary focus? 1. Family members within a system 2. Family process and relationships 3. Family relational and transactional concepts 4. Health needs of an individual member
4
Older adults experience a change in sexual activity. Which best explains this change? 1 The need to touch and be touched is decreased. 2 The sexual preferences of older adults are not as diverse. 3 Physical changes usually do not affect sexual functioning. 4 Frequency and opportunities for sexual activity may decline.
4
On entering a room the nurse sees the patient crying softly. What is the most therapeutic response? 1. Using silence 2. Asking, "Why are you crying today?" 3. Using therapeutic touch 4. Stating, "I see that you're crying."
4
Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult? 1 When the sexual partner passes away, the survivor no longer feels sexual. 2 A decrease in an older adult's libido occurs. 3 Any outward expression of sexuality suggests that the older adult is having a developmental problem. 4 All older adults, whether healthy or frail, need to express sexual feelings.
4
The nurse is completing an admission assessment with an 80 year old man who experienced a hip fracture following a fall. He is alert, living alone, and has very poor hygiene. He reports a 20 pound weight loss in the last 6 months following his wife's death, as well as estrangment from his only child. He admits to falls before this most recent fall. What should the nurse suspect? 1. Dementia 2. Elder abuse 3. Delirium 4. Alcohol abuse
4
The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following is an example of "Do" from that model? 1. Implementing the new skin care protocol on all medicine units 2. Reviewing the data collected on patients cared for using the protocol 3. Reviewing the quality improvement reports on the six patients who developed ulcers over the last 3 months 4. Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol
4
Which activity performed by a nurse is related to maintaining competency in nursing practice? 1. Asking another nurse about how to change the settings on a medication pump 2. Regularly attending unit staff meetings 3. Participating as a member of the professional nursing council 4. Attending a review course in preparation for a certification examination
4
Which of the following most greatly affects a family's access to adequate health care, opportunity for education, and sound nutrition? 1. Development 2. Family function 3. Family structure 4. Economic stability
4
Which of the following statements is true regarding Magnet status recognition for a hospital? 1. Nursing is run by a Magnet manager who makes decisions for the nursing units. 2. Nurses in Magnet hospitals make all of the decisions on the clinical units. 3. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need. 4. Magnet is a special designation for hospitals that achieve excellence in nursing practice.
4
A nurse has the responsibility of managing a deceased patient's postmortem care. What is the proper order for postmortem care? 1. Bathe the body of the deceased 2. Collect any needed specimens 3. Remove all tubes and indwelling lines 4. Position the body for family viewing 5. Speak to the family members about their possible participation 6. Ensure that the request for organ/tissue donation was completed 7. Notify support person (e.g. spiritual care provider, bereavement specialist) for the family 8. Accurately tag the body, including the identity of the deceased and safety issues regarding infection control 9. Elevate the head of the bed
6 9 2 5 7 3 1 4 8
A nurse is caring for a client who has left-sided hemiplegia resulting from a cerebrovascular accident. The client works as a carpenter and is now experiencing a situational role change based on physical limitations. The client is the primary wage earner in the family. Which of the following best describes the client's role problem? A. Role conflict B. Role overload C. Role ambiguity D. Role strain
A
A single young adult female interacts with a group of close friends from college and work. They celebrate birthdays and holidays together. In addition, they help one another through many stressors. She views these individuals as: A. Family. B. Siblings. C. Substitute Parents. D. Alternative Family Structure.
A
Middle-age adults frequently find themselves trying to balance responsibilities related to employment, family life, care of children, and care of aging parents. People finding themselves in this situation are frequently referred to as being a part of: A. The sandwich generation B. The millennial generation C. Generation X D. Generation Y
A
Sexually transmitted infections (STIs) continue to be a major health problem in young adults. Men ages 20 to 24 years have the highest rate of which STI? A. Chlamydia B. Syphilis C. Gonorrhea D. Herpes Zoster
A
Intimate partner violence (IPV) is linked to which of the following factors? (Select all that apply.) A. Alcohol abuse B. Pregnancy C. Unemployment D. Drug use E. Marriage
A B C D
Chronic illness (e.g., diabetes mellitus, hypertension, rheumatoid arthritis) may affect a person's roles and responsibilities during middle adulthood. When assessing the knowledge base of both the middle-age patient with a chronic illness and his family, the assessment should include which of the following? (Select all that apply.) A. The medical course of the illness. B. The prognosis for the patient. C. Socioeconomic status D. Coping mechanisms of the patient and the family. E. The need for community and social services.
A B D E
A 45-year-old obese woman tells the nurse that she wants to lose weight. After conducting a thorough assessment, the nurse concludes that which of the following may be contributing factors to the woman's obesity? (Select all that apply.) A. The woman works in an executive position that is very demanding. B. The woman works out at the corporate gym at 5am two mornings a week. C. The woman says that she has little time to prepare meals at home and eats out at least 4 nights a week. D. The woman says that she tries to eat "low cholesterol" foods to help lose weight. E. The woman says that she vacations annually to reduce stress
A C D
a nurse is preparing a health promotion course for a group of middle adults. which of the following strategies should the nurse recommend? (select all that apply) A. eye examination every 1-3 years B. decrease intake of calcium supplements C. DXA screening for osteoporosis D. increase intake of carbohydrate in the diet E. screening for depressive disorders
A C D E
Formation of positive health habits may prevent the development of chronic illness later in life. Which of the following are examples of positive health habits? (Select all that apply.) A. Routine screening and diagnostic tests. B. Unprotected sexual activity. C. Regular exercise. D. Excess alcohol consumption. E. Consistent seat belt use
A C E
a nurse is collecting history and physical examination data from a middle adult. the nurse should expect to find decreases in which of the following physical examination data from a middle adult. the nurse should expect to find decreases in which of the following physiological functions? (select all that apply) A. metabolism B. ability to hear low pitched sounds C. gastric secretions D. Far vision E. Glomerular filtration
A C E
A 50-year-old male patient is seen in the clinic. He tells the nurse that he has recently lost his job and his wife of 26 years has asked for a divorce. He has a flat affect. Family history reveals that his father committed suicide at the age of 53. The nurse should assess for the following: A. Cardiovascular disease B. Depression C. Sexually transmitted infection D. Iron deficiency anemia
B
A nurse is caring for a client whose partner passed away 4 months ago and who has been recently diagnosed with diabetes mellitus. He is tearful and states, "How could you possibly understand what I am going through?" Which of the following is an appropriate response by the nurse? A. "It takes time to get over the loss of a loved one." B. "You are right; I cannot really understand. Perhaps you'd like to tell me more about what you're feeling." C. "Why don't you try something to take your mind off your troubles, like watching a funny movie." D. "I might not share your exact situation, but I do know what people go through when they deal with a loss."
B
With the exception of pregnant or lactating women, the young adult has usually completed physical growth by the age of: A. 18 B. 20 C. 25 D. 30
B
a nurse is counseling a middle adult client who describes having difficulty dealing with several issues. which of the following client statements should the nurse identify as the priority to assess further? A. "i am struggling to accept that my parents are aging and need so much help." B. "Its been so stressful for me to think about having intimate relationships." C. "i know i should volunteer my time for a good cause, but maybe I am just selfish." D. "i love my grandchildren, but my child expects me to relive my parenting days."
B
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions for stress, coping, and adherence to the treatment plan would be appropriate at this time? (Select all that apply.) A. Suggest coping skills for the client to utilize in this situation. B. Allow the client to provide input in the treatment plan. C. Assist the client with time management, and address the client's priorities. D. Provide extensive instructions on the client's treatment regimen. E. Encourage the client in the expression of feelings and concerns.
B C E
a nurse is collecting data to evaluate a middle adult's psychosocial development. the nurse should expect middle adults to demonstrate which of the following developmental tasks? (select all that apply) A. develop an acceptance of diminished strength and increased dependence on others. B. spend time focusing on improving job performance C. welcome opportunities to be creative and productive D. commit to finding friendship and companionship E. become involved with community issues and activities
B C E
A 50-year-old woman has elevated cholesterol profile values that increase her cardiovascular risk factor. One method to control this risk factor is to identify current diet trends and describe dietary changes to reduce the risk. This nursing activity is a form of: A. Referral B. Counseling C. Health Education D. Stress Management Techniques
C
A nurse is caring for a client awaiting transport to the surgical suite for a coronary artery bypass graft. Just as the transport team arrives, the nurse takes the client's vital signs and notes an elevation in blood pressure and heart rate. The nurse should recognize this response as which part of the general adaptation syndrome (GAS)? A. Exhaustion stage B. Resistance stage C. Alarm reaction D. Recovery reaction
C
A nurse is counseling a young adult who describes having difficulty with dealing with several issues. Which of the following client statements should the nurse identify as the priority to assess further? a. "I have my own apartment now, but its not easy living away from my parents" b. "its been so stressful for me to even think about having my own family" c. "I don't even know who I am yet, and now im supposed to know what to do" d. "my girlfriends pregnant, and I don't think I have what it takes to be a good father"
C
The nurse is completing an assessment on a male patient, age 24. Following the assessment, the nurse notes that his physical and laboratory findings are within normal limits. Because of these findings, nursing interventions are directed toward activities related to: A. Instructing him to return in 2 years. B. Instructing him in secondary prevention. C. Instruction him in health promotion activities. D. Implementing primary prevention with vaccines.
C
When determining the amount of information that a patient needs to make decisions about the prescribed course of therapy, many factors affect the patient's compliance with the regimen, including educational level and socioeconomic factors. Which additional factor affects compliance? A. Gender B. Lifestyle C. Motivation D. Family History
C
A 34-year-old female executive has a job with frequent deadlines. She notes that, when the deadlines appear, she has a tendency to eat high-fat, high-carbohydrate foods. She also explains that she gets frequent headaches and stomach pain during these deadlines. The nurse provides a number of options for the executive, and she chooses yoga. In this scenario yoga is used as a(n): A. Outpatient referral B. Counseling technique C. Health promotion activity D. Stress-management technique
D
A patient is laboring with her first baby, which is coming 2 weeks early. Her husband is in the military and might not bet back in time, and both families are unable to be with her during labor. The doctor decides to call in which of the following people employed by the birthing area to be a support person to be present during labor? A. Nurse B. Midwife C. Assistant D. Lay Doula
D
Sharing eating utensils with a person who has a contagious illness increases the risk of illness. This type of health risk arises from: A. Lifestyle. B. Community. C. Family History. D. Personal Hygiene habits.
D
Which of the following approaches should the nurse use when working with a family using an open structure for coping with crisis? A. Prescribing tasks unilaterally B. Delegating care to one member C. Speaking to the primary client privately D. Convening a family meeting
D
a charge nurse is explaining the various stages of the lifespan to a group of newly licensed nurses. which of the following examples should the nurse include as a developmental task for middle adulthood? A. the client evaluates their behavior after a social interaction B. the client states they are learning to trust others C. the client wishes to find meaningful friendhsips D. the client expresses concerns about the next generation.
D
A nurse is using an interpreter to communicate with a client. Which of the following actions should the nurse use when communicating with a client and family members? (select all that apply) a. talk to the interpreter about the family while the family is in the room b. determine client understanding several times during the conversation c. look at the interpreter when asking the family questions d. use lay terms if possible. e. do not interrupt the interpreter and the family as they talk
b d e
A nurse is reviewing CDC immunization recommendations with a young adult client. Which of the following vaccines should the nurse recommends routine, rather than catch-up, during young adulthood (select all that apply) a. influenza b. measles mumps rubella c. pertussis d. tetanus e. polio
a c d
A nurse is talking with an older adult client about improving her nutritional status. Which of the following interventions should the nurse recommend? (Select all that apply.) A. Increase protein intake to increase muscle mass. B. Decrease fluid intake to prevent urinary incontinence. C. Increase calcium intake to prevent osteoporosis. D. Limit sodium intake to prevent edema. E. Increase fiber intake to prevent constipation.
a c d e
A nurse is consoling the partner of a client who just expired after a long battle with liver cancer. The partner is displaying grief and states, "I hate him for leaving me." Which of the following statements by the nurse successfully facilitate mourning for the grieving partner? (Select all that apply.) A. "Would you like me to contact the chaplain to come speak with you?" B. "You will feel better soon. You have been expecting this for a while now." C. "Let's talk about your children and how they are going to react." D. "You know, it is quite normal to feel anger toward your husband at this time." E. "Tell me more about how you are feeling."
a d e
A nurse is discussing the plan of care for a client who reports following Islamic practices. Which of the following statements from the nurse indicates culturally responsive care to the client? a. "I will make sure the menu includes kosher options" b. "I will ask the client if they want to schedule some times to pray during the day" c. "I will avoid discussing care when the client's family is around" d. "I will make sure daily communion is available for this client"
b
A nurse is teaching a young adult client about health promotion and illness prevention. Which of the following statements by the client indicates an understanding of the teach? a. "I already had my immunizations as a child, so im protected in that area" b. "it is important to schedule routine health care visits even if I am feeling well." c. "I will just go to an urgent care center for my routine medical care" d. "theres no reason to seek help if I am feeling stressed because its just part of life"
b
A nurse is reviewing safety precautions with a group of young adults at a community health fair. Which of the following recommendations. should the nurse include to address common health risks for this age group? (select all that apply) a. install bath rails and grab bars in the bathrooms b. wear a helmet while skiing c. install a carbon monoxide detector d. secure firearms in a safe location e. remove throw rugs from the home
b c d
A nurse is planning a presentation for a group of older adults about health promotion and disease prevention. Which of the following interventions should the nurse plan to recommend? (Select all that apply.) A. Human papilloma virus (HPV) immunization B. Pneumococcal immunization C. Yearly eye examination D. Periodic mental health screening E. Annual fecal occult blood test
b c d e
A nurse is collecting data from an older adult client as part of a comprehensive physical examination. Which of the following findings should the nurse expect as associated with aging? (Select all that apply.) A. Skin thickening B. Decreased height C. Increased saliva production D. Nail thickening E. Decreased bladder capacity
b d e
A charge nurse is explaining the various stages of the lifespan to a group of newly licensed nurses. Which of the following examples should the charge nurse include as a developmental task for a young adult? a. becoming actively involved providing guidance to the next generation b. adjusting to major changes in roles and relationships due to losses c. devoting a great deal of time to establishing an occupation d. finding oneself sandwich between and being responsible for two generations
c
A nurse is caring for a client who has stage IV lung cancer and is 3 days postop following a wedge resection. the client states, i told myself that i would go through with the surgery if i quit smoking, if i could just live long enough to attend my daughters wedding. based on kubler-ross's model, which stage of grief is the client experiencing? a. anger b. denial c. bargaining d. acceptance
c
A nurse is caring for a client who has terminal lung cancer. The nurse observes the client's family assisting with all ADLs. which of the following rationales for self-care should the nurse communicate to the family? a. allowing the client to function independently will strengthen her muscles and promote healing b. the client needs to be given privacy at times for self- reflecting and organizing her life. c. the client's sense of loss can be lessened through retaining control of certain areas of her life d. performing ADLs is required prior to discharge from an acute care facility
c
A nurse is caring for two clients who report following the same religion. Which of the following information should the nurse consider when planning care for these patients? a. members of the same religion share similar feelings about their religion b. a shared religious background generates mutual regard for one another c. the same religious beliefs can influence individuals differently d. the nurse and client should discuss the differences and commonalities in their beliefs
c
The nurse enters the room of a client who is crying while reading from a religious book and asks to be left alone. Which of the following actions should the nurse take? a. contact the hospital's spiritual services b. ask what is making the client cry c. ensure no visitors or staff enter the room for a short period of time d. turn on the television for a distraction
c
A nurse is providing teaching for an older adult client who has lost 4.5 kg (9.9 lb) since his last admission 6 months ago. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. "Eat three large meals a day." B. "Eat your meals in front of the television." C."Eat foods that are easy to eat, such as finger foods." D."Invite family members to eat meals with you." E. "Exercise every day to increase appetite."
c d e
a nurse is assisting a newly licensed nurse with postmortem care to a client. the family wishes to view the body. which of the following statements by the newly licensed nurse indicate an understanding of this procedure? select all that apply a. remove the dentures from the body b. make sure the body is lying completely flat c. apply fresh linens and place a clean gown on the body d. remove all equipment from the bedside e. dim the lights in the room
c d e
A nurse is caring for a client who tells the nurse that based on religious values and mandates, a blood transfusion is not acceptable treatment option. Which of the following responses should the nurse make? a. "I believe in this case you should really make an exception and accept the blood transfusion." b. " I know your family would approve of your decision to have a blood transfusion." c. "Why does your religion mandate that you cannot receive any blood transfusion?" d. "Let's discuss the necessity for a blood transfusion with your religious and spiritual leaders and come to a reasonable solution"
d
A nurse is counseling an older adult who describes having difficulty dealing with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority? A. "I spent my whole life dreaming about retirement, and now I wish I had my job back." B. "It's been so stressful for me to have to depend on my son to help around the house." C."I just heard my friend Al died. That's the third one in 3 months." D."I keep forgetting which medications I have taken during the day."
d
a nurse is caring for a client who has a terminal illness. death is expected within 24 hr. the client's family is at the bedside and asks the nurse about anticipated findings at this time. which of the following findings should the nurse include in the discussion? a. regular breathing patterns b. warm extremities c. increased urine output d. decreased muscle tone
d
