N149 - Advanced Placement Exam 1 Study Questions (14th edition Med-Surg Ch. 1, 4, 13, 23)

The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of health care. Which of the following activities are considered integral to the CNP role? Select all that apply. A) Educating patients and family members B) Coordinating care with other disciplines C) Using direct provision of interventions D) Educating registered nurses and practical nurses E) Coordinating payment plans for patients

'Ans: A, B, C Feedback: This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in home care and community nursing. Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to perform care, and by coordinating and collaborating with other disciplines to provide needed services. The other answers are incorrect because NPs do not commonly perform education of nurses and they do not focus on matters related to payment

Health care professionals are involved in the promotion of health as much as in the treatment of disease. Health promotion has evolved as a part of health care for many reasons. Which of the following factors has most influenced the growing emphasis on health promotion? A) A changing definition of health B) An awareness that wellness exists C) An expanded definition of chronic illness D) A belief that disease is preventable

Ans: A Feedback: The concept of health promotion has evolved because of a changing definition of health and an awareness that wellness exists at many levels of functioning. The other options are incorrect because health promotion has not evolved because we know that wellness exists or a belief that disease is preventable. No expanded definition of chronic illness has caused the concept of health promotion to evolve.

A community health nurse has witnessed significant shifts in patterns of disease over the course of a four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of disease in the United States? A) Type 1 diabetes management B) Treatment of community-acquired pneumonia C) Rehabilitation from traumatic brain injuries D) Management of acute Staphylococcus aureus infections

Ans: A Feedback: Management of chronic diseases such as diabetes is a priority focus of the current health care environment. This supersedes the treatment of acute infections and rehabilitation needs.

A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is one characteristic the nurse would cite as necessary to possess to be an effective nurse? A) Sensitivity to cultural differences B) Team-focused approach to problem-solving C) Strict adherence to routine D) Ability to face criticism

Ans: A Feedback: To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict adherence to routine are not characteristics needed to be an effective nurse. The ability to handle criticism is important, but to a lesser degree than cultural competence.

The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process? A) Diffusion B) Osmosis C) Active transport D) Filtration

Ans: A Feedback: Diffusion is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration. It occurs through the random movement of ions and molecules. Examples of diffusion are the exchange of oxygen and carbon dioxide between the pulmonary capillaries and alveoli and the tendency of sodium to move from the ECF compartment, where the sodium concentration is high, to the ICF, where its concentration is low. Osmosis occurs when two different solutions are separated by a membrane that is impermeable to the dissolved substances; fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. Active transport implies that energy must be expended for the movement to occur against a concentration gradient. Movement of water and solutes occurring from an area of high hydrostatic pressure to an area of low hydrostatic pressure is filtration.

You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You start the infusion and check the insertion site as per protocol. During your most recent check, you note that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration? A) Extravasation of the medication B) Discomfort to the patient C) Blanching at the site D) Hypersensitivity reaction to the medication

Ans: A Feedback: Irritating medications, such as chemotherapeutic agents, can cause pain, burning, and redness at the site. Blistering, inflammation, and necrosis of tissues can occur. The extent of tissue damage is determined by the medication concentration, the quantity that extravasated, infusion site location, the tissue response, and the extravasation duration. Extravasation is the priority over the other listed consequences.

You are admitting a patient to your medical unit after the patient has been transferred from the emergency department. What is your priority nursing action at this time? A) Identifying the immediate needs of the patient B) Checking the admitting physicians orders C) Obtaining a baseline set of vital signs D) Allowing the family to be with the patient

Ans: A Feedback: Among the nurses important functions in health care delivery, identifying the patients immediate needs and working in concert with the patient to address them is most important. The other nursing functions are important, but they are not the most important functions.

Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the changing health needs of our aging population. What is one factor that has impacted the need for certified nurse practitioners (CNPs)? A) The increased need for primary care providers B) The need to improve patient diagnostic services C) The push to drive institutional excellence D) The need to decrease the number of medical errors

Ans: A Feedback: CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primary care or acute care. CNPs help meet the need for primary care providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs

A team of community health nurses are planning to draft a proposal for a program that will increase the communitys alignment with the principles contained in the Healthy People 2020report. Which of the following activities would best demonstrate the priorities identified in this report? A) Addressing determinants of health such as clean environments and safety in the community B) Lobbying for increased funding to the county hospital where many residents receive primary care C) Collaborating with health professionals in neighboring communities to pool resources and increase efficiencies D) Creating clinical placements where nursing students and members of other health disciplines can gain experience in a community setting

Ans: A Feedback: Healthy People 2020 addresses social determinants of health such as safety and the state of the environment. This report does not specifically address matters such as hospital funding, nursing education, or resource allocation

A public health nurse has been commissioned to draft a health promotion program that meets the health care needs and expectations of the community. Which of the following focuses is most likely to influence the nurses choice of interventions? A) Management of chronic conditions and disability B) Increasing need for self-care among a younger population C) A shifting focus to disease management D) An increasing focus on acute conditions and rehabilitation

Ans: A Feedback: In response to current priorities, health care must focus more on management of chronic conditions and disability than in previous times. The other answers are incorrect because the change in focus of health care is not an increasing need for self-care among our aging population; our focus is shifting away from disease management, not toward it; and we are moving away from the management of acute conditions to managing chronic conditions

A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing assessments and interventions with the aid of a pathway, the nurse should prioritize what goal? A) Helping the patient to achieve specific outcomes B) Balancing risks and benefits of interventions C) Documenting the patients response to therapy D) Staying accountable to the interdisciplinary team

Ans: A Feedback: Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount

A hospitals current quality improvement program has integrated the principles of the Institute for Healthcare Improvement (IHI) 5 Million Lives Campaign. How can the hospital best achieve the campaign goals of reducing preventable harm and death? A) By adhering to EBP guidelines B) By reducing nurse-to-patient ratios and increasing accountability C) By having researchers from outside the facility evaluate care D) By involving patients and families in their care planning

Ans: A Feedback: The 5 Million Lives Campaign posits that if evidence-based guidelines it advocated were voluntarily implemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a two- year period. Nurse-to-patient ratios, family participation, and independent evaluation are not stated components of the campaign

Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the patient. Which of the following is the best example of a collaborative practice model? A) The nurse and the physician jointly making clinical decisions. B) The nurse accompanying the physician on rounds. C) The nurse making a referral on behalf of the patient. D) The nurse attending an appointment with the patient.

Ans: A Feedback: The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model.

Over the past several decades, nursing roles have changed and expanded in many ways. Which of the following factors has provided the strongest impetus for this change? A) The need to decrease the cost of health care B) The need to improve the quality of nursing education C) The need to increase the number of nursing jobs available D) The need to increase the public perception of nursing

Ans: A Feedback: The role of the nurse has expanded to improve the distribution of health care services and to decrease the cost of health care. The other answers are incorrect because the expansion of roles in nursing did not occur to improve education, increase the number of nursing jobs, or increase public perception

A nurse is planning an educational event for a local group of citizens who live with a variety of physical and cognitive disabilities. What variable should the nurse prioritize when planning this event? A) Health-promotion needs of the group B) Relationships between participants and caregivers C) Wellness state of each individual D) Learning needs of caregivers

Ans: A Feedback: The nurse must be aware of the participants specific health-promotion needs when teaching specific groups of people with physical and mental disabilities. This is a priority over the relationships between participants and caregivers, each persons wellness state, or caregivers learning needs.

A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of the following? A) National Council of Nursings guidelines for care B) National League for Nursings Code of Conduct C) American Nurses Associations Social Policy Statement D) Department of Health and Human Services White Paper on Nursing

Ans: C Feedback: Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN published a specific code of conduct

A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help the nurse achieve what goal? A) Increasing career satisfaction B) Obtaining federal grant money C) Ensuring high quality patient care D) Enhancing the publics esteem for nursing

Ans: C Feedback: Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money are not priorities

A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and self-care. Which of the following activities would best demonstrate the principles of health promotion? A) A discharge planning initiative between acute care and community care nurses B) Collaboration between several schools of nursing in an urban area C) Creation of a smoking prevention program undertaken in a middle school D) Establishment of a website where patients can check emergency department wait-times

Ans: C Feedback: Smoking prevention is a clear example of health promotion. Each of the other listed activities has the potential to be beneficial, but none is considered health promotion

The ANA has identified central characteristics of nursing practice that are applicable across the wide variety of contexts in which nurses practice. A nurse can best demonstrate these principles by performing which of the following actions? A) Teaching the public about the role of nursing B) Taking action to control the costs of health care C) Ensuring that all of his or her actions exemplify caring D) Making sure to carry adequate liability insurance

Ans: C Feedback: The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a central tenet of nursing practice

Research has shown that patient adherence to prescribed regimens is generally low, especially when the patient will have to follow the regimen for a long time. Which of the following individuals would most likely benefit from health education that emphasizes adherence? A) An older adult who is colonized with methicillin-resistant Staphylococcus aureus (MRSA) B) An 80-year-old man who has a small bowel obstruction C) A 52-year-old woman who has a new diagnosis of multiple sclerosis D) A child who fractured her humerus in a playground accident

Ans: C Feedback: Many people do not adhere to their prescribed regimens; rates of adherence are generally low, especially when the regimens are complex or of long duration (e.g., therapy for tuberculosis, multiple sclerosis, and HIV infection and hemodialysis). This is less likely in a person with MRSA, an arm fracture, or a bowel obstruction.

A recent nursing graduate is aware that the nursing scope of practice goes far beyond what is characterized as bedside care. Which of the following is a nurses primary responsibility? A) To promote activities that enhance community cohesion B) To encourage individuals self-awareness C) To promote activities that foster well-being D) To influence individuals social interactions

Ans: C Feedback: As health care professionals, nurses have a responsibility to promote activities that foster well-being, self-actualization, and personal fulfillment. Nurses often promote activities that enhance the community and encourage self-awareness; however, they are not a nurses central responsibility. As professionals, nurses do not actively seek to influence social interaction

A gerontologic nurse has observed that patients often fail to adhere to a therapeutic regimen. What strategy should the nurse adopt to best assist an older adult in adhering to a therapeutic regimen involving wound care? A) Demonstrate a dressing change and allow the patient to practice. B) Provide a detailed pamphlet on a dressing change. C) Verbally instruct the patient how to change a dressing and check for comprehension. D) Delegate the dressing change to a trusted family member.

Ans: A Feedback: The nurse must consider that older adults may have deficits in the ability to draw inferences, apply information, or understand major teaching points. Demonstration and practice are essential in meeting their learning needs. The other options are incorrect because the elderly may have problems reading and/or understanding a written pamphlet or verbal instructions. Having a family member change the dressing when the patient is capable of doing it impedes self-care and independence.

The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders? A) Cimetidine B) Maalox C) Potassium chloride elixir D) Furosemide

Ans: A Feedback: H2 receptor antagonists, such as cimetidine (Tagamet), reduce the production of gastric HCl, thereby decreasing the metabolic alkalosis associated with gastric suction. Maalox is an oral simethicone used t break up gas in the GI system and would be of no benefit in treating a patient in metabolic alkalosis. KCl would only be given if the patient were hypokalemic, which is not stated in the scenario. Furosemide (Lasix) would only be given if the patient were fluid overloaded, which is not stated in the scenario.

A patient has questioned the nurses administration of IV normal saline, asking whether sterile water would be a more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water intravenously? A) Never, because it rapidly enters red blood cells, causing them to rupture. B) When the patient is severely dehydrated resulting in neurologic signs and symptoms C) When the patient is in excess of calcium and/or magnesium ions D) When a patients fluid volume deficit is due to acute or chronic renal failure

Ans: A Feedback: IV solutions contain dextrose or electrolytes mixed in various proportions with water. Pure, electrolyte free water can never be administered by IV because it rapidly enters red blood cells and causes them to rupture

You are the nurse evaluating a newly admitted patients laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)? A) Increased serum sodium B) Decreased serum potassium C) Decreased hemoglobin D) Increased platelets

Ans: A Feedback: Increased serum sodium causes increased thirst and the release of ADH by the posterior pituitary gland. When serum osmolality decreases and thirst and ADH secretions are suppressed, the kidney excretes more water to restore normal osmolality. Levels of potassium, hemoglobin, and platelets do not directly affect ADH release.

Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurses title? A) Nursing care expert B) Clinical nurse specialist C) Nurse manager D) Staff nurse

Ans: B Feedback: Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care (e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse

A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement? A) By liaising with the members of the interdisciplinary care team B) By critically appraising the outcomes of care that is provided C) By integrating the patients preferences into the plan of care D) By documenting care in the electronic health record in a timely fashion

Ans: B Feedback: Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement activities

A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee. When describing quality improvement programs to nursing colleagues and members of other health disciplines, what characteristic should the nurse cite? A) These programs establish consequences for health care professionals actions. B) These programs focus on the processes used to provide care. C) These programs identify specific incidents related to quality. D) These programs seek to justify health care costs and systems

Ans: B Feedback: Numerous models seek to improve the quality of health care delivery. A commonality among them is a focus on the processes that are used to provide care. Consequences, a focus on incidents, and justification for health care costs are not universal characteristics of quality improvement efforts

Leadership of a medical unit have been instructed to integrate the principles of the Quality and Safety Education for Nurses (QSEN) competency of quality improvement. What action should the units leaders take? A) Provide access to online journals and Web-based clinical resources for nursing staff. B) Use flow charts to document the processes of care that are used on the unit. C) Enforce continuing education requirements for all care providers. D) Reduce the use of chemical and physical restraints on the unit

Ans: B Feedback: One of the quality improvement skills is to use tools, such as flow charts and cause-effect diagrams, to make processes of care explicit. Each of the other listed actions has the potential to benefit patients and care givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency

Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized patients. How does this demonstrate a role of the APRN? A) Involving patients in their care while hospitalized B) Contributing to the scientific basis of nursing practice C) Critiquing the quality of patient care D) Explaining medical studies to patients and RNs

Ans: B Feedback: Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving patients in their care

The ANA has identified several phenomena toward which the focus of nursing care should be directed, and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates these priorities? A) Encouraging the patients dependence on caregivers B) Fostering the patients ability to make choices C) Teaching the patient about nurses roles in the health care system D) Assessing the patients adherence to treatment

Ans: B Feedback: The ANA identifies several focuses for nursing care and research, including the ability to make choices. The other answers are incorrect because they are not phenomena identified by the ANA

With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses, as when acute care nurses collaborate with public health and home health nurses. What nursing function has increased in importance because of this phenomenon? A) Prescribing medication B) Performing discharge planning C) Promoting family involvement D) Forming collegial relationships

Ans: B Feedback: The importance of effective discharge planning and quality improvement cannot be overstated. The other answers are incorrect because giving medication and family involvement in the patients care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible

Advanced practice nursing roles have grown in number and in visibility in recent years. What characteristic sets these nurses apart from the registered nurse? A) Collaboration with other health care providers B) Education that goes beyond that of the RN C) Advanced documentation skills D) Ability to provide care in the surgical context

Ans: B Feedback: There is wide variety in APRN roles. However, a commonality is that they require education beyond that of the professional RN. All nurses collaborate with other health care providers to provide nursing care totheir patients. Advanced documentation skills are not what sets advanced practice nurses apart from the staff nurse. RNs have the ability to provide care in the operating room

A nurse has planned a teachinglearning interaction that is aimed at middle school-aged students. To foster successful health education, the nurses planning should prioritize which of the following components? A) Pretesting B) Social and cultural patterns C) Patient awareness D) Measurable interventions

Ans: B Feedback: A patients social and cultural patterns must be appropriately incorporated into the teachinglearning interaction. Pretesting may or may not be used; patient awareness is a phrase that has many meanings, none of which make the teachinglearning interaction successful. Interventions are not measured; goals and outcomes are.

The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter? A) Choose a hairless site if available. B) Consider potential effects on the patients mobility when selecting a site. C) Have the patient briefly hold his arm over his head before insertion. D) Leave the tourniquet on for at least 3 minutes.

Ans: B Feedback: Ideally, both arms and hands are carefully inspected before choosing a specific venipuncture site that does not interfere with mobility. Instruct the patient to hold his arm in a dependent position to increase blood flow. Never leave a tourniquet in place longer than 2 minutes. The site does not necessarily need to be devoid of hair.

The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to the educational programs that teach nurses and members of other health professions. According to this report, what activity should educational institutions prioritize? A) More clearly delineate each professions scope of practice during education B) Move toward developing a single health curriculum that can be adapted for any health profession C) Include interdisciplinary core competencies into curricula D) Elicit input from patients and families into health care curricula

Ans: C Feedback: Health Professions Education: A Bridge to Quality challenged health professions education programs to integrate interdisciplinary core competencies into their respective curricula to include patient-centered care, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input, or a single curriculum

Professional nursing expands and grows because of factors driven by the changing needs of health care consumers. Which of the following is a factor that nurses should reflect in the planning and provision of health care? A) Decreased access to health care information by individuals B) Gradual increases in the cultural unity of the American population C) Increasing mean and median age of the American population D) Decreasing consumer expectations related to health care outcomes

Ans: C Feedback: The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer school-age children and more senior citizens, many of whom are women. The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. Access to information and consumer expectations continue to increase

Nurses in acute care settings must work with other health care team members to maintain quality care while facing pressures to care for patients who are hospitalized for shorter periods of time than in the past. To ensure positive health outcomes when patients return to their homes, what action should the nurse prioritize? A) Promotion of health literacy during hospitalization B) Close communication with insurers C) Thorough and evidence-based discharge planning D) Participation in continuing education initiatives

Ans: C Feedback: Following discharges that occur after increasingly short hospital stays, nurses in the community care for patients who need high-technology acute care services as well as long-term care in the home. This is dependent on effective discharge planning to a greater degree than continuing education, communication with insurers, or promotion of health literacy.

A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within this framework of understanding, what would be the nurses first priority? A) Allowing the family to see a newly admitted patient B) Ambulating the patient in the hallway C) Administering pain medication D) Teaching the patient to self-administer insulin safely

Ans: C Feedback: In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family addresses a higher level need related to love and belonging. Teaching the patient is also a higher level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the patient can address these higher levelg needs

CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states, what right do CNPs have that RNs do not possess? A) Perform health interventions independently B) Make referrals to members of other health disciplines C) Prescribe medications D) Perform surgery independently

Ans: C Feedback: In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope of practice and all professional nurses may perform interventions and make certain referrals

A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of needs, what dimension of care should the nurse consider primary in importance when caring for a dying patient? A) Spiritual B) Social C) Physiologic D) Emotional

Ans: C Feedback: Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patients strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for a dying patient, though each should certainly be addressed

The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. How should the nurse always start the process of insertion? A) Leave one hand ungloved to assess the site. B) Cleanse the skin with normal saline. C) Ask the patient about allergies to latex or iodine. D) Remove excessive hair from the selected site

Ans: C Feedback: Before preparing the skin, the nurse should ask the patient if he or she is allergic to latex or iodine, which are products commonly used in preparing for IV therapy. A local reaction could result in irritation to the IV site, or, in the extreme, it could result in anaphylaxis, which can be life threatening. Both hands should always be gloved when preparing for IV insertion, and latex-free gloves must be used or the patient must report not having latex allergies. The skin is not usually cleansed with normal saline prior to insertion. Removing excessive hair at the selected site is always secondary to allergy inquiry.

You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patients signs and symptoms? A) Hypocalcemia B) Hyponatremia C) Hyperchloremia D) Hypophosphatemia

Ans: C Feedback: The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma. A high chloride level is accompanied by a high sodium level and fluid retention. With hypocalcemia, you would expect tetany. There would not be edema with hyponatremia. Signs or symptoms of hypophosphatemia are mainly neurologic.

A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site? A) Leave the hair intact. B) Shave the area. C) Clip the hair in the area. D) Remove the hair with a depilatory.

Ans: C Feedback: Hair can be a source of infection and should be removed by clipping; it should not be left at the site. Shaving the area can cause skin abrasions, and depilatories can irritate the skin.

A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospitals leadership? A) Decreased need for physician services B) Improved patient and family education C) Increased adherence to the principles of EBP D) Increased coordination of health services

Ans: D Feedback: Case management is a system of coordinating health care services to ensure cost-effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies. Reducing the need for physician services is not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role

The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a large, university medical center according to core measures. Evaluators should perform this evaluation in what way? A) By auditing the medical centers electronic health records B) By performing focus groups and interviews with care providers from numerous disciplines C) By performing statistical analysis of patient satisfaction surveys D) By comparing the centers patient outcomes to best practice indicators

Ans: D Feedback: Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seek treatment for a specific disease or who need a specific treatment as compared to evidence-based guidelines and standards of care. Benchmark standards of quality are used to compare the care or treatment patients receive with the best practice standards. Patient satisfaction is considered, but this is not the only criterion

The home health nurse is assisting a patient and his family in planning the patients return to work after surgery and the development of postsurgical complications. The nurse is preparing a plan of care that addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the patients need for self-fulfillment relate? A) Physiologic B) Transcendence C) Love and belonging D) Self-actualization

Ans: D Feedback: Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does not relate directly to them

With increases in longevity, people have had to become more knowledgeable about their health and the professional health care that they receive. One outcome of this phenomenon is the development of organized self-care education programs. Which of the following do these programs prioritize? A) Adequate prenatal care B) Government advocacy and lobbying C) Judicious use of online communities D) Management of illness

Ans: D Feedback: Organized self-care education programs emphasize health promotion, disease prevention, management of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and Internet activities are secondary

A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched within the past decade. In this role, the nurse should prioritize which of the following activities? A) Acting as a spokesperson for the nursing profession B) Generating and disseminating new nursing knowledge C) Diagnosing and treating health problems that have a predictable course D) Helping patients to navigate the health care system

Ans: D Feedback: The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical leadership, educated to help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role

A group of nursing students are participating in a community health clinic. When providing care in this context, what should the students teach participants about disease prevention? A) It is best achieved through attending self-help groups. B) It is best achieved by reducing psychological stress. C) It is best achieved by being an active participant in the community. D) It is best achieved by exhibiting behaviors that promote health

Ans: D Feedback: Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle

Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of practice for the nurse in todays health care environment is home health care. What is the main basis for the growth in this health care setting? A) Chronic nursing shortage B) Western focus on treatment of disease C) Nurses preferences for day shifts instead of evening or night shifts D) Discharge of patients who are more critically ill

Ans: D Feedback: With shorter hospital stays and increased use of outpatient health care services, more nursing care is provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting

The nurse is preparing discharge teaching for a 51-year-old woman diagnosed with urinary retention secondary to multiple sclerosis. The nurse will teach the patient to self-catheterize at home upon discharge. What teaching method is most likely to be effective for this patient? A) A list of clear instructions written at a sixth-grade level B) A short video providing useful information and demonstrations C) An audio-recorded version of discharge instructions that can be accessed at home D) A discussion and demonstration between the nurse and the patient

Ans: D Feedback: Demonstration and practice are essential ingredients of a teaching program, especially when teaching skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. When special equipment is involved, such as urinary catheters, it is important to teach with the same equipment that will be used in the home setting. A list of instructions, a video, and an audio recording are effective methods of reinforcing teaching after the discussion and demonstration have taken place.

A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1 diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had several admissions to the hospital medical unit, and the nurse has often carried out health promotion interventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health? A) The medical nurse B) The community health nurse who has also worked with Mrs. Griffin C) Mrs. Griffins primary care provider D) Mrs. Griffin

Ans: D Feedback: American society places a great importance on health and the responsibility that each of us has to maintain and promote our own health. Therefore, the other options are incorrect.

An adult patient will be receiving outpatient intravenous antibiotic therapy for the treatment of endocarditis. The nurse is preparing to perform health education to ensure the patients adherence to the course of treatment. Which of the following assessments should be the nurses immediate priority? A) Patients understanding of the teaching plan B) Quality of the patients relationships C) Patients previous medical history D) Characteristics of the patients culture

Ans: D Feedback: Before beginning health teaching, nurses must conduct an individual cultural assessment instead of relying only on generalized assumptions about a particular culture. This is likely a priority over previous medical history and relationships, though these are relevant variables. The teaching plan would not be created at this early stage in the teaching process.

A nurse is planning care for an older adult who lives with a number of chronic health problems. For which of the following nursing diagnoses would education of the patient be the nurses highest priority? A) Risk for impaired physical mobility related to joint pain B) Functional urinary incontinence related decreased mobility C) Activity intolerance related to contractures D) Risk for ineffective health maintenance related to nonadherence to therapeutic regimen

Ans: D Feedback: For some nursing diagnoses, education is a primary nursing intervention. These diagnoses include risk for ineffective management of therapeutic regimen, risk for impaired home management, health-seeking behaviors, and decisional conflict. The other options do not have patient education as the highest priority, though each necessitates a certain degree of education

A public health nurse understands that health promotion should continue across the lifespan. When planning health promotion initiatives, when in the lifespan should health promotion begin? A) Adolescence B) School age C) Preschool D) Before birth

Ans: D Feedback: Health promotion should begin prior to birth because the health practices of a mother prior to the birth of her child can be influenced positively or negatively. This makes the other options incorrect.

The nursing profession and nurses as individuals have a responsibility to promote activities that foster well-being. What factor has most influenced nurses abilities to play this vital role? A) Nurses are seen as nurturing professionals. B) Nurses possess a baccalaureate degree as the entry to practice. C) Nurses possess an authentic desire to help others. D) Nurses have long-established credibility with the public.

Ans: D Feedback: Nurses, by virtue of their expertise in health and health care and their long-established credibility with consumers, play a vital role in health promotion. The other options are incorrect because they are not the most influential when it comes to health promotion by nursing and nurses.

20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin. When planning the appropriate educational interventions and considering variables that will affect his learning, the nurse should prioritize which of the following factors? A) Patients expected lifespan B) Patients gender C) Patients occupation D) Patients culture

Ans: D Feedback: One of the major variables that influences a patients readiness to learn is the patients culture, because it affects how a person learns and what information is learned. Other variables include illness states, values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables that are usually less salient

The nurse is planning to teach a 75-year-old patient with coronary artery disease about administering her prescribed antiplatelet medication. How can the nurse best enhance the patients ability to learn? A) Provide links to Web sites that contain evidence-based information. B) Exclude family members from the session to prevent distraction. C) Use color-coded materials that are succinct and engaging. D) Make the information directly relevant to the patients condition.

Ans: D Feedback: Studies have shown that older adults can learn and remember if the information is paced appropriately, relevant, and followed by appropriate feedback. Family members should be included in health education. The nurse should not assume that the patients color vision is intact or that the patient possesses adequate computer skills.

A school nurse is facilitating a health screening program among junior high school students. What purpose of health screening should the nurse prioritize when planning this program? A) To teach students about health risks that they can expect as they grow and develop B) To evaluate the treatment of students current health problems C) To identify the presence of infectious diseases D) To detect health problems at an early age so they can be treated promptly

Ans: D Feedback: The goal of health screening in the adolescent population has been to detect health problems at an early age so that they can be treated at this time. An additional goal includes efforts to promote positive health practices at an early age. The focus is not on anticipatory guidance or evaluation of treatment. Health screening includes infectious diseases, but is not limited to these.

A nurse who provides care at the campus medical clinic of a large university focuses many of her efforts on health promotion. What purpose of health promotion should guide the nurses efforts? A) To teach people how to act within the limitations of their health B) To teach people how to grow in a holistic manner C) To change the environment in ways that enhance cultural expectations D) To influence peoples behaviors in ways that reduce risks

Ans: D Feedback: The purpose of health promotion is to focus on the persons potential for wellness and to encourage appropriate alterations in personal habits, lifestyle, and environment in ways that reduce risks and enhance health and well-being. The other options are incorrect because the purpose of health promotion is not to teach people how to grow in a holistic manner, to accommodate their limitations, or to change the environment in ways that enhances cultural expectations.

You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results? A) Respiratory acidosis with no compensation B) Metabolic alkalosis with a compensatory alkalosis C) Metabolic acidosis with no compensation D) Metabolic acidosis with a compensatory respiratory alkalosis

Ans: D Feedback: A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO3 is also low, which causes alkalosis. The bicarbonate is low, which causes acidosis. The pH bicarbonate more closely corresponds with a decrease in pH, making the metabolic component the primary problem

You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patients plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patients health? A) Nutritional status B) Potassium balance C) Calcium balance D) Fluid volume status

Ans: D Feedback: A specific gravity will detect if the patient has a fluid volume deficit or fluid volume excess. Nutrition, potassium, and calcium levels are not directly indicated.

When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? A) Active transport of hydrogen ions across the capillary walls B) Pressure of the blood in the renal capillaries C) Action of the dissolved particles contained in a unit of blood D) Hydrostatic pressure resulting from the pumping action of the heart

Ans: D Feedback: An example of filtration is the passage of water and electrolytes from the arterial capillary bed to the interstitial fluid; in this instance, the hydrostatic pressure results from the pumping action of the heart. Active transport does not move water and electrolytes from the arterial capillary bed to the interstitial fluid, filtration does. The number of dissolved particles in a unit of blood is concerned with osmolality. The pressure in the renal capillaries causes renal filtration.

A patients most recent laboratory results show a slight decrease in potassium. The physician has opted to forego drug therapy but has suggested increasing the patients dietary intake of potassium. Which of the following would be a good source of potassium? A) Apples B) Asparagus C) Carrots D) Bananas

Ans: D Feedback: Bananas are high in potassium. Apples, carrots, and asparagus are not high in potassium

You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis? A) Hypertension B) Kussmaul respirations C) Increased DTRs D) Shallow respirations

Ans: D Feedback: If hypermagnesemia is suspected, the nurse monitors the vital signs, noting hypotension and shallow respirations. The nurse also observes for decreased DTRs and changes in the level of consciousness. Kussmaul breathing is a deep and labored breathing pattern associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA), but also renal failure. This type of patient is associated with decreased DTRs, not increased DTRs

Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis? A) Metastases B) Excessive potassium intake C) Water intoxication D) Excessive administration of chloride

Ans: D Feedback: Normal anion gap acidosis results from the direct loss of bicarbonate, as in diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate). Based on these facts, the other listed options are incorrect.

The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acidbase disorder? A) Respiratory acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Mixed acidbase disorder

Ans: D Feedback: Patients can simultaneously experience two or more independent acidbase disorders. A normal pH in the presence of changes in the PaCO2 and plasma HCO3 concentration immediately suggests a mixed disorder, making the other options incorrect.

Our world is connected by a sophisticated communication system that makes much health information instantly accessible, no matter where the patient is being treated. This instant access to health information has impacted health care delivery strategies, including the delivery of nursing care. What is one way the delivery of health care has been impacted by this phenomenon? A) Brisk changes as well as swift obsolescence B) Rapid change that is nearly permanent C) Limitations on the settings where care can be provided D) Increased need for social acceptance

Ans: A Feedback: The sophisticated communication systems that connect most parts of the world, with the capability of rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift obsolescence in health care delivery strategies. The other answers are incorrect because, although we have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care itself evolves. Giving nursing care has not become easier, it becomes more complex with every change; and it does not need to be more socially acceptable; it needs to be more culturally sensitive

Nurses who are providing patient education often use motivators for learning with patients who are struggling with behavioral changes necessary to adhere to a treatment regimen. When working with a 15-year-old boy who has diabetes, which of the following motivators is most likely to be effective? A) A learning contract B) A star chart C) A point system D) A food-reward system

Ans: A Feedback: Using a learning contract or agreement can also be a motivator for learning. Such a contract is based on assessment of patient needs; health care data; and specific, measurable goals. Young adults would not respond well to the use of star charts, point systems, or food as reward for behavioral change. These types of motivators would work better with children.

A public health nurse is planning educational interventions that are based on Beckers Health Belief Model. When identifying the variables that affect local residents health promotion behaviors, what question should the nurse seek to answer? A) Do residents believe that they have ready access to health promotion resources? B) Why have previous attempts at health promotion failed? C) How much funding is available for health promotion in the community? D) Who is available to provide health promotion education in the local area?

Ans: A Feedback: Barriers, Beckers second variable, are defined as factors leading to unavailability or difficulty in gaining access to a specific health promotion alternative. The other listed questions do not directly relate to the four variables that Becker specified.

A nurse recognizes that individuals of different ages have specific health promotion needs. When planning to promote health among young adults, what subject is most likely to meet this demographic groups learning needs? A) Family planning B) Management of risky behaviors C) Physical fitness D) Relationship skills training

Ans: A Feedback: Because of the nationwide emphasis on health during the reproductive years, young adults actively seek programs that address prenatal health, parenting, family planning, and womens health issues. The other options are incorrect because they are not health promotion classes typically sought out by young adults.

You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of your patients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior best demonstrates this patients willingness to learn? A) The patient requests a visit from the hospitals diabetic educator. B) The patient sets aside a dessert brought in by a family member. C) The patient wants a family member to meet with the dietician to discuss meals. D) The patient readily allows the nurse to measure his blood glucose level.

Ans: A Feedback: Emotional readiness also affects the motivation to learn. A person who has not accepted an existing illness or the threat of illness is not motivated to learn. The patients wiliness to learn is expressed through the action of seeking information on his or her own accord. Seeking information shows an emotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn.

The nurse is teaching a local community group about the importance of disease prevention. Why is the nurse justified in emphasizing disease prevention as a component of health promotion? A) Prevention is emphasized as the link between personal behavior and health. B) Most Americans die of preventable causes. C) Health maintenance organizations (HMOs) now emphasize prevention as the main criterion of health care. D) External environment affects the outcome of most disease processes.

Ans: A Feedback: Healthy People 2020 defines the current national health-promotion and disease-prevention initiative for the nation. The overall goals are to (1) increase the quality and years of healthy life for people and (2) eliminate health disparities among various segments of the population. Most deaths are not classified as being preventable. HMO priorities do not underlie this emphasis. The external environment affects many disease processes, but the course of illness is primarily determined by factors intrinsic to the patient.

Health promotion ranks high on the list of health-related concerns of the American public. Based on current knowledge, what factor should the nurse prioritize in an effort to promote health, longevity, and weight control in patients? A) Good nutrition B) Stress reduction C) Use of vitamins D) Screening for health risks

Ans: A Feedback: It has been suggested that good nutrition is the single most significant factor in determining health status, longevity, and weight control. A balanced diet that uses few artificial ingredients and is low in fat, caffeine, and sodium constitutes a healthy diet. Stress reduction and screening for health risks are correct answers, just not the most significant factors. Vitamin use is not normally necessary when an individual eats a healthy diet, except in specific circumstances.

A public health nurse is assessing the nutritional awareness of a group of women who are participating in a prenatal health class. What outcome would most clearly demonstrate that the women possess nutritional awareness? A) The women demonstrate an understanding of the importance of a healthy diet. B) The women are able to describe the importance of vitamin supplements during pregnancy. C) The women can list the minerals nutrients that should be consumed daily. D) The women can interpret the nutrition facts listed on food packaging

Ans: A Feedback: Nutritional awareness involves an understanding of the importance of a healthy diet that supplies all of the essential nutrients. The other options are incorrect because vitamin supplements are not necessary for a healthy diet, a certain amount of all minerals need to be eaten daily, and understanding what constitutes the recommended daily nutrients is not necessary for nutritional awareness.

You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patients labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults? A) Substantially reduced renal function B) Acute kidney injury C) Decreased cardiac output D) Alterations in ratio of body fluids to muscle mass

Ans: A Feedback: Normal physiologic changes of aging, including reduced cardiac, renal, and respiratory function, and reserve and alterations in the ratio of body fluids to muscle mass, may alter the responses of elderly people to fluid and electrolyte changes and acidbase disturbances. Renal function declines with age, as do muscle mass and daily exogenous creatinine production. Therefore, high-normal and minimally elevated serum creatinine values may indicate substantially reduced renal function in older adults. Acute kidney injury is likely to cause a more significant increase in serum creatinine.

You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients most recent laboratory reports, you note that the patients magnesium levels are high. You should prioritize assessment for which of the following health problems? A) Diminished deep tendon reflexes B) Tachycardia C) Cool, clammy skin D) Acute flank pain

Ans: A Feedback: To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.

Middle-aged adults are part of an age group that is known to be interested in health and health promotion, and the nurse is planning health promotion activities accordingly. To what suggestions do members of this age group usually respond with enthusiasm? Select all that apply. A) How lifestyle practices can improve health B) How to eat healthier C) How exercise can improve your life D) Strategies for adhering to prescribed therapy E) Exercise for the aging

Ans: A, B, C Feedback: Young and middle-aged adults represent an age group that not only expresses an interest in health and health promotion but also responds enthusiastically to suggestions that show how lifestyle practices can improve health; these lifestyle practices include nutrition and exercise. Middle-aged adults may not respond positively to teaching aimed at the aging. Adherence is not noted to be a desired focus in this age group.

A parish nurse is describing the relationships between health and physical fitness to a group of older adults who all attend the same church. What potential benefits of a regular exercise program should the nurse describe? Select all that apply. A) Decreased cholesterol levels B) Delayed degenerative changes C) Improved sensory function D) Improved overall muscle strength E) Increased blood sugar levels

Ans: A, B, D Feedback: Clinicians and researchers who have examined the relationship between health and physical fitness have found that a regular exercise program can promote health in the following ways: by decreasing cholesterol and low-density lipoprotein levels; delaying degenerative changes, such as osteoporosis; and improving flexibility and overall muscle strength and endurance. Physical fitness does not improve the senses or increase blood sugar.

You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that apply. A) Milk B) Beef C) Poultry D) Green vegetables E) Liver

Ans: A, C, E Feedback: If the patient experiences mild hypophosphatemia, foods such as milk and milk products, organ meats, nuts, fish, poultry, and whole grains should be encouraged.

You are the clinic nurse providing patient education to a teenage girl who was diagnosed 6 months ago with type 1 diabetes. Her hemoglobin A1C results suggest she has not been adhering to her prescribed treatment regimen. As the nurse, what variables do you need to assess to help this patient better adhere to her treatment regimen? Select all that apply. A) Variables that affect the patients ability to obtain resources B) Variables that affect the patients ability to teach her friends about diabetes C) Variables that affect the patients ability to cure her disease D) Variables that affect the patients ability to maintain a healthy social environment E) Variables that affect the patients ability to adopt specific behaviors

Ans: A, D, E Feedback: Nurses success with health education is determined by ongoing assessment of the variables that affect a patients ability to adopt specific behaviors, to obtain resources, and to maintain a healthy social environment. The patients ability to teach her friends about her condition is not a variable that the nurse would likely assess when educating the patient about her treatment regimen. Type 1 diabetes is not curable.

A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply. A) Decreased kidney mass B) Increased conservation of sodium C) Increased total body water D) Decreased renal blood flow E) Decreased excretion of potassium

Ans: A, D, E Feedback: Dehydration in the elderly is common as a result of decreased kidney mass, decreased glomerular filtration rate, decreased renal blood flow, decreased ability to concentrate urine, inability to conserve sodium, decreased excretion of potassium, and a decrease of total body water.

The view that health and illness are not static states but that they exist on a continuum is central to professional health care systems. When planning care, this view aids the nurse in appreciating which of the following? A) Care should focus primarily on the treatment of disease. B) A persons state of health is ever-changing C) A person can transition from health to illness rapidly. D) Care should focus on the patients compliance with interventions

Ans: B Feedback: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The other answers are incorrect because patient care should not focus just on the treatment of disease. Rapid declines in health and compliance with treatment are not key to this view of health

As the nurse working in a gerontology clinic, you know that some elderly people do not adhere to therapeutic regimens because of chronic illnesses that require long-term treatment by several health care providers. What is the most important consideration when dealing with this segment of the population? A) Health care professionals must know all the dietary supplements the patient is taking. B) Health care professionals must work together to provide coordinated care. C) Health care professionals may negate the efforts of another health care provider. D) Health care professionals must have a peer witness their interactions with the patient.

Ans: B Feedback: Above all, health care professionals must work together to provide continuous, coordinated care; otherwise, the efforts of one health care professional may be negated by those of another. Interactions do not necessarily need to be witnessed. The care team should be aware of the patients use of supplements, but this is not a priority principle that guides overall care.

A community health nurse has been asked to participate in a health fair that is being sponsored by the local senior center. The nurse should select educational focuses in the knowledge that older adults benefit most from what kind of activities? A) Those that help them eat well B) Those that help them maintain independence C) Those that preserve their social interactions D) Those that promote financial stability

Ans: B Feedback: Although their chronic illnesses and disabilities cannot be eliminated, the elderly can benefit most from activities that help them maintain independence and achieve an optimal level of health. For many older adults, this is a priority over social interaction, finances, or eating well, even though each of these subjects is important

A team of public health nurses are doing strategic planning and are discussing health promotion activities for the next year. Which of the following initiatives best exemplifies the principles of health promotion? A) A blood pressure clinic at a local factory B) A family planning clinic at a community center C) An immunization clinic at the largest local mall D) A workplace safety seminar

Ans: B Feedback: Health promotion may be defined as those activities that assist people in developing resources that maintain or enhance well-being and improve their quality of life. A family planning clinic meets these criteria most closely. Workplace health and safety would be considered a protection service. A blood pressure clinic and immunization clinic would fall under the category of preventive services.

A nurse is working with a male patient who has recently received a diagnosis of human immunodeficiency virus (HIV). When performing patient education during discharge planning, what goal should the nurse emphasize most strongly? A) Encourage the patient to exercise within his limitations. B) Encourage the patient to adhere to his therapeutic regimen. C) Appraise the patients level of nutritional awareness. D) Encourage a disease-free state,

Ans: B Feedback: One of the goals of patient education is to encourage people to adhere to their therapeutic regimen. This is a very important goal because if patients do not adhere to their therapeutic regimen, they will not attain their optimal level of wellness. In this patients circumstances, this is likely a priority over exercise or nutrition, though these are important considerations. A disease-free state is not obtainable.

A nurse has been studying research that examines the association between stress levels and negative health outcomes. Which relationship should underlie the educational interventions that the nurse chooses to teach? A) Stress impairs sleep patterns. B) Stress decreases immune function. C) Stress increases weight. D) Stress decreases concentration.

Ans: B Feedback: Studies have shown the negative effects of stress on health and a cause-and-effect relationship between stress and infectious diseases, traumatic injuries (e.g., motor vehicle crashes), and some chronic illnesses. It is well known that stress decreases the immune response, thereby making individuals more susceptible to infectious diseases. The other options can also be correct in certain individuals, but they are not those that best support stress-reduction initiatives.

A public health nurse is preparing to hold a series of health-promotion classes for middle-aged adults that will address a variety of topics. Which site would best meet the learning needs of this population? A) A well-respected physicians office B) A large, local workplace C) The local hospital D) An ambulatory clinic

Ans: B Feedback: The workplace has become a center for health-promotion activity. Health-promotion programs can generally be offered almost anywhere in the community, but the workplace is often more convenient for the adult, working population. This makes this option preferable to a hospital, doctors office, or ambulatory clinic.

An elderly female patient has come to the clinic for a scheduled follow-up appointment. The nurse learns from the patients daughter that the patient is not following the instructions she received upon discharge from the hospital last month. What is the most likely factor causing the patient not to adhere to her therapeutic regimen? A) Ethnic background of health care provider B) Costs of the prescribed regimen C) Presence of a learning disability D) Personality of the physician

Ans: B Feedback: Variables that appear to influence the degree of adherence to a prescribed therapeutic regimen include gender, race, education, illness, complexity of the regimen, and the cost of treatments. The ethnic background of the health care provider and the personality of the physician are not considered variables that appear to influence the degree of adherence to a prescribed therapeutic regimen. A learning disability could greatly affect adherence, but cost is a more likely barrier.

A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? A) Hydrostatic pressure B) Osmosis and osmolality C) Diffusion D) Active transport

Ans: B Feedback: Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume changes.

The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses best response? A) I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup. B) Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids. C) It is normal to be a little confused following surgery, and it is safe not to urinate at night. D) If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress.

Ans: B Feedback: In elderly patients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person. There is no mention of medications in the stem of the question or any specific evidence given for the need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly. Urinary retention does normally cause confusion.

The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit? A) Diarrhea B) Dilute urine C) Increased muscle tone D) Joint pain

Ans: B Feedback: Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling), and dysrhythmias. If prolonged, hypokalemia can lead to an inability of the kidneys to concentrate urine, causing dilute urine (resulting in polyuria, nocturia) and excessive thirst. Potassium depletion suppresses the release of insulin and results in glucose intolerance. Decreased muscle strength and DTRs can be found on physical assessment. You would expect decreased, not increased, muscle strength with hypokalemia. The patient would not have diarrhea following bowel surgery, and increased bowel motility is inconsistent with hypokalemia.

You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect? A) Hypophosphatemia B) Hypocalcemia C) Hypermagnesemia D) Hyperkalemia

Ans: B Feedback: Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include paresthesias and anxiety.

A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. C) The kidneys react rapidly to compensate for imbalances in the body. D) The kidneys regulate the bicarbonate level in the intracellular fluid.

Ans: B Feedback: The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. The kidneys obviously cannot compensate for the metabolic acidosis created by renal failure. Renal compensation for imbalances is relatively slow (a matter of hours or days).

A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acidbase imbalance? A) Respiratory acidosis B) Respiratory alkalosis C) Increased PaCO2 D) CNS disturbances

Ans: B Feedback: The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to hyperventilation. Acute respiratory acidosis occurs in emergency situations, such as pulmonary edema, and is exhibited by hypoventilation and decreased PaCO2 . CNS disturbances are found in extreme hyponatremia and fluid overload.

You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patients admission total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN slowly? A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly. B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively. C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia. D) Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate

Ans: B Feedback: The nurse identifies patients who are at risk for hypophosphatemia and monitors them. Because malnourished patients receiving parenteral nutrition are at risk when calories are introduced too aggressively, preventive measures involve gradually introducing the solution to avoid rapid shifts of phosphorus into the cells. Patients receiving TPN are not at risk for hypercalcemia or hypernatremia if calories or fluids are started to rapidly. Digestive enzymes are not a relevant consideration.

You are the nurse planning to teach tracheostomy care to a patient who will be discharged home following a spinal cord injury. When preparing your teaching, which of the following is the most important component of your teaching plan? A) Citing the evidence that underlies each of your teaching points B) Alleviating the patients guilt associated with not knowing appropriate self-care C) Determining the patients readiness to learn new information D) Including your nursing colleagues in the planning process

Ans: C Feedback: Assessment in the teachinglearning process is directed toward the systematic collection of data about the person and familys learning needs and readiness to learn. Patient readiness is critical to accepting and integrating new information. Unless the patient is ready to accept new information, patient teaching will be ineffective. Citing the evidence base will not likely enhance learning. Patient guilt cannot be alleviated until the patient understands the intricacies of the condition and his physiologic response to the disease. Inclusion of colleagues can be beneficial, but this does not determine the success or failure of teaching

A nurse is working with a teenage boy who was recently diagnosed with asthma. During the current session, the nurse has taught the boy how to administer his bronchodilator by metered-dose inhaler. How should the nurse evaluate the teachinglearning process? A) Ask the boy specific questions about his medication. B) Ask the boy whether he now understands how to use his inhaler. C) Directly observe the boy using his inhaler to give himself a dose. D) Assess the boys respiratory health at the next scheduled visit

Ans: C Feedback: Demonstration and practice are essential ingredients of a teaching program, especially when teaching skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. By observing the patient using the inhaler, the nurse may identify what learning needs to be enhanced or reinforced. Asking questions is not as an accurate gauge of learning. Respiratory assessment is a relevant, but indirect, indicator of learning. Delaying the appraisal of the patients technique until a later clinic visit is inappropriate because health problems could occur in the interval.

Positive patient outcomes are the ultimate goal of nursepatient interactions, regardless of the particular setting. Which of the following factors has the most direct influence on positive patient-care outcomes? A) Patients age B) Patients ethnic heritage C) Health education D) Outcome evaluation

Ans: C Feedback: Health education is an influential factor directly related to positive patient-care outcomes. The other options are incorrect because ethnicity, the patients age, and outcome evaluation are less influential factors related to positive patient-care outcomes, though each factor should be considered when planning care

A nursing student is collaborating with a public health nurse on a local health promotion initiative and they recognize the need for a common understanding of health. How should the student and the nurse best define health? A) Health is an outcome systematically maximizing wellness. B) Health is a state that is characterized by a lack of disease. C) Health is a condition that enables people to function at their optimal potential. D) Health is deliberate attempt to mitigate the effects of disease.

Ans: C Feedback: Health is viewed as a dynamic, ever-changing condition that enables people to function at an optimal potential at any given time. Health does not necessarily denote the absence of disease, an effort to maximize wellness, or mitigate the effects of disease.

The nursing instructor has given an assignment to a group of certified nurse practitioner (CNP) students. They are to break into groups of four and complete a health-promotion teaching project and present a report to their fellow students. What project most clearly demonstrates the principles of health- promotion teaching? A) Demonstrating an injection technique to a patient for anticoagulant therapy B) Explaining the side effects of a medication to an adult patient C) Discussing the importance of preventing sexually transmitted infections (STI) to a group of high school students D) Instructing an adolescent patient about safe and nutritious food preparation

Ans: C Feedback: Health promotion encourages people to live a healthy lifestyle and to achieve a high level of wellness. Discussing the importance of STI prevention to a group of high school students is the best example of a health-promotion teaching project. This proactive intervention is a more precise example of health promotion than the other cited examples

The nurse is working with a male patient who has diagnoses of coronary artery disease and angina pectoris. During a clinic visit, the nurse learns that he has only been taking his prescribed antiplatelet medication when he experiences chest pain and fatigue. What nursing diagnosis is most relevant to this assessment finding? A) Acute pain related to myocardial ischemia B) Confusion related to mismanagement of drug regimen C) Ineffective health maintenance related to inappropriate medication use D) Ineffective role performance related to inability to manage medications

Ans: C Feedback: This patients actions suggest that by taking his medications incorrectly he is not adequately maintaining his health. Role performance is not directly applicable to the patients actions and confusion suggests a cognitive deficit. Pain is not central to the essence of the problem.

A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A patient in renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability? A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH. B) The kidneys buffer acids through electrolyte changes. C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.

Ans: C Feedback: The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs regulate and reabsorb carbonic acid to change and maintain pH. The kidneys do not buffer acids through electrolyte changes; buffering occurs in reaction to changes in pH. Carbonic acid works as the chemical medium to exchange O2 and CO2 in the lungs to maintain a stable pH whereas the kidneys use bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+

One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will achieve which of the following? A) Help distinguish hyponatremia from hypernatremia B) Help evaluate pituitary gland function C) Help distinguish reduced renal blood flow from decreased renal function D) Help provide an effective treatment for hypertension-induced oliguria

Ans: C Feedback: If a patient is not excreting enough urine, the health care provider needs to determine whether the depressed renal function is the result of reduced renal blood flow, which is a fluid volume deficit (FVD or prerenal azotemia), or acute tubular necrosis that results in necrosis or cellular death from prolonged FVD. A typical example of a fluid challenge involves administering 100 to 200 mL of normal saline solution over 15 minutes. The response by a patient with FVD but with normal renal function is increased urine output and an increase in blood pressure. Laboratory examinations are needed to distinguish hyponatremia from hypernatremia. A fluid challenge is not used to evaluate pituitary gland function. A fluid challenge may provide information regarding hypertension-induced oliguria, but it is not an effective treatment.

You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patients skin turgor? A) Overhydration is common among healthy older adults. B) Dehydration causes the skin to appear spongy. C) Inelastic skin turgor is a normal part of aging. D) Skin turgor cannot be assessed in patients over 70.

Ans: C Feedback: Inelastic skin is a normal change of aging. However, this does not mean that skin turgor cannot be assessed in older patients. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy.

You are making initial shift assessments on your patients. While assessing one patients peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy? A) Air emboli B) Phlebitis C) Infiltration D) Fluid overload

Ans: C Feedback: Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid overload are not indications of infiltration

You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the mornings blood work, you notice that the patients potassium is below reference range. You should recognize that the patient may be at risk for what imbalance? A) Hypercalcemia B) Metabolic acidosis C) Metabolic alkalosis D) Respiratory acidosis

Ans: C Feedback: Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia. This patient would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost all cases of hypercalcemia. The nasogastric tube is removing stomach acid and will likely raise pH. Respiratory acidosis is unlikely since no change was reported in the patients respiratory status.

The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could cause inadequate ventilation? A) Endocarditis B) Multiple myeloma C) Guillain-Barr syndrome D) Overdose of amphetamines

Ans: C Feedback: Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations and, consequently, increased levels of carbonic acid. Acute respiratory acidosis occurs in emergency situations, such as acute pulmonary edema, aspiration of a foreign object, atelectasis, pneumothorax, overdose of sedatives, sleep apnea, administration of oxygen to a patient with chronic hypercapnia (excessive CO2 in the blood), severe pneumonia, and acute respiratory distress syndrome. Respiratory acidosis can also occur in diseases that impair respiratory muscles, such as muscular dystrophy, myasthenia gravis, and Guillain-Barr syndrome. The other listed diagnoses are not associated with respiratory acidosis.

The nurse is assessing the patient for the presence of a Chvosteks sign. What electrolyte imbalance would a positive Chvosteks sign indicate? A) Hypermagnesemia B) Hyponatremia C) Hypocalcemia D) Hyperkalemia

Ans: C Feedback: You can induce Chvosteks sign by tapping the patients facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvosteks sign. Both hypomagnesemia and hypocalcemia may be tested using the Chvosteks sign.

An occupational health nurse is in the planning stages of a new health promotion campaign in the workplace. When appraising the potential benefits of the program, the nurse should consider that success depends primarily on what quality in the participants? A) Desire to expand knowledge B) Self-awareness C) Adequate time- and task-management D) Taking responsibility for oneself

Ans: D Feedback: Taking responsibility for oneself is the key to successful health promotion, superseding the importance of desire to learn information, self-awareness, or time-management.

The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health? A) Health is being disease free. B) Health is having fulfillment in all domains of life. C) Health is having psychological and physiological harmony. D) Health is being connected in body, mind, and spirit.

Ans: D Feedback: The World Health Organization (WHO) defines health in the preamble to its constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. The other answers are incorrect because they are not congruent with the WHO definition of health.

A group of nursing students are learning about recent changes in the pattern of disease in the United States. Which of the following statements best describes these current changes? A) Infectious diseases continue to decrease in incidence and prevalence. B) Chronic illnesses are becoming increasingly resistant to treatment. C) Most acute, infectious diseases have been eradicated. D) Most, but not all, communicable diseases are declining

Ans: D Feedback: Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibiotic resistance is a more serious problem in acute, not chronic, illnesses

A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurses most likely explanation for the low urine output? A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place. B) The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin. C) The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output. D) The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone system that results in diminished urine output.

Ans: D Feedback: Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of renin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely causing the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall and hip injury would make his ability to urinate difficult. No assessment information indicates he has a head injury or heart failure.

The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect? A) Decrease in the release of aldosterone B) Increase of filtration in the Loop of Henle C) Decrease in the reabsorption of sodium D) Decrease in glomerular filtration

Ans: D Feedback: Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the release of aldosterone, and increases sodium and water reabsorption. None of the other listed options occurs with increased sympathetic stimulation.

You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. During your assessment, you note the patient complains of a new onset of weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume deficit. You should recognize that this patient may be experiencing what electrolyte imbalance? A) Hypernatremia B) Hypomagnesemia C) Hypophosphatemia D) Hypercalcemia

Ans: D Feedback: The most common causes of hypercalcemia are malignancies and hyperparathyroidism. Anorexia, nausea, vomiting, and constipation are common symptoms of hypercalcemia. Dehydration occurs with nausea, vomiting, anorexia, and calcium reabsorption at the proximal renal tubule. Abdominal and bone pain may also be present. Primary manifestations of hypernatremia are neurologic and would not include abdominal pain and dehydration. Tetany is the most characteristic manifestation of hypomagnesemia, and this scenario does not mention tetany. The patients presentation is inconsistent with hypophosphatemia.

You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance? A) Metabolic alkalosis B) Hypermagnesemia C) Hypercalcemia D) Hypovolemia

Ans: D Feedback: Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.

A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurses preceptor is going over the patients past lab reports with the new nurse. The nurse takes note that the patients PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurses best response? A) The patients calcium will rise dramatically due to pituitary stimulation. B) Oxygen will increase the patients intracranial pressure and create confusion. C) Oxygen may cause the patient to hyperventilate and become acidotic. D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.

Ans: D Feedback: When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. No information indicates the patients calcium will rise dramatically due to pituitary stimulation. No feedback system that oxygen stimulates would create an increase in the patients intracranial pressure and create confusion. Increasing the oxygen would not stimulate the patient to hyperventilate and become acidotic; rather, it would cause hypoventilation and acidosis.