Nantroup's SATA Questions

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply.

Ketosis-prone Little or no endogenous insulin Younger than 30 years of age Explanation: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.

The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.

"How long have you experienced this pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." "What aggravates your chest pain?" Explanation: The nurse needs to assess pain as to intensity, timing, location, and aggravating factors. Assessing frequency is important, but the statement "You've never had this pain before, have you" is leading and nontherapeutic.

A nurse is planning the care of a client who has been diagnosed with kidney injury, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply.

Diseases where complete cures are rare Diseases that do not resolve spontaneously Diseases that have a prolonged course Explanation: Chronic conditions can also be defined as illnesses or diseases that have a prolonged course, that do not resolve spontaneously, and for which complete cures are unlikely or rare.

A nurse is caring for a client who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply.

Erythrocyte sedimentation rate C-reactive protein Explanation: Simultaneous elevation in the ESR and CRP has a sensitivity of 88% and a specificity of 98% in making the diagnosis of GCA when coupled with clinical findings. Erythrocyte counts, creatinine clearance, and D-dimer are not diagnostically useful.

A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply.

Foods high in vitamin D Foods high in protein Foods high in calcium Explanation: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.

Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply.

Hydrocortisone Acetaminophen Methimazole Iodine Explanation: Salicylates (i.e., aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply.

Hypothermia Hypotension Hypoventilation Explanation: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply.

May improve blood glucose levels Decrease the need for exogenous insulin Help reduce cholesterol levels Explanation: Increased fiber in the diet may improve blood glucose levels, decrease the need for exogenous insulin, and lower total cholesterol and low-density lipoprotein levels in the blood (ADA, 2008b; Geil, 2008).

The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply.

Pallor Rapid respiratory rate Hypotension Explanation: The client at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.

The nurse is preparing a client for a thyroid test. Which medications that the client is taking should be documented on the laboratory slip as possibly affecting the thyroid test?

Phenytoin Metoclopramide Furosemide Amphetamine Explanation: If a client has recently taken a drug that contains iodine or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate. Other drugs also affect the results of thyroid tests. Phenytoin can lower T4 values. Metoclopramide can raise TSH levels. Amphetamine can lower TSH levels. Furosemide can increase T4 level. Be sure to enter on the laboratory request slip all drugs the client is taking or has taken within the past 3 months. The other drugs do not have relevance to the thyroid test.

A client has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply.

Potassium level Blood pressure Explanation: Clients with aldosteronism exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response, peripheral pulses, and renal function are not directly affected.

The nurse is performing an initial assessment of a client with a disability. The nurse should assess for which condition? Select all that apply.

Abuse Depression Explanation: Clients with a disability are at increased risk for physical, emotional, financial, and sexual abuse. The assessment should also include a screening for depression. The initial assessment of a client with a disability would not include an assessment for psychosis or bipolar disorder unless there client was exhibiting signs/symptoms or had a history of these disorders.

A public health nurse reviews data on chronic illness in the community over time and notes that chronic illness rates are climbing. Which factors may contribute to the increased chronic illness rates? Select all that apply.

A decrease in mortality from infectious diseases An increase in obesity rates Explanation: Chronic illness rates are climbing due in part that there is a decrease in mortality from infectious diseases and an increase in obesity rates. There is not an increase in infectious disease rates, a decrease in client education about chronic illness, or a decrease in global awareness of chronic illness.

The nurse is performing a shift assessment of a client with aldosteronism. What assessments should the nurse include? Select all that apply.

Urine output Blood pressure Explanation: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP. The client's peripheral pulses, risk of VTE, and skin integrity are not typically affected by aldosteronism.

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.

dietary substances environmental factors viruses Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply.

dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.

When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.

muscle weakness cramps and spasms in the legs loss of balance and coordination Explanation: Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply.

Sit in a straight-backed chair with arm rests. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under." Explanation: All choices are correct, except that a soft pillow support is recommended to eradicate the hollow of the back.

Which of the following agents suppress release of thyroid hormones? Select all that apply.

Sodium iodide Potassium iodide Dexamethasone Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, dexamethasone, and SSKI suppress the release of thyroid hormones. Methimazole blocks the synthesis of thyroid hormone.

A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.)

assesses the client for any sun exposure avoids shaving the irradiated skin Explanation: The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage.

The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply.

susceptibility abnormal innate and adaptive immune responses autoantibodies immune complexes inflammation damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply.

Alleviate and manage symptoms Validate individual self-worth Validate family functioning Explanation: The challenges of living with chronic conditions include the need to accomplish the following: alleviate and manage symptoms, validate individual self-worth and family functioning, manage threats to identity, and die with dignity and comfort.

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurse's interview with the client, she admits that she drinks around 600 mL (20 oz) of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.

Breast cancer Esophageal cancer Liver cancer Explanation: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply.

Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client has not consumed sufficient calories. Client has been exercising more than usual. Explanation: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.

A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.

Decrease in serum thyroid-stimulating hormone (TSH) Increased T3 Increased T4 Increase in radioactive iodine uptake Explanation: Laboratory findings include a decrease in serum TSH (with primary disease), increased Ts and T4, and an increase in radioactive iodine uptake.

A client is lethargic with a systolic blood pressure of 74, heart rate of 162 beats/min, and rapid, shallow respirations. Crackles are audible in the lungs. The nurse assesses frequently for which of the following? Select all answers that apply.

Increased paCO² levels Reports of chest pain Loss in consciousness Ecchymoses and petechiae Explanation: The client is in the progressive stage of shock. Continuation of shock leads to organ systems decompensating. The client will retain and exhibit increased levels of carbon dioxide. Because of the dysrhythmias and ischemia, the client may experience chest pain and suffer a myocardial infarction. As the client's lethargy increases, the client will begin to lose consciousness. Metabolic activities of the liver are impaired, and liver enzymes will increase.

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply.

Leakage of fluid or serum (exudates) Microaneurysms Focal capillary single closure Explanation: Almost all patients with type 1 diabetes and the majority of patients with type 2 diabetes have some degree of retinopathy after 20 years (ADA, 2013). Changes in the microvasculature include microaneurysms, intraretinal hemorrhage, hard exudates, and focal capillary closure.

Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply.

Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Explanation: Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands.

Which of the following are clinical manifestations of impingement syndrome? Select all that apply.

Pain Shoulder tenderness Limited movement Muscle spasms Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear.

While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply.

"This must be very difficult for you." "Tell me more about what's on your mind." Explanation: The nurse needs to listen effectively and empathetically, acknowledging the client's fears and concerns. Statements such as "This must be very difficult for you" and "Tell me more about what's on your mind" address the client's concerns and help to focus the discussion on the client. Telling the client that the nurse knows how the client feels ignores the client's concerns. Saying that there is still time for a good life or telling the client to focus on what the doctor has planned ignores the client's feelings and blocks communication.

A client has been admitted to the medical unit for the treatment of Paget disease. When reviewing the medication administration record, the nurse should anticipate what medication?

Bisphosphonates Explanation: Bisphosphonates are the cornerstone of Paget therapy in that they stabilize the rapid bone turnover. Alkaline phosphatase is a naturally occurring enzyme, not a drug. Calcium gluconate and estrogen are not used in the treatment of Paget disease.

Which of the following is an age-related change that may affect diabetes? Select all that apply.

Decreased renal function Taste changes Decreased vision Explanation: Age-related changes include decreased renal function, taste changes, decreased vision, decreased bowel motility, and decreased proprioception.

Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.

Kidney Prostate Lung Breast Ovary Explanation: The most common primary sites of tumors that metastasize to bone are the kidney, prostate, lung, breast, ovary, and thyroid.

A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply.

Provides pain relief Integrates spirituality Offers a team approach to care Enhances quality of life Explanation: The principles of palliative care include providing relief from pain and distressing symptoms. In the early course of disease, chemotherapy and radiation may be used to define care needed, but in the later stages, chemotherapy is typically not used. Psychological support including spirituality and bereavement counseling for family members is available. The care does not hasten nor postpone death but is aimed at enhancing a quality of the life that is remaining. A team approach meets the needs of the client and family.

A nurse is preparing to provide discharge teaching for a hospitalized 19-year-old client who is hearing impaired with functioning hearing aides. The television is on, and several of the client's fraternity brothers are present. What are potential teaching barriers for the nurse? Select all that apply.

television in use fraternity brothers Explanation: Barriers to learning include the television and visitors, which are both potential distractions. Visitors in the room do not promote privacy and confidentiality. The client's age, gender, and hearing impairment should not inhibit the nurse's ability to provide discharge teaching.

A client with diabetes calls the clinic reporting a "flu bug." What should the nurse tell the client to do? Select all that apply.

"Try to eat small amounts of carbs, if possible." "Take your usual dose of insulin." Explanation: For prevention of DKA related to illness, the client should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours and the client should take the usual dose of insulin.

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply.

Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. Explanation: This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.

A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.)

Corticosteroid injections Surgical excision Aspiration of the cyst Explanation: A ganglion—a collection of neurologic gelatinous material near the tendon sheaths and joints—appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. It frequently occurs in women younger than 50 years (Porth & Matfin, 2009). The swelling is locally tender and may cause an aching pain. When a tendon sheath is involved, weakness of the finger occurs. Treatment may include aspiration, corticosteroid injection, or surgical excision. After treatment, a compression dressing and immobilization splint are used.

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.

Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes Explanation: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.

An older adult in the hospital with a fractured hip is being prepared for surgical repair. The bilateral hearing aids were forgotten at the client's home and the client is having difficulty hearing. To promote communication, which of the following actions should the nurse perform? Select all answers that apply.

Talk directly to the client. Use a deeper tone of voice. Ask the client to repeat what was stated. Explanation: Actions that a nurse can take to help a client with hearing loss include the following: talk directly to the client; use a deep tone rather than a high tone; and ask the client to repeat what was stated to ensure understanding. The nurse does not speak in a loud voice, because in doing so, the nurse would use a higher tone, which is more difficult to hear. The nurse should minimize background noises in the room by turning off the television.

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply.

Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases total cholesterol Increases glucose uptake by body muscles Explanation: All of the options are benefits of exercise except the effect of decreasing the levels of HDL. Exercise increases the levels of HDL.

A client and family are dealing with the client's recent terminal diagnosis. A nurse identifies a nursing diagnosis of hopelessness. Which of the following would be most helpful in supporting hope for this family? Select all that apply.

Arranging for appropriate psychosocial counseling Encouraging the client to participate in care to foster control Helping to obtain support from the community Explanation: To enable, support, and foster hope in terminally ill clients and their families, nurses should encourage and support the client's control over circumstances, choices, and environment whenever possible, make referrals for psychosocial and spiritual counseling, and assist with developing supports in the home and community when none exist. Goals set should be realistic, rather than long-term. Information and feelings should be shared. The information provided also should be accurate.

The nurse is working with a client with a chronic condition. The nurse includes which elements in the plan of care? Select all that apply.

Assessment for identity changes Interventions to manage symptoms Interventions to prevent complications Explanation: The nurse should assess for identity changes, plan interventions to manage the client's symptoms, and prevent complications of the chronic condition. Chronic conditions do not resolve spontaneously.

The nurse is working with a coalition that is creating a global strategy to prevent and control diabetes. The nurse suggests which strategies? Select all that apply.

Focusing on healthy lifestyle programming Monitoring incidence and prevalence rates Creating policies for diabetes prevention Partnering with the American Diabetes Association Explanation: Diabetes is a chronic condition. Global action plans for the prevention and control of chronic illness include interventions such as programs to promote healthy lifestyles to reduce modifiable risk factors for chronic illness. Global action plans should also include monitoring incidence and prevalence rates, creating policy for prevention of chronic illness, and developing partnerships to prevent and control chronic illness.

While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply.

Gurgling as the client breathes through the mouth Decrease in amount of urine produced Refusal to ingest food or fluids Explanation: As death approaches, a client typically has secretions that collect in the back of the throat and rattle or gurgle as the client breathes through the mouth. Breathing may become irregular with periods of no breathing. Urine output may decrease in amount and frequency, and loss of bladder and bowel control may occur. The person approaching death shows less interest in eating and drinking; for many, refusal of food is an indicator that they are ready to die. Vision and hearing may be somewhat impaired and speech may be difficult to understand.

A nursing instructor is preparing a class on pressure ulcers. Which of the following would the instructor most likely include as a possible risk factor? Select all that apply.

Immobility Anemia Increased moisture Explanation: Risk factors associated with pressure ulcer development include immobility, decreased sensory perception, anemia, decreased tissue perfusion, and increased moisture.

A woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply.

Reinvesting in new relationships at the appropriate time Reminiscing about the relationship she had with her husband Relinquishing old attachments to her husband at the appropriate time Explanation: Six key processes of mourning allow people to accommodate to the loss in a healthy way:1.) Recognition of the loss2.) Reaction to the separation, and experiencing and expressing the pain of the loss3.) Recollection and re-experiencing the deceased, the relationship, and the associated feelings4.) Relinquishing old attachments to the deceased5.) Readjustment to adapt to the new world without forgetting the old6.) Reinvestment Reiterating her anger and renewing her lifelong commitment may be counterproductive to the mourning process.

Clients must contend with chronic illness daily. Nurses relate more effectively to clients when they understand the following as characteristics of chronic illness. Choose all that apply.

The management of chronic conditions is a process of discovery. Managing chronic conditions must be a collaborative process. Chronic illness affects the entire family. Explanation: Management of chronic conditions is a process of discovery. Chronic illness affects the entire family to the point that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. Chronic conditions usually involve many different phases over the course of a person's lifetime. Chronic illness involves not only treating the medical problems but may also include the psychological and social problems.

The nurse is caring for a client admitted to the medical-surgical unit after an injury. The client states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the client's care, what variables should the nurse consider? Select all that apply.

How the presence of pain affects clients and families Resources that can assist the client with pain management The advantages and disadvantages of available pain relief strategies Explanation: Nurses should understand the effects of chronic pain on clients and families and should be knowledgeable about pain relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this client and the difference between acute and intermittent pain has no immediate bearing on this client's care.

The client with blindness is hospitalized following a myocardial infarction. Which care measures would the nurse take with this client? Select all that apply.

Identify self when walking into the client's room. State when the nurse is leaving the room. Orient the client to the room using a clock reference. Explanation: Suggestions when providing care to a client with low vision or blindness include identifying oneself to the client, stating when leaving the room, and orienting the client to the room. The nurse uses a normal tone of voice, not even slightly louder. The nurse does not pat service animals without the owner's prior permission.

A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, interventions should address what? Select all that apply.

Impaired physical mobility Acute pain Disturbed auditory sensory perception Risk for injury Explanation: Clients with Paget disease are at risk of decreased mobility, pain, hearing loss, and injuries resulting from decreased bone density. Paget disease does not affect blood glucose levels.

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.

Safe exercise Medication dosages and side effects Assistive devices Explanation: The client with rheumatoid arthritis who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints, walkers, and canes, may assist the client to perform safe self-care. Narcotics are not commonly used, and there would be no reason for dressings.

One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply.

Try to appreciate and understand the illness from the client's perspective. Assist clients with performing a life review. Provide interventions that facilitate end-of-life closure. Explanation: Nurses are responsible for educating clients about their illness and for supporting them as they adapt to life with the illness. Nurses can assist clients and families with life review, values clarification, treatment decision making, and end-of-life closure. The only way to do this effectively is to try to appreciate and understand the illness from the client's perspective. The nurse's personal experiences should not normally be included and a cure is often not a realistic hope.

A client who will undergo emergency surgery suffers from chronic depression. The nurse is performing client teaching prior to the surgery. To make the client more comfortable, which of the following actions should the nurse take? Select all answers that apply.

Wait for the client to complete speaking even when answers are slow. Face the client when speaking to the client. Address the client by title and last name. Allow extra time for this client. Explanation: Nursing interventions to promote communication with clients who have mental health challenges include allowing them extra time to provide answers and waiting for them to finish speaking. Nurses address clients by titles and last names and use first names only if doing so with other people who may be present. Nurses face clients and speak directly to them. Even though a client may not appear to be listening, this symptom may be related to the chronic depression. The nurse provides preoperative teaching.

The nurse administered an analgesic to a client who was reporting pain. The medication is ordered as needed every 3 hours. Forty minutes later the client states he has had little relief. The nurse does all of the following:

evaluates the pain level using the established pain scale assesses respirations, pulse, and blood pressure consults with the healthcare provider about the client's report Explanation: The dose of the pain medication is ineffective in relieving the client's pain. The nurse evaluates client response using the same pain scale and vital signs. The nurse may need to consult with the healthcare provider and inform of the ineffectiveness of the medication. The nurse places the client in a position of comfort to enhance effectiveness of the medication now, not later. The nurse's statement delays appropriate treatment for the client.

The client has suffered an injury to his right leg and is reporting pain at the level of "5" on a scale of 0 to 10. The client has a history of peripheral arterial disease. The client requests nonpharmacologic interventions. What interventions are appropriate for the nurse to perform? Select all that apply.

massages the client's back and shoulders teaches the client to perform slow, rhythmic breathing turns on the television to a show the client asks to watch Explanation: Nonpharmacological interventions that promote comfort include a massage even to an unaffected area, relaxation techniques as in counted breathing, and distraction as in watching the television. Ice is not applied to an area with impaired circulation. Macrobiotic diet is an alternative therapy that may be harmful.

A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply.

Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray Explanation: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and x-rays. Angiography is not related to the etiology of back pain.

A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply.

Age Cigarette smoking Occupation Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in Black men remain substantially higher than those among White men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.

A client with cancer is receiving chemotherapy and reports to the nurse that his or her mouth is painful and has difficulty ingesting food. What actions should the nurse take? Select all that apply.

Asks the client to open his or her mouth to facilitate inspection of the oral mucosa Instructs the client to brush the teeth with a soft toothbrush Consults with the healthcare provider about use of nystatin Explanation: The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin (Mycostatin) is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.

The nurse understands the definition of pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Which of the following comments by a client confirm the client's understanding of the fundamental concepts of pain? Select all that apply.

"I am tired of living with this nagging pain; I'm not sure how much longer I can go on." "I would love to go to church, but my back pain is too uncomfortable to make it through the service." "I used to walk every day for exercise; pain in my knee made me stop walking." Explanation: A fundamental concept of pain is that pain is a complex phenomenon that can affect a person's psychosocial, emotional, and physical functioning. Helplessness is an emotional response to pain. Inability to continue normal activities, such as going to church, is a psychosocial consequence of pain. Inability to perform normal exercise because of pain is a physical restriction related to pain. Pain is highly personal and subjective. The client's report is the most reliable indicator of pain. The client works with the nurse and doctor to establish a pain management regimen.

A 36-year-old mother of three was recently diagnosed with a chronic illness. The nurse prepared information for the patient on how to manage her illness. To help her cope with the shock and resentment that she was experiencing, the nurse gave her facts about her illness with honesty and empathy. Which of the following are the best comments that the nurse can include when talking to the patient about chronic illness? Select all that apply.

It is characterized by a progressive decline in normal physiologic function It can be associated with exacerbations and remissions. It results in residual disability due to non-reversible pathology. Explanation: Chronic illnesses are often defined as medical illnesses or health problems with associated symptoms or disabilities that require long-term management (3 months or longer). Chronic illness refers to diseases that are caused by non-reversible pathology; are characterized by a slow progressive decline in normal physiological function; are permanent with cure unlikely; and require long-term surveillance, leaving residual disability.

A client has been hospitalized with myxedema. Which of the following actions will the nurse take to care for this client? Select all that apply.

Measure the client's arterial blood gases Monitor the client's oxygen saturation levels Turn and reposition the client at regular intervals Give fluids to the client with caution Explanation: Myxedema requires nursing management measures to maintain the client's vital functions. Oxygen saturation levels and arterial blood gases should be monitored and measured to determine the need for assisted ventilation. Caution should be used when giving fluids because of the risk of water intoxication. The client should be turned and positioned to minimize risks associated with immobility. Active warming should be avoided to prevent the client's oxygen demands from increasing and to prevent hypotension. Instead passive warming with a blanked is recommended.

For which reasons are nonpharmacologic pain management techniques used? Select all that apply.

They help decrease the sensation of pain. They help decrease the distress a client experiences as a result of pain. They allow clients to match the technique to their own individual and cultural preferences. Explanation: Nonpharmacologic pain management techniques are usually used in conjunction with medications and help to decrease the sensation of pain and the distress the client experiences as a result of pain. Nonpharmacologic methods are used to complement, not replace, pharmacologic methods in cases of severe pain. Many clients find that the use of nonpharmacologic methods helps them cope better with their pain and feel they have greater control over the pain. Nonpharmacologic methods do not have any relation to a client's risk of becoming addicted to pain medications. A variety of techniques allows clients to match the technique to their own individual and cultural preferences.

A nursing instructor is lecturing to the junior students about common misconceptions of chronic illness. The instructor asks the students to write down and share some misconceptions with one another. Which of the following are common misconceptions? Select all that apply.

Everyone has to die of something and so chronic illness should not be treated. Chronic diseases cannot be prevented. Chronic diseases mainly affect people who are rich. Explanation: Some common misconceptions about chronic illness include that because everyone has to die of something, there is nothing that can be done anyway; chronic diseases cannot be prevented; and chronic diseases mainly affect people who are rich (affluent). One truth about chronic illness is that 80% of deaths from them occur in low- and middle-income countries.

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.

Financial pressures on health care providers Client reluctance to accept this type of care Advances in "curative" treatment in late-stage illness Explanation: Physicians are reluctant to refer clients to hospice, and clients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those clients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible clients.

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply.

The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. Explanation: Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client.

A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply.

instructs the client to discontinue calcium asks about nausea and vomiting teaches the client to report abdominal or bone pain Explanation: The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client's other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea.