NUR2120 1-5
Which is considered an isotonic solution? (CH4) 0.9% normal saline Dextran in normal saline 0.45% normal saline 3% NaCl
.9% normal saline
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? (CH4) 0.45% sodium chloride 0.9% sodium chloride 5% glucose in water 5% glucose in normal saline solution
0.45 sodium chloride
The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? (CH4) 1 L 500 ml 1500 ml 1250 ml
1 L
The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be (CH4) 155 mEq/L (155 mmol/L) 145 mEq/L (145 mmol/L) 135 mEq/L (135 mmol/L) 125 mEq/L (125 mmol/L)
155 mEq/L The client is experiencing signs and symptoms (S/S) of hypernatremia. Hypernatremia is a serum sodium concentration >145 mEq/L (>145 mmol/L). A cause of hypernatremia is near drowning in seawater (which contains a sodium concentration of approximately 500 mEq/L). S/S of hypernatremia include thirst, elevated body temperature, swollen and dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, simple partial or tonic-clonic seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, elevated pulse, and elevated blood pressure.
Adequate hourly urine output for a client with an indwelling urinary catheter is (CH5) 0.5 mL/kg/h. 1.0 mL/kg/h. 1.5 mL/kg/h. 2.0 mL/kg/h.
2.0 mL/kg/h If the client has an indwelling urinary catheter, output is monitored hourly and rates <0.5 mL/kg/h are reported.
HCO3 (CH4)
22-26
PACO2 (CH4)
35-45
A patient is admitted with a diagnosis of renal failure. The patient complains of "stomach distress" and describes ingesting several antacid tablets over the past 2 days. Blood pressure is 110/70 mm Hg, face is flushed, and the patient is experiencing generalized weakness. Which is the most likely magnesium level associated with the symptoms the patient is having? (CH4) 11 mEq/L 5 mEq/L 2 mEq/L 1 mEq/L
5 mEq/L
PH (CH4)
7.35-7.45
Medicare
A federal program of health insurance for persons 65 years of age and older
The nurse is concerned that a postoperative patient may have a paralytic ileus. What assessment data may indicate that the patient does have a paralytic ileus? (CH5) Abdominal tightness Abdominal distention Absence of peristalsis Increased abdominal girth
Absence of peristalsis
A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have? Chronic disability Impaired disability Developmental disability Acquired disability
Acquired disability
The nurse is correct to state that a client's body needs to have adequate nutrition to maintain energy. Which type of transport of dissolved substances requires adenosine triphosphate (ATP)? (CH4) Osmosis Passive diffusion Facilitated diffusion Active transport
Active transport
A postoperative client returns to a surgical nursing unit. The nurse assesses the client and notes tachycardia and muscle rigidity. What is the most important nursing action? (CH5) notifying the health care provider administering supplemental oxygen monitoring temperature inserting a urinary catheter
Administering supplemental oxygen
Health education is an integral component of all nurse-person interactions. However, certain individuals have a greater need for health education than others. Which one of the following individuals likely has the greatest need for health education? (Ch2) An IV drug user who is receiving antibiotics for the treatment of endocarditis A young adult who has suffered traumatic injuries in a motorcycle accident The parents of an infant who has been admitted for treatment of respiratory syncytial virus (RSV) An elderly woman who has just been diagnosed with congestive heart failure (|CHF)
An elderly woman who has just been diagnosed with congestive heart failure All of these individuals require health education. However, people with chronic illnesses and disabilities such as CHF are among those most in need of health education.
The nurse develops a program of increased ambulation for a patient with an orthopedic disorder. This is an example of what component of the nursing process? (CH2) A) Assessment B) Planning C) Implementation D) Evaluation
B) Planning The entire planning phase concludes with the formulation of the teaching plan.
The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? (CH4) PaO2 PO2 Carbonic acid Bicarbonate
Bicarbonate
A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? (CH4) renin-angiotensin-aldosterone system bicarbonate-carbonic acid buffer system sodium-potassium pump ADH-ANP buffer system
Bicarbonate-carbonic acid buffer system
The nurse is educating the client about management of diabetes. Which statement by the student would indicate to the nurse that further teaching is necessary? (CH2) "You will need to ingest an 1800-calorie diet every day." "Exenatide (Byetta) is prescribed twice a day." "Checks of blood glucose level are to be done ac and hs." "Avoid alcohol ingestion while taking glimeperide."
Checks of blood glucose level are to be done ac and hs When providing education, the nurse is to give clear information and avoid the use of medical terminology or "jargon" as in ac and hs.
Which statement is a misconception about chronic disease?(CH3) Almost half of chronic disease-related deaths occur prematurely in people Chronic illness typically does not result in sudden death. The major cause of chronic disease is known. Chronic illnesses cannot be prevented.
Chronic illness cannot be prevented A misconception regarding chronic disease is that chronic illnesses cannot be prevented. Almost half of chronic disease-related deaths occur prematurely in people younger than 70 years of age. Chronic illness typically does not result in sudden death. The major cause of chronic disease is known.
A client with emphysema is at a greater risk for developing which acid-base imbalance? (CH4) chronic respiratory acidosis metabolic alkalosis metabolic acidosis respiratory alkalosis
Chronic respiratory acidosis
The nurse is working at an institution that uses a collaborative practice model. Which of the following would most likely be reflected at this institution? A) Centralized organizational structure B) Physician as the primary decision-maker C) Isolated participation from the patient D) Shared accountability for care
D) Shared accountability for care
During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: (CH5) verapamil (Isoptin) dantrolene sodium (Dantrium) potassium chloride an acetaminophen suppository
Dantrolene sodium
Collaborative practice model
Decision making shared by all- shared participation, responsibility, and accountability.
Factors relating to increased incidence of chronic illness (CH3)
Decrease in mortality, longer lifespans, improved screenings, prompt and aggressive management, advanced age, lifestyle factors
A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? (CH3) Medical directive by proxy Living will declaration Durable power of attorney for health care End-of-life treatment directive
Durable power of attorney for health care A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.
A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause? (CH3) Lowered stress and increased physical activity lifestyles Shorter lifespans An increased mortality rate from infectious diseases Early detection and treatment of diseases
Early detection and treatment of diseases
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? (CH4) Low heart rate Elevated blood pressure Rapid respiration Subnormal temperature
Elevated blood pressure
The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition. (CH3) Type 2 diabetes mellitus Carcinoma-in-situ Coronary artery disease End-stage renal disease
End-stage renal disease Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.
Active transport (CH4)
Energy must be expended for movement to occur
Isotoaic (CH4)
Equal concentration of solution Reason used: Increase in extracellular fluid volume, blood loss, dehydration, vomiting, diarrhea, surgery Fluid Types: 0.9% saline 5% D5W 5% dextrose Lactated ringer
Hypertonic (CH4)
Excessive concentration of solution Fluid Types: 3% saline 5% saline 10% dextrose in water 5% dextrose in .9% saline 5% dextrose in half saline 5% dextrose in LR Reason used: Hyponatremia, cerebral edema, used to help meet caloric requirements or to treat hypoglycemia in NPO pts.
A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? (CH4) Extracellular fluid volume deficit Altered blood urea nitrogen (BUN) value Metabolic alkalosis Respiratory acidosis
Extracellular fluid volume defecit
Which nerve is implicated in the Chvostek's sign? (Ch4) Facial Hypoglossal Optic Spinal accessory
Facial
An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the mostserious adverse effect of diuretic use? (CH4) Hyperkalemia Hypokalemia Hypernatremia Hypophosphatemia
Hypokalemia Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in total potassium stores. Potassium-losing diuretics, such as furosemide, can induce hypokalemia. Hyperkalemia refers to increased potassium levels. Loop diuretics can bring about lower sodium levels, not hypernatremia. Furosemide does not affect phosphorus levels.
Which could be a potential cause of respiratory acidosis? (CH4) Vomiting Hypoventilation Diarrhea Hyperventilation TAKE ANOTHER QUIZ
Hypoventilation Respiratory acidosis is always due to inadequate excretion of CO2, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid. In addition to an elevated PaCO2, hypoventilation usually causes a decrease in PaO2.
Early signs of hypervolemia include (CH4) a decrease in blood pressure. thirst. moist breath sounds. increased breathing effort and weight gain.
Increased breathing effort and weight gain
Which electrolyte is a major cation in body fluid? (Ch4) Chloride Bicarbonate Potassium Phosphate
Potassium
Which condition might occur with respiratory acidosis? (CH4) Increased intracranial pressure Decreased blood pressure Decreased pulse Mental alertness
Increased intracranial pressure
The Healthy People 2020 initiative targets the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of this plan? (CH2) Increasing technological innovations Preventing treatable problems Applying a systematic approach to health improvement Increasing the quality and length of a healthy life
Increasing the quality and length of a healthy life
Health education (ch 2)
Independent function of nursing practice and a primary nursing responsibility. PROMOTE WELLNESS!
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? (CH3) "It will hasten the death of the patient." "It will prolong life in a dignified manner." "It will use artificial means of life support if the patient requests it." "It will enable the patient to remain home if that is what is desired."
It will enable the patient to remain home if that is what is desired
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? (CH4) Nausea or vomiting Abdominal pain or diarrhea Hallucinations or tinnitus Light-headedness or paresthesia
Light headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.
A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the (CH4) malignancy is causing the electrolyte imbalance. client's diet is lacking in calcium-rich food products. client may be developing hyperaldosteronism. client has a history of alcohol abuse.
Malignancy is causing the electrolyte imbalance
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? (CH5) malignant hyperthermia hypothermia infection fluid volume excess
Malignant hyperthermia
Corticosteroids have which effect on wound healing? (CH5) Reduce blood supply Mask the presence of infection Cause hemorrhage May cause protein-calorie depletion
Mask the presence of infection Corticosteroids may mask the presence of infection by impairing the normal inflammatory response. Edema may reduce blood supply. Corticosteroids do not cause hemorrhage or protein-calorie depletion.
An example of evidence-based practice would be: Morning insulin coverage for hospitalized patients is given at 6:45 AM so report can be given before breakfast trays arrive. (CH2) Patients on bed rest are turned every 2 hours to prevent the formation of bedsores. Shower baths are given to nursing home residents weekly so that total skin assessments can be performed. Hospitalized patients are assisted out of bed to the chair for 60 minutes, twice daily, to promote increased gastrointestinal transit time.
Patients on bed rest are turned every 2 hours to prevent the formation of bedsores
A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display? (CH4) prolonged T waves elevated ST segment peaked T waves shortened PR interval
Peaked T waves The earliest changes occur when the serum potassium level is 7 mEq/L (mmol/L). Cardiac tracings include peaked and narrow T waves, ST segment depression, and a shortened QT interval.
The nurse recognizes that written informed consent is required for insertion of a(n): (CH5) Nasogastric tube. Urinary catheter. Peripherally-inserted central catheter. Oral airway.
Peripherally-inserted central catheter
Grief (CH3)
Personal feelings
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility? (CH5) Explain that the client cannot go into the operating room with jewelry on. Medicate the client and then remove the ring. Place gauze under and over the ring and apply adhesive tape over it. Tell the physician and anesthesiologist.
Place gauze under and over the ring and apply adhesive tape over it. If the client is reluctant to remove a wedding band, the nurse may slip gauze under the ring, then loop the gauze around the finger and wrist or apply adhesive tape over a plain wedding band. You would not tell the client that he or she cannot go to the operating room wearing the ring. You would never medicate the client and then remove the ring against his or her will. It is not necessary to tell the physician and the anesthesiologist that the client does not want to remove the wedding band.
A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to (CH3) Instruct the client what he or she must do. Plan with the client how to incorporate the regimen into the client's activities of daily living. Refer the client to physical therapy for ambulation exercise two times a week. Assist the familly in obtaining equipment that would help the client to walk.
Plan with the client how to incorporate the regimen into the client's activities of daily living.
health-illness continuum
Possessing both health and illness. Person is neither completely ill or completely healthy.
A nurse is discussing the need for a client to increase activity level and eat a heart-healthy diet. The client tells the nurse, "I eat just fine and I'm not that fond of exercising." The nurse would identify this client at which stage of change? (CH2) Precontemplation Contemplation Preparation Action
Precontemplation
3 phases of perioperative nursing (Ch5)
Preoperative, intraoperative, postoperative
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? (CH4) Prepare to assist with ventilation. Monitor the client's heart rhythm. Prepare for gastric lavage. Obtain a urine specimen for drug screening.
Prepare to assist with ventilation
What complication is the nurse aware of that is associated with deep venous thrombosis? (CH5) Pulmonary embolism Immobility because of calf pain Marked tenderness over the anteromedial surface of the thigh Swelling of the entire leg owing to edema
Pulmonary embolism Serious potential venous thromboembolism complications of surgery include deep vein thrombosis and pulmonary embolism (Rothrock, 2010).
The hospice nurse understands that many factors directly or indirectly affect how a person dies. Which of the following is a changeable factor that can be influenced by the nurse when dealing with the dying patient? (CH3) Cultural attitude toward death Relationship with the health care providers Disease progression Previous experiences with illness
Relationship with health care providers
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? (CH4) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Respiratory acidosis
Maslow's Heirarchy of Human Needs
Self actualization, esteem and self respect, belonging and affection, safety and security, physiological needs
The nurse is participating in the care of a client who had a peripherally inserted central catheter (PICC) placed in the right arm. After catheter placement, the nurse should complete which action? (CH4) Send the client for a chest x-ray. Administer the prescribed IV fluids. Obtain written consent for the procedure. Assess the client's blood pressure (BP) on the right arm.
Send the client for a chest x-ray
Which of the following arterial blood gas results would be consistent with metabolic alkalosis? (CH4) Serum bicarbonate of 28 mEq/L PaCO2 less than 35 mm Hg Serum bicarbonate of 21 mEq/L pH 7.26
Serum bicarb 28 Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.
What does the nurse recognize as one of the best indicators of the patient's renal function? (CH4) Blood urea nitrogen Serum creatinine Specific gravity Urine osmolality
Serum creatinine
A 22-year-old man with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patient's most recent blood work, the nurse should pay particular attention to the patient's levels of: (CH4) Phosphate Calcium Blood urea nitrogen (BUN) Sodium
Sodium
A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give? (CH3) "Why do you think that?" "Did someone tell you that you are dying?" "Tell me more about what's on your mind." "I am not at liberty to disclose that information."
Tell me more about what's on your mind
Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care? (CH3) "A key component of hospice care is following your family for up to a year after your death." "Denial, sadness, anger, fear, and anxiety are normal grief reactions." "Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness." "Tell me who or what gives you strength."
Tell me who or what gives you strength
An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate: (CH4) A decreased level of blood urea nitrogen (BUN) An increased level of serum potassium The administration of a hypertonic IV solution The administration of hypotonic or isotonic IV solution
The administration of hypontonic or isotonic IV solution
A nurse is caring for a client who is three hours post op from open abdominal surgery. During routine assessment, the nurse notes the previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the client's change in condition? (CH5) The client is displaying early signs of shock. The client is showing signs of a medication reaction. The client is displaying late signs of shock. The client is showing signs of an anesthesia reaction.
The client is displaying early signs of shock
The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without oophorectomy, and the nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent? (CH5) "I know I'll be fine because the health care provider said he has done this procedure hundreds of times." "I know I'll have pain after the surgery." "The health care provider is going to remove my uterus and told me about the risk of hemorrhage." "Because the health care provider isn't taking my ovaries, I'll still be able to have children."
The health care provider is going to remove my uterus and told me about the risk of hemorrhage
Bereavement (CH3)
The period of time in which mourning takes place
Palliative (CH3)
Therapeutic interventions that aim to prevent and relieve suffering
Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)? (Ch4) Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad Three ounces of sliced ham, beets, and a salad A frozen, packaged low-fat dinner with a side salad Tomato juice, low-fat cottage cheese, and three slices of bacon
Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying? (Ch3) Pretrajectory Trajectory onset Acute Stable
Trajectory onset According to the Trajectory Model of Chronic Illness, the trajectory onset phase includes the period of diagnostic workup and announcement of the illness. While the other answer choices are phases of the Trajectory Model of Chronic Illness, these are not the correct answer choices.
Hypotonic (CH4)
Under/ beneath concentration of solution Fluid types: 0.45% saline .2225% saline .337% saline Reason used: When cell becomes hydrated, hypoglycemia DON'T GIVE: Increased cranial pressure burns trauma
A 51-year-old woman is distraught about her new diagnosis of multiple sclerosis (MS). During a recent discussion with her nurse, the nurse mentioned the concept of wellness, which prompted the patient to state, "How can you be talking about wellness at the same time that I've got MS?" Which of the following principles should underlie the nurse's response to the patient? (CH2) Wellness is synonymous with health. Wellness involves maximizing function despite limitations. Wellness is defined as acceptance of one's disabilities. Wellness is a concept that is understood better by people who have chronic illnesses than by healthy individuals.
Wellness involves maximizing function despite limitations
patient and family centered care
a model of nursing care in which mutual partnerships among the patient, family, and health care team are formed to plan, implement, and evaluate the nursing and health care delivered
WHO defines health as
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Readiness to learn (ch 2)
assessed prior to teaching an individual
Hospice (CH3)
associated with end pts. life- realistic emotional, social, spiritual, financial preparations for death
A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned? (CH4) Potassium Phosphorus Calcium Magnesium
calcium
5 stages of grief (CH3)
denial, anger, bargaining, depression, acceptance
Mourning (CH3)
individual, family, group, and cultural expression of grief
Medicaid
low income families
Which term best describes a living will? (CH5) Proxy directive Medical directive Health care power of attorney Durable power of attorney for health care
medical directive
Osmosis (Ch4)
movement of water caused by a higher concentration gradient
Chronic Illness (CH3)
non-self-limited nature, association with persistent and recurring health problems, duration measured in months and years not days and weeks.
Which is a correct route of administration for potassium? (CH4) Subcutaneous Intramuscular Oral IV (intravenous) push
oral
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be (CH4) 7.50 7.45 7.35 7.30
7.5 The patient is experiencing respiratory alkalosis. Respiratory alkalosis is a clinical condition in which the arterial pH is >7.45 and the PaCO2 is <38 mm Hg. Respiratory alkalosis is always caused by hyperventilation, which causes excessive "blowing off" of CO2 and, hence, a decrease in the plasma carbonic acid concentration. Causes include extreme anxiety, hypoxemia, early phase of salicylate intoxication, gram-negative bacteremia, and inappropriate ventilator settings.
Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice.(CH3) However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? Lack of fully credentialed and trained hospice nurses Clients and families view palliative care as giving up Lack of Medicare/Medicaid funding for hospice Difficulty obtaining Medicare certification for hospice services
Clients and families view palliative care as giving up
As part of a large hospital's IV team, two nurses are responsible for inserting peripherally inserted central catheters (PICCs) at the bedside for patients who require this form of venous access. Which of the following patients would most likely require a PICC? (CH4) A woman who recently suffered a pelvic fracture in a motor vehicle accident An elderly man who has been admitted from the community with a fluid volume deficit A man whose hypocalcemia requires a stat infusion of calcium gluconate A woman who has just been ordered total parenteral nutrition (TPN)
A woman who has just been ordered TPN
To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes: (CH5) Assisting with incentive spirometry every 6 hours Ambulating the client as soon as possible Positioning the client in a supine position Assessing breath sounds at least every 2 hours
Ambulating the client as soon as possible
A group of students are reviewing various evidence-based practice (EBP) tools used for planning client care. The students demonstrate understanding when they identify which of the following as the most detailed type? A) Care map B) Multidisciplinary action plan C) Clinical guidelines D) Algorithms
B) Multidisciplinary action plan Care maps, multidisciplinary action plans, clinical guidelines, and algorithms are evidence-based practice (EBP) tools for planning client care. Of these, multidisciplinary action plans are the most detailed.
Major anions (CH4)
Cl-,HCO3-,PO4-,SO4-, and proteinate
A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is? (CH3) Suspected awareness Mutual pretense awareness Closed awareness Open awareness
Closed awareness
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? (CH4) Confusion Headache Nausea Hallucinations
Confusion Normal serum concentration ranges from 135 to 145 mEq/L (135-145 mmol/L). Hyponatremia exists when the serum concentration decreases below 135 mEq/L (135 mmol/L). When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. General manifestations of hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.
A nurse is aware of both the importance of health education and the fact that it is an independent function of nursing practice. Under which of the following circumstances should a nurse consider providing health education? (CH2) A) When a patient or patient's condition has a reasonable chance of resolution B) During each contact that the nurse has with a health care consumer C) When health education is specified in a health care consumer's plan of nursing care D) When the nurse possesses advanced practice credentials in health education
D) During each contact that the nurse has with a health care consumer
A priority nursing intervention for a client with hypervolemia involves which of the following? (CH4) Establishing I.V. access with a large-bore catheter. Drawing a blood sample for typing and crossmatching. Monitoring respiratory status for signs and symptoms of pulmonary complications. Encouraging the client to consume sodium-free fluids.
Monitoring resp status for signs and symptoms of pulmonary complications
Filtration (Ch4)
Movement of water and solute from high hydro-static pressure to low
Major cations (CH4)
NA+,K+,Ca2+, mg2+, and H+
Diffusion (CH4)
Natural tendency of a substance to move from a higher concentration to a lower concentration.
A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns? (CH3) Most infectious diseases have been controlled or eradicated. The prevalence of chronic illness is decreasing due to the emphasis on healthy living. Obesity along with conditions associated with it has become a major health concern. People with acute illnesses are considered the largest group of health care consumers.
Obesity along with conditions associated with it has become a major health concern.
The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next? (CH5) Make the client NPO and order a stat hemoglobin and hematocrit. Remove the dressing, assess the wound, and apply a new sterile dressing. Outline the drainage with a pen and record the date and time next to the drainage. Take the client's vital signs and call the surgeon.
Outline drainage with a pen and record the date and time next to the drainage.
The calcium concentration in the blood is regulated by which mechanism? (Ch4) Parathyroid hormone (PTH) Thyroid hormone (TH) Adrenal gland Androgens
PTH
As the moment of death approaches, which of the following does the nurse encourage the family to do? (CH3) Have the family sit in front of the client so they can be seen. Rub the client's hand and arm to comfort the client. Speak to the client in a calm and soothing voice. Lie next to the client and hold the client.
Speak to the client in a calm and soothing voice
When providing discharge instructions, the nurse recognizes that which client is most likely to comply with the therapeutic treatment regimen? (CH2) The client with pneumonia who requires 1 week of oral antibiotics The patient with newly diagnosed type 2 diabetes who requires nutritional counseling The client with a positive tuberculosis skin test who requires 9 months of isoniazid The client with kidney failure who requires hemodialysis
The client with pneumonia that requires 1 week of oral antibiotics
The nurse develops outcome criteria for a patient with chronic obstructive pulmonary disease. Which outcome criteria are appropriate for this patient? (CH2) The patient will have the ability to climb a flight of stairs without experiencing difficulty in breathing. The patient will not experience an alteration in skin integrity. The patient will perform passive range-of-motion exercises once daily. The nurse will obtain a pulse oximetry reading twice a day.
The patient will have the ability to climb a flight of stairs without experiencing difficulty in breathing
The termination stage of the Transtheoretical Model of Change begins when which action occurs? (CH2) The person has the ability to resist relapsing back to unhealthy behavior The person takes steps to operationalize the plan of action The person constructs a plan to change behavior The person is not thinking about making a change
The person has the ability to resist relapsing back to unhealthy behavior
You are part of the health care team at an oncology center. Your patient has been diagnosed with leukemia and the prognosis is poor. The patient is unaware of the prognosis. How can the bad news best be conveyed to the patient? (CH5) Family should be given the prognosis first. The prognosis should be delivered with the patient at eye level. The health care provider should deliver the news to the patient alone. The appointment should be scheduled at the end of the day.
The prognosis should be given at eye level NR
In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea? (CH3) Offer small amounts of nourishment frequently Gently massage the arms and legs Use imagery, humor, and progressive relaxation Encourage the patient to sleep
Use imagery, humor, and progressive relaxation. Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? (CH5) Verify consent. Document the start of surgery. Acquire ordered blood products. Count sponges and syringes.
Verify consent
A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse? (CH3) "You will be able to stay only for approximately 1 month and then you will be discharged." "You will be able to stay for 2 months before being discharged." "There is no time limit for your stay. You can stay until you die." "When your stay reaches 6 months, you will be recertified for a continued stay."
When your stay reaches 6 months, you will be recertified for a continued stay
Future healthcare policy in the United States will be significanly affected by a population that is: A) aging and becoming more culturally diverse. B) becoming skeptical about conventional medicine's reliance on pharmaceuticals and surgery. C) becoming more knowledgeable about nutrition and more likely to undertake dietary changes. D) aging and includes a higher percentage of people with addictions.
A) Aging and becoming more culturally diverse.
The nursing instructor has given an assignment to a group of nurse practitioner students. They are to break into groups of four and complete a health-promotion teaching project and present a report back to their fellow students. What project is the best example of health-promotion teaching? (CH2) 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 (STIs) to a group of 12th-grade students D) Instructing an adolescent patient about safe food preparation
C) Discussing the importance of preventing sexually transmitted infections to a group of 12th grade students.
The home health nurse is assisting a patient and his family in planning the patient's return to work after an extensive illness. On which level of Maslow's hierarchy of basic needs does the patient's need for self-fulfillment fit? A) Physiologic B) Safety and security C) Love and belonging D) Self-actualization
D) Self- actualization
Which of the following would least likely impact health care delivery and nursing? Growth in the population Cultural diversity Increased consumer knowledge Decline in genetic focus
Decline in genetic focus Factors impacting health care delivery and nursing include growth in the population, increasing cultural diversiy, increased consumer knowledge, and advances in technology and genetics.
Health promotion (ch 2)
Defined as "The process of enabling people to increase control over their health and its determinants thereby improving their health."
A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient's ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient's most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations? (CH4) Confusion and decreased level of consciousness Shortness of breath, rales, and peripheral edema Dysphagia, tetany, and emotional lability Fatigue, cramps, and weakness
Fatigue, cramps, and weakness
Which step of the nursing process determines whether the client understands the health teaching that is provided? (CH2) A) Evaluation B) Assessment C) Planning D) Implementation
A) Evaluation Evaluation includes observing the client, asking questions, and then comparing the client's behavioral responses with the expected outcomes. Assessment includes determining the client's readiness regarding learning. Planning includes identification of teaching strategies and writing the teaching plan. Implementation is the step during which the teaching plan is put into action.
Our population is aging, and with the increased numbers of patients reaching age 65, health care has had to change its focus. What is one focus of health care today? A) Management of chronic conditions and disability B) Increasing dependency among the aging population C) A shifting focus to disease management D) Management of acute conditions and rehabilitation
A) Management of chronic conditions and disability
Which phase of the nursing process encompasses the establishment of expected outcomes? (CH2) A)Planning B) Assessment C) Implementation D) Evaluation
A) Planning Planning encompasses specifying expected outcomes. Assessment is directed toward the systematic collection of data about the client's learning needs and readiness to learn. In the implementation phase, the client, the family, and the members of the nursing and health care teams carry out activities outlined in the teaching plan.
A nurse who has provided care in perioperative settings for many years has seen first-hand the trend toward increasing numbers of surgical procedures being performed in ambulatory surgical centers and on an outpatient basis. What factors have contributed most significantly to this trend? (CH5) The emergence of managed care and the large number of Americans who lack health insurance The nursing shortage and decreasing numbers of health care providers who are choosing surgical specialties Advances in anesthesia and in the technology surrounding surgical techniques Pressure from health care consumers to avoid hospital stays and the decreasing incidence of acute illnesses
Advances in anesthesia and in the technology surrounding surgical techniques
What foods can the nurse recommend for the patient with hypokalemia? (CH4) Fruits such as bananas and apricots Green, leafy vegetables Milk and yogurt Nuts and legumes
Fruits such as bananas and apricots
Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic? (CH5) Halothane Fentanyl Succinylcholine Propofol
Halothane
With which condition should the nurse expect that a decrease in serum osmolality will occur? (CH4) Diabetes insipidus Hyperglycemia Kidney failure Uremia
Kidney failure Failure of the kidneys results in multiple fluid and electrolyte abnormalities including fluid volume overload. If renal function is so severely impaired that pharmacologic agents cannot act efficiently, other modalities are considered to remove sodium and fluid from the body.
The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?(CH3) The principle of justice The principle of nonmaleficence The principle of fidelity The principle of autonomy
The principle of autonomy By promoting open discussion and informed decision making, the nurse is empowering the client to make his own decisions leading to autonomy. The principle of justice requires fairness and justice to all clients. The principle of nonmaleficence requires that nurse does not intentionally or unintentionally inflict harm on others. The principle of fidelity maintains that nurses are faithful to the care of the clients.
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? (CH4) Confusion and seizures Sunken eyeballs and spasticity Flaccidity and thirst Tetany and increased blood urea nitrogen (BUN) levels
confusion and seizures
The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is: (CH3) care that will reduce the client's physical discomfort and manage clinical symptoms. care that is provided at the very end of an illness to ease the dying process. an alternative therapy that uses massage and progressive relaxation for pain relief. offered to terminally ill clients who wish to remain in their homes in lieu of hospice care.
Care that will reduce the clients physical discomfort and manage clinical symptoms Palliative care is used in conjunction with other end-of-life treatments and has many principles. Its aim is to reduce physical discomfort and other distressing symptoms but does not alter a disease's progression. Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life. Palliative care of a terminally ill client not only provides relief from pain and other distressing symptoms but it integrates other facets of patient care as well, including psychological and spiritual aspects. Palliative care is part of hospice care.
A nursing student is preparing for a class presentation addressing the collaborative practice model. Which of the following would the student expect to include? A) A discussion of a centralized organizational structure B) Participation in decision making that is shared by all involved C) Accountability that is primarily attributed to the patient D) Nurses and physicians playing major roles in clinical decsions
B) Participation in decision making that is shared by all involved
The World Health Organization defines health as: A) "a condition of homeostasis and adaptation." B) "reflecting an individual's location along a wellness--illness continuum." C) "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." D) "a fluid, ever-changing balance reflected through physical, mental, and social behavior."
C) A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.
Which is an example of a direct measurement technique used to evaluate the teaching-learning process? (CH2) A) Behavioral observation B) Patient satisfaction surveys C) Attitude surveys D) Instruments that evaluate specific health status variables
A) Behavioral observation Direct measurement techniques include behavioral observation, checklists, and anecdotal notes to document the behavior. Client satisfaction surveys, attitude surveys, and oral questioning, and instruments that evaluate specific health status variables, are indirect measurements.
A health care provider asked a nurse to teach a patient how to self-administer subcutaneous insulin. After collecting her assessment data and drafting her plan, the nurse selected the teaching strategy that research has indicated has the highest chance of reinforcing knowledge. Which of the following strategies did the nurse select? (CH2) Providing reading materials with illustrations of how to perform the injection Showing the equipment and explaining the procedure Asking the patient to hold the syringe and insulin while viewing a slide show about the process Assisting the patient to perform the skill in a simulated setting
Assisting the patient to perform the skill in a simulated setting
The nurse is administering a new medication to an elderly male client and begins instruction about the medication. The client states, "Tell my wife. She takes care of all this kind of stuff." The nurse replies (CH2) A) "It is necessary that you learn about this medication." B) "When your wife comes in to visit, I will return and provide the information to both of you." C) "I will print the information about this medication and leave it with you to give to her." D)"I will have to return when she arrives."
B) "When your wife comes in to visit, I will return and provide the information to both of you."
Case management has gained such prominence in health care because of A) longer hospital stays. B) lower costs of care associated with inpatient stay. C) ability to discharge from specialty care units to home. D) limited availability for inter-unit hospital transfers.
B) Lower costs of care associated with inpatient stay. Case management has gained such prominence because the decreased cost of care associated with shorter hospital stays, coupled with rapid and frequent inter-unit transfers from specialty to standard care units. In general, length of hospital stay has decreased over the past 5 years. In general, patients are transferred from specialty care units to standard care units at least 24 hours before discharge. In general, patients in acute care hospitals undergo frequent inter-unit transfers from specialty to standard care units.
When describing influences on health care delivery, a nurse cites information about current population demographics. Which of the following would be most accurate? A) Increased birth rate B) Fewer school-aged children C) Fewer elderly persons D) More people living in rural areas
B)fewer school aged children Population demographics reveal that the birth rate has declined, school-aged children are fewer, older adults are more numerous, and greater numbers of people live in urban areas.
A nurse is preparing an in-service education program for a group of nurses involved in health education. When describing the connection between health teaching and health promotion, which information would the nurse most likely include? (CH2) Both are linked by the common goal of achieving high-level wellness. Health teaching goals are achieved before those for health promotion. Health teaching, not health promotion, is the major determinant of health policy. Health care professionals are the primary managers of health conditions addressed by health teaching.
Both are linked by the common goal of achieving high level wellness.
Which is an insensible mechanism of fluid loss? (CH4) Urination Bowel elimination Breathing Nausea
Breathing Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable. Nausea does not result in fluid loss, however if the client would develop emesis ( vomiting) this would be considered loss of body fluids and would need measured.
The nurse is preparing discharge teaching for a patient 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 effective for this patient? (CH2) A) Providing the most up-to-date information available B) Alleviating the patient's guilt associated with not knowing appropriate self-care C) Determining the patient's readiness to learn new information D) Building on previous information
C) Determining the patient's readiness to learn new information.
How should the registered nurse be responsive to the changing health care needs of society? A) Focus care on the traditional disease-oriented approach to patient care, because hospitalized patients today are more acutely ill than they were 10 years ago. B) Learn how to delegate discharge planning to ancillary personnel so that registered nurses can spend their time managing the "high-tech" equipment needed for patient care. C) Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness. D) Stress the curative aspects of illness, especially the acute, infectious disease processes.
C) Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness. Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. The result has been the evolution of a wide range of health promotion strategies, including multiphasic screening, genetic testing, lifetime health monitoring, environmental and mental health programs, risk reduction, and nutrition and health education. A growing interest in self-care skills is reflected by the many health-related publications, conferences, and workshops designed for the lay public.
A hospice nurse performs a follow-up telephone call to the spouse of a client who died about 1 year ago. The spouse tells the nurse, "I'm always feeling so sad. Life just doesn't feel worth living." Further conversation reveals that the spouse is having trouble sleeping and eating since her husband's death and that the spouse is "drinking more since he died." The nurse identifies which nursing diagnosis as the priority? (CH3) Ineffective coping Complicated grieving Grieving Stress overload
complicated grieving Complicated grieving is characterized by prolonged feelings of sadness and feelings of general worthlessness or hopelessness that persist long after the death, prolonged symptoms that interfere with activities, or self-destructive behaviors such as alcohol or substance abuse and suicidal ideation or attempts. Thus, the nursing diagnosis of complicated grieving would be the priority and most appropriate. Although the client may be having trouble coping or experiencing stress, complicated grieving is more applicable. Although there is no time table to denote grieving, the nursing diagnosis of grieving would be more appropriate in the period surrounding the husband's death, rather than 1 year later.
