QSEN and ppt NCLEX q's

Which of the following is the FIRST priority in preventing infections when providing care for a client? A. Hand washing B. Wearing gloves C. Using a barrier between client's furniture and nurse's bag D. Wearing gowns and goggles

A

The Surgical Care improvement project includes which of the following? Select All that Apply. a. Prophylactic antibiotic received within one hour prior to surgical incision time. b. Antibiotics discontinued within 24 hours after surgery end time. c. Hair removal. d. Urinary Catheter placement. e. Hold of any beta blocker medications prior to surgery to prevent bradycardic events. f. Induced hypothermia to preserve and improve brain function after surgery.

A, B, C. AB and C are all part of the surgical care improvement project bundle.

Of these, which is the most common ways peritonitis can be caused? (select all that apply) A. Peptic ulcer disease b. diverticulitis c. hemodialysis d. toe ulcer e. leakage of fluid during surgery

A, B, E *peritoneal dialysis not hemo*

Which of the following is the correct definition of safety? A. Minimize risk of harm to patients and providers through both system effectiveness and individual performance B. Use of information and technology to communicate, man age, knowledge, mitigates error, and support decision-making. C. Appreciate shared decision-making and patient and family participation. D. Integrate the understanding of patient centered care using multiple dimensions.

A. Minimize risk of harm to patients and providers through both system effectiveness and individual performance

Which surgical care intervention should be administered and planned for the surgery? A. Prophylactic antibiotic therapy within 1 hour before the surgical incision. B. Make sure hair is not removed or modified in any way. C. Antibiotics should be discontinued within 72 hours after surgery. D. Urinary catheter removal postoperative day 5 ot 6. (Day of surgery = day 0)

A. Prophylactic antibiotic therapy within 1 hour before the surgical incision.

A client admitted to the hospital with suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment finding would be consistent with acute pancreatitis? Select all that apply. 1. Diarrhea 2. Black tarry stools 3. Hyperactive bowel sounds 4. Gray-blue color at the flank 5. Abdominal guarding and tenderness 6. LUQ pain with radiation to the back

ANS: 4, 5, 6 Rationale: Gray-blue color at the flank is Grey-Turner's sign which occurs as the result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity The client may demonstrate abdominal guarding and may complain of tenderness upon palpation The pain associated with acute pancreatitis is often sudden in onset and is located in the epigastric region or LUQ with radiation to the back

All of the following are causes of chronic pancreatitis EXCEPT for A. alcoholism B. immunoglobulin destruction C. gallstones D. drug use

ANS: D Rationale: Drug use is a risk factor for acute pancreatitis, not chronic. All other answers are potential causes of chronic pancreatitis.

The nurse determines that the patient is in need of further education when she makes the following statement about the symptoms of cholecystitis: A. I may experience abdominal pain B. I may experience indigestions C. I may experience hematochezia D. I may experience fever

Answer: C Explanation: Cholecystitis symptoms include upper abdominal pain, N/V, indigestion, fever, and clay-colored stools. Hematochezia, blood in stools, is not a common symptom.

Which statements below are CORRECT regarding the role of bile? Select all that apply:* A. Bile is created and stored in the gallbladder. B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin.

B, C, D

A client has been diagnosed with a cerebrovascular accident after his admittance to the Emergency Room. The client also presented with atrial fibrillation. Which physician's order would the nurse question? A) Administer tissue plasminogen activator (tPA) per protocol B) Anticoagulation therapy: warfarin C) Give patient PO aspirin D) Keep head of bed elevated at least 30 degrees.

C) Give patient PO aspirin

The nurse understands the acute myocardial infarction interventions when she states: A) Fibrinolytic therapy must be given within 60 minutes upon arrival B) Acetaminophen is administered upon arrival C) Perform percutaneous coronary intervention within 90 minutes upon arrival D) Both an ACE inhibitor and an ARB are administered upon discharge

C) Perform percutaneous coronary intervention within 90 minutes upon arrival

Evidence-based practice is defined as: A. Nursing care based on tradition B. Scholarly inquiry of nursing and biomedical research literature C. A problem-solving approach that integrates best current evidence with clinical practice. D. Quality nursing provided in an efficient and economically sound manager

C. A problem-solving approach that integrates best current evidence with clinical practice.

An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, auscultates her lung sounds, listens to her heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? A. Diagnosis B. Evaluation C. Assessment D. Implementation

C. Assessment

A patient is admitted to a medical unit for a home-acquired pressure ulcer. The patient has Alzheimer's disease and has been incontinent of urine. The nurse inserts a Foley catheter. You will identify a link in the infection chain as A. Restraints B. Poor hygiene C. Foley catheter bag D. Improper positioning

C. Foley catheter bag

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? A. Decreased blood pressure B. Absence of muscle tremors C. Relief of nausea and vomiting D. No further episodes of diarrhea

C. Relief of nausea and vomiting

A public health nurse is educating the low-income population about the importance of an annual flu shot. Which of these factors are considered high-risk populations? A) Smoker B) Asthma C) Chronic Renal Failure D) All of the above

D

The nurse is caring for a patient who had knee replacement surgery 5 days go. The patient's knee appears red and warm to the touch and patient is requesting increased pain medication. What complication should the nurse be concerned about? A) Nothing, this is expected post operatively B) Patient is becoming dependent on pain medication C) Post operative wound dehiscence D) Post operative wound infection

D) Post operative wound infection

The nurse will include what postoperative teaching when caring for the client who is preparing to undergo endoscopic cholecystectomy? Select all that apply. A. "You'll have a small, midline abdominal incision." B. "You can't eat or drink for a few days after the procedure." C. "You won't be able to return to regular activity for several weeks." D. "Generally the pain associated with this procedure is minimal." E. "This procedure has a low incidence of infection." F. "The hospital stay after this procedure is typically 1 to 2 days."

D, E, F

The nurse has evaluated the hospital environment. Which intervention is the best to decrease the risk of client falls? A. Keep the call button within reach at all times. B. Electrical cords are kept under the bed C. Read all label directions. D. Clean the environment of clutter

D. Clean the environment of clutter

The nurse is teaching a client about nutrition and diverticulosis. Which food will the nurse teach the client to avoid? A. Popcorn B. Oatmeal C. Bran D. Lettuce

A. Foods such as nuts, corn, popcorn, cucumbers, tomatoes, figs, and strawberries—all of which contain seeds or indigestible material—may block a diverticulum and should be avoided. Oatmeal, bran, and lettuce are acceptable for patients with diverticulosis to eat.

A nurse is taking care for a patient with lung cancer. The patient wants to go home with oxygen to be more comfortable. The family demands the patient have the new surgery procedure. The nurse explains the risk and benefit of the surgery to the family and discusses patient's wishes with family. In this situation, the nurse is acting as the patient's: A. Advocate B. Educator C. Caregiver D. Case manager

A. Advocate

A patient arrives to the Emergency Room presenting with chest pain radiating to the right arm and jaw. The Doctor is suspecting Acute MI. What is the time sensitive intervention that must be provided based on the Quality Core Measures? Select All that Apply. a) Administration of 325 mg aspirin b) Initiation of a beta blocker c) Ativan to decrease the patients anxiety d) Percutaneous coronary intervention (PCI) e) Fibrinolytic therapy f) Smoking cessation education

Answer D. All other interventions are part of treatment for AMI but D is the only time sensitive intervention and Quality Core Measure.

The nurse is caring for a client who has had paracentesis performed. Which nursing intervention is appropriate? a. Keep the head of the bed flat b. measure, describe, and record drainage c. ambulate 30 minutes post procedure d. weigh client e. label fluid container and send for laboratory analysis

B, D, E

A patient was just given the wrong medication for his peptic ulcer disease (PUD). When tracing back the error, it was discovered that the doctor put in the wrong order. Who is to blame for the patient receiving the wrong medication? A) The doctor for rushing through his charting. B) The pharmacist for not calling the doctor to verify. C) The nurse for not calling the doctor, even though she suspected something was wrong. D) The patient for taking a medication that he did not recognize. E) Not an individual, but the system as a whole.

?? I guess E

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to: A. Administer IV fluids B. Give stool softeners and enemas. C. Order a diet high in fiber and fluids. D. Prepare the patient for colonoscopy.

A A pt w/ acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given, and these will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis

The nurse is monitoring a client with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing interventions? A. Notify the health care provider b. administer prescribed pain meds c. call and ask the operating room team to perform surgery as soon as possible d. Reposition the client and apply a heating pat on the warm setting to the client's abdomen

A. *never apply heat, risk of rupture*

The nurse is reviewing the prescription for a client admitted to the hospital with acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply A. NPO B. Encourage coughing and deep breathing C. Give small, frequent, high calorie feedings D. Maintain a supine and flat position E. Give morphine as prescribed

ANS: A, B, E Rationale: The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is necessary. Because abdominal pain is a prominent symptom of pancreatitis, pain medications such as morphine or hydromorphone are prescribed.. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help to ease the pain. The client is susceptible to respiratory infections because the retro- peritoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted

For a client recently diagnosed with biliary cholangitis, which medications would the nurse expect to be prescribed? Select all that apply A. Urodeoxycholic acid B. fibrates C. Azythromycin D. Obeticholic acid E. Keflex

ANS: A,B,D Explanation: Ursodeoxycholic acid (UDCA) is used to help move bile within the liver; Fibrates (Tricor) help to reduce inflammation in the liver, while Obeticholic acid (Ocaliva) helps to improve liver function. All three of these are usually prescribed to patients with Biliary Cholangitis aka Biliary Cirrhosis. Azithromycin is an antibiotic often used to treat bacterial infections like pink eye Keflex is also an antibiotic used to treat upper respiratory infections, ear infections, skin infections, urinary tract infections, & bone infections

Which diagnostic result leads the nurse to suspect that a client may have gallbladder disease? A. Decreased WBC count, visualization of non-calcified gallstones and increased alkaline phosphatase B. Increased WBC count, visualization calcified gallstone and increased alkaline phosphatase C. Increased WBC, noncalcified gallstones and edema of the gallbaldder wall d. decreased WBC, noncalcified gallstones and increased alkaline phosphatase E. increased wbc, calicified gallstones, edema of gallbladder wall

Answer: Correct Answer is E) An increased WBC count is expected, calcified gallstones (NOT uncalcified gallstones) are the only thing visualized on a abdominal X-ray, edema is expected with gallbladder disease -Alkaline phosphatase will be elevated if liver function is abnormal; however this is not common in gallbladder disease therefore alkaline phosphatase is not important for this question

You are planning discharge instructions for your 54 year old male patient with a diagnosis of peritonitis secondary to a bowel obstruction. Which statement by the patient indicates successful understanding of discharge instructions? A. I will contact my provider every time I pass gas." B. Taking diuretics that I have at home should help my abdominal discomfort C. I can discontinue my antibiotics once I start to feel better. D. I will contact my healthcare provider if I develop a fever

Answer: D Fever is an indicator that the infection is not responding to prescribed antibiotic. The patient should call their HCP right away for additional treatment A- passing gas is a good sign. The patient should expect to pass gas. B- do not take additional medication that is not prescribed by the HCP. Diuretics will not help clear the abdominal fluid because the fluid is in the third space. C- entire course of antibiotics must be taken to ensure infection is cleared.

What are the "Basic needs" for QSEN/NCLEX? (SELECT ALL THAT APPLY) A) Water B) Oxygen C) Nutrition D) Shelter E) Temperature

B) Oxygen C) Nutrition E) Temperature

You need to reposition a patient that weighs 300 lbs. What of the following strategies will you use to prevent a back injury? A. Put bed in Trendelenburg and pull from head of bed. B. Call 2-3 more staff to help C. Bend at waist and pull the lift pad using arms. D. Turn patient by yourself using the lift pad and applying pillows

B. Call 2-3 more staff to help

The nurse performs patient centered care for a 70 year-old female diagnosed with gastric cancer receiving medication when they state, A) "We give this medication for all our patients, so you have to take it." B) "You have to take this medication because the healthcare provider ordered it." C) "Do you have any questions I can answer for you in regard to the medication?" D) "Just shut up and take the medication."

C) "Do you have any questions I can answer for you in regard to the medication?"

The Surgical Care improvement project includes which of the following? Select All that Apply. a. Prophylactic antibiotic received within one hour prior to surgical incision time. b. Antibiotics discontinued within 24 hours after surgery end time. c. Hair removal. d. Urinary Catheter placement. e. Hold of any beta blocker medications prior to surgery to prevent bradycardic events. f. Induced hypothermia to preserve and improve brain function after surgery.

a. Prophylactic antibiotic received within one hour prior to surgical incision time. b. Antibiotics discontinued within 24 hours after surgery end time. c. Hair removal.

Which of the following is the best example of providing patient centered care by offering respect of patient's preferences, values and needs? a. Telling a patient they have to take their 0900 am morning meds because the doctor ordered them despite the patients refusal. b. Bringing a patient down for a procedure before the procedure has been properly explained by the doctor. c. Allowing the patient and their family to participate in the discharge planning to an Acute Rehab Center after suffering a stroke. d. Checking a patient's blood sugar and administering insulin injections despite the patients request to check their own blood sugar as a patient who has managed their Diabetes for the last 20 years.

Answer C. Allowing the patient and their family to participate in the discharge planning to an Acute Rehab Center after suffering a Stroke is an example of patient centered care.

The nurse is caring for a patient who reports jaundiced and reports pruritus. Which intervention will the nurse include in the plan of care? a. Monitor the client's vital signs and intake and output b. Instruct the client to scratch with knuckles instead of nails c. Assist the client with a hot bath and apply moisturizer d. Encourage the client to eat a high protein, high cholesterol diet

B the client will be itchy from the bilirubin (jaundice) and they can scratch themselves to bleed and get risk for infection

Which nursing diagnosis related to urinary function and catheter care in an older adult should be a nurse's first priority? A) Self care deficit related to decreased mobility B) Risk of infection C) Anxiety related to urinary incontinence D) Impaired self esteem related to lack of independence

B) Risk of infection

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

B. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.

The nurse would increase the comfort of the patient with appendicitis by A. Having the patient lie prone B. Flexing the patient's right knee C. Sitting the patient upright a chair D. Turning the patient onto his or her left side

B. The patient with appendicitis usually prefers to lie still, often with the right leg flexed to decrease pain

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain

B. Heartburn

Which action of the nurse reflects the value of patient-centered care? A. Patient was told by the doctor only to have 3 months to live. The nurse tries to convince that hospice care would be the better option compared to traveling. B. Nurse assists the family and arranges orthodox rituals for a Bulgarian family. C. When the family and the patient are having an argument about the treatment plan, the nurse interrupts and says: "I don't think you are making the best decisions for the patient. Only health care professionals know what's the best for the patient." D.The nurse gathered the patient and family members to make a plan for physical therapy.

B. Nurse assists the family and arranges orthodox rituals for a Bulgarian family.

A patient arrives to the ED for chest pain. The patient is diagnosed with an acute MI. What is the top priority of this patient? A. Provide meds upon arrival (Aspirin, Beta blockers) B. Perform percutaneous coronary Intervention within 90 minutes on arrival C. Smoking cessation counseling D. Appropriate ACE-inhibitor or angiotensin receptor blocker at discharge

B. Perform percutaneous coronary Intervention within 90 minutes on arrival

You are training a new grad on the ICU, you would intervene if the new grad states?: A) I should place the ventilated patient's HOB at 30 degrees to help prevent ventilator-acquired pneumonia (VAP) B) Foley catheters should be avoided if necessary, to help prevent catheter acquired urinary tract infections C) The femoral artery is preferred when placing a central line as it significantly reduces the chances of infection, as it is more sterile than other sites that come into contact with outside bacteria D) Prophylactic antibiotics should be discontinued 24 hours after surgery

C

Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply: A. Right lower quadrant pain with rebound tenderness B. Negative Murphy's Sign C. Epigastric pain that radiates to the right scapula D. Pain and fullness that increases after a greasy or spicy meal E. Fever

C, D, E Option A and B are not associated with cholecystitis, but a POSITIVE Murphy's Sign is.

The nurse is caring for four clients, which client is at the highest risk for hepatitis B infection? a. 24- year old with abdominal pain who just returned from Central America b. 40-year old who is 2 days postpartum and is breast feeding c. 65-year old who reports using street drugs 10 years ago when homeless d. 81-year old who donated blood before a surgical procedure

C. 65-year old who reports using street drugs 10 years ago when homeless

Which clinical manifestation does the nurse expect with acute appendicitis? A. High fever B. Nausea and vomiting C. rebound tenderness D. pain relieved with ambulation

C. One manifestation of acute appendicitis is localized and rebound tenderness of McBurney point upon palpation. A high fever is a manifestation of a perforated appendix. Nausea and vomiting are generalized symptoms and are not present exclusively with appendicitis. Ambulation increases pain in appendicitis.

The nurse is caring for a patient with stage-4 metastatic esophageal cancer. The patient has expressed to the nurse that they wish to end all treatments and go home where they are more comfortable. The patient's family has expressed that they want the patient to try a new experimental procedure, which if successful, could prolong the patient's life. The nurse explains the risks and benefits of the procedure with the family and discusses the patient wishes. In this scenario, the nurse is acting as: A. The charge nurse B. A nurse educator C. A patient advocate D. The unit case manager

C. A patient advocate

Which of the following are examples of how we as care providers can practice and ensure patient safety? a. Scanning our patient's armband, using two patient identifiers and scanning all medications as our third check prior to administering any medications to the patient. b. Review our patient's allergies at the beginning of every shift and prior to any medication administration. c. Following SBAR (Situation, Background, Assessment and Recommendation) for any hand off reporting of our patients. d. All of the Above

D. All of the above are examples of how to ensure patient safety.

You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A non nursing colleague asks about this code. Which of the following statements best describes this code? A. Improves self-health care B. Protects the patient's confidentiality C. Ensures identical care to all patients D. Defines the principles of right and wrong to provide patient care.

D. Defines the principles of right and wrong to provide patient care.

When a patient with AMI was first admitted to ED, which intervention is the top priority? A. Scheduling a smoking cessation counseling. B. Administering fibrinolytic therapy within 30 minutes upon arrival. C. Gathering all personal items from the patients. D. Percutaneous Coronary Intervention within 90 minutes upon arrival to the hospital.

D. Percutaneous Coronary Intervention within 90 minutes upon arrival to the hospital.

The workmen cause an electrical fire when installing a new piece of equipment in the intensive care unit. A client is on a ventilator in the next room. The first action the nurse should take is to: A. Attempt to extinguish the fire B. Pull the fire alarm C. Call the physician to obtain orders to take the client off the ventilator D. Use an Ambu bag and remove the client from the area

D. Use an Ambu bag and remove the client from the area

You're providing discharge teaching to a patient who was hospitalized with diverticulitis. Which statement by the patient requires you to re-educate the patient? A. "It is important I consume a diet high in fiber and keep hydrated to keep my stool soft." B. "The physician prescribed me to take Psyllium every day which will help prevent constipation." C. "I will be sure to always cook and skin my fruits and vegetables rather than eating them fresh." D. "I will notify my physician if I develop abdominal pain and fever."

The answer is C. The patient should consume fresh fruits and vegetables because they contain the most fiber. Fruits and vegetables that have been skinned or cooked have low amounts of fiber in them. The patient needs to follow a high-fiber diet..not low-fiber. A low fiber diet is only followed when the patient has experienced an episode of diverticulitis and is not fully healed from the inflammation.

When educating a patient about wound healing the nurse should include what in the teaching? A) Inadequate nutrition delays wound healing and increases risk of infection. B) Chronic wounds heal better in a dry, open environment so leave them open to air. C) Fat tissue heals more rapidly because there is less vascularization. D. Long term steroid use diminishes the inflammatory response and speeds up wound healing

A)

A patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

A. less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort.

Select all of the following are population at higher risk factors of influenza: SELECT ALL THAT APPLY A. 65 years or older B. Children under 6 C. Healthy individuals D. Smokers E. People with diabetes

A. 65 years or older B. Children under 6 D. Smokers E. People with diabetes

1) With knowledge of QSEN's mission statement "A collaboration of HealthCare professionals focused on education, practice and scholarship to improve quality and safety of healthcare systems" which of the following encompasses the six QSEN competencies? a. Patient Centered Care, Teamwork and Collaboration, Evidence Based Practice, Quality Improvement, Safety, and Informatics. b. Patient Centered Care, Monetary Gain, Evidence Based Practice, Quality Improvement, Safety, and Informatics. c. Physician Director Care, Teamwork and Collaboration, Evidence Based Practice, Quality Improvement, Safety and informatics. d. None of the above

Answer A. The six competencies of QSEN include Patient Centered Care, Teamwork and Collaboration, Evidence Based Practice, Quality Improvement, and Informatics.