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A nurse is developing a plan of care for a client with cancer who has a prescription for transcutaneous electrical nerve stimulation (TENS) for pain management. Which of the following actions should the nurse include in the plan? A. After applying electrodes, turn the knob until the client feels slight buzzing or tingling. B. Apply the TENS unit for no longer than 30 min. C. Instruct the patient on how to adjust the voltage on the TENS unit. D. Avoid administering analgesics when using the TENS unit.

Correct Answer: A. After applying electrodes, turn the knob until the client feels slight buzzing or tingling. After applying electrodes, the nurse should turn the output knob until the client feels a tingling or buzzing. The intensity should be adjusted for client comfort. When using an older TENS unit, the nurse should apply a conductive gel before applying the electrodes from the TENS unit to the skin to provide good conduction between the electrode and the skin. Conductive gel may not be necessary for all TENS units, so the nurse should check the manufacturer's specifications. Incorrect Answers: B. TENS units can be applied for as long as is required and prescribed by the provider. C. The provider, nurse, or someone specially trained in TENS unit equipment should adjust the dial for voltage to be delivered to the client. D. The nurse can administer pain medication while the client is using the TENS unit. Vital Concept: Many clients who have cancer experience chronic pain. The use of non-pharmacologic methods of pain relief in combination with prescribed medications can improve client comfort. Transcutaneous electrical nerve stimulation (TENS) unit electrodes can be applied directly to the skin. The unit will send small electrical currents to the areas of pain to provide relief of symptoms. The therapy decreases pain levels by electrically stimulating local sensory fibers, which overrides the brain's ability to process pain messages from the affected area.

A nurse is planning care for a child who has ADHD. Which of the following medications should the nurse plan to administer? A. Atomoxetine B. Lorazepam C. Donepezil D. Zolpidem Next Question Feedback

Correct Answer: A. Atomoxetine The nurse should identify that atomoxetine is a nonstimulant norepinephrine reuptake inhibitor medication used in the treatment of ADHD. Incorrect Answers: B. This The nurse should identify that lorazepam is a benzodiazepine used to treat anxiety disorders. C. The nurse should identify that donepezil is a cholinesterase inhibitor used to treat Alzheimer's disease. D. The nurse should identify that zolpidem is a nonbenzodiazepine receptor agonist used to treat insomnia. Vital Concept: Children who have Attention Deficit Hyperactivity Disorder, or ADHD, exhibit inattentiveness, impulsivity, and hyperactivity. Treatment includes medication, a structured environment, and clear and consistent boundaries and consequences for unacceptable behaviors.

What is the most appropriate nursing action when administering a unit of packed red blood cells to a client with a bleeding peptic ulcer and anemia who currently has D5W infusing through a 20-gauge catheter? A. Discontinue D5W and flush the catheter with normal saline before starting transfusion B. Use an intravenous (IV) infusion pump to piggyback on the existing line C. Start an 18-gauge catheter to replace the 20-gauge before infusing packed red blood cells using the existing intravenous line (IV) D. Attach the transfusion set to the port closest to the client using the existing intravenous tubing Next Question Feedback

Correct Answer: A. Discontinue D5W and flush the catheter with normal saline before starting transfusion The only fluid that can be administered with a blood transfusion is normal saline. Cell lysis may result from a dextrose solution, and other IV solutions are incompatible with blood and may result in precipitation. A dedicated IV line must be used to infuse blood products. If using tubing that is currently in place, the infusion and tubing should be discontinued, and the catheter should be flushed with normal saline before connecting the tubing for administration of blood. After the transfusion is complete, the nurse should clear the catheter with a flush of NS before administering any fluids or medications. Incorrect Answers: B. A dedicated IV line must be used to infuse blood products. If using tubing that is currently in place, the infusion and tubing should be discontinued, and the catheter should be flushed with normal saline before connecting the tubing for administration of blood products. C. It is not necessary to replace the 20-gauge catheter, although larger-bore catheters are preferable for infusion of blood products. However, a dedicated IV line is essential. D. A dedicated IV line must be used to infuse blood products. Vital Concept: Transfusion of blood and blood components is a temporary support for the client, pending resolution of the underlying problem. Blood components can safely be administered through a needle that is 20-gauge or larger. An 18-gauge or 16-gauge is recommended for rapid transfusion. A Y tubing set with microaggregate filter is used for transfusion. One limb of the Y is used for normal saline and the other limb of the Y is used for the blood product. Dextrose solution and lactated ringers cause hemolysis of red blood cells. Unless the tubing is cleared with saline solution, nothing should be administered by blood tubing.

A nurse is providing discharge teaching about diet and fluid restrictions to a client who has a calcium oxalate kidney stone. Which instruction should the nurse include in the teaching? A. Increase intake of spinach. B. Limit sodium to no more than 2,300 mg/day. C. Increase intake of vitamin C supplements. D. Limit consumption of high-purine foods. Next Question Feedback

Correct Answer: B. Limit sodium to no more than 2,300 mg/day. Increased sodium intake may result in urinary calcium excretion by decreasing calcium reabsorption. Incorrect Answers: A. Spinach is a food that is high in oxalate and, when combined with calcium, might result in calcium stone formation. C. Large doses of vitamin C can cause calcium stone formation. D. Foods that contain purine, such as organ meats and red wine, cause uric acid stone formation. Vital Concept: Stones that consist of calcium oxalate require a limitation of the client's dietary calcium intake to no more than 1,000 to 1,200 mg of calcium a day. Clients should avoid calcium supplements. References: Definition & Facts for Kidney Stones Dudek, S. G. (2017). Nutrition essentials for nursing practice (8th ed.). Philadelphia: Lippincott Williams & Wilkins. Peer Comparison A 5% B 43% C 11% D 41% Response Time: 0:32 Difficulty level: Hard

A nurse is assessing a client who has HIV. Which finding should the nurse identify as a manifestation of HIV-associated muscle wasting? A. Unintentional weight loss of 15% of body weight in 6 months B. Fecal impaction C. Diminished strength D. Report of increased fat gain on the back of the neck Next Question Feedback

Correct Answer: C. Diminished strength A client who has HIV‑associated muscle wasting will report a decrease in strength as well as muscle wasting caused by gastrointestinal malabsorption of nutrients. Incorrect Answers: A. HIV associated weight loss and wasting might cause an unintentional weight loss of less than 5% of body weight in 6 months. B. A client who has HIV‑associated muscle wasting might report having diarrhea, rather than a fecal impaction, which is generally found in a client who has constipation. D. A client report of increased fat gain in the back of the neck can be a manifestation of HIV-associated lipodystrophy. It is not a manifestation of HIV‑associated muscle wasting. Lipodystrophy causes loss of fat in the limbs, face, and buttocks while increasing fat deposits on the back of the neck and the trunk. Vital Concept: HIV-associated muscle wasting can have many causative factors. Muscle wasting can result from inflammatory changes that increase the body's calorie use, resulting in protein breakdown.

A nurse manager is planning to implement a procedural change involving the responsibilities of the charge nurses using Lewin's stages of change theory. Which of the following actions should the nurse manager plan to take during the moving stage of change? A. Identify the problem. B. Inform the charge nurses that a change to established procedures is needed. C. Require the charge nurses to comply with the new procedures. D. Set a target date for the implementation of the new procedures. Next Question Feedback

Correct Answer: D. Set a target date for the implementation of the new procedures. The second stage of Lewin's change theory is the moving stage. During the moving stage, the nurse manager should develop the plan for change and set the target date for the implementation of the new procedures. Tasks Associated With the Change Stage • Develop a plan for introducing and implementing the change, including goals, objectives and strategies. • Include all team members who will be affected by the change in the planning process. • Identify those who support the change and those who are resistant. • Set a target date for implementing the strategies. • Implement the strategies. • Offer support and encouragement to team members throughout the change process. • Devise and implement strategies to meet resistance to change. • Evaluate the integration of the change and revise strategies as needed. Incorrect Answers: A. There are three stages involved in Lewin's change theory. The first stage is the unfreezing stage in which the nurse manager should identify the problem, determine the need for a change, and then obtain buy-in from the members of the group. B. During the unfreezing stage, the nurse manager should make the charge nurses aware that a change is needed. This should be based upon the assessment findings and can take the form of conversations with the charge nurses as a group. C. The third stage of Lewin's change theory is the refreezing stage. During this time, the nurse manager should focus on integration of the new procedure with the charge nurses. This includes engaging with the charge nurses to support the change and encouraging them through the change process. It also includes requiring the charge nurses to integrate the procedural changes into their work. Vital Concept: As a change agent, the nurse manager is responsible for guiding staff through the change process. Keeping everyone who will be impacted by the change involved in the entire process will promote acceptance of the change and increases overall success in the change process.

A nurse in an outpatient clinic is assessing a client who reports night sweats, fatigue, cough, nausea, and diarrhea. The client asks the nurse if it is possible he has human immunodeficiency virus (HIV). Which of the following actions should the nurse take initially? (Select all that apply.) A. Perform a physical assessment. B. Determine when manifestations began. C. Provide education about HIV transmission. D. Draw blood for HIV testing. E. Obtain a sexual history from the client.

Correct Answers: A. Perform a physical assessment. B. Determine when manifestations began. E. Obtain a sexual history from the client. Incorrect Answers: C. Teaching the client about HIV transmission is not an appropriate action by the nurse at this time. Once an initial assessment has been completed such teaching may be warranted, but not initially. D. Drawing blood for HIV testing is not an appropriate action by nurse at this time. Vital Concept: Human immunodeficiency virus (HIV) is an infection that invades and attacks the immune system. The nurse should know that the manifestations of HIV are very similar to those found with any virus (e.g., fever, night sweats, muscle and joint aches, headaches). It is important to identify any instances where the client came into contact with potentially infected body fluids, which can increase the potential for HIV infection.

A nurse is caring for a client diagnosed with hemorrhoids. Which of the following does the nurse expect the healthcare provider to recommend for management of this condition (select all that apply)? A. Topical analgesic ointments B. Astringent pads C. Low-fiber diet D. Fluid restriction E. Iron supplementation Next Question Feedback

Correct Answers: A. Topical analgesic ointments B. Astringent pads Hemorrhoids are caused by dilation of veins in the anorectal region and may occur internally or externally. External hemorrhoids occur outside the anal sphincter, and internal hemorrhoids occur inside the sphincter. Constipation, pregnancy, and other conditions that increase anorectal pressure can result in hemorrhoids. Hemorrhoids are clinically characterized by pain, anal pruritus (itching), and blood-streaked stools. Treatment measures include increasing fluids and fiber to soften stool and reduce straining. Rest, use of warm compresses and cold packs, Sitz baths, astringent pads, topical analgesic ointments, and suppositories are all used to manage hemorrhoids conservatively. When thrombosis occurs, surgical ligation may be required. Rubber band ligation can be used to resect a hemorrhoid that is not thrombosed. Infrared photocoagulation is another treatment used for non-thrombosed hemorrhoids. Incorrect Answers: C. Fiber should be increased in the diet to prevent straining with defecation. D. Increasing fluid will lubricate and soften stool. E. Iron supplementation is given for iron-deficiency anemia, which occurs with chronic GI bleeding. Vital Concept: Lifestyle modifications can reduce or prevent hemorrhoids, including increase of fluid and fiber in diet to soften stool and reduce constipation and use of warm compresses, cold packs, and sitz baths. Astringent pads, topical analgesics and suppositories can also be helpful, but surgical ligation is indicated for thrombosis of a hemorrhoid.

While working at a community clinic, a nurse teaches some parents about proper car seat use. Which of the following information, according to the American Academy of Pediatrics, should the nurse give to the families? (Select all that apply.) A. Infant car seats should face the rear until the infant weighs 10 lbs B. Car seats should never be placed in a front seat with an airbag C. When children outgrow the rear-facing car seat, they should be placed in a forward-facing booster seat with a lap and shoulder belt D. Children should use a booster seat with a lap and shoulder belt until they are at least 4 feet 9 inches tall, or approximately 8 to 12 years old E. All children under age 13 should be restrained in the back seat of the car when possible, and not the front seat Next Question Feedback

Correct Answers: B. Car seats should never be placed in a front seat with an airbag D. Children should use a booster seat with a lap and shoulder belt until they are at least 4 feet 9 inches tall, or approximately 8 to 12 years old E. All children under age 13 should be restrained in the back seat of the car when possible, and not the front seat While some car seats may vary according to each manufacturer, the American Academy of Pediatrics has given guidelines to follow when restraining a child or baby in a car seat in order to best uphold the safety of the child. All babies should be restrained in a rear-facing car seat until they are two years old or they have reached the highest weight given by the car seat's manufacturer. A booster seat is used until the child is approximately 4 feet, 9 inches tall or 8 to 12 years old. It is recommended that children sit in the back seat until they are 13 years old and if using a car seat in the front seat, it should never be placed in front of an airbag. Incorrect Answers: A. All babies should be restrained in a rear facing car seat until they are two years old C. Once a child is too big to sit in a rear-facing car seat, he should be seated in a forward-facing car seat with a harness Vital Concept: It is the nurse who most commonly escorts the new parents and their child out of the hospital for their first trip home. The nurse must be well prepared to provide client education about car seats and how to keep their baby safe while driving. Peer Comparison A 13% B 91% C 44% D 83% E 78% Response Time: 0:59 Difficulty level:

A nurse is caring for an adolescent who has Grave's disease. Which of the following findings should the nurse expect? (Select all that apply.)

Correct Answers: B. Moist skin D. Tachycardia E. Weight loss Due to the increased metabolic state associated with excessive thyroid hormone, the adolescent might exhibit signs of overproduction of the sweat glands, causing diaphoresis and moist skin. Due to the increased metabolic state associated with excessive thyroid hormone, the adolescent might exhibit excessive work of the heart, which would cause the pulse to be elevated. Due to the increased metabolic state associated with excessive thyroid hormone, the adolescent might exhibit gastrointestinal irritability, such as loose stools. The adolescent might have decreased appetite and increased metabolism, which can lead to weight loss. Incorrect Answers: A. Due to the increased metabolic state associated with excessive thyroid hormone, the adolescent might exhibit muscle weakness. Hypertonic muscles are associated with hypothyroidism. C. Due to the increased metabolic state associated with excessive thyroid hormone, the adolescent might exhibit signs of hair follicles being overstimulated. The hair will appear to have a fine texture and will be unable to hold waves. Vital Concept: Grave's disease, or hyperthyroidism, is thought to be an autoimmune response to thyroid-stimulating hormone (TSH) that causes the body to produce thyroid hormone. Thyroid hormones are responsible for maintaining homeostasis and maintaining metabolic effects throughout the body. The affected adolescent can experience signs and multisystem effects of increased metabolism. Gastrointestinal effects of over-stimulation can cause gastric irritability, and the adolescent can exhibit weight loss and loose stools. The adolescent can also experience other signs of increased metabolism, such as irritability, diaphoresis, moist skin, fine hair growth, intolerance to heat, blurry vision, tachycardia, insomnia, tremors, muscle weakness, and exophthalmos. Treatment for Grave's disease includes decreasing stimulation of the TSH, antithyroid medications, using radioactive iodine to shrink the thyroid gland or thyroidectomy.