3106: EXAM #1 MULTIPLE CHOICE (SPRING 2021)

c. Bargaining

A patient hospitalized with alcoholism tells the nurse, "If God lets me live this time, I promise to quit drinking forever." Which stage of grieving does the patient demonstrate through this statement? a. Anger b. Resolution c. Bargaining d. Acceptance

3. Return demonstration

A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place? 1. Verbalization of steps to use in splinting 2. Selecting from a series of flash cards the images showing the correct technique 3. Return demonstration 4. Cloze test

b. Respiratory tract

The portal of exit for the influenza virus is which area? a. Blood b. Respiratory tract c. Reproductive tract d. Skin and mucous membrane

2. A patient describes how to set up a pill organizer for newly ordered medicines. 4. A patient demonstrates how to take his blood pressure at home.

Which of the following scenarios demonstrate that learning has taken place? (Select all that apply.) 1. A patient listens to a nurse's review of the warning signs of a stroke. 2. A patient describes how to set up a pill organizer for newly ordered medicines. 3. A patient attends a spinal cord injury support group. 4. A patient demonstrates how to take his blood pressure at home. 5. A patient reviews written information about resources for cancer survivors.

1. Reservoir 2. Portal of exit 3. Mode of transmission 4. Portal of entry 5. Susceptible host

Place the chain of infection in the correct order. Portal of entry, Portal of exit, Reservoir, Susceptible host, Mode of transmission

a. Scabies

Which disease requires contact precautions? a. Scabies b. Measles c. Diphtheria d. Pharyngitis

a. Affective

Which domain of learning occurs when a patient is both verbally and nonverbally participating in group activities? a. Affective b. Cognitive c. Attentional d. Psychomotor

a. Altered body image b. Emotional changes d. Changed self-concept e. Modified family roles

Which factor is an effect of illness on the patient and family? Select all that apply. One, some, or all responses may be correct. a. Altered body image b. Emotional changes c. Health prevention d. Changed self-concept e. Modified family roles

a. Able to state the signs of heart attack e. Able to perform exercises in the correct way that is necessary to improve cardiac function and prevent trauma as well Rationale: TO EVALUATE A LEARNING OBJECTIVE IT NEEDS TO BE MEASUREABLE! The nurse can evaluate patient learning by asking the patient to state the signs of heart attack and to demonstrate exercises because these performances can be measured. Objectives such as understanding a concept, verbalizing feelings, and increasing knowledge are vague and ambiguous and cannot be measured.

Which learning objective would be evaluated in the discharge notes of a patient with coronary artery disease? Select all that apply. One, some, or all responses may be correct. a. Able to state the signs of heart attack b. Understands the importance of exercises to improve heart function c. Verbalizes feelings of anxiety related to limitation of activity imposed by the condition d. Expresses knowledge about the lifestyle modifications required to prevent heart failure e. Able to perform exercises in the correct way that is necessary to improve cardiac function and prevent trauma as well

b. Demonstration c. Return demonstration

Which method is appropriate to teach a patient how to self-administer insulin? Select all that apply. One, some, or all responses may be correct. a. Lecture b. Demonstration c. Return demonstration d. Role playing e. Question and answer session

d. Reassessing the patient for the presence of physical, social, and environmental risks

Which nursing activity is involved in evaluation to determine patient safety? a. Identifying the patient's perceptions of safety needs and risks b. Identifying the actual and potential threats to the patient's safety c. Determining the effect of the underlying illness on the patient's safety d. Reassessing the patient for the presence of physical, social, and environmental risks

b. Contact precautions Rationale: Contact precautions require a gown and gloves because the handling of contaminated body fluids may cause infections. Droplet precautions require a surgical mask within 3 feet (0.9 m) of a contagious patient. Airborne precautions require a specially equipped room with a negative airflow, referred to as an airborne infection isolation room. Protective environment precautions require a specialized room with a positive airflow set to greater than 12 air exchanges per hour.

Which type of transmission-based precaution requires a gown and gloves? a. Droplet precautions b. Contact precautions c. Airborne precautions d. Protective environment precautions

4. Readiness to learn

A 55-year-old adult male has been in the hospital over a week following surgical complications. The patient has had limited activity but is now finally ordered to begin a mobility program. The patient just returned from several diagnostic tests and tells the nurse he is feeling quite fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient's condition? 1. Motivation to learn 2. Developmental stage 3. Stage of grief 4. Readiness to learn

3. Role-playing

A 63-year-old woman is a family caregiver for her 88-year-old mother who has dementia. The caregiver asked the home health nurse how to manage her mother when she becomes confused and violent. The best instructional method a nurse can use for this situation is: 1. Demonstration 2. Preparatory instruction 3. Role-playing 4. Group instruction with other family caregivers

1. Speak in a low tone. 2. Begin and end the session with the most important information regarding melanoma. 4. Provide specific information in frequent, small amounts for older adult patients.

A nurse is teaching an older adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.) 1. Speak in a low tone. 2. Begin and end the session with the most important information regarding melanoma. 3. Provide a pamphlet about melanoma with large font in blues and greens. 4. Provide specific information in frequent, small amounts for older adult patients. 5. Speak quickly so that you do not take up much of the patient's time

3. Cognitive domain 5. Psychomotor domain

A patient asks a nurse to provide instruction on how to perform a breast self-exam. Which domains are required to learn this skill? (Select all that apply.) 1. Affective domain 2. Sensory domain 3. Cognitive domain 4. Attentional domain 5. Psychomotor domain

2. Telling approach

A patient suddenly experiences a severe headache with numbness and decreased movement in the left arm. The emergency room physician suspects a stroke and is going to have the patient undergo an emergent angiogram to remove the clot. Which teaching approach is most appropriate? 1. Selling approach 2. Telling approach 3. Entrusting approach 4. Participating approach

1. The organism is usually transmitted through the fecal-oral route. 2. Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer. 3. Everyone coming into the room must be wearing a gown and gloves

A patient who has been placed on Contact Precautions for Clostridium difficile (C. difficile) asks you to explain what he should know about this organism. What is the most appropriate information to include in patient teaching? (Select all that apply.) 1. The organism is usually transmitted through the fecal-oral route. 2. Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer. 3. Everyone coming into the room must be wearing a gown and gloves. 4. While the patient is in Contact Precautions, he cannot leave the room. 5. C. difficile dies quickly once outside the body

a. Explain the situation to a relative or significant other. b. Explain carefully the significance and need for prompt tumor removal.

A patient's breast biopsy results return as positive for cancer. The patient says that there is some mistake and that she cannot have breast cancer. Which action would the nurse take to provide further information to this patient? Select all that apply. One, some, or all responses may be correct. a. Explain the situation to a relative or significant other. b. Explain carefully the significance and need for prompt tumor removal. c. Discuss chemotherapy treatment. d. Inform the patient about breast implants. e. Talk to the patient in a firm voice.

b. Blood c. Semen e. Vaginal secretions

Human immunodeficiency virus (HIV) is transmitted via which major reservoir? Select all that apply. One, some, or all responses may be correct. a. Feces b. Blood c. Semen d. Mouth lesions e. Vaginal secretions

d. Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform.

In which case would the nurse wear a gown? a. The patient's hygiene is poor. b. The nurse is assisting with medication administration. c. The patient has acquired immunodeficiency syndrome (AIDS) or hepatitis. d. Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform.

3. Remove gloves. 4. Remove eyewear or goggles. 2. Untie waist and neck strings of gown. Allow gown to fall from shoulders and discard. Remove gown, rolling it onto itself without touching the contaminated side. 1. Untie top, then bottom mask strings and remove from face 5. Perform hand hygiene.

Place in order the correct steps for removal of protective barriers after leaving an isolation room. 1. Untie top, then bottom mask strings and remove from face. 2. Untie waist and neck strings of gown. Allow gown to fall from shoulders and discard. Remove gown, rolling it onto itself without touching the contaminated side. 3. Remove gloves. 4. Remove eyewear or goggles. 5. Perform hand hygiene.

1. Patient avoids discussion of illness. 2.Patient blames and complains to the nurse often. 5.Patient offers to live a better life in exchange for good health 4.Patient begins to express emotions openly. 3.Patient recognizes reality of condition.

Place the following patient behaviors in chronological order according to the stages of grieving. 1. Patient avoids discussion of illness. 2. Patient recognizes reality of condition. 3. Patient blames and complains to the nurse often. 4. Patient begins to express emotions openly. 5. Patient offers to live a better life in exchange for good health.

b. Mother died from CAD at age 48 c. History of hypertension e. Elevated cholesterol level

The nurse assesses the risk factors for coronary artery disease (CAD) in a female patient. Which of these factors are classified as genetic and physiological? (Select all that apply.) a. Sedentary lifestyle b. Mother died from CAD at age 48 c. History of hypertension d. Eats diet high in sodium e. Elevated cholesterol level

ALL! a. Eating utensils b. Urinals c. Bedpans d. Bath basins e. Bedclothes Rationale: Sharing eating utensils, urinals, bedpans, and bath basins among patients easily leads to cross-infection by indirect contact. Because certain microorganisms travel easily through the air, the caregivers should not shake linens or bedclothes.

The nurse provides education about the risk of exposure to pathogens to a group of nursing students. The nurse discusses which item that harbors infectious agents? Select all that apply. One, some, or all responses may be correct. a. Eating utensils b. Urinals c. Bedpans d. Bath basins e. Bedclothes

a. Holistic

When taking care of patients, a nurse routinely asks whether they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? a. Holistic b. Health belief c. Transtheoretical d. Health promotion

b. Above the elbows

When the nurse is performing surgical hand asepsis, where would the nurse keep his or her hands? a. Below the elbows b. Above the elbows c. At a 45-degree angle d. In a comfortable position

b. When the patient's pain medications are working c. Just before lunch, when the patient is most awake and alert

When would the nurse plan to teach a patient about the importance of exercise? Select all that apply. One, some, or all responses may be correct. a. When there are visitors in the room b. When the patient's pain medications are working c. Just before lunch, when the patient is most awake and alert d. When the patient is talking about current stressors in his or her life e. In the evening, when the patient is tired but the floor is quiet

a. Constipation b. Incontinence c. Pressure injury

Which complication would the nurse be aware of when using physical restraints? Select all that apply. One, some, or all responses may be correct. a. Constipation b. Incontinence c. Pressure injury d. Increased appetite e. Improved alertness

b. Cognitive Rationale: Cognitive learning occurs when a patient acquires knowledge and comprehends it to gain information about his or her condition. Because the patient is not expressing feelings, opinions, or values about the disease, the patient is not exhibiting affective learning.

Which learning domain involves learning about a disease and understanding how it relates to another condition? a. Affective b. Cognitive c. Psychosocial d. Psychomotor

a. Implanting a prosthetic foot for the left leg b. Referring the patient for vocational retraining c. Referring the patient to an occupational therapist Rationale: Tertiary measures include implanting a prosthetic foot for the left leg, referring the patient for vocational retraining, and referring the patient to an occupational therapist. Tertiary measures are taken after permanent, irreversible disability and focus on rehabilitation. Advising the patient about measures to prevent accidents is a primary prevention activity, not tertiary. Administering antidepressants is a secondary prevention activity, not tertiary.

Which tertiary preventive measure would be advised for a depressed patient with an amputated left foot who is prescribed antidepressants? Select all that apply. One, some, or all responses may be correct. a. Implanting a prosthetic foot for the left leg b. Referring the patient for vocational retraining c. Referring the patient to an occupational therapist d. Advising the patient about measures to prevent accidents e. Administering antidepressant medications to the patient

b. Iatrogenic Rationale: An iatrogenic infection is a health care-associated infection caused by an invasive or diagnostic procedure such as colonoscopy. A localized infection occurs around the site of a wound. An endogenous infection often happens when a patient receives broad-spectrum antibiotics that affects the normal floras. Suprainfection develops when broad-spectrum antibiotics kill a wide range of normal floras.

Which type of infection is the nurse trying to prevent when practicing aseptic techniques during a colonoscopy? a. Localized b. Iatrogenic c. Endogenous d. Suprainfection

1. Disposable gown 2. N95 respirator mask 5. Gloves

Which type of personal protective equipment should the nurse wear when caring for a pediatric patient who is placed on Airborne Precautions for confirmed chickenpox/herpes zoster? (Select all that apply.) 1. Disposable gown 2. N95 respirator mask 3. Face shield or goggles 4. Disposable mask 5. Gloves

3. Set mutual goals for the education session.

A nurse is preparing to teach a patient who has sleep apnea how to use a CPAP machine at night. Which action is most appropriate for the nurse to perform first? 1. Allow patient to manipulate machine and look at parts. 2. Provide a teach-back session. 3. Set mutual goals for the education session. 4. Discuss the purpose of the machine and how it works.

b. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer."

As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast selfexamination for the women's group. Which statement made by one of the participants is related to the individual's accurate perception of susceptibility to an illness? a. "I have a door hanging tag in my bathroom to remind me to do my breast self-examination monthly." b. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer." c. "Since I am only 25 years of age, the risk of breast cancer for me is very low." d. "I participate every year in our local walk/run to raise money for breast cancer research."

c. "What do you think is the greatest reason why stopping smoking would be challenging for you?"

Based on the Transtheoretical Model of Change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!" a. "That's fine. Some people who smoke live a long life." b. "OK. I want you to decrease the number of cigarettes you smoke by one each day, and I'll see you in 1 month." c. "What do you think is the greatest reason why stopping smoking would be challenging for you?" d. "I'd like you to attend a smoking-cessation class this week and use nicotine replacement patches as directed.

a. All patients receiving care

To which patients do standard precautions apply? a. All patients receiving care b. Patients with bloodborne infections c. Patients with infected, draining wounds d. Patients believed to have an infectious disease

d. Asking the health care provider to act as his or her advocate

Which action taken by the patient indicates that the patient needs further teaching about The Joint Commission (TJC) Speak Up program? a. Asking about medication errors b. Asking about the qualifications of the health care provider c. Asking about the purpose of medications given during the treatment d. Asking the health care provider to act as his or her advocate

a. Holistic

Which health model is described when the nurse routinely asks patients if they take any vitamins or herbal medications, encourages family members to reminisce, and frequently suggests the use of therapeutic touch? a. Holistic b. Health belief c. Transtheoretical d. Health promotion

2. Droplet Precautions

A patient is diagnosed with meningitis. Which type of isolation precaution is most appropriate for this patient? 1. Reverse isolation 2. Droplet Precautions 3. Standard Precautions 4. Contact Precautions

d. Respirator Rationale: Patients with pulmonary tuberculosis require airborne precautions because the droplets are smaller than 5 microns and remain for long periods in the air. Therefore a respirator is the most appropriate PPE that the nurse should use. Gowns and gloves are most important when a nurse performs a physical examination to avoid a contact infection. A head cap is applied when the nurse is in a surgical room.

A patient is diagnosed with pulmonary tuberculosis. Which personal protective equipment (PPE) is the most important to wear when entering the patient's room? a. Gown b. Gloves c. Head cap d. Respirator

c. The hospital bed is in the high position. d. There is no gait belt at the bedside. e. The overbed table with the patient's glasses is positioned against the wall opposite the end of the bed.

A nurse enters the hospital room of a patient who had a total knee replacement the day before. Which of the following pose potential safety risks? (Select all that apply.) a. A current safety inspection sticker is on the IV fluids pump. b. A walker is positioned near the patient's bedside. c. The hospital bed is in the high position. d. There is no gait belt at the bedside. e. The overbed table with the patient's glasses is positioned against the wall opposite the end of the bed.

a. Physiological

A nurse is conducting a home visit with a new mom and her three children. While in the home the nurse weighs each family member and reviews their 3-day food diary. She checks the mom's blood pressure and encourages the mom to take the children for a 15- to 30-minute walk every day. The nurse is addressing which level of need, according to Maslow? a. Physiological b. Safety and security c. Love and belonging d. Self-actualization

b. "I know several nurses who feel this way every now and then. Tell me about the patients you have cared for recently. Did you find it difficult to care for them?" d. "Describe for me what you do with your time when you are not working." e. "The hospital just started a group where nurses get together to talk about their feelings. Would you like for me to e-mail the schedule to you?"

A nurse working on a medical patient care unit states, "I am having trouble sleeping, and I eat nonstop when I get home. All I can think of when I get to work is how I can't wait for my shift to be over. I wish I felt happy again." What are the best responses from the nurse manager? (Select all that apply.) a. "I'm sure this is just a phase you are going through. Hang in there. You'll feel better soon." b. "I know several nurses who feel this way every now and then. Tell me about the patients you have cared for recently. Did you find it difficult to care for them?" c. "You can take diphenhydramine over the counter to help you sleep at night." d. "Describe for me what you do with your time when you are not working." e. "The hospital just started a group where nurses get together to talk about their feelings. Would you like for me to e-mail the schedule to you?"

c. Tertiary prevention

A patient discharged a week ago following a stroke is currently participating in rehabilitation sessions provided by nurses, physical therapists, and registered dietitians in an outpatient setting. In what level of prevention is the patient participating? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Transtheoretical prevention

c. Anxiolytic medicines Rationale: Anxiolytic medicines, which are not a part of the patient's regular prescription, can be used as chemical restraints. These medications help manage patients' behavior by making them calm and inducing sleep.

A patient has been advised bed rest but often becomes anxious and moves out of bed by removing the intravenous (IV) lines. Which chemical restraint would the nurse anticipate for this patient? a. Protective helmet b. A mechanical device c. Anxiolytic medicines d. Immobilizing equipment

a. Difficulty paying his bills e. Family practice of not routinely seeing a health care provider Rationale: External factors impacting health practices include family beliefs and economic impact. The way that patients' families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors (or lack of them) influence how patients think about health. Economic variables may affect a patient's level of health by increasing the risk for disease and influencing how or at what point the patient enters the health care system.

A patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been praying daily to help him through this difficult time. He does not have a primary health care provider because he has never really been sick, and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) a. Difficulty paying his bills b. Praying daily c. Age of patient (46 years) d. Stress from the divorce and the loss of a job e. Family practice of not routinely seeing a health care provider

c. The stage of bargaining

A patient is diagnosed with colorectal cancer and is scheduled for surgery. After the surgery, the health care provider informs the patient the surgery was successful. However, the patient is told that she needs chemotherapy because the cancer had spread to other organs. The patient asks the nurse whether the spread of cancer will stop if she stops smoking and consuming alcohol. Which stage of grieving is the patient experiencing? a. The stage of denial b. The stage of anger c. The stage of bargaining d. The stage of resolution

3. Explain the reasons for isolation procedures and provide meaningful stimulation.

A patient is placed on Airborne Precautions for pulmonary tuberculosis. The nurse notes that the patient seems to be angry, but he knows that this is a normal response to isolation. Which is the best intervention? 1. Provide a dark, quiet room to calm the patient. 2. Reduce the level of precautions to keep the patient from becoming angry. 3. Explain the reasons for isolation procedures and provide meaningful stimulation. 4. Limit family and other caregiver visits to reduce the risk of spreading the infection

c. Resolution Rationale: The patient is concerned that Alzheimer's disease will change her life and openly expresses her emotions about it. This is the resolution stage of grieving. In the stage of denial, the patient is not ready to accept the altered condition. During the anger stage, the patient expresses anger toward others. During the acceptance stage, the patient accepts the medical condition, pursues information, and is willing to deal with the implications of the diagnosis.

A patient newly diagnosed with Alzheimer's disease expresses sadness and feeling concern that the disease has affected her daily life. This patient is in which stage of grieving? a. Denial b. Anger c. Resolution d. Acceptance

a. Explain the situation to the patient's family. Rationale: It is difficult for a patient to accept a temporary or permanent loss of health. The patient needs to grieve. This process of grieving provides time to adapt psychologically to the emotional and physical implications of the illness. Here, the patient is avoiding discussion about the illness and may be distorting information that has not been presented clearly. Therefore the nurse should carefully explain the situation to the patient's family. The nurse should not focus on teaching important skills or knowledge because the patient has not accepted the reality of the condition. When a patient reaches the psychosocial stage of acceptance, the nurse should provide necessary discharge information to the patient or the patient's family. The nurse should avoid any attempt to convince the patient about the illness. This will likely result in further anger or withdrawal.

A patient recently diagnosed with acquired immunodeficiency syndrome (AIDS) states, "I am perfectly fine, and I don't want to discuss my treatment and condition." After considering the patient's current stage of grief, which action by the nurse would be appropriate? a. Explain the situation to the patient's family. b. Focus on skills the patient will require in the coming weeks. c. Provide necessary information to the family for the patient's discharge. d. Convince the patient that the treatment for the illness is essential.

A. "My husband wants to get another opinion, even after a clear diagnosis." Rationale: The patient is not ready to accept reality and thinks his diagnosis is wrong, so he wants a second opinion. This indicates that the patient is in the denial stage. The patient blames and shows anger toward his health care provider in the anger stage of grief. If the patient does not show any interest in normal activities, such as playing games and watching movies, it indicates that the patient is experiencing depression and has lost the will to live. Wanting to spend as much time as possible with family indicates that the patient is showing acceptance.

After interacting with the wife of a patient who has terminal cancer, the nurse anticipates that the patient is experiencing denial. Which statement by the wife supports the nurse's conclusion? A. "My husband wants to get another opinion, even after a clear diagnosis." B. "My husband is blaming the health care provider for his condition." C. "My husband is not showing any interest in his favorite games and movies." D. "My husband says he wants to spend as much time as possible with the family."

2. The patient pays attention to the information and receives information. 3. The patient actively participates through listening and reacting orally and verbally. 5. The patient attaches worth and value to the acquired knowledge as demonstrated by the patient's behavior. 1. The patient develops a value system by identifying and organizing values according to their worth. 4. The patient acts and responds with a consistent value system and requires introspection and self-examination of one's own values in relation to an ethical issue or particular experience.

Arrange the patient's behaviors in order of increasing complexity according to the affective domain of learning. 1. The patient develops a value system by identifying and organizing values according to their worth. 2. The patient pays attention to the information and receives information. 3. The patient actively participates through listening and reacting orally and verbally. 4. The patient acts and responds with a consistent value system and requires introspection and self-examination of one's own values in relation to an ethical issue or particular experience. 5. The patient attaches worth and value to the acquired knowledge as demonstrated by the patient's behavior.

1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance

Arrange the stages of the Transtheoretical Model of Change in the correct order. Contemplation Action Preparation Maintenance Pre-contemplation

a. Neonate b. A 78-year-old f. Assisted-living resident

During an infection control surveillance study, the nurse reviews various medical records and identifies that which person is at risk for infection? Select all that apply. One, some, or all responses may be correct. a. Neonate b. A 78-year-old c. Breastfed infant d. Middle-aged adult e. High school student f. Assisted-living resident

b. 15 years Rationale: In hospital settings, each original restraint order and renewal is limited to 8 hours for adults, 2 hours for ages 9 to 17, and 1 hour for children under age 9. Therefore a 15-year-old patient will require ordering and renewing a restraint order every 2 hours. The 8-year-old child will require ordering and renewal every hour. The 21-year-old and 35-year-old patients will require renewal every 8 hours.

In a hospital, the use of a restraint is ordered and renewed every 2 hours. Which is the likely age of the patient? a. 8 years b. 15 years c. 21 years d. 35 years

1. School age child 2. School age child 3. School age child 4. Preschooler 5. Preschooler 6. Preschooler

Match the intervention for promoting child safety with the correct developmental stage School-age child OR Preschooler? 1. Teach children proper bicycle and skate board safety. 2. Teach children how to cross streets and walk in parking lot. 3. Teach children proper techniques for specific sports. 4. Teach children not to operate electric toothbrushes while unsupervised. 5. Teach children not to talk to or go with a stranger. 6. Teach children not to eat items found in the grass.

False Rationale: Although gloves are an additional tool to decrease the spread of infection from patient to patient, touching gloves with unclean hands as you put them on contaminates the gloves so that they are no longer clean.

Patient-to-patient transmission of infection cannot occur if gloves are routinely used. True/False?

1. Teaching correct handwashing to assigned patients 2. Using correct procedures in starting and caring for an intravenous infusion 3. Providing perineal care to a patient with an indwelling urinary catheter

The infection control nurse has asked the staff to work on reducing the number of iatrogenic infections on the unit. Which of the following actions on your part would contribute to reducing health care-acquired infections? (Select all that apply.) 1. Teaching correct handwashing to assigned patients 2. Using correct procedures in starting and caring for an intravenous infusion 3. Providing perineal care to a patient with an indwelling urinary catheter 4. Isolating a patient on antibiotics who has been having loose stool for 24 hours 5. Decreasing a patient's environmental stimuli to decrease nausea

a. Allow patients to receive support from other patients in the group. d. Help patients learn from others' experiences. e. Promote responsiveness, valuing others, and organization.

The nurse attends to a group of patients with depression. The nurse conducts a group discussion with the patients to teach them effective learning skills. How will the group discussion help the patients? Select all that apply. One, some, or all responses may be correct. a. Allow patients to receive support from other patients in the group. b. Encourage patients to express concerns. c. Allow patients to discuss personal and sensitive things. d. Help patients learn from others' experiences. e. Promote responsiveness, valuing others, and organization.

3. Provide scheduled toileting rounds every 2 to 3 hours. 4. Institute a routine exercise program for the patient. 6. Keep the pathway from the bed to the bathroom clear

The nurse finds a 68-year-old woman wandering in the hallway and exhibiting confusion. The patients says she is looking for the bathroom. Which interventions are appropriate for this patient? (Select all that apply.) 1. Ask the health care provider to order a restraint. 2. Recommend insertion of a urinary catheter. 3. Provide scheduled toileting rounds every 2 to 3 hours. 4. Institute a routine exercise program for the patient. 5. Keep the bed in high position with side rails down. 6. Keep the pathway from the bed to the bathroom clear

d. Preschooler Rationale: The nurse uses role play, imitation, and play to make learning fun for a preschooler. For an infant, the nurse would maintain routines; however, an infant would be unable to engage in role pay and imitation. The nurse uses problem solving to help adolescents make choices but would not engage them in play. The nurse teaches a school-aged child the psychomotor skills required to maintain health.

The nurse includes role play, imitation, and play in the teaching method to make learning fun. The nurse is teaching which age-group of children? a. Infant b. Adolescent c. School-aged d. Preschooler

a. Role play

The nurse is applying which teaching technique when allowing a patient to actively apply knowledge in controlled situations? a. Role play b. Discussion c. Independent project d. Question and answer session

b. Involve the family in teaching information for discharge. d. Encourage the expression of feelings. e. Set aside formal times for discussion.

The nurse is caring for a patient with cancer who was previously in a state of denial but has now accepted the illness. The patient asks the nurse questions about the illness and expresses emotions openly. Which intervention would the nurse perform at this stage? Select all that apply. One, some, or all responses may be correct. a. Provide support and empathy. b. Involve the family in teaching information for discharge. c. Introduce only reality. d. Encourage the expression of feelings. e. Set aside formal times for discussion.

a. It should cater to the needs of the patient. b. Teaching should be problem based. c. Provide only necessary information. e. It should prompt the learner to engage in activities that lead to a desired change.

The nurse is designing a teaching plan for a patient to prevent urinary tract infections. When planning the teaching, which factor would the nurse keep in mind? Select all that apply. One, some, or all responses may be correct. a. It should cater to the needs of the patient. b. Teaching should be problem based. c. Provide only necessary information. d. Teaching should be based on mutually exclusive experiences. e. It should prompt the learner to engage in activities that lead to a desired change.

c. Anxiety related to fear of falling

The nurse is encouraging a patient with hemiparesis to use coping skills that the patient has used previously. To prevent which action would be a possible reason behind this nursing intervention? a. Risk of falling b. Impaired physical mobility c. Anxiety related to fear of falling d. Unilateral neglect related to brain injury

1. Perform hand hygiene. 2. Put on a gown. 3. Put on a mask and eyewear. 4. Put on gloves.

The nurse is going to perform a procedure on a patient who is positive for the human immunodeficiency virus (HIV) infection. The nurse needs to put on personal protective equipment (PPE). Arrange the steps in the appropriate order. Put on a mask and eyewear. Perform hand hygiene. Put on gloves. Put on a gown.

a. The patient's educational status b. The socioeconomic status of the patient c. The culture to which the patient belongs e. The willingness of the patient to participate

The nurse is planning to prepare a teaching plan on healthy nutrition. Which factor would be considered before preparing the teaching plan on healthy nutrition? Select all that apply. One, some, or all responses may be correct. a. The patient's educational status b. The socioeconomic status of the patient c. The culture to which the patient belongs d. The consent of the health care provider e. The willingness of the patient to participate

d. "I would like to participate in the discussion about the treatment plan." Rationale: The affective domain of learning may involve the patient beginning to accept the chronic nature of a disease and learn positive coping mechanisms. Therefore the statement, "I would like to participate in the discussion about the treatment plan" is an example of the affective domain of learning. In the cognitive domain of learning, a patient may learn about the disease and how that disease affects his or her body. Therefore the statements, "Diabetes may cause cataracts and glaucoma" and "Insulin injections would help lower my blood glucose level" indicate the cognitive domain of learning. In the psychomotor domain of learning, a patient learns about the tests he or she would perform at home. Therefore the statement, "I will regularly check my blood glucose level with the glucometer" indicates the psychomotor domain of learning.

The nurse is teaching a patient about diabetes. Which statement made by the patient indicates the affective domain of learning? a. "Diabetes may cause cataracts and glaucoma." b. "Insulin injections will help lower my blood glucose level." c. "I will regularly check my blood glucose level with the glucometer." d. "I would like to participate in the discussion about the treatment plan."

a. Organizing c. Responding d. Characterizing

The nurse is teaching a patient about hygiene practices. During the interaction, the patient expresses feelings and opinions about the teaching provided and hygiene practices. The nurse understands that these expressions are a part of the affective domain of learning. Which behavior is included in affective learning? Select all that apply. One, some, or all responses may be correct. a. Organizing b. Perception c. Responding d. Characterizing e. Comprehension

a. Cognitive Rationale: Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning. Affective learning might include role play. Adaptation learning occurs when motor skills are developed but can be modified if a problem occurs. Psychomotor learning includes demonstration.

The nurse is teaching a patient how to adjust insulin dosages based on blood glucose results. This is an example of which type of learning? a. Cognitive b. Affective c. Adaptation d. Psychomotor

d. Performing hand hygiene before and after patient care

The nurse provides education for a group of nursing students about the prevention of health care-associated infections (HAIs). The nurse recognizes that which intervention is the most effective way to break the chain of infection? a. Placing patients in reverse isolation b. Using protective eyewear while bathing patients c. Donning gown and gloves before entering patient rooms d. Performing hand hygiene before and after patient care

c. Droplet Rationale: If a patient is not isolated, he or she may spread a tuberculosis infection through droplet nuclei and airborne particles during coughing, sneezing, and talking. Infections such as human immunodeficiency virus (HIV) are transmitted through indirect contact, such as needles. Malaria may be transmitted through vectors such as mosquitoes. Vehicles such as blood may transmit infections like hepatitis B, HIV, and hepatitis C.

Tuberculosis is spread through which method of transmission? Select all that apply. One, some, or all responses may be correct. a. Indirect b. Vectors c. Droplet d. Vehicles e. Airborne

d. Providing support, empathy, and careful explanations of all procedures while they are being performed Rationale: When the patient is not prepared to deal with a problem, it indicates that the patient is in the denial or disbelief stage of grieving. In this stage, the nurse should provide support and empathy to the patient, and give careful explanations of all procedures while they are being performed. This will help control the emotions of the patient. When the patient recognizes the reality of the situation, it indicates the acceptance stage of grieving. In this stage, the nurse should focus teaching on future skills and knowledge required. When the patient shows anger to the nurse, it indicates the anger stage of grieving. In this stage, the nurse should avoid arguing with the patient and listen calmly to the patient's concerns about his or her health. When the patient offers to live a better life in exchange for a promise of better health, it indicates the bargaining stage of grieving. In this stage, the nurse should continue to convey only reality to the patient and help the patient accept that reality.

Which action of the nurse would be effective for a patient with cancer who is not prepared to deal with the diagnosis? a. Focusing teaching on future skills and knowledge required b. Avoiding arguing with the patient and listening calmly to the concerns c. Persistently conveying only reality to the patient and helping the patient accept that reality d. Providing support, empathy, and careful explanations of all procedures while they are being performed

a. The field is lower than the nurse's waist. b. The package is slightly damp on the bottom. d. An instrument is out of the nurse's line of sight. e. The syringe tip touches the nurse's clean glove. Rationale: A sterile object becomes contaminated when a nurse touches the sterile object with clean gloves, when the sterile objects are out of the nurse's line of sight or below the nurse's waist, or when the package becomes damp. The edges of the sterile field are considered contaminated, so avoiding them prevents contamination.

Which action performed during a sterile aseptic procedure indicates potential contamination? Select all that apply. One, some, or all responses may be correct. a. The field is lower than the nurse's waist. b. The package is slightly damp on the bottom. c. The nurse avoids touching the edges of the field. d. An instrument is out of the nurse's line of sight. e. The syringe tip touches the nurse's clean glove.

c. Individual and mass screening surveys d. Selective examinations to cure and prevent disease processes e. Provision of facilities to limit disability and prevent death Rationale: Individual and mass screening surveys, selective examinations to cure and prevent disease processes, and provision of facilities to limit disability and prevent death are examples of secondary prevention. The activities of secondary prevention are aimed at early diagnosis, prompt treatment, and disability limitation. The activities include individual and mass screenings and selective examinations to diagnose diseases in early stages and provide timely treatment. Secondary prevention also includes provision of facilities to limit disabilities and prevent death. Immunization administration and environmental sanitation projects are included in primary prevention, not secondary.

Which activity is included in the secondary prevention of diseases? Select all that apply. One, some, or all responses may be correct. a. Immunization administration b. Environmental sanitation projects c. Individual and mass screening surveys d. Selective examinations to cure and prevent disease processes e. Provision of facilities to limit disability and prevent death

a. Screening techniques of diseases b. Treating diseases at an early stage Rationale: Screening techniques of diseases and treating diseases at an early stage are secondary prevention. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and are at risk of developing complications or worsening conditions. It includes screening techniques and treating early stages of a disease to limit disability by averting or delaying the consequences of advanced disease. Primary (not secondary) prevention aimed at health promotion includes offering marriage counseling. Tertiary prevention occurs when a defect or disability is permanent and irreversible; activities are directed at rehabilitation rather than early diagnosis and treatment as in secondary prevention. Using environmental sanitation is a primary prevention technique, not secondary.

Which activity would be classified as secondary prevention? Select all that apply. One, some, or all responses may be correct. a. Screening techniques of diseases b. Treating diseases at an early stage c. Offering marriage counseling d. Providing rehabilitation activities e. Using environmental sanitation

b. A communicable disease

Which can be transmitted directly from one person to another? a. A susceptible host b. A communicable disease c. A port of entry to a host d. A port of exit from the reservoir

a. Cognitive b. Affective Rationale: The cognitive domain involves acquisition of knowledge, comprehension, and application of the acquired knowledge. The affective domain involves expressing feelings and accepting attitudes, opinions, and values. The nurse should focus on these two domains while teaching the patient about behavioral modifications. The psychomotor domain involves the use of mental and muscular activity. "Attentive" and "Psychosocial" are not domains of learning.

Which domain of learning would the nurse focus on while teaching a patient with heart failure about behavioral and lifestyle modifications? Select all that apply. One, some, or all responses may be correct. a. Cognitive b. Affective c. Psychomotor d. Attentive e. Psychosocial

a. Autoclave Rationale: Autoclaves use moist heat to kill pathogens and spores on surgical instruments to prevent infections. Boiling water is used to clean urinary catheters, suction tubes, and drainage collection devices. Chemical sterilants are used to disinfect heat-sensitive instruments and equipment such as endoscopes and respiratory therapy equipment. ETO gas is used for most medical materials.

Which equipment is used to sterilize surgical instruments? a. Autoclave b. Boiling water c. Chemical sterilants d. Ethylene oxide (ETO) gas

c. Individual's perception of susceptibility to an illness d. Individual's perception of the seriousness of an illness e. Likelihood that a person will take preventive action Rationale: The components of the HBM include an individual's perception of susceptibility to an illness, perception of the seriousness of the illness, and the likelihood that a person will take preventive action. Behavior-specific knowledge and affect and individual characteristics and experiences are components of the health promotion model, not the HBM.

Which example is a component of the health belief model (HBM)? Select all that apply. One, some, or all responses may be correct. a. Behavior-specific knowledge and affect b. Individual characteristics and experiences c. Individual's perception of susceptibility to an illness d. Individual's perception of the seriousness of an illness e. Likelihood that a person will take preventive action

c. Cultural background d. Employment status e. Visibility of symptoms

Which factor is considered an external variable influencing illness and illness behavior? Select all that apply. One, some, or all responses may be correct. a. Coping skills b. Locus of control c. Cultural background d. Employment status e. Visibility of symptoms

a. Attempts to create conditions for optimal health b. Recognizes patients as the ultimate experts about their health c. Incorporates the patient's subjective experience as relevant in healing Rationale: Features include attempts to create conditions for optimal health, recognizes patients as the ultimate expert about their health, and incorporates the patient's subjective experience as relevant in healing. Maslow's hierarchy model (not holistic health model) helps demonstrate the relationship of basic human needs and is based on the belief that certain human needs are more basic than others.

Which feature is true about the holistic health model? Select all that apply. One, some, or all responses may be correct. a. Attempts to create conditions for optimal health b. Recognizes patients as the ultimate experts about their health c. Incorporates the patient's subjective experience as relevant in healing d. Demonstrates the relationship of basic human needs e. Is based on the belief that certain human needs are more basic than others

d. BMI of 16 Rationale: The low BMI of 16 is an internal variable affecting health. A low BMI of 16 indicates the woman is underweight. Access to clinic, snoring, and employment status can affect the women's health, but these are examples of external variables, not internal.

Which internal variable affecting a woman's health is described when the clinic nurse finds that the patient has a low body mass index (BMI) of 16, the obese spouse snores loudly, and both are unemployed? a. Access to clinic b. Snoring c. Employment status d. BMI of 16

b. Secondary Rationale: This situation describes secondary prevention. Patients with health problems or who are at risk of developing complications need medical interventions. Early diagnosis and treatment can limit further damage and help patients recover. Primary prevention occurs before development of a medical problem; the patient is currently obese. Tertiary prevention is required for patients who need rehabilitation for a permanent or irreversible defect or disability; obesity is not permanent or irreversible. While the focus is specific for diet, it is not classified as specific prevention.

Which level of prevention describes an obese patient who follows a healthy low-calorie diet and after 6 months the patient has lost weight? a. Primary b. Secondary c. Tertiary d. Specific

a. Saliva b. Blinking d. Macrophages Rationale: Saliva, blinking, and macrophages are nonspecific body defense systems that help protect against infections. Saliva washes away particles containing microorganisms and reduces infection. Blinking reduces entry of particles containing pathogens, thus reducing the dose of organisms that cause infections. Macrophages engulf and destroy microorganisms that reach alveoli. Erythrocytes and thrombocytes are not associated with the body's defense systems.

Which nonspecific defense system of the body helps to prevent infections? Select all that apply. One, some, or all responses may be correct. a. Saliva b. Blinking c. Erythrocytes d. Macrophages e. Thrombocytes

c. Bacteroides fragilis Rationale: Bacteroides fragilis is a part of the normal flora of the human colon. This microorganism can cause infections if it enters the bloodstream or tissue during injury or surgery. Escherichia coli causes gastroenteritis in the colon. Candida albicans causes candidiasis, pneumonia, and sepsis. Plasmodium falciparum causes malaria.

Which normal flora of the human colon can cause an infection when it enters the bloodstream? a. Escherichia coli b. Candida albicans c. Bacteroides fragilis d. Plasmodium falciparum

b. Verbally explaining to the patient how to use the wheelchair Rationale: The cognitive domain of learning involves discussion of specific patient concerns. Therefore the action of the nurse verbally teaching the patient about the use of the wheelchair is an example of the cognitive domain of teaching.

Which nursing action is an example of teaching to a patient's cognitive learning style? a. Giving patients examples of other patients' experiences b. Verbally explaining to the patient how to use the wheelchair c. Asking the patient to demonstrate the use of the wheelchair after teaching d. Showing the patient how to use the wheelchair

b. Teach while touring the blood bank. d. Ask the students questions during the session. e. Demonstrate the procedure of blood donation in the actual setting. Rationale: The nurse should teach the students about blood donation while touring the blood bank where students can see the blood bank activities, which can increase their interest levels. The nurse should ask questions to engage the students in the learning activity and should demonstrate an actual blood donation. This would allow active participation of the students, make them aware of the procedure, and allow them to make informed decisions. Handing out pamphlets would not engage the students in learning. Giving a lecture in the hallway would be distracting, and the students might not participate in the teaching.

Which nursing action would encourage active participation of students regarding the importance of donating blood? Select all that apply. One, some, or all responses may be correct. a. Hand out pamphlets. b. Teach while touring the blood bank. c. Give a lecture in a hallway. d. Ask the students questions during the session. e. Demonstrate the procedure of blood donation in the actual setting.

a. Explaining the importance of a nutritious diet Rationale: Explaining the importance of a nutritious diet is primary prevention. Primary prevention interventions are done before the development of a disease or disorder. Interventions can take the form of health education or nursing interventions such as immunizations. Primary prevention also includes a nutritious diet to maintain health and prevent illness. Supplying a nutritious diet to children with malnutrition is secondary prevention, not primary, because a disease (malnutrition) is already present. Teaching disabled children to use their capacities to the fullest would be considered tertiary (not primary) prevention, because disability has already occurred. Conducting health examinations to identify children with malnutrition and supplying nutritious diets to children with malnutrition would be considered secondary (not primary) prevention, because these measures are directed toward managing a disease that has already manifested.

Which nursing intervention is considered primary prevention for school children younger than 10 years old? a. Explaining the importance of a nutritious diet b. Supplying a nutritious diet to children with malnutrition c. Teaching disabled children to use their capacities to the fullest d. Conducting health examinations to identify children with malnutrition

2. Keep the sterile field in view at all times. 3. Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated.

Which of the following actions by the nurse demonstrate the practice of core principles of surgical asepsis? (Select all that apply.) 1. The front and sides of the sterile gown are considered sterile from the waist up. 2. Keep the sterile field in view at all times. 3. Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated. 4. Only health care personnel within the sterile field must wear personal protective equipment. 5. After cleansing the hands with antiseptic rub, apply clean disposable gloves.

1. Proper cleaning requires mechanical removal of all soil from an object or area. 2. General environmental cleaning is an example of medical asepsis. 4. Cleaning in a direction from the least to the most contaminated area helps reduce infections.

Which of these statements are true regarding disinfection and cleaning? (Select all that apply.) 1. Proper cleaning requires mechanical removal of all soil from an object or area. 2. General environmental cleaning is an example of medical asepsis. 3. When cleaning a wound, wipe around the wound edge first and then clean inward toward the center of the wound. 4. Cleaning in a direction from the least to the most contaminated area helps reduce infections. 5. Disinfecting and sterilizing medical devices and equipment involve the same procedures.

b. Confused patients d. Patients who repeatedly fall e. Patients who try to remove medical devices

Which patient would need a temporary restraint? Select all that apply. One, some, or all responses may be correct. a. Alert patients b. Confused patients c. Accommodating patients d. Patients who repeatedly fall e. Patients who try to remove medical devices

a. Adequate strength b. Sensory acuity c. Coordination

Which quality will enable the patient to perform dressing changes at home? Select all that apply. One, some, or all responses may be correct. a. Adequate strength b. Sensory acuity c. Coordination d. A caregiver's attitude e. Self-esteem

a. Helps reduce the risk of patient injury from falls b. Prevents the patient from removing intravenous (IV) infusions d. Helps reduce the risk of injury to others by the patient

Which reason would justify the use of restraints on a disoriented patient? Select all that apply. One, some, or all responses may be correct. a. Helps reduce the risk of patient injury from falls b. Prevents the patient from removing intravenous (IV) infusions c. Helps control the patient d. Helps reduce the risk of injury to others by the patient e. Minimizes the need for supervision of the patient

d. "You should make sure that you are getting the right treatment from the right health care professional." Rationale: The nurse is responsible for teaching patients about their rights.

Which statement by the nurse would make the patient pay more attention to the care being provided? a. "You should learn about the medical tests." b. "You should ask questions if you do not understand something." c. "You should ask a trusted family member to be your advocate." d. "You should make sure that you are getting the right treatment from the right health care professional."

d. The nurse should wear a sterile gown while assisting a health care provider during surgery.

Which statement is true regarding donning a sterile gown? a. The circulatory nurse should wear a sterile gown. b. Nurses should wear sterile gowns before applying masks. c. The collar of a surgical gown is considered sterile. d. The nurse should wear a sterile gown while assisting a health care provider during surgery.

d. Restraints are a part of the patient's prescribed medical treatment and plan of care. Rationale: If restraints are to be used, they must be a part of a patient's prescribed medical treatment and plan of care. Restraints are not ordered prn. The use of restraints involves a psychological adjustment for both the patient and the family, not just the family. Informed consent from family members is required before using restraints only in long-term care facilities, not in acute care settings.

Which statement is true regarding the use of patient restraints? a .Restraints are ordered prn. b. The use of restraints involves a psychological adjustment for the family. c. Informed consent from family members is required before using restraints. d. Restraints are a part of the patient's prescribed medical treatment and plan of care.

a. "Teaching is most effective when it responds to the learner's needs." c. "Teaching is the concept of imparting knowledge through a series of directed activities." e. "Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills." Rationale: Teaching is most effective when it responds to the learner's needs. The learner's needs are assessed by asking questions and determining the learner's interest. Teaching is the concept of imparting knowledge through a series of directed activities. Effective teaching consists of a conscious, deliberate set of actions that help the learner gain new knowledge, change attitudes, adopt new behaviors, or perform new skills. Learning, not teaching, is a process of both understanding and applying newly acquired concepts. Likewise, learning is purposeful attainment of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus.

Which statement made by the nursing student about effective teaching indicates effective learning? Select all that apply. One, some, or all responses may be correct. a. "Teaching is most effective when it responds to the learner's needs." b. "Teaching is a process of both understanding and applying newly acquired concepts." c. "Teaching is the concept of imparting knowledge through a series of directed activities." d. "Teaching is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus." e. "Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills."

a. Vasodilation occurs at the site of injury. Rationale: Vasodilation occurs at the site of injury resulting in excessive blood loss at the site. The immediate response to a cellular injury is an acute inflammation. Increased blood flow at the site of inflammation leads to redness and warmth at the site of inflammation. The cellular response involves white blood cells at the site of inflammation.

Which statement regarding vascular and cellular responses is true? a. Vasodilation occurs at the site of injury. b. Chronic inflammation is an immediate response to cellular injury. c. Increased blood flow leads to coldness at the site of inflammation. d. The cellular response involves red blood cells at the site of infection.

a. Give oral medication using a paper cup. b. Wash hands with soap and water.= d. Discard safety needles into the sharps container. e. Wear gloves when administering an injection.

Which step would the nurse take to prevent contamination when administering medication to a patient with Clostridium difficile? Select all that apply. One, some, or all responses may be correct. a. Give oral medication using a paper cup. b. Wash hands with soap and water. c. Wear a respirator mask while in the room. d. Discard safety needles into the sharps container. e. Wear gloves when administering an injection.

a. Fatigue e. Malaise Rationale: Fatigue, malaise, fever, and vomiting are the generalized symptoms of systemic infections. Localized infections can be assessed by redness, warmth, and swelling caused by inflammation.

Which symptom indicates the presence of a systemic infection? Select all that apply. One, some, or all responses may be correct. a. Fatigue b. Redness c. Swelling d. Warmth e. Malaise

b. Use role playing, imitation, and play to make learning fun. e. Encourage learning together through pictures and short stories about how to perform hygiene.

Which teaching intervention would facilitate learning when teaching handwashing to a group of preschoolers? Select all that apply. One, some, or all responses may be correct. a. Teach psychomotor skills needed to maintain health. b. Use role playing, imitation, and play to make learning fun. c. Provide information regarding the health problem to the child. d. Allow the preschooler to make decisions about health and health promotion. e. Encourage learning together through pictures and short stories about how to perform hygiene.

c. Using play to teach procedures and activities Rationale: For a toddler, the nurse uses play to teach procedures and activities. The nurse would have an infant touch different textures. The nurse speaks softly to an infant to convey a sense of trust. For a preschooler, the nurse uses pictures to teach how to perform hygiene.

Which teaching method would the nurse include for a toddler? a. Having the toddler touch different textures b. Speaking softly to convey a sense of trust c. Using play to teach procedures and activities d. Using pictures to teach how to perform hygiene

a. Use role playing and imitation. b. Encourage questions and offer explanations. c. Encourage the children to learn together through short stories and pictures.

Which teaching method would the nurse use to teach preschoolers how to wash their hands? Select all that apply. One, some, or all responses may be correct. a. Use role playing and imitation. b. Encourage questions and offer explanations. c. Encourage the children to learn together through short stories and pictures. d. Encourage participation in a teaching plan. e. Encourage independent learning.

a. Performing hand hygiene Rationale: Performing hand hygiene is the most effective and basic technique in preventing and controlling the transmission of infection. Isolation precautions cannot control the transmission of microorganisms that cause infections unless the nurses and other health care workers follow proper control measures to prevent infections. Performing sterilization procedures helps control the transmission of infections through surgical instruments or other medical materials. Wearing PPE is important when performing procedures that carry the risk of direct contact with contaminated material, but this intervention is a more complicated step.

Which technique is most effective in preventing and controlling the transmission of an infection? a. Performing hand hygiene b. Using isolation precautions c. Performing sterilization procedures d. Wearing personal protective equipment (PPE)

b. Weight reduction c. Continuing medication d. Physical exercise Rationale: The nurse would suggest weight reduction, continuing medication, and physical exercise. The goal of tertiary prevention is to minimize the impact of an ongoing illness or injury that has lasting effects. Tertiary prevention for this patient includes weight reduction (prevents excess pressure on the affected joints), continuation of maintenance medication (reduces the pain of arthritis), and physical exercise (maintains movement of joints, because stiffness of joints is a common problem in patients with arthritis). Immunizations are considered primary prevention, not tertiary. Diagnostic tests are secondary prevention, not tertiary.

Which tertiary prevention intervention would a nurse suggest to a patient who has arthritis, is managed with maintenance medication, and whose height is 167 cm (5 feet 5 inches) and weight is 75 kg (165 pounds)? Select all that apply. One, some, or all responses may be correct. a. Immunizations b. Weight reduction c. Continuing medication d. Physical exercise e. Diagnostic tests

a. It allows peer support. b. It involves both the nurse and the patient. d. It helps the patient learn from others' experiences.

While studying the different domains of learning, the nurse finds discussion to be the appropriate teaching method based on cognitive learning. Which characteristic is true of the discussion method? Select all that apply. One, some, or all responses may be correct. a. It allows peer support. b. It involves both the nurse and the patient. c. It involves presentation of procedures or skills by the nurse. d. It helps the patient learn from others' experiences. e. It allows the patient to assume responsibility for completing learning activities at his or her own pace.