Fundamentals Quizzes (6-10)

The client is newly diagnosed as having a terminal disease and asks, "I'm going to die soon, aren't I ?" What are the most appropriate statements by the nurse? Select all that apply

"How do you feel about that? " "What have you been told by your health care provider? "

A nurse who provides care on a palliative care unit of a busy urban hospital performs numerous task and roles in the provision of holistic care to patients and their families. Which of the following tasks is essential for nurses to manage patients at the end of life? Select all that apply

1. Educate patients and families about end -of-life decision making. 2. Manage pain and symptoms 3. Contribute to a coordinated, interdisciplinary plan of care

Nurse is caring for a 73 y/o make pt with a urethral obstruction related to prostatic enlargement. the nurse is aware this may result in what?

A UTI

A patient with amyotrophic lateral sclerasis (TALS) wishes to use his Medicare Hospice Benefit in an effort to maximize his quality of life prior to death. What criterion will determine whether the pt qaulifies for this benefit

A life expectancy of less than 6 months

Which of the following individuals would be likely to require administration of exogenous erythropoietin?

A man with a diagnosis of acute renal failure secondary to type 1 diabetes

Which order for potassium (KCl) would the nurse question? (Select all that apply.)

A. 1000mL D5 0.9% NS with 100 mEq KCl IV 150ml/hour B. Potassium chloride (KCl), 20 mEq rapid IV push C. Potassium chloride (KCl) 20 mEq/100mL to be given over 30 mins

Which topics should the nurse include in the discharge teaching plan for a pt who has been hospitalized with chronic HF

A. How to take and record daily weight B. How to read dietary labels for sodium content C. Symptoms indicating worsening HF D. actions and side effects of presecribed meds

A pt is who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient?

Acetaminophen (tylenol)

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?

Administer the spironolactone (Aldactone) and ask the provider about the furosemide (Lasix)

A client's physician has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply

Alanine aminotransferase (ALT) Alkaline phosphatase (ALP) Alanine aminotransferase (AST)

The nurse is performing a physical assessment on a pt suspected of being in HF during auscultation of the heart, HF would be suggested by:

An S3 heart sound

A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has vigilant about monitoring the trajectory of disease and adhering to his prescribed tx regimen. The man had scheduled an appt with his primary provider because he has noted a weight hain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following tx measures?

An increase in the dose of his prescribed diuretic

A public health nurse works with numerous patients who live with chronic obstructive pulmonary disease (COPD) in the community and has seen firsthand effects of many risk factors underlying the diease. Which of the following public health intiatives addresses the most salient risk factor for COPD?

Anti-smoking campaign in a junior high school

A pt. with a new ileostomy is preparing to go home. What should the pt. be taught about changing his ileostomy?

Apply skin barrier to the peristomal skin prior to applying the pouch

Your 24y/o male pt had a foley cath post Op after hand surgery yesterday, & you removed it at 0600 as ordered. At 0900 the pt has not urinated, & complains of lower abd discomfort. He is slightly diaphoretic and a little restless with normal vital signs & pulse ox. Which of the following actions will you do first?

Assist him to a standing position to urinate & turn on the bathroom faucet

A male pt. Who has had outpatient surgery is unable to void while lying supine. What can the nurse do to facilitate his voiding?

Assist him to a standing postion

After inspecting the abodomen for skin color and surface characteristics, and surface movement, your next assessment of the abdomen is to

Ausculatate for bowel sounds

Which topic is most important to include in patient teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?

Avoiding alcohol ingestion

Which diagnostic test will be most useful to the nurse determining whether a patient admitted with acute shortness of breath has heart failure?

B- type natriuretic peptide

A specially trained nurse has inserted a PICC line. What would be done next?

B. Confirm placement by radiologic exam .

The nurse is performing an admission of a pt who has a hx of asthma. The nurse should be aware that the most common sign of asthma are what ?

Bilateral wheezes

A pt has been admitted to the hospital with exacerbation of HF that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the pts s/s of HF. How can the nurse best monitor the pts fluid balance?

By performing daily weights at the same time every day

A nurse measures a client's 24 hour fluid intake and documents the findings. To be an accurate indicator of fluid status, what must the nurse also do with the info?

Compare total intake and output of fluids for the 24 hours

The home care nurse visits a client who has dyspnea. The nurse notes the client has pitting edema in his feet and ankles. What additional assessment would the nurse expect to observe

Crackles in lower lobes

A nurse is assessing the stoma of a client with an ostomy. What would the nurse assess in normal, healthy stoma?

Dark red & moist

The long-term care nurse is evaluating the effectiveness of protein supplements for an older resident who has a low serum total protein level. Which assessment finding indicates that the patients condition has improved?

Decreased peripheral edema

66-year -old man underwent a partial gastroectomy for the tx of stomach cancer 3 yrs ago. At follow up he complains about numbness in his lower extremities and his blood work indicated anemia. The nurse who is contributing to the patients care should recognize that the patients anemia may be attributable to what factor?

Decreased vitamin b 12 absorption

A nurse has catheterized a client to obtain urine for measuring postvoid residual (PVR) amount. The nurse obtains 40 ml of urine. What should the nurse do next ?

Document this normal finding for post void residual

Nurse who works in a busy ED provides care for numerous pts who present with compaints of chest pain. Which of the following questions is most likely to help the nurse differentiate between chest pain that is attributable to angina and chest pain due to MI

Does resting and remaining still help your cheat pain to decrease

The clinic nurse is teaching a young women about preventing recurrent UTI. What info should the nurse include?

Drink liberal amounts of fluids

A 69y/o man has been experiencing progressive dyspnea and activity intolerance in recent months and is currently undergoinging a diagnostic workup for heart failure. During echocardiography, systolic HF could be differentiated from diastolic HF by appraising the patients:

Ejection fraction

The nurse is caring for a 24 y/o pt with alpha 1 antitrypsin deficiency who stated that she has never smoked in her life. An antitrypsin deficiency predisposes the pt with what ?

Emphysema

A pt with COPD has poor gas exchange. Which action by the nurse would be most appropriate

Encourage patient to sit up at the bedside chair and lean slightly forward

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?

Fewer episodes of bleeding varicies

What are the main fluid and acid base characteristics of diabetic ketoacidosis?

Fluid deficit, metabolic acidosis

58 y/o with a longstanding diagnosis of diverticulitis has been admitted to the hospital due to an acute exacerbation in her symptoms. The care team has deemed surgery unnecessary, but is pursuing aggressive medical treatment. What pathopysiological process is contributing to this womens health problem?

Food & bacteria have accumulated in a herniated area of the pts colon

A nursing student is performing a urinary catheter for the first time in contaminates the catheter by touching the bed linens. what should the nurse do to maintain surgical asepsis with this procedure?

Gather new materials and start over

A nurse is receiving change of shift report about an older adult patient who has a diagnosis of COPD . The nurses colleague reports she has applied oxygen at 6L/min by nasal prongs in effort to bring the pts oxygen stat level above 92%. How should the nurse best interpret this colleagues action ?

Guving oxygen at a high rate has potential to over correct the pts ABG & interfere with the patients hypoxic drive

A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client states that she fell when transferring to the commode. The client's vital signs are within reference ranges and the nurse observes no apparent injuries, What is the nurse's most appropriate action?

Have the client assessed by the primary provider due to the risk of internal bleeding

You are working on a burn unit. One of your patients is exhibiting S/S of third spacing, which occurs when fluid moved out of the intravascular space. Based upon this fluid shift, what would the nurse expect the patient to demonstrate?

Hypovolemia

While caring for a client near end of life, a student talks to her pt. Another student asks why she is talking to someone who is dying. Which response would be accurate?

I believe the client can hear me as long as she is alive .

The nurse is planning and providing the care of a patient with heart fallure (HF), What will be the overall goals of management for this pt?

Improve fuctional status Extend survival Relieve patient symptoms

You are the nurse gving palliative care to a patient with a diagnosis of chronic obstructive pul monary disease (COPD) What is the primary goal of paliative care?

Improve the pts qaulity of life

The nurse is caring for a pt with a hematologic disorder, the pt asked the nurse where the body forms blood cells. Where should the nurse tell the or that blood cells are formed?

In the bone marrow

A nurse is caring for a cient with liver failure and is performing an assessment in the knowledge of the clients increased risk of bleeding. The nurse recognizes that this risk is related to the clients inability of synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

Inability of liver to use Vit K

Iv complications are classified by location. Local complications, those that occur at or in close proximity to insertion site include:

Infiltration Phlebitis Hematoma Thrombosis Extravasation

Before the nurse begins the physical exam of a client with congestive heart failure, the client reports having to get up at night to void freq. which action should the nurse take in response to the clients report ?

Inspect for dependent edema

A client asks a nurse to explain a living will. What is the nurse's best answer?

It lists specific instructions for health care provisions

The nurse is caring for a patient with the diagnosis of hypoproliferative anemia. When planning this pts care the nurse should be aware that this type of anemia is due to what?

Lack of production of red blood cells

A nurse assesses a client who reports abd pain. Which technique should the nurse use during the physical exam to detect tenderness?

Light palpation

a nurse is caring for a client with dehydration. Which of the following signs is observed in a patient with dehydration ? Select all that apply

Low urine output Decreased blood pressure Decreased skin turgor over sternum

A patient receives 3 % Nacl solution correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?

Lung sounds

A dying client and family have requested that no attempts be made to resuscitate the client in the event of death. A doctor has written a DNR order. What is nurse 's responsibility if the client dies ?

Make No attempt to resuscitate the client

The triage nurse in the ED assesses a 66 y/o male who has presented to the ed with complaints of midsternal chest pain that has lasted for the last 5 hours. The care team suspects an MI. The nurse is aware that the length of time the patient has been experiencing symptoms, the followong may have happened to the myocardium

May have developed an increased area of in infarction

A women is diagnosed with peptic ulcers for several months and has been vigilant about implementing the nurses recommened lisfestyle modifications. The women states she is motivated to control her ulcers becuase she has a sister who has to be hospitalized for the tx of a bleeding ulcer. A bleeding ulcer is strongly suggested when a patient exhibits:

Melena stool

The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance?

Monitor weight daily

75 y/o male presents at the ED with symptoms of small bowel obstruction. An ER nurse is obtaining assessment data from this pt. What assessment finding is characteristic of a small bowel obstriction?

N/V

22-year-old college student has been diagnosed with Crohn's disease after a diagnostic workup that was prompted by his complaints of recurring abdominal pain and diarrhea. The nurse who is contributing to this patient's care should recognize the possibility which complications of his disease?

Nutritional deficits, Fistula, Fluid and electrolyte imbalances

The nurse has paged the hospital patients primary care provider because the patients urine output over the past 12 hours is approx. 140mL. The nurse would recognize that this patient is experiencing what health problem?

Oliguria

A client with COPD on oxygen therapy is experiencing increased dyspnea which interferes with the residents ability to eat. The nurse recognizes the potential nursing diagnosis of altered nutrition: less than body requirements. How can the nurse best foster this residents nutritional status

Order small, frequent meals & nutritional supplements for resident

You only have one docusate (colace) tablet. Which patient needs it most?

Patient recovering from MI

A client with dehydration is being administered IV fluids. During her rounds, the nurse noticed that the skin immediately surrounding the IV site is reddish in color and showing signs of inflammation. The nurse recognizes that what phenomenon is likely responsisble?

Phlebitis

Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse tell the family?

Please stay with your loved one and talk to him

C.Diff infection Has been moving through an extended care facility & several of the elderly residents have been experiencing severe diarrhea. One particularly sick resident has told the nurse that he is now experiencing extreme fatigue and muscle cramps and his heart feels like it occasionally skips a beat. The nurse should facilitate a stat assessment of this residents:

Potassium level

A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern?

Potassium level of 3.0 mEq/L

During a home visit, the nurse learns that the client ensures a bowel movement with the help of lacatives. The client feels that deviation from a bowel movement every day is unhealthy. Which nursing diagnosis would the nurse most likely identify?

Precieved constipation

A nurse is educating a home care client on how to do pursed-lip breathing. What is the therapeutic effect of this procedure?

Prolonging expiration to reduce airway resistance

For a patient with cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?

Providing oral hygiene after a meal

A client has a physician's order for NPO (nothing by mouth) following abdominal surgery to repair a bowel obstruction. The client has a nasogastric tube inserted to low intermittent suction. The client requires intravenous therapy for what purpose

Replace fluid electrolytes

38y/o male patient with ulcerative colitis is recoverinf after colostomy 2 days ago. You plan to teach him about self care whole changing his colostomy appliance. When changing the appliance you note intact skin around the stoma, a pale pink stoma with slight edema, and brown, odorous effulent. What is your next action?

Report you assessment findings to the surgeon

A patient in the ICU starts complaining of being short of breath. An arterial blood gas (ABG s) drawn, The ABG has the following values: pH: 7.21, Paco2: 64mm Hg , HCO3: 24mm Hg. What does the ABG reflect ?

Respiratory acidosis

A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the client is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?

Respiratory alkalosis

A 50 y/o woman recently sought care for her primary provider & was diagnosed with hypo proliferation anemia following a diagnostic workup. The nurse at the clinic has been charged with the responsibility for organizing the women's care and is consequently creating a nursing care plan. When planning this women's care, what nursing diagnosis should the nurse prioritize ?

Risk for fatigue

While completing the cardiovascular system health history. A client reports difficulty falling asleep unless she is in an upright position. Which of the following potential problems should the nurse further investigate?

SOB

The nurse is planning the care of a complex elderly pt who has been admitted to the medical ward for the tx of an infection. The pt has a longstanding hx of COPD. What assessment finding would most clearly indicate the need for oxygen therapy?

SaO2 of 86% on room air

A terminally ill client states to the nurse, "My situation is hopeless; I have no control over anything." The nurse implements which of the following interventions to enable hope for the client?

Sit in a chair next to the client Hold the client's hand Encourage the client to discuss his feelings

A 40y/o man newly diagnosed with HTN is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient avoid tabacco use. What is the rationale behind the advice to the patient?

Smoking increases risk of heart disease

A 22-year-old with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patients most recent blood work, the nurse should pay particular attention to the patient's levels of

Sodium

A community health nurse is conducting a workshop for adults who have hypertension and is now teaching participants about reading food labels when they are shopping at the supermarket. What teaching point should this have nurse prioritize?

Take particular note of the amount of sodium that a serving contains

A 66yo male pt with a high body mass indez & a hx of HTN made an appointment with his primary care provider because of the sudden, severe, and unprecedented fatigue over the past several days. The care provider referred the pt to the ED, where the patient underwent assessment for acute coronary syndrome. Assessment of the man's cardiac biomarkers revealed normal levels of myoglobin and CK-MB but elevated levels of tropinn 1. What conclusiom is suggested by these data?

The man had an MI in the recent past

The nurse is providing care for a 60-year-old patient who has been admitted for the treatment of community-acquired pneumonia. The nurse reads in the patient's chart that he has an 80 pack year history of cigarette smoking. During health education about smoking cessation, the patient tells the nurse that he began smoking as a 20-year-old when conscripted into the army. What conclusion can the nurse draw from these data?

The patient has been smoking two packs a day for most of his adult life

A pts health care provider has ordered blood work that included a WBC differential. The results of this blood test reveal bandemia, in which the pts WBC count indicates higher-than-normal proportion of band cells. What should the nurse infer from the assessment finding ?

The pt is currently fighting an infection

An 82-year-old resident of a long-term care facility has had a scheduled appointment with his primary care provider and had blood work drawn thereafter The results of the resident's blood work are suggestive of anemia. How should the nurse best interpret this lab finding?

The specific etiology of the residents anemia should be investigated

The nurse is conducting a morning assessment of an 80-year-old female patient who has longstanding diagnosis of heart falilure (HF). The nurse notes an elevation in Jugular venous pressure greater than 4cm above the womans sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding?

The women may be experiencing exacerbation of right-sided heart failure

After an extensive diagnostic workup, a 64 y/o man has received a diagnosis of COPD. He is eager to learn as much as possible about his new diagnosis & he asked the nurse numerous questions about his course of tx and his prognosis. Which of the following statements is most accurate

There is no cure for COPD but there are several measures that can help you maintain your quality of life.

A patient with a recent history of hematologic abnormalities has been scheduled for bone biopsy. The patient has expressed to the nurse. That sounds like an incredibly painful experience. How should the nurse best respond to this patient's concern?

There is some pressure felt when the doctor advances the needle & removes the marrow, but this should be short lasting

A nurse assesses a terminally ill patient with a DNR ORDER, with findings of decreases blood pressure, urinary and bowel incontinenece, loss of reflexes and cheyne-strokes respirations. Based on these findings. The nurse recognized which of the following?

These are signs of impending death

A patient with angina is beginning nitrogylcerin. Before adminstering the drug the nurse informs the patient that immediately after administration the patient may experience what?

Throbbing headaches and dizziness

A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

Two to three soft bowel movements daily and decreased serum ammonia level

30 y/o woman has presented for care stating "im pretty sure that ive got a UTI." In the presence of a UTI, the nurse would expect the women to have which of the following S/S ?

Urinary frquency Urgency Pain on urination

The nurse is caring for a pt who has a central venous access device (CAVD). Which action by the nurse is appropriate ?

Use the push pause/push pulse method to flush the CAVD after giving medications

A nurse has provided edu for a pt newly diagnosed with HTN who is just beginning therapy with antihypertensive meds. Which statement by the patient indicated a need for further teaching?

When my symptoms subside, i may discontinue the medications

A 60 y/o women has been BIBA after she experienced a sudden onset of dsypnea and phoned 911. The woman is obese but clains an unremarkable medical history and denies chest pain. When assessing the pt, the nurse in the ed should be award that:

Women often present with an MI much differently than do men

To prepare a patient with ascites for paracentesis, the nurse

asks the patient to empty the bladder.

A pt with renal failure has decreased erythropoieten production. Upon analysis of the pts CBC, the nurse will expect which of the following CBC results?

decreased hemoglobin and hematocrit

Kübler-Ross defines five stages of psychosocial death. Which of the following statements is characteristic the of bargaining stage?

just let me live to see my grandson born.

Your patient with diabetic ketoacidosis (DKA) has Kussmaul's respirations, which are

rapid and deep

A patient who was injured at home is brought to the emergency department. The nurse caring for this patient notes a respiratory rate of 32 breaths per minute and a heart rate of 90 beats per minute. The injuries are minor, but the patient is inconsolable, hysterical, and complaining of tingling in fingers. The nurse expects that initial management will include:

rebreathing expired air

You are infusing an isotonic Ⅳ solution with potassium chloride added into your patient. You are assessing the VAD site now with about half of the infusion complete. the correct nursing action for your assessment findings

red, warm, tender "cord" along vein above infusion site for 4 cm, IV solution infusing easily Action: discontinue venous access device, start new VAD for infusion in other extremity, apply warm compress to original site

A nurse is teaching a home care client and the family about using prescribed oxygen. What is a critical factor that must be included in teaching?

the safety measures necessary to prevent a fire

As part of a large hospital's IV team, two nurses are responsible for inserting peripherally inserted central catheters (PICCs) at the bedside for require this form of venous access. Which of the following patients would most likely require a PICC?

woman who has been ordered intravenous antibiotics for 21-28 days.