Med Surg Exam 1

5) According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient days at the inpatient level? a. 30 b. 10 c. 20 d. 40

20

The nurse is caring for a client with hypoxia. The nurse understands that brain cell death may occur in a little as how many minutes? a. 1-3 b. 3-6 c. 6-9 d. 9-12 the length of time that different tissues can survive without oxygen varies. Brain cells may succumb to 3-6 minutes depending on the situation

3-6

8. A preferred provider organization is described as a a. Prepaid group health practice system b. Limited insurance program c. Health care savings account program d. Business arrangement between the hospital and physician

Business arrangement between the hospital and physician

A 75 year old woman had surgery for her hip fracture yesterday. She is under stress due to pain, sleep deprivation and hospital surroundings. The nurse caring for her implements a proactive approach to pain management. Plans include frequent communication to establish an acceptable pain rating, conducting hourly pain assessments and hourly evaluation of the patients control in addition to improved patient outcomes, how else might the nurse benefit from the nurses actions? a. Improved quality and safety education for nurses (QSEN) survey scores b. Additional funding from the institute for healthcare improvement c. Improved hospital consumer assessment of healthcare providers and systems (HCAPS) survey scores d. Continued accreditation from the Joint Commision Rationale: HCAHPS survey measure patients' satisfaction with the quality of nursing they receive, including their satisfaction with their communication with the nurses, the responsiveness of the hospital staff, the quietness of the environment, their pain management, communication about their medications and their discharge information. Institute for Healthcare Improvement is a non-profit organization whose mission is adapted form the IOM's six aims for improvement. IHI is not a funding source for hospitals. Accreditation from The Joint Commission has a larger scope outside of pain management measures. QSEN prepares future nurses with the knowledge, skills and attitudes (KSA) required to continuously improving the quality and safety of the health care system.

Improved hospital consumer assessment of healthcare providers and systems survey scores

The preferred route of administration of medication in the most acute care situations is through which of the following a. IM b. epidural c.subcutaneous d. intravenous IV is preferred because it is the most comfortable, and peak serum levels and pain relief occur more rapidly and reliably. Epidural issued to control postoperative and chronic pain. Subcutaneous results in slow absorption of medication. IM is absorbed more slowly than IV

Intravenous

5. Which of the following would be considered an expanded nursing role? a. Respiratory therapist b. Social worker c. Certified nurses aide d. Nurse practitioner

Nurse practitioner

Which of the following situations would be appropriate for ethic committee review? SAA a. restraining a patient, after all other viable options have been exhausted b. institutional participation in gene chip technology directed at disease prevention c.patient refusal of a life saving blood transfusion related to religious preference d. request to administer fertilization injections to an infertile couple e. placing a 21 year old cystic fibrosis patient on the double transplant list

Patient refusal of a livesaving blood transfusion related to religious preference, placing 21 year old cystic fibrosis patient on the double lung transplant list, institutional participation a gene chip technology directed at disease prevention

30. A patient has been admitted in the emergency care unit with conditions of respiratory distress, coupled with pneumonia. The patient's condition worsens and he is placed on mechanical ventilation. While visiting this patient in the hospital, his family observes the members of the healthcare team washing their hands when entering and leaving the room. By implementing recommended hand hygiene measures which of the following organizations is the healthcare team supporting? a) Institute of Medicine (IOM) b) Agency for Healthcare Research and Quality (AHRQ) c) The Joint Commission d) The National Council of State Boards of Nursing (NCSBN)

The joint commission

4. Which of the following statements best defines the term culture? a. A group of people distinguished by genetically transmitted material b. The status of belonging to a particular region by origin, birth or naturalization c. The classification of a group based upon certain distinctive characteristics d. The learned patterns of behavior, beliefs and values that can be attributed to a particular group of people

The learned patterns of behavior, beliefs and values that can be attributed to a particular group of people

25. A student nurse observes a nurse case manager coordinating discharge for a patient diagnosed with congestive heart failure. Which of the following statements made by the patient indicates to the student that the patient understands the role of case manager? a. "The nurse case manager organized by daily nursing care during my hospitalization and arranged for the dietician to teach me the importance of following a diet low in sodium b. "The nurse case manager arranged to have a wheelchair waiting to take me to my room. I was so short of breath I could not walk very far." c. "The nurse case manager worked with my physician to coordinate my admission from his office to the hospital." d. "The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." Rationale: Coordination of care between nurses, other health care personnel, and insurance companies are roles of the nurse case manager. Nurse case managers coordinate patient care form the time of hospital admission to the time of discharge and often follow discharge from an acute care setting. Care coordination provided by the nurse care manager is not episodic.

The nurse case manager organized by daily nursing care during my hospitalization and arranged for the dietician to teach me the importance of following a diet low in sodium

29. A 54-year-old woman on a fixed income has had an electrocardiogram (ECG) as part of her annual physical examination. Her physician notes an abnormal Q wave on an otherwise unremarkable ECG. What legislation supports this focus on disease prevention, health promotion, and management of chronic conditions? a) A New Health System for the 21st Century Bill b) Building a Safer Health System Act c) The Patient Protection and Affordable Care Act d) Healthcare Research and Quality Improvement Bill

The patient protection and affordable care act

3. Consuming which of the following is a strategy to enhance health as a part of health promotion a. A diet rich in vitamin a b. A diet rich in grains c. A diet rich in vitamin c d. A diet rich in proteins Rationale: Health promotion means engaging in strategies like consuming a diet rich in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities and practicing stress-reduction techniques. Consuming a diet rich in vitamin A, vitamin b and proteins is not a strategy of health promotion.

a diet rich in grains

10. An advanced directive in which one person identifies another person to make health care decisions on his or her behalf is known as a. A living will b. Hospice c. A DNR order d. A durable power of attorney for health care Rationale: a durable power of attorney for health care is a type of advance directive in which on person identifies another person to make health care decisions on his or her behalf. Living wills are limited to situations in which the patient medical condition is deemed terminal. A DNR order is an order to not resuscitate. Hospice is a type of palliative care for persons with terminal diagnoses.

a durable power of attorney

Which of the following statements reflects the World Health Organization definition of health a. a fluid, ever-changing balance reflected through physical, mental and social behavior b. a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity c. It reflects and individuals location along a wellness-illness continuum d. It is a condition of homeostasis and adaptation

a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity

a nurse is planning community health promotion program on stress and stress reduction. The nurse includes which of the following statements related to the physiologic response to exposure to long term stress? a. sympathetic adrenal medullary discharge b. activation of the sympathetic nervous system c. activation of the hypothalamic-pituitary system d. norepinephrine-epinephrine discharge the initial response to stress is the sympathetic nervous system discharge followed by sympathetic adrenal medullary discharge. If the stress persist the hypothalamic pituitary system is activated

activation of the sympathetic nervous system

A patient is being treated in a substance abuse unit of a local hospital. The nurse understand that when a patient has compulsive behavior to use a drug for it psychic effect, the patient needs to be monitored for which of the following a. placebo effect b. addiction c. dependence d. tolerance

addiction

A 75 year old patient had surgery for her hip fracture yesterday. She is under stress due to the pain, the medications, sleep deprivation, and hospital surroundings. Which of the following nursing interventions to treat the patient's pain when ordered by the doctor should the nurse question? a. advil for pain management b use of tranelectrical nerve stimulator c. morphine rather than advil for pain mangemtn d. acetaminophen for pain managment NSAIDs such as advil, increase the risk of GI toxicity in individuals older than 60 years and should be assessed further prior to administration. There are many risk factors for opioid-induced respiratory depression in indiviuals older than 65 years; a thorough respiratory assessment is indicated. Acetaminophen should be used for mild pain. Nonpharmalogic methods of pain management such as TENS are acctable in this situation. SOciety has proposed that opiods are a safer choice than NSAIDs in many older adults because of the increased risk for NSAID induced GI adverse effects in that population

advil for pain management

19. Which critical thinking skill involves identification of patient problems indicated by data? a. Interpretation b. Analysis c. Explanation d. Inference Rationale: Analysis is used to identify patient problems indicated by data. Interpretation is used to determine the significance of data that is gathered. Inference is used by the nurse to draw conclusions. Explanation is justification of actions or interventions used to address patient problems and help a patient move toward desired outcomes.

analysis

15) A terminal patient has feelings of rage toward the nurse. According to Kubler-Ross, the patient is in which stage of dying? a. Anger b. Depression c. Denial d. Bargaining

anger

Which of the following would be included as a goal of case management? a. Prescriptive authority b. Appropriateness of services c. Utilization of the nursing process d. Attainment of fixed price reimbursement Rationale: the goals of care management are quality, appropriateness, and timeliness of service as well as cost reduction. Case managers do not have prescriptive authority. Fixed price reimbursement is a feature of managed care. Case managers do not utilize the nursing process.

appropriateness of services

12. Which step of the nursing process entails analyzing data related to a patients health status a. Assessment b. Evaluation c. Diagnosis d. Implementation Rationale: analysis of data is included as part of the assessment. Diagnosis is the identification of patient problems. Implementation is the actualization of the plan of care through nursing interventions. Evaluation is the determination of the patient's responses to the nursing interventions and the extent to which the outcomes have been achieved.

assessment

14. Which component of the nursing process deals with the identification of patient problems? a. Implementation b. Assessment c. Diagnosis d. Planning Rationale: nursing diagnosis are actual or potential health problems that can be managed by independent nursing interventions. Assessment is the systemic collection of data to determine the patient's health status and any actual or potential health problems. Planning is the development of goals and outcomes. Implementation is the actualization of the plan of care through nursing interventions.

assessment

The nurse is caring for a patient with diabetes who has an infection. the nurse creates a plan of care for the patient based on knowledge of the hypothalamic pituitary response to stress by including which of the following nursing interventions in the plan of care a. increasing insulin dosage b. assessment for hyperglycemia c. measurement of intake/output d. restriction of dietary protein

assessment for hyperglyemia

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? a. prior to respiratory assessment b. at the same time the first patch is applied c. immediately following the morning shower d. there are no administration requirement the skin must be clean and dry prior to patch application; no shower is required. Respiratory assessment must be conducted prior to applying the fentanyl patch. Because it takes 12-24 hours for the fentanyl levels to increase gradually from the first patch, the last dose of sustained release morphine should be administered at the same time the first patch is applied. The other time frames are incorrect

at the same time the first patch is applied

1. The use of patient restraints limits which of the following ethical principles? a. Justice b. Autonomy c. Trust d. Beneficence Rationale: It is important to weigh carefully the risk of limiting a person autonomy and increasing the risk of injury by using restraints against the risk of not using restraints

autonomy

Which of the following interventions should a nurse perform during the grieving period when caring for dying patients? a. Providing palliative care b. Spending time with patient c. Avoiding criticism or giving advice d. Allowing a period of privacy

avoiding criticism or giving advice

According to Kubler-Ross, when the dying patient pleas for more time to reach an important goal, the patient is using? a. anger b. acceptance c. denial d. bargaining

bargaining

4. Which of the following ethical principles is related to the duty to do good? a. Confidentiality b. Beneficence c. Nonmalificence d. Autonomy Rationale: Beneficence is the duty to good and the active promotion of benevolent acts. Autonomy refers to self-rule. Confidentiality related to the concept of privacy. Nonmalificence is the duty to not to inflict hard as well as to prevent and remove harm

beneficence

8) Of the following terms, which is used to refer to the period of time during which mourning a loss takes place? a. Mourning b. Hospice c. Grief d. Bereavement

bereavement

26. A nurse asks a chronic obstructive pulmonary disease patient to breathe in slowly through the nose, taking in a normal breath. The she asks the patient to pucker his lips as if preparing to whistle. Finally, she asks him to exhale slowly and gently through puckered lips. The nurse recognizes that teaching the patient pursed-lip breathing helps the patient relax and gain control of dyspnea, reducing the feelings of panic they experience. Which of the ANA tenets characteristic of all nursing practice is the nurse demonstrating? (SAA) a. Caring b. Evidence- based nursing c. Using the nurse process d. Individualized nursing practice e. Establishment of professional work environment f. Interdisciplinary collaboration Rationale: teaching pursed-lip breathing to a patient with COPD is individualized based on the patient's diagnosis. The nurse demonstrates caring by providing education to support desired patient outcomes. The nurse uses the nursing process of assessment and analysis to determine the need to teach the client pursed-lip breathing. The nurse's actions do not indicate work place environment changes or interdisciplinary collaboration. Evidence-based nursing is not an ANA tenet characteristic of all nursing practice.

caring, using the nursing process, individualized nursing practice

18. Which factor is demanded form a nurse in order to provide high-quality nursing care? a. High level of technical competency b. Case managers dictating choice of services c. Well defined, common problems d. Complex role involving coordination of all care Rationale: Today's dynamic health care environment challenges the traditional roles of health care providers. In many instances, case managers dictate choice of services, which is a traditional decision of the attending physician. Such changes have called on nursing to provide high-quality nursing care. LPN/LVNs care for patients with well-defined, common problems that often require a high level of technical competency and expertise. The RN's role is more complex, involving the management and coordination of all the care provided to a group of patients.

case managers dictating choice of services

9) Glaser and Strauss (1995) identified four "awareness contexts". Which awareness context occurs when the patient is unaware of his or her terminal state but others are aware? a. Closed awareness b. Suspected awareness c. Mutual pretense awareness d. Open awareness Rationale: Closed awareness occurs when the patient is unaware of his or her terminal state, whereas others are aware. Suspected awareness occurs when the patient suspects what others know and attempt to find out details about his or her condition. Open awareness occurs when the patient, family and the health care professionals are aware that the patient is dying and openly acknowledge that reality. Mutual pretense awareness occurs when the patient, the family and the health care professionals are aware that the patient is dying but all pretend other wise.

closed awareness

Which of the following terms, according to Lazarus, refers to the process through which an even is evaluated with respect to what is at stake and what might and can be done? a. cognitive appraisal b. hardiness c. adaptation d. coping The outcome of cognitive appraisal is identification of the situation as either stressful or not stressful. Coping consists of both cognitive and behavioral efforts made to manage the specific external or internal demand that taxes a persons resources. Hardiness is a personality character that is composed of control, commitment and challenge. Lazarus believed adaptation was affected by emotion that subsumed stress and coping

cognitive appraisal

14. Which management function involves a team effort to achieve patient care outcomes? a. Supervision b. Time management c. Collaboration d. Advocacy Rationales: collaboration involves a team effort to achieve patient care outcomes. Time management involves organizing time, as well as delegating tasks to other personnel and making optimal use of time. Advocacy means promoting the cause of another person or an organization. Supervision is the process of guiding, directing, evaluating and following up tasks delegated to others.

collaboration

15. Which of the following programs focus on processes used to provide care? a. Quality Assurance b. Health Maintenance organization c. Continuous quality improvement d. Preferred provider organization Rationale: CQI focuses on the processes used to provide care, with aim of improving quality by assessing and improving those interrelated processes that most affect patient care outcomes and patient satisfaction. Quality assurances focuses on individual incidents or errors and minimal expectations. PPOs and HMOs are types of health care delivery systems

continuous quality improvement

7. The primary task of nursing research is to a. Coordinate health care services to ensure cost-effectiveness b. Assist patients to meet their needs to direct intervention c. Assume responsibility for the actions of others directed toward determining patient care goals d. Contribute to the scientific base of nursing practice

contribute to the scientific base of nursing practice

The primary task of nursing research includes which of the following? a. Contributing to the scientific base of nursing practice b. Determining the nursing diagnosis c. Managing the care of an entire caseload of patients d. Decreasing the overall operating cost to the health care system

contributing to the scientific base of nursing practice

a nurse is evaluating a patients social support network. the nurse evaluates the network will assist the patient in coping with stress when which of the following is noted? a. patients friends ask her for advice b.daughter helps mom with laundry c. patient avoids situations exposing her to new people d. son does not acknowledge his mothers diagnosis

daughter helps mom with laundry

The reason that case management has gained such prominence in health care can be traced to the a. decreased cost of care associated with inpatient stay b. ability to discharge from specialty units to home c. limited availability for inter-unit hospital transfers d. increase length of hospital stay rationale: The reason case management has gained such prominence can be traced to the decreased cost of care associated with decreased length of hospital stay, coupled with rapid and frequent inter-unit transfers from specialty to standard care units. In general, length of hospital stay has decreased over the past 5 years. In general, patients are transferred from specialty care units to standard care units at least 25 hours prior to discharge. In general, patients in acute hospitals undergo frequent inter-unit transfers from specialty to standard care units.

decreased cost of care associated with inpatient stay

Which of the following is a traditional definition of nursing by American Nurses Association (ANA)? a. Diagnosing and treating human responses to actual or potential health problems b. Discussing what nurses would do for themselves if they had the necessary strength, will or knowledge c. Putting the patients d. Helping people carry out activities contributing to health, recovery or a peaceful death Rationale: The ANA traditionally defined nursing as the "diagnosis and treatment of human responses to actual or potential health problems." Florence Nightingale described the role of the nurse as putting "the patient in the best condition for nature to act upon him." Virginia Henderson envisioned the role of a nurse as helping people (sick or healthy) to carry out the activities that contribute to their health, recovery or peaceful death as well as the activities that they would do for themselves if they had the necessary strength, will or knowledge.

diagnosing and treating human responses to actual or potential health problems

Which of the following nursing interventions should a nurse perform when caring for a patient who is prescribed opiate therapy for pain? a. monitor weight, vital signs and serum glucose level b. avoid caffeine or other stimulants, such as decongestants c. monitor blood counts and liver function test d. do not administer if respirations are less than 12 per min the nurse should not administer with the prescribed opiate therapy if respirations are less than 12 per min. the nurse should instruct a patient who is prescribed psychostimulants to avoid caffeine or other stimulants such as decongestants. the nurse should minor weight, vital signs and serum glucose level when adminstering corticosteroids. when administering anticonvulsants, the nurse should also monitor blood counts and function liver test

do not administer if respirations are less than 12 minutes

2) Which of the following is also known as a proxy directive? a. Medical directive b. Durable power of attorney for health care c. Living will d. Treatment directive

durable power of attorney for heath care

6) The family members of a dying patient are finding it difficult to verbalize their feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations? a. Encourage the family members to express their feelings and listen to them in their frank communication b. Encourage conversation on the impending death of the patient c. Encourage the patient's family members to spend time with the patient d. Be a silent observer and allow the patient to communicate with the family members

encourage family members to express their feelings and listen to them in their frank communication

A nurse is assessing a patient for signs and symptoms of stress. which of the following should the nurse include in the assessment? SAA a.energy level b.substance use/abuse c. menstrual cycle d. oral mucus symptoms of stress include decreased energy level and fatigue, dry mouth, changes in menstrual cycle, and substance use/abuse as well as gastrointestinal genitournary, cardiovascular, neuromuscular and psychosocial changes including feeling weak or dizzy, hyperactivity, difficulty sleeping, palpitations and anxiety, increased urination, nausea and decreased appetite

energy level, oral mucus, menstrual cycle, substance use/abuse

3. Which of the following is a formal systematic study of moral beliefs? a. Fidelity b. Ethics c. Veracity d. Moral uncertainty Rationale: ethics is the formal, systematic study of moral beliefs. Veracity is the obligation to tell the truth and not to lie or deceive others. Fidelity is promise keeping. Moral uncertainty occurs when a person cannot accurately define what the moral situation is or what moral principles apply but he or she has a strong feeling that something is not right

ethics

15. Which component of the nursing process results in the determination of the patient's responses to the nursing interventions and the extent to which outcomes have been achieved? a. Implementation b. Evaluation c. Diagnosis d. Planning

evaluation

a patient has been prescribed a fentanyl patch for pain control. the nurse understands that this patch should be replaced how often? a. every 48 hours b. every 24 hours c. every 36 hours d. every 72 hours

every 72 hours

When conducting a community education program on stress, the nurse includes which of the following a. excessive stress response increases susceptibility to illness b. short term stress increases susceptibility to disease c. effective stress adaptation is a disease precursor d. stressors elicit a state of homeostasis excessive stress response and long term-stress increases an individual susceptibility to illness. stressors elicit a state of disturbed physiologic equilibrium. stress and maladaptation are precursors to a disease

excessive stress response increases susceptibility to illness

2. Alfaro-LeFervre identified critical thinkers as being a. Fair-minded b. Dependent on the thinking of others c. Close minded d. Inflexible Rationale: Alfaro-LeFevre identified critical thinkers as individuals with the following characteristics: active thinkers, fair-minded, open-minded, persistent, empathetic, flexible, insightful and independent in though

fair minded

10. According to Hood & Leddy, which of the following are components of wellness? a. Feelings of well being b. Inability to obtain personal goals c. Expression of disharmony d. Inability to adapt to changing situations

feelings of well being

6. Which of the following would the least important reason that nurses utilize research in nursing practice? a. Replication b. Financial obligation c. Dissemination d. Validation

financial obligation

9. Which ethics theory focuses on ends or consequences of actions a. Adaptation theory b. Deontological theory c. Formalist theory d. Utilitarian theory Rationale: Utilitarian theory is based on the concept of the greatest good for the greatest number of people. Formalist theory argues that moral standards exist independently of the ends or consequences. Deontological theory argues that moral standards exist independently of the ends or consequences. Adaptation theory is not an ethics theory.

formalist theory

The advance nurse practitioner treating a patient diagnosed with neuropathic pain decides to start adjuvant analgesic agent therapy. Which of the following medications is appropriate for the nurse practitioner to prescribe? a. hydromorphone b. tramadol c. gabapentin d. kentamine the anticonvulsants gabepentin is a first line analgesic for neuropathic pain. Tramadol is designated as a second line analgesic agent for the treatment of neuropathic pain. Kentamine is used as a third-line analgesic agent for refractory acute pain. Hydromorphine is a first line opioid not used as an analgesic agent for neuropathic pain

gabapentin

Which of the following terms is used to describe the personal feeling that accompany an anticipated or actual loss? a. Grief b. Bereavement c. Spirituality d. Mourning Rationale: grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is the period which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.

grief

which of the following examples of therapeutic communication techniques may occur during the planning stage and increase the patient's perceptions of available options? a. "you appear confused about assisted living facilities" b. home health services are also available in our community if you feel an assisted living situation is uncomfortable c. lets discuss specific concerns you have regarding assisted living facilities d. i hear you say that you are uncomfortable with the idea of going to an assisted living facilty

home health services are available in our community if you feel an assisted living situation is uncomfortable

24. A nurse working in the intensive care unit (ICU) refers to the institute for Healthcare Improvement (IHI) Ventilator Bundle prior to planning patient care. The nurse realizes nursing interventions outlined in the bundle will improve patient's outcomes. Which of the following statements best describe how IHI-established nursing interventions should be included in each bundle? a. Hospitals, physicians and nurses worked collaboratively to design patient care activities included in IHI bundles b. Nurse case managers serving as patient advocates recommend nursing interventions to be included in the IHI bundles based on patient preference c. Best practice derived from valid and reliable research studies guided nursing interventions being added to the IHI bundles d. Nursing interventions found within the IHI bundles were selected based on the ability to provide optimal time management for the nurse Rationale: Bundles include evidence-based practices. Hospitals, physicians and nurses work collaboritvely to provide care directed by bundles. Nurses advocate on behalf of the patient. Effective time management is a key element in the provision of care, however, IHI-based bundles on evidence based practice.

hospitals, physicians and nurses worked collaboratively to design patient care activities included in IHI bundles

what is the term for an adaptation to environmental stress that occurs when tissue mass enlarges due to cell multiplication and increased stress stimulation? a. metaplasia b. hyperplasia c. dysplasia d. atrophy hyperplasia is an increase in the number of new cells in an organ or tissue. Atrophy is the shrinkage in the size of a cell, leading to a decrease in organ size. Dysplasia is the change in the appearance of cells after they have been subjected to chronic irritation. Metaplasia is a cell transformation in which highly specialized cells change to less specialized cells

hyperplasia

The nurse is conducting a community education program on stress is including LAzarus's cognitive appraisal theory. The nurse evaluates that the participants understand the teaching when they state that during primary appraisal which of the following occurs a. conflict between desire and need b. changing a previous opinion c. evaluation of what might be done d. identification of the event as stressful during primary appraisal the even is evaluated with respect to what is at stake and result in the situation being identified as either nonstressful or stressful. Evaluation of what might be done occurs during secondary appraisal

identification of the even as stressful

13. Which of the following is involved in planning phase of the nursing process a. Complete health history b. Carry out the nursing orders c. Identify measurable outcomes d. Identify collaborative problems Rationale: The planning steps of the nursing process involve identifying measurable outcomes, selecting nursing interventions and documenting the planning steps. The implementation step involves carrying out nursing orders. The diagnosis step involves identifying collaborative problems. Completing a health history is done in the assessment step

identifying measurable outcomes

28. A nurse working in an acute care setting volunteers to participate in a research study. The Nurse understands that research findings add to the scientific base of nursing practice. Evidence-based practice accomplishes which of the following? (Select all that apply) a. Decrease heal care cost b. Provides answers to ethical questions c. Establish best nursing practices d. Validate nursing diagnosis e. Delineate the health-illness continuum f. Improve patient outcomes Rationale: EBP are developed from valid and reliable research studies that improve patient outcomes, establish best nursing practice, and decrease healthcare cost through decreased readmission and shortened lengths of stay. EBP does not validate nursing diagnosis. The health-illness continuum is used to describe a person's health status; EBP does not delineate the health illness continuum. Information from EBP may be used to gather information to increase one's knowledge related to ethical issues; however EBP would be only one aspect in the answering of ethical questions.

improve patient outcomes, establish best nursing practices, and decrease healthcare cost

9. Which of the following is true regarding population demographics a.Increase in the culturally diverse population b.Decrease in life span c.Increase in birth rate d.Decrease in homelessness Rationale: the population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. The number of homeless people has significantly increased. There is a decrease in birth rates and an increase in lifespan.

increase in the culturally diverse population

Prostaglandins are chemical substances with which of the following properties a. inhibition of the transmission noxious stimuli b. inhibition of the transmission of pain c. reduction of the perception of pain d. increased sensitivity of pain receptors Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin

increased sensitivity of pain receptors

about which of the following issues should the nurse inform patients who use pain medications on a regular basis a. minimize the intake of fiber during the therapy b. inform the primary health care provider about the use of salicylates before any procedure, and avoid OTC analgesics consistently without consulting a physician c. avoid harsh sunlight for 2 hours after administering analgesic agents or salicylates d. consume the medications just before or along with meals

inform the primary health care provider about the use of salicylates before any procedure, and avoid OTC analgesics consistently without consulting a physician

11. Which communication technique in health teaching about relevant aspects of a patient's well being and self-care? a. Humor b. Reflection c. Silence d. Informing Rationale: informing is helpful in health teaching or patient education about relevant aspects of he patient's well-being and self-care. Silence involves periods of no verbal communication among participants for therapeutic reasons. Reflection validates the nurse's understanding of what the patient is saying and signifies empathy, interest and respect for the patient. Humor promotes insight by bringing repressed material to consciousness, resolving paradoxes, tempering aggression and revealing new options.

informing

Which of the following is a sign of approaching death? a. clear sensorium b. insomnia c. increase in urinary output d. irregular breathing patterns rationale: Irregular breathing patterns are a sign of impending death. Other signs of approaching death include decreased urinary output, mental confusion and sleeping for longer periods of time.

irregular breathing pattern

8. Patient health education provided by the nurse a. Requires a physicians order b. Must be approved by the physician c. Must focus on wellness issues d. Is an independent function of nursing practice Rationale: health education is an independent function of nursing practice and is included in all state nurse practice acts. Teaching, as a full function of nursing, is included in all state nurse practice acts. Health education is a primary responsibility of the nursing profession. Health education by the nurse focuses on: promoting, maintaining and restoring health, preventing illness and assisting people to adapt to the residual effects of illness.

is an independent function of nursing practice

21. Which of the following is a factor upon which the financial stability of health maintenance organizations (HMOs) is based? a. Providing entertainment programs for patients in order to distract them from their illness b. Keeping patients healthy and out of the hospital through periodic screening, health education and preventative services c. Maintaining the statistics and records of all the patients admitted in hospitals on a regular basis d. Keeping patients satisfied by providing them regular financial assistance and looking after their medical requirements

keeping patients healthy and out of the hospital through periodic screening, health education and preventative services

16) Which of the following terms best describes of a living will? a. Medical directive b. Proxy directive c. Health care power of attorney d. Durable power of attorney for health Rationale: a living will is a type of advance medical directive in which the individual who is of sound mind, documents treatment preferences. A proxy directive is the appointment and authorization of another individual to make medical decisions of behalf of the person who created an advance directive when he or she is no longer able to speak for him or herself. Health care power of attorney is a legal document that enables the signer to designate another individual to make health care decisions on his or her behalf when he or she is unable to do so.

medical directive

Based on the nurses knowledge of the increased risk for bleeding in a patient undergoing chemotherapy or radiation, which of the following interventions does the nurse need to include in the patient's plan of care? SAA

monitor the platelet count, monitor signs of abnormal bleeding, instruct the patient to use a soft toothbrush, instruct client to use an electric razor

3) Which of the following "awareness contexts" is characterized by the patient, family, and health care professionals understanding that the patient is dying but pretending otherwise? a. Mutual pretense awareness b. Open awareness c. Closed awareness d. Suspected awareness

mutual pretense awareness

The advance practice nurse is treating a patient experiencing a neuropathic pain syndrome. Which of the following statements when made by the patient demonstrates an understanding of concepts related to neuropathic pain? a. neuropathic pain will only last a few days and is easily treated with cox 2 analgesic agents b. my phantom limb pain serves no purpose, and i may need to take antidepressants to help c. when the inflammation in my foot resolves i will no longer have pain from neuropathy d. neuropathic pain is the body's normal response to tissue damage causing pain neuropathic pain is chronic and not treated with cox-2 analgesics. neuropathic pain is abnormal processing of sensory input by the peripheral or central nervous system or both. Neuropathic pain may occur in the absense of tissue damage and immflammation. Neuropathic pain serves no useful purpose. Evidence based practice guidelines recommend the TCAs despiramine and nortripyline and the SNRIs duocetine and venlafacine as first line opitions for neuropathic pain treatment

my phantom limb pain serves no purpose, and i may need to take antidepressants to help

17. The basic difference between nursing diagnosis and collaborative problem is that a. Nurses manage collaborative problems using physician-prescribed interventions b. Nursing diagnosis incorporate physiologic complications that nurses monitor to detect change in status c. Collaborative problems can be managed by independent nursing interventions d. Nursing diagnoses incorporate physician prescribed interventions Rationale: collaborative problems are physiologic complications that nurses monitor to detect onset or changes and manage through the use of physician- prescribed and nursing-prescribed interventions to minimize complications of events. Collaborative problems require both nursing and physician-prescribed interventions. Nursing diagnoses can be managed by independent nursing interventions. Nursing diagnoses refer to actual or potential health problems that can be managed by independent nursing interventions

nurses manage collaborative problems using physician-prescribed interventions

Which of the following are specific nursing directions, written so that all health care members understand exactly what to do for the client? a. Patient database b. Expected outcomes c. Nursing diagnosis d. Nursing orders Rationale: nursing orders are specific nursing directions so that all healthcare team members understand exactly what to do for the patient. After the registered nurse determines the interventions, they are documented in the written plan as nursing orders. A patient database is different because it includes all the information obtained from the medical and nursing history, physical examination, and diagnostic studies. Nursing diagnoses represent a registered nurse's attempt to examine and analyze the client database to identify actual or potential health problems. Expected outcomes represent the specific desired results of treatment and are determined from the nursing diagnosis.

nursing orders

1) What state is currently the only one with a statute legalizing physician assisted suicide? a. Iowa b. New Hampshire c. California d. Oregon

oregon

Which of the following is an important role for a nurse in the health care delivery system? a. Participation in disease prevention and health promotion activities b. Participation in treatment decisions regarding health restoration c. Participation in the diagnosis and treatment of the disease d. Balance of work with leisure activity

participation in disease prevention and health promotion activities

A nurse is developing a plan of care to assist a patient in coping with a right leg below the knee amputation. Which of the following interventions should the nurse include? a. establishment of nurse determined goals b. patients verbalization of feelings of loss c. discouragement of complimentary medicine d. subjective appraisal of event by patient

patients verbalization of feelings of loss

1. According to Maslow, which category of needs represents the most basic on the hierarchy? a.Physiologic needs b.Belongingness c.Self-actualization d.Safety and security needs Rationale: Physiologic needs must be met before an individual is able to move toward psychological health and well-being. Self-actualization is the highest level of need. Safety and security needs, while a lower level of need, are not essential to physiologic survival. Belongingness and affection needs are not essential to physiologic survival.

physiologic needs

Which of the following approved by the United States Food and Drug Aministration, is the only use for lidocaine 5% patch? a. postherpic neuralgia b. epidural anesthesia c. general anesthesia d. diabetic neuropathy a lidocaine 5% patch has been shown to be affective in postherpic neuralgia. Lidoderm has not been approved for epidural anesthesia, general anesthesia or diabetic neuropathy

postherpetic neuralgia

A type of nursing which includes individualized care provided by the same nurse throughout the period of care is defined as a. case management b. functional nursing c. patient-focused nursing d. primary nursing Rationale: primary nursing refers to comprehensive, individualized care provided by the same nurse throughout the period of care. Case management is not a type of health care delivery. Patient focused nursing is characterized by assigning a nurse to manage the care of a caseload of patients during a given shift who may then delegate activities to other nursing personnel. Functional nursing is not individualized to the extent that one nurse cares for the patient throughout the entire period of care.

primary nursing

The nurse is conducting a health risk appraisal. the nurse should include which of the following. select all that apply a. recreational activities b. educational level c. blood pressure d. driving habits when conducting a health risk appraisal, the nurse should include personal and family history of disease, lifestyle choices and physical measurements, including recreational activities, driving habits and blood pressure. educational level is not included in a health risk appraisal

recreational activities, driving habits, blood pressure

which of the following route of medication administration should the nurse consider first in an NPO postoperative patient following IV removal? a. subcutaneous b. intrathecal c. topical d. rectal The rectal route is an alternative route when oral or IV analgesic agents are not an option. The rectum allows passive diffusion of medication and absorption into systemic circulation. topical agents produce effects in the tissues immediately under the site of application. Intrathecal catheters for acute pain managemtn are used most often for providing anesthesia or a single bolus dose of an analgesic agent. The subcutaneous route of administration is not recommended in this situation.

rectal

7. Which of the following is an important function of accurate and thorough documentations a. Makes judgment based on evidence b. Involves purposeful and outcome-directed thinking c. Provides a foundation for evaluation and quality improvement d. Requires knowledge, skill and experience Rationale: accurate and thorough documentation shows trends and patterns in patient status and provides a foundation for evaluation and quality improvement. In nursing, critical thinking makes judgment based on evidence. The nursing process requires knowledge, skill and experience and involves purposeful and outcome directed thinking

requiring knowledge, skill and experience

14) A patient has been declared to have a terminal illness. What is the nursing intervention a nurse will perform in the final decision of a dying patient? a. Ask the family members about spiritual care b. Abide by all wishes of the dying patient c. Share emotional pain d. Respect the patient and family members' choices

respect the patient and family members choices

4) Which of the following is one of the levels of hospice care covered under Medicare and Medicaid Hospice benefits that include 5-day inpatient stay and is provided on an occasional basis to relieve the family caregivers? a. Respite care b. Continuous care c. Routine home care d. General inpatient care Rationale: Inpatient respite care is a 5-day inpatient stay, provided on an occasional basis to relieve the family caregivers. Routine home care entails that all services provided are included in the daily rate to the hospice. Continuous care is provided in the home management of a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.

respite care

WHen a person thinks about whether it is possible to do something about a situation, he or she is exhibiting what type of appraisal? a. secondary b. reapprasial c. primary d. hardiness secondary appraisal is an evaulation of what might and can be done about a situation. Primary apprasial results in a situation being identified as either nonstressful or stressful. Reappraisal is a change of opinion based on new information. Hardiness is the name given to a general quality that comes from having rich, varied and rewarding experiences.

secondary

which type of healing occurs when the edges are not approximated and the would fills with granulation tissue a. third intention b. secondary intention c. cellular necrosis d. first intention secondary intention healing, the edges are not approximated and the wound fillls with granulation tissue. IN first intention healing, the wound egdes are approximated as in a surgical wound. In third intention healing, the wound edges are not approximated and healing is delayed. Cellular necrosis is part of the inflammatory process

secondary intention

the nurse is teaching the benson relaxation response to a patient for stress reduction. The nurse instructs the patient to do which of the following a. practice the technique daily b. maintain an active demeanor c. select a focus word d. think of a comforting scene the nurse should instruct the patient to select a focus word, maintain a passive demeanor, and practice the technique twice daily. thinking of a comforting scene is a part of guided imagery

select a focus word

2. According to Maslow's hierarchy of human needs, which of the following is the highest level of need? a. Self-actualization b. Physiological needs c. Belongingness d. Safety and security Rationale: Maslow's hierarchy of need shows how a person moves from fulfillment of basic needs to higher level of needs. The ultimate goal is integrated human function and health. Self-actualization is the highest level need. Safety and security, physiological needs and belongingness are below this level of need.

self-actualization

which type of cell as a latent ability to regenerate? a. labile b. permanent c. stable d. Epithelial Stable cells have a latent ability to regenerate if they are damaged or destroyed; they are found in the kidney, liver and other body organs. Labile cells multiply constantly to replace cells work out by normal physiologic processes. Permanent cells include neurons or the nerve cell bodies, but not their axons. Destruction of a neuron causes permanent loss but axons may regenerate. Epithelial cells are a type of labile cell that multiply constantly to replace cells worn out by normal physiologic processes

stable

20. Which of the following is a tool often used by case managers a. Outcome criteria b. Bottom line c. Service cost measurement d. standards of care rationale: case managers usually make use of tools, such as critical pathways, practice guidelines and standards of care to health them plan and coordinate care. Insurance companies measure the cost of services provided to the case managers patients as a means of assessing his or her effectiveness. One of the complaints about case management is that the "bottom line" will become more important than quality. For this reason, and because they are in the best position to collect outcome data, case managers usually are integral members of hospital-based and insurance-based quality improvement programs.

standards of care

16. Which of the following therapeutic communication techniques may occur during the planning stage, when the patient is presented with alternative ideas for consideration relative to problem solving? a. Focusing b. Suggesting c. Clarification d. Reflection Rationale: suggesting is the presentation of alternative ideas for the patient's consideration relative to problem solving. Clarification is asking the patient to explain what he or she means or attempting to help verbalize the patient's vague ideas or unclear thoughts to enhance the nurses understanding. Focusing includes questions or statements to help the patient develop or expand an idea

suggesting

5. Which of the following would be an intellectual skill used in critical thinking by nurses? a. Supporting evidence with facts b. Determining nurse specific outcomes c. Utilizing bias to achieve goals d. Priority setting with broad time constraints Rationale: intellectual skills used in critical thinking include supporting evidence with facts, priority setting with timely decision making and determination of patient-specific outcomes. Bias is not used to achieve goals.

supporting evidence with facts

the nurse is using progressive muscle relaxation with a patient to reduce stress. the nurse instructs the patient to do which of the following a. stand in a quiet, darkended area b. tense and relax specific muscles c. repeat a word or phrase d. select a pleasant scene during progressive muscle relaxation, the patient lies in a quiet room and tenses the muscles of the body one at the time. the person holds the tension and then relaxes. repetition of a word or phrase is used in the benson relation response and selection of pleasant scene is used in guided imagery

tense and relax specific muscles

The nurse needs to carefully monitor a patient with traumatic injuries. Which of the following actions by the nurse demonstrates the understanding of the most essential component of the patient's pain assessment? a. the nurse asses the response to medication after every meal consumed by the patient b. the nurse administers ketorolac on admission to the unit c. the nurse validates the patients report of pain by assessing the patients blood pressure d. the nurse administers pain medication based on the patients reported pain level the absence of an elevated BP or heart rate does not mean the absence of pain. the ability of a patient to give report on their pain is the essential component of pain assessment.

the nurse administers pain medication based on the patients reported pain level

23. A nurse working in the emergency room department reviews arterial blood gas values for a patient diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, PO2 95, CO2 23, HCO2 22 and SO2 98%. Which of the following nursing interventions demonstrates the nurses' understanding of the patient's ABG's and knowledge of Maslow's hierarchy of needs when providing care for this patient? a. The nurse completes a spiritual assessment and provides appropriate clergy support for the patient b. Lab values are within normal limits and contacts the patient's family to be with the patient while in the ED c. The nurse prepares for endotracheal intubation and mechanical ventilation for the patient d. The nurse immediately starts an intravenous line of dextrose 50% in a water solution Rationale: The patient is experiencing respiratory alkalosis related to heatstroke. The pH level is elevated in hyperventilation; the patient's hyperventilation will "blow off" more CO2 leading to lower pCO2 levels. Decreased pCO2 is caused by hyperventilation. Decreased CO2 levels are seen in renal failure. Renal failure is a sign of heatstroke. With rapid breathing SO2 can be increased with deep or rapid breathing. Acute airway management is indicated to improve tissue oxygenation. Airway support meets the patient's physiologic need for a clear airway. Spiritual support is higher level (self-actualization) on Maslow's hierarchy. Providing IV management for circulatory support is a basic physiologic need; however, airway management is a priority.

the nurse prepares for endotracheal intubation and mechanical ventilation for the patient

When a person who has been taking opioids becomes less sensitive to drugs analgesic properties, that person is said to have developed which of the following? a. an addiction b. balanced analgesia c. a dependence d. a tolerance Tolerance is the need for increasing dose requirements to maintain the same level of relief. Addiction is a behavioral pattern of substance use characterized by a compulsion to take the drug primarily to experience psychic effects. Dependence is when a patient experiences withdrawal syndrome when the opioids are discontinues. Balanced analgesia is when patient is using more than one form of analgesia to obtain more pain relief with fewer side effects

tolerance

6. Which of the following is at the center of the process of clinical reasoning and clinical judgment? a. Critical thinking b. Research c. Use of opinions to evaluate situations d. Basic problem solving Rationale: the center of the process of clinical reasoning and clinical judgment is critical thinking. Critical thinking goes beyond basic problem solving into a realm of inquisitive exploration Critical thinkers validate information presented to make sure that it is accurate (not just supposition or opinion)

use of opinions to evaluate situations

7) In spite of administering the prescribed pain medication, a dying patient is still in pain due to fear and anxiety. Which of the following nursing interventions should a nurse use to potentiate the effects of the pain medication? a. Encouraging the patient to fall asleep b. Gently massaging the arms and legs c. Offering small amounts of nourishment frequently d. Using imagery, humor and progressive relaxation

using imagery, humor and progressive relaxation

In which of the following situations is the nurse demonstrating the ethical principle of beneficence a) refusing to give an ordered medication based on assessment findings b)ensuring adequate staffing to provide to all patients c)volunteering to provide vaccinations at the local health center d)providing truthful and accurate information to a patient about a procedure rationale: beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict as well as to prevent and remove, harm" it is more binding than beneficence

volunteering to provide vaccinations at the local health center

The nurse is assessing a postoperative patients surgical incision site. The nurse anticipates which of the following findings a. abnormal cell functionality b. wound edge approximated c. granulation tissue formation d. moderate amount of scar formation

wound edge approximated