NUR401 Midterm
When a mother asks the nurse about introducing solid foods into the child's diet, which of the following would be the best answer? "Introduce solid foods by mixing two or three foods together." "Introduce solid foods by adding strained food to the infant's bottle." "Introduce one solid food at a time several days apart." "Introduce meat first
"Introduce one solid food at a time several days apart."
The worried mother of an accident victim asks the nurse how much circulating blood an average adult male is supposed to have. What will the nurse reply? 10 pines 12 pints 14 pints 8 pints
12 pints
What is the average apical heart rate for a 2-month-old infant? -80 beats/min -100 beats/min -150 beats/min -120 beats/min
120 beats/min
The nurse who works in a sleep clinic knows that approximately __________% of adults suffer from insomnia. -50 to 60 -10 to 20 -30 to 40 -70 to 80
30 to 40
The mother of a 5-month-old child is concerned because the child cannot sit by himself. The nurse explains that sitting alone is not expected until the baby reaches what age? You Answered -8 months -9 months -6 months -7 months
7 months
The inability to fall asleep or stay asleep is called: -nocturnal myoclonus. -hypersomnia. -narcolepsy. -insomnia
insomnia
A 14-year-old male patient has undergone a leg amputation. What should be the primary focus of the patient's care plan? -Socialization needs -Body image -Academic progress -Nutritional status
Body image
When assessing the adult victim for pulselessness, the CPR rescuer should palpate the most reliable and accessible pulse. Which pulse will be palpated? -Carotid -Femoral -Brachial -Radial
Carotid
A baby's muscular development progresses in what type of pattern? -Regressive -Unpredictable -Erratic -Cephalocaudal
Cephalocaudal
According to Piaget, what is the cognitive developmental level of the adolescent? -Sensorimotor stage -Formal operational stage -Preoperational stage -Concrete operational stage
Concrete operational stage
A patient who had taken a poisonous substance is brought to the emergency department. What is the first action the nurse should take? -Observe for symptoms. -Give syrup of ipecac. -Give milk to coat the stomach. -Contact the poison control center
Contact the poison control center
Which theory of aging suggests that previously developed coping abilities and the ability to maintain previous roles and activities are critical to adjustment to old age? -Continuity theory -Autoimmunity theory -Disengagement theory -Wear-and-tear theory
Continuity theory
What is the main issue for adolescents with anorexia? -Control -Body image -Appropriate behavior -Anxiety
Control
The nurse arrives on the scene of a fire. What is the first thing the nurse will do for a burn victim? -Apply dressings. -Cover with a blanket. -Cool the burn immediately. -Apply topical ointment.
Cool the burn immediately
A patient is receiving epidural analgesics. What should the nurse monitor closely in this patient? -Temperature elevation from 98° to 99.2°F (36.6° to 37.3°C) -Decrease in respirations from 16 to 14 -Decrease in blood pressure from 120/80 to 110/68 -Increase in pulse rate from 88 to 99
Decrease in respirations from 16 to 14
What stage of family development involves the grown children departing from home? -Establishment stage -Disengagement stage -Senescence stage -Expectant stage
Disengagement stage
A young athlete asks the nurse why he felt little pain when he broke his leg during a game. What does the nurse describe as having an effect on this patient's perception of pain? -Endorphins -Adrenaline -Hormones -Enzymes
Endorphins
Because thin skin and lack of subcutaneous fat predisposes the older adult to pressure injuries, the nurse alters the care plan to include turning the bedfast patient how often? -Every 2 hours -Every 4 hours -Once every shift -Each evening
Every 2 hours
A child who is able to use a systematic, scientific problem-solving approach is in which of the Piaget's stages of cognitive development? -Preoperational thought -Formal operational thought -Sensorimotor -Concrete operational thought
Formal operational thought
The nurse teaches noninvasive pain relief techniques, such as guided imagery, biofeedback, and relaxation. What is the primary advantage of these techniques? -Gives the patient some control. -Can be done any time. -Is most effective. -Does not require a nurse.
Gives the patient some control
A nurse assessing a 4-month-old infant would expect the infant to do which of the following? -Crawl up the stairs. -Hold head at a 90-degree angle while prone. -Walk upright with a waddling gait. -Creep on the floor at least 30 ft
Hold head at a 90-degree angle while prone
The nurse manager is providing an in-service regarding a "safe hospital environment." What will this education mainly focus on preventing? -Exposure to contaminants -Falls -Electric hazard -Injury
Injury
When assessing the older adult, the nurse considers which aspect of the patient's routine as a possible contributor to constipation? -Intake of antacids several times a day -Eating two apples a day -Excessive exercise routine -Taking a laxative once a week
Intake of antacids several times a day
Erikson identifies intimacy as a developmental task of adulthood. What will occur if intimacy is not established? -Mistrust -Guilt -Inferiority -Isolation
Isolation
The older patient informs the nurse that food has no taste and therefore the patient has no appetite. What is this most likely caused by? -Tasteless food -Lack of variety -Loss of taste buds -Overuse of salt
Loss of taste buds
Which patient instruction should the nurse include in the teaching plan relative to the management of systemic lupus erythematosus? -Maintain a balance between rest and activity. -Increase sodium consumption. -Increase exposure to the sun to increase vitamin D absorption. -Increase activity to promote mobility
Maintain a balance between rest and activity
An American Indian patient requests that an egg yolk be placed in a saucer and put under his bed to absorb the pain. What should the nurse do? -Explain that medication will relieve the pain better. -Place the egg in a saucer under the bed. -Warn that housekeeping staff will remove the egg. -Ask the health care provider for permission
Place the egg in a saucer under the bed
The nurse reminds the 80-year-old patient that her respiratory system has decreased resistance to respiratory infections. For what is this patient at increased risk? -Pneumonia -Atelectasis -COPD -Bronchitis
Pneumonia
A 58-year-old male is concerned about some hearing loss he is experiencing. The nurse recognizes that this might be due to a sensory change of this age group known as which of the following? -Presbycusis -Presbyopia -Otitis externa -Otitis media
Presbycusis
The nurse is caring for a patient using patient-controlled analgesia (PCA). What is a major advantage to this method? -Less addictive -Less expensive -More effective -Quicker
Quicker
A nurse assesses an accident victim who has bright red blood spurting from a laceration on his right forearm. Where will the nurse apply pressure after applying direct pressure and elevating the limb? -Right ulnar artery -Right subclavian artery -Right radial artery -Right brachial artery
Right brachial artery
A visitor in the hospital slips and falls. The patient's arm appears dislocated and the visitor is unable to move it. What is the first action the nurse should implement? -Apply cold packs. -Check range of motion. -Splint the arm. -Apply an Ace bandage
Splint the arm
During the emergent phase of burn management, what is the first responder's first intervention? -Cover victim with clean cloth or sheet. -Provide an open airway. -Transport victim to hospital. -Remove all nonadherent clothing and jewelry. -Stop, drop, and roll. -Control any bleeding
Stop, drop, and roll
A nurse arrives at an accident scene where the victim has just received an electrical burn. What is the nurse's primary concern? -The extent and depth of the burn -The likelihood of cardiac arrest -The sites of entry and exit -Control of bleeding
The likelihood of cardiac arrest
A nurse instructs a unlicensed assistive personnel about the proper use of a gait belt and is observing a return demonstration. What action by the unlicensed assistive personnel should cause the nurse to intervene? -Unlicensed assistive personnel is walking to the side of the patient. -Unlicensed assistive personnel is grasping the handles of the gait belt while the patient ambulates. -Unlicensed assistive personnel is walking on the patient's strong side. -Unlicensed assistive personnel is securing the gait belt securely around the patient's waist
Unlicensed assistive personnel is walking on the patient's strong side.
Why should a nurse promptly administer a prescribed analgesic after a pain assessment? -It is an efficient use of time. -Unrelieved pain can cause setbacks. -The health care provider has ordered it. -It meets the goals of the nursing care plan
Unrelieved pain can cause setbacks
What should the nurse do when administering a therapeutic bath to a patient who has severe pruritus? -Use Burow's solution to help promote healing. -Ensure that bath area is at least 85 degrees and dehumidified. -Limit bathing to three times a week. -Rub the skin briskly to decrease pruritus
Use Burow's solution to help promote healing
What is the best approach for a nurse to use when planning pain relief measures? -Use a variety of pain relief methods. -Use only nonopioid analgesics. -Use at least three alternating methods. -Use only one method at a time.
Use a variety of pain relief methods.
A patient developed a severe contact dermatitis of the hands, arms, and lower legs after spending an afternoon picking strawberries. The patient states that the itching is severe and cannot keep from scratching. Which instruction would be most helpful in managing the pruritus? -Use cool, wet dressings and baths to promote vasoconstriction. -Wear cotton gloves and cover all other affected areas with clothing to prevent environmental irritation. -Trim the fingernails short to prevent skin damage from scratching. -Expose the areas to the sun to promote drying and healing of the lesions.
Use cool, wet dressings and baths to promote vasoconstriction.
The nurse who is caring for a 23-year-old client with bulimia knows that the most common method of purging to monitor this client for is: -excessive enema use. -vomiting. -use of syrup of ipecac. -starvation
Vomiting
What is the initial intervention for relief of the pruritus of dermatitis venenata? -Apply cool compresses continuously. -Apply baking soda to lesions. -Expose area to air. -Wash area with copious amounts of water.
Wash area with copious amounts of water
A machinist visits the industrial nurse's clinic with a deep laceration of the thigh. What should be the nurse's first action? -Splint the thigh and apply tape to approximate the edges. -Wash the laceration with an antiseptic. -Give a tetanus booster injection. -Apply ice and a pressure dressing to the thigh.
Wash the laceration with an antiseptic
When should family members of a stroke victim expect to see some of the neurologic involvement disappear? -Within 3 to 6 months -Within 1 to 2 months -Within 2 to 3 weeks -Within 6 to 9 months
Within 3 to 6 months
A policeman complains of feeling tired and not able to sleep for an extended period of time after being assigned to work the night shift. He is most likely suffering from: -obstructive sleep apnea syndrome. -narcolepsy. -circadian rhythm sleep disorder. -primary hypersomnia
circadian rhythm sleep disorder
What should the nurse examine in assessing a patient for tinea corporis? -Armpits -Scalp -Soles of the feet -Abdomen
Abdomen
When assessing the skin of an older adult patient who is complaining of pruritus, what should the nurse advise the patient to avoid to reduce further drying of her skin? -Antibacterial soap -Hard-milled soap -Perfumed soap -Lotion soap
Antibacterial soap
A frail, older adult home health patient who had chickenpox as a child has been exposed to varicella (chickenpox) several days ago. What should the nurse do? -Arrange for the patient to receive gamma globulin. -Assess frequently for herpes zoster. -Encourage the patient to have a pneumonia vaccine. -Be aware of the patient's immunity to chickenpox.
Assess frequently for herpes zoster
CPR has been initiated on an adult patient. How will the nurse confirm the effectiveness of CPR? -Observing pupils that change from pinpoint to dilated -Assessing a palpable carotid pulse during each compression -Assuring a compression depth of mc004-1.jpg to 2 in -Assessing an EKG pattern with each compression
Assessing a palpable carotid pulse during each compression
Which theory of aging suggests that the body becomes less able to tolerate the "self"? -Biological programming theory -Autoimmunity theory -Free radical theory -Wear-and-tear theory
Autoimmunity theory
What is the best instruction by the nurse regarding reducing the risk factors for melanoma? -Use a sun lamp for tanning. -Watch for changes in moles, especially on the back. -Have all nevi removed. -Avoid exposure to the sun and use protective measures when exposure occurs.
Avoid exposure to the sun and use protective measures when exposure occurs.