Practice Questions
A nurse is caring for a client who has depressive disorder and is assessing his ability to perform activities of daily living prior to discharge. Which of the following activities should the nurse include in the assessment?
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A nurse is teaching a client who is obese and has obstructive sleep apnea how to decrease the number of nightly apneic episodes. Which of the following statements by the patient indicates an understanding of the teaching? A) It might help if I tried sleeping on my back. B) I'll sleep better if I take a sleeping pill at night. C) I'll get a humidifier to run at my bedside at night. D) If I could lose about 50 lbs, I might stop having so many apneic episodes.
A The flat, supine position increases the chance of obstructing the airway. Hypnotics (sleeping pills) aggravate sleep apnea and can also cause increased daytime somnolence (sleepiness). Bedside humidifiers are an effective way to help patients w/ thick pulmonary secretions, but they do not help sleep apnea. Sleep apnea is a disorder in which breathing stops during sleep for at least 10 seconds at least 5 times/hour. Excessive weight is one of the three major risk factors associated w/ sleep apnea and is the only one the client can modify. Weight loss and maintenance are the primary interventions.
A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? A) Crushing the medication might cause you to have a stomachache or indigestion. B) Crushing the medication is a good idea, and I can mix it in some ice cream for you. C) Crushing the medication would release all the medication at once, rather than over time. D) Crushing is unsafe, as it destroys the ingredients in the medication.
A The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection. Crushing the pill will destroy the enteric coating, and the client should be advised against this. The client should be told not to break, crush, or chew enteric-coated tablets. The enteric-coating does not prevent the release of medication. Sustained release preparations disburse the medication over time. Many meds can be safely crushed. The client should check with the provider for information about which meds can be crushed
Which of the following statements should the nurse include when providing teaching for the client about leuprolide? For each statement made by the nurse, indicate whether the statement is essential, nonessential, or contraindicated. A) This med will cause you to stop having menstrual periods B) This med might cause your voice to temporarily become deeper. C) You should continue to take this med if you become pregnant. D) This med will need to be administered on a monthly basis E) This med will decrease the discomfort that you are having due to your condition. F) This med might cause low Ca+ levels.
A) Essential B) Nonessential C) Contraindicated D) Essential E) Essential F) Contraindicated Leuprolide is a gonadotropin-releasing hormone agonist that when administered to clients who have endometriosis, decreases hormone production by the ovaries, which results in temporary cessation of menses. Therefore, this statement by the nurse is anticipated. Deepening of the voice is not associated with the administration of leuprolide. Therefore, this statement by the nurse is nonessential. Leuprolide has a teratogenic effect on a developing fetus and should not be administered during pregnancy, Therefore, informing the client that they may continue the medication if they become pregnant is contraindicated. Leuprolide may be given as either a subcutaneous or intramuscular injection. For clients who have endometriosis, leuprolide is administered intramuscularly every 1 to 3 months. The prescription indicates the client should receive the mediation once monthly. Therefore, informing the client that the medication will be administered on a monthly basis is anticipated. Leuprolide is a gonadotropin-releasing hormone agonist that when administered to clients who have endometriosis, decreases hormone production by the ovaries, which results in temporary cessation of menses and reduction of endometrial lesions. This decreases the amount of discomfort the client is having due to their condition. Therefore, this statement by the nurse is anticipated. Leuprolide is known to place the client at risk for developing hypercalcemia, not hypocalcemia, and osteoporosis. Therefore, this statement by the nurse is contraindicated.
A nurse is preparing a client for surgery. Prior to administering the prescribed hydroxyzine, the nurse should explain to the client that the medication is for which of the following indications? A) controlling emesis B) diminishing anxiety C) reducing the amount of narcotics needed for pain relief D) preventing thrombus formation E) drying secretions
A, B, C, E Hydroxyzine is an effective antiemetic that may be used to control nausea and vomiting in preoperative and post-op patients. It is an effective antianxiety agent that may be used to diminish anxiety in surgical patients, as well as in clients who have moderate anxiety. It potentiates the actions of narcotic pain medications; therefore, narcotic requirements may be significantly reduced. It is an antihistamine that has no role in the prevention of thrombi. It is commonly causes drying of the oral mucosa.
A nurse is preparing to administer vaccines to a 1-year-old child. Which of the following vaccines should the nurse give? A) MMR B) Diphtheria, tetanus, and pertussis (DTaP) C) Varicella (VAR) D) Rotavirus (RV) E) Human papillomavirus (HPV4)
A, C A 1 year old should receive the first of two doses of the MMR vaccine. By 1 year, the child should have already received 3 doses of DTaP, at 2 months, 4 months, and 6 months. The child should receive a fourth dose at 15 months. A 1 year old should receive the first two doses of the VAR vaccine. 1 year olds should have received the RV vaccine in a two or three dose series at 2 months. A child should receive a three dose series of the HPV4 vaccine at 11 or 12 years of age.
A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing syndrome? A) Alopecia B) Tremors C) Moon face D) Purple striations E) Buffalo hump
A, C, D, E
A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose might hasten the patient's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication? A) Utilitarianism B) Nonmaleficence C) Fidelity D) Veracity
B Utilitarianism refers to actions that are right when they contribute to the greatest good. Nonmaleficence is the duty to do no harm. The ethical mandate is that health care workers refrain from intentionally inflicting harm to the patients. Fidelity is the duty to keep one's promises or word. It refers to the obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others. Veracity is the duty to tell the truth. It means that one does not intentionally deceive or mislead clients.
A nurse is working with a team of nursing personnel within a facility. Which of the following are necessary task performance roles that members of the group or the leader must perform? A) Self-confessor B) Coordinator C) Evaluator D) Energizer E) Dominator
B, C, D Self-confessor is a role that some group members use to meet a need for personal expression. It is not a role that must be performed. Coordinator is a task performance role that focuses on clarification and coordination of ideas. Evaluator is a task performance role that focuses on comparing group accomplishments with expected standards. Energizer is a task performance role that focuses on stimulating the group to higher levels of action. Dominator is a role that some group members use in attempting to gain control and manipulate a group. It is not a role that must be performed.
Which of the following manifestations reported by the client should the nurse identify as a therapeutic effect of the nafarelin? (Select all that apply.) A) CNS manifestations B) Missed previous month's menstrual cycle C) Breast changes D) Pain level during sexual intercourse E) Nasal mucosa changes F) Dermatological manifestations
B, D Nafarelin is a gonadotropin-releasing hormone agonist that decreases ovarian function resulting in medical-induced menopause. Cessation of menstruation allows for shrinkage of endometrial lesions resulting in decreased pain during sexual intercourse, Therefore, the client reporting a decrease in pain with sexual intercourse is a therapeutic effect of the medication. Breast changes is incorrect. Nafarelin is a gonadotropin releasing hormone agonist that decreases ovarian function, which suppresses the release of estrogen. Suppression of estrogen can cause a decrease in breast size. Therefore, the client reporting a decrease in breast size is an adverse effect, not therapeutic effect, of the medication. Nasal mucosa changes is incorrect. Nafarelin is administered by giving 1 spray into one nostril in the morning, and 1 spray in the opposite nostril in the evening. The administration of nafarelin intranasally can result in rhinitis and nasal irritation. Therefore, the client's report of nasal mucosa irritation is an adverse effect, not therapeutic effect, of the medication. Missed previous month's menstrual cycle is correct. Nafarelin is a gonadotropin-releasing hormone agonist that decreases ovarian function, resulting in medically-induced menopause. The induction of menopause allows for shrinkage of endometrial lesions, resulting in decreased pain during sexual intercourse, decreased pelvic pain, decreased episodes of dysmenorrhea, and decreased episodes of constipation. Therefore, the client reporting they did not have a period the previous month is a therapeutic effect of the medication. CNS manifestations is incorrect. Headaches are a common adverse effect of nafarelin. Therefore, the client's report of experiencing headaches since beginning therapy with nafarelin is an adverse effect, not a therapeutic effect of the medication. Dermatological manifestations is incorrect. Acne is a common adverse effect of nafarelin. Therefore, the client's report of an increase in acne lesions since beginning therapy with nafarelin is an adverse effect, not a therapeutic effect of the medication.
A nurse is caring for a postpartum client. Which of the following statements indicates an understanding of the discharge teaching? A) "Because of my baby's weight loss, I need to supplement with formula after breastfeeding." B) "I should make sure that my baby feeds 8 to 12 times per day." C) "I should cover my sore nipples with plastic-lined breast pads after every feeding." D) "My baby's stools should turn to a yellow color within the next day or two." E) "I can increase my milk supply by drinking more water." F) "I should expect my breasts to become harder, warmer, and more tender when my milk comes in."
B, D, F A weight loss of 5% to 10% of birth weight is an expected finding in the first few days of life. This is not an indication to supplement the breastfeeding with formula. Newborns should feed 8 to 12 times per day, although it may not be on a regular schedule. Some newborns feed every hour for a few hours and then sleep for a longer period of time. During the first few days of life, newborns might need to be awakened to ensure adequate frequency of feedings. ***
A nurse is caring for a client who received a Dx of systemic scleroderma 5 years ago. Which of the following findings should the nurse expect? A) Periorbital edema B) Excessive salivation C) Finger contractures D) Thinning of the skin
C Manifestations include edema of the hands, fingers, and sometimes the lower extremities The patient will experience decreased salivation, which increases the risk of dental caries and gum disease. Scleroderma is a chronic disease that can cause thickening, hardening, or tightening of the skin, blood vessels, and internal organs. Manifestations include skin changes, Raynaud's phenomenon, arthritis, muscle weakness, and dryness of the mucous membranes. Contractures occur w/ advanced scleroderma unless the client follows a regimen of ROM and muscle-strengthening exercises, pain management, and joint protection. Thickening and hardening of the skin occurs
A nurse is providing teaching to a client who has a prescription for heat therapy for treatment of cellulitis of the right lower leg. Which of the following client statements indicates an understanding? A) "I will sit on the side of the tub and soak my right leg two times every day." B) "I'll keep a heating pad on the calf of my right leg when I am lying down." C) "I'll place my leg under a heat lamp every 3 hours." D) "I'll wrap a warm, wet towel around my right calf every 4 hours."
D Moist heat is more effective than dry heat in treating cellulitis. Moist heat relieves the manifestations of inflammation by increasing blood flow to the affected area. The nurse should instruct the client to elevate the right leg 8 to 15 cm (3 to 6 in) above the level of the heart and apply warm, moist heat to the site every 2 to 4 hr. Dry heat is not effective in the treatment of cellulitis. A heating pad uses dry heat, but cellulitis treatment requires a moist heat application every 2 to 4 hr. The nurse should instruct the client to elevate the calf when applying heat, rather than dangling it in water.
A home health nurse is developing a POC for a child who has hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care? A) Provide respite services for the parents B) Improve the client's communication skills C) Foster self-care activities D) Modify the environment
D Respite services are frequently used to provide support for parents who care for chronically ill or disabled children in the home. Although supporting the parents is important, this goal is not the priority. Communication is often impaired in children who have cerebral palsy. Self-care is often impaired in children who have cerebral palsy. Although fostering self-care is important for independence, this goal is not the priority. Using the safety and risk reduction priority-setting framework, maintaining safety is the highest priority for this client. Modification of the environment includes making the child's home accessible and safe from hazards that could cause injury.