Prep-U Questions and Answers

A nurse manager is reviewing staff behaviors that are resulting in elevated operating costs on the acute inpatient unit. Which behavior(s) will the nurse manager address with the nurses on the unit as contributing to waste? Select all that apply.

-Instructing unlicensed assistive personnel to strip all linens from clients' beds each morning. -Storing dressing and other disposable supplies at the bedside of a client on contact precautions. -Sending routine culture and sensitivity testing on client's blood from central venous devices.

A client who has sustained burns to the anterior chest and upper extremities is brought to the burn center. During the initial stage of assessment, which nursing diagnosis is primary?

Risk for Impaired Gas Exchange Explanation: During the initial assessment of a burn victim, the nurse must look for evidence of inhalation injury. Once oxygen saturation and respirations are determined, pain intensity is evaluated. The assessment of damage to the tissues and prevention of infection are secondary to airway issues.

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin Explanation: Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension. Reference:

The emergency department (ED) nurse should assess which client first?

a 40-year-old who was involved in a motorcycle accident and is now stating abdominal pain Explanation: When the nurse is presented a choice between who to see first, safety and seriousness of the condition are considerations. The individual from the motorcycle accident is stating pain that could indicate internal injuries, a serious complication. This individual would be assessed by the nurse first. Through delegation and prioritization of the remaining clients, the others will have their needs met by the registered nurse and members of the health care team. The nurse identifies physiological jaundice in the 3-day old neonate. Diagnostic lab work will be completed and parental teaching on increasing feedings. A simple dressing on the bleeding laceration could be placed by a licensed practical/vocational nurse or nursing assistant until seen by the healthcare provider. The fractured arm will be examined and x-rayed confirming the fracture.

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

gonorrhea Explanation: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.

A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider?

incompatibility between the child's history and the injury Explanation: Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. For example, the child may have a skull fracture but the parents state that the child fell off of the sofa. The other criteria also may suggest child abuse but are less reliable indicators.

The nurse managers of a home healthcare office wish to maximize nurses' freedom to characterize and record client conditions and situations in the nurses' own terms. Which documentation format is most likely to promote this goal?

narrative notes Explanation: One of the advantages of a narrative notes model of documentation is that it allows nurses to describe clinical encounters in their own terms, as they understand them. Other documentation formats, such as SOAP notes, focus charting, and charting by exception, are more rigidly delineated and allow nurses less latitude in their documentation.

A client diagnosed with gestational hypertension must have weekly blood pressure checks and urine testing at a clinic. She does not have transportation. How can the nurse help this client be compliant with her care?

Ask the clinic case manager to speak with the client. Explanation: The nurse should ask the case manager to speak with the client because the case manager is familiar with community resources that can assist with transportation. Resources and additional support will greatly increase the client's compliance. The nurse can't set up cab service if the client doesn't have the funds to pay for transportation. The client may be noncompliant if she has no assistance or if she has to rely on a friend to help.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

For their immunosuppressant effects Explanation: Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician to perform?

joint manipulation and immobilization Explanation: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks. Reference:

Which of the following interventions should a nurse recommend for fostering effective coping skills and a sense of hardiness?

Daily exercise Explanation: A nurse should recommend a daily exercise program to reduce stimulating neurotransmitters and release endorphins and enkephalins. Diet and periodic checkups are not essential to foster effective coping skills and a sense of hardiness. It is essential for the client to avoid a nonprescribed sedative drug for self-treatment, because it does not foster effective coping skills and a sense of hardiness.

A client is being treated for injuries resulting from a skateboarding accident and is very agitated as the nurse cleans several gashes on the client's head. Which of the nursing responsibilities outlined by the American Nurses Association is the nurse fulfilling?

administering medications, wound care, and numerous other personal interventions Explanation: In 2012, the American Nurses Association (ANA) outlined seven nursing responsibilities, which include administering medications, wound care, and numerous other personal interventions. The other options are nursing responsibilities, but do not meet the description given in this scenario.

A nurse notices that a large number of clients who receive oxytocin to induce labor vomit as the infusion is started. The nurse assesses the situation further and discovers that these clients received no instruction before arriving on the unit and haven't fasted for 8 hours before induction. How should the nurse intervene?

Initiate a unit policy involving staff nurses, certified nurse-midwives, and physicians in teaching clients before labor induction. Explanation: The best intervention by the nurse is to initiate a unit policy that involves the multidisciplinary team. This approach creates an atmosphere of collegiality and professionalism with the goal of providing the best care for clients in labor. Telling the physicians they need to teach their clients blames the physician and doesn't promote multidisciplinary teamwork. Reporting the physicians is unnecessary because nothing indicates that the physicians provided inferior care. The nurse can approach the medical staff about initiating a protocol order that allows the nursing staff to administer promethazine; however, this option doesn't address the current problem — the lack of client education.

A registered nurse (RN) has been "care-paired" with a licensed practical nurse (LPN) during the evening shift. Whose care should the RN assign to the LPN?

the 2-year-old child who has started eating soft, solid foods following a tonsillectomy Explanation:The nurse can delegate care of the child who had the tonsillectomy to the LPN because that child is stable and likely preparing for discharge. The infant with a WBC count of 34/μl and fever requires close monitoring for additional signs of infection. Infection could lead to sepsis or septic shock. Although the infant with contusions from the motor vehicle accident may be stable, children sometimes experience delayed reactions to injury. This infant requires close monitoring for signs or injury or shock. The RN should care for the infant with type 1 diabetes, who could become ill very quickly.