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3 (Upcoding is the practice of using a current procedure terminology code that is reimbursed at a higher rate than the code for the service actually provided. Unbundling, overbilling, and misrepresentation aren't the terms used for this illegal practice.)

A client in a behavioral-health facility receives a 30-minute psychotherapy session and the provider bills for a 50-minute session. Under the False Claims Act, such illegal behavior is known as: 1. unbundling. 2. overbilling. 3. upcoding. 4. misrepresentation.

4 (Tachycardia may be a sign of heart failure. Mild tachycardia is more easily detected during sleep than during the day, when activity can cause an increase in heart rate. Medications given for rheumatic fever and rheumatic heart disease, such as digoxin (Lanoxin), exert their influence both day and night. Chorea, a symptom of rheumatic fever, is the loss of voluntary muscle control. However, it doesn't affect pulse because the child would be sitting quietly and not involved in purposeful movement. A 10-year-old child is unlikely to be able to consciously raise or lower his heart rate.)

A child with rheumatic fever must have his heart rate measured while awake and while sleeping. Why are two readings necessary? 1. To obtain a heart rate that isn't affected by medication 2. To eliminate interference from the jerky movements of chorea 3. To ensure that the child can't consciously raise or lower the heart rate 4. To compensate for the effects of activity on the heart rate

1 (Neomycin(an antibiotic related to streptomycin, active against a wide variety of bacterial infections.) lowers the blood ammonia level by reducing the number of ammonia-producing bacteria in the GI tract. The drug also exerts its antibacterial activity directly on the ribosomes of susceptible organisms, among them E. coli, by inhibiting protein synthesis via direct action on ribosomal subunits. When these bacteria are present, they convert urea to ammonia. Neomycin is bactericidal in high concentrations and bacteriostatic in low concentrations. Thus, it doesn't trap or bind with ammonia in the GI tract. )

A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. Her physician prescribes neomycin (Neo-Tabs), 4 g by mouth daily in four divided doses. Her husband asks how neomycin decreases his wife's serum ammonia concentration. How should the nurse respond? 1. It decreases the number of ammonia-producing bacteria in the GI tract. 2. It acidifies the colon and traps ammonia in the GI tract. 3. It binds with ammonia in the GI tract. 4. It increases the growth of such bacteria as Escherichia coli.

1 (A heart rate of 144 beats/minute indicates decreased diastolic filling time and a reduced blood volume ejected with each contraction, resulting in decreased cardiac output. The client's temperature and respiratory rate are elevated but not enough for a diagnosis of Ineffective thermoregulation or Ineffective breathing pattern to take precedence over one of Decreased cardiac output. The client's vital signs don't suggest a diagnosis of Ineffective renal tissue perfusion.)

A client is admitted with the following vital signs: temperature, 102° F (38.9° C); heart rate, 144 beats/minute and irregular; and respiratory rate, 26 breaths/minute. Which nursing diagnosis takes highest priority when planning this client's care? 1. Decreased cardiac output 2. Ineffective thermoregulation 3. Ineffective breathing pattern 4. Ineffective renal tissue perfusion

4 (Heart failure typically causes fluid overload, resulting in weight gain. Therefore, weight is the most accurate indicator of this client's status. One pound gained or lost is equivalent to 500 ml. Fluid intake and output and vital signs are less accurate than weight. Urine specific gravity reflects urine concentration, indicating overhydration or dehydration; although helpful, it isn't the most accurate indicator because it can be influenced by numerous factors.)

A client with heart failure must be monitored closely after starting diuretic therapy. What is the most accurate indicator of this client's status? 1. Fluid intake and output 2. Urine specific gravity 3. Vital signs 4. Weight

2 (Normal WBC count is: 4,500 to 11,000/μl. The client is at risk for infection because the WBC count is dangerously low. Hb level and HCT are within normal limits; therefore, fluid balance, rest, and prevention of injury are inappropriate. )

A client's blood test results are as follows: white blood cell (WBC) count is 1,000/μl; hemoglobin (Hb) level, 14 g/dl; hematocrit (HCT), 42%. Which goal would be most important for this client? 1. Promote fluid balance 2. Prevent infection 3. Promote rest 4. Prevent injury

4 (Tertiary prevention involves reducing the degree and quantity of injury, disability, and damage following a disaster or crisis. Aggregate prevention isn't a level of care prevention. Primary prevention focuses on keeping the crisis or disaster from happening. The goal of secondary prevention is to reduce the duration and intensity of the disaster or crisis.)

A community health nurse is working with disaster relief following a flood. Finding safe housing for survivors, providing support for families, organizing counseling, and securing physical care are examples of which type of prevention? 1. Aggregate care prevention 2. Primary prevention 3. Secondary prevention 4. Tertiary prevention

2 (The usual or most prevalent reason for lack of productivity in a group of competent nurses is inadequate communication or a situation in which the nurses have unexpressed feelings and emotions. Although the other answers could be contributing to the problematic situation, they're less likely to be the cause.)

A newly hired charge nurse assesses the staff nurses as competent individually but ineffective and nonproductive as a team. In addressing her concern, the charge nurse should understand that the usual reason for such a situation is: 1. unhappiness about the change in leadership. 2. unexpressed feelings and emotions among the staff. 3. fatigue from overwork and understaffing. 4. failure to incorporate staff in decision making.

3 ( When a nurse discovers substandard practice by another nurse, it's always appropriate to address the situation before conveying the information to a manager or supervisor. Informing the nurse-supervisor first doesn't promote goodwill between nurses and can affect nursing care. It may be necessary to correct the problem before the nurse returns, but a written report may not be necessary if the issues can be remedied informally. If the problem persists, it may be necessary to meet jointly with a manager, but initially the problem should be addressed by only those directly involved.)

A nurse works on a general medical-surgical unit where nurses work on 12-client pods. Each pod is staffed by two registered nurses. When one of the nurses leaves the unit for any reason, the remaining nurse cares for all 12 clients. If she needs help, she can call the agency's in-house resource nurse. One evening, when a coworker nurse left the unit, the remaining nurse, who was making rounds on the departed nurse's clients, found medications left at bedsides and a client with a blood-draw tourniquet remaining on his arm. In addressing the problems, the nurse should: 1. inform the nurse-supervisor right away. 2. correct the problems and submit a written report. 3. speak to the coworker when she returns to the unit. 4. ask for a meeting with the coworker and a manager.

3 (Racemic epinephrine is an adrenergic used to reduce inflammation and edema of the tissue surrounding the trachea in a client with croup. Albuterol, metaproterenol, and other beta2-adrenergic drugs are used to treat asthma. Ipratropium is an anticholinergic used to treat severe asthma.)

An emergency department nurse is caring for a child diagnosed with croup. The nebulizer treatment of choice for a child with croup 臀部 is: 1. albuterol (Ventolin). 2. metaproterenol (Alupent). 3. racemic epinephrine (Racepinephrine). 4. ipratropium (Atrovent).

1 (As a safety precaution, the nurse should discard(丢弃) an unlabeled syringe that contains medication. The other options are considered unsafe because they promote error.)

Before administering the evening dose of a prescribed medication, the nurse on the evening shift finds an unlabeled, filled syringe in the client's medication drawer. What should the nurse do? 1. Discard the syringe to avoid a medication error. 2. Obtain a label for the syringe from the pharmacy. 3. Use the syringe because it looks like it contains the same medication the nurse was prepared to give. 4. Call the day nurse to verify the contents of the syringe.

3 ( Preoperative teaching helps reduce the risk of postoperative complications by telling the client what to expect and providing a chance to practice before surgery any required postoperative activities, such as breathing and leg exercises. The physician — not the nurse — is responsible for determining the client's psychological readiness. It's inappropriate for the nurse to express personal concerns about surgery to a client. The physician should describe alternative treatments and explain the risks of surgery to the client when obtaining informed consent.)

Before preparing a client for surgery, the nurse assists in developing a teaching plan. What is the primary purpose of preoperative teaching? 1. To determine whether the client is psychologically ready for surgery 2. To express concerns to the client about the surgery 3. To reduce the risk of postoperative complications 4. To explain the risks and obtain informed consent

4 ( During gentamicin therapy, the nurse should monitor a client's serum creatine level because the most notable adverse reactions to aminoglycoside therapy are nephrotoxicity and ototoxicity. The drug isn't known to affect serum potassium or glucose levels or PTT. )

During gentamicin therapy, the nurse should monitor a client's: 1. serum potassium level. 2. serum glucose level. 3. partial thromboplastin time (PTT). 4. serum creatine level.

4 (The stress of being in an unfamiliar situation, such as admission to a hospital, can cause confusion in geriatric clients. Depression doesn't produce confusion, but it can cause mood changes, weight loss, anorexia, constipation, and early morning awakening. In geriatric clients, long-term memory usually remains intact, although short-term memory may be altered. Decreased LOC doesn't normally result from aging; therefore, it's a less likely cause of confusion in this client.)

During the initial admission process, a geriatric client seems confused. What is the most probable cause of this client's confusion? 1. Depression 2. Altered long-term memory 3. Decreased level of consciousness (LOC) 4. Stress of an unfamiliar situation

1 (The most important part of the nursing practice regard medication is administering the medications. Nurses must be knowledgeable about drug dosages and possible interactions when administering medications; they must follow appropriate policies to correct dosage errors or potential interactions. The nurse is responsible for questioning unclear or ambiguous physician orders and should never carry out an order for which she's uncomfortable. Notifying OSHA doesn't solve medication errors. OSHA establishes comprehensive safety and health standards, inspects workplaces, and requires employers to eliminate safety hazards. The client should be aware of his rights as a client, but that awareness doesn't play a key role in error prevention.)

In which way do nurses play a key role in error prevention? 1. Identifying incorrect dosages or potential interactions of prescribed medications 2. Never questioning the order of a physician because he's ultimately responsible for the client outcome 3. Notifying the Occupational Safety and Health Association (OSHA) of violations in the workplace 4. Informing the client of his bill of rights as a client

3 (An HMO provides comprehensive health services for a fixed rate of payment or capitation. A PPO pays health care expenses for members if they use a provider who's under contract to that PPO. Managed care provides beneficiaries with a variety of services for an established, agreed upon payment. A privately funded insurance company won't offer services for a fixed rate.)

The manager of an outpatient clinic is explaining the various health care delivery systems to a client who's interested in joining a system with a reasonable fixed capitation rate. Which organization is the client primarily interested in joining? 1. A preferred provider organization (PPO) 2. A managed-care organization 3. A health-maintenance organization (HMO) 4. A privately funded insurance company

4 (Synergism （协同作用）, or a synergistic effect, occurs when two drugs with the same qualitative effects produce a response when given together greater than either drug produces when given alone. Tolerance is a decreased response or decreased sensitivity of the receptor to a drug. Antagonism （对抗） occurs when the combined response to two drugs given together is less than the response either drug produces when given alone. Hyperactivity （低反应性） is a less-than-usual response to a normal drug dose.)

The nurse is administering two drugs concomitantly （伴随） to a client. Which interaction occurs when two drugs with the same qualitative effects produce a response when given together greater than either drug produces when given alone? 1. Tolerance 2. Antagonism 3. Hyporeactivity 4. Synergism

2 (Failing eyesight, especially close vision, is one of the first signs of aging in middle life (ages 46 to 64). More frequent aches and pains begin in the early late years (ages 65 to 79). Increase in loss of muscle tone occurs in later years (ages 80 and older). Accepting limitations while developing assets is socialization development that occurs in adulthood (ages 31 to 45.))

The nurse is assessing a 47-year-old client who has come to the physician's office for his annual physical. One of the first physical signs of aging is: 1. having more frequent aches and pains. 2. failing eyesight, especially close vision. 3. increasing loss of muscle tone. 4. accepting limitations while developing assets.

1 (Cheyne-Stokes respirations are breaths that become progressively deeper followed by shallower respirations with apneic periods. Biot's respirations are rapid, deep breaths with abrupt pauses between each breath, and equal depth between each breath. Kussmaul's respirations are rapid, deep breaths without pauses. Tachypnea is abnormally rapid respirations.)

The nurse is caring for a client who has suffered a severe stroke. During routine assessment, the nurse notices Cheyne-Stokes respirations. Cheyne-Stokes respirations are: 1. progressively deeper breaths followed by shallower breaths with apneic periods. 2. rapid, deep breaths with abrupt pauses between each breath. 3. rapid, deep breaths and irregular breathing without pauses. 4. shallow breaths with an increased respiratory rate.

2 ( For the first few days to a week after a client receives a colostomy, slight bleeding normally occurs when the stoma is touched because the surgical site is still fresh. However, profuse bleeding should be reported immediately. A dark stoma with a bluish hue indicates impaired circulation; a normal stoma should appear red, similar to the buccal mucosa. Swelling should decrease in 6 weeks, leaving a stoma that protrudes slightly from the abdomen; continued swelling suggests a blockage. A burning sensation under the faceplate is abnormal and indicates skin breakdown.)

The nurse is helping to plan a teaching session for a client who will be discharged with a colostomy. When describing a healthy stoma (气孔), which statement should the nurse be sure to include? 1. "The stoma should appear dark and have a bluish hue." 2. "At first, the stoma may bleed slightly when touched." 3. "The stoma should remain swollen distal to the abdomen." 4. "A burning sensation under the stoma faceplate is normal."

3 (Clients can become dependent on barbiturates (any of a class of sedative 镇静剂 and sleep-inducing drugs derived from barbituric acid. ), especially with prolonged use. Because of the rapid distribution of some barbiturates, no correlation exists between duration of action and half-life. Barbiturates are absorbed well and don't cause hepatotoxicity, although existing hepatic damage does require cautious use of the drug because barbiturates are metabolized in the liver.)

The nurse is monitoring a client for adverse reactions during barbiturate therapy. What is the major disadvantage of barbiturate use? 1. Prolonged half-life 2. Poor absorption 3. Potential for drug dependence 4. Potential for hepatotoxicity

1 (Only short-acting regular insulin is used in continuous insulin infusions. Insulin is added to normal saline solution and administered until blood glucose levels fall. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.)

The nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 1. 100 U of regular insulin in normal saline solution 2. 100 U of neutral protamine Hagedorn (NPH) insulin in normal saline solution 3. 100 U of regular insulin in dextrose 5% in water 4. 100 U of NPH insulin in dextrose 5% in water

4 (Rolling the vial gently between the palms produces heat, which helps dissolve the medication. Stirring the medication with a sterile applicator isn't accepted practice. Inverting the vial wouldn't help dissolve the medication. Shaking the vial vigorously could cause the medication to break down, altering its action.)

The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should: 1. stir the liquid with a sterile applicator. 2. invert the vial and let it stand for 2 to 3 minutes. 3. shake the vial vigorously. 4. roll the vial gently between the palms.

3 (High-pitched gurgles are a normal finding. Decreased bowel motility causes two or three bowel sounds per minute; increased bowel motility causes hyperactive bowel sounds. Abdominal cramping causes hyperactive, high-pitched tinkling bowel sounds and may indicate a bowel obstruction.)

When auscultating a client's abdomen, the nurse detects high-pitched gurgles over the lower right quadrant. Based on this finding, the nurse suspects: 1. decreased bowel motility. 2. increased bowel motility. 3. nothing abnormal. 4. abdominal cramping.

2 ( Washing the area with normal saline solution and applying a protective dressing are within the nurse's realm of interventions and will protect the area. Using a povidone-iodine wash and an antibiotic cream require a physician's order. Massaging with an astringent can further damage the skin. )

When caring for a client with a 3-cm stage I pressure ulcer on the coccyx, which of the following actions can the nurse institute independently? 1. Using a povidone-iodine wash on the ulceration three times per day 2. Using a normal saline solution to clean the ulcer and applying a protective dressing as necessary 3. Applying an antibiotic cream to the area three times per day 4. Massaging the area with an astringent every 2 hours

1 (When the central venous catheter is positioned correctly, its tip lies in the superior vena cava, inferior vena cava, or right atrium — that is, in the central venous circulation. Blood flows unimpeded around the tip, allowing the rapid infusion of large amounts of fluid directly into circulation. The basilic, jugular, and subclavian veins are common insertion sites for central venous catheters.)

When positioned properly, the tip of a central venous catheter should lie in the: 1. superior vena cava. 2. basilic vein. 3. jugular vein. 4. subclavian vein.

2 (Lying on the left side allows the enema 灌肠剂 solution to flow downward by gravity into the rectum and sigmoid colon. The other options don't accomplish this goal and therefore are less effective in evacuating the lower bowel.)

When preparing a client for a diagnostic study of the colon, the nurse teaches the client how to self-administer a prepackaged enema. Which statement by the client indicates effective teaching? 1. "I will administer the enema while sitting on the toilet." 2. "I will administer the enema while lying on my left side with my right knee flexed." 3. "I will administer the enema while lying on my right side with my left knee flexed." 4. "I will administer the enema while lying on my back with both knees flexed."

4 (Bronchoscopy 支气管镜检查 involves visualization of the trachea and bronchial tree. To prevent aspiration of stomach contents into the lungs, the nurse should instruct the client not to eat or drink anything for approximately 6 hours before the procedure. It's not necessary for the client to avoid walking, talking, or coughing.)

When preparing a client for bronchoscopy, the nurse should instruct the client not to: 1. walk. 2. cough. 3. talk. 4. eat.

2 (The nurse should instruct the client to touch the tip of the tongue to the roof of the mouth and then place the sublingual tablet on the floor of the mouth. Sublingual medications are absorbed directly into the bloodstream from the oral mucosa, bypassing the GI and hepatic systems. No drug is administered on top of the tongue or on the roof of the mouth. With the buccal route, the tablet is placed between the gum and the cheek.)

When teaching a client how to take a sublingual tablet, the nurse should instruct the client to place the tablet on the: 1. top of the tongue. 2. roof of the mouth. 3. floor of the mouth. 4. inside of the cheek.

3 (Two major clinical characteristics affect client compliance: the nurse-client relationship and the therapeutic regimen. The client's drug knowledge, psychosocial factors, and disease duration and severity are client characteristics, not clinical ones.)

Which clinical characteristic affects client compliance(承诺)? 1. Drug knowledge 2. Psychosocial factors 3. The nurse-client relationship 4. Disease duration and severity

2 (By assisting the client to the semi-Fowler position, the nurse promotes easier chest expansion, breathing, and oxygen intake. The nurse should secure the elastic band so that the face mask fits comfortably and snugly rather than tightly, which could lead to irritation. The nurse should apply the face mask from the client's nose down to the chin — not vice versa. The nurse should check the connectors between the oxygen equipment and humidifier to ensure that they're airtight; loosened connectors can cause loss of oxygen.)

Which intervention should the nurse use when administering oxygen by face mask to a client? 1. Secure the elastic band tightly around the client's head. 2. Assist the client to the semi-Fowler position if possible. 3. Apply the face mask from the client's chin up over the nose. 4. Loosen the connectors between the oxygen equipment and humidifier.

3 (The physician's signature must be included in a medication order. Other components of a medication order include the client's full name, drug name, dosage form, dose amount, administration route, time schedule, and the date and time of the order. The drug class and possible adverse reactions aren't components of a medication order. Client allergies should be recorded in the client's chart, not on the medication order.)

Which must be included in a medication order? 1. Drug class 2. Possible adverse reactions 3. Physician's signature 4. Client allergies

2 (Coping is the process by which a person deals with problems using cognitive and noncognitive components. Cognitive responses come from learned skills; noncognitive responses are automatic and focus on relieving discomfort. Age could have either a positive or negative effect during crisis, depending on previous experiences. Previous coping skills are cognitive and include the thought and learning necessary to identify the source of stress in a crisis situation. Therefore, option 2 is the best answer. Although sometimes useful, noncognitive measures, such as self-esteem, may prevent the person from learning more about the crisis as well as a better solution to the problem. The person involved could have correct or incorrect perception of the problem that could have either a positive or negative outcome.)

Which of the following factors would have the most influence on the outcome of a crisis situation? 1. Age 2. Previous coping skills 3. Self-esteem 4. Perception of the problem

4 (Primary prevention involves promoting health and helping clients achieve maximum wellness. Primary preventive measures are designed to prevent or delay the onset of specific illnesses; typically, these measures include lifestyle changes such as avoiding overexposure to the sun to prevent skin cancer. Participating in a cardiac rehabilitation program is an example of a tertiary preventive measure, which attempts to prevent complications of an existing disease. Annual physical examinations and monthly breast self-examinations are examples of secondary preventive measures, which promote early detection and treatment of disease.)

Which of the following is an example of a primary preventive measure? 1. Participating in a cardiac rehabilitation program 2. Obtaining an annual physical examination 3. Practicing monthly breast self-examination 4. Avoiding overexposure to the sun

2 ( High doses of penicillin G and extended-spectrum penicillins such as piperacillin-tazobactam inactivate aminoglycosides. This interaction is clinically relevant in clients with poor renal function because elevated blood concentrations of both agents may exist simultaneously. Doses of both agents should be separated by at least 1 hour. Penicillins shouldn't be mixed in the same I.V. fluid with ahminoglycosides.)

Which statement about concurrent (同时)administration of piperacillin-tazobactam (Zosyn) and gentamicin (Garamycin) is correct? 1. These drugs should be mixed and given together via continuous I.V. infusion to promote bacterial cell penetration. 2. The doses should be separated by at least 1 hour to prevent inactivation of gentamicin. 3. These drugs should be administered at the same time via I.V. bolus for maximum effectiveness. 4. These drugs should be separated by at least 15 minutes to prevent inactivation of piperacillin.

3 (The carotid arteries must be palpated one at a time to prevent severe bradycardia and impairment of cerebral circulation. The nurse must also remember to avoid massaging the carotid sinus, located at the bifurcation of the carotid arteries; the resulting bradycardia could lead to cardiac arrest.)

Why shouldn't the nurse palpate both carotid arteries at one time? 1. The pulse can't be assessed accurately unless the arteries are palpated one at a time. 2. It may cause transient hypertension. 3. It may cause severe bradycardia. 4. It may cause severe tachycardia.