320 module 4 questions

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What is an example of a community risk factor? A client is genetically inclined to develop crippling arthritis. An 80-year-old client is at risk for falls at home due to clutter in the hallways and stairways. Children are kept inside on a sunny day due to a lack of recreational opportunities. A child is born with a severe intellectual disability.

Children are kept inside on a sunny day due to a lack of recreational opportunities.

Which theorist supports the developmental framework of family assessment? Minuchin Duvall Satir Bowen

Duvall -Minuchin, Satir, and Bowen are nurses whose family nursing theory is based on systems theory.

A nurse is developing a plan of care for a client to meet the client's self-actualization needs. The nurse would focus on which area as most important? Emphasizing the client's strengths Addressing the client's problems Reducing fear Promoting socialization

Emphasizing the client's strengths -To help meet a client's self-actualization needs, the nurse focuses on the person's strengths and possibilities rather than on problems.

Which statement is true regarding Friedman's theory of family-centered nursing care? The role of the family is essential in every level of nursing practice. The family is composed of independent members who live and function individually. The focus on health should be directed at improving the health of the sickest member of the family. Illness of one family member strengthens the roles of the sick member in the family structure.

The role of the family is essential in every level of nursing practice.

A nurse is working with a single-parent family. When planning the care for this family, which need would the nurse anticipate as being a priority concern? Select all that apply. Financial concerns Shift in roles Child health issues Health promotion Excessive support systems

Financial concerns Shift in roles -Although child health issues, health promotion, and lack of support systems may be concerns for single-parent families, single parents often have special problems and needs, including financial concerns and role shifts

A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication? "Why are you treating me this way?" "You always act like this." "I think there is a better way to handle this." "What is your problem with me?"

I think there is a better way to handle this

The nurse is assessing the family structure of the client. The family household comprises two parents, three children, and one grandparent. The nurse recognizes that this is a(n): extended family. cohabiting family. blended family. traditional family

extended family.

A family that consists of two homosexual parents and three children living in the same house is an example of which type of family? Nuclear Extended Blended Single-parent

nuclear -sexuality has nothing to do with family structure

Which term refers to a purposeful activity that leads to action, improvement of practice, and better client outcomes? Memorization Reflection Assessment Evaluation

Reflection

A nurse is planning education on self-administration of insulin to the client and the client's family members. The client asks the nurse why the family members are also included in the teaching. What should the nurse's response be? "Family members can take you to the hospital if any emergency occurs." "Family members are a point of contact and are able to check on your progress." "Family members are at risk of developing diabetes mellitus in the future." "Family members are equally involved in planning and implementation of care."

"Family members are equally involved in planning and implementation of care."

A nurse is assessing a family with adolescents. The family consists of a father, mother, a 13-year-old son, a 14-year-old son from a previous marriage, and a 16-year-old daughter. Which statement by the parents would lead the nurse to suspect a potential risk factor for altered health with this family? "Our 16-year-old just seems to butt heads with us at every turn." "We've taught our kids to be assertive when appropriate." "All of us have faced problems along the way but we've worked them out." "We've encouraged our kids to talk to us about sex and sexually transmitted infections."

"Our 16-year-old just seems to butt heads with us at every turn."

A nurse is assessing a family and identifying where the family is in the family life cycle. During this assessment, the nurse applies Duvall's theory. Which theory forms the basis for Duvall's theory? Erikson's theory of psychosocial development Freud's psychoanalytic theory Kohlberg's theory of moral development Piaget's theory of cognitive development

-Erikson's theory of psychosocial development -Duvall (1985) identified critical family developmental tasks and stages in a family life cycle. Duvall's theory, based on Erikson's theory of psychosocial development, states that all families have certain basic tasks for survival and continuity, as well as specific tasks related to developmental stages throughout the life of the family

What is the most beneficial use of the nursing process in addressing the needs of the client? Provides a universally applicable framework for nursing activities Allows the nurse to determine a medical diagnosis for the client Allows student nurses to work on assignments Targets desired outcomes for particular illnesses, procedures, or conditions

-Provides a universally applicable framework for nursing activities -Critical pathways, not the nursing process, target desired outcomes for particular illnesses, procedures, or conditions.

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply. 1 "Are you ready to get out of bed?" 2 "What sorts of things do you do for fun?" 3 "What plans do you have after you are discharged?" 4 "Do you smoke cigarettes?" 5 "Is there any chance you might be pregnant?" 6 "Does it hurt when I touch you here?"

1, 4. 5, 6

Which guideline should a nurse use when choosing a position (location) in relation to a client during a verbal interaction? 1. Take note of the client's cues when choosing a position and act on these cues. 2. Assess the client's culture during the initial meeting or assessment. 3. Choose a position that is no closer than 2 feet, but no farther than feet. 4. The nurse should ask the client where he would like the nurse to position herself and move accordingly.

1. Take note of the client's cues when choosing a position and act on these cues

The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes? 1. contacting the interprofessional care team to discuss alternative treatment options 2. explaining the health consequences of refusing to undergo the prescribed treatment 3. asking the client's family to discuss the importance of the prescribed treatment with the client 4. recommending assessment of the client's cognitive capacity to make health care decisions

1. contacting the interprofessional care team to discuss alternative treatment options

A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should: 1. sit at the bedside and allow the client to explain the statement. 2. smile at the client and apologize. 3. ignore the statement and empty the urinary catheter. 4. inform the client that the unit was very busy that day.

1. sit at the bedside and allow the client to explain the statement.

A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? 1. "I will be by your side throughout the procedure; the procedure will be painless if you don't move." 2. "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." 3. "The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120." 4. "You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically."

2. "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position."

A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point? 1. Explaining in detail all of the pain management options available 2. Being sensitive to the client's emotional barriers 3. Sharing the nurse's own family and personal history of back pain 4. Reassuring the cleint that back surgery will likely alleviate the pain completely

2. Being sensitive to the client's emotional barriers

A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: 1. staring into the neonate's eyes and smiling. 2. softly humming a song near the neonate. 3. swaddling the child and gently stroking its head. 4. offering the neonate infant formula.

3. swaddling the child and gently stroking its head.

A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation? 1. "Is your name Evelyn?" 2. "Are you in a hospital?" 3. "Is today the first day of the month?" 4. "What day of the week is it?"

4. "What day of the week is it?"

What are examples of meeting physiologic needs according to Maslow's hierarchy of needs? (Select all that apply.) A nurse washes hands and puts on gloves before inserting a catheter in a client. A nurse invites a client's estranged son to visit the client. A nurse counsels an overweight teenager about proper nutrition. A nurse administers pain medication to a postoperative client. A nurse attains a master's degree in nursing. A home care practitioner requests quiet so that a client can sleep.

A nurse administers pain medication to a postoperative client. A nurse attains a master's degree in nursing. A home care practitioner requests quiet so that a client can sleep. -The nurse counseling an overweight teenager would be Level 4, self-esteem

When developing a nursing plan of care and associated client outcomes, what should the nurse recognize? Select all that apply. A plan of care should be comprehensive and ongoing, covering and being updated during all phases of care. All plans of care are the same for clients with certain medical diagnoses. Only the client is involved in outcome setting, not the family. Outcomes can be short- and long-term. Outcome setting allows for individualization of the plan of care.

A plan of care should be comprehensive and ongoing, covering and being updated during all phases of care. Outcomes can be short- and long-term. Outcome setting allows for individualization of the plan of care.

Which client requires priority intervention by a nurse providing care on a medical-surgical unit? A newly admitted client who is upset due to a new cancer diagnosis An older adult client who is yelling and angry with family members A postsurgical client who is feeling dizzy and has a heart rate of 45 beats/min A client with a blood pressure of 98/40 mm Hg who needs to ambulate to the bathroom

A postsurgical client who is feeling dizzy and has a heart rate of 45 beats/min

The nurse is explaining the expected developmental tasks of a typical family with adolescents. Which of the following would be incorrect for the nurse to include? Adjustment to retirement Maintain open communication Strengthen the marital relationship Maintain a supportive home environment

Adjustment to retirement -that is for families with adult children

A nurse is conducting focused data collection and recognizes the existence of cues. The nurse is most likely involved in which phase of the nursing process? Assessment Diagnosis Planning Implementation

Assessment

A nursing student's parents are both physicians. The nursing instructor may feel the student has Been educated in healthcare Been socialized in healthcare Difficulty in changing her attitudes Defined her future

Been socialized in healthcare

A nurse is working with a group of staff members to address the needs of a client as they develop the client's interdisciplinary plan of care. Which question if asked by the nurse addresses the standard of breadth when judging the group's thinking? "Could you elaborate on that point a bit more?" "How could we find out whether that is true?" "Could you be more specific in your observations?" "Is there another way to look at this situation?"

Breadth is demonstrated by asking whether there is another way to look at this situation. This question attempts to address other issues that may or may not be impacting the situation. Asking to elaborate demonstrates clarity; asking to find out if the issue is true reflects accuracy. The question about being more specific addresses precision.

The parents of a blended family have a baby boy age six months who is due for immunizations. The clinic closest to their home has recently closed, and they feel intimidated by the prospect of going to the large, university hospital near their home. Which type of factor is the primary influence on this aspect of the family's health? Community health care structure Economic factors Family risk factors Lifestyle influences

Community health care structure

A client says, "I live in a small community on the northwest side of the city." Why does the nurse consider it significant that the client reports living in a community rather than a neighborhood? Neighborhoods are, by definition, smaller units within a community. Community indicates people who share similar characteristics. Communities are defined by geography. Neighborhoods meet basic human needs, where communities do not.

Community indicates people who share similar characteristics.

Which are stressors that affect the health of the family? Many job opportunities with adequate income Family members who live in the same geographic location Public transportation present throughout the community Inadequate childcare services

Inadequate childcare services

The nurse is assessing a family parented by a 60-year-old grandmother and three school-age grandchildren. The nurse is aware that which problem may occur in a single-parent family at a greater level than in other types of families? Lack of knowledge about child safety Increased financial concerns Child abuse and neglect Conflict between family members

Increased financial concerns

Patient care dealing with nutrition and metabolism should include which factors? Select all that apply. Knowledge about the value of the MyPlate diagram Understanding food preferences of clients from the Jewish community Information on the client's financial status related to meal provisions Ability of the client to prepare food at home Knowledge of the different treatment procedures requiring fasting

Knowledge about the value of the MyPlate diagram Understanding food preferences of clients from the Jewish community Information on the client's financial status related to meal provisions Ability of the client to prepare food at home

A nurse is reading a journal article about providing individualized care. Which aspect would the nurse most likely read about as the almost universally accepted method for providing nursing care? Nursing process Clinical reasoning Reflection Experience

Nursing process

The nurse makes a contract with the client during which phase of the nurse-client relationship? Intimate phase Orientation phase Working phase Termination phase

Orientation phase

A nurse is caring for an adolescent who has just lost a leg in a motor vehicle accident. Which human need would the nurse most likely need to address? Love and belonging needs Safety and security needs Self-actualization needs Self-esteem needs

Self-esteem needs

A nurse is working at a community clinic that serves mostly families with young children. What would be a priority intervention for clients in this developmental stage? Setting up parenting classes Providing alcohol and drug information Screening for congenital defects Providing sex education

Setting up parenting classes

During the patient assessment, the client shares that the family attends church nearly every Sunday. Which function of the family does this represent? Socialization Economic Reproductive Physical

Socialization

The nurse is assessing the communication style of the client. Communication is an example of which dimension of the individual? Physical dimension Environmental dimension Sociocultural dimension Emotional dimension

Sociocultural dimension

What factors must the nurse consider when creating a holistic plan of care? (Select all that apply.) The client's physical environment The client's developmental life stage The client's emotional context The client's conceptual integration of life The client's physiologic health condition

The client's developmental life stage The client's emotional context The client's physiologic health condition

The nurse and the physical therapist discuss the therapy schedule and goals for a client on a rehabilitation unit. What type of communication is occurring between the nurse and the therapist? Interpersonal Intrapersonal Small-group Organizational

interpersonal

A client is experiencing a stress response each time the family visits the room. What nursing intervention is most appropriate? tell the family they are causing too much stress limit the family visits to once daily explain that family visits and support are important do not intervene and allow the client to work out the family issue

limit the family visits to once daily

During an annual performance review with an employee, the nurse manager does not maintain eye contact and seems concerned about the time and the next appointment. What type of communication is the manager exhibiting? Consistent Verbal Nonverbal Clarifying

non verbal

A client with persistent nausea is diagnosed with somatization. What is the appropriate nursing action when the client reports nausea? Immediately administer an antiemetic. contact the primary care provider sit with the client and ask them about their feelings explain that the physical symptoms are all in their head

sit with the client and ask them about their feelings

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario? The working phase The introduction phase The orientation phase The termination phase

the working phase

Several nurses on the same hospital unit communicate on the same social networking site. A nurse posts the following statement to the social networking page, "The lady in room 34 with heart failure was a train wreck!" In which manner has the nurse failed to apply the principles of confidentiality? 1. The nurse did not fail to apply the principles of confidentiality because the client's name was not used. 2. Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights. 3. The nurse did not fail to apply the principles of confidentiality because the hospital's name was not mentioned. 4. Sharing information about the client's diagnosis is unacceptable because it is viewed by the general public and not just other nurses.

2. Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights.

A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to: 1. plan a meeting where the dominant person cannot attend. 2. pick a team leader who is not the dominant member. 3. have group members confront the dominant member to promote the needed team work. 4. have group members issue a written warning to the dominant member

3. have group members confront the dominant member to promote the needed team work.

The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client? Approach the client with empathy and understanding and allow the client to share feelings without being judged. Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive. Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding. Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation.

Approach the client with empathy and understanding and allow the client to share feelings without being judged. - EMPATHY AND UNDERSTANDING AND NON JUDGEMENT BULD RAPPORT (TRUST) -ACTIVE LISTENING DOES NOT LEAD TO TRUST BUILDING

The nurse makes a home visit to evaluate a 3-week-old infant. On arrival at the family's home, the heterosexual nurse discovers that the parents are a lesbian couple. When planning appropriate nursing interventions for this family, which must the nurse do first? Determine whether the couple is legally married in their state. Assess for any personal biases about this nontraditional family structure. Plan additional visits to observe the lesbian couple's parenting skills. Address the couple's usual fears about being new parents.

Assess for any personal biases about this nontraditional family structure.

A hospital client has an aggressive fungal infection in the right eye that necessitates evisceration (removal of the eye). Consequently, the client requires twice-daily packing and dressing changes to the orbit. Which of the nurse's actions in the care of this client most clearly demonstrates interpersonal skills? Ensuring the client's privacy during dressing changes and providing an explanation during the procedure Documenting the condition of the client's orbit and the procedure of the dressing change in an accurate and timely manner Understanding the anatomy and physiology of the affected parts of the client's body Maintaining aseptic technique when performing the dressing change

Ensuring the client's privacy during dressing changes and providing an explanation during the procedure

The home health nurse is making an initial assessment visit to a family that consists of two parents and twin 3-year-old boys. During the interview, the nurse is most concerned if the client makes which statement? The father asks the nurse, "Do you mind if my little boy sits on my lap during the interview?" The mother states, "We like to pay cash for the things we need." The father states, "I don't discuss money matters with my wife because I don't want her to worry." The mother states, "This house would be a mess if I didn't clean it every day."

The father states, "I don't discuss money matters with my wife because I don't want her to worry." -Effective and healthy families exhibit open communication among its members. Protecting the spouse from worry by not discussing money matters stifles communication and jeopardizes the family's affective and coping functions


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med surg I- Chapter 22: Management of Patients With Upper Respiratory Tract Disorders

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