HE Final- Quiz Questions

A patient with rheumatoid arthritis complains of soreness in his joints. Which of the following homeopathic remedies might the nurse recommend for this patient? 1) arnica 2) calendula 3) nux vomica 4) Ignatia

1

Complications of Otitis media are which of the following? 1) All of the above. 2) Sensorineural hearing loss. 3) Meningitis. 4) Eardrum perforation.

1

Mr. A. is 66 and has chronic joint pain from arthritis and has a disturbed sleep pattern. Which of the following interventions will help Mr. A. the most to increase his sleep time? 1) Give pain meds for the joint pain in the evening. 2) Give a strong hypnotic medication at bedtime since he really needs to sleep and is sleep deprived. 3) Elderly patient's benefit most from an antidepressant to increase sleep time. 4) No medication should be given to this patient.

1

Some preparations of pseudoephedrine are contraindicated in which of the following disorders of the patient? 1) Hypertension. 2) Arthritis. 3) Asthma. 4) Anemia.

1

The Rinne test for hearing that is performed with a tuning fork is testing for? 1) Bone conduction to air conduction. 2) Kinesthetic sensation. 3) Sound transmission through bones of the skull. 4) Sensorineural conduction of waves.

1

Which of the following complementary and alternative therapies is based on the belief of supporting the body while the symptoms are allowed to "run their course." 1) homeopathy 2) qi Gong 3) traditional Chinese medicine 4) Ayurveda

1

Which of the following levels of basic human needs is most basic? 1) Physiologic 2) Safety and security 3) Love and belonging 4) Self-actualization

1

Which of the following is true about the influenza vaccine? 1) Anyone who has a history of hypersensitivity to eggs should not receive the influenza vaccine. 2) No one over the age of 65 should get the vaccine because it is a live, attenuated one. 3) The best time to get the influenza vaccine is during the coldest time of the year, either December or January. 4) Oseltamivir (Tamiflu) is used in the prevention of influenza

1 (Lewis, p. 539; The contraindications for administering the flu vaccine is 1) Guillaine-Barré syndrome and 2)hypersensitivity to eggs, because the vaccine is produced in eggs. Anyone over the age of 50 can get the inactivated vaccine. The best time of the year to get the vaccine is in mid-October. Before exposure occurs. Tamiflu is used in the treatment and not the prevention of the flu.

A patient is admitted to your unit and when you assess his respiratory status, you note that his rate is 28 breaths per minute and his lungs sound congested. The first intervention that you will do is: 1) Raise the head of the bed. 2) Administer oxygen per nasal cannula. 3) Help him deep breathe and cough. 4) Call the doctor for further instruction.

1 (maximal chest expansion is possible and the ventilation/perfusion ratio is optimal in the upright, unsupported position. This intervention is quick, easy and can be done for the patient immediately (takes no special equipment) whether the patient is alert or not. It takes time to gather and put the oxygen equipment on the patient (this should be the 2nd intervention); helping the patient to cough and deep breathe is a good way to improve upon the ineffective airway, but this can only be done if the patient is cooperative and if she/he is, then this would be the third intervention. Calling the doctor should be done after raising the HOB, administering oxygen (if hospital standing orders indicate) and helping the patient cough and deep breathe, if the patient can do this. However, if hospital protocol indicates that you must call the doctor first to get an order for oxygen administration, then this intervention will be done after the call.

If an individual has a body mass index (BMI) of 29.4 kg/m2, then that person is considered to be: 1) overweight. 2) normal weight. 3) obese. 4) underweight.

1 A person with a BMI below 18.5 kg/m2 is considered to be underweight; a person with a BMI between 18.5 and 24.9 kg/m2 is of normal weight; a person with a BMI between 25-29.9 kg/m2 is overweight; a person with a BMI between 30-39.9 kg/m2 is obese; and a person with a BMI of 40 kg/m2 or more is morbidly obese.

Which of the following is not a developmental task of the young adult? 1) Becoming less reliant on family and more reliant on self and others. 2) Developing philosophies of life and personal lifestyles. 3) Becoming participatory citizens. 4) Establishing autonomy from parents or parent surrogates.

1 A. During adolescence, not young adulthood, less reliance on family and increased reliance on self and others is seen. B. The young adult develops philosophies of life and personal lifestyles. C. The young adult may take on many roles, including parent, spouse or companion, son or daughter, citizen, civic leader, friend, and employee or employer. D. The young adult establishes autonomy from parents and parent surrogates. Question 11

Which of the following is not an objective of discharge planning? 1) Helping the client identify services to assist in achieving desired goals. 2) Making sure there will be no interruptions in the implementation of the therapeutic regime. 3) Providing adequate teaching and instruction to manage the therapeutic regime. 4) Identifying appropriate resources to ensure continuity of care.

1 A. Helping the client acknowledge and accept the problem and recognize the need for services are the initial steps in guiding the client through the health system. B. Making sure that there will be no interruption in the implementation of the therapeutic regime is an objective of discharge planning. C. Providing adequate teaching and instruction or additional demonstrations of procedures to manage the therapeutic regime is an objective of discharge planning. D. Identifying or familiarizing the client and family with appropriate resources to ensure continuity of care is an objective of discharge planning.

Which of the following is not included in the definition of primary health care created by the World Health Organization (WHO)? Primary health care: 1) Is the responsibility of the physician. 2) Provides equitable accessibility of health services to all populations. 3) Emphasizes services that are preventive and promotive rather than curative. 4) Emphasizes individual and community involvement in the planning and operation of health services.

1 A. In the WHO definition, primary health care is delivered by a variety of health professionals, not just the physician, working collaboratively with clients to maintain health, support wellness, and treat illness. B. The WHO definition of primary health care provides equitable accessibility of health services to all populations. C. The WHO definition of primary health care emphasizes services that are preventive and promotive rather than curative. D. The WHO definition of primary health care emphasizes individual and community involvement in the planning and operation of health services.

Which of the following is an overarching goal of Healthy People 2010-2020? 1) Increasing the quality and years of healthy life. 2) Providing access to quality health services. 3) Reducing alcohol and illicit drug use. 4) Seeking opportunities to enhance an employment situation.

1 A. Increasing the quality and years of healthy life and eliminating health disparities are the two overarching goals of Healthy People 2010-2020. B. This is a focus area for Healthy People 2010-2020. C. This is a focus are for Healthy People 2010-2020. D. This is an example of health-seeking behaviors.

To help the client explore meaning when experiencing spiritual distress, the nurse would include which of the following interventions? 1) Encouraging a life review. 2) Discouraging the use of reminiscence. 3) Avoiding the sharing of personal stories. 4) Avoiding the use of myths.

1 A. Interventions to relieve spiritual distress include helping the client explore the meaning. This can be done with life review, for example writing an autobiography or telling stories of childhood events. Understanding one's own life can help the client accept current circumstances, regardless of the expected long-term outcome. B. Reminiscence is another way to explore meaning. Clients can examine their life experiences to discover new meanings or to reconnect to forgotten moments that represent significant meaning. C. The nurse may need to share personal situations of suffering and ways he or she used to discover meaning and purpose to help the client transcend the present situation and perceive higher meaning and purpose. D. When clients are transitioning from one life stage to the next, tremendous anxiety, pain, and turmoil may be encountered. Myths deal with such passages and function to bring the person into harmony and destiny.

Which of the following is not a source of lead? 1) Homes built after 1978. 2) Solder on plumbing fixtures. 3) Artist's paints and jewelry. 4) Soil near mines.

1 A. Over 80% of homes built before 1978 contain lead-based paint, although homes built before 1950 pose the greatest threat. B. The solder on older plumbing and brass fixtures contains lead. C. Artist's paints and jewelry are known sources of lead.

The psychological health of clients can be determined by assessing which of the following? 1) Coping skills 2) Cultural practices 3) Religious beliefs and values 4) Nutrition

1 A. Patters of psychological health can be determined by assessing coping skills. B. Sociocultural health is assessed through cultural practices. C. Religious beliefs and values are determinants of spiritual health. D. Health practices can be determined by assessing nutrition.

In planning health teaching with students, the school nurse would include which physical change as the hallmark of puberty in girls? 1) First menstrual period 2) Breast development 3) Pubic hair growth 4) Increase in weight and height

1 A. Puberty refers to the physical process that causes the reproductive organs to mature. In girls, the first menstrual period, referred to as menarche, is the hallmark of puberty. B. Breast development is one of the secondary sexual characteristics that appear during adolescence. Secondary sexual characteristics develop in the same sequence in all adolescents, although the timing is different from person to person. Breast development is not the hallmark of puberty in girls. C. Pubic hair develops during adolescence as secondary sexual characteristics appear. The appearance of pubic hair does not serve as the hallmark of puberty in girls. D. Adolescents do experience a growth spurt characterized by an increase in weight and height, however, this adolescent growth spurt is not an indicator of puberty. Question 2

Which of the following is not a characteristic of spirituality? 1) Seeing. 2) Doing. 3) Knowing. 4) Being.

1 A. Seeing is not a characteristic of spirituality. B. Doing is a characteristic of spirituality and is defined as what one does and how one acts. C. The spiritual characteristic of knowing is defined as what and how one knows. D. Being is a characteristic of spirituality and includes important relationships and a sense of connection with oneself.

The nurse teaching health promotion to a group of parents includes the point that which of the following is the leading cause of death in children? 1) Accidents 2) Cancer 3) Heart defects 4) Infection

1 Accidents are the leading cause of death in children. Some common accidents are aspiration, choking, falls, burns, car accidents, and drowning. They may result from a child's natural curiosity about and exploration of the environment.

A toddler burns a finger on a hot radiator. Following this experience the toddler does not touch the radiator again. The nurse interprets that this behavior change occurs because of which of the following abilities in cognitive development? 1) Adaptation 2) Activation 3) Accommodation 4) Assimilation

1 Adaptation, or coping behavior, is the change that occurs as a result of assimilation and accommodation of new learning.

Mr. T lived with his roommate Mr. S for 10 years before his death last month. Mr. T was allowed off work only for the memorial service. His coworkers are unaware of the situation and Mr. S's family will not acknowledge him as part of the family and have barred him from the private funeral service. Which type of grief would the nurse identify Mr. T is experiencing? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief.

1 Disenfranchised grief is encountered when a loss is experienced and cannot be openly acknowledged, socially sanctioned or publicly shared. Usually the survivor is not recognized by employers for time off for funeral or memorial services. They may not be recognized by the biological family members and excluded from rites, rituals and traditions for loss ELNEC teaching supplement types of grief.

The nurse would recommend which one of the following toys to the parents of a 34-month-old child? 1) Tricycle 2) Marbles 3) Skateboard 4) Remote control airplane

1 Gross motor skills of the child who is approaching 3 years of age include climbing, walking up and down stairs unassisted, running easily, bending over without falling, peddling a tricycle, and kicking a ball. This makes the tricycle the toy of choice.

Your client is female, 14-years-old, well developed, and sexually active. She states that she is popular and has been dating a 16-year-old boy for the past year. She tells you that her period is late and that she is not using any contraceptives because her boyfriend doesn't approve of them. Which of the following nursing diagnoses would be most appropriate? 1) Ineffective health maintenance 2) Ineffective individual coping 3) Risk for infection 4) Delayed growth and development

1 Ineffective health maintenance is the inability to identify, manage, and/or seek out help to maintain health.

In the early stages of hypertension, the patient usually has: 1) No symptoms. 2) Mild discomfort associated with increased heart rate. 3) Headaches in the frontal region. 4) Vague feelings of physical discomfort.

1 Lewis, p. 766: HTN is often called the "silent killer" because it is frequently asymptomatic until it becomes severe and target organ damage has already occurred.

A patient is on the DASH (Dietary Approaches to Stop Hypertension) diet and he tells the nurse what he consumed for lunch. Which item on his menu indicates that he is nonadherent to his diet and needs further teaching? 1) Canned vegetables. 2) Two slices of white toast with jelly. 3) One cup of low-fat yogurt. 4) One cup of coffee.

1 Lewis: p. 770 and 834: The DASH eating plan requires that the patient with HTN restrict sodium to 2.4 g per day. ½ cup of canned vegetables can have between 140 and 460 mg of sodium. 8 oz. of coffee has 5 mg of sodium. 6 oz of fat-free yogurt has about 85 mg of sodium. 2 tablespoons of Jelly contain 5 mg of sodium. One slice of whole wheat bread is about 149 mg. of sodium.

The most meaningful intervention provided by the nurse for a patient with a terminal illness is: 1) The nurse's presence; just being with the patient. 2) Minimizing losses due to isolation and loss of control. 3) Encourage health promoting strategies for strength. 4) Devise strategies to work through suffering and loss.

1 Presence validates one' existence amidst the experience of suffering p. 218.

The mother of a stillborn may experience which type of grief? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief.

1 Society may not acknowledge a relationship between the mother and a child who experienced death prior to birth. ELNEC supplement types of grief.

Which of the following sleep-related changes is seen in the older adult? 1) decreased sleep efficiency. 2) increased slow-wave sleep. 3) increased stage 4 sleep. 4) decreased nocturnal awakenings.

1 Studies have shown the elder spend more time in bed but less time asleep. They spend less time in REM and slow wave sleep and often take naps.

When interacting with a patient, the nurse answers, "I am sure everything will be alright. You have nothing to worry about". This is an example of which of the following inappropriate communication techniques? 1) Cliché 2) Giving advice 3) Being judgmental 4) Changing the subject

1 Telling a patient everything is going to be alright is a cliché. The use of this statement is giving false assurance. The use of clichés gives the patient the impression that the nurse is not interested in the patient's condition.

You have taught a client about the use of a continuous positive airway pressure (CPAP) mask for obstructive sleep apnea. Which client statement shows that the client understands your teaching? 1) "I will need to use CPAP every night for the rest of my life unless I elect to have surgery". 2) "The CPAP will prepare me for the surgery". 3) "I will use the CPAP when my symptoms are bad". 4) "I will take a tranquilizer because it will help me relax during the treatment".

1 The client using a CPAP mask to manage sleep apnea needs to understand that the underlying disease will recur if the apparatus is not used, even for short periods of time.

Your client is a 12-year-old boy who weighs 175 pounds. What would be an appropriate nursing diagnosis? 1) Ineffective health maintenance 2) Impaired parenting 3) Delayed growth and development 4) Ineffective family coping

1 The diagnosis of Ineffective health maintenance is directly related to growth and development. Positive health practices help ensure that growth and development proceed normally. Family health practices may place a child at risk for growing up unhealthy or experiencing specific illness or health care problems.

Evaluation involves the nurse reassessing the client to determine if outcomes were achieved. The outcome was achieved in which of the following examples? 1) The client reports performing breast self-examination. 2) The client identifies an exacerbation of symptoms during a follow-up visit. 3) The client maintains his weight in the first month of a reduced-calorie nutritional program. 4) The client is unable to verbalize the implications of not following the prescribed treatment.

1 The outcome is achieved. The client reports participation in an activity that increases health promotion to obtain optimal health. B. The outcome was not achieved since the client returns with an exacerbation of symptoms. The nurse must reassess the client to determine what factors have prevented his or her progress. C. The outcome was not achieved since the client has not lost weight. The nurse must reassess the client to determine what factors have prevented his progress. D. The client has a knowledge deficit regarding his prescribed treatment. The nurse must reassess the client to determine what factors have prevented his or her progress. The client has not achieved the outcome since he or she cannot verbalize what will happen if he or she does not follow prescribed treatment.

A client who is taking metoprolol (Lopressor) says, "My brother-in-law takes Inderal for his heart condition. I have high blood pressure, but I don't think anything is wrong with my heart". What is the best nursing response to his statement? 1) "Lopressor is used for high blood pressure as well as for several heart conditions". 2) "If you have questions about your medication, I recommend that you talk to your doctor". 3) "A heart condition is exactly what is causing your high blood pressure". 4) "Your brother-in-law must be confused. This drug is not used to treat heart disease".

1 The point in this question is to find out how the nurse would respond to a client's indirect inquery. First of all, lopressor is used to treat HTN as well as other heart diseases (angina, arrhythmias, etc.). The student will find this information in their drug book. Therefore, "D" is the wrong answer. "C" is the wrong answer because HTN is not always caused by a heart condition. It can be caused by a renal, endocrine or neurological condition or can be caused by other medications (Lewis, p. 765). "B" is the wrong answer because the client is depending on the nurse to give him information about the drug. Telling the patient to call the doctor for such a simple piece of information is inappropriate.

The parent of your preschool-aged client is concerned that the client is sleeping too much. The client sleeps approximately 11 hours a day. The child has no known physical or psychological problems. Which of the following is the correct response to the parent? 1) "There is no reason to be concerned. It is normal for preschool-aged children to sleep approximately 11 hours each day." 2) "Your child will need further evaluation. It is unusual for preschool-aged children to sleep that much during a 24-hour period." 3) "Are you sleeping about the same amount? If so, your child is picking up sleep patterns from you." 4) "You need to keep a sleep diary and return in a week. I will then have data to help analyze the cause of your child's excessive sleep."

1 The preschool-aged child sleeps approximately 11 hours per day.

Which of the following best describes the therapeutic nurse-client relationship? 1) It is a personal, client-focused, and aimed at realizing mutually determined goals. 2) A sharing of personal feelings, beliefs, and opinions occurs in a relationship that is reciprocal in nature. 3) An infinite range of nonspecific helping activities is undertaken by the nurse, reducing overall client stress. 4) The nurse interjects her professional medical expertise and, as a favorable outcome, receives more satisfaction than the client.

1 The therapeutic relationship is personal, client-focused, and armed at realizing mutually determined goals. B. These are elements of a social relationship. C. Nonspecific helping activities relate to a social relationship. Nursing activities (interventions) are clearly defined based on client needs. D. Social helping may give the nurse more satisfaction from the interaction than the person being helped, whereas the help provided in the therapeutic relationship is the main reason it exists; it is client-focused and has a specific purpose.

Which one of the following health risks is usually not associated with android obesity? 1) Osteoporosis 2) Diabetes 3) Breast cancer 4) Heart disease

1 Those people who have an obese body shape like an apple (android obesity), their health risks are heart disease, diabetes, breast and endometrial cancer. Those who possess gynoid obesity (pear-shaped obesity) have health risks of osteoporosis, varicose veins, cellulite, subcutaneous fat traps that store dietary fat, and trapped fatty acids that are stored as triglycerides.

The nurse documents that a toddler is engaging in the expected type of play according to age if the nature of the toddler's play is: 1) parallel. 2) interactive. 3) socialized. 4) shared.

1 Toddlers enjoy playing near others but frequently do not share objects or engage in close interactive activities with other children. In parallel play, toddlers play beside, but not with, their friends.

Which of the following drugs may be related to hearing loss? 1) All of the above. 2) Erythromycin. 3) ASA 4) Loop Diuretics.

1 p. 1041 Harkreader - Aminoglycoside antibiotics and furosemide are ototoxic. Aspirin can cause ringing in the ears.

The need to reach one's potential through full development of one's unique capability is known as which of the following? Self-actualization Self-concept Self-esteem Ideal self

1 p. 1493. The need for self-actualization is the need to reach one's potential through full development of one's unique capability. On the other end of the spectrum are identity diffusion and depersonalization.

Which of the following questions would provide the healthcare worker with the information needed first when assessing self-concept? How would you describe yourself to others? Do you like yourself? What do you see yourself doing 5 years from now? What are some of your personal strengths?

1 p. 1501. When assessing self-concept, the information needed first is the patient's description of self. Personal identity describes an individual's conscious sense of who he or she is. "How would you describe yourself to others?". Look for personal characteristics and traits, strengths, and fears.

Which of the following nursing diagnoses lacks a self-concept disturbance etiology? Self-Care Deficit related to dysfunctional grieving Noncompliance related to low self-esteem Post trauma response related to disturbance in personal identity Altered Health Maintenance related to altered role performance

1 p. 1505. Because disturbances in self-concept have the potential to affect so many other arenas of human functioning, they may serve as etiologies for numerous problem statements. When assessment data point to an alteration in self-concept the first task is to determine whether the altered self-concept is the problem, the cause of the problem (etiology), or merely a sign that a problem exists. Self-concept date seem to fit well in all three categories. It is important that an accurate determination be made because this directs the outcomes developed for the patient and related nursing interventions.

Which of the following describes the change that takes place as a result of a response to a stressor? 1) Adaptation 2) Stress 3) Defense mechanism 4) Anxiety

1 p. 1522. Adaptation is a change that takes place as a result of the response to a stressor. Adaptation is an ongoing process as a person strives to maintain balance in his or her internal and external environments. It occurs in families and groups and is necessary for normal growth and development. It is also needed to be able to tolerate changing situations, and have the ability to respond to physical and emotional stressors.

Which of the following statements concerning interactions with basic human needs is accurate? 1) As a person strives to meet basic human needs at each level, stress can serve as either a stimulus or barrier. 2) Basic human needs and responses to stress are generalized. 3) Basic human needs and responses to stress are unaffected by socio-cultural backgrounds, priorities, and past experiences. 4) Stress affects all people in their attainment of basic human needs in the same manner

1 p. 1527-1528 and box 42-3. Basic needs are common to all people. As a person strives to meet basic human needs at teach level, stress can be either a stimulus or a barrier. In all people, a failure to meet needs results in an imbalance in homeostatic mechanisms and eventually, illness. The effects of stress on the love/belonging need can result in an individual becoming: withdrawn and isolated, blames others for own faults, demonstrates aggressive behaviors, and becomes overly dependent on others.

A toddler going through potty training can be a stressful time for both parents and the child. This type of stress is considered: 1) Developmental stress 2) Situational stress 3) Crisis 4) Long-term stress

1 p. 1530 developmental stress occurs as a person progresses through the normal stags of growth and development from birth to old age. Within each state, certain tasks must be achieved to resolve the crisis and reduce the stress. Examples associated with developmental stress include: the infant learning to trust others, the toddler learning to control elimination, the school-aged child socializing with peers, the adolescent striving for independence, the middle aged adult accepting physical signs of aging, the older adult reflecting on past life experiences with satisfaction.

In which religion do common therapeutic measures include sucking, blowing, and drawing out with a feather fan? 1) Native American religion 2) Islam 3) Baha'i International Community 4) Roman Catholicism

1 p. 1650, table 46-1. Rituals mark important life changes: birth, puberty, initiation rites, death, medicine men and women have specialized spirits form whom they receive the mission to cure, common therapeutic measures include sucking, blowing, and drawing out with a feather fan.

A man with a terminal illness cannot accept his eventual death and asks you "what kind of God are you?" He is most likely experiencing what kind of spiritual distress? 1) Spiritual anger 2) Spiritual despair 3) Spiritual alienation 4) Spiritual loss

1 p. 1661. Inability to accept illness

An African American patient complains of gas after eating a bedtime snack of cheese and crackers. This may be a symptom of which of the following conditions? 1) Lactose intolerance 2) Keloid formation 3) Thalassemia 4) G6PD deficiency

1 p. 27. Various studies have shown that certain racial and ethnic groups are more prone to developing specific diseases and conditions. Common health problems among African Americans include hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids.

In which of the following ethnic groups would folk-healing practices and home remedies be used by some families for particular illnesses? 1) African American 2) White middle class 3) Asian 4) Jewish descent

1 p. 34, box 2-5. African Americans may still use various folk healing practices and home remedies for treating particular illnesses. This varies extensively and may include spiritualists, herb doctors, root doctors, conjurers, skilled elder family members, voodoo, and faith healing.

You respond to an approaching examination with a rapidly beating heart and shaking hands and the urge to go on a long run. This is the result of what type of response? 1) Coping mechanism 2) Stress adaptation 3) Defense mechanism 4) Withdrawal behavior

1 p.1527. Anxiety is often managed without conscious thought through coping mechanisms. Coping mechanisms are behaviors used to decrease stress and anxiety. Coping behaviors may have a positive or negative affect on health. Typical coping behaviors include: crying, laughing, sleeping, cursing, physical activity, exercise, smoking drinking, lack of eye contact, withdrawal, limiting relationships to those with similar values and interests.

Which of the following phrases best illustrates the panic level of anxiety? 1) Loss of control and rational thought 2) Increased alertness and motivated learning 3) Narrow focus on specific detail 4) Narrow perception field

1 p.1527. Panic causes the person to lose control and experience dread and terror. This results in a disorganized state characterized by increased physical activity, distorted perception of evens, and loss of rational thought.

In which of the following religions are women not allowed to make independent decisions and husbands must be present when consent is sought? 1) Islam 2) Judaism 3) Roman Catholicism 4) Protestantism

1 p.1650, table 46-1. Some Muslim women are not allowed to make independent decisions; husbands may need to be present when consent is sought.

Which of the following should you do to optimize sleep and address elimination needs for a client diagnosed with nocturnal enuresis? 1) restrict fluids in the evening hours. 2) put a diaper on the client. 3) prepare a "floor bed" as close to the bathroom as possible. 4) keep a light on to illuminate the path to the bathroom.

1 Treatment for nocturnal enuresis include low doses of tricyclic antidepressants, behavioral techniques such as bladder training or the use of a pad and buzzer, and fluid restriction in the evening.

A nurse caring for a patient who is in pain following abdominal surgery investigates the use of CAT for pain. Which of the following modalities could be used to relieve this patient's pain? Select all that apply 1) massage 2) acupuncture 3) guided imagery 4) Ayurveda 5) yoga 6) Shamanism

1, 2, 3

Which of the following populations are more inclined to use CAT? Select all that apply. 1) women 2) adults aged 20 to 30 3) people living in the east 4) former smokers 5) adults who are poor 6) adults with higher levels of education

1, 4, 6 A, D, F; "CAT use was more prevalent among women, adults aged 30-69, adults with higher levels of education, adults who were not poor, adults living in the West, former smokers, and adults who were hospitalized in the last year."

A client is admitted to the intensive care unit with a myocardial infarction. When taking a sleep history, you learn that the client's loud snoring often awakens the partner and that the client frequently experiences unrefreshing sleep. These findings suggest that the client has which of the following? 1) narcolepsy. 2) obstructive sleep apnea. 3) sleep deprivation. 4) REM sleep.

2

A nurse is providing care based on Maslow's hierarchy of basic human needs. For which of the following nursing activities is this approach useful? 1) Making accurate nursing diagnoses. 2) Establishing priorities of care. 3) Communicating concerns more concisely. 4) Integrating science into nursing care.

2

An annoying side effect of ACE inhibitors that may be minimized by switching to an angiotensin receptor blocking agent includes: 1) Orthostatic hypotension. 2) A dry, nonproductive cough. 3) Fatigue. 4) Hypokalemia.

2

For a client medically diagnosed with primary hypertension and with a nursing diagnosis of "ineffective management of therapeutic regimen", the nurse is alert to which one of the following signs and symptoms? 1) Pulse of 90 beats per minute. 2) Systolic BP of 142. 3) Moist mucous membranes. 4) Capillary refill of < 3 seconds.

2

How often should the nurse assess a client who is at high risk for disuse syndrome? 1) Daily 2) 1-2 hours 3) 2-4 hours 4) 4-6 hours

2

In which religion are members encouraged to obtain health care provided by members of the black community? 1) Baha'i International Community 2) American Muslim Mission 3) Native American religion 4) Islam

2

Kyphosis is: 1) an abnormal condition of the legs and trunk characterized by numbness or impaired sensation. 2) an abnormal condition of the vertebral column characterized by increased convexity in the thoracic spine when viewed from the side. 3) an abnormal condition of the vertebral column characterized by an inward (forward) curvature of the lumbar spine when viewed from the side. 4) an abnormal condition of the vertebral column characterized by lateral deviation of the thoracic spine when viewed from the back.

2

A community provides safe playgrounds for the children. This is an example of which determinant of population health? 1) Biology. 2) Physical Environment. 3) Social Environment. 4) Behaviors.

2 A. Biology refers to the genetic makeup, family history, and the physical and mental health problems acquired during life. An example of a family history or genetic risk factor would be diabetes mellitus, since it can be inherited. B. The physical environment is that which can be seen, touched, heard, smelled, or tasted, and other less tangible elements, such as radiation or ozone. A safe playground is an example of a physical environment. C. The social environment includes interactions with family, friends, co-workers, and others in the community. Affected by intellectual factors, an example would be the community's health status being influenced by the knowledge of its citizens. D. Behaviors are individual responses or reactions to internal stimuli and external conditions. Lifestyle choices are included here, and an example would be families choosing a healthy diet.

"Quad setting" exercises are known as: 1) isotonic. 2) isometric. 3) isokinetic. 4) isobionic.

2 "Quad setting" exercise is a type of isometric exercise in which the muscle tension increases by applying pressure against a stable resistance and involves no joint movement. Isotonic exercise is one in which the muscle contracts and moves. Isokinetic exercise is a type of isotonic exercise, if the exercise is dynamic and performed at a constant velocity. There is no such thing as an isobionic exercise.

Which of the following is the definition of hypoxemia? 1) Low oxygen level in the body tissue. 2) Low oxygen level in the blood. 3) The retention of carbon dioxide in the blood. 4) The retention of carbon dioxide in the body tissue.

2 (Harkreader, p. 896: hypoxemia is deficient oxygenation of the blood). Hypercapnia is high carbon dioxide level(retention) in the blood; hypoxia refers to inadequate oxygenation at the level of body tissues. I don't think there is a term for high levels of CO2 in the body tissue.

The nurse knows that the type of fire extinguisher used for type D fires involving combustible metals and certain other metals is the: 1) Foam extinguisher. 2) Dry powder extinguisher. 3) Multipurpose extinguisher. 4) Water pump extinguisher.

2 A. The foam extinguisher is used for type B fires involving flammable liquids, such as cooking oil and grease. B. The dry powder extinguisher is used for type D fires that involve combustible metals and certain other metals. C. The multipurpose extinguisher is used for all fires except type D fires involving combustible metals and certain other metals.

Which of the following nursing interventions would be the most likely one to maintain an effective airway in the patient: 1) Restrict fluids to 1 L/day. 2) Cough and deep breathe every 1-2 hours. 3) Minimize use of opioid analgesics. 4) Restrict activities.

2 (Harkreader, p. 922; a cough serves a protective function by clearing the airway of irritants and secretions. The client must be able to manage deep inspirations before the cough to increase the lung volume and widen the airways, allowing air to get behind mucus and propel it upward. Restricting fluids will cause the mucus to become dry and difficult to expel. If a patient is in pain, then he/she cannot be expected to cough and expel mucus. Maximizing the use of analgesics will facilitate an effective airway. Restricting activities will not help mobilize secretions. Encouraging the client to follow recommended activity level will help in mobilizing secretions.

The nurse would select which of the following nursing diagnoses as having the highest priority for a client with narcolepsy? 1) Self-care deficit. 2) Risk for injury. 3) Disturbed thought processes. 4) Insomnia.

2 A patient with primary sleep disorder is a high risk for injury. Two-thirds of narcoleptics have fallen asleep while driving and 80% have fallen asleep while at work.

Which of the following is defined as housing for older people with low or moderate income? 1) Board and care home 2) Housing for aging and disabled individuals 3) Nursing home 4) Subacute care facility

2 A. A board and care home is a group living arrangement that provides help with activities of daily living for those who cannot live on their own, but do not need nursing home care. B. Housing for older people with low or moderate income is called housing for aging and disabled individuals. Sponsored by the federal government and most states, residents usually live in their own apartment complex and receive assistance with meals and other activities. C. A nursing home is the traditional long term care facility for the elderly. Rooms are usually semiprivate and skilled nursing care for recovery from an acute illness or custodial care is provided. D. A subacute care facility is an inpatient facility for a client whose physical/medical condition does not warrant the intensive care of a hospital, but requires ongoing nursing needs for an unstable medical condition.

The nurse asks the client, "What has bothered you most about being sick?" With this question, the nurse is assessing which component of spirituality? 1) The client's religious practices. 2) The client's perception of the relationship between spiritual beliefs and health. 3) The client's beliefs, values, and concept of God or Divine Being. 4) The client's source of hope and strength.

2 A. Assessment of client's religious practices would include important religious practices, whether illness has made a difference in prayer or religious practice, and what religious books or symbols are helpful to the client. B. This is one aspect of the assessment of the client's perception of the relationship between spiritual beliefs and health. Included in this component would be assessing why the client feels illness has occurred and whether the illness has made any difference in feelings about God or faith practice. C. Assessment of the client's beliefs, values and concept of God or Divine Being include whether religion or God are significant, if prayer is helpful, and how the client describes God or objects of worship. D. Assessment of the client's source of hope and strength include what is most important to the client, to whom the client turns for help, and what the client's source of strength and hope is.

Which of the following most accurately describes ethnocentrism? 1) Recognizing the values and beliefs of both your client and yourself. 2) Believing that your own ethnic beliefs, customs, and attitudes are the correct and superior ones. 3) Assuming that an attribute present in some group members is present in all group members. 4) Actively seeking to understand other peoples.

2 A. Awareness includes recognition of your client's values and beliefs as well as your own, requiring you to clarify your own values and actively seek to understand and appreciate the values of others. B. Ethnocentrism is the belief that one's own ethnic beliefs, customs, and attitudes are the correct and thus superior ones. C. Stereotyping is the assumption that an attribute present in some members of a group is present throughout the group. D. Cultural competence is possessing sufficient knowledge of cultural groups different from your own to be able to interact in a manner that makes that person feel respected and understood. This requires an attitude that appreciates differences as a prerequisite to seeing strengths of a client with different values, beliefs, and behaviors.

The self-discovery process that allows a client to develop self-awareness related to attitudes and beliefs about lifestyle habits is called: 1) education. 2) counseling. 3) values clarification. 4) health-seeking behaviors.

2 A. Education is the process of providing the client with the knowledge to make a decision. B. Counseling is a method of communication that actively involves the client in recognizing personal risk factors and managing necessary behavioral changes. The client is guided through decision-making rather than merely being provided knowledge to make a decision. C. Values clarification is a self-discovery process that allows a person to find answers to situations or arrive at freely chosen values. D. Health-seeking behaviors is a health maintenance nursing diagnosis that is appropriately used when a well person is seeking ways to achieve a higher level of wellness.

Which of the following is a leading cause of death for adults younger than age 25 years? 1) Heart disease 2) Suicide 3) Cancer 4) Eating disorders

2 A. For adults 25 to 44 years of age, unintentional injuries, cancer, and heart disease are the leading causes of death. B. Unintentional injuries, suicide, and homicide are the leading causes of death in this age group. C. For adults 25 to 44 years of age, unintentional injuries, cancer, and heart disease are the leading causes of death. D. Anorexia nervosa and similar disorders are linked to a greater risk of early death from complications, but it is not the leading cause of death in this age group.

Which of the following statements about bulimia would the nurse include when teaching parents about possible disorders encountered in adolescence? 1) Individuals with bulimia are extremely underweight. 2) Bulimia is characterized by binging and purging. 3) The average age of onset for bulimia is early adolescence. 4) Individuals with bulimia usually exercise compulsively.

2 A. Girls with bulimia may experience mild weight loss or gain, but often have a stable weight. B. Bulimia nervosa is a disorder characterized by binge eating coupled with purging via emetics, laxatives, or self-induced vomiting. C. Bulimia nervosa has a slightly older age of onset, with college-age women more likely to present with the disorder than girls of high-school age or younger. D. Individuals with anorexia nervosa may exercise compulsively to work off food that was eaten.

Which of the following concerns would be considered part of the normal aging? 1) A decrease in intelligence 2) Presbyopia 3) Urinary incontinence 4) A decrease in sexuality and sexual interest

2 A. Healthy older adults do not demonstrate a decline in such intellectual abilities as wisdom, judgment, and common sense. There may be a slight gradual decline in short term memory, calculation ability, work fluency, and abstraction beginning at about age 60 years. Older adults can learn new skills, but it may be at a slower pace. B. Presbyopia, a normal function of aging, is a visual change that causes a decrease in accommodation (the ability to focus at various distances), resulting from a loss of flexibility in the lens. There is also a decrease in visual acuity. C. Urinary incontinence is not a part of normal aging. There are several types of urinary incontinence that can be identified through a good assessment of health and drug history. D. Sexuality and interest in sexual intercourse do not necessarily decrease as a person ages; however, physical problems that limit sexual activity do increase.

Which of the following is not a routine precaution for the client with a high risk for falling? 1) Keeping side rails up at all times. 2) Using physical restraints to prevent falls. 3) Assessing the client more frequently. 4) Maintaining the client's scheduled toileting routine.

2 A. If the client has a high risk of falling, the side rails should be raised at all times. B. Physical restraints are used only for the client's safety after other avenues of protecting the client have been pursued and their ineffectiveness has been documented. C. The client with a high risk of falling should be assessed more frequently.

Nursing theorists have long recognized the importance of spirituality. The theorist Watson stated that: 1) In a state of absolute consciousness, a person is aware of a unity that includes but is greater than the self. 2) The abstract spiritual concepts of soul, spirit, and transcendence explain the nature of a person and the goals of nursing. 3) There is no conflict between the spiritual and material dimensions of the self. 4) Human nature is rooted in connectedness to the absolute truth of the creator.

2 A. Newman said that a person who is in a state of absolute consciousness is aware of a unity that includes but is not greater than the self. B. Watson felt the abstract spiritual concepts of soul, spirit, and transcendence explained the nature of a person and the goals of nursing. C. Paterson and Zderad state that there is conflict between the spiritual and material dimensions of the self. D. Roy felt that human nature is rooted in connectedness to the absolute truth of the creator.

Which of the following contributing or related factors is included in the nursing diagnosis of Deficient Knowledge? 1) Side effect of therapy 2) Lack of recall 3) Risk versus benefit of therapy 4) Anticipated role change

2 A. Side effect of therapy is a related factor for the nursing diagnosis Noncompliance. B. Lack of recall is a related factor for the nursing diagnosis Deficient knowledge. C. Risk versus benefit of therapy is a related factor for the nursing diagnosis Decisional conflict. D. Anticipated role change (such as marriage, parenthood, or retirement) is a related factor for the nursing diagnosis Health-seeking behaviors (a wellness diagnosis).

In caring for a client who believes in spiritual or ritual healing, the nurse knows that: 1) Very few cultures believe in spiritual or ritual healing. 2) Many rituals are based on a supernatural explanation for disease. 3) This form of religious belief should be discouraged. 4) Spiritual or ritual healing does not cause overt harm.

2 A. Spiritual and ritual healings have been documented in nearly all cultures throughout history. B. Many rituals are based on a supernatural explanation for disease. These practices often use the elicitation of a state of ecstasy or altered state of consciousness to communicate with spiritual forces for the healing of the individual or community. C. It is important that nurses do not impose their own beliefs regarding spirituality on clients, either by encouraging a spiritual practice of the nurse or by prohibiting one that is not congruent with the nurse's beliefs. D. In some cases these practices may cause overt harm or delay appropriate medical treatment.

Many aspects of community health assessment are also included in individual and family health assessments. Which of the following is unique to community health assessment? 1) Spiritual assessment. 2) Social planning assessment. 3) Physical assessment. 4) Emotional assessment.

2 A. Spiritual assessment is included in individual, family, and community health assessments. B. Social planning practices of the community are evaluated using principles of population health. This is unique to community health assessment and includes such issues as a safe environment and affordable housing. C. Physical assessment is included in individual, family, and community health assessments. D. Emotional assessment is included in individual, family, and community health assessments.

The nurse is providing health instruction at a local Parent Teacher Association meeting. Which of the following would be presented as a leading cause of death for adolescents? 1) Substance abuse. 2) Suicide. 3) Sexually transmitted diseases. 4) Eating disorders.

2 A. Substance abuse is a primary risk factor for altered growth and development. It is a cofactor in the most common causes of death for adolescents, but it is not a leading cause of adolescent mortality. B. Suicide is reported to be one of the top three causes of death for adolescents, along with unintentional injuries and homicide. C. The sexual behavior of adolescents contributes to morbidity and mortality, but sexually transmitted diseases are not a leading cause of death in this age group. D. Eating disorders are predominant among adolescent girls and may have serious or life-threatening complications. However, eating disorders (anorexia nervosa and bulimia nervosa) are not a leading cause of death for adolescents.

Which of the following is the single most influential factor in increasing the client's participation in the effective management of the therapeutic regime? 1) Waiting for the client to ask questions. 2) Having a good relationship with the health care provider. 3) Identifying problems for the client to solve. 4) Telling the client what to do to solve problems.

2 A. The client may not know what to ask or have enough information to form questions about therapeutic regime. B. The single most influential factor in increasing the client's participation in effective management of a therapeutic regime is having a good relationship with the health care provider. C. The client is the major role-player in identifying and clarifying any problems to be solved regarding the therapeutic regime. D. Do not tell the client what to do to solve problems. Assist and guide the client with the problem-solving process regarding the effective management of the therapeutic regime.

When assessing the health of the older adult, the nurse knows which of the following to be helpful? 1) Older adults are objective when reporting their symptoms. 2) The assessment should start with the older adult's self-perception of health status. 3) Older adults tend to rely on public transportation when they can no longer able to drive. 4) The older adult's physician is the most reliable source of their medication history.

2 A. The nurse should consider that older adults may under report symptoms, thinking that their symptoms are part of normal aging and having a desire to make the physical and mental changes of aging. B. The health history should begin with asking the older adult to describe their health; for example, in their opinion, it is poor, good, or excellent. C. An elderly person may stop attending social functions rather than admit to not being able to drive. D. It is best to have the client bring in prescription bottles to look at the labeled containers to confirm drug name, dosage, and schedule. It may be possible that medications have been ordered by more than one physician and there may be medication incompatibilities. Encourage clients to talk about their prescriptions, including any over-the-counter medications they take.

Which of the following phases of the therapeutic relationship focuses on the completion of nursing interventions that address expected outcomes? 1) Termination phase. 2) Working phase. 3) Orientation phase. 4) Rapport phase.

2 A. The termination phase occurs near the end of the relationship when the work of the client and nurse is coming to a close. B. While the intervention and outcomes are addressed, information is presented and assistance is rendered to the client by helping them validate and clarify their understanding. C. In this phase a foundation is established with the client addressing such core issues as trust, personal feelings, and working boundaries. D. There is no specific rapport phase identified, therapeutic rapport is a special bond existing between nurse and client who have established trust and a mutual understanding of the course of the relationship.

Middle-aged adults are commonly referred to as the sandwich generation. This refers to the fact that they are caught between: 1) Responsibilities of family and career. 2) Responsibilities of children and career and frail parents. 3) Responsibilities of marriage and career. 4) Responsibilities of marriage and childrearing.

2 A. This is incorrect. B. Middle-aged adults are caught between the needs of caring for ill or frail parents while handling the competing demands of children and employment. Responsibility to their parents may range from financial support of retired parent to the physical care of a frail, demented, or dependent parent. C. This is incorrect. D. This is incorrect.

Which of the following statements made by an adolescent illustrates the formal operations stage of cognitive development? 1) I won't get into an accident if I drive after I have a few drinks. 2) I didn't study for the test so I probably won't get a good grade. 3) If I spend all of my allowance, my mother will give me more to go to the movies. 4) If I skip school, I'll never get caught.

2 A. This statement is not an illustration of formal operations. It illustrates egocentrism, with a belief that the adolescent is so special that no harm can come to him or her when engaging in an unsafe behavior. B. According to Piaget, the formal operations stage of cognitive development is reached during adolescence. Formal operations indicate the ability to reason abstractly and engage in "if-then" deliberations. This statement indicates an ability to think abstractly and reason logical consequences. C. This statement reflects what Elkind refers to as a personal fable, a belief in uniqueness of self. D. This statement does no illustrate formal operations. It characterizes the cognitive development of a younger child, such as a preschooler, whose thinking is magical and egocentric. These children believe their thoughts are powerful enough to make something happen.

The nurse is caring for a confused client who is attempting to dislodge the IV tube. Which type of restraint would be most appropriate for this client? 1) Wrist restraint. 2) Mitten restraint. 3) Belt restraint. 4) Jacket restraint.

2 A. Wrist restraints secure one or both hands. Although also used to prevent dislodgement of tubes and dressing, they are more restrictive than mitten restraints. B. The nurse should always choose the least restrictive device. Mitten restraints prevent the use of hands while allowing free arm movements. It is useful in preventing the client from dislodging an IV tube, indwelling the urinary catheter, NG tube, or wound dressing.

What therapeutic communication technique directs the client into a specific topic or concern, despite other numerous topics being mentioned? 1) Suggesting collaboration. 2) Focusing. 3) Asking for clarification. 4) Making observations.

2 A. in suggesting collaboration, the nurse offers to work together with the client, with the work focusing at all times on the client. B. Since not all of the client's concerns can be addressed simultaneously, you select a subject to explore further (focusing) and keep the others for future conversation. C. The nurse lets the client know that what was said was unclear. D. Using this technique, you acknowledge that something or someone exists or has changed in some way.

All statements about the understanding of death across the lifespan are true EXCEPT: 1) Children under 2 have a sense of separation but no concept of death. 2) Adolescence are like adults accepting of death but feel it usually happens when you are much older. 3) Ages 2-5 death is seen as transient but not permanent. 4) Middle age is more aware and accepting of dying.

2 Adolescents are similar to adults -they are mortal and will eventually die-but death is considered a future even and death anxiety is more evident than at earlier ages. p 202.

A newborn infant is able to use which sense to seek out its mother from birth? 1) Sight 2) Smell 3) Touch 4) All of the above

2 An infant can smell as soon as the mucus is cleared from the nose at birth and can be seen turning the head as the infant smells mother's milk.

Mrs. S has been a widow for 22 years and moved to America to live with her 22 year old son whom she is very attached to. Then one day her son dies suddenly in a car accident. Eight months later she has become more reclusive, not eating or sleeping well, and has developed physical ailments. Which type of grief would the nurse identify Mrs. S is experiencing? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief.

2 Complicated grief includes delayed grief that manifests in reactions that are suppressed or postponed. The survivor consciously or unconsciously avoids the pain of the loss. P 215/ and ELNEC teaching supplement types of grief.

Your client tells you that the client's children finally understand that glasses of different shapes can hold the same amount of milk. This is an illustration of which concept? 1) Decentering accommodation 2) Conservation 3) Concrete operations 4) Formal operations

2 Conservation is the ability to understand that changing the shape of a substance or container does not change its volume. Question 14

You are discussing safety issues with an adolescent client. The response you get is, "I know people have accidents from driving fast, but I have no fear." This is an example of which hallmark of adolescent cognitive development? 1) Feelings of superiority 2) Egocentrism 3) Formal operations 4) Conservation

2 Egocentrism refers to the tendency to spend so much time thinking about and focusing on your own thoughts and changes in your own body that you come to believe that others are focused on them as well. Some types of "typical" adolescent beliefs result from this type of thinking, such as "Other people will die, but not me."

The Palliative Care Nurse recognizes shock, protest, despair, and completion as processes of the phases of bereavement attached to which theorist's model? 1) Rando. 2) Bowlby. 3) Engel. 4) Kubler-Ross.

2 His theory is based on the Attachment Model (in which the child must separate from the mother). Numbness is the shock related to the loss, Yearning and Searching is the protest in an attempt to regain the loss, Disorganization and despair the individual feels trying to regain the lost object, and Reorganization when the mourning is complete and the individual stops searching and develops new relationships. P. 204.

Orthostatic hypotension is a rise in systolic blood pressure of 20 mmHg or more and a drop in diastolic blood pressure or more for 1 to 2 minutes after a client stands up. 1) True 2) False

2 Orthostatic hypotension is a drop in systolic blood pressure.

Which of the following consists of actions that minimize the effects of a permanent, irreversible disease or disability through interventions directed at preventing complication and deterioration? 1) Primary health care. 2) Tertiary prevention. 3) Secondary prevention. 4) Health promotion.

2 Primary health care focuses on prevention and health promotion, but with a much broader perspective than just medical and nursing care. B. Tertiary prevention involves minimizing the effects of a permanent, irreversible disease or disability through interventions directed at preventing complication and deterioration. C. Secondary prevention actions focus on the early diagnosis and prompt treatment of illnesses and the prevention of further complications. D. Health promotion consists of educational, political, organizational, regulatory, and environmental supports for actions and conditions of living that are conducive to the health of individuals, families, and communities.

When assessing a child's spiritual dimension, a nurse should be aware of which of the following basic tenets? 1) Children do not have a definite perception of God 2) Children attribute to God tremendous and expansive power 3) Children do no experience spiritual distress 4) Children view God as a person with divine powers

2 Spirituality has to do with the nonmaterial realm of being, a child must have some capacity for abstract thought before he or she can begin to understand the spiritual self. Central themes in all the children's descriptions include: notion of a god who works thought human intimacy and the interconnectedness of lives, believe that God is involved in self-change and growth and transformations that make the world fresh, alive and meaningful, attributing to God tremendous and expansive power and then showing considerable anxiety in the face of this power, image of light.

Mr. Smith, who has had several mild heart attacks in the past, has been asked by his neighbor, Mr. Jones, to take a 2-mile evening walk with him. During the exercise session, Mr. Smith finds that as he tries to stay with Mr. Jones's walking pace, he is breathing faster and heavier than usual. He begins to have chest pain. The most appropriate nursing diagnosis for Mr. Smith's problem is: 1) impaired physical mobility. 2) activity intolerance. 3) disuse syndrome. 4) ineffective breathing pattern.

2 The definition for activity intolerance is: a psychological energy to endure or complete a prescribed or desired activity. Pain is one of the defining characteristics. Physiologically, the client's heart may be using oxygen faster than it can be delivered to this organ. Thus, the reason for the chest pain. The answer would not be ineffective breathing pattern because with increased levels of dynamic exercises, the normal response by the respiratory system is an increase in respiratory rate and depth (this is effective and not a problem). This change is necessary to deliver more oxygen to the alveoli, so that there is an increase in the capillary/alveoli exchange of gases (oxygen and carbon dioxide). More oxygen is needed since more muscles and energy is being used for the fast-paced walk (as compared to lying down, sitting, standing, or a slow-paced walk). The definition for impaired physical mobility is: when a client has limited ability to physically move. The answer is not disuse syndrome (unable to perform activities of daily living, evidence of skin breakdown, etc.).

Which of the following is the most appropriate diagnosis for an obese 10-month-old infant who is unable to sit without support? 1) Deficient knowledge related to inability to sit. 2) Altered growth and development related to effects of infant obesity. 3) Ineffective health maintenance related to lack of knowledge. 4) Ineffective health maintenance related to lack of motivation.

2 The diagnosis Altered growth and development is appropriate when an infant or toddler has delay or difficulty in performing skills typical of the child's age group, or when there is altered physical growth (weight or height).

The nurse uses which of the following to provide baseline data about whether a toddler's growth and development are proceeding normally? 1) Parent's opinion 2) Physical examination 3) Speech only

2 The nurse uses the health history and the physical examination to measure whether the toddler is developing normally.

When the nurse encourages the bereaved to express feelings related to the loss, which task of bereavement does that fall under? 1) Accepting the reality of the loss. 2) Experiencing the pain of grief. 3) Adjusting to life without them. 4) Reinvesting energy into life.

2 The process of working through the loss emotionally and cognitively. p. 219.

Which of these comments does the nurse make that helps validate the griever's feelings and facilitate normal grief? 1) You had so many years together. You are so lucky. 2) It must be hard to accept that this has happened. 3) At least their suffering is over and they are in a better place. 4) I can imagine how you are feeling.

2 This helps the griever accept the loss and validate their pain. ELNEC supplement Unhelpful and helpful comments.

A widower dependent on her only son spirals into a deep depression after his death. The nurse identifies which type of grief she is experiencing? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief.

2 includes delayed grief that manifests in reactions that are suppressed or postponed-possibly when her husband died. The survivor consciously or unconsciously avoids the pain of the loss especially now with multiple losses with her dependence of the deceased. P. 215/ELNEC supplement types of grief.

When children identify sports figures as their heroes, they are experiencing which of the following aspects of self-concept? Self-knowledge Self-expectations Self-evaluation Self-actualization

2 p. 1495. Expectations for the self flow from various sources. The ideal self-constitutes the self one wants to be. These self-expectations develop unconsciously early in childhood and are based on the image of role models such as parents, other caregiving figures, and public figures.

A child is able to learn self-recognition in which of the following stages of childhood Infancy 18 months 3 years 6 to 7 years

2 p. 1496. Stages in development of the self include: self-awareness (infancy), self-recognition (18 months), self-definition (3 years), and self-concept (6-7 years).

In which of the stages of the GAS does the body attempt to adapt to the stressor? 1) Alarm reactions 2) Resistance 3) Exhaustion 4) Homeostasis

2 p. 1525. After the body perceived a threat and mobilized its resources, the body moves to the stage or resistance and attempts to adapt to the stressor. Vital signs, hormone levels, and energy production return to normal.

Which of the following terms describes anything that pertains to a person's relationship with a nonmaterial life force or higher power? 1) Religion 2) Spirituality 3) Faith 4) Belief

2 p. 1646. Spirituality is best defined as anything that pertains to a person's relationship with a nonmaterial life force or higher power. Whereas one person describes spirituality in terms of coming to know, love, and serve Gone, another speaks of transcending the limits of body and experience a universal energy.

The belief that one's own ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others is best defined as: 1) Ethnicity 2) Ethnocentrism 3) Cultural blindness 4) Cultural assimilation

2 p. 32. Ethnocentrism is describes as the belief that one's own ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others. When health professionals assume that they have the right to make choices and decisions for patients, of hen respond to such an attitude by the dominant culture.

If a patient refuses to allow the nurse to draw blood for a test because he believes blood is the body's life forces and cannot be regenerated, it is likely that he belongs to which of the following ethnic groups? 1) Hispanic-Puerto Rican 2) Asian 3) Hispanic-Mexican 4) African American

2 p. 34, box 2-5. Nursing considerations for a patient of Asian descent include: some members of the Asian cultures may be upset by the drawing of blood for lab tests. They consider blood to be the body's life force, and some do not believe that it can be regenerated.

Which of the best describes the type of health promotion practiced by Hawaiians? 1) One should eat a diet balanced with yin and yang foods and maintain harmony with friends and family 2) Past illness is viewed as part of the whole and there is an emphasis on preventative medicine with treatment using medicinal plants and minerals 3) Proper diet, proper behavior, and exercise in fresh air are prescriptions for maintaining health 4) Illness is seen as preventable; nutrition is important, but not physical activity.

2 p. 35. Hawaiian's view a patient's illness as part of the whole. Hispanics believe God gives health and allows illness for a reason. Treatments use more than 300 medicinal plants and minerals.

Which of the following is the most common response to stress? 1) Anger 2) Anxiety 3) Despair 4) Depression

2 p.1526. Anxiety is the most common human response to stress. Anxiety is a vague, uneasy feeling of discomfort or dread from an often unknown source. Anxiety is experiences at some time by all people and can involve one's body, self-perceptions, and social relationships.

Which of the following are bases of self-esteem as identified by Coppersmith (1967)? Select all that apply. Consequence Significance Competence Importance Capacity Power

2, 3, 6 p. 1495. Coppersmith (1967) identified the four bases of self-esteem as: 1. Significance, 2.Competence, 3. Virtue, and 4. Power

A nurse uses Therapeutic Touch to decrease a postoperative patient's nausea. Which of the following is a principle of this CAT modality? 1) A human being is a closed energy system. 2) A human being is bilaterally asymmetric. 3) Illness is an imbalance in a person's energy field. 4) Humans do not have the ability to transform.

3

An elderly patient with a vision loss may need which of the following? 1) A light that flashes on their telephone or door bell to alert them. 2) Flashing lights to warn of fires. 3) A flashlight for walking at night if they need to go to the bathroom. 4) Speaking to the patient directly, slowly and distinctly.

3

Which of the following is not a complication of acute streptococcal pharyngitis? 1) Rheumatic heart disease. 2) Glomerulonephritis. 3) Asthma. 4) Peritonsillar Abcess.

3

Which one of the following classification of drugs is not used to treat hypertension? 1) Beta blockers. 2) Vasodilators. 3) Antibiotics. 4) Diuretics

3

Which one of the following should the nurse teach the patient about using Phenylephrine (Neo-Synephrine) nasal spray? 1) While on therapy, liver function tests must be monitored periodically. 2) Tell the patient that driving may be dangerous because of the sedative effect of the medication. 3) Tell the patient that using the drug longer than 3 days can cause rebound vasodilation, which can worsen congestion. 4) Inform the patient that hoarseness, change in voice quality and laryngitis are side effects of the medication.

3

You are to give 90 mg. of Inderal. The available dosage strength is a scored 60mg. tablet. What amount will you give? 1) ½ tablets. 2) 1 tablet. 3) 1½ tablets. 4) 2 tablets.

3 1 tablet = 60 mg. ½ tablet = 30 mg. Since the tablet is scored, it is possible to cut the tablet in half. 60 + 30 = 90 mg.

In the African American family, the individual(s) responsible for maintaining and protecting the health of the family members is (are): 1) The primary health care provider. 2) Large family networks. 3) The African American woman. 4) Traditional women healers.

3 A. African Americans may feel alienated by the health care system. Also, with the use of home remedies and folk medicine used by some, they may tend to avoid local hospitals except in extreme emergencies. B. Large family networks provide support, but they are not responsible for maintaining and protecting the health of family members. C. African American women have traditionally been responsible for maintaining and protecting the health of family members. D. Traditional healers are usually women. They are used, but are not responsible for the health of family members.

The nursing planning care for the older adult should be aware of which of the following? 1) Depression is not a major problem in the older adult. 2) Older adults living in the community suffer more often from depression than nursing home residents. 3) The use of multiple drug therapy may contribute to depression. 4) More men than women suffer from depression.

3 A. Although not a normal part of aging, depression is the most common problem in older adults. Estimates claim that anywhere from 10% to 65% of those over the age of 60 years have depressive symptoms at some time during their old age. B. The incidence of depression is higher among nursing home residents than in community dwelling elders. C. The type of drug an adult may be taking, or a number of drugs taken to treat multiple problems, can contribute to depression, For example, several drugs that treat hypertension, heart disease, and insomnia are known to cause depression in some people. D. About 1 in 4 women suffer from depression, whereas 1 in 10 men suffer from depression.

An internal characteristic that increases the client's risk for poisoning is: 1) Peeling paint. 2) Medicines stored in unlocked cabinets. 3) Reduced vision. 4) Chemical contamination of food.

3 A. An external actor associated with the risk of poisoning is one that places the client at risk. Flaking or peeling paint is an example. B. Medicines stored in unlocked cabinets are an external factor associated with the risk for poisoning. C. An internal factor may make clients unable or unwilling to prevent poisoning in the presence of external factors that

In caring for a client from a Chinese culture, the nurse should be aware that the client may: 1) Express his/her opinion when there is a disagreement in treatment options. 2) Display sadness and emotion regarding poor prognosis of the medical diagnosis. 3) Look to the husband and/or elders as the authority in the family structure. 4) Establish lasting relationships with his/her health care provider.

3 A. Chinese Americans may avoid direct conflicts, finding it shameful to express their disagreement. This would cause them to lose face. B. Chinese Americans may suppress displays of negative emotions, such as anger, sadness, worry, and depression. C. Chinese Americans tend to have a hierarchy in the social and family structure, where husbands and elders have authority over wives and children. D.

Health care is the diagnosis and treatment of a disease based on the identification of a specific disorder and its etiology. Etiology is defined as: 1) Genetically transmitted defects. 2) Symptoms reappearing or becoming worse. 3) The cause of the disease. 4) Minimal or disappearing symptoms.

3 A. Genetically transmitted defects are examples of etiologies of disease but are not the definition of etiology. B. Symptoms reappearing or becoming worse are examples of the exacerbations of chronic diseases. C. Etiology is defined as the cause of the disease. D. Minimal or disappearing symptoms are examples of the remissions of chronic diseases.

The nurse must understand that communication difficulties, which arise between people of different cultures, involve more than speaking a different language. These difficulties also occur because: 1) Gestures and body language may carry commonly understood meanings in different cultures. 2) Nonverbal communication leads to increased understanding in all cultures. 3) Maintaining eye contact or smiling may be seen as intrusive or disrespectful to certain clients. 4) Idiomatic language has the same meaning when translated to another language.

3 A. Gestures and body language may carry different commonly understood meanings in different cultures. B. Nonverbal communication can lead to misunderstandings among different cultures. For example, smiling and nodding may mean that the client is trying to please you, not necessarily that you are understood. C. In some cultures, clients may perceive maintaining eye contact or smiling as intrusive, disrespectful, or dismissive. D. Idiomatic language does not have the same meaning when translated into another language. Also, it is not understood by people who have no experience in the social context in which the phrase is commonly understood.

Which theorist is credited with the psychosocial theory of aging that defines middle-age as a stage of generativity versus stagnation? 1) Levinson 2) Cumming and Henry 3) Erikson 4) Havighurst

3 A. Levinson conceived development as a sequence of qualitatively distinct eras or seasons in the middle-age adult where life must be restructured to express more of the self. Time represents both the possibility of further development and a threat to self. This is a period of fulfillment and a preparation for retirement. B. Cumming and Henry's theory of disengagement pertains to adults past the age of 65 years, not the middle-age adult. C. The best known theory of psychosocial development is credited to Erikson, who believed the middle-age adult's developmental task focuses on generativity versus stagnation. This stage involves the struggle between the ability to look outside oneself and care for others, versus caring for no one and being self-absorbed. D. Havighurst's theory of activity suggests a route to successful aging by remaining actively engaged with people and life events.

Poor nutrition, a compromised immune system, and difficulty swallowing are examples of which type of factor affecting safety? 1) Lifestyle. 2) Cognitive. 3) Physiological. 4) Development.

3 A. Lifestyle factors include not taking appropriate safety precautions, choosing a sedentary lifestyle, abusing chemical substances, and being unable or unwilling to provide self-care. B. Cognitive factors involve the ability to acquire and interpret information as a prerequisite for judgment, orientation, and socially appropriate behaviors. An example might be dementia.

Denial, anger, bargaining, depression, and acceptance are phases of coping the palliative care nurse recognizes as which theorist's model? 1) Rando. 2) Bowlby. 3) Kubler-Ross. 4) Engel.

3 Her work theorizes what individual go through (not necessarily sequentially) trying to cope with pending death. p. 203.

When teaching clients about the behavioral patterns of a healthy lifestyle, which of the following would not be included? 1) Obtaining adequate nutrition and rest. 2) Effectively managing a therapeutic regime prescribed by a physician. 3) Performing temporary prevention activities for a chronic illness. 4) Avoiding smoking and overeating.

3 A. Obtaining adequate nutrition and rest are behavioral patters that influence one's health and longevity. B. A healthy lifestyle is evident when a client effectively manages a therapeutic regime prescribed by a physician. C. When dealing with a chronic illness, permanent (not temporary) lifestyle changes are needed for successfully living with the disease. D. A healthy lifestyle is evident when one avoids poor health habits, such as smoking or overeating.

It is important for the nurse to recognize the influences of lifestyle factors upon a person's health. Which of the following is not a lifestyle factor: 1) Stress level. 2) Cultural practices. 3) Genetic predisposition. 4) Health practices.

3 A. Stress level is a lifestyle factor that influences a person's health. B. Cultural practices are lifestyle factors that influence a person's health. C. Heredity, or genetic predisposition to specific illnesses, raise known health risks. However, genetic predisposition is not a lifestyle factor influencing a person's health. D. Health practices are lifestyle factors that influence a person's health.

At the conclusion of a class on insulin injection, a client states, "I'm through." The nurse responds by asking, "When you say you are through, does that mean that you understand how to give yourself an injection of insulin, or that you would rather not be bothered with the whole process?" Which of the following best describes the types of communication pattern? 1) Summarizing. 2) Placing events in sequence. 3) Seeking consensual validation. 4) Encouraging descriptions of perceptions.

3 A. Summarizing is used to help ensure the client and nurse are in agreement about what went on, what decisions were made to help ensure that nothing was omitted. B. Data obtained from the client should be recorded or documented in chronological order, which places the events in a sequence. C. Consensual validation allows the client the opportunity to further clarify his or her statements, so that both the nurse and the client agree on the meaning of the term "through." D. Encouraging descriptions is a process in which the client is asked to describe perceptions and associated emotions.

Which of the following statements about genetic variations is true? 1) Tay-Sachs disease is more common among African Americans. 2) Sickle cell disease is more common among those of Jewish descent. 3) Thalassemia is more common among people of Mediterranean descent. 4) Genetic variations do not produce different health problems among different races.

3 A. Tay-Sachs disease is common among people of Jewish descent. B. Sickle cell disease is common among African Americans. C. Thalassemia is a disease common among people of Mediterranean descent. D. Genetic variations that produce different health problems in different races are uncommon, but do exist.

According to Erikson, what is the chief developmental task of adolescence? 1) Development of independence 2) Development of initiative 3) Development of identity 4) Development of intimacy

3 A. The chief developmental task for toddlers is to develop a sense of autonomy or independence. B. The chief developmental task for preschool-age children is to develop a sense of initiative. C. The chief developmental task for adolescents is to develop a sense of identity where the adolescent must be able to integrate past, present and future selves. Gradually the adolescent becomes less reliant on family and more reliant on self and others. D. A sense of intimacy is associated with the psychosocial development of early adulthood.

Of the elements widely accepted in the communication process, the means by which the message is sent is known as the: 1) Context. 2) Decoder. 3) Sensory channel. 4) Encoder.

3 A. The context is the condition under which a communication occurs. B. The receiver, or decoder, is the person(s) to whom a message is aimed. C. Used to send the message, the sensory channel consists of the visual, auditory, or kinesthetic channels. D. The sender, or encoder, is the person initiating a transaction to exchange information, convey thoughts and feelings, or engage another person.

The nurse is examining a healthy 15-year-old female and notes that the girl appears small for her age and has not developed secondary sexual characteristics. Which of the following conclusions is most accurate about this finding? 1) Normal adolescent 2) Anorexia nervosa 3) Constitutional delay of puberty 4) Pathological delay of puberty

3 A. The small body frame is not significant for a health problem, but secondary sexual characteristics should have appeared by this point. B. These findings do not correspond with anorexia nervosa. Individuals with anorexia nervosa have lost 25% or more of their normal body weight with no other apparent illness. Girls with anorexia nervosa are amenorrheic because a significant amount of body weight is lost. C. Constitutional delay of puberty is defined as an absence of early signs of puberty by age 13 in girls and 14 for boys. These individuals are small for their age and have a delayed bone age. They account for more than 90% of cases of delayed puberty. D. There is no indication from the data provided that this girl has an underlying condition that has delayed puberty.

Which of the following theories describes the wear-and-tear theory of biological aging? 1) The immune system declines with age, and the body loses the ability to protect itself from stress and disease. 2) Alterations in neuroendocrine control of homeostasis results in age-related physiological changes. 3) The accumulation of metabolic waste products or nutrient deprivation damages DNA synthesis. 4) Aging is caused by our genes or a predictable decline in functioning.

3 A. This description related to immunity theory, where the immune system declines with age, and the body loses its ability to protect itself from stress and the cumulative effects of illness and contamination in our environment. B. This description relates to the neuroendocrine theory where alterations in neuroendocrine control result in age-related physiological changes. As we get older, there is a significant decrease in hormone production. C. Wear-and-Tear theories describe how internal and external stressors take a toll on the body. Accumulation of metabolic wastes or nutrient deprivation is an internal stressor. External stressors may be diet and lifestyle. D. This is a description of the genetic theory, where lifespan is determined by the genes we inherit. Therefore, aging is much more a matter of destiny, and our lifespan, in part, is programmed even before our birth.

Which therapeutic communication technique allows the client to select a topic for discussion and sets parameters for those issues that the client is willing to discuss with the nurse? 1) Seeking consensual validation. 2) Focusing. 3) Providing broad openings. 4) Offering self.

3 A. Using this technique, the nurse paraphrases what the client has said. B. The nurse selects one topic for exploration from among several possible topics presented by the client. C. An open-ended statement, such as "What shall we cover next?" is a very broad client-focused opening. In this technique, the nurse invites the client to select a topic for conversation. D. Sitting with or talking quietly with the client is an example of offering self.

During a conversation, the client asks, "How am I doing with my physical therapy?" The nurse may ask in response, "How do you think you are doing?" This type of dialog is known as: 1) Verbalizing the implied. 2) Translating into feelings. 3) Reflecting. 4) Assessing emotions.

3 A. Verbalizing the implied involves not only understanding the client's words but also recognizing an underlying meaning that was hinted but not voiced. B. Helping the client by translating the message into verbal expressions of feelings. C. Demonstrating that you value the client's opinion by asking him or her to reflect on what he or she said. This helps the client gain confidence in making assessments and decisions and encourages the client's self-reliance. D. Allowing a client to be in touch with feelings and asking how he or she feels constitutes an assessment of emotions.

Within a multicultural society, which of the following approaches will help you as a nurse to provide optimal care to clients? 1) Sharing your world view and cultural practices with your clients. 2) Providing nursing care based on scientific principles. 3) Possessing knowledge of the client's culture. 4) Giving care in a friendly and efficient manner

3 A. When the nurse and client have different cultural practices and world views, the nurse must ensure that the client receives care acceptable to the client's culture. B. Although nursing care based on scientific principles is important, the way in which care is provided will differ across cultures. C. Possessing knowledge of the client's culture is the key to providing optimal care. D. Although efficiency in nursing care is always important, the degree of friendliness the nurse exhibits may be interpreted differently across cultures. The nurse should give care in a manner that is acceptable to the individual client's culture.

The nurse knows that the main reason for prolonged absence from work is: 1) Motor vehicle accidents. 2) Falls. 3) Back injuries. 4) Poisoning.

3 A. While motor vehicle accidents are the leading cause of accidental deaths in the United States, back injuries are the main reason for prolonged absence from work. B. Older adults form the group affected most often by falls, and they are not primarily in the work force. C. Back injuries are the main reason for prolong absence from work.

Which of the following type of accidental injuries most commonly results in death in those 65 years of age and under? 1) Poisoning. 2) Electrical hazards. 3) Motor vehicle accidents. 4) Falls.

3 A. While there are numerous toxic substances that could potentially poison the general population, relatively few deaths are caused by poisoning. B. Fatalities from electrical hazards are relatively uncommon. C. The type of accident that most commonly results in death in those 65 years of age is motor vehicle accidents.

Which of the following is a hormone-like substance found in soy, whole grains and legumes? It may reduce the risk of some cancers and inhibit platelet aggregation. 1) Flavonoids. 2) Carotenoids. 3) Phytoestrogens. 4) Antioxidants.

3 All of these substances are known as phytochemicals (plant chemicals) that are sometimes referred to as healing food, super foods, or power foods. Phytoestrogens are hormone-like substances that are found in whole grains, legumes and soy. They may reduce the risk of hormone-related cancers, enhance immunity, inhibit platelet aggregation and mimic some estrogen effects. Flavonoids are chemicals that give fruits and vegetables their color. They may reduce the risk of cancer, act as antioxidants or have antiallergenic and anti-inflammatory properties. Carotenoids are plant pigments found in cruciferous vegetables, red and yellow fruits and vegetables, green leafy vegetables and sea vegetables. They may act as antioxidants, precursors to vitamin A; they may protect the eyes from excessive light, and reduce the risk of prostate cancer. Antioxidants are found in yellow to red and green leafy vegetables, yellow or orange fruits, citrus fruits, nuts, refined grains and seafood. They may help in preventing cancer.

Your client, who is 4-years-old, has the cognitive ability to think about the future and start to plan what the client will be doing later in the day or in a few days, instead of concentrating on the here and now. Your client is in which phase of cognitive development according to Jean Piaget? 1) Preoperational phase 2) Accommodation 3) Phase of intuitive thought 4) Concrete phase

3 At about the age of 4 years, preschoolers first begin to think about the future and start to plan what they will be doing later in the day or in a few days, instead of concentrating on the here and now. This is Jean Piaget's phase of intuitive thought.

Predictable patterns of development are referred to as which of the following? 1) Attitudes 2) Habits 3) Milestones 4) Levels

3 Developmental milestones are the predictable patterns of normal development according to age. Growth and development are evaluated by comparison of an individual's characteristics with the range of growth and development characteristics expected for a person in the same age group.

For the first 12 months of life, what is the most desirable food? 1) Formula 2) Cow's milk 3) Human milk 4) Fruit juice

3 During the first 12 months of life, the preferred food for an infant is human milk, which provides the most nutrients for the infant.

The mean arterial pressure (MAP) of 150/90 is: 1) 80 mm Hg. 2) 120 mm Hg. 3) 110 mm Hg. 4) 40 mm Hg.

3 Equation can be found in the powerpoint about hypertension. MAP = 1/3 of systolic BP + 2/3 of diastolic BP. 1/3 of 150 = 50; 2/3 of 90 = 60. 50 + 60 = 110.

Mr. S was diagnosed with ALL 2 years ago and has undergone several treatments with periods of remission until 3 months ago. He is on the second round of this latest treatment but his body is not responding. His wife and teenage children have been working on a family photo album sharing it with him. What type of grief would the nurse identify this family is experiencing? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief

3 Experiencing anticipatory grief may provide time for families to prepare, and anticipate the loss. They have time to consider any unfinished business, review their life, and resolve any conflicts p. 206/ and ELNEC teaching supplement types of grief.

The nurse teaches a new parent that the best reason for routine immunization of newborns, infants, and toddlers is to: 1) treat infection. 2) provide protection at day care centers. Correct Response 3) prevent disease. 4) be cost-effective with health care dollars.

3 Immunization protects the child from being infected with a disease and prevents infection of others with whom the infant or child comes in contact. Answers 2 and 4 are secondary reasons, and answer 1 is incorrect.

Which of the four steps of the grief assessment process does the nurse discuss sleeping issues? 1) Type of grief. 2) Factors that influence. 3) Caregiver/Survivor health. 4) Grief reactions.

3 Many caregiver/survivors do not take care of themselves while caring for their loved ones and sleep deprivation can lead to other health issues and effect coping. (ELNEC slide 17 faculty outline).

Which of the following screening tests should be included in the health assessment of the adolescent? 1) Glucose tolerance test 2) Tetanus booster 3) Hemoglobin and hematocrit 4) Hepatitis B series

3 Primary prevention for adolescents does not include a glucose tolerance test. This test would be indicated if the adolescent reported symptoms of diabetes mellitus. B. A booster of tetanus and diphtheria is recommended every 10 years. An adolescent usually receives a booster at some point because the initial DPT immunization is administered between ages 4 and 6 years. C. A yearly health checkup for adolescents should include a hemoglobin and hematocrit. Iron deficiency anemia is a relatively common problem in adolescents, especially girls, as a result of menstrual blood loss and lack of iron in the diet. D. Adolescents should receive the hepatitis B immunization series.

Which type of grief does the nurse recognize when family members gather and reminisce about their lives and take time to talk with their loved one? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief .

3 Provides time for the family to prepare and consider any unfinished business or resolve any conflicts. p. 206 and ELNEC supplement types of grief.

You awaken a client during the night to measure blood pressure and heart rate. You observe that these vital signs are elevated. Based on your knowledge of normal sleep cycles, you can expect that the client was experiencing which of the following? 1) delta or slow-wave sleep. 2) stage 1 nonrapid eye movement (NREM) sleep. 3) rapid eye movement (REM) sleep. 4) stage 2 NREM sleep.

3 REM sleep is characterized by high brain activity, loss of muscle tone dreaming, variable arousability and potential physiological instability. BP, HR and cardiac output all increased and may begin to fluctuate.

You encourage your client to exercise his right arm and leg against resistance three times daily. What nursing diagnosis does your client have? 1) Ineffective role performance 2) Disturbed sensory perception 3) Risk for disuse syndrome 4) Self-care deficit

3 Risk for disuse syndrome: a state in which an individual is at risk for deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity.

Which of the following is true about illnesses in Mexican Americans? 1) The incidence of diabetes is low with infrequent complications. 2) The incidence of hypertension is low. 3) Alcoholism is a significant health problem. 4) Urban older adult migrant workers are at low risk for many age-related chronic conditions.

3 The incidence of diabetes among Mexican Americans is five times the national average, and complications are more frequent. B. Hypertension is a significant health care problem among Mexican Americans. C. Alcoholism is a crucial health problem. D. Urban elderly migrant workers with lower levels of education, poor nutrition, and meager financial resources are at risk for many age-related chronic health conditions.

Which comments or questions the nurse makes would help validate the griever's feelings and facilitate normal grief? 1) "It will just take time and soon things will be back to normal." 2) "He's in a better place." 3) "What was your relationship like?" 4) "Be grateful you had them in your life at all."

3 The nurse now focuses attention of the significant others in accepting the loss, experiencing the pain of grief. This will help them actualize the loss by talking about the loved one and validate their pain and grief. Unhelpful and Helpful comments handout and p. 219-Unhelpful and helpful comments handout.

Which of the following age groups is most likely to have sensory/perceptual alterations? 1) School-aged children. 2) Infants/toddlers. 3) Middle-aged/older adults. 4) Adolescents/young adults.

3 p. 1040 Harkreader - Age related changes begin in middle adult years around age 40 and continue into later adulthood.

Assessment of hearing loss in infants requires alertness to subtle signs. What generally alerts a parent to a possible hearing loss in their infant? 1) Difficulty discriminating consonants. 2) Garbled speech sounds by the infant. 3) Failure to awaken or startle at the sound of a sudden loud noise. 4) Delayed reaction to speech.

3 p. 1043 Harkreader - The first sign that alerts a parent to a possible hearing loss in an infant may be failure to respond to loud noises.

Which of the following questions would you expect to find on a self-concept assessment related to body image? Do you like who you are? Who influenced you the most growing up? How do you feel about any physical changes you noticed recently? Who would you most like to be?

3 p. 1501. It is important when conducting the assessment to realize the limitations of self-reporting. Body image is the subjective view a person has about his or her physical appearance. Body image disturbances can be expected with any alteration in bodily appearance, structure, or function. Appropriate questions to ask would be: "describe your body to me" or "what do you like most/least about your body?", or IS there anything about your body that you would like to change".

Which of the following questions would best relate to self-identity on a focused self-concept assessment? Would you like to be? What do you like most about your body? What are your personal strengths? Do you like being a teacher?

3 p. 1501. When assessing self-concept, the information needed first is the patient's description of self. Personal identity describes an individual's conscious sense of who he or she is. "How would you describe yourself to others?". Look for personal characteristics and traits, strengths, and fears.

A student nurse who has not maintained healthy relationships with his/her peers would be at risk for which of the following self-concept disturbances? Personal identity disturbance Body image disturbance Self-esteem disturbance Altered role performance

3 p. 1506. Low self-esteem includes feeling unloved or unapproved of by significant others, feelings of incompetence, failure to live according to personal moral ethical code, and powerlessness.

The primary controller for homeostatic mechanisms is which of the following systems? 1) Respiratory 2) Cardiovascular 3) Autonomic and Endocrine 4) Gastrointestinal

3 p. 1523. The autonomic nervous system and the endocrine system primarily control homeostatic mechanisms. Lessor involved systems include: respiratory, cardiovascular, GI, and renal.

Which of the following statements concerning atheists and agnostics is accurate? 1) Both deny the existence of God 2) Nurses should attempt to change the views of these patients and offer religious counseling 3) Both are guided by a philosophy of living that does not include a religious faith 4) Both have religious influence that are life denying

3 p. 1647. An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power. They deserve respect for what they choose to believe, just as do those who accept a particular religious creed.

Which of the following statements would best apply to Native American cultures? 1) The family is not expected to part of nursing care. 2) Direct eye contact is preferred when speaking to healthcare professionals 3) A low tone of voice is considered respectful 4) Careful notes are kept regarding home car and medications

3 p. 35, box 2-5. Nursing considerations for Native American cultures include: indirect eye contact is acceptable and sometimes preferred, note taking is taboo, a low tone voice is often considered respectful, and a patient may expect the caregiver to deduce the problem through instinct and not through asking many questions and history taking.

The use of eye contact varies from culture to culture. Which of the following assumptions may be accurate when eye contact is used as nonverbal communication by different cultural groups in the following situations? 1) A Native American stares at the floor while talking with the nurse. Assumption: He is embarrassed by the conversation. 2) A Hasidic Jewish man listens intently to a male physician, making direct eye contact with him, but refuses to make eye contact with a female nursing student. Assumption: Jewish men consider women inferior to men. 3) A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest. 4) An African American man rolls his eyes when asked how he copes with stress in the workplace. Assumption: He may feel he has already answered this question and has become impatient.

3 p.29. One of the most culturally variable forms of nonverbal communication is eye contact. The American dominant culture emphasizes eye contact while speaking, but other cultures regard this behavior in different ways. Muslin-Arab women indicate modesty by avoiding eye contact with men. Hasidic Jewish men tend to avoid direct eye contact with women.

A nurse attempts to integrate complementary and alternative therapies (CAT) into nursing practice. Which of the following are basic principles of CAT? Select all that apply. 1) Illness occurs in either the mind or the body, which are separate entities. 2) Health is the absence of disease. 3) Health is a state characterized by a dynamic balance of mind, body, and spirit. 4) Illness is a manifestation of imbalance or disharmony and is a process. 5) Curing is accomplished by external agents. 6) Healing is a natural, slow process that involves the body, mind, and spirit.

3, 4, 6

A nurse is conducting a health history and asks the patient about use of complementary and alternative therapies (CAT) to treat her chronic headaches. What response would require further questions? 1) "I practice meditation." 2) "I use relaxation to help me go to sleep." 3) "Each week, I have a total body massage." 4) "I take herbs to treat my headaches."

4

A nurse is practicing imagery to relieve stress. What might accompany the imagery to even further promote relaxation? 1) bright lighting 2) bodywork techniques 3) talking on the phone 4) listening to music

4

A nurse practices holistic patient care. Which of the following is a guiding principle of this practice? 1) Holism is focused on reductionism. 2) All living organisms exist independently. 3) The body is the sum of its parts. 4) The body is a unified, dynamic whole.

4

Irrigation of the ear is contraindicated in which situation? 1) Cerumin build up in the ear is severe. 2) Local irritation is present. 3) A small round bead has stuck in the ear. 4) Rupture of the eardrum is suspected.

4

Please choose from the following that makes this statement true: Isulin is produced in the __________ and ______ appetite. 1) Duodenum, increases 2) Pancreas, increases 3) Duodenum, decreases 4) Pancreas, decreases

4

Which of the following medications are appropriate for the patient having difficulty sleeping? Incorrect Response 1) Restoril or Ambien. 2) Dalmane or Ativan. 3) Sonata or Klonopin. 4) All of the above.

4

Which of the following sleep disorders is characterized by violent and repetitive grinding of the teeth? 1) Narcolepsy. 2) Sleep Terror. 3) Restless leg syndrome. 4) Bruxism.

4

Which one of the following is a risk factor that most likely contributes to the development of hypertension? 1) Having cancer. 2) Eating foods high in potassium. 3) Taking birth control pills. 4) Smoking cigarettes.

4

Which statement is true about the understanding of death across the lifespan? 1) Children under 2 have a sense of separation and see that as death. 2) Ages 2-5 death is seen as permanent not transient. 3) Adolescents see themselves as immortal but as a future event. 4) Middle age is more aware and accepting of death.

4

Your male client has begun adolescence. Which of the following marks the transition to puberty for males? 1) Appearance of secondary sexual characteristics 2) Increase in adipose tissue and rapid growth in height 3) Establishment as an independent person 4) First nocturnal emission

4

Identify the following statement which indicates to the hospice nurse the family may have a prolonged grieving process. 1) "We met with the lawyer and worked on our wills yesterday." 2) "Our pastor came by and we talked about my service." 3) "I have had such an outpouring of support from friends." 4) "When this happened we were talking about getting a divorce."

4 This comment reveals a conflict between the patient and significant other that is unresolved. It would be in the significant others best interest to recommend counseling to facilitate less complicated grief upon the family member's death. p 212.

Assessments for impaired gas exchange in the early stage would include all of the following EXCEPT: 1) Confusion. 2) Increased lethargy. 3) Change in mental status. 4) Decreased restlessness.

4 (Harkreader, p. 909; For a patient who becomes hypoxic, restlessness is the earliest and most often missed sign. A diminished level of consciousness may progress from difficulty concentrating to confusion, lethargy and finally coma. When a patient remains in impaired gas exchange, the restlessness becomes worse and not less.

A client has an oxygen saturation level of 75% per pulse oximeter. The most appropriate nursing diagnosis is: 1) Ineffective breathing pattern. 2) Ineffective airway clearance. 3) Activity intolerance. 4) Impaired gas exchange.

4 (Harkreader, page 903: pulse oximetry is a useful device for monitoring oxygen level in the arterial blood system; it measures saturation of the hemoglobin molecule in the blood; a low reading is a result of impaired gas exchange at the alveolar/capillary level. However, if left untreated, ineffective airway clearance, ineffective breathing pattern and activity intolerance can lead to impaired gas exchange (Harkreader, p. 909)

The common cold (acute viral rhinitis) is caused by: 1) Group ß-hemolytic streptococcus. 2) Streptococcus pneumonia. 3) Moraxella catarrhalis. 4) The adenovirus.

4 (Lewis, p. 536; Group ß-hemolytic streptococcus causes streptococcal pharyngitis, Streptococcus pneumonia causes a streptococcal pneumonia. Moraxella catarrhalis is a Gram-negative, aerobic diplococcus that can cause a respiratory tract infection in humans. The common cold is caused by the adenovirus.

The laboratory test that is most useful for determining short-term changes in protein status of an individual is the: 1) Transferrin. 2) Albumin. 3) Hematocrit. 4) Prealbumin.

4 A low BUN level may indicate low protein intake but is only reliable as long as the client does not have kidney disease. Albumin does not provide data about short-term changes in protein status. Hematocrit indicates anemic status due to deficiency of iron, pyridoxine, folate, vitamin B12 and protein, so this laboratory value is not specific for intake of protein. Prealbumin is the most appropriate laboratory value that shows a short-term change in intake of protein.

Heredity or genetic predisposition to specific illnesses raise known health risks. A family history of which of the following illnesses is not an example of a known genetic risk factor? 1) Cancer. 2) Diabetes mellitus. 3) Coronary artery disease. 4) HIV infection.

4 A. A family history of cancer is an example of a known genetic risk factor. B. A family history of diabetes mellitus is an example of a known genetic risk factor. C. A family history of coronary artery disease is an example of a known genetic risk factor. D. There is no genetic transmission of HIV infection.

Which of the following strategies would be recommended for the younger adult to promote sleep and rest? 1) "Sleeping in" on the weekends 2) Falling asleep while reading in bed 3) Falling asleep while watching TV in bed 4) Avoid eating or drinking before bedtime

4 A. A regular sleep schedule should be kept, going to bed and getting up at the same time. This includes weekends. B. Relaxing activities, such as reading or listening to music is encouraged at bedtime, but these activities should be done in another room. The bed should be used for sex and sleep only. C. Relaxing activities, such as reading or listening to music is encouraged at bedtime, but these activities should be done in another room. The bed should be used for sex and sleep only. D. It is recommended that eating and drinking before bedtime should be avoided to promote rest and sleep.

Which of the following statements is true about the baby boomer generation? 1) Baby boomers have little knowledge of their health care needs. 2) Baby boomers will have a few health care needs during their retirement years. 3) Baby boomers will have economic security in retirement. 4) The baby boomers female has a higher level of education than past generations.

4 A. Baby boomers can be expected to be a knowledgeable group of health care consumers, using technology to enhance their work, life and health. B. Baby boomers can be expected to place high demands on the health care system for specialists. As they progress into older adult stage, many physiological changes, including chronic illness and sensory deficits, will tax the health care system. C. Baby boomers will enter retirement with two-income retirement benefits from a two-income family; although this is not a guaranteed, because they have also faced downsizing and layoff in their past years and have not typically been a generation of savers. D. This generation, especially women, will enter retirement more educated than in the past.

Which religion's fundamental teachings are monotheistic and follow the Torah and Talmud? 1) Buddhism. 2) Hinduism. 3) Islam. 4) Judaism.

4 A. Buddhism teaches that life is suffering caused by one's desires for pleasure, power, and existence. One must follow the Eightfold Path to stop suffering. B. Hinduism stresses that each person is on a spiritual journey to discover the self or consciousness. C. The Islamic religion worships Allah, who created the universe and sustains its inhabitants. D. Monotheism is a fundamental teaching of Judaism. The Torah and the Talmud are viewed as divine revelations on the rules for living and the experiences of others with God.

During which of the following developmental stages is respect for the person's spiritual being important? 1) Childhood. 2) Adolescence and young adulthood. 3) Middle adulthood. 4) Older adulthood.

4 A. Children usually need help in applying religious principles in their daily lives. B. Adolescents usually are questioning the meaning of their lives and religious teachings. Young adults are usually going through a separation phase. C. During middle adulthood, close interpersonal relationships may be more important for personal satisfaction and sense of success. D. Religion tends to become increasingly important as the person ages. Older adults need to be respected as spiritual beings because of their spiritual perception of themselves.

Which religion's primary beliefs include focus on Jesus Christ as the son of God, the Trinitarian God (Father, Son, and Holy Spirit), and revelation of God's word in the Bible? 1) Native American religion. 2) Hinduism. 3) Taoism. 4) Christianity.

4 A. Followers of Native American religions worship many gods and surrounding objects, such as the sun and moon. B. Hinduism stresses that each person is on a spiritual journey to discover the self or consciousness. C. Taoists believe in three gods and use metaphysical practices, such as magic, to tap into the power of the universe. D. These are some of the primary beliefs of Christianity.

What is the most appropriate response for the nurse to offer to an adolescent boy who is concerned about his enlarged breasts? 1) Enlargement of breast tissue is an indication of a serious health problem. 2) It is caused by an imbalance between testosterone and progesterone. 3) The condition usually requires surgical intervention. 4) Most of the time the enlarged tissue disappears in a year and a half.

4 A. Gynecomastia is a benign increase in breast tissue and is a common complaint of adolescent boys. Occasionally the condition may be caused by a health problem or certain drugs. B. Gynecomastia results from an imbalance in circulating estrogens and androgens. C. No intervention is indicated for gynecomastia. Surgery or drug therapy is indicated only when breasts are extremely enlarged. D. Most cases of gynecomastia resolve spontaneously within 12 or 18 months, and it is a normal and relatively common part of puberty.

Pender describes several components of health assessment that focus on wellness. In performing the health-risk appraisal component of the health assessment, the nurse obtains essential information about which of the following? 1) Health-related physical fitness 2) Family support 3) Skill-related physical fitness 4) Health threats

4 A. Health-related physical fitness is part of the physical fitness evaluation that is divided into skill-related and health-related physical fitness. The health-related physical fitness evaluation includes qualities that contribute to one's general health, such as muscular strength and body composition. B. Family support, along with emotional, informational, and instrumental support, is part of the social support component. Social support systems, such as family, are important in enhancing successful coping and promoting comfortable living. C. Skill-related physical fitness is the second part of the physical fitness evaluation and includes agility, speed, power and reaction time. D. A health-risk appraisal provides clients with essential information about health threats to which they are vulnerable because of family history, lifestyle, or hereditary factors.

Nonverbal components of speech, called paralanguage, can assist greatly in grasping the content of the client's message. Which of these components is affected by physical and emotional conditions of the speaker? 1) Intonation. 2) Pitch. 3) Rate. 4) Quality.

4 A. Intonation refers to the variety of stress and pause patterns within a phrase or sentence. B. Pitch refers to whether the voice is high or low. C. Rate refers to the number of syllables spoken per unit of time. D. The measure of clarity, hoarseness, or nasality in a person's voice, as affected by physical and emotional factors of the speaker, is referred to as the quality.

Which of the following is important for the nurse to know about Navajo culture? 1) Few Navajos speak English. 2) Navajos shake hands when greeting a person. 3) Navajos believe in the germ theory of medicine. 4) Navajo people believe that family members are responsible for one another.

4 A. Many Navajos speak English as their primary language, but many are fluent in both Navajo and English. B. Navajos do not shake hands but extend a hand and lightly touch the hand of the person being greeted. C. Navajos do not subscribe to the germ theory of medicine. D. Navajos believe that family members are responsible for one another. Therefore, the nurse should know that it is not unusual for many family members to come to the hospital to care for the Navajo client.

Which of the following is an appropriate assessment guideline for the nurse who is interviewing an adolescent? 1) Interview the adolescent with a parent present. 2) Do not ask the adolescent about illegal drug use. 3) Begin the interview with the most personal questions. 4) Avoid making a judgment about information the adolescent tells you.

4 A. Most health problems experienced by well adolescents are the results of health-risk behaviors. Most adolescents would prefer to discuss these behaviors privately, so it is best, if possible, to interview an adolescent client without the parents present and reassure the adolescent that your conversation will be confidential unless the teen is suicidal or homicidal. B. Most health problems experienced by well adolescents are the result of health-risk behaviors. Do not be afraid to ask questions about illegal, unsafe, or otherwise undesirable behavior. Research has shown that they will not interpret the question as approval to engage in that behavior. C. An appropriate guideline for interviewing individuals of all ages is to begin the interview with the least personal questions and then proceed to more sensitive topics. This allows the client to become comfortable talking with the nurse. D. Adolescents are more likely to be honest when they feel they are respected. They are sensitive to the interviewer's perception of them. It is important to remain nonjudgmental during the interview.

Which of the following consists of actions that focus on the early diagnosis and prompt treatment of people who have health problems or illnesses and are at risk for developing complications or worsening condition? 1) Primary health care. 2) Tertiary prevention. 3) Health promotion. 4) Secondary prevention.

4 A. Primary health care focuses on prevention and health promotion, but with a much broader perspective than just medical and nursing care. B. Tertiary prevention involves minimizing the effects of a permanent, irreversible disease or disability through interventions directed at preventing complications and deterioration. C. Health promotion consists of educational, political, organizational, regulatory, and environmental supports for actions and conditions of living conducive to the health of individuals, families, and communities. D. Secondary prevention actions focus on the early diagnosis and prompt treatment of illnesses and the prevention of further complications.

Which of the following is not a factor in radiation exposure? 1) Sunlight. 2) X-rays. 3) Nuclear power plants. 4) Farms.

4 A. Radiation burns results from exposure to radiant heat in the form of sunlight. B. Working with x-rays results in exposure to radiation, which can be reduced by lead shielding and use of safety procedures. C. Working in proximity to nuclear power plants increases exposure to radiation.

A person's perceived ability to control his or her environment (such as health care) depends on whether the person operates primarily from an internal locus of control or an external locus of control. Which of the following statements is true when the person has an internal locus of control? 1) The person is more likely to believe that events are due to chance or luck. 2) The person feels helpless to change his or her circumstances. 3) The person relinquishes control to others, allowing them to make decisions for the person. 4) The person feels empowered to influence his or her environment.

4 A. The person with an external locus of control believes that events are primarily due to chance, fate, or luck. B. The person with an external locus of control may feel helpless to change his or her environment or circumstances. C. The person with an external locus of control readily relinquishes control to others, such as nurses, allowing them to make decisions for the person. D. The person with an internal locus of control feels empowered to influence his or her environment.

The first priority in case of fire in a health care institution is to: 1) Activate the fire alarm. 2) Confine the fire. 3) Extinguish the fire. 4) Rescue the clients.

4 A. The second priority in case of fire is to call for help by activating the nearest fire alarm or reporting the fire to the switchboard operator, whatever is fastest. B. The third priority is to confine the fire, closing doors and windows and turning off the oxygen source and electrical equipment.

The nurse asks the client, "What is your religion?" The client says, "I'm an atheist." By this client's answer, the nurse can determine that the client: 1) Believes in the existence of God, who created and rules the universe. 2) Believes in existence of more than one god. 3) Is undecided about the existence of God or a higher power. 4) Believes there is no God or other higher power.

4 A. This type of belief is called monotheism. B. Polytheism is the belief in more than one god. C. This person is classified as an agnostic. D. An atheist is a person who has no faith in God or a Supreme Being and denies the possibility of the existence of God. Question 4

Several theorists have advanced thought on the interaction between the nurse, client, and communication elements in the therapeutic process. Which of the following theorists viewed communication as the vehicle by which human relationships are developed and maintained, and therefore it requires an atmosphere of mutual respect? 1) Watzlawick. 2) Travelbee. 3) Peplau. 4) King.

4 A. Watzlawick wrote of the pragmatics of the communication process, believing in communication as inevitable. B. Travelbee held the nurse to be a human being vulnerable to stereotypes, labels, and generalizations, making it impossible for one stereotype (the nurse) to relate to another stereotype (the client) in a humanistic manner. C. Peplau stated that the nurse who related with clients in a healthy manner could provide corrective interpersonal experiences for them, resulting in a client's healthier relationship with others. D. King viewed communication as the vehicle by which human relationships are developed and maintained, requiring an atmosphere of mutual respect. Communication is verbal, nonverbal, situational, perceptual, transactional, and irreversible.

The short-term effects of diuretics include all of the following except: 1) Increased salt and water excretion. 2) Decreased intravascular volume. 3) Decreased systemic vascular resistance. 4) Activation of the renin-angiotensin system.

4 Activation of the renin-angiotensin system always occurs (normal function of the body), as a function of regulating blood pressure. Diuretics will eventually and indirectly affect the renin-angiotensin system, but this is mediated by the processes described in A, B and C.

You discover in your patient's history that she has been taking a diuretic, a sleeping pill, a nonsteroidal anti-inflammatory (NSAID) drug and a stool softener. Which one of these is important to consider to help determine her perfusion state? 1) Sleeping pills. 2) Stool softener. 3) NSAID. 4) Diuretic.

4 Complications of HTN is related to ineffective perfusion to several target organs (brain, cardiovascular, kidney, eyes, Lewis, p. 778, Table 33-12). Diuretics is the first drug of choice when treating a patient with HTN. Sleeping pills, stool softner and NSAIDS are not used in the treatment of HTN, (Lewis, p. 773, Table 33-8)

Which of the following essential oils can be used during aromatherapy to treat nausea? 1) lavender 2) garlic 3) parsley 4) Peppermint

4 D; Ginger and peppermint are commonly used for nausea

Your client is the mother of a teenage girl. She asks your advice about talking to her daughter about sex. You advise her that one of the most effective ways for parents to help prevent their teenagers from becoming pregnant or acquiring sexually transmitted diseases (STDs) is to: 1) advise the teenagers to "Just say 'no.'" 2) buy condoms for the teenagers. 3) condone the teenagers' behavior so they will feel comfortable coming to their parents when they want advice. 4) talk to their teenagers about sexual activity in a nonjudgmental and informative manner.

4 Encourage parents to talk with teens about sexual activity in a nonjudgmental and informative manner in order to attempt to prevent pregnancy and the transmission of STDs.

Which of the following theorists described major psychosocial stages during development of the personality? 1) Havighurst 2) Piaget 3) Freud 4) Erikson

4 Erik Erikson described a series of psychosocial stages to outline the emotional and social development of the personality. Each stage is defined by a task that must be achieved and completed before the next stage is achieved.

The nurse caring for a neonate interacts with this young client with the understanding that the neonate is: 1) insensitive to pain. 2) alert to everything, but cannot distinguish forms. 3) able to express negativism. 4) capable of hearing and turning toward sound.

4 Familiar sounds are recognizable to a neonate, and the newborn often turns toward the sound. Newborns can follow large moving objects and are sensitive to temperature extremes and pain.

The nurse would encourage which of the following bedtime snacks for a client with a sleep pattern disturbance? 1) a large serving of nachos with cheese. 2) a cup of tea and a chocolate bar. 3) a 12-ounce glass of beer. 4) an 8-ounce glass of milk.

4 Instruct patient to avoid alcohol, nicotine and caffeine because all these substances have been associated with increased frequency of arousals. A light bedtime snack may be helpful. Some patients respond well to foods high in tryptophan such as bananas and milk.

What does the nurse expect to find when examining a patient with a 5-year history of poorly-controlled HTN? 1) Right atrial dilation. 2) Right ventricular hypertrophy. 3) Left atrial dilation. 4) Left ventricular hypertrophy.

4 Lewis, p. 767; Sustained high BP increases the cardiac workload and produces left ventricular hypertrophy.

Which one of the following is not included in the diagnostic criteria for metabolic syndrome? 1) Fasting glucose. 2) Waist circumference. 3) Blood pressure. 4) Low density lipoprotein cholesterol (LDL).

4 Measures used to diagnose metabolic syndrome is waist circumference, triglyceride level, high-density lipoprotein cholesterol (HDL), blood pressure and fasting blood glucose. LDL is not listed.

Spiritual needs of the patient are best met by: 1) Separating the religious practices from the nursing care. 2) Leaving the patient alone for long periods of time to provide private times to contemplate. 3) Letting the chaplain of the hospital minister to her needs. 4) The nurse supporting religious practices, listening to and talking with the patient.

4 Patients feel dehumanized during the medical care they need reassurance that they feel respected and valued. p. 218.

Your client has a fear of receiving an injection and cries out not only from the pain but also from sight of the "injury." This kind of fear is normal for which age-group? 1) 6- to 8-year-olds 2) Infants 3) School-aged children 4) Preschoolers

4 Some preschoolers have a fear of bodily harm that may make it difficult for them to cooperate with medical personnel and treatment, such as a needlestick or an otoscopic examination.

Which type of grief would the nurse recognize in a person who has recently reconnected with old friends, and is resuming activities they once enjoyed? 1) Disenfranchised Grief. 2) Complicated Grief. 3) Anticipatory Grief. 4) Normal Grief.

4 They show signs of coming to terms with the death of a loved one and moving forward with their life. These are signs of normal grief. p. 207/212/219 ELNEC supplement types of grief.

A person who is 63 inches in height and 135 pounds has a BMI of: 1) 21.4 kg/m2. 2) 38.3 kg/m2. 3) 29.9 kg/m2. 4) 23.9 kg/m2.

4 Using the formula, 135 pounds divided by (63 inches) 2 = 135 divided by 3969 inches = 0.034014. 0.034014 x 703 = 23.9 kg/m2.

Your client suffers from amblyopia, defined as which of the following? 1) Loss of near vision. 2) Vision of 20/200 or less. 3) Appearance of dots of various size in the visual field. 4) Loss of vision in the non-focusing eye.

4 p. 1038 Harkreader - Amblyopia is visual loss in the affected eye.

Your client, who is younger than two years old, has suffered repeated ear infections. Your client may suffer what type of hearing loss as a result? 1) Presbycusis. 2) Partial deafness. 3) Sensorineural loss. 4) Conduction deafness.

4 p. 1038 Harkreader - Conduction deafness can occur due to repeated ear infections.

Which of the following conditions results in loss of central vision? 1) Cataracts. 2) Glaucoma. 3) Multiple Sclerosis. 4) Macular Degeneration.

4 p. 1041 - Leading cause of blindness in older adults. Caused by deterioration of macula, which is responsible for detailed vision.

You can test your client's near vision by asking your client to read which of the following? 1) Words on the television. 2) Snellen alphabet chart mounted on a wall 20 feet from the client. 3) Snellen chart held about 2 feet from the client's eyes. 4) Newspaper held about 14 inches from the client's eyes.

4 p. 1043 - Near vision can be tested by asking a client to read from a newspaper, Snellen chart, or card held about 14 inches from the client's eyes.

When a nurse asks a patient to describe her personal characteristics and traits, the nurse is most likely assessing the patient for which of the following self-concept factors? Body image Role performance Self-esteem Personal identity

4 p. 1501 When assessing self-concept, the information needed first is the patient's description of self. Personal identity describes an individual's conscious sense of who he or she is

A withdrawn and isolated patient is most likely suffering from which of the following stressors on basic human needs? 1) Physiologic needs 2) Safety and security needs 3) Self-esteem needs 4) Love and belonging needs

4 p. 1527-1528 and box 42-3. Basic needs are common to all people. As a person strives to meet basic human needs at teach level, stress can be either a stimulus or a barrier. In all people, a failure to meet needs results in an imbalance in homeostatic mechanisms and eventually, illness. The effects of stress on the love/belonging need can result in an individual becoming: withdrawn and isolated, blames others for own faults, demonstrates aggressive behaviors, and becomes overly dependent on others.

A patient is complaining of dry mouth and a headache. He recently found out bad news concerning his lab reports. He is handing stress by using which of the following 1) Adaptation technique 2) Coping mechanism 3) Withdrawal behavior 4) Defense mechanism

4 p. 1527. Box 42-2. Defense mechanisms are unconscious reactions to stressors. They protect one's self esteem and are useful in mild to moderate anxiety. Extreme levels of stress can cause this mechanism to distort reality and create problems with relationships. At this point the mechanisms become maladaptive instead of adaptive. Common defense mechanisms include: backache, constipation, dilated pupils, dry mouth, headache, increased urination, increase pulse, blood pressure, and respirations, nausea, sleep disturbances, stiff neck, increased perspiration, chest pain, weight gain or loss, and a decreased sex drive.

According to Shelly and Fish (1988), which of the following is a spiritual need underlying all religious traditions? 1) Need for formal ceremony 2) Need for power in relationship with God 3) Need for justice 4) Need for meaning and purpose

4 p. 1644. According to Shelly and Fish (1988) there are three spiritual needs underlying all religious traditions and common to all people: need for meaning and purpose, need for love and relatedness, need for forgiveness.

A terminally ill patient tells you that he does not belong to an organized religion. It is safe to assume which of the following? 1) The patient is an atheist 2) The patient has no belief system 3) The patient is an agnostic 4) The patient may still be deeply spiritual

4 p. 1651 The Landscape survey reveals that people who are not affiliated with a particular religious tradition do not necessarily lack religious beliefs or practices. In fact, a large portion (41%) of the unaffiliated population says religion is at least somewhat important in their lives.

A Roman Catholic college student stops going to Mass on Sundays and moves in with her boyfriend; she tells you, "I really want to do this, but it still feels wrong". What type of spiritual distress is she most likely experiencing? 1) Spiritual anger 2) Spiritual pain 3) Spiritual anxiety 4) Spiritual guilt

4 p. 1660. Failure to live according to religious rules.

A 79 year old Native American woman is placed in a nursing home by her son, who is no longer able to care for her. She appears disoriented and complains of the "bright lights and constant activity". Her feelings are likely to be a result of which of the following conditions. 1) Culture assimilation 2) Culture disorientation 3) Culture blindness 4) Culture shock

4 p. 26. Culture shock is defined as feeling a person experiences when placed in a different culture perceived as strange. Culture shock may result in psychological discomfort or disturbances, as the patterns of behaviors a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new one. The person may feel foolish, fearful, incompetent, inadequate, or humiliated.

Which of the following statements about food accurately reflects foods that are dibble for various cultural groups? 1) For some Asians, Hispanics, and Seventh-Day Adventists, religious beliefs prohibit the consumption of pork 2) Patients following a vegetarian diet generally eat chicken 3) Vietnamese patients will not eat beans 4) French patients consider corn to be animal feed

4 p. 29, box 2-1. Dietary teaching must be individualized according to cultural values about the social significance and sharing of food. A culturally sensitive assessment of nutrition should be provided. In France, corn is considered an animal feed, whereas corn is a commonly eaten vegetable in the US.

Nursing is a subculture of which of the following larger cultures in our society? 1) Healthcare providers 2) Organizations of nurses 3) Institutions 4) Healthcare systems

4 p.31. The healthcare system is itself a culture with customs, rules, values, and a language of its own, with nursing as its largest subculture.

Humalog and NovoLog should be given _______ and regular insulin should be given _______ before meals. A) 0-15 minutes; 30 minutes. B) 30 minutes; 1 hour. C) 20-30 minutes; 15 minutes. D) 1 hour; 30 minutes.

A Lewis, p. 1224. Rapid-acting synthetic insulin analogs, which include Lispro (Humalog), aspart (NovoLog) and glulisine (Apidra), have an onset of action of approximately 15 minutes and should be injected 0-15 minutes before the meal. These rapid acting analogs most closely mimic natural insulin secretion in response to a meal. Short-acting regular insulin has an onset of action 30-60 minutes and should be injected 30-45 minutes before a meal to ensure that the onset of action coincides with meal absorption.

Which of the following statement most appropriately characterizes Type 1 diabetes ? A) Obesity. B) Lack of any insulin production. C) Insulin resistance. D) Inadequate insulin production.

B Lewis, p. 1219, Table 49-1. If the students examine this table, they will find that type 2 diabetes is characterized by obesity and lack of exercise, insulin resistance and decreased insulin production over time. Type 1 diabetes is characterized by absent or minimal insulin production.

For a finger stick blood sugar (FSBS) less than 40, the patient should be given which of the following: A) 8 ounces diet pop. B) 4-6 ounces fruit juice. C) 8 ounces milkshake. D) 4 packages of sugar mixed in 4 ounces of fruit juice.

B Lewis, p. 1246. "A' is not the answer because there is no fast-acting carbohydrate in a diet drink. "C" is not the answer because it may contain fat and fat may slowdown the absorption of sugar and delay the response to treatment. "D" is not the answer because this intervention may be overtreatment of large quantities of fast-acting carbohydrate. This may cause a rapid fluctuation to hyperglycemia and this should be avoided. "B" is the most appropriate treatment.

Which one of the following is not a counter regulatory hormone? A) Glucagon. B) Epinephrine. C) Ephedrine. D) Growth factor.

C

For a person with diabetes, which hemoglobin A1c test result is the most desirable? A) 9. B) 11.5. C) 6.5. D) 2.

C Lewis, p. 1222. For people with diabetes, the ideal A1C goal is 7.0% or less, according to the American Diabetes Association. The American College of Endocrinology recommends an A1C of less than 6.5%.

Which class of diabetic drugs primarily act to stimulate insulin secretion in order to achieve euglycemia? A) Metformin (class: biguanide; Glucophage). B) a-glucosidase inhibitors. C) Sulfonylureas (Glucotrol, Amaryl). D) Glitazones (TZDs or thiazolidinediones - Actos; Avandia).

C Lewis, p. 1229, Table 49-7. Metformin decreases rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles; Sulfonylureas stimulate release of insulin from pancreatic islets. Glitazones increase glucose uptake in the muscle and decrease endogenous glucose production. a-glucosidase inhibitors delay absorption of glucose from the GI tract.

A patient is exhibiting hyperglycemia. A priority nursing diagnosis would be: A) Disabled family coping: compromised. B) Knowledge deficient: disease process and treatment. C) High risk for fluid volume deficient. D) Imbalanced nutrition: less than body requirements.

C Lewis, p. 1242, Table 49-17. By examining the table, one compares manifestations of hypoglycemia with hyperglycemia. With hyperglycemia, there is increases urination, which places the patient at high risk for fluid volume deficit, which is a priority over knowledge deficit, imbalanced nutrition and disabled family coping (losing fluid is always a priority over less than nutritional requirements). Hyperglycemia produces an osmotic effect which produces polyuria, polydipsia and polyphagia.

A client with type II diabetes mellitus demonstrates a finger stick blood sugar (FSBS) of 120 mg/dL, a temperature of 101 degrees Fahrenheit , pulse of 88, respirations (RR) of 22, and blood pressure (BP) of 140/84 mm Hg. Which finding would be of most concern to the nurse? A) RR. B) BP. C) Temperature. D) Pulse.

C Lewis, p. 1251. The temperature of this client is a clue that he/she may be experiencing an infection. This situation will require more intense management, such as extra insulin to maintain glycemic goals and avoid hyperglycemia.

Which medication is the one most likely to contribute to hyperglycemia? A) Allopurinol (Zyloprim). B) Phenelzine (Nardil). C) Atenolol (Tenormin). D) Prednisone (Deltasone).

D Lewis, p. 1231, Table 49-8. Atenolol (ß-blocker), Phenelzine (monoamine oxidase inhibitor) and allopurinol (xanthine oxidase inhibitor) are listed as those that lower blood glucose. Prednisone is a corticosteroid and is well-known to raise blood glucose.

Which of the following are symptoms of mild hypoglycemia? A) Fatigue, headache, slurred speech. B) Blurred vision, bradycardia, dizziness. C) Coma, seizures. D) Tremors, hunger, weakness.

D Lewis, p. 1242, Table 49-17 has the comparison of hyperglycemia and hypglycemia. The student should know the major differences between hypoglycemic and hyperglycemia symptoms. Common manifestations of hypoglycemia can mimic alcohol intoxication. Symptoms include: confusion, irritability, diaphoresis, tremors, hunger, weakness and visual disturbances. Hyperglycemia, especially from type 1 diabetes is primarily manifested by polyuria, polyphasia, and polydipsia. Weakness and fatigue can also be exhibited. Those symptoms commonly found with hyperglycemia episode from type 2 diabetes included recurrent infections, prolonged wound healing and visual changes.