NUR 1020C Test 3 Intro Nursing

What are the priority nursing interventions for a client with neutropenia in an emergency department? Select all that apply. Monitor for rashes and pruritus. Prepare an appropriate diet plan. Obtain blood cultures immediately. Teach hygiene measures to be followed. Administer antibiotic STAT as prescribed.

Rationale Identifying the causative agent for neutropenia is important for starting treatment. Therefore the priority nursing intervention is to obtain blood cultures immediately and administer antibiotic STAT as prescribed to the client. The nurse can monitor for rashes and pruritus after administering the medication. The nurse can prepare a diet plan and teach hygiene measures after stabilizing the client.

A nursing student is examining different scenarios to understand Quality and Safety Education for Nurses (QSEN) competencies. Which scenarios are examples of the QSEN competency called quality improvement? Select all that apply. A nurse studies old medical cases about clients with Alzheimer's disease before formulating the care plan for a client. A nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional healthcare practices. A nurse demonstrates the method of using electronic health records to assure a client about confidentiality of the records. A nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators. A nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights.

A nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional healthcare practices. A nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators. A nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights. Rationale According to the Quality and Safety Education for Nurses (QSEN) competency called quality improvement, a nurse should use data to monitor the outcomes of care processes. The nurse should also use improvement methods to design and test changes in order to improve the quality of healthcare services. A nurse who uses data to compare the effectiveness of two different types of healthcare practices is an example of quality improvement. A nurse who complies with quality improvement would design a method of ensuring surgical asepsis to bring about a qualitative change in healthcare delivery. After implementing a weekly client education program about the use of nurse call lights, the nurse notes a decline in client injuries. The nurse then prepares a flow chart to show the improvement in the safety of the health care delivery system. This is another example of quality improvement. The nurse adheres to evidence-based practice by referring to old cases of Alzheimer's disease in order to formulate a care plan for a new client. The concept of informatics requires the nurse to use information and technology to communicate, manage knowledge, mitigate errors, and support decision-making. The nurse complies with this competency by demonstrating to a client that the proper use of electronic health records helps in maintaining confidentiality of medical information.

A nurse assesses the vital signs of a 50-year-old female client and documents the results. Which of the following are considered within normal range for this client? Select all that apply. Oral temperature of 98.2° F (36.8° C) Apical pulse of 88 beats per minute and regular Respiratory rate of 30 per minute Blood pressure of 116/78 mm Hg while in a sitting position Oxygen saturation of 92%

Oral temperature of 98.2° F (36.8° C) Apical pulse of 88 beats per minute and regular Blood pressure of 116/78 mm Hg while in a sitting position Rationale The client's temperature, pulse, and blood pressure are within normal ranges for a 50-year-old female. The client's respirations are mildly elevated, and the oxygen saturation level is below normal. A normal respiratory rate for a female client in this age group would be 12 to 20 per minute, and oxygen saturation level should be 95%.

The nurse is caring for a client with tuberculosis. Which suggestions from the nurse will be beneficial for the client? Select all that apply. <p>The nurse is caring for a client with tuberculosis. Which suggestions from the nurse will be beneficial for the client? <b>Select all that apply.</b> </p> "Take the daily dose during daytime." "Avoid exposure to any inhalation irritants." "Eat foods that are rich in protein, vitamins C and B." "Cover the mouth and nose with a tissue when coughing or sneezing." "Avoid sputum specimens for 2 to 4 weeks once drug therapy is initiated."

Rationale A client with tuberculosis should avoid exposure to any inhalation irritants because these can cause further lung damage. To increase physical stamina, the client should eat a well-balanced diet that includes foods that are rich in iron, protein, and vitamins C and B. While coughing or sneezing, the client should cover the mouth and nose with a tissue to prevent spread of infection. A client with tuberculosis should take the daily dose at nighttime to prevent nausea. Sputum specimens are usually needed every 2 to 4 weeks once the drug therapy is initiated. When the results of three consecutive sputum cultures are negative it indicates that the client is no longer infectious.

An older adult is brought to the emergency department after being found in the street without a coat during a snowstorm. What actions should the nurse implement? Select all that apply. Massage extremities. Obtain a rectal temperature. Assess the fingers for areas of frostbite. Determine client's level of consciousness. Ask for client identification.

Rationale A rectal temperature provides the most accurate temperature. Older adults have less subcutaneous fat and inefficient temperature-regulating mechanisms, which makes them vulnerable to extremes in environmental temperature. The extremities are more distal sites of circulation and are at increased risk for frostbite. Hypothermia decreases cerebral perfusion, which will result in confusion and a decreased level of consciousness. Getting client identification will help in learning more about the client's previous health history and aid in contacting family members. Massage is contraindicated because it may injure tissues that have sustained frostbite.

Which qualities should a nurse who is promoted to leader of a unit possess? Select all that apply. Having adaptability to hospital rules Encouraging the newly appointed nurses Penalizing the nurses for poor performance Doubting the healthcare staff performances Being aware about the events of organization Collaborating with the staff for decision making

Rationale As a leader, the nurse should be able to adapt to the rules of the hospital to perform accordingly. A nurse leader should motivate or encourage the newly appointed staff to reach the desired goals. A nurse leader should also be aware of any organization events; this helps in managing the team effectively. Collaboration with the staff and allowing them to participate in decision making helps to reduce medical errors and improves job satisfaction. Penalizing the nurses for poor performance is the duty of the nurse manager. Incredulity or doubting the staff performance may reduce job satisfaction instead of motivating nurses to improve their performance.

Which symptoms of depression, often overlooked in the older adult client, should the nurse include in the assessment process? Select all that apply. Anxiety Insomnia Weight loss Weight gain General fatigue Test-Taking Tip: Look for the option based on the responsibilities and traits of a leader. Correct (8)

Rationale Insomnia and general fatigue are symptoms of depression that are often overlooked for the older adult client. Anxiety, weight loss and weight gain are all symptoms of depression; however, these symptoms are not often overlooked for the older adult client.

The nurse is teaching a sex education course to high school students. What information should the nurse provide regarding the rationale for an increase in gonorrhea prevalence? Select all that apply. <p>The nurse is teaching a sex education course to high school students. What information should the nurse provide regarding the rationale for an increase in gonorrhea prevalence? <b>Select all that apply.</b> </p> Symptoms of the disease are vague. Screening blood tests are expensive. The incubation period is relatively short. Causative organisms have become resistant to treatment. Diagnostic tests for the causative organism are not yet available.

Rationale Many clients with gonorrhea are asymptomatic. The incubation period is 3 to 5 days. There is no effective, readily available blood test for gonorrhea. Gonorrhea responds well to treatment, but the Centers for Disease Control and Prevention has received several reports of resistant strains. At times backup secondary medications must be used in order to treat the infection. Urethral/vaginal smears or cultures are specific for the identification of the gonococcal organism.

The nurse observes a client with chronic obstructive pulmonary disease (COPD) breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. What action should the nurse take? Encourage the client to take slow, deep breaths and administer 5 L/min oxygen per nasal cannula. Place the client in a side-lying position and perform chest physiotherapy using clapping and vibration. Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula. Assist the client in assuming a position of comfort and perform postural drainage.

Rationale Sitting facilitates breathing by increasing lung expansion; 2 L of oxygen promotes respirations while preventing carbon dioxide narcosis. However, the

An adolescent is admitted to the hospital in respiratory distress, and the primary healthcare provider prescribes oxygen at 40% by way of a Venturi mask. The instructions for the Venturi mask indicate that delivery of 4 L/min equals 24% to 28% oxygen, delivery of 8 L/min equals 35% to 40% oxygen, and 12 L/min equals 50% to 60% oxygen. Where should the ball of the flow meter should be raised to deliver the percentage of oxygen prescribed by the primary healthcare provider? src="//eolscontent.elsevier.com/10D35D8019H/image/4840_adolescents_q71_image.png" alt=""/> </p> A B C D Analgesics alleviate pain by binding with opioid receptors in the brain, thus altering the perception of and response to pain; patient-controlled analgesia (PCA) via an epidural catheter gives the client control over medication administration and usually results in the client using less medication. Opioids do not facilitate oxygen use; they decrease the respiratory rate, and less oxygen is used; the client should be monitored. Although decreasing anxiety and restlessness may be responses to an opioid, they are not the primary reason why opioids are used after abdominal surgery. Opioids are not given to dilate blood vessels; antianginal medications and vasodilators are used for this purpose. The nurse is preparing to educate a group of clients about health promotion to prevent head and neck cancer. Which clients are of highest priority for education? Select all that apply. A client who chews tobacco A client who has multiple sex partners A client who uses condoms when having sex A client with a history of alcohol abuse for 5 years A client who brushes with a soft bristle toothbrush Rationale Tobacco, alcohol, and human papilloma virus (HPV) are the major causes of neck cancer. The nurse should counsel the client who chews tobacco and educate regarding the importance of oral hygiene. The nurse should advise the client to stop chewing tobacco to reduce the risk of head and neck cancer. The nurse should educate the client with multiple sex partners about protecting against human papilloma virus (HPV), which is a risk factor for cancer. The nurse should place a high priority on health promotion in a client with a history of alcohol abuse for 5 years because it is one of the major risk factors for head and neck cancer. The client should use condoms when having sex with potentially infectious partners to prevent HPV infections that can lead to head and neck cancer. A client should maintain proper oral hygiene by brushing his or her teeth regularly with a soft bristle brush and flossing. In which role does the nurse oversee the budget of a specific nursing unit or agency? Nurse educator Nurse manager Nurse researcher Nurse practitioner Rationale The nurse manager is responsible for the budget of a specific nursing unit or agency. The nurse educator works primarily in schools of nursing, staff development departments of health care agencies, and client education programs. The nurse researcher investigates problems to improve nursing care. The nurse practitioner provides health care to a group of clients usually in an outpatient, ambulatory care, or community-based setting. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively. A postmenopausal woman who has cancer of the breast decides to have a lumpectomy followed by chemotherapy. After receiving chemotherapy for several weeks, she tells the nurse that she does not feel well. The nurse reviews the medical record and notices WBCs 2200/mm 3 (2.2 x 10 9/L), RBCs 4.0 million/mm 3 (4.7 x 10 12/L), hemoglobin 12.0 g/dL (120 mmol/L), hematocrit 38%, platelets 170,000/mm 3 (170 x 10 9/L). Vital signs are heart rate 97 beats/minute, respiration rate 25 breaths/minute, oral temperature 99.1 ºF (37.3 ºC), blood pressure 110/72. Based on this information, what does the nurse conclude is the client's priority need? Promoting rest Preventing infection Avoiding bodily harm Maintaining fluid balance Rationale The prevention of infection is the priority because an infection can be life threatening for a client who is immunocompromised. Chemotherapeutic medications depress the bone marrow, causing leukopenia. This client's white blood cell count is below the expected range of 4500 to 11,000/mm 3 (4.5 to 11 x 10 9/L) for an older female adult. Although the elevation in the client's temperature, pulse, and respirations may be related to the direct effects of the chemotherapeutic agents, they also may reflect that the client is resisting a microbiologic stress. Although a balance between rest and activity is important, it is not the priority. Although chemotherapeutic medications depress the bone marrow and cause anemia, this client's red blood cell count is within the expected range of 4.0 to 5.0 million/mm 3 (4.7 to 6.1 x 10 12/L) for an older female adult. The client's hemoglobin level is within the expected range of 11.5 to 16.0 g/dL (115 to 160 mmol/L). Even though preventing injury is important, it is not the priority. Although chemotherapeutic medications depress the bone marrow, causing thrombocytopenia, this client's platelet count is within the expected range of 150,000 to 400,000/mm 3 (150 × 10 9 /L to 400 × 10 9 /L) for an adult. Although maintaining fluid balance is important, it is not the priority. The client's hematocrit is within the expected range of 38% to 41% for an older female adult, indicating that the client is not dehydrated. The client's blood pressure is not decreased, which occurs with dehydration. Although chemotherapeutic medications may cause nausea, vomiting, and diarrhea, the client did not indicate that these occurred. Which client would the nurse consider to have the highest risk of pneumonia? Client 1 Client 2 Client 3 Client 4 Rationale Client 4, who is an older adult with chronic lung disease and has received the pneumococcal vaccination more than 5 years ago, has the highest risk of pneumonia. An infection may occur because older adults with chronic lung disease are at a higher risk of infection. Client 1 received the pneumococcal vaccination in the last 3 months and thus has a lower risk of pneumonia. Client 2 received a pneumococcal vaccination in the last 2 years and may not have an elevated risk of pneumonia. Client 3 may have a lower risk of pneumonia due to receiving the pneumococcal vaccine a year ago.

Rationale The ball of the oxygen flowmeter should be set at 8 L/min, shown in Option C, to deliver 40% oxygen through the Venturi mask.

What is the main reason a nurse raises three of the four side rails on the bed of an 83-year-old client who had surgery for a fractured hip? As a safety measure because of the client's age Because clients older than 60 years of age should use side rails To be used as handholds to facilitate the client's ability to move in bed Because all older adults are disoriented for several days after anesthesia As a safety measure because of the client's age

Rationale The need to use side rails for safety is important with any older client because the client could fall or try to get out of bed without assistance. Side rails are not always used on all clients over 60 years of age. Each individual must be evaluated based on mental and physical status. The client may use the side rails to move around in bed, but safety is always first. Some older adults become disoriented for a few days after anesthesia, but not all older adults.

A registered nurse is teaching a nursing student about the importance of values in nursing practice. Which information provided by the registered nurse is appropriate? Select all that apply. "People may consider strong values as opinions." "Evaluate a client's values and beliefs in terms of your own values." "Values vary among clients and develop and change over time." "The values that an individual holds reflect cultural and social influences." "To discuss differences in opinions and values, the nurse should be clear about his or her own values."

Rationale The nurse should know that values vary among people and develop and change over time. The nurse should know that the values an individual hold reflect cultural and social influences. The nurse should know that it is important to be clear about one's own values before discussing the differences of opinions and values. People consider strong values as facts rather than opinions. The nurse should never evaluate the client's values and beliefs in terms of his or her own values and beliefs.

What are the minor attributes that affect the quality of care provided for the client by the nurse? Select all that apply. Timely care Equitable care Cost-effective care Patient-centered care Sound decision-making

Safe Effective Efficient Rationale Being equitable, being timely, and patient-centered care are the minor attributes that affect the quality of care. Equitability helps the nurse provide similar quality of care to all the clients irrespective of their gender, ethnicity, geographic location, or socioeconomic status. Being timely reduces the wait times and harmful delays in treatment. Patient-centered care helps nurses treat clients with respect and dignity and to make the client feel comfortable. Cost-effective care and sound decision-making are the major attributes that affect the quality of care.

Which method of oxygen delivery should a nurse anticipate will be prescribed for a client with a pulse oximetry reading of 65%? Face tent Venturi mask Nasal cannula

results of one recent study of clients with stable COPD indicate that the hypercarbic drive is preserved with oxygen higher than 2 L. More research is needed before this theory is applied clinically. Five liters of oxygen may cause respiratory depression and carbon dioxide narcosis in a client with COPD. Chest physiotherapy may be done later after the client's condition improves. Delaying intervention likely will worsen the respiratory distress. Nonrebreather mask Rationale The expected value of a pulse oximetry reading is 95% to 100%. Nonrebreather mask will deliver high oxygen concentrations (95% to 100%) at a liter flow of 10 to 15 L/min. When using a nonrebreather mask, the client breathes only the oxygen source from the bag. A face tent delivers 30% to 50% oxygen when set at a flow rate of 4 to 8 L/min. A Venturi mask delivers 24% to 50% oxygen when set at a flow rate of 4 to 10 L/min. A nasal cannula delivers 24% to 45% oxygen when set at a flow rate of 2 to 6 L/min.