PN Learning System Comprehensive Final Quiz: Focus review for my mistakes.
#124: A nurse is caring for a client who is taking acarbose to treat type 2 diabetes mellitus. For which of the following adverse effects of this medication should the nurse monitor?
Diarrhea. The most common adverse effects of acarbose, an alpha-glucoside inhibitor, are gastrointestinal. They include diarrhea, abdominal distention and cramping, and flatulence.
#118: A nurse in a substance use disorder program is interacting with a client. Which of the following statements indicates that the client is using intellectualization as a ways of coping with the anxiety of admission?
"I have read that problems with substances can have a variety of predisposing factors." The nurse should identify this response as a use of intellectualization. Intellectualization is an attempt to use intellectual processes to avoid expressing the emotions that stem from stressful situations.
#93: A female client who has recurrent cystitis asks the nurse about preventing future episodes. For which of the following statements should the nurse provide further reinforcement of teaching?
"I prefer tub baths to showering." Cystitis is an inflammation of the bladder lining that commonly occurs with a urinary tract infection (UTI). Women who are at risk for UTIs should avoid tub baths because they increase the risk for infection. The nurse should remind the client to take showers instead of tub baths.
#89: A nurse is reinforcing teaching with a client who has a spinal cord injury and will need to perform intermittent urinary self-catheterization at home after discharge. Which of the following statements indicates that the client understands the procedure?
"I will perform intermittent self-catheterization every 2 to 3 hours." The client may initially require self-catheterization every 2 to 3 hr with the frequency eventually increasing to every 4 to 6 hr. A longer interval can result in bladder distention and increased risk for urinary tract infection.
#102: A nurse is reinforcing teaching with a school-age child who has just had a fiberglass cast application following lower-extremity fracture. Which of the following instructions should the nurse reinforce with the child and his parents about care during the first 48 hr?
"Keep the cast above the level of your heart." Immediately following the injury, and for at least the first 48 hr, the child should keep the affected limb above the level of the heart to help prevent edema and pain and to promote venous return.
#106: A nurse is collecting data from a 66-year-old client during a routine physical examination at her first clinic visit and she does not have her medical records. When the nurse asks if she has received the pneumococcal immunization, the client replies, "I am not sure, but it's been at least 5 years since I had any immunizations." Which of the following responses should the nurse make?
"Let's go ahead with giving you this immunization." The Centers for Disease Control and Prevention recommends this immunization for people who are 65 years old and older. If the client did receive this immunization more than 5 years ago, the nurse should administer another one because the client is over 65.
#117: A nurse is collecting data from a preschooler who has recurrent and persistent otitis media. When obtaining the child's history from her parent, which of the following questions should the nurse ask?
"Does anyone smoke around or in the same house as your child? " Otitis media is an infection of the middle ear. Passive smoking promotes adherence of respiratory pathogens to the lining of the middle ear space. It also prolongs the inflammation and impedes drainage from the ear.
#112: A nurse is reinforcing teaching with a client who is going to have an electroencephalogram (EEG) in the morning. Which of the following information should the nurse provide the client?
"Shampoo your hair before the procedure, and don't put any styling products on it afterward." An electroencephalogram (EEG) is a painless test that records the electrical activity of the brain. For the test, the technician attaches electrodes to the scalp to record the tiny electrical charges the nerve cells in the brain release. So that the electrodes will adhere to the scalp, the client's hair has to be clean and free of oil and hair-care products.
#5: A client at a routine prenatal care visit asks the nurse if it is common to develop vaginal yeast infections during pregnancy. Which of the following responses should the nurse make?
"The hormonal changes of pregnancy change the acidity of the vagina, making yeast infections more common." This is an information-seeking question; therefore, the therapeutic response is an answer that provides the client with the information she is requesting.
#9: A nurse at a family planning clinic is preparing to give a presentation to clients about how to use a diaphragm. Which of the following information should the nurse plan to include in the session?
"Use spermiciadal jelly whenever you use your diaphragm." A diaphragm is a barrier device that helps prevent pregnancy. Use of a diaphragm alone is not 100% effective in preventing pregnancy, but the use of spermicidal jelly with it increases the effectiveness of the device.
#108: A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse make?
"You don't have to give up pasta; just adjust the amount you eat." The American Diabetes Association recommends individualizing carbohydrates restriction for each client. A careful evaluation of the client's usual dietary practices and modifications is an important part of helping clients manage this disorder.
#33: A nurse is reinforcing teaching with a client who is scheduled for laser-assisted in situ keratomileusis (LASIK) surgery. Which of the following information should the nurse include?
"Your procedure will only take 10 or 15 minutes for each eye." LASIK is a type of refractive laser eye surgery performed to correct myopia, hyperopia, and astigmatism, which are common causes of nearsightedness. The procedure typically takes 10 to 15 min per eye.
#46: A nurse is reinforcing teaching with a client who has come to the family planning clinic requesting an intrauterine device (IUD). Which of the following information should the nurse reinforce with the client?
"Your risk for ectopic pregnancy increases with an IUD." An IUD is a family planning device the provider inserts through the cervix into uterus to prevent pregnancy. The IUD works by changing the lining of the uterus and Fallopian tubes, making fertilization in the uterus more difficult. Consequently, an IUD increases the risk for ectopic pregnancy.
#46: A nurse is caring for a toddler. Which of the following objects should the nurse select from the playroom for this child during hospitalization?
A 10-piece wooden puzzle. Age-appropriate toys for a toddler include puzzles, large crayons, blocks, picture books, push-pull toys, finger paints, modeling clay, and musical toys. These toys allow for manipulation and exploration and meet the child's developmental and diversional activity needs.
#20: A community health nurse is contributing to the plan of care for four high-risk newborns who were discharge yesterday. Which of the following newborns should the nurse recommend to care for first?
A 4-day-old newborn who has an elevated bilirubin level and requires phototherapy. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to the client's safety, the risk posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which of risk poses the greatest threat to the client. An elevated bilirubin level can lead to kernicterus; therefore, it is imperative for the nurse to initiate phototherapy immediately to help prevent this dangerous outcome.
#65: A nurse on a pediatric unit receives the laboratory results for several clients. Which of the following results should the nurse report to the provider?
A client who has diabetic ketoacidosis (DKA) and a blood glucose of 375 mg/dL. The initial goal of therapy for DKA is a blood glucose level below 240 mg/dL. To accomplish this, the client should receive regular insulin via continuous IV infusion, and the nurse should monitor the blood glucose level hourly. The nurse should report the client's result so that the provider can adjust the insulin dosage.
#85: A nurse is assisting with the plan of care for a client who is postoperative following a hip arthroplasty. In the client's medical record, the nurse notes a history of chronic obstructive pulmonary disease (COPD). Which of the following oxygen-delivery methods should the nurse recommend to use for this client?
A nasal cannula. A nasal cannula delivers precise concentrations of oxygen; therefore, it is an appropriate device for a client who has COPD and requires a precise percentage of inspired oxygen.
#1: A nurse on a pediatric unit is assisting with the plan of care for a preschooler who will be having a surgical procedure in the morning. The child has been crying despite his parent's presence at his bed side. The nurse should recommend engaging the child in therapeutic play for the care plan because it offers which of the following benefits?
Allows the child to manipulate toy medical equipment. A major function of play therapy is making potentially unmanageable situations manageable through symbolic representation, which provides children with opportunities to learn to cope. A preschooler does not have the language development to express his fear of the unfamiliar medical equipment in the hospital. The nurse encourages the child to touch the equipment to decrease the child's fear and intimidation in a safe environment using age-appropriate vocabulary. The use of toys enables children to transfer anxieties, fears, fantasies, and guilt to objects rather than people.
#72: A nurse in an urgent care center is reviewing laboratory results for several clients who have manifestations of influenza. Which of the following clients should the nurse report to the provider immediately?
An infant who WBC count is 24,000/mm3. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. This WBC count is high and indicates infection and possibly sepsis, which poses the greatest risk to the client. The provider must initiate blood, urine, and spinal fluid cultures and begin antimicrobial therapy.
#54: A nurse is facilitating a group discussion with preschool teachers about child abuse. Which of the following data should the nurse use as a common example of a suggestive finding?
Arm cast for a spiral fracture of the forearm. Spiral fractures occur from twisting of an extremity. In most instances, spiral fractures of the arm result from an abusive injury.
#26: A nurse is assisting with the admission of a child who has a urinary tract infection (UTI) and a history of myelomeningocele. After the admission history is complete, which of the following actions should the nurse recommend?
Attach a latex allergy alert identification band. Myelomeningocele, a serious complication of spina bifida, is a neural tube defect in which the spinal cord and meninges are in a cerebrospinal fluid-filled sac at birth. Clients who have neural tube defects are at risk for latex allergy; therefore, the nurse should avoid the use of common medical products containing latex, such as latex gloves, for this client.
#121: A nurse is caring for a client who has deep partial-and full-thickness burns and requires a topical antimicrobial drug. The nurse should reinforce with the client that the goal of this medication therapy is to reduce which of the following outcomes?
Bacterial growth. Topical antimicrobial medications (particularly broad-spectrum antimicrobials) help prevent bacteria from entering the body when a client has an impairment of the protective covering of the skin, as with burns. It creates a protective barrier, along with the dressing, between bacteria and the exposed body tissues. This therapy helps prevent infection.
#63: A nurse is reinforcing discharge teaching with a client who had a transient ischemic attack (TIA). The nurse should instruct the client to monitor which of the following parameters at home?
Blood pressure. A temporary disturbance of the blood supply to the brain causes TIAs, which are brief alterations in neurologic function. The most common causes are atherosclerotic plaque in the carotid arteries and hypertension; therefore, the client should track his BP regularly to promote hypertension management and reduce the risk of cerebrovascular accident.
#6: A nurse in a prenatal clinic is collecting data from several clients. Which of the following client reports should the nurse identify as an expected physiologic adaptation to pregnancy?
Breast tenderness. Breast tenderness is common during the first and third trimesters of pregnancy. The nurse should explain to the client that this is expected and that she should wear a well-fitting, supportive bra to help alleviate the tenderness.
#120: A nurse is collecting data from a toddler who has AIDS. The nurse should identify which of the following findings as an indication of an opportunistic infection?
Candidiasis. Candidiasis, or oral thrush, results from the overgrowth of Candida albicans, an opportunistic fungus that commonly infects the oral cavity of clients who have immature or compromised immune systems. Candidiasis appears as a cheesy, white plaque that looks like milk curds on the buccal mucosa and tongue. Thrush is often the initial opportunistic infection in an HIV-positive child who is developing AIDS.
#52: A nurse is reinforcing teaching with an assistive personnel (AP) about dietary restriction for a client who is taking phenelzine to treat depression. The AP's selection of which of the following foods for the client's lunch indicates an understanding of the instructions?
Chicken salad. Pheneizine is an MAOI. Clients taking MAOIs must avoid foods that contain tyramine due to a dangerous food-drug interaction. Foods high in tyramine include those that are processed and aged, such as luncheon meats and cheeses. This menu selection does not contain food high in tyramine; therefore, it is the best choice.
#4: A nurse is caring for a client during her first prenatal visit and notes that she is lactose intolerant. Which of the following foods should the nurse include on a list of calcium sources for this client?
Collard greens. Collard greens are a good source of lactose-free calcium. One cup of collard greens provides approximately the same amount of calcium as the equivalent volume of 240 mL (8 oz) of milk. They also contain folic acid, which is a nutrient women should consume during pregnancy to prevent birth defects.
#73: A nurse is caring for a client who has new diagnosis of acute systemic lupus erythematous (SLE) and is to begin medication therapy. Which of the following types of medications should the nurse expect to administer?
Corticosteroids. Corticosteroids, such as prednisone, are the treatment of choice for acute systemic manifestations of SLE because of their rapid anti-inflammatory action.
#25: A nurse is collecting data from a client who is taking varenicline for smoking cessation. Which of the following findings is nurse's priority?
Erratic behavior. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The greatest risk to the client is the development of neuropsychiatric effects that can progress to depression and suicide. Therefore, the highest priority finding is erratic behavior.
#123: A nurse is reviewing the laboratory data of a client who reports manifestations that suggest systemic lupus erythematous (SLE). The nurse should expect an increase in which of the following parameters for a client who has SLE?
Erythrocyte sedimentation rate (ESR) SLE is a chronic systemic autoimmune disease that causes skin, heart, lung, and kidney inflammation. Like most autoimmune diseases, a series of exacerbations and remissions is typical. Most clients who have an exacerbations of SLE have an increased ESR.
#111: A nurse is assisting with the care of a client who has Addison's disease and comes to the emergency department reporting nausea, vomiting, diarrhea, and abdominal pain. To prevent Addisonian crisis, the nurse should expect that the provider will prescribes which of the following medications?
Hydrocortisone. Addison's disease causes adrenal gland's hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening, with severe fluid and electrolyte imbalances. Without treatment, sodium levels fall and potassium levels increase. Rapid infusion of IV fluids, such as 0.9% sodium chloride, and IV administration of high dose corticosteroids, such as hydrocortisone, to correct the glucocorticoid deficiency are essential.
#42: A nurse is caring for a client who is taking warfarin. Which of the following laboratory values should the nurse recognize as an effective response to the medication?
INR 3.0 Warfarin is an anticoagulant that prevents thrombus formation in susceptible clients. The INR measures its effectiveness. For most clients taking warfarin, an INR of 3.0 indicates effective therapy.
#37: A charge nurse is coordinating the evacuation of clients from a facility following a bomb threat. Which of the following actions should the nurse take when implementing the evacuation process?
Instruct clients who are able to ambulate to leave. Clients who are able to ambulate should leave first in an evacuation process because it quickly reduces the number of clients who require evacuation assistance.
#24: A nurse on the antepartum unit is caring for a client who is at 28 weeks of gestation and reports dizziness when lying on her back. Into which of the following positions should the nurse assist the client?
Lateral. A lateral, or side-lying position, promotes uteroplacental blood flow and thus helps relieve the symptoms of supine hypotension, including faintness, dizziness, and breathlessness.
#18: A nurse is collecting data from a client who has tuberculosis and a prescription for ethambutol. The nurse should inform the client that he is likely to develop which of the following alterations as an adverse effect of this medication?
Loss of red/green color discrimination. Ethambutol is an anti tubercular medication that impairs ribonucleic acid synthesis. A common adverse reaction is the loss of red/green color discrimination due to optic neuritis. The nurse should notify the provider of this finding and expect a prescription to discontinue the medication.
#53: A nurse is caring for an infant who is experiencing dehydration. Which of the following data related to hydration status is the nurse's priority to collect?
Measure the client's weight daily. The nurse should apply the urgent versus non-urgent priority-setting framework. Using this framework, the nurse should consider urgent findings the priority because they more readily indicate the degree of threat to the client. The nurse may also need to use nursing knowledge to identify which finding is the most critical. Daily weights are the most sensitive indicator of fluid balance in clients of all ages. Daily weights are especially critical for infants and children because fluid accounts for a greater portion of body weight.
#31: A nurse is caring for a client who has chronic phantom limb pain following an above-knee amputation. Which of the following medication prescriptions should the nurse verify with the provider?
Meperidine. Opioids are more effective for residual limb pain rather than phantom limp pain; additionally, meperidine is not recommended for chronic pain because using it long-term can cause accumulation of a toxic metabolite.
#28: A nurse in an urgent care center is collecting data from an infant who has laryngotracheobronchitis. Which of the following findings should the nurse report to the provider as an indication of impending airway obstruction?
Nasal flaring. Acute laryngotracheobronchitis, or croup, causes dyspnea and swelling of the upper airway. Indications of impending airway instruction include tachycardia, tachypnea, increasing restlessness, flaring nares, and intercostal retractions.
#22: A nurse is reinforcing teaching for a client who has coronary artery disease about the difference between angina pectoris and a myocardial infarction (MI). Which of the following manifestations should the nurse identify as indications of an MI? (Select all that apply.)
Nausea and vomiting. Diaphoresis and dizziness. Anxiety and feelings of doom. Nausea, vomiting, and epigastric distress are common manifestations of MI. Diaphoresis (sweating), dizziness, fatigue, and anxiety are common manifestations of MI. Anxiety and feelings of doom and fear are common manifestations of MI.
#17: A nurse is preparing to care for a client who is in balanced skeletal tractions to stabilize a femur fracture. Which of the following actions should the nurse recommend for the client's plan of care?
Offering the client a diet high in fluid and fiber. A client who is immobile is at risk for constipation. The nurse should encourage a diet high in fluid and fiber to promote gastrointestinal function.
#91: A nurse is reinforcing teaching with the parent of a child who has severe reactive airway disease about glucocorticoid therapy. The parent asks why her child has to inhale the medication instead of taking it orally. Which of the following information should the nurse provide the parent?
Oral glucocorticoids are more likely to slow linear growth in children. Chronic use of oral glucocorticoids in high doses by children can result in decreased linear growth. Inhaled glucocorticoids deliver the anti-inflammatory agent directly to the local target area (the client's airways), resulting in a decreased risk for adrenal suppression.
#19: A nurse is assisting with the care of a client who had a precipitous delivery. The nurse should identify the collection of which of the following data as the priority during the fourth stage of labor?
Palpating the client's fundus. The should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. A precipitous delivery is one that follows labor of less than 3 hr. Regardless of the cause of the rapid delivery, uterine atony can result, causing postpartum hemorrhage. The nurse should palpate the funds and massage as needed to monitor for and reduce the risk of hemorrhage.
#61: A nurse is reinforcing teaching with a client who has a new prescription for doxycycline. The nurse should reinforce to the client the need to monitor for which of the following adverse effects of this medication?
Photosensitivity. An adverse effect of doxycycline, a tetracycline antibiotic, is photosensitivity. The skin reacts abnormally to light, especially ultraviolet radiation or sunlight. Prevention involves avoiding direct exposure to sunlight and ultraviolet light, wearing protective clothing outdoors, and using sunscreen.
#116: A nurse is planning to delegate the postoperative care of a client following an appendectomy. Which of the following actions should the nurse assign to assistive personnel (AP)?
Record urinary output after emptying the indwelling urinary catheter. Emptying an indwelling urinary catheter and recording I&O is within the scope of practice for an AP. This tasks is routine and has predictable outcome; therefore, the nurse may delegate this task to an AP.
#44: A nurse is reinforcing discharge teaching with a client who has had a transient ischemic attack (TIA). Which of the following instructions should the nurse include?
Reduce dietary sodium. A temporary disturbance of the blood supply to the brain causes TIAs, which are brief alterations in neurologic function. The most common causes are atherosclerotic plaque in the carotid arteries and hypertension; therefore, the client should limit sodium intake to help control hypertension and prevent future TIAs.
#51: A nurse is collecting data from a client who has an abdominal aortic aneurysm (AAA). Which of the following findings should indicate to the nurse that the AAA is expanding?
Report of sudden, sever back pain. An aortic aneurysm is a weak spot in the wall of the aorta that allows the aorta to expand and increase in diameter. Sudden and increasing lower abdominal and back pain indicates that the aneurysm is extending downward and pressing on the lumbar sacral nerve roots.
#60: A nurse is collecting data from a client who has an acute visual disturbance and describes it as a "curtain" pulled over his visual field with occasional flashes of light. The nurse should notify the provider that this client might have which of the following disorders?
Retinal detachment. The retina is the thin layer of light-sensitive tissue on the back of the wall of the eye. Retinal detachment is a medical emergency in which the retina of the eye peels away from its underlying layer of support tissue. Without immediate treatment, the entire retina can detach, leading to permanent vision loss. Manifestations include a sudden onset of decreased peripheral or central vision, dark floaters, flashes of light, and a s shadow or curtain over a part of the visual field.
#2: A nurse is collecting data from a school-age child who has celiac disease. Which of the following findings should the nurse expect?
Steatorrhea. Foul, fatty, frothy stools, known as steatorrhea, are a manifestation of celiac disease, a malabsorptions syndrome.
#13: A nurse is collecting data from a client who is receiving clozapine to treat schizopherenia. The nurse should identify that an increase in which of the following parameters is an early indication of agranulocytosis?
Temperature. Antipsychotic medications, such as clozapine, can cause agranulocytosis, which is the depletion of WBCs. This increases the client's risk for infection. Fever is an early indication that the client should have a WBC count checked to detect agranulocytosis.
#14: A nurse is assisting to plan teaching about secondary prevention actions for colorectal cancer for a health fair for adults in the community. Which of the following topics should the nurse recommend to include?
The importance of colonoscopy screening starting age 50 years old. Screening examinations for colorectal cancer are secondary prevention.
#40: A nurse is assisting to prepare for the transfer of a client from the post anesthesia care unit (PACU) following a subtotal thyroidectomy. Which of the following equipment should the nurse have available at the clients bedside?
Tracheostomy tray. With the laryngeal edema that is common post thyroidectomy, respiratory distress could result in airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk for hemorrhage by increasing tension on the incision during insertion. The nurse should have a tracheostomy tray available for this client.
#110: A nurse is reinforcing teaching with a client about treatment options for profound sensorineural hearing loss. The nurse should include which of the following information about the functions of cochlear implants?
Transmits impulses directly to auditory nerve endings nerve endings. Cochlear implants work by directly stimulating nerve endings in the cochlea.
#43: A nurse is preparing to administer 10 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take?
Use separate syringes for administering insulin glargine and NPH insulin. The nurse should not mix insulin glargine with any other insulin. The nurse should administer the NPH insulin and insulin glargine separately.
#45: A nurse is assisting with planning recreational activities for a young adult client who has an acute exacerbation of schizophrenia. Which of the following activities should the nurse recommend for this client?
Walking with a staff member. The nurse should plan to encourage the client to participate in nonthreatening, noncompetitive physical activities. Walking with the staff also provides an opportunity for verbal interaction between the client and the staff.