Week 3 Capstone Quiz

Filgrastim (Neupogen) 5 mcg/kg/day by injection is prescribed for a client who weighs 132 lb. The vial label reads filgrastim 300 mcg/mL. How many milliliters should the nurse administer? Record the answer using a whole number.

1ml The health care provider prescribed 5 mcg/kg; therefore, 5 × 60 = 300 mcg. This desired amount is contained in 1 mL, as indicated on the vial label.

A nurse assisting in a research study calculates the risk-benefit ratio and concludes that there were no harmful effects associated with a survey of diabetic clients. This researcher was applying which principle?

Beneficence Beneficence is defined as the promotion of well-being and abstaining from the injuring of others as well as doing good, being kind, and charitable. In this situation, the possible benefits outweigh the possible harm for the clients participating in a research study. In this situation, human dignity and human rights are underlying principles of research ethics but are not directly related to the risk-benefit ratio. Utilitarianism relates to the ethical doctrine that virtue is based on utility, and that conduct should be directed toward promoting the greatest good for the greatest number of people.

The nurse should instruct a client with an ileal conduit to empty the collection device frequently because a full urine collection bag may:

Cause the device to pull away from the skin. If the device becomes full and is not emptied, it may pull away from the skin and leak urine. Urine in contact with unprotected skin will irritate and cause skin breakdown. A full urine collection bag will not cause urine to back up into the kidneys, suppress the production of urine , or tear the ileal conduit .

A client with rheumatoid arthritis does not want the prescribed cortisone and informs the nurse. Later, the nurse attempts to administer cortisone. When the client asks what the medication is, the nurse gives an evasive answer. The client takes the medication and later discovers that it was cortisone. The client states an intent to sue. What factors in this situation must be considered in a legal action? (Select all that apply.)

Clients have a right to refuse treatment. Nurses are required to answer clients truthfully. The health care provider should have been notified. Clients who are mentally competent have the right to refuse treatment; the nurse must respect this right. Client's questions must always be answered truthfully. The health care provider should be notified when a client refuses an intervention so that an alternate treatment plan can be formulated. This is done after the nurse explores the client's reasons for refusal. The client had a discussion with the nurse that indicated that the client had sufficient information to make the decision to refuse the medication. The client has a right to refuse treatment; this right takes precedence over the health care provider's prescription.

A client reaches the point of acceptance during the stages of dying. What response should the nurse expect the client to exhibit?

Detachment When an individual reaches the point of being intellectually and psychologically able to accept death, anxiety is reduced and the individual becomes detached from the environment. Although detached, the client is not apathetic but still may be concerned and use time constructively. Although resigned to death, the individual is not euphoric. In the stage of acceptance, the client is no longer angry or depressed.

A nurse is preparing a community health program for senior citizens. The nurse teaches the group that the physical findings that are typical in older people include:

Increased blood pressure and decreased hormone production With aging, narrowing of the arteries causes some increase in the systolic and diastolic blood pressures; hormone production decreases after menopause. There may or may not be changes in libido; there is a loss of skin elasticity. Salivary secretions decrease, not increase, causing more difficulty with swallowing; there is some impairment of fat digestion. There may be a decrease in subcutaneous fat and decreasing body warmth; some swallowing difficulties occur because of decreased oral secretions.

Based on the client's reported pain level, the nurse administers 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. It is most appropriate for the nurse to ask which member of the health care team to be the witness?

Licensed practical nurse (LPN) The wasting of controlled substances should be witnessed by two licensed personnel according to federal regulations; this can be done by a registered nurse (RN) or LPN. Although the nursing supervisor is licensed and may perform this function, it is not an efficient use of this individual's expertise. Federal regulations do not require the participation by the client's health care provider in this situation. A nursing assistant is not a licensed person who can take responsibility for the wasting of controlled substances.

A senior high school student, whose immunization status is current, asks the school nurse which immunizations will be included in the precollege physical. Which vaccine should the nurse tell the student to expect to receive?

Measles, mumps, rubella (MMR) Individuals born after 1957 should receive one additional dose of MMR vaccine if they are students in postsecondary educational institutions. Currently there is no vaccine for hepatitis C. The HIB immunization is unnecessary. If the student received an additional DTaP at age 12, it is not necessary. A booster dose of tetanus toxoid (Td) should be received every 10 years.

An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance should the nurse identify based on these results?

Metabolic acidosis A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis. The CO 2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis.

A client has been admitted with a urinary tract infection. The nurse receives a urine culture and sensitivity report that reveals the client has Vancomycin Resistant Enterococcus (VRE). After notifying the physician, which action should the nurse take to decrease the risk of transmission to others?

Move the client to a private room. Contact precautions are used for clients with known or suspected infections transmitted by direct contact or contact with items in the environment, therefore, infectious clients must be placed in a private room. There is no need to insert an indwelling catheter, as this can increase the risk for additional infection. Droplet precautions are used for clients known or suspected to have infections transmitted by the droplet route. These infections are caused by organisms in droplets that may travel 3 feet, but are not suspended for long periods.

What is the most important factor relative to a therapeutic nurse-client relationship when a nurse is caring for a client who is terminally ill?

Personal feelings about terminal illness To be effective in a relationship with a client, the nurse must know and understand personal feelings about terminal illness and death. Knowledge alone is not enough to ensure an effective nurse-client relationship. Although the family is an important part of a client's support system, the client's feelings are more important to the relationship. Previous experiences can be positive or negative and will not guarantee an effective nurse-client relationship.

Alternative therapy measures have become increasingly accepted within the past decade, especially in the relief of pain. Which methods qualify as alternative therapies for pain? (Select all that apply.)

Prayer Hypnosis Aromatherapy Guided imagery Prayer is an alternative therapy that may relax the client and provide strength, solace, or acceptance. The relief of pain through hypnosis is based on suggestion; also, it focuses attention away from the pain. Some clients learn to hypnotize themselves. Aromatherapy can help relax and distract the individual and thus increase tolerance for pain, as well as relieve pain. Guided imagery can help relax and distract the individual and thus increase tolerance for pain, as well as relieve pain. Analgesics, both opioid and non-opioid, long have been part of the standard medical regimen for pain relief, so they are not considered an alternative therapy.

What does a nurse consider the most significant influence on many clients' perception of pain when interpreting findings from a pain assessment?

Previous experience and cultural values Interpretation of pain sensations is highly individual and is based on past experiences, which include cultural values. Age and sex affect pain perception only indirectly because they generally account for past experience to some degree. Overall physical condition may affect the ability to cope with stress; however, unless the nervous system is involved, it will not greatly affect perception. Intelligence is a factor in understanding pain so it can be tolerated better, but it does not affect the perception of intensity; economic status has no effect on pain perception.

A nursing supervisor sends unlicensed assistive personnel (UAP) to help relieve the burden of care on a short-staffed medical-surgical unit. Which tasks can be delegated to UAP? (Select all that apply.)

Taking routine vital signs. Answering clients' call lights. Changing linens on an occupied bed. Taking routine vital signs is a universal activity that all UAP are taught to perform regardless of the setting; it is within the job description for UAP. Answering call lights is a universal activity that all UAP are taught to perform regardless of the setting; it is within the job description for UAP. Making an occupied bed is a universal activity that all UAP are taught to perform regardless of the setting; it is within the job description for UAP. UAP do not have the expertise or credentials to apply sterile dressings. UAP do not have the expertise or credentials to administer intravenous solutions. Registered nurses are not permitted to delegate assessment.

A nurse is caring for a client who has paraplegia as a result of a spinal cord injury. Which rehabilitation plan will be most effective for this client?

The plan is formulated and implemented early in the client's care. To promote optimism and facilitate smooth functioning, rehabilitation planning should begin on admission to the hospital. The client and family often are unaware of the options available in the health care system; the nurse should be available to provide the necessary information and support. Rehabilitation helps a client adjust to a new lifestyle that must compensate for the paralysis. The goal of rehabilitation is to foster independence wherever the client may live after discharge.