Week 3 vn

65. A client with psoriasis tells the nurse, "I finally found a remedy online that will cure my psoriasis." What is the appropriate nursing response?

"Advertised remedies that promise a cure may be a scam."

103. Which teaching will the nurse include when educating a client about stump socks?

"Stump socks can be made of cotton or wool."

7. A client being discharged from the hospital asks the nurse, "When I go visit my family out of state, should I take my living will with me, or do I need a new one for that state?" What is the most appropriate response made by the nurse?

"Take it with you. It is recognized universally in the United States."

57. A nurse is referring a client with a preferred provider organization (PPO) to a specialist. Which statement made by the nurse to the client demonstrates proper knowledge of PPOS?

"The specialist should be in-network."

47. The nurse manager notices that a nurse is wearing artificial fingernails. What is the appropriate nurse manager action? (Select all that apply.)

7 Refer the nurse to the agency policy on artificial fingernails. / polish artificial fingernails. Remind the nurse that artificial fingernails can spread fungal infections Provide the nurse with evidence that demonstrates outcomes of appropriate hand hygiene.

71. During a nursing shift, which events warrant completion of an incident report? (Select all that apply.)

An intravenous antibiotic was administered 2 hours late because the IV site infiltrated. A client falls while being transferred from the bed to the chair. A visitor slipped and fell in the hallway, but was not injured.

66. Which scenario is using a prospective payment plan to reimburse for services?

An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price

93. The nurse is caring for a client who will be raised via a tilt table. Which intervention will the nurse perform first?

Apply antiembolism stockings.

63. An older adult has been admitted to a long-term care facility after unsuccessful attempts to continue living independently. The nurse's admission assessment reveals the presence of long, ingrown toenails that appear to contribute to the resident's unsteady gait and decreased mobility. How should the nurse follow up this assessment finding?

Arrange for the client to be seen by a podiatrist.

91. The nurse is fitting a client for axillary crutches. Which action will the nurse perform first?

Assist the client who can support his or her own body weight to a standing position at the bedside.

48. A nurse warns a client that he may fall off his bed during a seizure attack if he does not put on the side rails of the bed. Before leaving the client's room, the nurse puts on the side rails, but after the nurse has left, the client lowers them again. Later, the client has a fall from the bed and holds the nurse responsible for it. Which legal provision protects the nurse in this case?

Assumption of risk

45. A nurse is explaining the need for bathing to an elderly client who has been avoiding a daily bath. Which benefit of bathing should the nurse explain to the client?

Bathing reduces the possibility of infection.

client who tore his quadriceps muscle during a soccer match has been prescribed exercise for the quadriceps muscles. How should the client perform quadriceps-setting exercises?

By alternatively tensing and relaxing the musclses

101. After experiencing an ST-wave elevation myocardial infarction, a 64-year-old man has been admitted to the cardiac unit of the hospital for care. The nurse has completed a comprehensive assessment and is creating a plan of care that is holistic in its focus, How can the nurse best integrate the principles of holism into the client's care?

By integrating each of the various dimensions of the client's identity into his care

39. A nurse is preparing to help a client with a skin infection have a tub bath, In which way can the nurse ensure the client's safety?

Check that the bathroom has a non-skid floor

30. The nurse is preparing to provide hygiene for a client who has a leg cast and activity restrictions. Which is the priority nursing intervention that will be performed to prepare for hygiene care?

Check the nursing care plan for hygiene directives.

104. A nurse is providing nail care to clients admitted to a health care facility. The nurse should know that which clients are most susceptible to nail problems?

Clients with diabetes

55. An elderly client has been admitted to a health care facility with a fractured arm and the nurse has to help the client change from a hospital gown into the clients clothing. How should the nurse ensure the clients comfort?

Clothes should have front zippers

21. The nurse is educating a client and family about home safety. Which teaching will the nurse include? (Select all that apply.)

Consider adding grab bars to shower or tub Assess for adequate lighting so client can see clearly when walking. Replace rubber tips on cane as soon as they become worn or dirty.

102. The nurse is caring for a client with diabetes who has thick toenails. What is the appropriate nursing intervention?

Contact a podiatrist to care for toenails.

A client who has started using contact lenses visits a health care facility with an eye infection. The nurse observes that the client also has an eye abrasion. What could be the possible reason for the eye infection?

Contact lenses were not cleaned.

84. The nurse is teaching a client about hearing aid care. Which teaching is appropriate? (Select all that apply.)

Do not get hair spray or other chemicals on the hearing aid. Carefully wipe the outer surface of the hearing aid to maintain cleanliness. Keep extra batteries on hand.

49. A nurse has noticed that an older adult's hearing aid frequently produces a shrill, high- pitched noise. What possible solution should the nurse suggest to this problem with feedback?

Encourage the client to make sure the hearing aid is fully inserted in the ear canal

89, A nurse is caring for a client who has undergone total hip replacement and is advised to undergo physiotherapy after discharge. Which level of care is the physiotherapy center?

Extended care

12. A nurse has become involved in political efforts to ensure that a greater percentage of Americans have access to affordable health care, regardless of their individual circumstances. This view of health is reflective of what belief?

Health is a right.

50. The nurse is teaching a nursing student about caring for a client with dentures. Which education will the nurse provide?

Hold dentures over a plastic basin or towel when cleaning them.

The nurse is teaching a client who is recovering from surgery about using a walker. Which teaching will the nurse include?

Hold the walker at the padded handgrips.

27. The nurse is teaching a client who had a below-the-knee amputation about a temporary prosthetic limb. Which client statement demonstrates that teaching has been effective?

I will loosen the belt when I go to sleep.

77. A nurse finds that a colleague is intoxicated while on duty. What appropriate action should the nurse take?

Inform the nursing supervisor

37. An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her, Which offense has the nurse committed?

Invasion of privacy

90. After several years of providing bedside care in an inpatient setting, a nurse has taken a position with the state board of nursing. In this role, the nurse contribute activities of a state board of nursing?

Issuing and transferring nursing licenses within the state

72. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse explains to the client that COPD is a chronic disease. Why is COPD considered a chronic disease?

It has a gradual onset and lasts for a long time.

61. The nurse is caring for a client who has a large furuncie in the right axillae. What education will the nurse provide?

Launder personal bath items in hot water and bleach.

A client informs the nurse that he wants to discontinue his treatment and go home. Later, the nurse finds the client dressed to leave. Which action should the nurse take in this situation?

Let the client go after signing a document stating he is going against medical advice.

94, A nurse is caring for a client whose fractured ankle is in a cast. The client needs crutches to ambulate What would help prepare this client for ambulation?

Modified hand pish-ups

95. A nurse is caring for a client with multiple sclerosis. The client informs the nurse that a lawyer is coming to prepare a living will and requests the nurse to sign as witness. Which actions should the nurse take?

Note that the nurse caring for the client cannot be a witness.

9. A group of nursing students are reviewing the ANA's current code of ethics. A code of ethics is important in the nursing profession because:

Nursing practice invovles numerous interactions between laws and individual

59. The daughter of an elderly man who resides at a long-term care facility has confronted the nurse with the fact that her father has not been receiving full baths on a frequent basis and has instead been receiving partial baths. What an acceptable rationale for providing partial baths rather than full baths to older adult clients?

Partial baths deplete less of the client's skin oils than a full bath

client at a health care facility is to undergo amputation of the left leg due to gangrene. The client will be fitted with an immediate post-operative prosthesis (IPOP) after the surgery. What is the function of the IPOP?

Promotes intact body image

52. A nurse is reading the goals stated in the Healthy People 2020 report. Which goal is targeted in the Healthy People 2020 report?

Reducing infections caused by key food-borne pathogens

28. A nurse is providing care for a client who is unconscious following a traumatic brain injury suffered in a motor vehicle accident. The nurse provides thorough oral care to the client on a regular basis. When providing this care, the nurse should take specific action to reduce the client's risk of what nursing diagnosis?

Risk for Aspiration

4. A nurse is explaining the use and handling of dentures to an older adult client. What measures should the nurse mention to the clent?

Store the dentures in water in a covered cup.

nurse is caring for a very weak client with multiple pregnancies. Which view would a teleologist have in such a situation?

Support the procedure of selective abortion.

6. A nurse is a caring for a diabetic dlient whose right leg had to be amputated due to the development of gangrene. The client uses crutches to ambulate and is waiting to be fitted with a prosthetic leg. What gait should the nurse observe in this client?

Swing-through

53. A nurse witnesses a traffic accident in which a child is badly hurt. The nurse dresses the open wounds sustained by the child. The family tries to give monetary compensation, which the nurse refuses. Later, in the hospital, the child develops complications due to infection in the wound. The family holds the nurse responsible for the complications and wants to file a lawsuit. Which of the following statements is true regarding the Good Samaritan law?

The Good Samaritan law will provide legal immunity to the nurse.

82. An elderly client is being seen at the clinic after experiencing a fall inside his home. He appears to have suffered no ill effects of the fall but his wife has asked the nurse he might benefit from the use of a cane. The nurse should be aware of what criterion use of a cane?

The client should first demonstrate that a walker does not provide sufficient support during ambulation.

100. A client is admitted with symptoms of psychosis. The nurse hurries to the client's room when she hears the client calling for help. She finds the client lying on the ground. The nurse assists the client back to the bed and performs a thorough assessment. The nurse informs the physician and completes the incident report. Which statement should the nurse document in the incident report?

The client was found lying on the floor.

32. A 22-year-old woman has begun using axilary crutches following open reduction and internal fixation of an ankle fracture that she suffered during a basketball game. What assessment finding by the nurse should suggest that the client's crutches are fitted correctly?

The client's wrist is slightly hyperextended when she stands upright and grasps her crutches

83. A nurse is caring for a child with Huntington's chorea, a hereditary condition. Which statement is true of hereditary conditions?

The condition is acquired from genes of one or both parents.

79. An older adult client is trialing the use of an infrared listening device (IRLD). How does this device have the potential to increase the client's ability to hear?

The device converts light into an auditory stimulus

78. A group of nurses who work at a large, long-term care facility have become embroiled in controversy over a large number of residents who are refusing a seasonal influenza vaccination. Specifically, there is controversy around the appropriate amount of influence that nurses can exercise when encouraging residents to become immunized. A teleological perspective on this issue would prioritize what consideration?

The greatest good for the greatest number

106. A nurse enters a client's room and finds that the client is lying on the floor. The nurse makes the client comfortable on the bed and completes an examination. She informs the physician and the nursing supervisor about this incident and also completes an incident report. Which action by the nurse indicates correct knowledge of handling an incident report?

The nurse documents a complete description of the happenings in the client's records.

14. A home care nurse is caring for a paralyzed client who needs regular position changes and back massages. A man identifying himself as a family friend inquires if he can be of any help to the family. What should be the nurse's response be?

The nurse should ask the man to talk to the family directly.

81. A client arrives at a health care facility complaining of pain in the abdomen and diarrhea. The physician diagnoses the client with colitis, an acute illness. Why is colitis considered an acute illness?

The onset is sudden.

19. A 71-year-old client is concerned about brown patches of skin on their face and forearm. What is the appropriate nursing statement?

Those are senile lentigines and are common in older adults."

nurse at a health care facilty has been assigned the care of an elderly client. For which reason would the nurse use a tilt table when preparing this client for ambulation?

To help the client bear weight on the feet

92. The nurse is delegating ambulation of a client with generalized weakness to the unlicensed assistive personnel (UAP). Which teaching will the nurse provide? (Select all that apply.)

Utilize a gait belt around the client's waist. When available, use parallel bars for support.

A nurse who is infected with human immunodeficiency virus (HIV) accidentally gets a cut while debriding a wound, exposing the client to possible HIV infection. Failure of the nurse to report this incident violates which ethical principles? (Select all that apply.)

Veracity Nonmaleficence Fidelity

29. An elderly client with a diagnosis of osteoporosis and early stage Alzheimer disease requires the use of an assistive device that will maximze stablity during ambulation. What debice will best meet this clients needs?

Walker

25. A nurse is assessing a client during a health care camp. The nurse observes that the client has poor hygiene and an itchy, infected scalp. What should the nurse ask the client to do?

Wash hair daily

amputated due to complications related to gangrene. When would a permanent prosthetic 15. The right leg of a client who was involved in a motor vehicle accident needs to be limb be constructed for this client?

When the stump size stabilizes

98. An illegal immigrant with no health insurance sustained life-threatening injuries following an automobile accident. Which action demonstrates the ethical principle of justice?

airlifting the client to a local trauma center for emergency surgery

80. Which nursing activity reflects care given on the tertiary level of healthcare delivery?

assisting with transplant surgery

75. An elderly client is admitted to a health care facility for the treatment of frequent seizures. What should the nurse use when attending to the personal hygiene of a client with seizures?

bag bath

An oncology nurse is caring for a client suffering from metabolic encephalopathy and end stage kidney disease. The client has no known family and no advanced directives. Upon entering the room, the nurse observes the client is pale and has no spontaneous respiration. What is the priority action the nurse should take?

begin CPR

73. Which ambulatory aid could a nurse suggest to assist a client who has weakness in one side of his body?

cane

87. A nurse is applying a leg prosthesis to a client at a health care facility. Why is it important for the nurse to observe the ease or difficulty of inserting the stump into the socket when applying the prosthesis?

check the number of stump socks that are required

26. A client with a bone infection had a central venous catheter ordered for the long-term administration of antibiotics. The intravenous line was inserted at the bedside by a qualified nurse, but the nurse was observed to make a serious lapse in aseptic technique and the client developed sepsis. What type of law most directly addresses this situation?

civil law

54. A nurse at a health care facility is caring for clients using crutches to ambulate. In which client would the nurse observe a four-point walking gait?

clients with disabilities such as arthritis or cerebral palsy

44. A client is discharged from the hospital 2 days post-appendectomy because of diagnostic-related groups (DRGS). What should the discharge nurse be most concerned about?

continuity of care

3. The nurse is caring for a dient who has a fungal infection in the groin. The client reports feeling sore and itchy. Upon assessment, the nurse notes a cluster of vesicles that are scaly and cracked. What tinea condition does the nurse anticipate?

cruris

24. A nurse is caring for an older adult client at a health care facility. What should the nurse consider to be a normal, age-related change?

decreased or unsteady mobility

62. The client is admitted to the hospital with pneumonia, along with various other signs and symptoms. Which is the priority for the nurse to manage?

difficulty breathing

A client with Crohn's disease in remission is admitted to the nursing unit for follow-up care. The remission state is characterized by:

disappearance of signs and symptoms associated with the disease.

43. A nurse is administering prescribed carbamide peroxide to a client with excess cerumen. Which condition may have prompted this treatment?

ear wax accumulation leading to hearing loss

Type of care

extended care

23. A client is admitted to the mental health center with attempted suicide. Which of the clients problems is priority for the nirse to manage?

freedom from harm

97. Which client growth needs are included in the love and belonging level of Maslows hierarchy? (Select all that apply.)

friendship family Intimacy

56. A nurse is assessing a client with dental problems including irritation, inflammation, and bleeding gums. The nurse recognizes that what condition may be contributing to these signs and symptoms?

gingivitis

8. A nurse at a health care facility suggests the use of parallel bars for a client who has recently been fitted with a prosthetic limb. How would parallel bars help this client?

helping the client to practice ambulating

40. A nurse is caring for a client with a strained gluteal muscle at a health care facility. The nurse should understand that the function of the gluteal muscles is to aid:

in extending the legs

60. The nurse is working in an acute care setting and performs primary, secondary, and tertiary prevention Which activity performed by the nurse is classified as tertiary prevention?

instructing a client how to use crutches

directive. The client states, "I do not know, what is an advanced directive?" What is the 41. A nurse completing admission paperwork asks the client about having an advanced nurse's best response?

is a witten document that identifies person's preferences regarding which medical interyentions to use in the event of a terminal condition."

prosthetic limb. Which component can be found only in an above-the-knee prosthetic? due to a mountain climbing accident. The client has been fitted with an above-the-knee 22. A nurse is caring for a client whose legs have been amputated from above the knee

knee system

18. A nurse is called to a deposition for a malpractice charge that has resulted in the death of a client. As the chart is reviewed, the prosecuting attorney questions the nurse about several defaming comments written in the medical record about the client. What charges can be filed against the nurse due to these comments?

libel

13. A nurse is caring for a hospitalized client. Which nursing action demonstrate a caring and compassionate attitude? (Select all that apply.)

listening to the client tell stories about past experiences explaining all nursing procedures clearly offering snacks and beverages to visiting family

33. A nurse is assisting a client at a health care facility dangle his legs before he ambulates. The nurse places the client in Fower's position for a few minutes. What is possible reason for this action?

maintain safety should the client become dizzy or faint

105. A nurse is delegating some aspects of client hygiene to an unlicensed care provider and is ensuring the care provider has adequate knowledge to safely perform shaving. With which client would the use of a razor be contraindicated?

man who has a history of stroke and who takes oral anticoagulants

99. A nurse had learned that more than 8% of Americans are currently living with diabetes mellitus. This statistic represents what epidemiological concept?

morbidity

17. A nurse is caring for a client with hypertension whose blood pressure has increased from 154/78 mm Hg to 196/98 mm Hg with a heart rate of 110 beats per minute during the past hour. The nurse goes to lunch without reporting the change to the healthcare provider, and the client suffers a cardiac arrest. What principle has the nurse violated?

negligence

69. A client who has undergone resection of the intestine is on a liquid diet with a nasogastric tube in place. He refuses the food tray with regular food that comes to his room and insists that a physician be called. The nurse insists that it is the right food and makes the client take it. The client develops complications and requires another operation. How negligence determined in this situation?

nurse did not realize the importance of the tube

88. A client arrives at a health care facility complaining of diarrhea and abdominal pain for the past 24 hours. The physician diagnoses the client with gastritis, an acute illness. Why is gastritis considered an acute illness?

onset is sudden.

2. When assisting a client with ambulation using an assistive device such as parallel bars or a walking belt, what should the nurse observe the client for?

pallor, weakness, dizziness

38. The nurse has delegated oral care for an unconscious client to an unlicensed assistive personnel (UAP). Which UAP action requires immediate nursing intervention?

placing the client supine to perform mouth care

11. A client who has been staying at a health care facility for 2 months develops corns on his feet. A corn is a kind of inflammation on the feet. For relief from the corns, the nurse should send this client to a(an):

podiatrist

A nurse is explaining A1C diagnostic testing to a client with diabetes. What level of healthcare delivery does this test suggest?

primary

46. A client experiencing symptoms of cold is referred to the specialist for diagnosis and consultation. Consultation and diagnostic tests are included in which level of the health care system?

secondary care

68. A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist, and learns that the nurse wrongfully attributed the disease to the client's contact with sex workers. With what legal action could the nurse be charged?

slander

74. A client who is scheduled for hernioplasty needs clarification regarding the procedure. The nurse calls the physician at the client's insistence. The physician, who is in a bad mood, is overheard telling the client that the nurse does not know anything. has the physician committed?

slander

middle-aged client is distraught at receiving a diagnosis of type 2 diabetes in spite of being conscientious about her health for the majority of her adult life. The client tells the nurse, "I can't believe I no longer have my health." The nurse should be aware that the World Health Organization defines health as:

state of physical, mental, and social well-being.

A nurse is caring for a client who is confined to bed due to paralysis. The client has a medical history of stroke, hypertension, and diabetes mellitus for the past five years, besides having asthma since childhood. Which is a secondary illness seen in the client?

stroke

16. The nurse is caring for a client with lower extremity paralysis who has been placed in bilateral leg braces. Which crutch-walking gait will the nurse teach?

swing-through

1. A client admitted for hernioplasty is discharged two days later than the calculated time due to postoperative complications. The client is insured through a capitation scheme. In the event of late discharge of the client, who is at loss?

the hospital

31. A nurse who works on a palliative care unit has participated in several clinical scenarios that have required the application of ethics. Ethics is best defined as:

the laws that govern acceptable and unacceptable behavior.

58. A nurse is caring for a client who underwent surgery for the amputation of the right foot. The client has been fitted with a temporary prosthetic limb. What should the nurse ensure during this period?

the wound heals and no complications develop

36. A nurse is applying for professional liability insurance. The nurse knows that professional liability insurance is important for which reason?

to be familiar with legal mechanisms

35. A child with a day-old fever is admitted to a health care facility. Which bath will be most appropriate for the client?

towel bath

20. The nurse is caring for a client who sustained a severe ankle sprain while playing soccer. Which crutch-walking gait will the nurse teach?

two-point three-point non-weight-bearing

5. What does the nurse identify as a goal for a dient with the nursing diagnosis of impaired physical mobility related to a new prosthetic limb?

will take sixteen steps independently by Monday