3rd Semester Final Review
Which condition is the most common cause of anemia in pregnancy? -alpha thalassemia -beta thalassemia -iron-deficiency anemia -sickle cell disease
Iron-deficiency anemia.
The nurse is assisting with the circumcision of a male infant. Which nursing intervention is priority immediately after the procedure? -Monitor the site for bleeding. -Administer acetaminophen orally. -Apply a petroleum gauze dressing. -Assess the newborn for infection.
1 or 3.
A 6-yr-old has been administered a hypnotic before going to surgery. The child remains kicking and screaming. The nurse is considering whether restraints should be used in this situation. Which guidelines should the nurse follow in this instance? Select all that apply. -Use the least amount of restraint necessary -obtain a primary care provider's prescription for restraint -Explain to the parents the need to restrain their child. -Explain calmly to the child that he is being punished for his poor bx. -Apply a gag to the child's mouth to prevent distracting screams.
1, 2, 3.
A client is being treated for alcoholism. Which organization can be recommended to assist the FAMILY in coping with this disease? -AI-Anon -Narcotics Anonymous -Rational Recovery -Alcoholics Anonymous
AI-Anon
In which situation(s) will the nurse anticipate client admission tot he labor and delivery unit? Select all that apply. -The client reports experiencing regular contractions every 5 minutes. -The nurse notes that the cervix has thinned with 7cm dilation. -The client reports a burst of energy and starting the home nursery. -The health care provider has documented pelvic change from the clients last visit. -The client reports frequent fetal movements throughout the day. -The client reports a gush of fluid from the perineal region.
1, 2, 4, and 6.
The nurse removed a clients indwelling urinary catheter 24hrs after the cesarean birth. Four hrs later, the client has not yet voided. The client reports 6/10 incisional pain and no urge to void. The nurse can palpate a full bladder. What action(s) will the nurse take? Select all that apply. -Encourage increased oral fluid intake. -Provide analgesic for incisional pain. -Run water while the client attempts to void. -Perform in-and-out catheterization -Collect a urine specimen for c&s.
1, 2, and 3.
A school- aged child is in isolation at the hospital and her family members ask what they can do to help the child feel less lonely. What would the nurse suggest to this family? Select all that apply. -Have the child's classmates send cards -have parents bring the child's electronic game system. -Limit the time the nurse spends with the child when performing procedures. -Have the child wear a gown and mask so he/she will feel like everyone else. -Draw a smile on the nurse's mask before entering the room.
1, 2, and 5.
Which of the following assessment findings is most important in determining the presence of alcohol dependency in a client? Select all that apply. -Patterns of use. -Weight loss. -Fluctuation in appetite. -Absenteeism from work. -Blurred vision. -Blackouts.
1, 3, 4, and 5
The nurse is planning care for a family whose 3-yr-old child is in the final stages of dying. Which outcome demonstrates that the interventions have been successful? Select all that apply. -The parents identify coping measures that are helping -the child expresses emotions related to impending death -the family prepares a scrapbook with favorite photos. -the child remain free of pain during the end stage of life -The parents identify a support group for their family. -The parents express hope their child will go into remission.
1, 3, 4, and 5.
The mother of a 4-yr-old is concerned her child is not eating well. In addressing the concerns of this mother, which foods should the nurse point out are high in protein? Select all that apply. -Cheese and crackers -Cookies and juice -Whole grain granola with yogurt -strawberries and bananas -Turkey sandwich.
1, 3, and 6.
A nurse is providing a community seminar about eating disorders. Which age group would the nurse be most likely to target because of their increased risk? -12 to 25 -25 to 35 -35 to 45 -45 and older.
12 to 25
A postpartum woman is concerned about constipation following delivery. What factor(s) contribute to this problem? Select all that apply. -Poor diet after delivery -Perineal pain -Hemorrhoidal discomfort -Iron Supplements -Intake of too many fluids.
2, 3, and 4.
A woman arrives at the prenatal clinic and is accompanied by her partner. Which bx's would be suggestive of intimate partner violence? Select all that apply. -The pregnant client looks at the examiner when asked questions. -The partner answers questions for the pregnant client. -The partner is overly protective of the pregnant client. -Poor weight gain during the pregnancy and low-birth-weight infant. -The client asks questions of the nurse about her pregnancy.
2, 3, and 4.
The emergency department nurse manager is orienting the new nurse regarding bioterrorism. The nurse manager would include which indicator(s) as an example of bioterrorism? -Small amount of people sick in a variety of locations in the area. -Clusters of sick people form a shared locale -High outbreak of similar symptoms among previously healthy people -Increased numbers of sick people seeking health care. -Majority of individuals presenting with general malaise.
2, 3, and 4.
A primigravida is 1cm dilated, in early latent labor, and interested in avoiding epidural anesthesia. After asking about which nonpharmacologic options for pain relief she can use at this time, which option(s) should the nurse point out to the client? -It is too late for nonpharmacologic measures -Sitting in a tub of warm water -Simple breathing excersises -Effleurage -Walking and then using a birthing ball.
3, 4, and 5.
The nursing student is preparing a teaching presentation on disaster preparedness for a nursing class assignment. Which action(s) would the student include in the presentation? -Keep a supply of fresh food on hand -Keep a 24 hr supply of medications on hand at all times. -Affix a tag to a pet's collar with contact information. -Store a supply kit with extra batteries, flashlight, and radio. -create a network of persons who can provide support during and after the disaster.
3, 4, and 5.
The nurse in the emergency department is caring for a client who has an elevated BP and elevated RR. The nurse is aware that the client may be experiencing withdrawal from heroin if the client displays which other s/sx? Select all that apply. -Yawning. -Stuffy nose. -Pinpoint pupils. -Goosebumps. -Diarrhea.
4 and 5.
The family of a client stung by a bee, rushed the client to the emergency room. The client is experiencing hives and redness at the site. Upon arrival, the client states, "I feel a lump in my throat and I am sweating. I can't breathe. I think I am going to die!" The nurse anticipates which emergency treatment next? -Administer metoprolol (lopressor) 5mg IV -Administer albuterol inhaler 2 puffs stat. -Administer an injection of epinephrine IV stat. -Place the client in high fowlers position.
Administer an injection of epinephrine IV stat.
A nurse teaching family members about the brain's connection to behaviors commonly seen in mental illnesses is using the tern neurotransmitter. The nurse should explain that a neurotransmitter is: -A hormone in the brain. -A chemical that is released in the brain. -A specific location in the brain. -A nerve that transmits impulses in the brain.
A chemical that is released in the brain.
A 10-yr-old child is receiving end of life care at home. The home care nurse recommends repositioning the client every 2 hrs. The caregiver responds, My child has been through so much already! Why can't we just let the child stay in a comfortably position? How will the nurse address the parents' concerns? -Repositioning regularly will provide mobility and decrease the risk of pain from constipation. -We can reposition your child quickly so that the child can become comfortably again very quickly. -A pressure injury could cause additional pain; we can gently reposition your child to reduce this risk. -If you prefer, we could reposition your child every 4 hrs instead of every 2.
A pressure injury could cause additional pain; we can gently reposition your child to reduce this risk.
A client has gained 100 lbs over the past 20 yrs, and wants to lose weight. What strategy will greatly contribute to this clients success? -A sensible weight loss regimen prescribed by a dietitian - caloric intake reduced by half -daily 2 mile run. -All of the above.
A sensible weight loss regimen prescribed by a dietitian.
The nurse is spending time with a client who has just learned, unexpectedly, that she is pregnant. Which initial task should the nurse assist the client to focus on? -Accepting the pregnancy. -Accepting a coming child. -Making plans for the baby. -Sharing time with a significant other.
Accepting the pregnancy.
The nurse explains to the clients family the alcoholic's recovery. What is the first step in recovering from excessive alcohol use? -Admitting an inability to control drinking. -Forming a close support network -Relying on some form of religious belief. -Checking into an inpatient rehabilitation unit.
Admitting an inability to control drinking.
A client has just learned of having a terminal illness. Which assessment finding(s) indicate to the nurse that the client is experiencing a sympathetic nervous system response to this diagnosis? Select all that apply. -Dilated pupils. -HR 112. -BP 170/90 -Glucose 140 -RR 26 and shallow.
All of the above.
A client is developing increasing symptoms of anxiety disorder and reports having urges to self harm. The nurse secures admission to a residential treatment facility and the client begins to shout at the nurse for betraying trust and ruining the clients life. What is the nurse's role in this situation? -Assuring the clients safety -Helping the client problem-solve -modifying communication -All of the above.
All of the above.
The pediatric nurse is aware that chronic illness can affect which of the following for a child? -physical development -psychosocial development -cognitive development -all of the above
All of the above.
A 5-yr-old child is brought to the emergency room with an open chin laceration following a bike accident. The child appears extremely frightened and asks if he will bleed to death. Which nursing action should the nurse prioritize to best assist this child? -Seat him where he can watch TV with his parents. -Tell him that big boys like him must be brave -Reassure him that he will not run out of blood. -Allow him to sit on his parents lap until time to suture the laceration.
Allow him to sit on his parents lap until time to suture the laceration.
To prepare the community for the possible threat of anthrax, a nurse must teach that: -immunizations can prevent anthrax - blood and body secretions can transmit anthrax. -physicians use isoniazid, rifampin, and pyrazinamide to treat anthrax. -Anthrax can infect integumentary, GI, and respiratory systems.
Anthrax can infect integumentary, GI, and respiratory systems.
A 3-yr-old client has been hospitalized for 1 week with her mother rooming in; however, the mother has gone home to tend to other family responsibilities for a few days. After being inconsolable for the first 24 hrs after the mothers departure, the nurse notes the child is now lying quietly in bed sucking her thumb. Which response should the nurse prioritize in this situation? - Are you feeling sad? Your mom didn't want to leave, but she will be back after two more breakfasts. -I'm glad you're feeling better. You must be tired from all that crying. -Do you miss your mom? Your sister missed her too, so she had to go home to visit for a few days. -Should I read a story to you or would you like to play a game?
Are you feeling sad? Your mom didn't want to leave, but she will be back after two more breakfasts.
The nurse discharging a newly delivered mother and her newborn infant needs to assess the mothers knowledge about how to take care of herself and her baby. This is her second child. Which approach would be best to verify the client's understanding of these topics? -Have her fill out a questionnaire on the subject. -Ask her questions and observe her caring for her baby. -Since she has had a previous child, she should already know how to do most everything. -Have her demonstrate how to do all the baby care tasks as well as her care tasks.
Ask her questions and observe her caring for her baby.
Which of the following instructions should a nurse provide a client with alcohol dependence who is prescribed disulfiram? -Maintain bed rest for 1hr after medication. -Avoid mixing disulfiram and alcohol. -Avoid driving for 3 hrs after medication. -Take in adequate fluids before medication.
Avoid mixing disulfiram and alcohol.
A client at 27wks gestation still walks daily but reports "terrible" heartburn at night. Which action should the nurse point out will best address this situation? -Stop or severely curtail her exercise. -Take sodium bicarbonate. -Seek emergency medical care. -Elevate the HOB.
Elevate the HOB.
To develop a therapeutic relationship with an anxious client, the nurse looks for ways to build trust. What nursing intervention is most likely to help the nurse gain the clients trust? -Leave the client alone during a new experience. -Give support in nonverbal ways. -Be available and attentive to the clients requirements. -Give detailed explanations and do not repeat them frequently.
Be available and attentive to the clients requirements.
It is important for a nurse not to argue about the validity of a schizophrenic client's delusions or try and convince him or her that they are wrong because clients may: -Become more fixated on their delusions -be distressed -respond violently to what he or she perceives as a threat -Become nervous.
Become more fixated on their delusions.
A 43 yr old, physically fit, healthy woman who is newly married tells the nurse that she and her husband would like to have a child. What is an appropriate first response? -You must know that's pretty risky. Have you thought about adopting instead? -Well, I'm sure you know there are some risks involved so it's helpful that you've been taking such good care of yourself. - You're in great shape now, but are you sure that at your age you'll have enough energy to care for a child? -If you got pregnant now you'd be at risk for multiple fetal pregnancies, chromosomal abnormalities, spontaneous abortion, and hypertension among other things. Are you ready to take that risk?
Book says #2, Gene says #4.
A 30-minute-old newborn starts crying in a high-pitched manner and cannot be consoled by the mother. Which action should the nurse prioritize if jitteriness is also noted and the infant is unable to breastfeed? - Check blood glucose -Place child in radiant warmer. -Assess for pain source. -Assess the baby's temperature.
Check blood glucose.
The nurse is teaching a prenatal class illustrating the steps that are used to keep families safe. The nurse determine the session is successful when the parents correctly choose which precaution to follow after the birth of their infant? -Send a family member to accompany the infant when leaving the room. -Check the name on the baby's identification band. -Provide a list of approved visitors who can spend time with the infant. -Check the identification badge of any health care worker before releasing baby from room.
Check the identification badge of any health care worker before releasing baby from room.
What changes if any, should the nurse expect in the dietary patterns of a client who is clinically depressed? -Client either overeats excessively or under eats with little nutritional input. -Client continues to eat normal amounts of food but will skip breakfast. -Client goes to fast food restaurants twice a day. -None.
Client either overeats excessively or under eats with little nutritional input.
Which type of therapy assists the clients to alter their irrational thinking? -Psychopharmacology -Desensitization. -Bx therapy -cognitive therapy
Cognitive therapy
The nurse is caring for a victim of a chemical disaster. Medications given in the treatment of this client include amyl nitrate, sodium nitrite, and sodium thiosulphate. Which chemical agent does the nurse know this client has been exposed to? -Sarin -Mustard gas -Cyanide -Anthrax
Cyanide.
A postpartum client tells the nurse that she feels like crying for no apparent reason and is unable to sleep well. What should the nurse point out to the client that this may be related to? -Increased thyroid hormone lvls -Increased estrogen lvls -Decreased hemoglobin lvls -Decreased progesterone lvls.
Decreased progesterone lvls.
The nurse is caring for a client who has recently lost a spouse. Which question asked by the nurse is essential in guarding the clients immune system? -Do you have friends and family to support you? -Do you live alone in a one-story house? -Are you able to prepare nutritious meals? -Are your neighbors able to check on you?
Do you have friends and family to support you?
Impaired balance and uncontrolled tremors of parkinson's disease is correlated with which neurotransmitter? -Glutamate -Acetylcholine -Dopamine -Serotonin
Dopamine
The nurse is working with a 12-yr-old who is hospitalized with a chronic illness. Which action by the nurse might help the chronically ill preteen thrive while hospitalized? -Encourage the client to wear his or her own clothes, talk to friends on the phone, and interact with other clients who have similar illnesses. -Make all treatment and care decisions; the preteen is too young to have any responsibility for his/her own care. -Create a clear list of behavioral rules to give to the client when he/she arrives. -Encourage the client to keep his or her limitations foremost in mind when trying a new skill or task at which his/her peers have begun to excell.
Encourage the client to wear his/her own clothes, talk to friends on the phone, and interact with other clients who have similar illnesses.
A client with bulimia nervosa tells a nurse she was doing well until last week when she had a fight with her father. Which nursing intervention would be most helpful? -Examining the relationship between feelings and eating. -Discussing the importance of therapy for the entire family. -Encouraging the client to avoid certain family members. -Identifying daily stressors and learning stress management skills
Examining the relationship between feelings and eating.
In which manner is the fetal status best assessed during the active and transition stages of labor? -Fetal heart rate at the peak of a contraction. -fetal movement on the tocometer. -fetal heart rate between contractions. -Fetal kicks over 1-minute period.
Fetal heart rate at the peak of contraction.
The nursing instructor is teaching a class on the nutritional needs of the pregnant client. The instructor determines the session is successful when the students correctly choose which supplement as being known to prevent up to 70% of CNS birth defects? -Iodine -Zinc -Folic Acid -Vitamin A
Folic Acid
As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month old daughter, born 2 days after her estimated due date; a 3 yr old son born at 35wks, and two lost pregnancies, one at 12wks, and one at 21 wks. How should the nurse document the history? -G5 T1 P2 A1 L2 -G4 T1 P1 A2 L2 -G5 T2 P2 A1 L1 -G4 T1 P2 A2 L2
G5 T1 P2 A1 L2
The nurse is triaging victims during a mass casualty incident. The nurse uses which color tag for a victim whose care can be delayed.? -Red -Yellow -Green -Black
Green
A woman delivered her infant 2 hrs ago and calls to tell the nurse that she needs to go to the bathroom. When the nurse arrives, the mother is getting out of bed alone. What should the nurse do? -Assist the client to the bathroom. -Have the client sit dangling her legs off the side of the bed for 5 minutes. -Ask the client to lie back down and get her a bedpan. -Suggest catheterizing her this time to prevent the possibility of fainting.
Have the client sit dangling her legs off the side of the bed for 5 minutes.
A client arrives at the mental health clinic. He had been ordered a tricyclic antidepressant about a month ago. The client states that he has been taking it correctly every day. What observation below would indicate that the client is actually taking the medication? -He repots that he has not gone to work for the last week. -He complains of not being able to do anything anymore. -He arrives at the clinic on time for his appointment with neat appearance and clean clothes. -He reports sleeping 12 hrs per night and 3-4 hrs in the day.
He arrives at the clinic on time for his appointment with a neat appearance and clean clothes.
The nurse is preparing to assess a toddler during a routine health maintenance visit. Which assessment will the nurse perform to determine the child's growth milestone? - BP -Urine specimen -Hemoglobin lvl -Height and Weight
Height and Weight.
The parents are bonding with their newborn when the nurse notes the infant's axillary temperature is 97.2 an hour after birth. Which intervention should the nurse prioritize for this family? -Help the mother provide skin-to-skin (kangaroo Care). -Place a second stockinette on the baby's head. -Administer a warm bath with temp slightly higher than usual. -Place the infant under a radiant warmer.
Help the mother provide skin-to-skin (kangaroo care).
The nurse is providing education via phone to a client who called stating that the newly prescribed imipramine(Tofranil) is not working as depression is still a problem. Which question is most important to ask first? -Are you feeling worse since taking the medication? -How long have you been taking the medication? -What time of day are you taking the medication?/ -What dosage of medication are you taking?
How long have you been taking the medication?
What statement by the mother of a preschooler indicates the need for further education by the nurse? -My child should not drink from someone else's cup -after blowing his nose, my child should wash his hands -My child should not share a toothbrush with another person. -If food falls on the floor, my child should pick it up quickly and wipe it off before eating it.
If food falls on the floor, my child should pick it up quickly and wipe it off before eating it.
Severe levels of anxiety can result in what? -a heightened sense of awareness. -Distorted sensory awareness -mild forgetfulness -Impaired ability to concentrate
Impaired ability to concentrate.
A client who binges on alcohol during the weekends denies having an alcohol dependency problem. Which is the best understanding, by the nurse, in regards to binge drinking? -Drinking only on weekends does not constitute a dependency problem. -Binge drinking can lead to daily drinking so needs to be monitored. -Inability to control drinking is a sign of dependency. -Binge drinkers are social drinkers not alcoholics.
Inability to control drinking is a sign of dependency.
Anthrax is acquired by which method develops into the most severe form? -Inhalation -Skin infection -Ingestion -Contact with body fluids or contaminated objects.
Inhalation
The nurse is caring for a newborn after the parents have spent time bonding. As the nurse performs the assessment and evidence-based care, which eye care will the nurse prioritize? -Instill 0.5% ophthalmic silver nitrate. -Instill 0.5% ophthalmic tetracycline. -Instill 0.5% ophthalmic erythromycin. -Watch for signs of eye irritation.
Instill 0.5% ophthalmic erythromycin.
The nurse is teaching a prenatal class on the functions of the various structures involved with a pregnancy., The nurse determines the class is successful when the class correctly chooses which function for amniotic fluid? -This is how the baby is fed. -It helps cushion the baby. -It prevents viruses from passing to the baby. -It provides oxygen to the fetus.
It helps to cushion the baby.
One week ago, the client was prescribed Buspirone for anxiety. The client phones the office and reports the medication has not eliminated the symptoms. Which is the best response by the nurse? -It may take up to 4 wks for full therapeutic response. -There are may other medications that can be offered. -Buspar will not eliminate all symptoms associated with anxiety. -Call back in one week if the symptoms continue.
It may take up to 4 wks for full therapeutic response.
During a visit to the prenatal clinic, a pregnant woman asks the nurse, "What causes labor to start?" Which response by the nurse would be appropriate? -Labor starts when the fetus moves into the pelvis. -Just before labor, the level of the hormone oxytocin drops. -labor starts when the uterus can't grow any further. -Labor starts from a combination of several maternal and fetal hormones working together.
Labor starts from a combination of several maternal and fetal hormones working together.
A child who is immobile states, "I am sad because I cannot do what my friends do." which response by the nurse is appropriate? -Do not worry. You will get better. -Be glad you are able to do what you can. -Let's try to figure out how you can do more. -Tell me what your friends are able to do.
Lets try to figure out how you can do more.
Four clients injured in an automobile accident enter the emergency department at the same time. The triage nurse evaluates them immediately. The nurse should assign the highest priority to the client with the: -Lumbar spinal cord injury and lower extremity paralysis. -Maxillofacial injury and gurgling respirations. -Severe head injury and no BP -Second-trimester pregnancy in premature labor.
Maxillofacial injury and gurgling respirations.
A client is seeking help for new onset of acne, scratches over face and arms, poor dentition, and stained rotten teeth. Which substance should the nurse suspect the client is using? -Heroin. -Cocaine. -Nicotine. -Methamphetamine.
Methamphetamine.
The skull is the most important factor in relation to the labor and birth processes. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps make this passage possible? -Molding -Caput Succedaneum -Cephalohematoma -Vertex Presentation
Molding
A client who has attempted to quit smoking and failed two times before is reluctant to make another attempt. Which response by the nurse is most appropriate? -You will know when the time is right -Most people who have tried and failed ultimately do succeed. -Tell me what you have tried before and we can make changes to your plan. -I know you can do it this time.
Most people who have tried and failed ultimately do succeed.
A nurse is caring for an older female client whose husband died 6 months ago. Which behavior by the client indicates ineffective coping? -Visiting her husbands grave once a month. -Participating in a senior citizens program. -Looking at family pictures in photo albums. -Neglecting her personal grooming and refusing to take showers/baths.
Neglecting her personal grooming and refusing to take showers/baths.
A new mother asks the nurse when she should begin caring for her baby's teeth. Which response os the most appropriate for the nurse to make at this time? -Now -at the age of 12 months -when solid food is eaten -when the first tooth appears.
Now.
A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client? -On her stomach with a pillow under her breasts. -On her side with the weight of the uterus on the bed. -On her back with a pillow under her knees and hips. -On her back with a pillow under her head.
On her side with the weight of the uterus on the bed.
The client recounts to the nurse an instance of jumping onto the hood of a car to avoid an approaching dog, and reports feeling embarrassed by this reaction. The client discloses suffering from a severe dog bite in childhood. The nurse classifies this symptom as which of the following? -Generalized anxiety -Panic Disorder -Phobic disorder -PTSD
Phobic Disorder.
The nurse is taking a nursing history on a client who has come to the clinic with c/o fatigue, weight gain, and constipation. The client states" i'm just depressed. The nurse knows that before the health care provider institutes therapy, the client will receive a full physical assessment for what reason? -Medications for depression are dosed according to weight. - Physical conditions such as hypothyroidism can mimic the symptoms of depression. -A full evaluation offers the opportunity to better determine what is causing the clients depression. -Performing a physical examination provides the client the feeling of caring by another individual.
Physical conditions such as hypothyroidism can mimic the symptoms of depression.
The nurse is caring for a client in active labor who states, "I need to go to the bathroom to have a bowel movement, now." Which action should the nurse take first? -Inform the client that this is a normal feeling during active labor. -request the unlicensed assistive personnel help the client to the restroom. -Obtain a bedpan and allow the client to stay in bed for the bowel movement. -Position the client for and perform a cervical assessment.
Position the client for and perform a cervical assessment.
A client was in a plane crash a year ago and several people were killed. The client is now experiencing nightmares, insomnia, headaches, loss of appetite, and fatigue. Which disorder is the client most likely experiencing? -Panic disorder. -Post-traumatic stress disorder -Bipolar disorder -Conversion disorder.
Post-traumatic stress disorder.
Assessment for surfactant lvl via lecithin/sphingomyelin (L/S) ratio in the amniotic fluid is a primary estimation of fetal maturity. The purpose of surfactant is to: -Prevent alveoli from collapsing on expiration -Increase lung resistance on inspiration -Encourage immunologic competence of lung tissue. -Promote maturation of lung alveoli.
Prevent alveoli from collapsing on expiration.
Exposure to gamma radiation can be decreased by completing which action? -wearing thick clothes -lengthening the duration of exposure -providing distance from radiation source -providing plastic shielding.
Providing distance from radiation source.
A mother tells the nurse that her toddler does not want to go to bed at night and keeps getting back up when she is put to bed. What recommendations would the nurse make to this mother to foster sleep in the toddler? -Place the child in her bed, tell her goodnight, and then lock the door -read the child a book in bed and take time to calm the child down before turning out the lights. -Instruct the toddler to stay in bed or she will have her favorite stuffed animal taken away from her. -If she does not want to go to sleep at her normal bedtime, let her stay up for a while longer.
Read the child a book in bed and take time to calm the child down before turning out the lights.
Following an explosion at a chemical plant, a nurse is triaging clients. One client has a penetrating abd. wound from a piece of shrapnel. What color coordinate would the nurse assign to this client? -Yellow -Red -Green -Black
Red
A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. OCD is associated with: -Repetitive thoughts and recurring impulses -Physical signs and symptoms with no physiological cause -Apprehension -Inability to concentrate
Repetitive thoughts and recurring impulses.
A client in labor received an opioid close to the time of birth. At the time of the birth, the nurse will assess for which effect? -respiratory depression in the newborn -Urinary retention in the pregnant client -abd. distention in the pregnant client -hyperreflexia
Respiratory depression in the newborn.
A nurse has been working with a bulimic college student to help control the eating disorder. Which recommendation by the nurse is most likely to be effective in helping the client control bulimia? -Keep a daily calorie count of all foods consumed. -Avoid eating in a fast food establishment. -Restrict using the bathroom for at least 2 hrs after meals. -Take a daily inventory of food offered at the dormatory.
Restrict using the bathroom for at least 2 hrs after meals.
The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD? -October 7. -September 8. -July 7 -August 8
September 8.
A client with alcoholism has just completed a residential treatment program. What can this client reasonably expect? -Her family will no longer be dysfunctional. -She'll need ongoing support to remain abstinent -She doesn't need to be concerned about abusing alcohol in the future. -She can learn to consume alcohol without problems.
She'll need ongoing support to remain abstinent.
The school nurse is aware that providing proper care involves cooperation from the adolescent. Which technique will the nurse prioritize to develop open communication with the adolescents? -Ask the parents questions first and then ask the adolescent the same question. -Focus the interview on the problems rather than on the adolescent themselves. -Show interest in the adolescent and develop a rapport before asking questions. -Avoid asking questions about their friends, hobbies, and school activities.
Show interest in the adolescent and develop a rapport before asking questions.
The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which of the following nursing interventions would be most appropriate? -Demonstrate empathy for the client by trying to mimic the clients state of anxiety. -Tell the client that you must leave to go report his symptoms to the psychiatrist on duty. -Tell the client this is an acute exacerbation with a positive prognosis and low morbidity. -Stay with the client, emphasizing that he is safe and that you will remain with him.
Stay with the client, emphasizing that he is safe and that you will remain with him.
A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile? -Travel no more than 120 miles daily. -Sit in the back seat with feet elevated. -Stop and walk every 2hrs. -Limit trips away from home, greater than 200 miles.
Stop and walk every 2 hrs.
The nurse has completed assessing the vital signs of several clients who are form 36 to 48 hrs postpartum. For which set of vital signs should the nurse prioritize for interaction? -Temp: 99.4, HR 90, RR 18, BP 112/67. -Temp: 97.0, HR 80, RR 20, BP 120/72 -Temp: 100.2, HR 65, RR 22, BP 130/78 -Temp: 98.6, HR 74, RR 16, BP 150/85
Temp: 98.6, HR 74, RR 16, BP 150/85.
A client with bipolar disorder has been taking lithium, as prescribed, for the past 3 yrs. Today family members brought this client to the hospital because he hadn't slept, bathed, or changed clothes in 4 days. Had lost 10lbs in the past month, and woke the entire family at 4am with plans to fly them to Hawaii for a vacation. Based on this information, what may the nurse assume? -The family isn't supportive of the client -The client had stopped taking the prescribed medication -The client hasn't accepted the diagnosis of bipolar disorder. -The lithium lvl should be measured before the client receives the next lithium dose.
The lithium lvl should be measured before the client receives the next lithium dose.
A group of nursing students are preparing a presentation depicting the fetal circulation. The instructor determines the presentation is successful when the students correctly illustrate which route for the ductus arteriosus? -The left to right heart atria -The aorta to the pulmonary veins. -The right ventricle to the aorta. -The pulmonary artery to the aorta.
The pulmonary artery to the aorta.
The parent of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the parent about this type of play bx? -This is peer play and is abnormal -This is parallel play and is expected -This is premature play and should be stopped -This is adjacent play and is only seen in school-age children.
This is parallel play and its expected.
During the second stage of labor, a women is generally: -Very aware of activities immediately around her. -Anxious to have people around her. -No longer in need of a support person. -Turning inward to concentrate on body sensations.
Turning inward to concentrate on body sensations.
A group of nursing students are analyzing the fetal circulation. After the session, the students correctly point out which fetal structure contains the highest concentration of oxygen? -Umbilical artery -umbilical vein -ductus arteriosus -pulmonary vein
Umbilical vein
A client is in the third stage of labor. Which finding alerts the nurse that the placenta is separating? -Uterus becomes globular. -Fetal head at vaginal opening. -umbilical cord shortens -Mucous plug is expelled.
Uterus becomes globular.
The nurse is caring for a client who has remained in stable condition at 37 wks gestation. The clients condition suddenly changes. Which assessment change should the nurse prioritize? -vaginal bleeding and no pain -Uterine contractions with vaginal mucus. -Fundal height and fetal heart rate. -Size and contour of the abd.
Vaginal bleeding and no pain.
If a known substance abuser presents to the emergency department with tachycardia and chest pain, what is the most appropriate question for the nurse to ask? -When did you last use heroin? -When did you last use cocaine? -When did you last use barbiturates? -When did you last use marijuana?
When did you last use cocaine?
The client who has recently stopped smoking, is irritable and complaining of feeling hungry. The nurse would interpret this as which of the following? -Addiction. -Withdrawal. -Dependency. -Tolerance.
Withdrawal.
A new mother asks the nurse what she is allowed to do when she goes home from the hospital. Which statement by the nurse would be correct? -You should be able to resume normal activities after 2 weeks. -You should not lift anything heavier than your infant in its carrier. -Only clean half of the house per day to allow yourself more rest. -You need to hire a maid for the first month after delivery to help out around the house.
You should not lift anything heavier than your infant in its carrier.
The maternal health nurse is caring for a pregnant client with pre-existing heart disease. Which concept will the nurse identify as a priority? -Balancing weight gain. -restricting sodium intake. -supplementing potassium intake. -Restricting exercise.
balancing weight gain.
During a facility disaster drill, an 'injured client' presents to the emergency department with c//o dry mouth, inability yo focus his vision, and double vision. A nurse notes that the client has an unsteady gait and appears to be very weak. The client states, "My arms and legs feel like they just can't move." A nurse suspects the client may be a victim of bioterrorism with: -botulism. -anthrax -herpes -ebola
botulism
When preparing for an emergency bioterrorism drill, the nurse instructs the drill volunteers that each biological agent requires specific client management and medications to combat the virus, bacteria, or toxin. Which statement reflects the client management of variola virus (smallpox)? -Acyclovir is effective against smallpox. -Smallpox is spread by inhalation of spores. -A vaccination is effective only if administered within 12-24hrs of exposure. -Smallpox spreads rapidly and requires immediate isolation.
smallpox spreads rapidly and requires immediate isolation.
