chronic and pall exam 1 prep us

A nurse is caring for a terminally ill client who is receiving chemotherapy and radiation for an aggressive lung cancer. The treatment success is limited in shrinking the tumor, and the treatments are making the client very ill. The client states, "I feel that I would like to stop treatments. I would like to enjoy the time that I have remaining with my family." Which emotional reaction does the nurse recognize that the client is experiencing? Denial Bargaining Acceptance Anger

Acceptance In the final stage, dying clients accept their fate and makes peace spiritually and with those to whom they are close. Clients begin to detach themselves socially and wish to be with only a small group of close friends and family. The other options are stages that occur earlier in the process.

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "Draining of the cysts and antibiotic therapy will cure your disease." "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

A young female client smokes two packs of cigarettes and drinks a six-pack of beer each day. The nurse is attempting to teach the client about smoking cessation and decreasing alcohol intake. The client states, "My grandmother lived to be in her 90s, and she smoked and drank. I come from good genes." What is the most appropriate statement the nurse can make in response? "Smoking cigarettes and drinking alcohol will kill you." "Certain illnesses can be traced to common risk factors and can be prevented." "Yes, you do come from good genes." "It is good that you know your body and your family history so well."

"Certain illnesses can be traced to common risk factors and can be prevented."

The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress? Serious, progressive illness Physician-certified illness Choice of palliative care over cure focused Limited life expectancy

Choice of palliative care over cure focused An important focus of hospice care is that care is palliative in nature. No further aggressive treatment to find a cure for the illness is administered. The client must accept this philosophy of care. The other options are factual and agreed on.

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 2,000 mL of fluid 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid

1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? Anemia Pericarditis Hyperkalemia Acidosis

Anemia Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.

Glaser and Strauss (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware? Closed awareness Mutual pretense awareness Suspected awareness Open awareness

Closed awareness Closed awareness occurs when the client is unaware of their terminal state, whereas others are aware. Suspected awareness occurs when the client suspects what others know and attempts to find out details about the condition. Open awareness occurs when the client, the family, and the health care professionals are aware that the client is dying and openly acknowledge that reality. Mutual pretense awareness occurs then the client, the family, and the health care professionals are aware that the client is dying but all pretend otherwise.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

Which of the following nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client? Administer warm intravenous fluids. Administer intramuscular injections. Gently massage the arms and legs. Change the position frequently.

Gently massage the arms and legs. A nurse should gently massage the client's arms and legs to transfer heat and improve circulation in a dying client. Changing the position frequently helps protect the client's skin from breakdown. Administering warm intravenous fluids and intramuscular injections will not help transfer heat and improve circulation in a dying client.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? Seizures Tremors Asterixis Gray-bronze skin color

Gray-bronze skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain

Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.

Empowering the client with a disability will better serve him or her than will promoting dependency. This type of approach is seen in which type of model of disability? Rehabilitation model Social model Interface model Medical model

Interface model In the interface model of disability, the client seeks or directs solutions toward the problem. The interface model may be most appropriate for use by nurses to provide care that is empowering rather than care that promotes dependency.

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using? General inpatient care Palliative care Continuous care Inpatient respite care

Palliative care Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain. Inpatient respite care is a 5-day inpatient stay provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home to manage a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.

A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? Red blood cells in the urine Protein elevation in the urine Sore throat 2 weeks ago Elevation of blood pressure

Sore throat 2 weeks ago Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.

A change that occurs during chronic glomerulonephritis is termed hypokalemia. metabolic alkalosis. anemia. hypophosphatemia.

anemia Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply. Alleviate and manage symptoms Ignore threats to identity Validate family functioning Validate individual self-worth Return to a better state of health than prior

Alleviate and manage symptoms Validate individual self-worth Validate family functioning

Which act mandates that people with disabilities have access to job opportunities and to the community? Title II Americans with Disabilities Act of 1990 Title XVI Rehabilitation Act of 1973

Americans with Disabilities Act of 1990

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? "Let's take this one day at a time; remember you have your daughter's dance recital next week." "You should seek a second medical opinion about your diagnosis." "I know another client with the same diagnosis who has been in remission for 10 years." "I believe that you will fight hard to beat this and see your babies grow up."

"Let's take this one day at a time; remember you have your daughter's dance recital next week." Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.

A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give? "I am not at liberty to disclose that information." "Why do you think that?" "Did someone tell you that you are dying?" "Tell me more about what's on your mind."

"Tell me more about what's on your mind." In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind"). The nurse then needs to listen intently, ask additional questions for clarification, and provide reassurance only when it is realistic.

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic? 6 months 16 weeks 8 weeks 3 months

3 months Chronic diseases or conditions are often defined as medical conditions or health problems with associated symptoms or disabilities that require long-term management. Some definitions use a duration of 3 months or longer, whereas others use a year or longer to indicate chronic disease. Definitions of chronic disease or chronic illness share the characteristics of being irreversible, having a prolonged course, and unlikely to resolve spontaneously (Lubkin & Larsen, 2013).

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6 tablets

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse Acknowledges the client's achievement when she walks to the bedside commode with her walker Assesses postural blood pressures Discontinues the intravenous needle and changes the surgical dressing prior to discharge from the hospital Teaches the client about osteoporosis

Acknowledges the client's achievement when she walks to the bedside commode with her walker In the comeback phase of the Trajectory Model of Chronic Illness, the nurse provides positive reinforcement for goals identified and accomplished by the client. This would be acknowledging the client's achievement when she ambulates to the bedside commode with her walker.

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition. End-stage renal disease Coronary artery disease Type 2 diabetes mellitus Carcinoma-in-situ

End-stage renal disease Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

Nursing care of patients with chronic illness is varied and occurs in a variety of settings. Care must be direct and supportive. To provide supportive care, a nurse would do which of the following? Provide treatments. Manage the medication regime. Make referrals for additional care. Assess the patient's physical status

Make referrals for additional care. Nursing care of patients with chronic illnesses is varied and occurs in a variety of settings. Care may be direct or supportive. Direct care may be provided in the clinic or health provider's office, the hospital, or the patient's home, depending on the status of the illness.

The client had a cerebrovascular accident with drooping of the face. Speech is slurred. The nurse is obtaining the admission assessment data. It would be best for the nurse to Ask a family member the questions. Chart that the nurse is unable to obtain information. Wait until past medical records can be obtained. Repeat back what the client states.

Repeat back what the client states. When communicating with a client who has speech disabilities or difficulties, the nurse repeats what the nurse understands the client has stated for clarification. The nurse asks questions of the client who is able to provide information, not a family member. The nurse does not chart "unable to obtain the information." The client's situation could have changed since past medical records were written.

A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying? Pretrajectory Stable Trajectory onset Acute

Trajectory onset According to the Trajectory Model of Chronic Illness, the trajectory onset phase includes the period of diagnostic workup and announcement of the illness. While the other answer choices are phases of the Trajectory Model of Chronic Illness, these are not the correct answer choices.

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse Removes unnecessary items from the beside table while the physician meets with the client Turns off the television Leaves the room Communicates with the daughter while the physician talks with the client

Turns off the television The nurse minimizes distractions so the client can focus on one thing, such as the physician who may impart important information. Distractions are having the television on, cleaning the room, and talking with someone else in the room. The nurse does not leave the room. The nurse remains so she can repeat information provided by or to the client.

Down syndrome is categorized as a(n) developmental disability. acquired disability. age-related disability. acute nontraumatic disorder.

developmental disability. Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.

A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life? drop in blood pressure and rapid heart rate irregular eating habits altered gastrointestinal function weight loss and inadequate food intake

weight loss and inadequate food intake The nurse should report weight loss and inadequate food intake so that the team can consider adding appetite stimulants and the nutritionist can alter the meal plan to give more satisfying meals as a comfort measure. The nurse knows that changes of gastrointestinal function such as irregular eating or bowel changes occur as part of the dying process and are not relevant to the desired intervention. Deteriorating vital signs are part of the dying process so that these signs are not relevant to the desired intervention.

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "Let's wait until after the surgery to discuss your treatment plan." "The doctor may decide to delay the use of immunosuppressant drugs." "Immunosuppressive drugs guarantee organ success."

"Even a perfect match does not guarantee organ success." Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity." "It is important to use strict aseptic technique."

"It is appropriate to warm the dialysate in a microwave." The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will hasten the death of the patient." "It will prolong life in a dignified manner." "It will enable the patient to remain home if that is what is desired." "It will use artificial means of life support if the patient requests it."

"It will enable the patient to remain home if that is what is desired." The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate? "His moaning does indicate pain, so we'll increase his pain medication." "He has secretions that are collecting at the back of the throat." "He is getting less oxygen to the brain, so the moaning means he is dreaming." "The moaning you hear is from air moving over very relaxed vocal cords."

"The moaning you hear is from air moving over very relaxed vocal cords." As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 30-59 mL/min/1.73 m2 A GFR of 90 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

A patient with amyotrophic lateral sclerosis (ALS) wishes to use his Medicare Hospice Benefit in an effort to maximize his quality of life prior to death. What criterion will determine whether the patient qualifies for this benefit? A demonstrated lack of a support system Exhaustion of all reasonable treatment options A life expectancy of less than 6 months Copayment by a health insurance provider

A life expectancy of less than 6 months According to Medicare, the patient who wishes to use his or her Medicare Hospice Benefit must be certified by a health care provider as terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course. Exhaustion of treatment options, copayment, and a lack of social support are not criteria used to determine qualification.

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin and exenatide and reports adhering to a diet. The glycohemoglobin is 5.9%. According to the stable phase of the Trajectory Model of Chronic Illness, how should the nurse respond? Responds, "There are some adjustments to your medications that need to be made" Advises the client that changes must be made to the diet Acknowledges that the client is performing satisfactorily States, "The glycohemoglobin is too high"

Acknowledges that the client is performing satisfactorily In the stable phase of the Trajectory Model of Chronic Illness, the nurse reinforces positive behaviors. The glycohemoglobin is at a level of good control for a client with diabetes. No adjustments need to be made to the diet or the medications.

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in? Acute Pretrajectory Stable Comeback

Acute In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute glomerulonephritis Nephrotic syndrome Acute renal failure Chronic renal failure

Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

Based on the most common concern of a dying patient, the hospice nurse should: Turn the patient every 2 hours to prevent decubitus ulcers. Offer supplemental fluids to prevent dehydration. Position the patient to prevent difficulties with breathing. Administer pain medication on a schedule that prevents pain from intensifying.

Administer pain medication on a schedule that prevents pain from intensifying. Pain management is the most common concern for the dying patient. Medication should be given on a PRN schedule that keeps the patient comfortable.

Which of the following is an appropriate intervention for the client with pulmonary edema? Administer the prescribed sedative to decrease anxiety. Use chest percussion. Position the client supine. Suction as needed to clear the lungs.

Administer the prescribed sedative to decrease anxiety. Suctioning will not clear the lungs or ease breathing if the client has pulmonary edema. In this situation, the physician may prescribe a sedative to relieve the anxiety created by the feeling of suffocation.

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care? Advice for the family to have fruit juices readily available at the client's bedside. Encouragement of the family to serve the client meat, especially beef. Arrangements for the client to eat meals while others are out of the home. Suggestions that the family offer the client foods that are hot.

Advice for the family to have fruit juices readily available at the client's bedside. To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.

A nurse practitioner would be applying the pre-trajectory model of chronic illness when she: Encouraged a post-fracture patient to continue physical therapy. Suggested home health care to a stroke victim. Explained the significance of a serum glucose level of 160 mg/dL. Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing.

Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing. The pre-trajectory phase involves the prevention of a chronic illness. For example, the focus of nursing care would be to refer the patient for genetic testing and counseling, if indicated, and provide education about prevention of modifiable risk factors and behaviors.

A client with a terminal illness has feelings of rage toward the nurse. According to Kubler-Ross, the client is in which stage of dying? Denial Anger Depression Bargaining

Anger Anger includes feelings of rage or resentment. Denial includes feelings of isolation. Bargaining occurs when a client and/or family pleads for more time to reach an important goal. Depression includes sadness, grief, and mourning for an impending loss.

A client has a tentative diagnosis of lung cancer following computed tomography (CT) scanning. He is scheduled for a fiberoptic bronchoscopy with biopsy. In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse Administers the preoperative medication for the bronchoscopy Obtains the signature of the client on the consent form Answers the client's questions about the bronchoscopy procedure Provides postprocedure care following the bronchoscopy

Answers the client's questions about the bronchoscopy procedure In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse provides explanations of diagnostic tests and procedures, such as the bronchoscopy with biopsy. The nurse will reinforce information and explanations provided by the physician.

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience? Attitudinal barrier Structural barrier Barrier to health care Transportation barrier

Attitudinal barrier Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.

Which intervention should a nurse perform during the grieving period when caring for a dying client? Avoiding criticizing or giving advice Spending time with the client Allowing a period of privacy Providing palliative care

Avoiding criticizing or giving advice The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not the required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Uses moisturizing creams Brief, hot daily showers Pats skin dry after bathing Keeps nails trimmed short

Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

The instructor provides corrective information to the nursing student when the student refers to the client as the Woman who has diabetes COPDer in 216 Man with an MI Patient who is disabled

COPDer in 216 "People-first" language means referring to the person first. Examples include patient who is disabled, man with an MI, and woman who has diabetes. Using "COPDer in 216" conveys that the illness or disability is of greater importance than the person.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? Calcium Phosphorus Sodium Magnesium

Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness? Chronic illness affects the entire family. Managing chronic conditions must be an individual process. One chronic disease never develops into another chronic condition. Chronic conditions only involve one aspect of a person's life.

Chronic illness affects the entire family. Chronic illness affects the entire family to the extent that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. One chronic disease can lead to the development of other chronic conditions. Chronic conditions usually involve many different phases over the course of a person's lifetime.

Which statement is a misconception about chronic disease? Chronic illnesses cannot be prevented. The major cause of chronic disease is known. Chronic illness typically does not result in sudden death. Almost half of chronic disease-related deaths occur prematurely in people <70 years of age.

Chronic illnesses cannot be prevented. A misconception regarding chronic disease is that chronic illnesses cannot be prevented. Almost half of chronic disease-related deaths occur prematurely in people younger than 70 years of age. Chronic illness typically does not result in sudden death. The major cause of chronic disease is known.

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? Citrus fruits Salad oils Cooked white rice Butter

Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms? Client's goals Invasiveness of the treatment Length of required treatment Physician's orders

Client's goals When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? Lack of Medicare/Medicaid funding for hospice Difficulty obtaining Medicare certification for hospice services Lack of fully credentialed and trained hospice nurses Clients and families view hospice care as giving up

Clients and families view hospice care as giving up Clients often equate hospice with giving up and are reluctant to accept hospice care. Lack of fully credentialed and trained hospice nurses is not a barrier to hospice care. Lack of Medicare funding and lack of certification for hospice service providers have not been documented as barriers to access of hospice services.

What barrier to end-of-life care does a dying client demonstrate with the statement, "I don't need hospice. Hospice is for people who are dying." Anger Acceptance Denial Bargaining

Denial Patient denial about the seriousness of terminal illness has been cited as a barrier to discussions about end-of-life treatment options. Denial includes feelings of isolation. Bargaining occurs when a client and/or family pleads for more time to reach an important goal. Anger includes feelings of rage or resentment. Acceptance occurs when the client and/or family are neither angry nor depressed.

The nurse is working with a client who has difficulty controlling blood sugar. The client is classified as overweight. The client does not adhere to a low-calorie diet and forgets to take medications and check blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, what action will the take first? Collaborates with the client to establish an agreed-upon goal Informs the client about what goal the nurse wants the client to achieve Sets the long-term goal as "the client's glycohemoglobin will be 6.9% in 3 months" Plans the short-term goal as "the client's blood sugar each AM will be less than 110 mg/dL"

Collaborates with the client to establish an agreed-upon goal When establishing a goal, the nurse should collaborate with the client. The nurse does not dictate to the client what the goal will be. Goals must be consistent with the abilities and motivation of the client. The long-term and short-term goals may not be realistic for this client.

Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness? Crisis Downward course Comeback Acute

Comeback

A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient? Compatible blood and tissue types Blood relationship Sex and size Need

Compatible blood and tissue types The donor and recipient must have compatible blood and tissue types. They should be fairly close in size and age, but these factors aren't as important as compatible blood and tissue types. When a living donor is considered, it's preferable to have a blood relative donate the organ. Need is important but it can't be the critical factor if a compatible donor isn't available.

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply. Comfort the client by saying it will all be over soon. Recommend that the client consider physician-assisted suicide. Control the client's pain with prescribed medication. Encourage the client to explain his or her wishes. Advise the client's health care provider of the client's condition.

Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Decrease in the blood flow through the kidneys Structural damage occurred in the nephrons of the kidneys

Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

Which is the initial stage of grief, according to Kübler-Ross? Depression Anger Bargaining Denial

Denial The stages of grief include denial, anger, bargaining, depression, and acceptance. Anger is the second stage of the process. Bargaining is the third stage of the process. Depression is the fourth stage of the process.

This type of disability represents one that occurs any time from birth to 22 years and results in impairment of physical or mental health, cognition, speech, language, or self-care. Developmental Acquired Age-related Acute nontraumatic

Developmental

Which chronic illness directly related to an unhealthy lifestyle does the nurse understand is increasing rapidly? Breast cancer Diabetes mellitus Colorectal cancer Emphysema

Diabetes mellitus The increasing prevalence of obesity has increased the incidence of heart disease, strokes, diabetes, and hypertension. Obesity also affects one's self-esteem, achievement, and emotional state (Galuska & Dietz, 2010).

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? Impaired immunologic response Electrolyte imbalances Diminished erythropoietin production Azotemia

Diminished erythropoietin production Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia.

A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as Stable Crisis Downward Acute

Downward The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? Durable power of attorney for health care Living will declaration End-of-life treatment directive Medical directive by proxy

Durable power of attorney for health care A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause? Shorter lifespans Lowered stress and increased physical activity lifestyles Early detection and treatment of diseases An increased mortality rate from infectious diseases

Early detection and treatment of diseases

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations? Encourage the family members to express their feelings and listen to them in their frank communication. Encourage the patient's family members to spend time with the patient. Be a silent observer and allow the patient to communicate with the family members. Encourage conversations on the impending death of the patient.

Encourage the family members to express their feelings and listen to them in their frank communication. Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient. It is not advisable for the nurse to encourage conversations on the impending death of the patient. Being a silent observer or encouraging the family members to spend time with the dying patient may not help the family members to express their feelings.

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? Keep the drainage catheter below the level of insertion. Monitor temperature every 4 hours. Administer isotonic fluid therapy as ordered. Encourage use of incentive spirometer every 2 hours.

Encourage use of incentive spirometer every 2 hours. To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following? Participate in a support group to learn clients' feeling on care. Explore own feelings on mortality and death and dying. Use evidence-based practice in daily care regimen. A workshop on caring for the dying client

Explore own feelings on mortality and death and dying. To care for others in the dying process, the nurse must explore his or her own feelings about mortality and death and dying. Understanding self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Absence of pain Fever Weight loss Diuresis

Fever Fever is an indicator of infection or transplant rejection.

A client, aged 87, undergoes continuous ambulatory peritoneal dialysis (CAPD) for acute renal failure (ARF). Which task would be most important for the nurse to do? Note a color change in the client's eyes, teeth, and nails. Monitor the client for hypoglycemia and hyperglycemia. Ensure a diet rich in proteins and potassium. Frequently monitor the client's progress.

Frequently monitor the client's progress. Older clients who are not candidates for kidney transplants may receive CAPD. More frequent monitoring of the client's progress is required when this technique is used. The recommendations for protein and potassium in the diet are highly variable based on the client's condition. Change in the color of client's teeth, eyes, and nails need not be monitored, nor does the client need to be monitored for hypoglycemia and hyperglycemia.

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Dysrhythmia Ureteral calculus

Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

Which term is used to describe the personal feelings that accompany an anticipated or actual loss? Spirituality Bereavement Grief Mourning

Grief Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.

A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to Obtain assistance of another staff member and not have the client use the walker. Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. Place a bedside commode next to the bed. Assist the client in using a bedpan.

Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. When the nurse offers seating to a client with low vision or blindness, the nurse should place the client's hand on the arm of the chair. This helps to guide the client in sitting. Though placing the bedside commode next to the bed is a good idea, it is not the best choice. The nurse will encourage the client to use the bedside commode, not the bedpan, for better emptying of the urinary bladder.

Acute dialysis is indicated during which situation? Dehydration Metabolic alkalosis Impending pulmonary edema Hypokalemia

Impending pulmonary edema Acute dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, or increasing acidosis.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase carbohydrates and limit protein intake. Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase protein, carbohydrates, and fat intake.

Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

A client who is an avid runner had an emergency below-the-knee amputation after a motor vehicle accident. The nurse hears a physical therapist tell the client that the client may have to stop running. The nurse considers this comment as an indication that the physical therapist has which frame of reference for caring for clients with disabilities? Biophysical model Medical model Interface model Rehabilitation model

Medical model In this example, the physical therapist's frame of reference, or approach to providing care, stems from the medical model. By telling the client that she would need to stop running, the therapist equated the client with her disability, acted as the authority figure, and promoted the client's dependence, rather than allowing the client to define the problem and seek/direct solutions. Equating the client with the disability, acting as the authority, and promoting passivity and dependence are hallmarks of the medical model of disability.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? Obstruction of the urinary collecting system Poor perfusion to the kidneys Damage to cells in the adrenal cortex Nephrotoxic injury secondary to use of contrast media

Nephrotoxic injury secondary to use of contrast media Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Restored glomerular function Acute tubular necrosis

Oliguria During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.

The nurse is planning a community education program on disabilities. The nurse plans to include which statement? Greater than 10% of children have a disability. People with disabilities are most likely to work part time. Less than 5% of people in the United States have a disability. Fifty percent of people with disabilities are employed.

People with disabilities are most likely to work part time. People with disabilities are more likely than those without disability to work part time. The employment rate for people with disabilities is 18.6-23.4%. Approximately 20% of the U.S. population has a disability and 5% of children have a disability.

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people? Medical jargon People-first First nation Nursing speak

People-first It is important to all people, with and without disabilities, to not be equated with an illness or a physical condition. Therefore, it is important for health care providers to refer to all people using "people-first" language.

What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hypokalemia Hyperalbuminemia

Proteinuria Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth? Provide gentle oral care after each meal. Place two drops of atropine ophthalmic 1% solution sublingually. Gently suction the client's mouth and buccal cavity. Begin 9% normal saline IV at 125 mL/hr.

Provide gentle oral care after each meal. Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis Previous episode of acute pyelonephritis

Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions? Providing evidenced-based advice for end-of-life care based on the nurse's experiences with previous clients in hospice Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Offering reassurance that the nurse has had 5 years of assisting clients in hospice and their families care for loved ones at the end of life Filling voids in conversation with information related to death and dying to avoid awkward moments during the admission interview

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? Respect the client's and family members' choices. Ask the family members about spiritual care. Abide by the dying client's wishes. Share emotional pain.

Respect the client's and family members' choices. In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Toileting self-care deficit Impaired urinary elimination Risk for infection Activity intolerance

Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

Which of the following would a nurse classify as a prerenal cause of acute renal failure? Prostatic hypertrophy Ureteral stricture Polycystic disease Septic shock

Septic shock Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

What is used to decrease potassium level seen in acute renal failure? IV dextrose 50% Calcium supplements Sorbitol Sodium polystyrene sulfonate

Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring? Pretrajectory Stable Unstable Trajectory onset

Stable In the Stable phase, the focus of nursing care is on reinforcing positive behaviors and offering ongoing monitoring. During the Pretrajectory phase, the focus is on referring the person for genetic testing and counseling, if indicated, and providing education about prevention of modifiable risk factors and behaviors. The trajectory onset phase provides explanation of diagnostic tests and procedures and reinforces information and explanation given by the primary health care provider. During the Unstable phase of the Trajectory Model, the focus of nursing care is on providing guidance and support and reinforcing previous teaching.

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate? Comeback Downward Stable Acute

Stable The stable phase indicates that the symptoms and disability are under control or managed. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The comeback phase is the period in the trajectory marked by recovery after an acute period. The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Multiple spiked P waves Tall, peaked T waves Prolonged ST segment Shortened QRS complex

Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

Which of the following describes the crisis phase of the trajectory model of chronic illness? The client is experiencing a critical or life-threatening situation requiring emergency treatment. The client may require more diagnostic tests. The course of the illness and symptoms are under control. The client is in the final days or weeks before death characterized by gradual or rapid shutting down of body processes.

The client is experiencing a critical or life-threatening situation requiring emergency treatment.

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness: The client adheres to the prescribed therapeutic regimen. The client stops taking some medications due to side effects that are disturbing to the client. The client and family do not allow the chronic illness to be the focal point of their lives. The client does not believe that the illness threatens self identity and body image.

The client stops taking some medications due to side effects that are disturbing to the client. Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.

A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client? The interpreter may lag a few words behind--especially if names or technical terms are to be finger spelled. The nurse should talk to the interpreter while teaching the client. An interpreter is not needed. A family member would be better to use as the interpreter.

The interpreter may lag a few words behind--especially if names or technical terms are to be finger spelled. If a nurse is speaking through a sign language interpreter, the interpreter may lag a few words behind-especially if names or technical terms are to be finger spelled. So the nurse should pause occasionally to allow the interpreter time to translate completely and accurately. The facility should provide an interpreter for the client with a disability. Family members should not serve as interpreters due to concern for misinterpretations of information and the need to maintain client privacy and confidentiality. The nurse should talk directly to the person who has hearing loss, not to the interpreter. However, although it may seem awkward, the person with hearing loss will look at the interpreter and may not make eye contact with the nurse during the conversation.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Blood urea nitrogen (BUN) level of 22 mg/dl Temperature of 100.2° F (37.8° C) Serum creatinine level of 1.2 mg/dl Urine output of 250 ml/24 hours

Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea? Offer small amounts of nourishment frequently Use imagery, humor, and progressive relaxation Encourage the patient to sleep Gently massage the arms and legs

Use imagery, humor, and progressive relaxation Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication.

A client experiencing a manic phase of bipolar disorder sustained cuts on the body from falling through a store window. The nurse is preparing to start an intravenous needle insertion. How should the nurse explain the procedure to the client? Giving specific details about the procedure and what is going to happen next Using clear and simple terms Interrupting the client's ravings Ignoring the client's statement of, "I don't want this."

Using clear and simple terms When communicating with clients who have psychiatric or mental health disabilities, the nurses uses clear and simple communication. The nurse needs to listen to the client and wait for the client to finish speaking. The client makes independent decisions, and the nurse does not ignore the client's refusal.

A cause related to the increasing number of people with chronic conditions is improved screening and diagnostic procedures. a tendency for these conditions to develop in younger people. shorter lifespans. an increase in mortality from infectious disease.

improved screening and diagnostic procedures. The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious diseases has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons.