Fundamentals of Nursing practice exam #1

Which of the following describes a nurse's application of a specific knowledge base during critical thinking? (Select all that apply.) 1. Initiative in reading current evidence from the literature 2. Application of nursing theory 3. Reviewing a policy and procedure manual 4. Considering a colleague's view of a patient's needs 5. Previous time caring for a specific group of patients

1, 2

To best assist a patient in the grieving process, which factors are most important for the nurse to assess? (Select all that apply.) 1. Previous experiences with grief and loss 2. Religious affiliation and denomination 3. Ethnic background and cultural practices 4. Current financial status 5. Current medications

1, 2, 3

A nurse is teaching an older adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.) 1. Speak in a low tone. 2. Begin and end the session with the most important information regarding melanoma. 3. Provide a pamphlet about melanoma with large font in blues and greens. 4. Provide specific information in frequent, small amounts for older adult patients. 5. Speak quickly so that you do not take up much of the patient's time.

1, 2, 4

A client who is at 28 weeks' gestation and in active labor is crying. She says, "I just know that this baby is going to die. What's the use of doing all this to save it?" Which explanation would interpret the client's statements? 1. She is depressed and needs firm, positive support during labor. 2. She is experiencing anticipatory grief and withdrawing from bonding. 3. She is in need of sedation to help her cope with the impending birth. 4. She is demonstrating difficulty dealing with the birth by using the word "it."

2

A client who recently was told by her primary health care provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. Which stage of death and dying is the client experiencing ? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

2

A nurse is teaching a patient about heart failure. Which environment will the nurse use? 1. A darkened, quiet room 2. A well-lit, ventilated room 3. A private room at 85° F temperature 4. A group room for 10 to 12 patients with heart failure

2

Which is the most appropriate nursing intervention when providing care for parents who have experienced a stillbirth? 1. Giving a detailed explanation of what may have caused the stillbirth 2. Providing the parents the opportunity to say goodbye to their newborn 3. Explaining that an autopsy is not recommended in the setting of a stillbirth 4. Waiting to provide any information about follow-up care until the parents have had an opportunity to adjust to the grief

2

Which is true about the effect of grief and loss in toddlers? 1. They show resilience after a loss. 2. They express a sense of change in sleeping. 3. They understand the concepts of permanence. 4. They get disrupted in developing an autonomous sense of self.

2

Which terminology system would the nurse use to enter nursing diagnoses, interventions, and outcomes in electronic health records? 1. Omaha system 2. Perioperative Nursing Data Set (PNDS) 3. Nursing Interventions Classification (NIC) 4. North American Nursing Diagnosis Association (NANDA) International

2

Which theory describes the phenomenon of grief or caring? 1. Grand theories 2. Descriptive theories 3. Prescriptive theories 4. Middle-range theories

2

A nurse has been caring for a patient with a chronic wound that has not been healing. The nurse talks with a nurse specialist in wound care to find alternative approaches from what the health care provider ordered for dressing the wound. The two decide that because of the patient's allergy to tape a nonallergenic dressing will be used. The nurse obtains an order from the health care provider for the new dressing. After two days there is improvement in the wound. This is an example of which critical thinking standards? (Select all that apply.) 1. Clear 2. Broad 3. Relevant 4. Risk taking 5. Creativity

3, 4, 5

A nurse is teaching a patient's family member about permanent tube feedings at home. Which purpose of patient education is the nurse meeting? 1. Health promotion 2. Illness prevention 3. Restoration of health 4. Coping with impaired functions

4

Which would the nurse understand by the quality improvement competency, according to Quality and Safety Education for Nurses (QSEN)? 1. Using information and technology to communicate, manage knowledge, mitigate errors, and support decision-making 2. Integrating best current evidence with clinical expertise along with client and family preferences and values for the delivery of quality health care 3. Functioning effectively within nursing and interprofessional teams by fostering open communication, mutual respect, and shared decision-making to achieve quality client care 4. Using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care system

4

A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. Which behaviors indicate the client is emotionally accepting the impending death? 1. Revising the client's will and planning a visit to a friend 2. Alternately crying and talking openly about death 3. Getting second, third, and fourth medical opinions 4. Refusing to follow treatments and stating they won't help anyway

1

A client with diabetes mellitus experiences a sudden fall in blood glucose levels while traveling by air. The client is not carrying any medications or a copy of a personal medical record. Which type of health information technology would be beneficial for this client? 1. Personal health record (PHR) 2. Clinical health care informatics 3. Electronic medical record (EMR) 4. Regional health information organization (RHIO)

1

A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the doctor's order. At the bedside the nurse checks the patient's name against the medication order as well. The nurse is following which critical thinking attitude? 1. Responsibility 2. Humility 3. Accurate 4. Fairness

1

A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include in the teaching session? 1. If you still do not understand, ask again. 2. Ask a nurse to be your advocate or supporter. 3. The nurse is the center of the health care team. 4. Inappropriate medical tests are the most common mistakes.

1

A patient's outcome was to have a pain level of 4 out of 10, 30 minutes after receiving medication. 30 minutes later the patient reported a pain level of 3 out of 10. Has the outcome been: 1. Met 2. Not met 3. Partially met 4. Not enough information

1

The nurse is caring for a patient who has just had a near-death experience (NDE) following a cardiac arrest. Which intervention by the nurse best promotes the spiritual well-being of the patient after the NDE? 1. Allowing the patient to discuss the experience 2. Referring the patient talk to another patient who has an NDE 3. Having the patient talk to another patient who has an NDE 4. Offering to pray for the patient

1

The nurse uses a visual analogue scale to rate the pain experienced by a client receiving oxycodone therapy. Which terminology would the nurse use to enter the visual analogue scores in the client's electronic health record (EHR)? 1. Omaha system 2. Nursing Interventions Classification (NIC) 3. American Medical Informatics Association (AMIA) 4. North American Nursing Diagnosis Association (NANDA) International

1

A patient states, "I don't have confidence in my doctor. She looks so young." The nurse therapeutically responds: (Select all that apply.) 1. Tell me more about your concern. 2. You have nothing to worry about. Your doctor is perfectly competent. 3. You are worried about your care? 4. You can go online and see how others have rated your doctor. I do that. 5. You should ask your doctor to tell you her background.

1, 3

Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

1, 3

One element of clinical decision making is knowing the patient. Which of the following activities affect a nurse's ability to know patients better? (Select all that apply.) 1. Caring for similar groups of patients over time 2. Reading the evidence-based practices appropriate to patients 3. Learning how patients typically respond to their clinical situations 4. Observing patients 5. Engaging with patients experiencing illness

1, 3, 4

When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help with the patient lip-read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

1, 3, 4

Motivational interviewing (MI) is a technique that applies understanding a patient's values and goals in helping the patient make behavioral changes. When using motivational interviewing, what outcomes does the nurse expect? (Select all that apply.) 1. Gaining an understanding of the patient's motivations 2. Directing the patient to avoid poor health choices 3. Recognizing the patient's strengths and supporting his or her efforts 4. Providing assessment data that can be shared with families to promote change

1, 3, 5

A nurse is trying to help a patient begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? 1. Lecture 2. Role play 3. Demonstration 4. Question and answer sessions

2

A patient has heart failure and kidney failure. The patient needs teaching about dialysis. Which nursing action is most appropriate for assessing this patient's learning needs? 1. Assess the patient's total health care needs. 2. Assess the patient's health literacy. 3. Assess all sources of patient data. 4. Assess the goals of patient care.

2

A patient has just learned she has been diagnosed with a malignant brain tumor. She is alone; her family will not be arriving from out of town for an hour. The nurse has been caring for her for only 2 hours but has a good relationship with her. What is the most appropriate intervention for support of her spiritual well-being at this time? 1. Make a referral to a professional spiritual care adviser. 2. Sit down and talk with the patient; have her discuss her feelings and listen attentively. 3. Move the patient's Bible from her bedside cabinet drawer to the top of the over-bed table. 4. Ask the patient whether she would like to learn more about the implications of having this tumor.

2

A patient learns that a normal adult heartbeat is 60 to 100 beats/min after a teaching session with a nurse. In which domain did learning take place? 1. Kinesthetic 2. Cognitive 3. Affective 4. Psychomotor

2

A patient suddenly experiences a severe headache with numbness and decreased movement in the left arm. The emergency room physician suspects a stroke and is going to have the patient undergo an emergent angiogram to remove the clot. Which teaching approach is mot appropriate? 1. Selling approach 2. Telling approach 3. Entrusting approach 4. Participating approach

2

When taking a patient's health history, the nurse nods to certain information trying to show acceptance or agreement. What non-verbal cue is the nurse demonstrating? 1. Physical appearance 2. Gestures 3. Touch 4. Posture

2

The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse's silence? (Select all that apply.) 1. Prevent the nurse from saying the wrong thing 2. Prompt the patient to talk when he or she is ready 3. Allow the patient time to think and gain insight 4. Allow time for the patient to drift off to sleep 5. Determine if the patient would prefer to talk with another staff member

2, 3

A nurse is caring for a young patient who has been told he has multiple sclerosis. The nurse has planned time to conduct a teaching session that will focus on the disease and principles of management. The nurse chooses to use the EDUCATE model to proceed with instruction. Which of the following are components of the model? (Select all that apply.) 1. State goals of the session for the patient. 2. Repeat the most important information. 3. Practice empathetic skills 4. Be aware of the nonverbal messages. 5. Use a standard question list for the chosen topic.

2, 3, 4

Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.) 1. Improve the nurse's status with the health team members 2. Reduce the risk of errors to the patient 3. Provide optimum level of patient care 4. Improve patient outcomes 5. Prevent issues that need to be reported to outside agencies

2, 3, 4

The nurse therapeutically responds to an adult patient who is anxious by: (Select all that apply.) 1. Matching the rate of speech to be the same as that of the patient 2. Providing good eye contact 3. Demonstrating a calm presence 4. Spending time attentively with the patient 5. Assuring the patient that all will be well

2, 3, 4

Which interventions does a nurse implement to help a patient at the end of life maintain autonomy while in a hospital? (Select all that apply.) 1. Use therapeutic techniques when communication with the patient. 2. Allow the patient to determine timing and scheduling of interventions. 3. Allow patients to have visitors at any time. 4. Provide the patient with a private room close to the nurses' station. 5. Encourage the patient to eat whenever he or she is hungry.

2, 3, 5

A nurse enters a patient's room at the beginning of a shift to conduct an assessment of his condition following a blood transfusion. The nurse cared for the patient on the previous day as well. The patient has a number of issues he wishes to share with the nurse, who takes time to explore each issue. The nurse also assesses the patient and finds no signs or symptoms of a reaction to the blood product. The nurse observed the patient the prior day and sees a change in his behavior, a reluctance to get out of bed and ambulate. Which of the following actions improve the nurse's ability to make clinical decisions about this patient? (Select all that apply.) 1. Working the same shift each day 2. Spending time during the patient assessment 3. Knowing the early mobility protocol guidelines 4. Caring for the patient on consecutive days. 5. Knowing the pattern of patient behavior about ambulation

2, 4

A nurse is assigned to care for a woman who is expecting her first child. The nurse organizes herself and plans to gather data about the patient by applying Pender's health promotion model, including the patient's characteristics and experience and situational influences. She plans to observe patient behavior and consider the patient's psychosocial issues. Such data will offer a clear understanding to help the nurse identify the patient's needs. This is an example of which of the following concepts? (Select all that apply.) 1. Diagnostic reasoning 2. Deductive reasoning 3. Inductive reasoning 4. Assessment 5. Problem solving

2, 4

Which of the following scenarios demonstrate that learning has taken place? (Select all that apply.) 1. A patient listens to a nurse's review of the warning signs of a stroke. 2. A patient describes how to set up a pill organizer for newly ordered medicines. 3. A patient attends a spinal cord injury support group. 4. A patient demonstrates how to take his blood pressure at home. 5. A patient reviews written information about resources for cancer survivors.

2, 4

A nurse works with a patient using therapeutic communication and the phases of the therapeutic relationship. Place the nurse's statements in order according to these phases. 1. The nurse states, "Let's work on learning injection techniques." 2. The nurse is mindful of his/her own biases and knowledge in working with the patient with B12 deficiency. 3. The nurse summarizes progress made during the nursing relationship. 4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.

2, 4, 1, 3

A 65-year-old woman is a family caregiver for her 88-year-old mother who has dementia. The caregiver asked the home health nurse how to manage her mother when she becomes confused and violent. The best instructional method a nurse can use this situation is: 1. Demonstration 2. Preparatory instruction 3. Role-playing 4. Group instruction with other family caregivers

3

A client had a first-trimester abortion and has been unable to function for 3 months. Which type of grief is the client experiencing? 1. Complex bereavement 2. Anticipatory 3. Disenfranchised 4. Complicated

3

A nurse is preparing to teach a patient who has sleep apnea how to use CPAP machine at night. Which action is most appropriate for the nurse to perform first? 1. Allow patient to manipulate machine and look at parts. 2. Provide a teach-back session. 3. Set mutual goals for the education session. 4. Discuss the purpose of the machine and how it works.

3

A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place? 1. Verbalization of steps to use in splinting 2. Selecting from a series of flash cards the images showing the correct technique 3. Return demonstration 4. Close test

3

A recently widowed client says, "His death has complicated my life even more than the hassles he caused when he was alive!" Which term would best describe the marital relationship? 1. Loving 2. Long-term 3. Ambivalent 4. Subservient

3

A terminally ill client repeatedly talks about her son's upcoming wedding and how much she wants to attend. Which stage of the Kubler- Ross theory of death and dying is the client displaying? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

3

A toddler is going to have surgery on the right ear. Which teaching method is most appropriate for this developmental stage? 1. Encourage independent learning. 2. Develop a problem-solving scenario. 3. Wrap a bandage around a stuffed animal's ear. 4. Use discussion throughout the teaching session.

3

The nurse working in a cardiac center is preparing to enter client data using health information technology. The nurse needs to refer to these data during subsequent follow-up client visits. Which type of record would the nurse use to enter the client's data? 1. Personal health record (PHR) 2. Electronic health record (EHR) 3. Electronic medical record (EMR) 4. Regional Health Information Organization (RHIO) heath record

3

Which behavior would be exhibited in a 2-year-old child after the death of a family? 1. The child shows resiliency over the loss. 2. The child understands the cause of the loss. 3. The child exhibits changes in eating and sleeping patterns. 4. The child is unable to develop an autonomous sense of self.

3

Which organization assists in establishing policies related to Medicare and Medicaid payment for meaningful use of electronic health records (EHRs)? 1. National Institutes of Health (NIH) 2. American Medical Informatics Association (AMIA) 3. Center for Medicare and Medicaid Services (CMS) 4. Health Information Management Systems Society (HIMSS)

3

You are going into surgery and your nurse says, "I'm sure you're going to be fine!" What type of interviewing trap is this? 1. Giving unwanted advice 2. Leading or biased question 3. Providing false assurance 4. Talking too much

3

A patient asks a nurse to provide instruction on how to perform a breast self-exam. Which domains are required to learn this skill? (Select all that apply.) 1. Affective domain 2. Sensory domain 3. Cognitive domain 4. Attentional domain 5. Psychomotor domain

3, 5

A 55-year-old adult male has been in the hospital over a week following surgical complications. The patient has had limited activity but is now finally ordered to begin a mobility program. The patient just returned from several diagnostic tests and tells the nurse he is feeling quite fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient's condition? 1. Motivation to learn 2. Developmental stage 3. Stage of grief 4. Readiness to learn

4

A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of: 1. Creativity. 2. Fairness. 3. Clinical reasoning. 4. Applying ethical criteria.

4

A nurse is caring for a patient who has poor pain control. The patient has a history of opioid abuse. During the day the patient made frequent requests for a pain medication. In order to make an effective clinical decision about this patient, the nurse needs to ask questions about the data available on the patient to make a thorough and thoughtful decision. The nurse asks herself, "How does my view about the patient's pain tolerance compare with the patient's, and does that pose a problem?" This is an example of: 1. A question about assumptions. 2. A question about evidence. 3. A question about procedure. 4. A question about perspective.

4

A nurse is teaching a patient with a risk for hypertension how to take a blood pressure. Which action by the nurse is the priority? 1. Assess laboratory results for high cholesterol and other data. 2. Identify that teaching is the same as the nursing process. 3. Perform nursing care therapies to address hypertension. 4. Focus on a patient's learning needs and objectives.

4

A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. Which element represents feedback? 1. The nurse 2. The patient 3. The nurse teaching about healthy food choices 4. The patient stating that eating yogurt is better than eating cake

4

A nurse's goal is to provide teaching for restoration of health. Which situation indicates the nurse is meeting this goal? 1. Teaching a family member to provide passive range of motion for a stroke patient 2. Teaching a woman who recently had a hysterectomy about possible adoption 3. Teaching expectant parents about changes in childbearing women 4. Teaching a teenager with a broken leg how to use crutches

4

The nurse is assessing the needs of a client who just learned that a tumor is malignant and has metastasized to several organs and that the illness is terminal. Which behavior would the nurse expect the client to exhibit during the initial stage of grieving? 1. Crying uncontrollably 2. Criticizing medical care 3. Refusing to receive visitors 4. Asking for a second opinion

4

What is an example of a leading question? 1. How much do you smoke per day? 2. How long have you smoked for? 3. Have you ever smoked? 4. You don't smoke do you?

4

Which key factor assists the nurse in assessing how a client will cope with the body image change after an above-the-knee amputation? 1. Extent of the change 2. Suddenness of the change 3. Obviousness of the change 4. Personal perception of the change

4

Which nonverbal skill would suggest the patient could be physically or emotionally ill? 1. Open posture 2. Nodding while listening 3. Maintaining eye contact 4. Lack of grooming

4

Which question is most important to ask a client whose spouse died 2 years ago and she is now exhibiting a general lack of interest, poor personal hygiene, and social isolation? 1. "How do you feel about your spouse's death?" 2. "What do you think is causing your depressed behavior?" 3. "What can you tell me about your marital relationship?" 4. "Have you recently been thinking about suicide?"

4

Which statement made by a patient who is recovering after recently experiencing third-degree burns shows connectedness? 1. "My pain medicine helps me feel better." 2. "I know I will get better if I just keep trying." 3. I see God's grace and become relaxed when I watch the sun set at night." 4. "I feel so much closer to God after I read my Bible and pray."

4

Which would the nurse recommend to help a client during the period immediately after a spouse's death? 1. Crisis counseling 2. Family counseling 3. Marital counseling 4. Bereavement counseling

4

The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.) 1. Validate health care needs through verbal discussion with the patient. 2. Compare actual and expected patient care outcomes with the patient. 3. Provide support through therapeutic communication techniques. 4. Complete a nursing history using verbal communication techniques.

4, 1, 3, 2