Giddens Unit 6 Questions

Many grandparents today are caring for grandchildren in place of a parent. Identify the reasons why this phenomenon is happening. (Select all that apply.) a. Children prefer living with their grandparents. b. Parents are incarcerated. c. Parents are deceased. d. Grandparents are better caregivers. e. Parents are mentally ill. f. Parents are substance abusers.

B, C, E, F Grandparents are usually caring for children because the parents are deceased, in prison, substance abusers, or mentally ill and cannot care for the children. The fact that children prefer to live with the grandparents or the grandparents may be better caregivers is not a main reason for this phenomenon to happen.

4. An 80-year-old patient is being discharged after he was diagnosed with diabetes mellitus and retinopathy. His daughter has been part of the discharge instruction process. Understanding of the instructions is evident when the daughter says which of the following? a. "I will make sure that dad always wears warm socks." b. "Dad needs to wear his glasses so he can delay the onset of macular degeneration." c. "I will ask the home health aide to carefully inspect dad's feet every day when she helps him bathe." d. "We will give him only warm foods, so that he doesn't burn his mouth."

c. "I will ask the home health aide to carefully inspect dad's feet every day when she helps him bathe." Diabetes increases risk of peripheral neuropathy, and it is hard to inspect one's own feet. Though socks that fit well are important, warmth is not the main issue. Glasses do not affect the onset of eye disorders, including macular degeneration. The sensory deficit regarding perception of heat and cold is usually associated with the distal extremities.

The new nurse correctly defines a law when stating which information? a. "Law is a fundamental concept for healthcare professionals." b. "Law's rule is developed by the employee's organization." c. "Law's rule is enacted by a government agency that defines what must be done in a given circumstance." d. "Law is a mandate from the Joint Commission or other accrediting agency."

c. "Law's rule is enacted by a government agency that defines what must be done in a given circumstance."

A young wife is talking with the nurse about her husband who is returning from the military. The wife confides that her husband is physically okay but is behaving differently. What is the nurse's best response? a. "He is just trying to adjust to civilian life again; he'll be okay." b. "You should observe him closely, because he could attack you." c. "Many times people need care for emotional trauma." d. "Talk with your physician to get medication, and then put it in his food."

c. "Many times people need care for emotional trauma." The nurse is alerting the young wife to the fact that people who have experienced emotional trauma need care too. The nurse does not know how the husband is adjusting so the other options are incorrect.

In which of the following answers is the hospital in compliance with the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA)? a. The emergency department staff asks a patient to stay in the waiting room until the patients with insurance are treated. b. The emergency registration personnel explain to a patient that they must have proper identification to receive treatment. c. A patient with chest pain is triaged directly to a room for evaluation and registration information is obtained after the patient is stabilized. d. The emergency department physician discharges and instructs a patient who is actively suicidal to go to the neighborhood facility that has psychiatric services.

c. A patient with chest pain is triaged directly to a room for evaluation and registration information is obtained after the patient is stabilized. EMTALA requires that any hospital that operates an emergency department and receives Medicare funds provide an appropriate screening exam to anyone who presented and stabilize any emergency medical condition prior to transfer to another facility. The other choices are in conflict with EMTALA because a medical screening exam must be provided without consideration of the patient's insurance, whether the patient has identification, or the facility's services.

Comfort care is an intervention carried out by which professional discipline? a. Clergy b. Medicine c. Nursing d. Volunteers

c. Nursing Comfort care is a term that is often used by physicians and nurses in the context of dying, terminally ill, or seriously ill patients. Yet, comfort care is predominantly used by nurses, who attend to the dying patient and family by providing physical comfort measures, such as repositioning, mouth care, and skin care, while valuing the ongoing medical management of the patient's symptoms. Therefore, the other answers are incorrect—it is primarily the nurse who provides comfort care.

A nursery nurse performing the first physical assessment of the newborn observes that there is no clear identification of genitalia as being either female or male. How should the nurse identify this newborn? a. Gender neutral b. Bisexual c. Observation of intersex d. Asexual

c. Observation of intersex Intersex represents a group of conditions where the external genitalia of an infant does not appear as either male or female and/or is not consistent with genetic sex or organs. The nurse cannot attribute sexual preference such as asexual or bisexual. Gender neutral does not apply to this clinical situation.

Mr. Walker is caring for his ailing wife, who was diagnosed with a terminal illness. Mr. Walker is talking with a nurse, and states, "I miss my old life. I don't see any of my friends anymore. Caring for my wife is much more difficult than I thought. I want things to be the way they used to be." Which emotional strain should the nurse realize that Mr. Walker is experiencing? a. Caregiver stress b. Remorse over being healthy c. Anger that his children are not helping d. Grief over losing his friends

a. Caregiver stress Mr. Walker is showing signs of caregiver stress because he expresses that he wants his situation to change. He is not remorseful about being healthy. No children are mentioned in the question. He has not lost his friends; he just does not see them any more.

The nurse is admitting a prenatal patient for diagnostic testing. While eliciting the psychosocial history, the nurse learns the patient smokes a pack of cigarettes daily, drinks a cup of cappuccino with breakfast, has smoked marijuana in the remote past, and is a social drinker. Which action should the nurse first take? a. Strongly advise immediate tobacco cessation b. Elimination of all caffeinated beverages c. Serum and urine testing for drug use and alcohol use d. Referral to a 12-step program

a. Strongly advise immediate tobacco cessation There are numerous risk factors for women and men affecting reproductive health and pregnancy outcomes. These can be categorized into biophysical, psychosocial, sociodemographic, and environmental factors. Some of the risk factors for human reproduction fit into multiple categories. Psychosocial factors cover smoking, excessive caffeine, alcohol and drug abuse, psychological status including impaired mental health, addictive lifestyles, spouse abuse, and noncompliance with cultural norms. Drinking a cup of a caffeinated beverage a day is not associated with adverse fetal outcomes usually. Serum and urine testing for drug/alcohol use is not required for stated marijuana use in the remote past. Patient referral to a 12-step program is usually advisable for current alcohol and/or drug use.

The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function? a. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. b. Alter the internal state by modifying electronic signals related to physiologic processes. c. Replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities. d. Reduce catecholamine production and promote the production of additional -endorphins.

a. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. When the sympathetic nervous system is operative, the individual experiences muscular tension and an elevated pulse, blood pressure, and respiratory rate. Relaxation is achieved when the sympathetic nervous system is quieted and the parasympathetic nervous system is operative. Modifying electronic signals is the basis for biofeedback, a behavioral approach to stress reduction. Altering thinking and activities from more-stressful to less-stressful reflects the cognitive approach to stress management. Reducing catecholamine production is the basis for guided imagery's effectiveness.

A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations? a. Teaching the patient to recognize, reconsider, and reframe irrational thoughts b. Encouraging the patient to imagine being in calming circumstances c. Teaching the patient to use instruments that give feedback about bodily functions d. Provide the patient with a blank journal and guidance about journaling

a. Teaching the patient to recognize, reconsider, and reframe irrational thoughts Meaning-focused coping leads the individual to focus on his/her own values and beliefs to modify the personal interpretation and response to a problem. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking.

The community health nurse is assessing a family who has a chronically ill child. The child needs special care, and the nurse has to coordinate the care for the home setting. What behavior will the nurse assess for to know that the family can care for the child? a. The family is willing to learn about the care and share the caregiving needs. b. The mother is going to care for the child and the family herself. c. The older siblings are going to care for the child while the parents are at work. d. An outside agency will be coming to the home three times a week to give care.

a. The family is willing to learn about the care and share the caregiving needs. The nurse will look for a family who is willing to provide care plus support each other in this need. Having a situation where just siblings or a mother or an outside agency give care puts an undue burden on the caregiver and brings disharmony to the family.

The nurse is working with a college student who is planning to become sexually active. She is requesting a reliable method of birth control that could be easily discontinued if necessary. Which is the best option for this college student? a. Coitus interruptus b. Natural family planning c. Oral contraceptive pills d. Intrauterine device (IUD)

c. Oral contraceptive pills Oral contraceptive pills prevent ovulation, are easy to stop, and are 99% effective in pregnancy prevention. Intrauterine devices, coitus interruptus, and natural family planning will not prevent ovulation; they should not be recommended for this college student who desires a reliable method of birth control that can be easily discontinued.

The emergency department nursing assessment of a pregnant female at 35 weeks gestation reveals back pain, blood pressure 150/92, and leaking of clear fluid from the vagina. Which complication of pregnancy does the nurse suspect? a. Ectopic pregnancy b. Spontaneous abortion c. Premature rupture of membranes d. Supine hypotension

c. Premature rupture of membranes Leaking of clear fluid from the vagina with back pain and elevated BP is associated with premature rupture of membranes, a complication of pregnancy. An ectopic pregnancy usually manifests as unilateral pain early in the pregnancy. Vaginal bleeding is a classic sign of miscarriage, or spontaneous abortion, not leaking of clear fluid. This patient's blood pressure is elevated. Supine hypotension occurs when the woman is lying supine; then low blood pressure occurs due to the decrease in venous return from the gravid uterus placing pressure on the vena cava.

A 45-year-old female patient, gravida 3 para 3, presents with complaints of decreased desire to engage in sexual activity with her husband as it is becoming more painful. What physical assessment data should the nurse focus on? a. Urine culture to identify potential STD. b. Obtain vital signs as a baseline to rule out infection. c. Prepare for a vaginal exam. d. Inspection of the abdomen for pelvic mass.

c. Prepare for a vaginal exam. Based on the patient's reported complaint and obstetrical history, it may be likely that the patient has a pelvic prolapse. Therefore, a vaginal exam would be indicated to help identify possible anatomical changes. There is no clinical data that supports a potential pelvic mass and inspection alone would not confirm this finding. Obtaining vital signs as well as a urine culture may be needed, but the focus should be on determination of physical findings related to the pelvic area.

The nurse is counseling a woman who is caring for her 83-year-old father. The father has had mental changes and is becoming more confused. The father lives with the daughter in her home. The nurse knows the daughter understands the father's care needs when she states which of the following? a. "Dad will only need my help for a short time, and then he will get better." b. "I can leave dad alone during the day; I'll just deadbolt the door." c. "I can send dad to the adult daycare; that way I can work and care for him at night." d. "Dad misses mom since she passed; he will be okay in a few weeks."

c. "I can send dad to the adult daycare; that way I can work and care for him at night." The father will be cared for at the adult daycare, and it is a nice alternative for the daughter. She will be able to work and know that her father is safe during the day. The daughter thinking the father will be okay in a few days is not realistic, nor can she deadbolt the door and lock him in the house.

A patient tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response? a. "Why not start by learning to meditate? That technique will cover everything." b. "In cases like yours, physical exercise works to elevate mood and reduce anxiety." c. "Reading about stress and how to manage it might be a good place to start." d. "Let's talk about what is going on in your life and then look at possible options."

d. "Let's talk about what is going on in your life and then look at possible options." In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. As a result, further assessment is indicated before potential solutions can be explored. Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

The student demonstrates a lack of understanding of palliative care when making which statement? a. "Palliative care is designed to promote comfort." b. "Palliative care is designed to reduce disease exacerbations." c. "Palliative care is designed to decrease acute care hospital admissions." d. "Palliative care is designed to promote a cure for chronic disease."

d. "Palliative care is designed to promote a cure for chronic disease." Palliation is the reduction of symptoms without elimination of the cause. Palliative care refers to the provision of care for patients who are diagnosed with a disease or condition without a cure.

The nurse has been asked to administer a coping measurement instrument to a patient. What education would the nurse present to the patient related to this tool? a. "This tool will let us compare your stress to other patients in the hospital." b. "This tool is short because it only measures the negative stressors you are experiencing." c. "You will need to ask your parents about stressors you had as a child to complete this tool." d. "This tool will help assess recent positive and negative events you are experiencing."

d. "This tool will help assess recent positive and negative events you are experiencing." Coping measurement tools measure recent positive and negative life events as perceived by the individual. There is no objective scale for comparison with other patients because each person reacts differently to stressors. Both negative and positive events are assessed. Childhood stressors are not part of this type of evaluation as they are intended to measure recently occurring events.

An adult male patient is complaining of decreased appetite. He states he just finished taking his antibiotics for an episode of pneumonia. What is the nurse's best response? a. "Your wife should increase the spices in your food, as the pneumonia changes your sense of smell." b. "Notify your doctor immediately, because this is a concerning reaction to the medication." c. "You need to take an appetite stimulant, as your body will need good nutrition to recover from the infection." d. "You should see an improvement in the next week or so. Call if this continues."

d. "You should see an improvement in the next week or so. Call if this continues." Many medications cause a change in sense of taste, including antibiotics. This is temporary and does not require interventions. Pneumonia affects the lower respiratory tract, and is less likely to cause change in smell. The short-term effects of the antibiotic should not necessitate major concern regarding diet intake, including stimulants.

Many middle-aged adults are called the "sandwich" generation because they are caring for their children and their aging parents. What is the priority reason for aging parents needing care? a. Mental clarity b. Immobility c. Blindness d. Multiple chronic illnesses

d. Multiple chronic illnesses Multiple chronic illnesses come with the aging process. Middle-aged adults are becoming the caregivers for the generation before them and the one after them. Mental clarity is a positive aspect of aging and does not need care. Immobility and blindness do not always mean that the person needs direct care.

Today most patients are living for several years before dying with multiple chronic conditions, such as COPD, congestive heart failure, diabetes, and obesity. These concomitant diseases contribute to multiple symptoms that interfere with the patient's quality of life. What type of care would you consider for this patient? a. End-of-life care b. Supportive care c. Comfort care d. Palliative care

d. Palliative care Palliative care provides optimal symptom management in the setting of multiple chronic conditions. The relief and management of these symptoms help to promote improved quality of life for the patient and help to maintain physical functioning.

A family is talking with a nurse because a family member is experiencing a chronic illness. The family asks the nurse how they should cope with their changing roles. What is the nurse's best response? "Don't worry about the role changes; everyone will know what to do." "As the nurse, I can decide about the role changes and what would be best for the family." "I know you are worried about this, so you should talk with the physician." "The family should discuss the changing roles and what is needed for everyone."

"The family should discuss the changing roles and what is needed for everyone." The nurse should encourage the family to discuss the changes and what everyone needs and wants with this new situation. This approach will allow every family member to recognize their own needs in addition to the changing needs of the family. Everyone may not know what to do, so answer A is incorrect. Talking to the physician is fine, but he or she will not take on the role of problem solver for the family. The nurse does not have the right to decide for the family; decisions about role changes have to be made by the family members.

Which nursing diagnoses for patients with sensory perceptual variances may be included in a plan of care? (Select all that apply.) a. Impaired mobility b. Altered nutrition that is less than the body requirements c. Risk for injury d. Decreased cardiac output e. Knowledge deficit for nutrition

A, B, C Taste and smell deficits may lead to lack of appetite and decreased intake, but there is no supportive evidence that there is a knowledge deficit regarding nutrition with sensory impairments. Multiple sensory deficits can contribute to injury, and visual, auditory, and tactile changes can lead to injury. Likewise, mobility may be impaired by both tactile and visual changes. Decreased cardiac output does not directly stem from sensory variances.

Caregivers are often categorized by their relationship to the person being cared for. Which of the following are the roles? (Select all that apply.) a. Grandparent b. Spouse c. Parent d. Adult children e. Neighbor/friend f. Young children

A, B, C, D, E All of these options can provide care whether it is on a temporary or permanent basis. Young children do not provide care.

The nurse is completing a care plan for a patient who is exhibiting poor coping after receiving a serious medical diagnosis. Which interventions should the nurse consider? (Select all that apply.) a. Review pamphlets about treatment options with the patient. b. Compile a list of activities that are of interest to the patient. c. Recommend a glass of wine before dinner each night for relaxation. d. Reinforce the fact that the medical team can make treatment decisions, so the patient does not need to worry. e. Identify positive aspects of the illness, such as the chance to spend more time with family.

A, B, E Interventions that develop an action plan (activities that the patient is still able to do), education about the illness (review of treatment options), and changing how the patient views some aspect of the illness (have more time with family members) are all interventions that help coping skills. Recommending the use of alcohol is not good, because the drinking may get out of control or the alcohol may interact with prescribed medications. Having the medical team make all decisions reinforces the lack of control the patient feels and encourages negative coping mechanisms of denial and avoidance.

Which statement(s) by the nurse aim to help the patient to cope by addressing the mediators of stress? (Select all that apply.) a. "I have found a support group for newly divorced persons in your neighborhood." b. "You said you used to jog; getting back to aerobic exercise could be helpful." c. "Slowing your breathing by counting to three between breaths will calm you." d. "Perhaps a short-term loan from your father will make your layoff less stressful." e. "Journaling gives one more awareness of how experiences have affected them." f. "A divorce, while stressful, can be the beginning of a new, better phase of life."

A, D, E, F Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter his perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how one perceives and responds to stress (or how one's personality affects how one responds to stressors). A loan could help the patient perceive a layoff differently by reducing the financial pressures that accompany it. Participation in support groups is an excellent way to expand one's support network relative to specific issues. However, neither aerobic exercise nor breath control exercises, while helpful in other ways, affect stress mediators.

What are the most important reasons for considering the use of palliative care in patient care management? (Select all that apply.) a. Palliative care is reserved for those patients who are considered terminally ill. b. Patients live with multiple chronic diseases several years before dying. c. Palliative care is recommended until cures for illnesses are discovered. d. Patients live with debilitating symptoms that interfere with the quality of life. e. Palliative care is used to reduce the symptoms associated with chronic disease.

B, D, E Because of the aging population in the United States, the older patient often lives with multiple diseases for several years before dying. These diseases produce symptoms that interfere with the activities of daily living and quality of life. Palliative care is symptom management and should be integrated into the management of chronic disease and not reserved only for terminal illness. Palliative care is utilized to help patients live as comfortably as possible (quality of life) for an unspecified amount of time, not just until cures are discovered.

Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? (Select all that apply.) a. Assess for bradycardia. b. Ask about epigastric pain. c. Observe for increased appetite. d. Check for elevated blood glucose levels. e. Monitor for a decrease in respiratory rate.

B,C,D The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and elevation of blood glucose levels. Stress causes an increase in the respiratory and heart rates.

What matters can palliative care be used to promote? (Select all that apply.) a. Surgical treatment plans versus medical b. Discussion on advance directives c. Physical functioning d. Reduction in disease exacerbations e. Improved quality of life

B,C,D,E If optimally delivered, palliative care can provide patients with aggressive symptom management while helping to restore and promote physical functioning. Management of symptoms helps to reduce the exacerbations that are common to chronic disease. Palliative care provides an opportunity to engage patients and families with earlier and supportive discussions about advance care planning. Palliative care supports an improved quality of life, whether the treatment plan is through surgical or medical intervention.

The nurse is working with a patient who recently lost her spouse after a lengthy illness. The patient shares that she would like to sell her home and move to another state now that her spouse has passed away. Which of the following interventions would be considered a priority for this patient? (Select all that apply.) a. Notify the provider to evaluate for antidepressant therapy. b. Suggest that the patient consider a support group for widows. c. Suggest that the patient learn stress reduction breathing exercises. d. Suggest that the patient take prescribed antianxiety medications. e. Assist the patient in identifying support systems. f. Notify the provider to evaluate the need for antianxiety medications.

B,C,E Stress prevention management involves counseling, education, and implementation of techniques to manage problem-oriented and emotion-oriented stress. To prevent physical symptoms, relaxation and deep breathing are effective and individuals can learn to prevent the stress response through cognitive behavioral strategies. Medications are not indicated for patients with known stressors unless the stress is prolonged or the patient has ineffective coping mechanisms.

A nursing instructor and a student nurse are talking about caregivers and their role in the caring process. What are some of the emotions and obstacles that caregivers experience that the nursing instructor should include in the discussion? (Select all that apply.) a. Understanding of the disease b. Anxiety c. Social isolation d. Euphoria e. Denial f. Financial prosperity

B,C,E The caregiver experiences emotions such as anxiety and denial of the disease process and faces obstacles such as social isolation when caring for someone else. Financial prosperity is usually not occurring; quite the opposite is likely because a caregiver may be drained of his or her savings. A caregiver does not feel euphoria, because the caregiver is not happy about the situation. The caregiver may not understand the disease process and may not know what to expect as he or she assumes the caregiver role.

A diabetic patient who is hospitalized asks the nurse what factors are associated with increased blood glucose while in the hospital. Which response(s) by the nurse are appropriate? (Select all that apply.) a. A patient's diet is different here in the hospital than at home, and that is the most likely because of the increased glucose level. b. Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times. c. Medications such as steroids may increase glucose levels. d. Stressors such as illness cause the release of hormones that increase blood sugar. e. Blood sugar may be higher in the hospital due to decreased activity or rest.

C, D, E The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. Activity decreases blood glucose; therefore, increase in blood glucose while in the hospital could be related to inactivity. Steroids cause increases in blood glucose levels. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

When considering the trajectory of a specific disease, what is the most important concept? a. Hospital admissions b. Physical functioning c. Quality of life d. Symptom management

b. Physical functioning The disease trajectory occurs from the onset of a life-limited diagnosis until death. Physical functioning determines the decline in the patient's physical status. Decline in status is used to determine when to intervene with palliative and end-of-life care.

Which of the following is an example of a nurse violating the Health Insurance Portability and Accountability Act (HIPAA) of 1996? a .The nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital. b. A group of fellow employees are discussing a patient's clinical status in a public place. The nurse manager requests that they step into private room to complete the discussion c. After entering the progress notes on a patient's electronic medical record, the nurse logs off the computer to allow her coworker to use the terminal. d. As a family approaches the nursing desk, the nurse removes the patient census sheet from view on the counter.

a .The nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital. When the nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital, the nurse is accessing protected health information not required for the nurse to perform his or her job. This is a violation of privacy even if it is a relative. The other choices are all actions that are consistent with protecting a patient's privacy right as defined by HIPAA.

The nurse is assessing the coping abilities of a patient recently diagnosed with a degenerative neuromuscular disease with no known cure. Which statement by the patient alerts the nurse that more intervention is needed? a. "I am sleeping much better when I have two drinks and smoke before bed." b. "I am scheduling a family reunion for the upcoming holiday." c. "I have decided to sell my house and move into an apartment with my son." d. "I have decided to take some art lessons at the community center."

a. "I am sleeping much better when I have two drinks and smoke before bed." Using alcohol, smoking, or drugs to enhance sleep is not a positive coping mechanism, and it is also a safety hazard; other interventions should be enlisted to help the patient cope with the devastating diagnosis. Taking art lessons and planning a family reunion are positive ways to not focus on the illness and keep the patient from becoming more isolated. Moving in with a family member is a problem-solving strategy that allows the patient to maintain more control over the illness outcome.

A mother is talking with the community-based nurse concerning her adult son. The son is mentally challenged and not able to live on his own. The mother is concerned about her son's welfare when she is no longer able to care for him. What is the best response by the nurse? a. "Let's look into the community resources that are available to assist you." b. "You have raised your son well, and he will be okay on his own." c. "Contact your distant relatives to see if anyone would take your son." d. "There are places for mentally challenged adults; let's place him there."

a. "Let's look into the community resources that are available to assist you." The mother, with the assistance of the nurse, can research resources in the community that will service and care for her son when she is no longer able to do so. How the son is raised does not mean that he will be okay on his own. Distant relatives may not want or be able to care for the son, so this may not be a viable option. Placing the son is too general of an option, and he may not do well in this setting.

The nurse is teaching a family about sensory alterations. The nurse needs to provide additional teaching if a family member makes which statement? a. "My cousin has autism, and I am going to hug him more so he understands how much I care." b. "If I stop smoking, I might enjoy eating more!" c. "I am going to wear earplugs when I mow the lawn." d. "So grandpa's stroke is why he thinks his left arm and leg aren't there any more."

a. "My cousin has autism, and I am going to hug him more so he understands how much I care." Autistic individuals tend to have touch disturbances, and hugging would be overwhelming for them. Earplugs can help prevent hearing deficits due to exposure to loud noises. Ceasing smoking may result in the return of both increased taste and smell sensations. A cerebrovascular accident (CVA), or stroke, may cause changes in perception of the body, including not being aware of one side of body.

A patient has come to the health clinic for an annual checkup. He reports increased stress at work and having to work a lot of mandatory overtime. He has not been able to do his usual daily exercise for several weeks. What is the best response by the nurse? a. "Regular exercise would be good because it helps the body deal with stress." b. "Have you considered a medication to help you sleep at night?" c. "There are other ways you can reduce your stress, such as cutting back on your work hours." d. "Including exercise in your schedule will just increase the stress from work."

a. "Regular exercise would be good because it helps the body deal with stress." Exercise is a form of emotion-based coping that increases a feeling of well-being. Cutting back on hours may not be an option in his current work climate, although it might help reduce stress. There are other nonpharmacological methods that may help with stress, such as music or meditation, which would not involve possible side effects from medications. Exercise will decrease feelings of stress when balanced with the time requirements of the stressor.

A patient is the primary caregiver for a disabled family member at home, and has now been unexpectedly hospitalized for surgery. What action can the nurse take to enhance the coping ability of the patient? a. Ask if there is another family member who can help at home while the patient is in the hospital. b. Plan to transfer the patient to a rehabilitation unit after surgery to allow uninterrupted time to recover. c. Coordinate an ambulance transfer of the family member to an alternate family member's home. d. Ask social services to assess what the patient's needs will be after discharge to home.

a. Ask if there is another family member who can help at home while the patient is in the hospital. The best action by the nurse is to help the patient develop an action plan to assess what resources may already be available to meet responsibilities at home. A long absence from the home on a rehabilitation unit does not address the immediate need to provide care for the disabled family member. An ambulance transfer to another family member is premature until the placement is identified as an appropriate placement based on the disabled person's needs, availability to provide the care by another, and distance of the transfer. Assessing the patient's needs after discharge does not address the immediate need to provide care for the disabled family person.

A female patient comes to the clinic at 8 weeks' gestation. She lives in a house beneath electrical power lines, which is located near an oil field. She drinks two caffeinated beverages a day, is a daily beer drinker, and has not stopped eating sweets. She takes a multivitamin and exercises daily. She denies drug use. Which finding in the history has the greatest implication for this patient's plan of care? a. Drinking alcohol should be avoided during pregnancy because of its teratogenic effects. b. Living near an oil field may mean the water supply is polluted. c. Eating sweets may cause gestational diabetes or miscarriage. d. Electrical power lines are a potential hazard to the woman and her fetus.

a. Drinking alcohol should be avoided during pregnancy because of its teratogenic effects. Stages of development include the ovum, the embryo, and the fetus. The embryonic period lasts from the beginning of the fourth week to the end of the eighth week of gestation. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. During pregnancy, a woman should avoid exposure to all potential toxins, especially alcohol, tobacco, radiation, and infectious agents. Living beneath power line or near an oil field is not teratogenic in itself. Stopping sweets can be addressed after the alcohol cessation is addressed.

The nurse is reviewing the care plan for a patient experiencing difficulty coping with stress. Which action should the nurse implement to assist the patient? a. Identifying the cause of fear b. Accessing a community support group c. Identifying relaxation methods d. Reviewing an educational pamphlet

a. Identifying the cause of fear Identifying the cause of a negative perception is the first step in helping an individual to be able to utilize coping strategies. Accessing a community support group is an example of accessing resources to enhance coping. Identifying relaxation methods is an example of developing an action plan. Reviewing an educational pamphlet is an example of using education to enhance coping.

What is the most prominent goal of palliative care? a. Integrate into chronic disease management sooner rather than later. b. Enroll the patient into the Medicare Hospice Benefit. c. Ensure that the patient has a 6-month prognosis. d. Reserve this type of care until the patient is actively dying.

a. Integrate into chronic disease management sooner rather than later. The goal of palliative care is to integrate symptom management interventions earlier into the course of chronic disease sooner rather than later. This helps to promote optimal quality of life.

What is one of the major attributes of healthcare law? a. It defines the expected behavior of persons in the business of health care. b. The law or rule is easy to interpret and comply with. c. It is established by any healthcare authority. d. The creator must be an expert in health care.

a. It defines the expected behavior of persons in the business of health care. A healthcare law or rule defines expected behavior of persons in the business of health care or in healthcare relationships. Healthcare law is not easy to interpret or comply with and can only be established by organizations with legal authority for law making. Creators of healthcare law are often not experts in health care.

The nurse is examining the eyes of a newborn infant. If the nurse notes the absence of the red reflex, what is the nurse's priority action? a. Notify the physician. b. Document the finding in the records. c. Recheck the reflex after several hours. d. Monitor the eye movements and pupil reactions closely.

a. Notify the physician. The absence of the red reflex suggests the presence of congenital cataracts, which is an abnormal finding. It will not change in several hours, nor do the eye movements and pupil reaction provide significant changes in this situation.

Which would be a violation of the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986? a. The hospital emergency room physician suspects that a patient is not competent in making decisions for his post-care treatment. The physician does not complete a competency evaluation prior to transfer for a non-emergent treatment and allows the patient with suspected incompetence to sign the consent for transfer. b. The hospital does not contract with the patient's insurance company. The emergency room physician completes a medical screening examination and stabilizes the patient for discharge. The patient financial services department informs the patient of insurance status after discharge and arranges for payment options. c. After providing a medical screening examination, the patient's attending physician determines that transfer for a psychiatric service is necess

a. The hospital emergency room physician suspects that a patient is not competent in making decisions for his post-care treatment. The physician does not complete a competency evaluation prior to transfer for a non-emergent treatment and allows the patient with suspected incompetence to sign the consent for transfer. The physician who allows the patient with suspected incompetence to sign the consent for transfer did not complete the medical screening examination. EMTALA required that any hospital that operated an emergency department and received Medicare funds provide an appropriate screening examination to anyone who presented and stabilize any emergency medical condition prior to transfer to another facility.

Which is one of the biggest challenges facing current nursing practice? a. The number of aging Americans living with chronic disease b. The number of patients entering into hospice programs c. The number of cancer patients receiving supportive care d. Reduced length of stay in hospice care

a. The number of aging Americans living with chronic disease Millions of Americans are living with one or more chronic debilitating diseases, and 7 out of 10 can expect to live with their diseases several years before dying. When coupled with the advancing age of the eight million baby boomers who now qualify for Medicare, this will soon create a huge demand on health-care resources and community-based services.

The nurse is assessing a patient's coping abilities related to expected placement in a long-term care facility. Which risk factor is of most concern to the nurse? a. The patient was recently diagnosed with Alzheimer disease. b. The patient is a retired police officer. c. The patient will need assistance in moving from his home. d. The patient's family members all live several hours away.

a. The patient was recently diagnosed with Alzheimer disease. Poor cognition is a key risk factor for poor coping because the patient has difficulty assessing a situation and making decisions that allow a sense of control. Limited support is a risk factor, but decreased cognition adds to the patient's inability to understand changes. A retired police officer would typically have experienced stress and have some strengths in managing stress. Needing assistance to move is a short-term need; the inability to understand the need for the move or a new situation because of poor cognitive function is the greater concern.

Although sexual activity is considered a normative process, some individuals place themselves at increased risk for negative consequences related to this process. Which nonsexual behavior is likely to increase risk-taking activities? a. Using alcohol, marijuana, or illicit substances b. Having multiple sexual partners c. Having gay, lesbian, or bisexual partners d. Refraining from safe-sex practices such as condom use

a. Using alcohol, marijuana, or illicit substances The influence of nonsexual high-risk behavior such as the use of alcohol, marijuana, and illicit substances increases sexual risk-taking behavior. The abuse of alcohol or drugs results in impaired judgment and less thoughtfulness related to the sexual act, particularly when substances are ingested close to the time of sexual activity. More varied sexual experiences and intercourse with multiple partners are significant individual sexual risk-taking behaviors. Gay, lesbian, and bisexual youth; men who have sex with men; and women who primarily have sex with women have been found to engage in more high-risk sexual practices. Youth in particular are less likely to engage in safer sex practices such as condom use. This is a sexual behavior that significantly increases the risk for contracting sexually transmitted infections, including human immunodeficiency virus (HIV) infection, and for unintended pregnancy.

The interprofessional core team includes members from which disciplines? a. Nursing, medicine, volunteers, and nutrition b. Medicine, nursing, social work, and clergy c. Medicine, nursing, physical therapists, and volunteers d. Nursing, home health aides, volunteers, and clergy

b. Medicine, nursing, social work, and clergy An interprofessional team approach involving healthcare professionals from different disciplines is central to optimal palliative care practice and quality outcomes. The interdisciplinary core team includes members from medicine, nursing, social work, and clergy. Ancillary disciplines are also included. Volunteering is not considered a discipline in health care.

The nurse is providing health teaching to a group of mothers of school-aged children. Which statement by a mother indicates the need for additional instruction? a. "I will take my child to the audiologist because he doesn't seem to hear me except when I look directly at him." b. "Both of my children have the same eye medication, which is a real bonus because I only need to buy one bottle." c. "Making my child wear ear plugs when she goes to a rock concert may save her hearing!" d. "I see now why when my child has a cold, he complains about everything tasting blah!"

b. "Both of my children have the same eye medication, which is a real bonus because I only need to buy one bottle." Each person should always have their own eye medication to prevent infection transfer between them. The child who only hears with direct visional contacts may be lip-reading and have a hearing loss. Exposure to loud noises is known to cause hearing loss. Sense of taste and smell can be altered by upper respiratory infections.

A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate? a. "It is probably just coincidental that your blood sugar is high when you are ill." b. "Stressors such as illness cause the release of hormones that increase blood sugar." c. "Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times." d. "Your diet is different here in the hospital than at home, and that is the most likely cause of the increased glucose level."

b. "Stressors such as illness cause the release of hormones that increase blood sugar." The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. The increase in blood sugar is not coincidental. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

The embryonic period is critical because external and internal structures in the fetus are forming. When is it most important for the pregnant patient to avoid all teratogens? a. 8-12 weeks b. 4-8 weeks c. 12-16 weeks d. 16-20 weeks

b. 4-8 weeks The embryonic period lasts from the beginning of the fourth week to the end of the eighth week. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. A woman should avoid exposure to all potential toxins during pregnancy, especially alcohol, tobacco, radiation, and infectious agents. At the end of this period, the embryo has human features. The span of gestation from 8 to 12 weeks, from 12 to 16 weeks, or from 16 to 20 weeks is not within the embryonic stage of fetal development, when teratogenicity is of greatest concern.

An adult patient comes for a well-check up to the primary care provider's office. In completing the office admission form, the patient does not indicate gender on the form and seems somewhat agitated when providing the form back to the nurse. How should the nurse respond? a. Ask the patient to complete all of the information at this time. b. Ask the patient if you can assist with completing the form. c. The nurse should just indicate which gender she/he thinks is appropriate. d. Tell the patient that if the form is not completed, then the doctor will not see you.

b. Ask the patient if you can assist with completing the form. Gender identity is defined by the individual patient. The nurse should not designate this description or identity nor should the nurse tell the patient that if the form is not completed, that the patient will not be seen by the healthcare provider. Asking the patient to complete the information without acknowledging that the patient is exhibiting signs of distress is not therapeutic. The nurse should offer to provide assistance to the patient.

A nurse is talking with a woman who is caring for her elderly father. The woman states that she has very little time for herself or any of the activities she used to enjoy. What process is the nurse using to assess this situation? a. Understanding the father's wishes b. Cognitive ability of appraisal c. Diagnosing the father's health d. Understanding the woman's wishes

b. Cognitive ability of appraisal The cognitive ability of appraisal allows the nurse to assess the woman's feelings and her ability to care for her father. Understanding the woman's or the father's wishes is good, but it is not a process of appraisal of the situation. Diagnosing the father's health is outside of the nursing realm.

Palliative care is used in the management of a patient with symptomatic chronic obstructive pulmonary disease (COPD). Which option does the nurse identify as being accurate? a. Palliative care is used when the patient is beginning to die. b. Palliative care is used to help manage the symptoms that often accompany COPD. c. Hospice nurses must be involved to provide palliative care in a cancer patient. d. Patient must be enrolled into the Medicare Hospice Benefit to receive palliative care.

b. Palliative care is used to help manage the symptoms that often accompany COPD. Palliation is the relief or management of symptoms without providing a cure. To palliate is to reduce the severity of an actual or potential life-threatening condition or a chronic debilitating illness. Palliation is not equivalent to cure, but it is the reduction of undesirable effects resulting from the incurable disease or condition.

A female infertility patient is found to be hypoestrogenic at the preconceptual clinic visit. She asks the nurse why she has never been able to get pregnant. Which is the best nursing response? a. Circulating estrogen contributes to secondary sex characteristics. b. Estrogen deficiency prevents the ovum from reaching the uterus and may be a factor in infertility. c. Hyperestrogen may be preventing the zona pellucida from forming an ovum protective layer. d. The corona radiata is preventing fertilization of the ovum.

b. Estrogen deficiency prevents the ovum from reaching the uterus and may be a factor in infertility. The cilia in the tubes are stimulated by high estrogen levels, which propel the ovum toward the uterus. Without estrogen, the ovum won't reach the uterus. The results of a series of events occurring in the ovary cause an expulsion of the oocyte from the ovarian follicle known as ovulation. The ovarian cycle is driven by multiple important hormones: (1) gonadotropic hormone, (2) follicle-stimulating hormone (FSH), and (3) luteinizing hormone (LH). The cilia in the tubes are stimulated by high (4) estrogen levels, which propel the ovum toward the uterus. The zona pellucida (inner layer) and corona radiata (outer layer) form protective layers around the ovum. If an ovum is not fertilized within 24 hours of ovulation by a sperm, it is usually reabsorbed into a woman's body. A patient who is hypoestrogenic would not have excess circulating estrogen. A patient with low estrogen would not be classified as hyperestrogenic. Without sufficient estrogen, there can be no fertilization of the ovum.

Optimal symptom management is primarily based upon which type of care? a. Nurse-directed care b. Evidence-based practice c. Hospice-directed care d. Physician-directed care

b. Evidence-based practice The use of the best evidence can support high-quality interventions that are used in optimal symptom management and improved quality of life. Physician-directed care and Nurse-directed care are incorrect since palliative care is an interdisciplinary team approach to care. Hospice-directed care is incorrect as it is for the terminally ill and dying patient.

The nurse is surveying the assisted living facility regarding safety features for patients with sensory deficits. Which are the most appropriate accommodations? a. Steps painted with dark colors b. Fire and smoke alarms with sound and flashing lights c. Colorful throw rugs to designate the purpose of various rooms d. Alarms on all exit doors

b. Fire and smoke alarms with sound and flashing lights Sound and flashing lights for alarms are helpful for both visual and auditory deficits. Throw rugs, though colorful, present a mobility hazard. Exit door alarms are not required for sensory deficits but are more essential for patients with cognitive impairments. Steps painted with dark colors are a hazard to the elderly because their depth perception may be impaired.

A nurse is working with a male patient being treated for erectile dysfunction. Which statement indicates that additional teaching is needed? a. "I like to go walking around my community each night after dinner." b. I have a few drinks during the week when I go out after work." c. "I have maintained my weight for the past 5 years after losing 20 pounds." d. "I monitor my blood pressure at home using a portable cuff."

b. I have a few drinks during the week when I go out after work." Erectile dysfunction (ED) is a common problem affecting the male population and can be chronic or transient in nature. Alcohol use can affect ED, so the patient's reported alcohol intake indicates that additional teaching is warranted. Exercise, maintaining a healthy weight and monitoring of blood pressure are examples of appropriate activities.

During the examination of the ear, a dark yellow substance is noted in the ear canal. The tympanic membrane is not visible. The patient's wife complains that he never hears what she says lately. These findings would suggest that the nurse prepare the patient for which procedure? a. Tympanoplasty b. Irrigation of the ear c. Pure tone test d. Otoscopic exam by a specialist

b. Irrigation of the ear The symptoms are consistent with blockage of the ear canal with cerumen, which then needs to be removed by irrigation, so that further examination of the ear drum and hearing can be accomplished. A tympanoplasty is only warranted if there has been a perforation, which is unknown at the present.

Which of the following is false regarding state licensure laws? a. These laws establish the requirements for licensure to practice. b. Licensure is not necessary if the individual has completed training. c. The state regulatory agencies such as the state board of nursing are responsible for creating and enforcing these rules. d. The scope of practice defines what the professional can and cannot do within the scope of their licensure.

b. Licensure is not necessary if the individual has completed training. Licensure is required to practice after the completion of all required training for the profession. The state laws establish the requirements to practice and the state regulatory agencies are responsible for creating and enforcing the rules. The scope of practice defines what activities the professional is legally authorized to perform.

Human sexuality is interrelated with a variety of other nursing concepts that may affect sexuality or be affected by healthy sexual functioning. Prompt diagnosis and treatment of potential concerns related to concept overlap is an important nursing function. Which other concept is most likely to overlap with sexuality? a. Stress b. Reproduction c. Pain d. Gas exchange

b. Reproduction The most obvious overlap between concepts is that of sexuality and reproduction. An example may be the use of contraceptives in order to avoid pregnancy. Women who are unable to conceive a child may experience emotional distress. A sexual relationship is likely to change as pregnancy advances. If a patient is feeling stress because of other life issues, this is likely to have a negative impact on his or her sexual relationships. The patient who has poor gas exchange may encounter challenges with sexual activity related to hypoxia. One physiological barrier to healthy sexual functioning is pain. Both chronic pain and pain during intercourse can negatively affect a patient's sexual relationship.

Which statement is true regarding The Joint Commission's authority relating to healthcare organizations? a. The Joint Commission standards have the same effect as law, and organizations can be fined by The Joint Commission for noncompliance. b. The Joint Commission regulations may be seen as having the effect of law because they accredit organizations to bill Medicare and the standards are frequently used in malpractice cases. c. The Joint Commission serves as an advisor to the federal government in establishing fines related to noncompliance. d. The Joint Commission regulations have no effect on the legal process in health care.

b. The Joint Commission regulations may be seen as having the effect of law because they accredit organizations to bill Medicare and the standards are frequently used in malpractice cases. The Joint Commission standards do not have the same effect as law; however, they are often utilized as best practice standards in a malpractice case against which negligence is measured. The Joint Commission does not establish fines for noncompliance.

Which of the following is true about healthcare legislation? a. The U.S. Constitution addresses healthcare law specifically to give the federal government the ability to license professionals and institutions. b. The power of the U.S. Constitution does not have a direct relationship to health care and reserves most of the power to the states. c. State laws are considered the highest source of healthcare law and trump the federal laws. d. The federal government asserts its power over healthcare legislation through the U.S. Constitution.

b. The power of the U.S. Constitution does not have a direct relationship to health care and reserves most of the power to the states. The power of the U.S. Constitution does not have a direct relationship to health care and reserves most of the power to the states. The other statements are false. The U.S. Constitution does not address health care specifically. Either state or federal laws can be considered the highest source of law depending on which law has the stricter regulation or rule.

Which is an example of a nurse protecting a patient's right to consent to a procedure? a. Knowing the patient is not competent to sign a consent form, the nurse asks the friend who came with the patient to sign it. b. When the nurse finds that the informed consent document is not yet complete, she holds the patient's pre-procedure narcotics until the physician can obtain patient consent. c. Finding that the informed consent document is not with the chart, the nurse gives the patient another consent document to sign before the procedure. d. The nurse finds that the consent form is unsigned in the chart and waits until after the procedure to get the document signed.

b. When the nurse finds that the informed consent document is not yet complete, she holds the patient's pre-procedure narcotics until the physician can obtain patient consent. To be valid, information for consent must be given prior to the procedure by the provider who will be performing the procedure and the information given must include a description of the procedure, a description of the risks and benefits of the procedure, and a discussion of any alternatives to the proposed procedure. Consent by the patient must be voluntarily given, and the person who consents must have the capacity to consent. Capacity can be determined by the healthcare provider and may be affected by drugs or the current or underlying medical condition. If the patient is unable to give consent directly, he or she may designate a person who can give consent on his or her behalf. If such a person is not designated by the patient, most states provide a statutory solution or a law that lists "statutory surrogates."

A married couple present to the preconceptual clinic with questions about how a fetus's chromosomal sex is established. What is the best response by the nurse? a. At climax, chromosomal sex is established. b. At ejaculation, chromosomal sex is established. c. At fertilization, chromosomal sex is established. d. At ovulation, chromosomal sex is established.

c. At fertilization, chromosomal sex is established. Remember that the primary spermatocyte contains two sex chromosomes, one X chromosome and one Y chromosome, and the primary oocyte contains two sex chromosomes, both X chromosomes. During the first reduction division, two secondary spermatocytes are produced, one X and one Y, establishing X and Y cell lines. The X-bearing cell line is established during oogenesis. Female gametes will all be X bearing and male gametes will be either X or Y bearing. A female develops through the fertilization of the ovum by an X-bearing sperm producing an XX zygote; a male is produced through the fertilization of a Y-bearing sperm producing an XY zygote. Therefore, at fertilization, chromosomal sex is established. Chromosomal sex is not established at ovulation, ejaculation, or climax, so these choices are erroneous.

A patient has begun smoking again and drinks six alcoholic beverages per day since experiencing the loss of his job. The nurse recognizes that the patient is exhibiting symptoms of which type of stress? a. Psychological b. Physiological c. Behavioral d. Emotional

c. Behavioral Signs and symptoms of behavioral stress include smoking, overeating, and substance abuse. Substance abuse is not a symptom of psychological, emotional, or physiological stress.

A 15-year-old female patient has come to the office for her annual physical and first pelvic examination. In this situation, which nursing action is most important? a. Ensure the patient that all information will be kept confidential. b. Screen for possible abuse. c. Excuse the parent. d. Encourage the patient to ask questions about sexuality.

c. Excuse the parent. Although all of these actions are important, in this situation the parent should be excused in order to allow the teen to discuss her sexual concerns without fear of repercussions. Adolescents may be concerned about their altered appearance and impulse control. This is the ideal time to encourage the patient to ask questions and reassure her that she does not appear ignorant. All patients should be screened for possible abuse, and this is the most appropriate time to do so. If the parent remains present, the patient may be reluctant to answer a question honestly about any history of childhood sexual abuse. The nurse must pose all questions to the patient in a nonjudgmental manner and ensure her that all answers will be kept strictly confidential.

A nurse working with a family whose child has recently told them that he identifies with the LGBTQ community asks the nurse to explain how this happened considering the fact that the child was raised as a male and played with appropriate toys. What is the best nursing response to the family's concerns? a. Tell them that there is no need for concern for their child has shared this information with them. b. Ask the parents if they ever noticed something different about their son as he was growing up. c. Explain that sexual orientation changes can occur over time. d. Suggest that this behavior may be temporary.

c. Explain that sexual orientation changes can occur over time. Sexual orientation and gender identification is now thought of as a fluid concept, with the term sexual fluidity being used to convey this meaning for individuals who identify with other than heterosexual relationships. The nurse should respond to the parent's concerns and not minimize their reaction but rather let them know that it is the chosen response of their child. Relating the sexual orientation or gender identification to how one was raised indicates an implied bias. Telling the family that the behavior may be temporary is not correct.

In order to fully understand the concept of sexuality, it is necessary to become familiar with the terms used when discussing this topic. Which term best describes how one views oneself as masculine or feminine? a. Sexual behavior b. Sexual identity c. Gender identity d. Sexual orientation

c. Gender identity Gender identity is socially derived from experiences with family, friends, and society. Sexual identity is defined as whether one is male or female based on biological sexual characteristics. Sexual orientation is how one views oneself in terms of being emotionally, romantically, or sexually attracted to an individual of a particular gender. Sexual behavior is how one responds to sexual impulses and desires.

After a management decision to admit terminal care patients to a medical unit, the nursing manager notes that nursing staff on the unit appear tired and anxious. Staff absences from work are increasing. The nurse manager is concerned that staff may be experiencing stress and burnout at work. What action would be best for the manager to take that will help the staff? a. Ask administration to require staff to meditate daily for at least 30 minutes. b. Have a staff psychologist available on the unit once a week for required counseling. c. Have training sessions to help the staff understand their new responsibilities. d. Ask support staff from other disciplines to complete some nursing tasks to provide help.

c. Have training sessions to help the staff understand their new responsibilities. Feeling unprepared for work responsibilities contributes to stress and poor coping in the workplace. Administration cannot require that staff participate in meditation or counseling sessions, although these can be recommended and encouraged. Asking other disciplines to assume nursing tasks is not appropriate for their scope of practice.

A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress? a. The patient's wife reports that he spends more time sitting quietly at home. b. He reports that his appetite, mood, and energy levels are all good. c. His systolic blood pressure has gone from the 140s to the 120s (mm Hg). d. He reports that he feels better and that things are not bothering him as much.

c. His systolic blood pressure has gone from the 140s to the 120s (mm Hg). Objective measures tend to be the most reliable means of gauging progress. In this case, the patient's elevated blood pressure, an indication of the body's physiologic response to stress, has diminished. The wife's observations regarding his activity level are subjective, and his sitting quietly could reflect his having given up rather than improved. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiologic changes from stress and may not reflect improved coping with stress. The patient's report that he feels better and is not bothered as much by his circumstances could also reflect resignation rather than improvement.

The nurse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy? a. Scheduling a regular exercise program b. Attending a seminar on treatment options c. Identifying a confidant to share feelings d. Attending a support group for families

c. Identifying a confidant to share feelings Problem-focused strategies are used to find solutions or improvement to the underlying stressor, such as accessing community resources or attending educational seminars. Exercise, emotional support, and support groups are emotion-based strategies that create a feeling of well-being.

A 20-year-old woman comes for preconceptual counseling. She wants to get pregnant soon. Which health-promoting habit would have the highest priority at this time? a. Getting daily exercise b. Avoidance of sweets c. Immediate tobacco cessation d. Stopping all caffeine

c. Immediate tobacco cessation Psychosocial factors affecting pregnancy include smoking, excessive use of caffeine, alcohol and drug abuse, psychological status including impaired mental health, an addictive lifestyle, spouse abuse, and noncompliance with cultural norms. Immediate tobacco cessation would be the highest priority because continued smoking could be teratogenic if the woman should become pregnant. Smoking causes vasoconstriction which restricts the amount of oxygen and nutrients to the rapidly growing fetus. Daily exercise promotes health but would not be the highest priority among these factors. Stopping caffeine and avoiding sweets are important and can be addressed after tobacco cessation.

The school nurse is assessing coping skills of high school students who attend an alternative school for students at high risk to not graduate. What is the priority concern that the nurse has for this student population? a. Altered vital sign readings b. Inaccurate perceptions of stressors c. Increased risk for suicide d. Decreased access to alcoholic beverages

c. Increased risk for suicide Adolescents with poor coping have increased risk for drug and alcohol use, risky sexual behaviors, and suicide. Pulse, respiratory rate, and blood pressure may change during stress, but patient safety is the priority concern. Adolescents may have inaccurate perceptions of stressors, and this actually increases the risk for unsafe behaviors. Adolescents under stress are more at risk for increasing their access to alcohol and illegal drugs.

An obstetric multipara with triplets is placed on bed rest at 24 weeks' gestation. Her perinatologist is managing intrauterine growth restriction with serial ultrasounds. This prescribed treatment is an example of which type of care? a. Antenatal diagnostics b. Primary prevention c. Secondary prevention d. Tertiary prevention

c. Secondary prevention An example of secondary prevention relating to reproductive health would be managing fetal intrauterine growth restriction by serial ultrasounds. This type of diagnostic maternal/fetal monitoring is performed to determine the best time for delivery due to potential fetal nutritional, circulatory, or pulmonary compromise. A cesarean section (operative delivery) may be performed if maternal or fetal conditions indicate that delivery is necessary. Antenatal diagnostics refers to prior to pregnancy. An example of primary prevention is teaching a high school class about reproductive health. An example of tertiary prevention would be aimed at improving health following an illness and/or rehabilitation.

A patient has not been sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patient's vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first? a. Go to sleep 30-60 minutes earlier each night to increase rest. b. Relax by spending more time playing with his pet dog. c. Slow and deepen breathing via use of a positive, repeated word. d. Consider that a new job might be better than his present one.

c. Slow and deepen breathing via use of a positive, repeated word. The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident in his elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system (i.e., Benson's relaxation response) will counter the sympathetic nervous system's arousal, normalizing these vital-sign changes and reducing the physiologic demands stress is placing on his body. Other options do not address his physiologic response pattern as directly or immediately.

The patient who had a hip replacement yesterday has a visual acuity of 20/200 after correction. What is the nurse's best action to provide recreational activities during the rehabilitation phase? a. Place the television to the left or right of patient's visual field. b. Encourage the patient to learn braille. c. Suggest use of talking books. d. Provide headphones for listening to music.

c. Suggest use of talking books. Talking books would provide a quick, short-term means of entertainment. Braille might be recommended as a long-term solution to visual deficits. The placement of the television is not helpful with low acuity, unless the patient has macular degeneration. Headphones may be nice, but the patient has a visual deficit and no indication that hearing is a problem.

A patient voices an understanding of instructions about furosemide (Lasix) when he makes which statement? a. "I know that I need to monitor my feet for possible skin changes." b. "I expect that this will cause me to have increased sensitivity to saltiness." c. "I will report any blurred vision." d. "If I notice ringing in my ears, I will call the doctor."

d. "If I notice ringing in my ears, I will call the doctor." One of the side effects of furosemide is ringing in the ears (tinnitus). Furosemide does not cause changes in vision, in taste regarding saltiness, or in sensation of the skin.

The nurse requests that a mother give permission for a hearing test in a newborn infant. The mother questions the importance of such a test. The nurse correctly responds with which of the following statements? a. <This will help us to identify your baby's risk for ear infections the first year of life.= b. <Hearing is important so your baby hears and responds to your voice, which makes you feel like a mother.= c. <Socialization skills include the need to hear in order to interpret the emotional aspect of the words that are spoken to your child.= d. <Imitation of sounds is the first step in language development, and it is important to identify alterations early.=

d. "Imitation of sounds is the first step in language development, and it is important to identify alterations early." Newborn screening of hearing does not identify risk of infection but only of sensory responses. The baby's response to the mother is important to bonding, but this not the most important reason to evaluate hearing. Likewise, socialization and tone recognition are functions of hearing, but the most significant reason to test hearing is to identify losses and provide compensatory ways to encourage language development.

Which is an example of the regulatory power to make law? a. Joint Commission establishing a medication reconciliation standard b. Centers for Disease Control and Prevention (CDC) developing recommendations for childhood immunizations c. Institute of Medicine (IOM) defining the approximate number of medication errors that result in significant patient harm or death d. Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals

d. Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals The Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals refers to the enactment of law, while the other answers discuss the development of standards and recommendations that do not have the authority of law. There are some healthcare rules that may define expected behavior, but if these rules were not created by a government entity with legal authority, then they are not healthcare laws.

Which term is the conglomerate of morals, values, beliefs, norms, and meanings that a group of people share and communicate from one generation to the next? a. Customs b. Religion c. Language d. Culture

d. Culture Culture is a blend of everything an individual experiences throughout the lifespan. Norms, values, beliefs, meanings, and morals are shared and taught to young persons. As an individual grows, he or she reflects on the teachings and molds them to fit his or her personal development.

After performing a screening assessment on a patient, which finding should be documented as a physiological stressor? a. Death of friend b. Caregiving of parent c. Divorce d. Dementia

d. Dementia Physiological stressors have physical causes. Dementia is an example of a physiological stressor. Caregiving, divorce, and death of a friend are examples of psychological or emotional stressors.

The Board of Nursing (BON) is reviewing a nurse's practice based on a reported violation of the Nurse Practice Act. What action can the BON take if the complaint is found to be unsupported? a. Censure the nurse. b. Assess a penalty in the form of monetary cost. c. Reinstate the nurse's license. d. Dismiss the complaint.

d. Dismiss the complaint. The Board of Nursing (BON) in each state defines and interprets the Nurse Practice Act. The BON is responsible for investigating and providing actions based on complaints and/or violations of the Nurse Practice Act. If the BON finds that the complaint is not supported by evidence, then the complaint will be dismissed with no disciplinary action taken. Actions allowable by the BON with a supported complaint and/or violation range from censure, talking additional courses, paying a fine/penalty, probation, suspension, and revocation to denial of licensure.

A nurse is reviewing concepts related to physiological responses that occur during sexual acts. Which statement should the nurse identify as not being accurate? a. During resolution, ADH and oxytocin are released. b. Most often in males, orgasm occurs with ejaculation. c. Genital congestion occurs as part of a reflexive response. d. Dopamine secretion acts as an inhibitory transmitter.

d. Dopamine secretion acts as an inhibitory transmitter. The general phases of sexual arousal include motivation, arousal, genital congestion, orgasm and resolution. Dopamine secretion is considered to be an excitatory and released during the arousal stage. Orgasm and ejaculation occur more frequently in males. Genital congestion is under reflexive autonomic response.

End-of-life care is most synonymous with which type of care? a. Palliative care b. Quality of life c. Supportive care d. Hospice care

d. Hospice care End-of-life care is most synonymous with hospice care. Hospice care uses palliative care for the imminently dying by introducing a team of interdisciplinary healthcare professionals at the end of a patient's life. The Medicare Hospice Benefit requires that a patient have a prognosis of 6 months or less to be enrolled in this type of care. Palliative care is incorrect since it can be used to manage symptoms in patients who are living with symptomatic chronic disease several years before death. Supportive care is the type of care predominately used for patients with cancer and undergoing active cancer therapies. Quality of life can be enhanced through the implementation of all of these deliveries of care.

The nurse at the family planning clinic conducts a male history for infertility evaluation. Which finding has the greatest implication for this patient's care? a. Practice of nightly masturbation b. Primary anovulation c. High testosterone levels d. Impotence due to alcohol ingestion

d. Impotence due to alcohol ingestion Factors affecting male infertility include impotence due to alcohol. Nightly masturbation and high testosterone levels do not have the greatest implication on male infertility in a patient with admitted alcohol issues. Primary anovulation refers to female infertility, so it is not a consideration for male infertility.

A 75-year-old woman walks into the emergency department with complaints of <not feeling well. Her blood pressure is 145/95, pulse 85 beats/min, respirations 24 breaths/min, and blood sugar 300. Upon inspection, the nurse notices that the woman has an open wound on the bottom of her foot, but the patient states she is not aware of this. How should the nurse interpret these findings? a. Normal in the older adult b. A need for the patient to be evaluated for cognitive impairment c. A side effect of anti-hypertensive medication d. Pathologic impairment of sensory responses

d. Pathologic impairment of sensory responses This degree of sensory impairment at this age is not expected. Lack of sensation does not imply lack of knowledge, but rather decreased ability to perceive the stimuli. Anti-hypertensive medication does not typically cause decreased skin sensation. This is more common in antineoplastic drugs. Most likely the patient has diabetes, which is causing decreased sensation. Not feeling well is secondary to a change in blood sugar as a result of the wound response.

The nurse is obtaining a sexual history from an adolescent patient. Which finding has the greatest implication for this patient's care? a. Patient denies any sexual activity. b. Patient states that he/she uses <safe sex= practices. c. Patient states that he/she is in a monogamous relationship. d. Patient has been intimate with more than one person in the last year.

d. Patient has been intimate with more than one person in the last year. The Center for Disease Control (CDC) had identified the 5P's with regard to obtaining information for a sexual history. They focus on partners, practices, protection from infection, past history of infection, and prevention of pregnancy. An individual who has had more than one partner within the time frame should be questioned regarding condom use. Denial of sexual activity is part of the patient's self-disclosure. The patient stating that he/she is in a monogamous relationship again represents self-disclosure. Use of <safe sex= practices may need to be further explored but it does not have the greatest implication at this point.

A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. Which action should the nurse take? a. Ask the healthcare provider for a psychiatric referral. b. Administer the PRN sedative medication every 4 hours. c. Suggest the use of a home caregiver to the patient's family. d. Plan to reinforce and repeat teaching about diabetes management.

d. Plan to reinforce and repeat teaching about diabetes management. Because behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be needed for these expected short-term cognitive changes. Sedation will decrease the patient's ability to learn the necessary information for self-management.

A nurse has begun working on a new unit with high-acuity patients. She also has care responsibilities for her children and her aging parents. The nurse is experiencing signs of being overwhelmed. What counsel by the nurse manager would help the nurse cope with her work stress? a. Enlist the help of other family members in the care of her children so she can focus on work. b. Take some time off to decide if she really wants to be a nurse. c. Encourage her to catch up on her documentation responsibilities while taking her lunch break. d. Request that another nurse help her focus on essential aspects of care rather than optional aspects of care.

d. Request that another nurse help her focus on essential aspects of care rather than optional aspects of care. Learning to prioritize care to what is essential to perform versus what would be nice to perform but could be eliminated on stressful days will help the nurse manage her physical and emotional resources at work. Taking time off does not address the underlying issue of how to handle work stress. Periodic breaks in a work day, such as a meal break, allow the staff to refocus and maintain energy to complete their work. Support from family may help address stressors at home but does not help manage stress at work.

The ability to receive and interpret stimuli is a priority for what human need? a. Mobility b. Socialization c. Nutrition d. Safety

d. Safety Safety is the highest priority of the needs listed. Socialization is affected by deficits. Nutrition concerns can be experienced but not at the same level as basic safety concerns. Mobility may lead to safety concerns when one is having decreased sensory input.

An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient's chief complaint? a. The patient is responsible for caring for two school-age grandchildren. b. The patient's daughter works to support the family. c. The patient is being treated for hypertension and is overweight. d. The patient has recently lost her spouse and needed to move in with her daughter.

d. The patient has recently lost her spouse and needed to move in with her daughter. The stress of losing a loved one and having to move are important contributing factors for stress-related symptoms in older people. Caring for children will increase the patient's sense of worth. Being overweight and being treated for hypertension are not the most likely causes of insomnia or headache. The patient's daughter may have added stress due to working, but this should not directly affect the patient.