Next Gen practice questions

A nurse is caring for a client who has a personality disorder. Nurses' Notes Day 1 - Admit note 0700 Talkative, well-groomed.States she is "looking forward to divorcing partner number four" because she has "found my next partner."Anxious if left alone - wants to remain close to nurse.Tells the nurse, "I feel like a bomb waiting to explode."​ Day 2 1000​ Restless for past 2 hr. Pacing from bedroom to dayroom and mumbling to self. Argued with nurse this morning about attending group therapy session.Staring at staff members with fists clenched. Diagnostic Results Day 1 0730 Hematocrit 45% (female: 37% to 47%) Hemoglobin 14.5 g/dL (female: 12 to 16 g/dL) Fasting blood glucose 92 mg/dL (74 to 106 mg/dL) Graphic Record Day 1 0715 Temperature 36.2° C (97.2° F) Heart rate 86/min Respiratory rate 16/min Blood pressure 112/76 mm Hg Day 2 0900 Temperate 36.7° C (98.2° F) Heart rate 98/min Respiratory rate 20/min Blo

1) A 2) B

A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty. History and Physical Day 1 0800: 75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their daily walk of 3 miles. History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism. No known allergies. Nurses' Notes Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess. I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was a

1) A 2) C 3) A 4) B 5) C 6) A

A nurse is caring for a client who has a personality disorder. Nurses' Notes Day 1 - Admit note 0700 Talkative, well-groomed. States she is "looking forward to divorcing partner number four" because she has "found my next partner. "Anxious if left alone - wants to remain close to nurse. Tells the nurse, "I feel like a bomb waiting to explode." Diagnostic Results Day 1 0730 Hematocrit 45% (female: 37% to 47%) Hemoglobin 14.5 g/dL (female: 12 to 16 g/dL) Fasting blood glucose 92 mg/dL (74 to 106 mg/dL) Graphic Record Day 1 0715 Temperature 36.2° C (97.2° F) Heart rate 86/min Respiratory rate 16/min Blood pressure 112/76 mm Hg History and Physical 36-year-old well-nourished female presenting with recurrence of labile behavior involving episodes of self-injury (cutting arms and legs) and hypersexualization, recent arrest for stealing money from family to cover credit card charges and instigating physical altercat

1) B 2) A 3) A and C 4) C 5) B

A nurse is reviewing a client's medical record. Nurses' Notes Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess. I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was awake most of the night and was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without assistance during the early morning hours. Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to answer questions about sur

1) B 2) A 3) B 4) A 5) A 6) A 7) C

A nurse is caring for a client who has a personality disorder. Nurses' notes Day 1 - Admit note 0700 Talkative, well-groomed. States she is "looking forward to divorcing partner number four" because she has "found my next partner." Anxious if left alone - wants to remain close to nurse. Tells the nurse, "I feel like a bomb waiting to explode." Day 2 1000 Restless for past 2 hr. Pacing from bedroom to dayroom and mumbling to self. Argued with nurse this morning about attending group therapy session. Staring at staff members with fists clenched. Day 2 1200 Cursing at staff and other clients. Knocked over the card table in the day room. Attempted to hit one of the nursing staff. Haloperidol 2 mg IM administered left ventrogluteal at 1205 for severe agitation and violent outbursts. Placed in seclusion and mechanical four-point restraints, as per facility policy for safety of client and others on unit. Provider inform

1) B 2) C 3) A 4) A

A nurse is caring for a client who is experiencing delirium. History and Physical Day 1 0800: 75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their daily walk of 3 miles. History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism. No known allergies. Nurses' Notes Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess. I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was awake most of the night and was restless

1) C 2) A

Nurse's Notes The client reports a history of anxiety; diagnosed with Alzheimer's disease 2 months ago. The client's partner died 6 months ago. Reports decreased appetite, low energy levels, and insomnia for several weeks; some memory loss. Graphic Results SaO2 96% on room air Respiratory rate 20/min Blood pressure 112/76 mm Hg (lying) Blood pressure 104/68 mm Hg (standing) Heart rate 68/min Temperature 36° C (96.8° F) Medication Administration Record Captopril 12.5 mg by mouth three times daily Digoxin 0.125 mg by mouth each morning Multivitamin with iron one by mouth daily Docusate sodium 50 mg by mouth each evening A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above their ideal body weight. Which of the following interventions should the nurse include in the plan? A) Use a screening tool to evaluate the client for depression. B) Ask the provider to decrease the dosage of the

A Depression can be underdiagnosed among older adult clients. The nurse should identify several risk factors for depression from the client's data, including having Alzheimer's disease, anxiety, and the loss of a loved one. Manifestations of depression can also be nonspecific for older adult clients and can include weight loss, decreased energy levels, and difficulty sleeping.

A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty. History and Physical Day 1 0800: 75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their daily walk of 3 miles. History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism. No known allergies. Nurses' Notes Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess. I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was a

A, C, E, and G Hospital environment is correct. Risk factors for delirium include a change in hospital rooms, such as moving from the ICU to a private room, client's age, vision or hearing impairments, recent surgical procedures, and infection. A change in room location can be disorienting to a client and lead to delirium. Client's age is correct. Risk factors for delirium include a change in hospital rooms, such as from the ICU to a private room, client's age, vision and hearing impairments, recent surgical procedures, and infection. Older adult clients have a higher risk for developing delirium from being in unfamiliar surroundings, such as a hospital. Postoperative is correct. Risk factors for delirium include a change in hospital rooms, such as from the ICU to a private room, client's age, vision or hearing impairments, recent surgical procedures, and infection. Surgical procedures increase a client's risk for delirium due to the effects of anesthesia and pain medications, the risk for infection, and the potential for altered vital signs and fluid and electrolyte balance. Fever is correct. Risk factors for delirium include a change in hospital rooms, such as from the ICU to a private room, client's age, vision or hearing impairments, recent surgical procedures, and infection. Altered vital signs and the risk for infection, as evidenced by fever, increase a client's risk for developing delirium.

A nurse is caring for a client who has a personality disorder. History and Physical 36-year-old well-nourished female presenting with recurrence of labile behavior involving episodes of self-injury (cutting arms and legs) and hypersexualization, recent arrest for stealing money from family to cover credit card charges and instigating physical altercations with current spouse. Axis 1: major depressive disorder; Axis 2: borderline personality disorder Client attends a group exercise class twice a week and eats a well-balanced diet. Employed as legal secretary for past 12 years. Nurses' Notes Day 1 - Admit note 0700 Talkative, well-groomed. States she is "looking forward to divorcing partner number four" because she has "found my next partner" Anxious if left alone - wants to remain close to nurse. Tells the nurse, "I feel like a bomb waiting to explode." Day 2 1000​ Restless for past 2 hr. Pacing from bedroom to

B and F Maintain continuous observation of the client while in restraints is correct. The nurse should ensure a staff member remains with the client continuously while the client is in restraints. Conduct debriefing with the client and other staff is correct. The nurse should conduct debriefing with other staff members to indicate the necessity of the intervention and to ensure that quality care was provided. The nurse should conduct a debriefing with the client to discuss their thoughts about what contributed to the intervention and strategies for crisis prevention in the future.

A nurse is evaluating the client after 2 weeks. Which of the following findings indicate an improvement in the client's condition? (Select all that apply.) A nurse is caring for a client who has anorexia nervosa. Vital Signs Day 1: Blood pressure 90/60 mm Hg Heart rate 54/min Respiratory rate 16/min Temperature 36.1° C (97° F) Day 14: Blood pressure 88/58 mm Hg Heart rate 64/min Respiratory rate 16/min Temperature 36.1° C (97° F) ​Diagnostic Results Day 1: Potassium 3.2 mEq/L (3.5 to 5.0 mEq/L) Sodium 150 mEq/L (136 to 145 mEq/L) BUN 35 mg/dL (10 to 20 mg/dL) Glucose 78 mg/dL (74 to 106 mg/dL) Day 14: Potassium 3.7 mEq/L (3.5 to 5.0 mEq/L) Sodium 143 mEq/L (136 to 145 mEq/L) BUN 18 mg/dL (10 to 20 mg/dL) Glucose 76 mg/dL (74 to 106 mg/dL) Physical Examination Day 1: • BMI 16.8 • Yellow sclera • Skin is cool • Reports no bowel movement for 5 days • 1+ peripheral edema • Reports exercising 2 hr per da

B, C, D, E, H, I, and J Heart rate is correct. Clients who have anorexia nervosa usually have bradycardia. The client's heart rate is now within the expected reference range. BMI is correct. Clients who have anorexia nervosa usually have a BMI of less than 17. The client's initial BMI indicates moderate anorexia nervosa while the current BMI indicates mild anorexia nervosa. Potassium is correct. Clients who have anorexia nervosa usually have hypokalemia. The client's potassium level is now within the expected reference range. Skin temperature is correct. Clients who have anorexia nervosa usually have cool skin. After 2 weeks, the client's skin is warm, which indicates improvement. Sodium is correct. Clients who have anorexia nervosa usually have hyponatremia. The client's sodium level is now within the expected reference range. Bowel movement is correct. The client's constipation has improved based on the increased frequency of their bowel movements. BUN is correct. Clients who have anorexia nervosa usually have an increased BUN. The client's BUN level is now within the expected reference range.

A nurse is caring for a client who is experiencing delirium. History and Physical Day 1 0800: 75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their daily walk of 3 miles. History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism. No known allergies. Nurses' Notes Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess. I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was awake most of the night and was restless

B, C, and D Offer the client warm milk at bedtime is correct. This will help the client to relax and encourage sleep. Maintain a low-stimulation environment for the client is correct. Overstimulation can worsen the client's manifestations of delirium. Maintaining a quiet environment will help the client to relax and encourage sleep. Approach the client from the front and speak slowly is correct. The nurse should approach the client from the front and speak slowly to avoid startling the client.

A nurse is caring for a client who has a personality disorder. Nurses' Notes Day 1 - Admit note 0700Talkative, well-groomed. States she is "looking forward to divorcing partner number four" because she has "found my next partner. "Anxious if left alone - wants to remain close to nurse. Tells the nurse, "I feel like a bomb waiting to explode." Diagnostic Results Day 1 0730 Hematocrit 45% (female: 37% to 47%) Hemoglobin 14.5 g/dL (female: 12 to 16 g/dL) Fasting blood glucose 92 mg/dL (74 to 106 mg/dL) Graphic Record Day 1 0715Temperature 36.2° C (97.2° F)Heart rate 86/min Respiratory rate 16/min Blood pressure 112/76 mm Hg Select the 6 findings found in the client's medical record that are manifestations of the client's diagnosed personality disorder. A) Exercises twice a week B) Well-nourished female C) Stealing money from family to cover credit card charges D) Hypersexualization E) Married multiple times F) Anx

C, D, E, F, I, and J Stealing money from family to cover credit card charges is correct. The nurse should identify that stealing money is an impulsive behavior, which is a manifestation of borderline personality disorder. Anxious if left alone is correct. The nurse should identify that the client's anxiety about being left alone is due to fear of separation, which is a manifestation of borderline personality disorder. Hypersexualization is correct. The nurse should identify that hypersexualization is an impulsive, self-damaging behavior, which is a manifestation of borderline personality disorder. Married multiple times is correct. The nurse should identify that unstable romantic relationships are a manifestation of borderline personality disorder. Incidences of self-injury is correct. The nurse should identify that self-injury is a manifestation of borderline personality disorder. Self-destructive behaviors, such as cutting, are common with this disorder. Physical altercations is correct. The nurse should identify that engaging in physical altercations is a manifestation of borderline personality disorder.

A nurse at an inpatient mental health facility is caring for a client who recently experienced a traumatic event. Vital Signs 0730: Temperature 36.6° C (97.8° F) Heart rate 74/min Respiratory rate 16/min Blood pressure 118/74 mm Hg 1400: Temperature 36.9° C (98.4° F) Heart rate 86/min Respiratory rate 18/min Blood pressure 114/78 mm Hg Nurses' Notes 0730 Admission: Client was a witness during a recent violent crime at their place of employment. Several of the client's coworkers were killed. The client has been experiencing feelings of guilt and anger. ​1400: The client continues to express feelings of guilt and anger and states, "I cannot ever go back to work. It is too dangerous." The client also states, "I don't know why I was allowed to survive. It's too painful to talk to my friends and family about what happened." The nurse is providing teaching to the client. Which of the following statements should the n

C, D, and E "You should seek help if you have thoughts of self-harm" is correct. The nurse should inform the client that they should seek help immediately if they experience thoughts of self-harm or suicidal ideation. "A support group might be helpful to you during this time" is correct. The nurse should encourage the client to participate in a support group, which can provide emotional support for a client who has experienced a traumatic event. "It is common for people who survived a traumatic event to experience feelings of anxiety" is correct. Clients who have experienced a traumatic event can demonstrate manifestations of severe anxiety and panic attacks, including impulsivity and regression.

A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty. History and Physical Day 1 0800: 75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their daily walk of 3 miles. History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism. No known allergies. Nurses' Notes Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess. I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was a

C, E, F, H, and G Cognitive awareness is correct. The nurse should evaluate the client for previous and current cognitive status to provide a safe environment. The client's sudden change in cognitive awareness should be reported to the provider because delirium is a medical emergency. Blood pressure is correct. The client's blood pressure is above the expected reference range and should be reported to the provider. Clients who are experiencing delirium might experience an elevated heart rate and blood pressure. Sleep/wake cycle is correct. The client's lack of sleep and restlessness during the night are indications that the client might be experiencing delirium and should be reported to the provider. Confusion and disorientation are often worse at night. I&O is correct. The client's intake of 750 mL is significantly less than the output of 2,500 mL and should be reported to the provider. The imbalance in fluid status, and the resulting alteration in heart rate and blood pressure, could be a cause of the client's delirium. Temperature is correct. A temperature of 38.6° C (101.5° F) on day 3 following right knee arthroplasty is above the expected reference range and should be reported to the provider.

For each of the provider's potential prescriptions, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

CT scan of brain is nonessential Monitor vital signs every 30 min is anticipated. Obtain an Alcohol Use Disorders Identification Test (AUDIT) is nonessential. Initiate IV access is anticipated Administer an anti-anxiety medication is anticipated. Wake the client every 30 min for neurological assessment is contraindicated.

A nurse is caring for a client in an outpatient psychiatric clinic who has been applying a selegiline 12 mg transdermal patch once daily. Exhibit 1: Nurses' Notes Tuesday: Client diagnosed with major depressive disorder 15 years ago. Visits clinic twice a week for outpatient group therapy with social worker and follow-up with nurse. Client actively participates in therapy. Acknowledges that relationship with family members has improved and there are fewer verbal altercations. Thursday: Client presents with irritability, diaphoresis, and severe headache, and states, "I am really feeling bad. My heart is pounding." Was excited to share they had met a friend for lunch before coming to the clinic. "Maybe it's something I ate, but we both had the same thing - corned beef sandwich with Swiss cheese. Do you think it is food poisoning?" ​ Exhibit 2: Vital Signs Tuesday:​Temperature 37° C (98.6° F) Blood pressure 114/78

Hypertensive crisis is correct. Rationale: Selegiline is a MAOI medication used to treat depression. Foods that contain tyramine, such as aged cheese, yeast, and smoked or aged meats should not be consumed because this can cause a hypertensive crisis. Other manifestations of hypertensive crisis include chest pain, severe headache, nausea and vomiting, tachycardia, palpitations, and fever. Consuming foods high in tyramine is correct. Rationale: The nurse should identify that consuming foods high in tyramine while taking an MAOI can lead to a hypertensive crisis. Selegiline is a MAOI medication used to treat depression. Foods that contain tyramine, such as aged cheese, yeast, and smoked or aged meats should not be consumed. Other manifestations of hypertensive crisis include chest pain, severe headache, nausea and vomiting, tachycardia, palpitations, and fever.

A nurse on a mental health unit is caring for a recently admitted patient. Vital Signs0800:Blood pressure 110/78 mm Hg Heart rate 76/min Respiratory rate 18/min Temperature 37° C (98.6° F)1200:Blood pressure 116/80 mm Hg Heart rate 88/min Respiratory rate 20/min Temperature 38° C (100.4° F)Medical History22-year-old client admitted following episodes of hallucinations and delusions. Outpatient treatment has been ineffective. Client has been unable to maintain a job and friends have said the client has been acting different than usual. Family members have noticed that the client no longer maintains a clean and neat appearance. For each potential assessment finding, click to specify if it is a positive or negative symptom of schizophrenia. Absence of intonation in speech Alogia Clang associations Delusions of grandeur Withdrawal from social activity Catatonia

Positive symptoms: Delusions of grandeur, clang associations, and catatonia Negative symptoms: Absence of intonation in speech, alogia, and withdrawal from social activities

A nurse is caring for a patient who has alcohol use disorder Exhibit 1: Vital Signs0800:Blood pressure 116/68 mm Hg Heart rate 80/min Respiratory rate 14/min Temperature 36.8° C (98.2° F)1200:Blood pressure 120/84 mm Hg Heart rate 96/min Respiratory rate 20/min Temperature 37° C (98.6° F) Exhibit 2: Nurses' Notes0800:Client alert and oriented to time, place, person, and situation. Visiting with other clients in the dayroom. Attended group session this morning and stated, "I think I'm beginning to see what I need to do to get better." Eager to have family visit with partner later this morning.1230:Client attended lunch with other clients but refused to eat or drink today. Staring intently at other clients and nursing staff. Posture is rigid and jaw is clenched. Pacing and restless. Complete the following sentence by using the list of options The patient is at greatest risk for __________ as evidenced by the pati

Violent behavior; Violent behavior is correct. The greatest risk for the client is engaging in violent behavior due to the withdrawal of alcohol, which is causing them increasing agitation. The nurse should closely monitor the client and be prepared to intervene to protect the client and others from injury. Agitation; Agitation is correct. The client is at greatest risk of engaging in violent behavior as evidenced by the client's agitation, which can be indicated by pacing, restlessness, staring, silence, rigid posture, and clenched jaw. The nurse should closely monitor the client and be prepared to intervene to protect the client and others from injury.

For each of the client assessment findings below, click to specify if the finding is consistent with alcohol toxicity or major depressive disorder. Each finding may support more than one disease process.

Weight change is consistent with major depressive disorder Level of consciousness (LOC) is consistent with alcohol toxicity. Nausea and vomiting is consistent with alcohol toxicity Mental status is consistent with alcohol toxicity and major depressive disorder. Respiratory rate is consistent with alcohol toxicity.

A nurse is updating the client's plan of care. For each of the following potential nursing interventions, click to specify if the potential intervention is anticipated, nonessential, or contraindicated for the client.

When addressing the client, approach them from the front when possible ANTICIPATED Use a vest restraint to keep the client in a medical recliner. CONTRAINDICATED Decrease sensory stimulation. ANTICIPATED Give directions to the client slowly and in a moderate tone of voice. ANTICIPATED Assign the client to a room near the nurses' station. ANTICIPATED Provide the client with high-calorie protein drinks hourly. NONESSENTIAL Ensure the bed is kept at a working height for the nurse. CONTRAINDICATED Keep the lights off in the client's bedroom and bathroom at night. CONTAINDICATED