Spring 2019 Unit 6, Stress & Coping, Communication, Teaching & Learning, Quality Improvement, Informatics

18. A nurse is asked to "float" to a telemetry floor and is to place a patient on telemetry monitor. The nurse is unfamiliar with placement of EKG leads and would consult which type of chart to learn the correct placement?

ANS: The Pareto chart is used to prioritize interventions that caused the majority of the problems. DIF: Application REF: p. 387, Figure 22-3

COMPLETION 1. Software programs that process data to produce or recommend valid choices are known as ______________.

ANS: decision support systems Decision support systems use software programs that process data to produce or recommend decisions by linking with an electronic knowledge base. DIF: Knowledge REF: p. 269

COMPLETION 1. Quality is defined by the ____________.

ANS: patient Quality is based on the perspective of the consumer or, in this instance, the patient. DIF: Knowledge REF: pp. 382-383

2. While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.

ANS: sentinel A sentinel event is an occurrence that results in death or serious illness and requires immediate investigation. DIF: Comprehension REF: p. 380

7. Arthur, who is diagnosed with obsessive-compulsive disorder, reports to the nurse that he cant stop thinking about all the potentially life threatening germs in the environment. What is the most accurate way for the nurse to document this symptom? A. Patient is expressing an obsession with germs. B. Patient is manifesting compulsive thinking. C. Patient is expressing delusional thinking about germs. D. Patient is manifesting arachnophobia of germs.

ANS: A Obsessions are unwanted, intrusive, repetitive thoughts. Compulsions are unwanted, repetitive behavior patterns in response to obsessive thoughts that are efforts to reduce anxiety.

16. A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? A. I will need scheduled bloodwork in order to monitor for toxic levels of this drug. B. I wont stop taking this medication abruptly, because there could be serious complications. C. I will not drink alcohol while taking this medication. D. I wont take extra doses of this drug because I can become addicted.

ANS: A The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. No blood work is needed when taking a short-acting benzodiazepine. The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.

9. A client diagnosed with panic disorder states, When an attack happens, I feel like I am going to die. Which is the most appropriate nursing reply? A. I know its frightening, but try to remind yourself that this will only last a short time. B. Death from a panic attack happens so infrequently that there is no need to worry. C. Most people who experience panic attacks have feelings of impending doom. D. Tell me why you think you are going to die every time you have a panic attack.

ANS: A The most appropriate nursing reply to the clients concerns is to empathize with the client and provide encouragement that panic attacks last only a short period. Panic attacks usually last minutes but can, rarely, last hours. Symptoms of depression are also common with this disorder.

2. A client has a history of excessive fear of water. What is the term that a nurse should use to describe this specific phobia, and under what subtype is this phobia identified? A. Aquaphobia, a natural environment type of phobia B. Aquaphobia, a situational type of phobia C. Acrophobia, a natural environment type of phobia D. Acrophobia, a situational type of phobia

ANS: A The nurse should determine that an excessive fear of water is identified as aquaphobia, which is a natural environment type of phobia. Natural environmenttype phobias are fears about objects or situations that occur in the natural environment, such as a fear of heights or storms.

18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

ANS: A The nurse should determine that the clients absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses.

3. A newly admitted client asks, Why do we need a unit schedule? Im not going to these groups. Im here to get some rest. Which is the most appropriate nursing reply? A. Group therapy provides the opportunity to learn and practice new coping skills. B. Group therapy is mandatory. All clients must attend. C. Group therapy is optional. You can go if you find the topic helpful and interesting. D. Group therapy is an economical way of providing therapy to many clients concurrently.

ANS: A The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention.

5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. Are you currently thinking about harming yourself? B. Why do you want to harm yourself? C. Have you thought about the consequences of your actions? D. Who is your emergency contact person?

ANS: A The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should prioritize safety by assessing the client for thoughts of self-harm.

10. During an inpatient educational group, a client shouts out, This information is worthless. Nothing you have said can help me. These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

ANS: A The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others.

21. A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol dependence B. History of personality disorder C. History of schizophrenia D. History of hypertension

ANS: A The nurse should question a prescription of alprazolam (Xanax) for acute anxiety if the client has a history of alcohol dependence. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance abuse may be more likely to abuse other addictive substances and/or combine this drug with alcohol.

4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed.

2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit-setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members.

5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients bedside at the appropriate times.

ANS: A The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units; however, nurses must work with clients to foster independence and provide experiences that would foster increased self-esteem.

10. A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? A. Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder. B. Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder. C. Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks. D. Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks.

ANS: A The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine that can be abused and lead to physical dependence and tolerance. It can be used on an as-needed basis to reduce anxiety and its related symptoms.

8. During a group discussion, members freely interact with each other. Which member statement is an example of Yaloms curative group factor of imparting information? A. I found a Web site explaining the different types of brain tumors and their treatment. B. My brother also had a brain tumor and now is completely cured. C. I understand your fear and will be by your side during this time. D. My mother was also diagnosed with cancer of the brain.

ANS: A Yaloms curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by advice and suggestions given by other group members.

10. The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph? a. Time plot b. Pareto chart c. Flowchart d. Cause-and-effect diagram

ANS: A A run plot, or time plot, graphs data in time order to identify any changes that occur over time. DIF: Comprehension REF: p. 388

15. The surgical team arrives in the operating room and one member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is known as: a. time-out. b. a critical pathway. c. special cause variation. d. lean methodology.

ANS: A A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure. DIF: Comprehension REF: p. 391, Box 22-2

10. A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the author's credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing? a. Authority b. Objectivity c. Usability d. Currency

ANS: A Authority is the criterion that is related to the credentials and background that have prepared an author to publish on the subject. DIF: Comprehension REF: p. 276

Chapter 15: Information Technology in the Clinical Setting Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. Consumers are concerned with security issues related to their confidential health information being placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is: a. more secure. b. less secure. c. equivalent. d. not comparable with the paper-and-pencil record.

ANS: A Computer-based patient record systems, such as EHRs, provide better protection than paper-based systems. The EHR allows only authorized users to view data, and access to records can be audited for inappropriate use. DIF: Comprehension REF: p. 271

5. A consumer is learning about electronic health records at a local health fair and states, "I am worried that someone can read my health information and I really don't understand the difference between privacy and confidentiality." The nurse explains that an example of confidentiality would be: a. a pledge that states, "I will hold matters pertaining to my patients in strict intimacy." b. a patient who does not tell the physician that he has been treated for a sexually transmitted disease. c. a teenager who sustains a broken arm and in the emergency department and withholds information about her use of recreational drugs. d. locking medical records in cabinets to prevent unauthorized users from accessing patient information.

ANS: A Confidentiality is keeping private the personal information that was given to a health care provider, unless others have a legitimate need to know. DIF: Application REF: p. 271

9. An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as: a. decision support. b. telehealth. c. robotic technology. d. biometric technology.

ANS: A Decision support systems are computer-based information systems that include knowledge-based systems designed to support clinical decision making. DIF: Comprehension REF: pp. 268-269

13. A nurse works on a unit where electronic health records (EHR) are being initiated and asks, "What is meant by 'meaningful use' standards that are in our education packet?" The best answer is that "meaningful use": a. identifies a set of EHR proficiencies and benchmarks that EHR systems must meet to be certain that they are functioning to their maximum capacity and meeting this standard allows companies/organizations to qualify for funds to defray cost of the EHR from Medicare. b. refers to training competencies that all users must achieve to be able to access and transfer patient data/information. c. refers to a requirement that at least 50% plus one of all patients have data entered into the EHR. d. the requirement that rigorous confidentiality security is in place to protect all patient information from sources which have no right to the data.

ANS: A Meaningful use is "A defined set of EHR capabilities and standards that EHR systems must meet to ensure their full capacity is realized and for the users (hospitals and physician practices) to qualify for financial incentives from Medicare." DIF: Application REF: p. 271

12. According to the Quality Chasm report: a. health care providers should be proactive rather than reactive to patient needs. b. common needs rather than individual preferences should be the priority. c. medical information should be confined to the primary care provider. d. specialized providers or case managers should control health care decisions.

ANS: A Quality is based on predicting patient needs rather than reacting to needs. DIF: Comprehension REF: pp. 381-382

7. A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency? a. Safety b. Timely c. Equitable d. Patient-centered care

ANS: A Standardization contributes to safety and improves individual performance of care providers. DIF: Application REF: p. 381

6. Regardless of the term used to describe high-quality health care, the focus of quality is: a. what the consumer needs and wants. b. economical care. c. having the greatest technologic advancement. d. services equally distributed among populations.

ANS: A The customer determines quality on the basis of his or her unique perception of high-quality care

15. The Institute of Medicine (IOM) (2003) recommends that EHR systems offer eight functionalities. A patient has a severe allergy to eggs and penicillin. Which of the eight functions of the EHR would address sharing this information? a. Health information and data capture b. Results/data management c. Provider order entry management d. Clinical decision support

ANS: A The health information and data capture function includes information such as medical history, laboratory tests, allergies, current medications, and consent forms. DIF: Comprehension REF: p. 269, Table 15-1

Multiple Response 11. Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? Select all that apply. A. Tell me what happened. B. What coping methods have you used, and did they work? C. Describe to me what your life was like before this happened. D. Lets focus on the current problem. E. Ill assist you in selecting functional coping strategies.

ANS: A, B, C In the assessment phase, the nurse should gather information regarding the precipitating stressor and the resulting crisis. Focusing on the current problem and selecting functional coping strategies are nursing " interventions" rather than "assessments."

2. An interdisciplinary team is evaluating the hospital's care of patients admitted with a myocardial infarction (heart attack) compared to national standards. The team analyzes the hospital's clinical indicator, which would be: (select all that apply) a. aspirin order within 24 hours of discharge. b. patient teaching related to stopping smoking completed prior to discharge. c. beta blocker administered upon arrival. d. support of employer to modify stress in workplace. e. patient's willingness to adhere to a strict cardiac diet after discharge.

ANS: A, B, C Clinical indicators are measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished. National benchmarks are established according to guidelines related to quality care for patients admitted with heart attack and include: aspirin within 24 hours of admission, angiotensin receptor blocker at discharge, stop smoking instruction given, and beta blocker administered upon arrival and discharge. These are all measurable. DIF: Application REF: p. 385

30. A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply. A. Some antianxiety agents have been successful in treating social phobias. B. Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia). C. Specific phobias are generally not treated with medication unless accompanied by panic attacks. D. Beta-blockers have been used successfully to treat phobic responses to public performance.

ANS: A, B, C, D All of the listed pharmacological treatments are evidence-based treatments for phobic disorders.

12. Which of the following are effective interventions that a nurse should utilize when caring for an inpatient client who expresses anger inappropriately? Select all that apply. A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. C. Use therapeutic touch to convey empathy. D. Set limits on the behavior. E. Teach the client to avoid I statements related to expression of feelings.

ANS: A, B, D The nurse should determine that when working with an inpatient client who expresses anger inappropriately, it is important to maintain a calm demeanor, clearly define the consequences, and set limits on the behavior. The use of therapeutic touch may not be appropriate and could escalate the clients anger.

Multiple Response 21. Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? Select all that apply. A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others.

ANS: A, B, D The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer.

29. A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this clients symptoms? Select all that apply. A. Encourage the client to recognize the signs of escalating anxiety. B. Encourage the client to avoid any situation that causes stress. C. Encourage the client to employ newly learned relaxation techniques. D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. E. Encourage the client to avoid caffeinated products.

ANS: A, C, D, E Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to cognitively reframe thoughts about anxiety-provoking situations, and to avoid caffeinated products. Avoiding situations that cause stress is not an appropriate intervention, because avoidance does not help the client overcome anxiety. Stress is a component of life and is not easily evaded.

MULTIPLE RESPONSE 1. A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2012 National Patient Safety Goals by implementing which protocols? (select all that apply) a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.

ANS: A, C, D, E The 2012 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required. DIF: Application REF: p. 391, Box 22-2

27. A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? Select all that apply. A. Fatigue B. Anorexia C. Hyperventilation D. Insomnia E. Irritability

ANS: A, D, E The nurse should expect that a client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.

MULTIPLE RESPONSE 1. A new nurse asks, "Since Electronic Medical Records can improve quality care by having seamless data available for a patient, why doesn't everyone just replace paper and pencil charts"? Barriers to a universal health information infrastructure include the fact that: (select all that apply) a. competition from individual companies to build EMR prevent a universal infrastructure. b. cost is prohibitive even with federal funding for larger health care systems. c. preventive health reminders for immunizations and yearly screenings such as mammograms are used in clinical decision making. d. insurance companies have halted sharing of some patient data due to fear of law suits. e. the full capacity of EHRs has not been realized with only Stage 1 of 3 nearing completion.

ANS: A, E It has been recommended that only a federal-based EMR would provide an infrastructure that allows access to comprehensive patient information. The first stage, years 2011 and 2012, forms the foundation for electronic data capture and information sharing. DIF: Comprehension REF: p. 271

20. A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess? A. Risk for suicide B. Cardiac status C. Current stressors D. Substance use history

ANS: B Although all of the listed aspects of assessment are important, the priority is to evaluate cardiac status since a person having an MI, CHF, or mitral valve prolapse can present with symptoms of anxiety.

15. A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? A. The client will refrain from ritualistic behaviors during daylight hours. B. The client will wake early enough to complete rituals prior to breakfast. C. The client will participate in three unit activities by day 3. D. The client will substitute a productive activity for rituals by day 1.

ANS: B An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. The nurse should also provide a structured schedule of activities and later in treatment begin to gradually limit the time allowed for rituals.

26. A client is taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for drug overdose? A. When the client has a knowledge deficit related to the effects of the drug B. When the client combines the drug with alcohol C. When the client takes the drug on an empty stomach D. When the client fails to follow dietary restrictions

ANS: B Both Librium and alcohol are central nervous system depressants. In combination, these drugs have an additive effect and can suppress the respiratory system, leading to respiratory arrest and death.

8. A despondent client, who has recently lost her husband of 30 years, tearfully states, Ill feel a lot better if I sell my house and move away. Which nursing reply is most appropriate? A. Im confident you know whats best for you. B. This may not be the best time for you to make such an important decision. C. Your children will be terribly disappointed. D. Tell me why you want to make this change.

ANS: B During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. The nurse should also assist the client in determining whether any changes are realistic and if timing of change is appropriate. This response encourages the client to think through what may be an impulsive decision.

4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? A. Peer pressure B. Structured programming C. Visitor restrictions D. Mandated activities

ANS: B The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups.

19. A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300 mg daily, for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor reply is most accurate? A. High doses of tricyclic medications will be required for effective treatment of OCD. B. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. C. The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia. D. The dosage of Luvox is outside the therapeutic range and needs to be questioned.

ANS: B The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the U.S. Food and Drug Administration for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness.

11. A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member states, Should I seek psychiatric help for my mother? Which is an appropriate nursing reply? A. My mother also worries unnecessarily. I think it is part of the aging process. B. Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning. C. From what you have told me, you should get her to a psychiatrist as soon as possible. D. Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications.

ANS: B The most appropriate reply by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers.

ANS: B The nurse should assess that tense facial expressions and body language may indicate that a clients anger is escalating. The nurse should conduct a thorough assessment of the clients past and current violent behaviors and develop interventions for de-escalation.

12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. Its hard for me to tell my story when Im not sure about the reactions of others. B. I think Joes Antabuse suggestion is a good one and might work for me. C. My situation is very complex, and I need professional, not peer, advice. D. I am really upset that you expect me to solve my own problems.

ANS: B The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change.

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis

ANS: B The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or inability to assume personal responsibility.

Townsend, Chapter 10. Therapeutic Groups Multiple Choice 1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

ANS: B The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer.

6. A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain to the spouse the etiology of this fear? A. Your spouse may be unable to resolve internal conflicts, which result in projected anxiety. B. Your spouse may be experiencing a distorted and unrealistic appraisal of the situation. C. Your spouse may have a genetic predisposition to overreacting to potential danger. D. Your spouse may have high levels of brain chemicals that may distort thinking.

ANS: B The nurse should explain that from a cognitive perspective the client is experiencing a distorted and unrealistic appraisal of the situation. From a cognitive perspective, fear is described as the result of faulty cognitions.

5. Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses association advertises for candidates for president.

ANS: B The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity.

15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

ANS: B The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement.

7. What is the best rationale for including the clients family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors

ANS: B The nurse should include the clients family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment.

Townsend, Chapter 27. Anxiety, Obsessive-Compulsive, and Related Disorders Multiple Choice 1. A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred? A. These clients do not recognize that their fear is excessive, and they rarely seek treatment. B. These clients have overwhelming symptoms of panic when exposed to the phobic stimulus. C. These clients experience symptoms that mirror a cerebrovascular accident (CVA). D. These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis.

ANS: B The nursing instructor should evaluate that learning has occurred when the student knows that clients experiencing phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimulus produces an immediate anxiety response.

23. A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis would best describe the problems evidenced by these symptoms? A. Ineffective coping B. Disturbed body image C. Complicated grieving D. Panic anxiety

ANS: B The symptoms presented describe the DSM-5 diagnosis of body dysmorphic disorder, and the related nursing diagnosis is disturbed body image.

7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yaloms curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

ANS: B This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved.

9. Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to as a(n): a. benchmark. b. critical pathway. c. algorithm. d. case management.

ANS: B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. DIF: Knowledge REF: pp. 388-389

4. A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n): a. standardization of care. b. root cause analysis. c. process variation. d. analysis of a deployment flowchart.

ANS: B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. DIF: Application REF: p. 380

3. A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a: a. root cause. b. sentinel event. c. variation in performance. d. causal factor.

ANS: B A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. DIF: Comprehension REF: p. 380

Chapter 22: Quality Improvement and Patient Safety Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a: a. deployment flowchart. b. top-down flowchart. c. Pareto chart. d. control plot.

ANS: B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. DIF: Comprehension REF: p. 379 |p. 388

7. A nurse walks up to a computer in the hallway and presses the index finger to the sensor, thereby gaining access to patient data. A few moments later another nurse performs the same steps and is granted access. A visitor who is watching from a room walks over and places the index finger on the sensor, only to receive an "error and access denied" message. Security is being maintained by: a. robot technology. b. biometric technology. c. telehealth. d. ubiquitous computing.

ANS: B Biometric fingerprint identification uses personal characteristics to allow access to health information. DIF: Comprehension REF: p. 277

12. A nurse providing care at the bedside receives an "alert" that a patient's stat potassium level is 2.5 and digoxin (Lanoxin) is scheduled. The nurse holds the medication and prevents a possible complication. This feature of the Electronic Health Record is available through which core function of EHR? a. Order entry/order management b. Decision support c. Patient support d. Administrative support

ANS: B Decision support provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making. DIF: Comprehension REF: pp. 268-269

7. A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation? a. Run chart b. Pareto chart c. Flowcharts d. Cause-and-effect diagrams

ANS: B Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all errors were caused by interruptions, so this should be the area of priority. DIF: Comprehension REF: pp. 385-386

11. A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this information's: a. authority. b. objectivity. c. accuracy. d. currency.

ANS: B Sites sponsored by organizations such as pharmaceutical companies may influence the content. DIF: Comprehension REF: p. 276

23. Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies? a. Patient-centered care b. Informatics c. Teamwork d. Quality improvement

ANS: B Technology (PDA) is used to aid decision making and reduce errors. DIF: Comprehension REF: p. 393

2. A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the: a. Institute for Safe Medication Practices. b. Institute of Medicine. c. National Committee for Quality Assurance. d. The Joint Commission.

ANS: B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health. DIF: Comprehension REF: pp. 379-380

5. Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is: a. Pareto chart. b. control chart. c. deployment chart. d. top-down flowchart.

ANS: B The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. DIF: Comprehension REF: p. 380

14. A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin damage when infiltrated. The order reads, "infuse over 1 hour by portacath." The nurse accesses the Personal Digital Assistant for software that lists the steps to access a portacath. The nurse is using: a. electronic health records. b. point-of-care technology. c. data management. d. telehealth.

ANS: B Using a Personal Digital Assist device to access information at the bedside is considered point-of-care technology. The nurse was able to retrieve the steps for accessing a portacath electronically while remaining at the bedside. DIF: Comprehension REF: p. 273

28. A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? Select all that apply. A. Benzodiazepine therapy B. Systematic desensitization C. Imploding (flooding) D. Assertiveness training E. Aversion therapy

ANS: B, C The nurse should explain to the client that systematic desensitization and imploding are the most commonly used behavioral therapies in the treatment of phobias. Systematic desensitization involves the gradual exposure of the client to anxiety-provoking stimuli. Imploding is the intervention used in which the client is exposed to extremely frightening stimuli for prolonged periods of time.

22. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? Select all that apply. A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that rules established by the group do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group

ANS: B, C, D During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development.

11. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? Select all that apply. A. Respiratory therapist B. Occupational therapist C. Recreational therapist D. Social worker E. Mental health technician

ANS: B, C, D, E The typical interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, dietician, psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. Other disciplines may be included on the basis of resources available in a particular hospital setting and individual patient needs.

3. A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. These include: (select all that apply) a. advanced health assessment techniques. b. patient-centered care. c. prescriptive pharmacology content. d. quality improvement. e. safety.

ANS: B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. DIF: Comprehension REF: p. 393

12. Which of the following are accurate descriptors of a therapeutic community? Select all that apply. A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists.

ANS: B, E In a therapeutic community the unit responsibilities are assigned according to client capability, and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills.

8. How does a democratic form of self-government in the milieu contribute to client therapy? A. By setting punishments for clients who violate the community rules B. By dealing with inappropriate behaviors as they occur C. By setting community expectations wherein all clients are treated on an equal basis D. By interacting with professional staff members to learn about therapeutic interventions

ANS: C A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input.

19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

ANS: C A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine.

3. How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)? A. Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can manage anxiety only with medications. B. Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not. C. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. D. Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.

ANS: C Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social phobia is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.

22. Warrens college roommate actively resists going out with friends whenever they invite him. He says he cant stand to be around other people and confides to Warren They wouldnt like me anyway. Which disorder is Warrens roommate likely suffering from? A. Agoraphobia B. Mysophobia C. Social anxiety disorder (social phobia) D. Panic disorder

ANS: C Social anxiety disorder is an excessive fear of social situations R/T fear that one might do something embarrassing or be evaluated negatively by others.

24. How should a nurse best describe the major maladaptive client response to panic disorder? A. Clients overuse medical care because of physical symptoms. B. Clients use illegal drugs to ease symptoms. C. Clients perceive having no control over life situations. D. Clients develop compulsions to deal with anxiety.

ANS: C The major maladaptive client response to panic disorder is the perception of having no control over life situations, which leads to nonparticipation in decision making and doubts regarding role performance.

12. A client is experiencing a severe panic attack. Which nursing intervention would meet this clients immediate need? A. Teach deep breathing relaxation exercises B. Place the client in a Trendelenburg position C. Stay with the client and offer reassurance of safety D. Administer the ordered prn buspirone (BuSpar)

ANS: C The nurse can meet this clients immediate need by staying with the client and offering reassurance of safety and security. The client may fear for his or her life, and the presence of a trusted individual provides assurance of personal safety.

3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: C The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style.

11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

ANS: C The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group.

9. A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results? A. The psychiatrist B. The psychiatric social worker C. The clinical psychologist D. The clinical nurse specialist

ANS: C The nurse should consult with the clinical psychologist to review psychological testing results for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process.

10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger

ANS: C The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst is to process feelings and concerns related to the witnessed intervention.

20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. Psychodrama provides a safe setting in which to discuss painful issues. B. In psychodrama, the client is the protagonist. C. In psychodrama, the client observes actor interactions from the audience. D. Psychodrama facilitates resolution of interpersonal conflicts.

ANS: C The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist.

14. A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client? A. Using your imagination, we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge. B. Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response. C. Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety. D. In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate.

ANS: C The nurse should explain to the client that systematic desensitization exposes the client to a series of increasingly anxiety-provoking steps that will gradually increase anxiety tolerance. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.

5. Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? A. Long-term treatment with diazepam (Valium) B. Acute symptom control with citalopram (Celexa) C. Long-term treatment with buspirone (BuSpar) D. Acute symptom control with ziprasidone (Geodon)

ANS: C The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients with GAD. It takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.

16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: C The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members.

Townsend, Chapter 12. Milieu Therapy The Therapeutic Community Multiple Choice 1. An angry client on an inpatient unit approaches a nurse, stating, Someone took my lunch! People need to respect others, and you need to do something about this now! The nurses response should be guided by which basic assumption of milieu therapy? A. Conflict should be avoided at all costs on inpatient psychiatric units. B. Conflict should be resolved by the nursing staff. C. Every interaction is an opportunity for therapeutic intervention. D. Conflict resolution should be addressed only during group therapy.

ANS: C The nurses response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve psychological health and functioning.

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations

ANS: C The priority nursing diagnosis for this client is Risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes on the basis of potential safety risk to the client and/or others. Nursing diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is determined to be potential.

13. A college student is unable to take a final examination because of severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? A. Noncompliance R/T test taking B. Ineffective role performance R/T helplessness C. Altered coping R/T anxiety D. Powerlessness R/T fear

ANS: C The priority nursing diagnosis for this client is altered coping R/T anxiety. The nurse should assist in implementing interventions that should improve the clients healthy coping skills and reduce anxiety.

25. A client diagnosed with generalized anxiety states, I know the best thing for me to do now is to just forget my worries. How should the nurse evaluate this statement? A. The client is developing insight. B. The clients coping skills are improving. C. The client has a distorted perception of problem resolution. D. The client is meeting outcomes and moving toward discharge.

ANS: C This client has a distorted perception of how to deal with the problem of anxiety. Clients should be encouraged to openly deal with anxiety and recognize the triggers that precipitate anxiety responses.

9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yaloms curative group factor of altruism? A. Ill give you the name of a friend that rents inexpensive rooms. B. The last time we helped a family, they got back on their feet and prospered. C. I can give you all of my baby clothes for your little one. D. I can appreciate your situation. I had to declare bankruptcy last year.

ANS: C Yaloms curative group factor of altruism occurs when group members provide assistance and support to each other, creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern.

21. Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated? a. Quality improvement b. Evidence-based practice c. Teamwork and collaboration d. Patient-centered care

ANS: C An interdisciplinary team is working to prevent hand-off errors on discharge. DIF: Application REF: p. 393

19. Which of the following occurrences would be classified as a sentinel event? a. A postpartum patient who elects to breastfeed only twice daily develops mastitis. b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator. c. A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin. d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously, resulting in a drop in the patient's serum glucose from 160 to 100 mg.

ANS: C Any procedure performed on a wrong person or organ constitutes a sentinel event. DIF: Application REF: p. 380 |p. 391

2. A nurse interested in quality improvement tools performed a search for cause and effect diagrams using www.ishikawa.com. A page opened that provided images and templates for performing fishbone diagrams. Which type of search did the nurse conduct? a. Quick and dirty b. Advanced c. Brute force d. Link searching

ANS: C Brute force is a method of searching where you type in what you think might logically be a web address and see what happens. DIF: Comprehension REF: p. 275

16. Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." When explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism, the instructor states: a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.

ANS: C C stands for check if the change improved the process and what was learned. DIF: Analysis REF: p. 397, Figure 22-7

14. The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is a: a. cause-and-effect diagram. b. run chart. c. Pareto chart. d. flowchart.

ANS: C Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized. DIF: Comprehension REF: pp. 385-386

3. When paper-and-pencil medical records are compared with computer-based records: a. paper-and-pencil records provide controls to determine who has viewed the health information. b. information contained in a paper-and-pencil record has the capability of being more in-depth than that found in computer-based records. c. patients have the right to know that the confidentiality of their records is strictly maintained, regardless of the type of medical record used. d. patients must sign for each item of information released on the computer record.

ANS: C Regardless of the type of record used, the Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of the patient's medical information and imposes legal consequences for those who breech confidentiality. DIF: Comprehension REF: p. 271

6. A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patient's signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as: a. privacy. b. confidentiality. c. security. d. data capture.

ANS: C Security is the limitation of access to health care information through passwords and other precautions. DIF: Comprehension REF: p. 271

2. During a search for the term informatics, when the nurse finds the domain ".edu," the site is affiliated with a(n): a. government agency. b. commercial site. c. educational institution d. Internet service provider.

ANS: C The domain of an educational institution is .edu. DIF: Knowledge REF: p. 276

20. A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. This situation would represent: a. a sentinel event. b. an adverse event. c. patient-centered care. d. the communication technique of "call-out."

ANS: C The nurse and dietitian are respecting patient values, preferences, and expressed needs. DIF: Comprehension REF: pp. 381-382

10. In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects

ANS: D The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the clients safety and physiological needs are met within the milieu.

6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior.

ANS: D The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client and does not reinforce appropriate behavior.

2. A client on an inpatient unit angrily states to a nurse, Peter is not cleaning up after himself in the community bathroom. You need to address this problem. Which is the appropriate nursing response? A. Ill talk to Peter and present your concerns. B. Why are you overreacting to this issue? C. You should bring this to the attention of your treatment team. D. I can see that you are angry. Lets discuss ways to approach Peter with your concerns.

ANS: D The most appropriate nursing response involves restating the clients feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills.

13. Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress.

18. A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this clients problem? A. Distract the client with other activities whenever ritual behaviors begin. B. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. C. Lock the room to discourage ritualistic behavior. D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

ANS: D The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to avoid the anxiety, he or she must first learn to recognize precipitating factors. Attempting to distract the client, seeking medication increase, and locking the clients room are not appropriate interventions because they do not help the client recognize anxiety triggers.

7. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. Youve really been helpful. Can I count on you for continued support? B. I dont work out anymore. C. Im really glad I didnt go home. It would have been hard to come back. D. I carry mace when I jog. It makes me feel safe and secure.

ANS: D The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention.

3. A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this clients crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6.

ANS: D The nurse should identify that a realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific, measurable, realistic, and contain a time frame.

6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic? A. Dream analysis B. Creative cooking C. Paint by number D. Stress management

ANS: D The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a clients learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance.

17. A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? A. Sublimation B. Dissociation C. Rationalization D. Intellectualization

ANS: D The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of obsessive-compulsive disorder in detail while avoiding discussion of feelings. Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis.

4. How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? A. GAD is acute in nature, and panic disorder is chronic. B. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. C. Hyperventilation is a common symptom in GAD and rare in panic disorder. D. Depersonalization is commonly seen in panic disorder and absent in GAD.

ANS: D The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety

8. A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive workup in an emergency department reveals no pathology. Which medical diagnosis is suspected, and what nursing diagnosis takes priority? A. Generalized anxiety disorder and a nursing diagnosis of fear B. Altered sensory perception and a nursing diagnosis of panic disorder C. Pain disorder and a nursing diagnosis of altered role performance D. Panic disorder and a nursing diagnosis of panic anxiety

ANS: D The nurse should suspect that the client has exhibited signs/symptoms of a panic disorder. The priority nursing diagnosis should be panic anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.

Townsend-8th-Edition-Psychiatric-Mental-Health-Nursing Chapter 13. Crisis Intervention Multiple Choice 1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

ANS: D The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance.

17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group.

6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yaloms curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others.

14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. There is little research to support AAs effectiveness. B. Self-help groups used to be the treatment of choice, but their popularity is waning. C. These groups have no external regulation, so clients need to be cautious. D. Members themselves run the group, with leadership usually rotating among the members.

ANS: D The student indicates an understanding of self-help groups when stating, Members themselves run the group, with leadership usually rotating among the members. Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences.

8. An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a: a. Pareto chart. b. control chart. c. top-down flowchart. d. deployment chart.

ANS: D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. DIF: Comprehension REF: p. 385

13. During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation? a. Failure to take time to put on shoes due to urgency b. Unsteady gait due to narcotic administration c. Poor lighting that led to decreased vision d. Improper construction that caused the leak and towel placement

ANS: D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project. DIF: Application REF: p. 383

22. Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct? a. Each competency is mutually exclusive. b. The competencies focus on individual efforts to reduce errors. c. Physicians lead the team to achieve each competency. d. The competencies address both individual and system approaches to transform care.

ANS: D Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care. DIF: Comprehension REF: p. 381

4. A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The most efficient and effective means of conducting an Internet search to gather information for this publication is to use: a. a search engine such as Google or Yahoo. b. a consumer health website. c. a decision support system. d. MEDLINE database.

ANS: D MEDLINE is one of the scientific and research scholarly databases, and it would be the most appropriate for use in gathering information for a scholarly publication. DIF: Comprehension REF: p. 276

11. A group of nurses is presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that: a. being insured has little effect on a person's longevity and the quality of care received. b. lobbyists for the drug companies are able to gain permission for the use of new drugs within 1 year of their discovery. c. although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS). d. medication-related errors place a tremendous financial burden on the U.S. health care system.

ANS: D Medication-related errors for hospitalized patients cost roughly $2 billion annually. DIF: Comprehension REF: pp. 381-382

8. A nurse who is teaching a class to introduce telehealth to the staff would include which example? a. A robot performs menial housekeeping chores for an invalid patient. b. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler. c. A physician speaks into a computer, and the admission history is recorded and saved in the patient file. d. While a patient in Wyoming performs peritoneal dialysis, a nurse watches remotely from California to ensure that all steps are being followed correctly.

ANS: D Telehealth is the delivery of care to a patient who is at a distance from the health care provider. DIF: Application REF: p. 273

Question 13 Type: MCSA The patient is receiving escitalopram (Lexapro) for treatment of generalized anxiety disorder. The patient asks the nurse, I am just nervous, not depressed. Why am I taking an antidepressant medicine? What is the best response by the nurse? 1. The same brain chemicals are involved with anxiety as well as depression, and these medications are very safe. 2. You are really depressed; it is just manifested as anxiety. These medications are safer than benzodiazepines. 3. Your doctor thinks that this is the best treatment for your anxiety, and these medications are safer than benzodiazepines. 4. The two disorders go together, and if you treat depression, the anxiety goes away.

Correct Answer: 1 Rationale 1: Antidepressants are frequently used to treat symptoms of anxiety. They reduce anxiety by altering levels of norepinephrine and serotonin. These neurotransmitters are also involved in depression. Selective serotonin reuptake inhibitors (SSRIs) are safer than benzodiazepines, but depression and anxiety are two separate disorders. The patient is being treated for generalized anxiety, this is different from depression. Telling the patient that the doctor knows best is a condescending reply, and does not answer the patients question.

Question 10 Type: MCSA The nurse works with a physician who frequently prescribes benzodiazepines. The use of benzodiazepines in which patient would cause the nurse the most concern? 1. An 87-year-old patient who uses a cane for ambulation 2. A 9-year-old child with panic attacks 3. A 42-year-old businessman who travels internationally 4. A 32-year-old mother of two preschool children

Correct Answer: 1 Rationale 1: Benzodiazepines should be used with caution in elderly patients. Elderly patients are at highest risk because their metabolism and excretion is slowed; and there is a higher potential for overdose and sedation. There have been few studies of benzodiazepine use in the pediatric population; benzodiazepines must be used with caution, but these patients are not at as high risk as the elderly population. There is minimal concern with benzodiazepine use in a 32-year-old patient. There is minimal concern with benzodiazepine use in a 42-year-old patient.

Question 23 Type: MCSA At the completion of a teaching session, the nurse wants to evaluate the effectiveness of instruction. In a situation where the client was learning a bandaging technique, which would be the most effective evaluation? 1. Shared by the nurse and client 2. A return demonstration by the client 3. When the nurse is satisfied that the client can complete the technique 4. If the wound heals

Correct Answer: 1 Rationale 1: Both the client and the nurse should evaluate the learning experience. The client can tell the nurse what was helpful and provide a demonstration that shows mastery of the skill. The nurse needs to evaluate whether the client has an understanding of the rationale behind the technique. Rationale 2: Using only the return demonstration is one sided. The evaluation is of the bandaging technique, and it may or may not be covering a wound. Rationale 3: Focusing on the nurses satisfaction with the clients performance is one sided. Rationale 4: The evaluation is of the bandaging technique, and it may or may not be covering a wound.

Kozier & Erbs Fundamentals of Nursing, 10/E Chapter 27 Question 1 Type: MCSA The nurse has completed client teaching regarding medication administration. Which client statement best illustrates compliance? 1. Im glad to know about my medications. It makes taking them a lot easier. 2. I already knew most of what you told me. 3. I think you should have waited until I was ready to go home. Maybe Id remember better. 4. If I take my medications as prescribed, Ill feel better.

Correct Answer: 1 Rationale 1: Compliance is best illustrated when the person recognizes and accepts the need to learn, then follows through with appropriate behaviors that reflect learning. Learning about the medications helps the client understand why theyre prescribed and improves the possibility for following the prescribed regimen. Rationale 2: Statements of prior knowledge do not necessarily lead to compliance. Rationale 3: Following the advice of the health care prescriber does not necessarily lead to compliance. Rationale 4: Following the advice of the health care prescriber does not necessarily lead to compliance.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 14 Question 1 Type: MCSA The patient tells the nurse he worries about everything all day, feels confused, restless, and just cant stop worrying. What is the best response by the nurse? 1. You have generalized anxiety; I will teach you some relaxation techniques. 2. This sounds like social anxiety. You need to calm down and youll be fine. 3. You have posttraumatic stress disorder (PTSD), and it is time for your therapy session. 4. This is called panic disorder; Ill get your medication for you.

Correct Answer: 1 Rationale 1: Generalized anxiety disorder is characterized by excessive anxiety, but not to panic levels. Other symptoms include restlessness, muscle tension, and loss of focus and ability to concentrate. Relaxation techniques are effective in reducing anxiety. Panic disorder is characterized by intense feelings of apprehension, terror, and impending doom, and increased autonomic nervous system anxiety; the patient does not have these symptoms. Posttraumatic stress disorder is situational anxiety that develops in response to re-experiencing a previous traumatic life event; there is no information that the patient has experienced a trauma. Social anxiety disorder is characterized by performance anxiety, i.e., extreme fear when a patient is in a social situation; there is no information to support that this is what the patient is experiencing. Also, telling the patient to calm down is non-therapeutic.

Question 6 Type: MCSA The patient has been treated by the same physician for 2 years and has had insomnia the entire time. Many different medications have been tried with limited success. What should be the nurses primary assessment at this time? 1. Assess for a primary sleep disorder such as sleep apnea. 2. Assess if the patient has been selling his medications to addicts. 3. Assess if the patient has an addictive personality disorder. 4. Assess the patient for a primary personality disorder.

Correct Answer: 1 Rationale 1: If the patient has a primary sleep disorder such as sleep apnea, this must be treated to relieve the insomnia. Also, medications such as benzodiazepines depress respiratory drive and would aggravate the sleep apnea. There is no information that the patient might have a personality disorder. If he did, the nurse would most likely recognize this after 2 years of treatment. While it is remotely possible that the patient is selling his medication; it is not likely for a patient with an anxiety disorder to do this. There is no information that the patient might have an addictive personality disorder. If he did, the nurse would know this after 2 years of treatmen

Question 9 Type: MCSA A home health client having difficulty keeping his medication schedule organized says There are so many pills and the names are all confusing to me. I dont even understand what theyre for. What should the nurse do? 1. Help the client remember color and size in relationship to dosing time. 2. Write out the generic and trade name of all the pills for the client. 3. Fill a pill bar and tell the client not to worry, and just take the pills according to that system. 4. Have the physician talk to the client about his medications.

Correct Answer: 1 Rationale 1: Learning is facilitated by material that is logically organized and proceeds from the simple to the complex. This helps the learner comprehend new information, apply it to previous learning, and form new understandings. Naming the pills by color and size and dosing time helps the client move from that level to learning what each medication is for and why he is taking itsimple to complex. Rationale 2: Learning generic and trade names is memorization and may not make sense for this client. Rationale 3: Filling a pill box or bar is not helping the client learn about his meds; it merely puts them into an order without information. Rationale 4: Nurses must rely on their own creativity and resourcefulness, not depend on physician input.

Question 18 Type: MCSA A home health nurse is working with a client who has pulmonary fibrosis. Of the following teaching priorities, which will take the highest priority? 1. Client will be able to set up and administer a nebulizer treatment by the end of the day. 2. Client will have increased activity level by the end of the week. 3. Client will be able to do activities of daily living (ADLs) without shortness of breath in 3 days. 4. Client will have a positive attitude about the diagnosis by the end of the month.

Correct Answer: 1 Rationale 1: Learning outcomes state the client behavior and are ranked according to priority. Nurses can use theoretical frameworks such as Maslows hierarchy of needs to establish priorities. In this case, the physiological need of learning how to administer medication takes priority over activity and attitudinal needs. Rationale 2: This outcome cannot be measured. Rationale 3: In this case, the physiological need of learning how to administer medication takes priority over activity needs. Rationale 4: In this case, the physiological need of learning how to administer medication takes priority over attitudinal needs.

Question 23 Type: MCSA A patient taking which of the following medications should avoid foods high in tyramine? 1. MAOIs 2. SSRIs 3. Beta blockers 4. Benzodiazepines

Correct Answer: 1 Rationale 1: MAOIs and foods high in tyramine can produce a hypertensive crisis, and therefore should not be taken together.

Question 8 Type: MCSA The patient has been taking lorazepam (Ativan) for 2 years. The patient stopped this medication after a neighbor said the drug manufacturers plant was contaminated with rat droppings. What best describes the nurses assessment of the patient when seen 3 days after stopping his medication? 1. Increased heart rate, fever, and muscle cramps 2. Nothing different; it is safe to abruptly stop lorazepam (Ativan) 3. Pinpoint pupils, constipation, and urinary retention 4. A sense of calmness and lack of anxiety

Correct Answer: 1 Rationale 1: Many central nervous system (CNS) depressants can cause physical and psychological dependence. The withdrawal syndrome for some central nervous system (CNS) depressants can include fever, seizures, increased pulse, anorexia, muscle cramps, disorientation, etc. It is not safe to abruptly stop lorazepam (Ativan); withdrawal symptoms will occur. Pinpoint pupils, constipation, and urinary retention are signs of opioid use. The patient would be anxious, not calm, during benzodiazepine withdrawal.

Question 3 Type: MCSA The patient tells the nurse that she is interested in the human brain, and questions which parts of the brain control anxiety and insomnia. What is the best reply by the nurse? 1. The limbic system and reticular activating system control anxiety and insomnia. 2. The frontal lobes and limbic system control anxiety and insomnia. 3. The thalamus and reticular activating system control anxiety and insomnia. 4. The limbic system and hypothalamus control anxiety and insomnia.

Correct Answer: 1 Rationale 1: Neural systems associated with anxiety and restlessness includes the limbic system and the reticular activating system. The reticular activating system is responsible for sleeping and wakefulness and performs an alerting function for the entire cerebral cortex. The limbic system and the reticular activating system, not the hypothalamus, are responsible for anxiety and sleep. The limbic system and the reticular activating system, not the frontal lobes, are responsible for anxiety and sleep. The limbic system and the reticular activating system, not the thalamus, are responsible for anxiety and sleep.

Question 31 Type: MCSA A client tells the nurse that he has no questions about his illness, as he did a search for information on the Internet. What should the nurse do? 1. Ask the client to share the information obtained from the Internet search. 2. Document that the client has received instruction. 3. Tell the client that the Internet is a form of entertainment, not instruction. 4. Document that the client refused instruction.

Correct Answer: 1 Rationale 1: The Internet is an important source of health information for many adult clients in the United States. Nurses need to know and be able to integrate this technology into the teaching plans for those clients who use the Internet. The nurse should ask the client to share the information obtained from the Internet search in order to integrate the content into the clients teaching plan. Rationale 2: The nurse needs to ask the client to share the information, and not just document that the client has received instruction. The nurse does not know what instruction the client has received. Rationale 3: The Internet is a source of information, and not just a form of entertainment. Rationale 4: The client did not refuse instruction.

Question 4 Type: MCSA A nursing student is presenting a teaching project to the class using each of Blooms domains. The student has several activities included in the project. Which activity is an example of the affective domain? 1. Each member of the class must identify two attitudinal changes that have occurred in their lives since beginning their nursing education. 2. All members must list the technical skills theyve learned. 3. Members must demonstrate a favorite nursing skill at the end of the class period. 4. Members must read a paragraph about a new clinical trial, summarize the information, and present it to the rest of the class.

Correct Answer: 1 Rationale 1: The affective domain of Blooms theory of learning is also known as the feeling domain. It includes emotional responses to tasks such as feelings, emotions, interests, attitudes, and appreciations. Rationale 2: Listing technical skills and reading or summarizing information is part of the thinking domain, which includes knowing, comprehending, application, analysis, synthesis, and evaluation. Rationale 3: The psychomotor domain is the skill domain and includes hands-on motor skills such as demonstration. Rationale 4: Listing technical skills and reading or summarizing information is part of the thinking domain, which includes knowing, comprehending, application, analysis, synthesis, and evaluation.

Question 16 Type: MCSA An individual who has difficulty sleeping due to two final examinations scheduled for the same day later in the week most likely would be suffering from 1. situational anxiety. 2. social anxiety. 3. obsessive-compulsive disorder. 4. performance anxiety.

Correct Answer: 1 Rationale 1: The final examination is a temporary event that is the cause of the anxiety. Once the examination is over, it is likely that the situational anxiety will end. Social anxiety is a fear of crowds. Performance anxiety is frequently referred to as stage fright. Although the situation presented required the student to perform on the exam, it is best defined as situational anxiety.

Question 18 Type: MCSA Which area of the brain is primarily responsible for maintaining sleep and wakefulness? 1. Reticular activating system 2. Cerebral cortex 3. Limbic system 4. Cerebellum

Correct Answer: 1 Rationale 1: The reticular activating system is responsible for sleeping and wakefulness. The limbic system is responsible for emotional expression, learning, and memory. The primary functions of the cerebral cortex and cerebellum do not include sleep and wakefulness.

Question 35 Type: MCMA The nurse instructs a client on self-care for a new ostomy. Which client behaviors demonstrate that instruction has been effective? Standard Text: Select all that apply. 1. Client provides skin care and changes ostomy device. 2. Client states what items are needed to perform ostomy care. 3. Client is unable to identify changes in skin around the stoma. 4. Client tells the nurse that he does not want to do the care. 5. Client asks his wife to learn how to perform the care so he will not have to do it.

Correct Answer: 1, 2 Rationale 1: The acquisition of psychomotor skills is best evaluated by observing how well the client carries out a procedure such as self-care for an ostomy. Rationale 2: In cognitive learning, the client demonstrates acquisition of knowledge by responding appropriately to oral questions. Rationale 3: The inability to identify changes in the skin around the stoma would indicate that instruction has not been effective. Rationale 4: The clients stating he does not want to perform self-care to the ostomy would indicate that effective learning did not occur. Rationale 5: The clients asking his wife to learn the care would indicate that effective learning did not occur.

Question 32 Type: MCMA The nurse instructs the older client to access the Internet to complete a post-hospitalization survey and update health information. The client tells the nurse that he does not have a computer and would not know how to use one. What should the nurse do? Standard Text: Select all that apply. 1. Suggest the client learn how to use a computer through classes held at a local library. 2. Provide times for the client to attend basic computer use classes through the community learning center. 3. Document that the client is resistant to instruction. 4. Notify the physician that the client will not be adhering to medical instruction as planned. 5. Identify the client as being noncompliant with instruction.

Correct Answer: 1, 2 Rationale 1: The older client might not own a computer or have Internet access. The nurse could suggest that the client learn how to use a computer through classes held at a local learning center. Rationale 2: The nurse should provide times for the older client to attend basic computer use classes though the community learning center. Rationale 3: The client who does not have a computer or does not know how to use one is not resistant to instruction. Rationale 4: The physician does not need to be notified. The client is not refusing to adhere to medical instruction as planned. Rationale 5: The client who does not have a computer or does not know how to use one is not being noncompliant with instruction.

Question 27 Type: MCMA A client is being discharged after a 23-hour stay for a surgical procedure. When preparing the instructions for this client, what does the nurse need to do? Standard Text: Select all that apply. 1. Ensure the clients safe transition to home. 2. Include information about what the client has been taught. 3. Include what the client still needs to learn when discharged. 4. Check the clients insurance for hospitalization coverage. 5. Call the clients prescriptions in to the clients local pharmacy.

Correct Answer: 1, 2, 3 Rationale 1: Because of decreased lengths of stay, time constraints on client education can occur. The nurse needs to provide education that will ensure the clients safe transition to home. Rationale 2: Discharge plans must include information about what the client has been taught. Rationale 3: Discharge plans must include what the client still needs to learn when discharged. Rationale 4: The nurse does not need to check the clients insurance for hospitalization coverage when preparing discharge instructions. Rationale 5: The nurse does not call the clients prescriptions in to the clients local pharmacy when preparing discharge instructions.

Question 30 Type: MCMA The nurse is utilizing humanistic theory when instructing a client. What will the nurse demonstrate when utilizing this theory? Standard Text: Select all that apply. 1. Empathy 2. Encouraging the client to establish goals 3. Encouraging the client to participate in self-directed learning 4. Multisensory teaching strategies 5. Providing a physical environment conducive to learning

Correct Answer: 1, 2, 3 Rationale 1: Conveying empathy is a characteristic of humanism. Rationale 2: Encouraging the client to establish goals is a characteristic of humanism. Rationale 3: Encouraging the client to participate in self-directed learning is a characteristic of humanism. Rationale 4: Selecting multisensory teaching strategies is a characteristic of cognitivism. Rationale 5: Providing a physical environment conducive to learning is a characteristic of cognitivism.

Question 34 Type: MCMA The nurse is designing a teaching plan for a client to learn a new psychomotor skill. What strategies can the nurse use to facilitate learning for this client? Standard Text: Select all that apply. 1. Demonstration 2. Practice 3. Modeling 4. Discovery 5. Role playing

Correct Answer: 1, 2, 3 Rationale 1: Demonstration is used to learn a psychomotor skill. Rationale 2: Practice is used to learn a psychomotor skill. Rationale 3: Modeling is used to learn a psychomotor skill. Rationale 4: Discovery is used to learn concepts within the affective and cognitive domains. Rationale 5: Role playing is used to learn concepts within the affective and cognitive domains.

Question 28 Type: MCMA The nurse serves as an educator of other health care personnel. In what capacity will this nurse participate in education? Standard Text: Select all that apply. 1. Preceptor of new graduate nurses 2. Instructing a part of the critical care course 3. Clinical instruction of nursing students 4. One-to-one teaching of clients 5. Teaching grandparents how to care for children

Correct Answer: 1, 2, 3 Rationale 1: Nurses are involved in the instruction of professional colleagues, such as functioning as preceptors for new graduate nurses. Rationale 2: Nurses with specialized knowledge and experience may share that knowledge and experience with nurses by instructing a part of the critical care course. Rationale 3: Nurses in nursing practice settings are often involved in the clinical instruction of nursing students. Rationale 4: One-to-one teaching of clients is not an example of being an educator of other health care personnel. Rationale 5: Teaching grandparents how to care for children is not an example of being an educator of other health care personnel.

Question 33 Type: MCMA The nurse suspects a client has low literacy. What did the nurse assess to come to this conclusion? Standard Text: Select all that apply. 1. Incorrect completion of previous hospitalizations form 2. Client refusing to sign forms because eyeglasses are at home 3. Client saying he forgot to report for laboratory testing 4. Score of 6 on the Newest Vital Sign assessment tool 5. Questioning the dosage pattern on a newly prescribed medication

Correct Answer: 1, 2, 3 Rationale 1: The nurse should suspect a literacy problem when a client incorrectly completes forms. Rationale 2: The nurse should suspect a literacy problem when a client refuses to sign forms because of lack of eyeglasses. Rationale 3: The nurse should suspect a literacy problem when appointments are missed. Rationale 4: A score of 6 on the Newest Vital Sign assessment tool indicates adequate literacy. Rationale 5: Questioning a medication would indicate that the client read the prescription, and would not suggest a literacy problem.

Question 29 Type: MCMA The nurse planning an educational session for adult clients should include which andragogy concepts? Standard Text: Select all that apply. 1. People move from dependence to independence with maturity. 2. Previous experiences can be used as a resource for learning. 3. Learning is related to an immediate need or problem. 4. Learning is reinforced by prompt feedback. 5. Adults are oriented to learning when the material is useful sometime in the future.

Correct Answer: 1, 2, 3, 4 Rationale 1: An andragogy concept about adult learners is that as people mature, they move from dependence to independence. Rationale 2: An andragogy concept about adult learners is that an adults previous experiences can be used as a resource for learning. Rationale 3: An andragogy concept about adult learners is that learning is related to an immediate need or problem. Rationale 4: An andragogy concept about adult learning is that learning is reinforced by prompt feedback. Rationale 5: An andragogy concept about adult learning is that an adult is more oriented to learning when the material is useful immediately, and not sometime in the future.

Question 36 Type: MCMA The nurse is documenting the teaching plan for a client. What should be included in this documentation? Standard Text: Select all that apply. 1. Actual information to be taught 2. Teaching strategies to use 3. Skills to be taught 4. Amount of time needed to teach each topic 5. Vital signs before and after each teaching session

Correct Answer: 1, 2, 3, 4 Rationale 1: The written teaching plan that the nurse uses to guide future teaching sessions can include the actual information to be taught. Rationale 2: The written teaching plan that the nurse uses to guide future teaching sessions can include the teaching strategies to use. Rationale 3: The written teaching plan that the nurse uses to guide future teaching sessions can include the skills to be taught. Rationale 4: The written teaching plan that the nurse uses to guide future teaching sessions can include the amount of time needed to teach each topic. Rationale 5: Vital signs before and after each teaching session do not need to be included in the clients teaching plan.

Question 38 Type: MCMA The nurse is creating a teaching plan for a client recovering from total hip replacement surgery. What should the nurse include in this clients plan? Standard Text: Select all that apply. 1. The content to be included 2. The outcome for the teaching 3. The approaches used to teach the content 4. The evaluation of the effectiveness of teaching 5. The amount of time needed to cover the content

Correct Answer: 1, 2, 3, 5 Rationale 1: Elements of a teaching plan include the content. Rationale 2: Elements of a teaching plan include learning outcomes. Rationale 3: Elements of a teaching plan include teaching strategies. Rationale 4: Evaluation of the effectiveness of the teaching occurs after the teaching has been completed. Rationale 5: Elements of a teaching plan include the time frame needed for teaching.

Question 29 Type: MCMA A patient whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications to induce sleep. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Walking 2?3 miles or engaging in some other exercise every morning can enhance sleep. 2. There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy. 3. Eating a large meal at bedtime will help induce sleep. 4. Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime. 5. Count sheep after lying down in order to enhance sleep.

Correct Answer: 1,2,4 Rationale 1: Exercise therapy (except just prior to sleeping), nutrition therapy, and deep breathing are alternative treatments for insomnia. Rationale 2: Acupuncture, aromatherapy, yoga, prayer, massage, meditation, biofeedback therapy, hypnosis, guided imagery, and music therapy are alternative treatments for anxiety and insomnia. Rationale 3: Eating a large meal prior to bedtime is a secondary cause of insomnia. Rationale 4: Amphetamines, cocaine, caffeinated beverages, corticosteroids, sympathomimetics, antidepressants, alcohol use, nicotine, and tobacco use are secondary causes of insomnia. Rationale 5: There is no evidence that counting sheep at bedtime helps to induce sleep.

Question 19 Type: MCMA A school nurse is putting together a program for adolescents about positive lifestyle choices. What should the nurse keep in mind when preparing content to present to this age group? Standard Text: Select all that apply. 1. Based on learning outcomes 2. Current 3. Adjusted to the adolescent client 4. Based on sources available within the school system 5. Consistent with the teaching topics

Correct Answer: 1, 2, 3, 5 Rationale 1: Nurses can select among many sources of information, including books, nursing journals, and other nurses and physicians. Whatever sources the nurse chooses, content should be based on learning outcomes. Rationale 2: Nurses can select among many sources of information, including books, nursing journals, and other nurses and physicians. Whatever sources the nurse chooses, content should be current. Rationale 3: Nurses can select among many sources of information, including books, nursing journals, and other nurses and physicians. Whatever sources the nurse chooses, content should be adjusted to the learners age. Rationale 4: Nurses can select among many sources of information, including books, nursing journals, and other nurses and physicians. Whatever sources the nurse chooses, content should be selected with consideration of how much time and what resources are available for teaching. Rationale 5: Nurses can select among many sources of information, including books, nursing journals, and other nurses and physicians. Whatever sources the nurse chooses, content should be consistent with the information that the nurse is teaching.

Question 26 Type: MCMA A school nurse is planning a program for adolescents about positive lifestyle choices. The nurse should keep in mind that content presented to this age group must be Standard Text: Select all that apply. 1. based on learning outcomes. 2. current. 3. adjusted to the adolescent client. 4. based on sources available within the school system. 5. accurate.

Correct Answer: 1, 2, 3, 5 Rationale 1: Whatever sources the nurse chooses, content should be based on learning outcomes. Rationale 2: Whatever sources the nurse chooses, content should be current. Rationale 3: Whatever sources the nurse chooses, content should be adjusted to the learners age. Rationale 4: Nurses can select among many sources of information, not just those available within the school system. Rationale 5: Whatever sources the nurse chooses, content should be accurate.

Question 39 Type: MCMA The nurse is preparing to teach a client on skin care and application of a stoma device. What should the nurse keep in mind when teaching the client this information? Standard Text: Select all that apply. 1. Address the clients concerns first. 2. Assess what the client knows already. 3. Address anxietyproducing issues last. 4. Teach the basics before complicated tasks. 5. Leave time for review and answering questions.

Correct Answer: 1, 2, 4, 5 Rationale 1: The nurse should start with something that the client is concerned about. Rationale 2: The nurse should assess what the client knows and then proceed to the unknown. This gives the learner confidence. Rationale 3: Issues that are causing anxiety should be addressed first. A high level of anxiety can impair learning. Rationale 4: The nurse should teach the basics before proceeding to variations, adjustments, or complicated steps. Rationale 5: The nurse should schedule time for the review of content and any questions the client may have to clarify information.

Question 24 Type: MCMA The nurse has completed a teaching session for a client with a tracheostomy. Documentation of the session should include what information? Standard Text: Select all that apply. 1. Diagnosed learning needs 2. Supplies required 3. Client outcomes 4. Need for additional teaching 5. Topics taught

Correct Answer: 1, 3, 4, 5 Rationale 1: The parts of the teaching process that should be documented in the clients chart include diagnosed learning needs. Rationale 2: The parts of the teaching process that should be documented in the clients chart include resources provided. Rationale 3: The parts of the teaching process that should be documented in the clients chart include client outcomes. Rationale 4: The parts of the teaching process that should be documented in the clients chart include need for additional teaching. Rationale 5: The parts of the teaching process that should be documented in the clients chart include topics taught.

Question 37 Type: MCMA The nurse has completed a teaching session for a client with a tracheostomy. What should the documentation include? Standard Text: Select all that apply. 1. Diagnosed learning needs 2. Supplies required 3. Client outcomes 4. Need for additional teaching 5. Topics taught

Correct Answer: 1, 3, 4, 5 Rationale 1: The parts of the teaching process that should be documented in the clients chart include diagnosed learning needs. Rationale 2: The supplies needed for instruction do not need to be documented. Rationale 3: The parts of the teaching process that should be documented in the clients chart include client outcomes. Rationale 4: The parts of the teaching process that should be documented in the clients chart include need for additional teaching. Rationale 5: The parts of the teaching process that should be documented in the clients chart include topics taught.

Question 27 Type: MCMA The patient is diagnosed with post-traumatic stress disorder. What will the nurse assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Tachycardia 2. Extreme nervousness or panic attacks 3. A fear of crowds 4. A fear of exposure to germs 5. Hallucinations, nightmares, or flashbacks

Correct Answer: 1,2,5 Rationale 1: Tachycardia is a symptom of post-traumatic stress disorder. Rationale 2: Extreme nervousness or panic attacks are symptoms of post-traumatic stress disorder. Rationale 3: A fear of crowds is typical in social anxiety disorder. Rationale 4: A fear of exposure to germs is typical of obsessive-compulsive disorder. Rationale 5: In post-traumatic stress disorder the person re-experiences traumatic events, which can take the form of nightmares, hallucinations, or flashbacks.

Question 26 Type: MCMA It is important for the nurse to obtain a thorough history from a patient who is experiencing anxiety. This history will help to distinguish Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. the best method of pharmacotherapy. 2. whether the patient might benefit from individual or group therapy. 3. the category of anxiety disorder. 4. the region of the brain that is causing the anxiety disorder. 5. substances that might worsen anxiety.

Correct Answer: 1,2,5 Rationale 1: The health care provider must accurately diagnose the anxiety disorder, because treatment differs among the various types of anxiety disorders. Some anxiety disorders are debilitating and require effective pharmacotherapy. Rationale 2: Some patients benefit from individual or group psychotherapy, which can help them identify and overcome the root causes of their worry and fear. Rationale 3: A thorough health history is not used to determine the category of anxiety disorder. Rationale 4: A thorough health history is not used to determine the region of the brain that is causing the anxiety disorder. Rationale 5: When obtaining a comprehensive medication history during the initial patient assessment, the nurse should observe any substances the patient is taking that might worsen or cause anxiety symptoms. Sometimes discontinuing or substituting an alternate drug for these anxiety-promoting medications can lessen patient symptoms.

Question 4 Type: MCMA The patient tells the nurse, I am really confused after talking to my doctor. He said I would be taking different kinds of medications for my anxiety and insomnia. Will you please explain it? What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. You will be taking medications known as sedative-hypnotics. 2. You will be taking medications known as antidepressants. 3. You will be taking a medication known as paraldehyde. 4. You will be taking medications known as barbiturates. 5. You will be taking medications known as benzodiazepines.

Correct Answer: 1,2,5 Rationale 1: The three categories of medications used to treat anxiety and sleep disorders include the benzodiazepines, antidepressants, and sedative-hypnotics. Barbiturates are no longer used for anxiety or insomnia because of significant side effects and the availability of more effective medications. Paraldehyde is no longer used for anxiety or insomnia because of significant side effects and the availability of more effective medications.

Question 2 Type: MCMA The nurse has completed group education for patients with anxiety disorders. The education is evaluated as successful when the patients make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Relaxation techniques will often decrease anxiety. 2. Antianxiety medicine should be used until our anxiety is gone. 3. Antianxiety medicine should not be used indefinitely. 4. We need therapy to learn where this anxiety comes from. 5. We need different medicines for anxiety, and for difficulty in sleeping.

Correct Answer: 1,3,4 Rationale 1: Patients with anxiety disorders should be encouraged to uncover the cause of the anxiety through cognitive-behavioral therapy or other counseling techniques. Nonpharmacological techniques such as relaxation techniques are effective in reducing some levels of anxiety. For most patients, anti-anxiety medication is intended for short-term use. Absence of anxiety is an unrealistic goal because all individuals will have some level of anxiety during their lifetime. Often, the same medication can be used for anxiety as well as insomnia.

Question 10 Type: MCSA At the end of a busy clinical day a staff nurse asks the instructor if a student would like to administer a Z-track injected medication. This is a skill that the students have not yet been exposed to yet. What should the instructor respond to the staff nurse that supports timing and learning environment? 1. It will take me a moment to explain the procedure to the students because weve not practiced this, but Ill find somebody to administer it. 2. Would it be OK if the students observed today? Then, well do it next time were here. 3. Were leaving now, but thanks for asking. 4. Ill check with the students and see if one of them would like to volunteer.

Correct Answer: 2 Rationale 1: After a busy day in the clinical area, students may not be ready for the learning experience, even though it would be a good opportunity for them. Taking time to explain the procedure first might put the learning moment in the wrong time and environment, and the students may not retain the information as best they could. Rationale 2: Allowing them to observe the staff nurse, then coming back when they are more refreshed would allow a better learning experience for the students. Rationale 3: Simply declining the opportunity doesnt make for good rapport with the staff nurse. Rationale 4: Allowing a student to simply volunteer puts the instructors license at risk, especially if it is a skill the student has not learned or practiced.

Question 21 Type: MCSA Which of the following common adverse effects of selective serotonin reuptake inhibitors (SSRIs) would be stressed by the nurse during patient discharge? 1. Drowsiness and coma 2. Weight gain and sexual dysfunction 3. Headache and nausea 4. Dry mouth and urine retention

Correct Answer: 2 Rationale 1: Although anticholinergic effects such as dry mouth and urine retention could occur, they are not as common as weight gain or sexual dysfunction. Headache is not a common adverse effect, and neither is drowsiness or coma. Overdoses will cause anxiety and restlessness (not drowsiness).

Question 20 Type: MCSA Benzodiazepines are often the drug of choice for managing anxiety and insomnia. Which statement best explains why? 1. Benzodiazepines are the most effective. 2. Benzodiazepines have the lowest risk of dependency and tolerance. 3. Benzodiazepines are most likely to be covered under insurance premiums. 4. Benzodiazepines are the most affordable.

Correct Answer: 2 Rationale 1: Benzodiazepines have a lower risk of dependency and tolerance than do other drugs used for anxiety and insomnia (such as the barbiturates). They are not necessarily more effective, affordable, or likely to be covered under insurance premiums. Although economics is an important factor in pharmacology, drug safety is essential for widespread use.

Question 11 Type: MCSA The nurse has completed medication education for the anxious patient who is receiving buspirone (BuSpar). The nurse determines that the patient needs additional instruction when the patient makes which statement? 1. Side effects I might experience include dizziness, headache, and drowsiness. 2. I can take this medication when I feel anxious and it will relax me. 3. I have to take this medicine on a regular basis for it to help me. 4. I dont need to worry about becoming dependent on this medication.

Correct Answer: 2 Rationale 1: Buspirone (BuSpar) works by altering levels of neurotransmitters and takes a few weeks to achieve optimal anxiety reduction. It cannot be used as an as needed (prn) medication. Side effects of buspirone (BuSpar) include dizziness, headache, and drowsiness. Dependence and withdrawal are less of a concern with buspirone (BuSpar) than with some other antianxiety drugs. Buspirone (BuSpar) works by altering levels of neurotransmitters and takes a few weeks to achieve optimal anxiety reduction. The drug must be taken consistently for this to occur.

Question 5 Type: MCSA A client is practicing using an incentive spirometer after surgery. The nurse has explained the use, demonstrated how it works, and also given the rationale for the client to continue to use this device. When mastering the use of this device, the client will demonstrate learning in which of Blooms domains? 1. Cognitive 2. Psychomotor 3. Affective 4. Imitation

Correct Answer: 2 Rationale 1: Cognitive abilities include the thinking process that begins with knowing, comprehending, and applying knowledge. Rationale 2: The psychomotor domain is the skill domain and includes motor skills, such as being able to use an incentive spirometer. Rationale 3: The affective domain involves attitudes or emotional responses and includes feelings, emotions, interests, and appreciations. Rationale 4: Imitation is not one of Blooms domains of learning.

Question 22 Type: MCSA A community health nurse runs a clinic that provides health screening to mainly Mexican American and Native American clients. The nurse wants to have a class on smoking cessation for interested adults of this group. In order to adjust to their time orientation, what is the best action of the nurse? 1. Make sure that the classes are held at specific times. 2. Begin classes when a group of clients are gathered. 3. Mail letters ahead of time to make sure clients are informed about the upcoming class. 4. Make posters and place them in areas of the community frequented by these groups.

Correct Answer: 2 Rationale 1: Cultures with a predominant orientation to the present include the Mexican American and Navajo Native American. Schedules have to be very flexible in present-oriented societies. Rationale 2: The nurse must be quite flexible, treat the cultures beliefs with respect, and not expect that cultural practices will change to reflect the nurses needs. Rationale 3: Time constraints are not significant for cultures that are oriented to the present, so advertising about specific classes may not be effective. Rationale 4: Time constraints are not significant for cultures that are oriented to the present, so advertising about specific classes may not be effective.

Question 16 Type: MCSA A client being discharged after a myocardial infarction has been prescribed several new medications and a low-fat diet. The client states: Im never going to understand what to do, when to do it, and why I should be doing all these things. Which nursing diagnosis should the nurse formulate for this client? 1. Health-Seeking Behavior related to desire to prevent heart problems 2. Deficient Knowledge (diet and medication regimen) related to inexperience 3. Noncompliance related to situational factors 4. Risk for Myocardial Infarction related to deficient knowledge

Correct Answer: 2 Rationale 1: Health-Seeking Behavior is a diagnostic label used when the client is seeking health information. Rationale 2: The NANDA label Deficient Knowledge is used when the client is seeking health information or when the nurse has identified a learning need, as in this case. The area of deficiency (diet and medication regimen) should always be included in the diagnosis. Rationale 3: Noncompliance is used when the client or caregiver fails to follow a plan, which is too early to tell in this case. Rationale 4: Risk for Myocardial Infarction is not a NANDA label. If a risk exists, the label could be Risk for Noncompliance related to deficient knowledge.

Question 12 Type: MCSA A nurse is working with the family of a child who is hospitalized with asthma. The family members speak little English, and the child is being sent home on nebulizer treatments as well as an inhaler. In addition to enlisting an interpreter to help with the language barrier, the nurse should 1. provide written instructions before discharge. 2. address any healing beliefs the family has. 3. make sure the child comes back for the follow-up appointment. 4. make sure the parents can set up the treatments for their child.

Correct Answer: 2 Rationale 1: It is important to provide written material, but the first priority is ascertaining any belief conflicts that may interfere with the treatment. Rationale 2: If the prescribed treatment conflicts with the client/familys cultural healing beliefs, the client may not be compliant with the recommended treatments. To be effective, nurses must deal directly with any conflicts and differing values held by the client. Rationale 3: If the prescribed treatment conflicts with the client/familys cultural healing beliefs, the client may not be compliant with the recommended treatments. Rationale 4: The client who does not understand will learn little, and providing an interpreter to assist with communication is extremely important in this situation. However, if the prescribed treatment conflicts with the client/familys cultural healing beliefs, the client may not be compliant with the recommended treatments.

Question 7 Type: MCSA A nurse is working in a neonatal intensive care unit, teaching parents how to care for their tiny babies while they are still in the hospital. Which statement by a parent reflects a readiness to learn? 1. Im so afraid Ill hurt my baby with all these tubes. 2. I want to make sure my spouse is here, in case I dont hear everything thats said. 3. When my baby is just a little bigger, Ill be able to handle him. 4. Youll give us written instructions before we go home, correct?

Correct Answer: 2 Rationale 1: Statements about fear of the situation need to be addressed so the fear will not inhibit the learning process. Rationale 2: Readiness to learn is the demonstration of behaviors or cues that reflect a learners motivation, desire, and ability to learn at a specific time. The client who wants the spouse involved is demonstrating motivation and willingness, but also wants support from the spouse as well. Rationale 3: Wanting to wait until the baby is older reflects uncertainty and possibly fear and should be addressed before learning can occur. Rationale 4: Wanting to wait until discharge reflects uncertainty and possibly fear and should be addressed before learning can occur.

Question 24 Type: MCSA Which statement regarding the use of zolpidem (Ambien) for insomnia is accurate? 1. Patients using Ambien should avoid foods that contain tyramine. 2. Ambien will take longer to produce an effect when taken with food. 3. Ambien is contraindicated during pregnancy, but can be taken by breastfeeding mothers. 4. Ambien is classified as a benzodiazepine.

Correct Answer: 2 Rationale 1: The absorption of Ambien is slowed when taken with food. It is classified as a nonbenzodiazepine CNS depressant. It is classified as pregnancy category B, and should be avoided by breastfeeding mothers. Patients using MAOIs (not Ambien) should avoid foods high in tyramine.

Question 25 Type: MCMA When making an assessment of the clients learning needs, the nurse will focus on which elements? Standard Text: Select all that apply. 1. Nurses own knowledge 2. Clients age 3. Clients understanding of health problem 4. Sensory acuity 5. Learning style

Correct Answer: 2, 3, 4, 5 Rationale 1: The nurses own knowledge of common learning needs is a source of information but not part of the nurses assessment of the clients learning needs. Rationale 2: The clients age provides information on the persons developmental status that might indicate health teaching content and teaching approaches. Rationale 3: The clients understanding of health problems might indicate deficient knowledge or misinformation. Rationale 4: Sensory acuity is part of the psychomotor ability of which the nurse must be aware when planning a teaching session. Rationale 5: Learning style identifies the clients best way to learn so that the nurse can adapt teaching accordingly.

Question 28 Type: MCMA A patient has been in the intensive care unit for a week receiving various procedures throughout the day and night. Currently the patient, though physiologically stable, is irritable and paranoid and complains of vivid dreams when dozing off to sleep. What are the best actions for the nurse to take at this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Check the patients oxygen status. 2. Request an order for sleep medication. 3. Assess the patients vital signs. 4. Turn down the lights at night and reduce noise to a minimum. 5. Schedule all tests and procedures before 9 p.m. or after 7 a.m.

Correct Answer: 2,4,5 Rationale 1: The patient is physiologically stable. Rationale 2: Since it is important for the patient to get rest, an order for sleep medication would be appropriate. Rationale 3: It is not necessary to assess the patients vital signs, since the patient is physiologically stable. Rationale 4: When deprived of REM sleep, people experience a sleep debt and become frightened, irritable, paranoid, and even emotionally disturbed. It is speculated that to make up for their lack of dreaming, these persons experience far more daydreaming and fantasizing throughout the day. It is important to institute measures that promote restful sleep. Rationale 5: When deprived of REM sleep, people experience a sleep debt and become frightened, irritable, paranoid, and even emotionally disturbed. It is important to institute measures that promote restful sleep, which would include scheduling tests and procedures so as to not disturb the patients sleep.

Question 2 Type: MCSA A nurse is planning a community health education project that deals with organ donation, and the target audience is a group of adults. When following andragogy concepts, the nurse should make sure that the teaching includes which information? 1. Past statistics about organ donors 2. Written pamphlets 3. Directions about how to become an organ donor 4. Information on how this group can influence their children

Correct Answer: 3 Rationale 1: An adult is more oriented to learning when the material is useful immediately, not sometime in the future. Rationale 2: Written information may or may not be helpful, depending on what types of learners are included in the group. Rationale 3: An adult is more oriented to learning when the material is useful immediately, not sometime in the future. For this audience, giving clear directions on how to become an organ donor would be more helpful than past information and future activities such as influencing their children. Rationale 4: For this audience, giving clear directions on how to become an organ donor would be more helpful than past information and future activities such as influencing their children.

Question 6 Type: MCSA A nurse is presenting teaching sessions to a group of residents in a home for long-term physical rehabilitation. Which client exhibits the highest motivation? 1. An individual who has been struggling with following nursing directives regarding discharge goals 2. The client who has just moved in and is already waiting for discharge 3. A client who is excited to learn about his new prosthesis 4. A client who has been there the longest and is a great coach for newcomers

Correct Answer: 3 Rationale 1: Clients who struggle with rules or following prescribed courses of treatment are not motivated to learn the best reason for their particular plan of action. They may be bucking the system. Rationale 2: The client who is already waiting to go home may be motivated for that, but not to the extent of being ready to learn how to achieve this end. Rationale 3: Motivation is the desire to learn and influences how quickly and to what extent a person learns. It is generally greatest when a person recognizes a need and believes the need will be met through learning. The client who is excited to learn about his prosthesis understands that learning about it will help take his recovery to a high level. Rationale 4: Motivation must be experienced by the client, not by someone else (as in being a coach for newcomers).

Question 20 Type: MCSA The nurse is going to be working with a client who has a permanent colostomy and is ready to go home within the next several days. When organizing the teaching/learning experience, the nurse should 1. start from the beginning and proceed through all material. 2. break up sessions into shortened time periods. 3. discover what the learner knows before proceeding with further teaching. 4. make sure the clients spouse is present before the teaching session begins.

Correct Answer: 3 Rationale 1: Going over information already taught and learned isnt practicing good time management for the nurse or the client. Rationale 2: Unless the client has attention problems or may be elderly, breaking up the sessions may not be necessary. Rationale 3: Nurses should save time in constructing their own teaching sessions and should follow basic guidelines when sequencing the learning experience. The nurse should find out what the learner knows, and then proceed to the unknown. This gives the learner confidence. This information can be elicited either by asking questions or by having the client take a pretest or fill out a form. Rationale 4: Having the spouse present is always a good idea, but may not be possible all the time.

Question 19 Type: MCSA Which drug category can be used for treating anxiety? 1. Antitussives 2. Anticoagulants 3. Seizure drugs 4. Antibiotics

Correct Answer: 3 Rationale 1: In addition to antidepressants, several other drug classes are used to treat anxiety, including seizure drugs. Antibiotics are used primarily for bacterial infections. Antitussives are used as cough suppressants. Anticoagulants are used to prevent blood clots from forming.

Question 17 Type: MCSA The nursing diagnosis Readiness for Enhanced Knowledge (Nutrition) related to desire to improve nutritional intake has been formulated for a client who has decided to change his eating habits to be more nutritionally sound. What would be an appropriate outcome for this client? 1. Client will understand the importance of eating healthy. 2. Client will be able to lose weight. 3. Client will list foods that are nutritionally sound, low fat, and high fiber. 4. Client will appreciate the value of using the Food Guide Pyramid.

Correct Answer: 3 Rationale 1: Learning outcomes, like client outcomes, must be specific and observable so they can be measured. Words like understand are not measurable and are not observable. Rationale 2: Be able to lose weight is not specific enough, and with the information given, it is not known if that is really what the client wants to attain. Rationale 3: Learning outcomes, like client outcomes, must be specific and observable so they can be measured. Rationale 4: Words like appreciate are not measurable and are not observable.

Question 22 Type: MCSA Which sleep stage accounts for about one-half of total sleep? 1. NREM sleep stage 1 2. NREM sleep stage 3 3. NREM sleep stage 2 4. NREM sleep stage 4

Correct Answer: 3 Rationale 1: NREM sleep stage 2 accounts for 45-55% of total sleep. The other stages are considerably less than half.

Question 21 Type: MCSA A client needs discharge teaching regarding the use of a walker before going home. The clients room is small and adjacent to a soda machine and small lounge area. In planning a teaching session, which is the best thing the nurse can do? 1. Wait until just prior to discharge, then do the teaching in the hospital lobby. 2. Close the door to the clients room and make sure there is no clutter on the floor before the teaching session begins. 3. Take the client to a larger area (treatment room, for example) for teaching, then evaluate on the way back to the clients room. 4. Make sure a physical therapist is available to do the teaching and can see the client before discharge.

Correct Answer: 3 Rationale 1: Noise or interruptions can interfere with concentration, whereas a comfortable environment can promote learning. The hospital lobby does not provide privacy and can be noisy. There also would be little time to reinforce any teaching needs that might be necessary. Rationale 2: Noise or interruptions can interfere with concentration, whereas a comfortable environment can promote learning. Rationale 3: Going to a larger area and then evaluating the learning by watching the client ambulate back to the room would be the best way to implement teaching in this particular situation. Rationale 4: Not all hospitals have a physical therapist available to help implement teaching for clients.

Question 8 Type: MCSA The nurse is instructing a client on self-administration of insulin. Which statement regarding feedback will be most beneficial to the client? 1. You know, there are children who can learn to do this. 2. Maybe it would be better if we taught your spouse to help you with this. 3. Next time, dart the needle in your skin, instead of pushing it in. 4. If you dont learn this, you cant be discharged.

Correct Answer: 3 Rationale 1: Ridicule or sarcasm can lead to withdrawal from learning, as in reminding an adult client that a child can perform the task or of not being discharged until the skill is learned. Rationale 2: Statements about having somebody else learn the technique may also cause the learner to avoid the teaching moment and to avoid learning the technique altogether. Rationale 3: Feedback should be meaningful to the learner and should support the desired behavior through praise, positively worded corrections, and suggestions of alternative methods. Rationale 4: Ridicule or sarcasm can lead to withdrawal from learning, as in reminding an adult client that a child can perform the task or of not being discharged until the skill is learned.

Question 9 Type: MCSA The patient comes to the emergency department after an overdose of lorazepam (Ativan). The nurse will plan to administer which medication? 1. Pralidoxime (Protopam) 2. Naloxone (Narcan) 3. Flumazenil (Romazicon) 4. Nalmefene (Revex)

Correct Answer: 3 Rationale 1: Should an overdose of benzodiazepines occur, flumazenil (Romazicon) is a specific benzodiazepine receptor antagonist that can be administered to reverse central nervous system (CNS) depression. Naloxone (Narcan) is indicated for treatment of opiate overdose. Nalmefene (Revex) is indicated for treatment of opiate overdose. Pralidoxime (Protopam) is indicated for treatment of organophosphate poisoning.

Question 7 Type: MCSA The patient is scheduled to have an EEG to confirm the presence of a sleep disorder. The patient asks the nurse to describe Stage IV NREM sleep. What is the best response by the nurse? 1. This is the lightest stage of sleep, and is profoundly affected by anxiety. 2. Dreaming occurs here; without dreams you will be irritable and paranoid. 3. This is the deepest stage of sleep; without it you will be tired and depressed. 4. This stage comprises the greatest amount of sleep time, and is important.

Correct Answer: 3 Rationale 1: Stage IV NREM sleep is the deepest stage of sleep. Patients who are deprived of it experience depression and a feeling of apathy and fatigue. Dreaming occurs in REM sleep, not NREM sleep. Stage IV NREM sleep is the deepest stage of sleep, not the lightest stage of sleep. Stage II NREM sleep, not Stage IV NREM sleep, comprises the greatest amount of total sleep time.

Question 13 Type: MCSA A client who is legally blind requires vitamin B12 injections every 2 weeks and insists on self-administration. What is the best way for the nurse to assist this client? 1. Teach the spouse to draw up the medication, then the client can give the injection. 2. Make sure that the injection is scheduled during a visit, so the nurse can supervise. 3. Prefill syringes with the correct dose, so the client can use them for self-administration. 4. Schedule the clients clinic appointments in accordance with the dosing schedule, then give the injection when the client is at the clinic.

Correct Answer: 3 Rationale 1: Teaching a spouse is demeaning and does not support the clients wishes for independence. Rationale 2: Scheduling injections and visits to coincide is demeaning and does not support the clients wishes for independence. Rationale 3: Clients who have visual impairment may need the assistance of a support person or creative care in order to remain compliant with their treatment. Because the client insists on self-administration, prefilling syringes (and keeping them away from light and heat) would be a plausible solution. The client is concerned with independence, and allowing the client to maintain that would be quite important. Rationale 4: Scheduling injections and visits to coincide when the dose is due is demeaning and does not support the clients wishes for independence.

Question 30 Type: MCMA A patient who has recently experienced the loss of a spouse asks the nurse if there are any over-the-counter herbs or nonprescription medications that can be used to improve insomnia. How should the nurse respond to this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ginger root is commonly taken to improve sleep. 2. Ginkgo is an herb commonly taken to improve sleep. 3. Diphenhydramine (Benadryl) and doxylamine are over-the-counter meds sometimes taken to produce drowsiness. 4. Valerian and melatonin are herbs commonly taken to improve sleep. 5. Kava is an herb taken to improve sleep.

Correct Answer: 3,4 Rationale 1: Ginger root is not used to improve sleep. Rationale 2: Ginkgo is not used to improve sleep. Rationale 3: Diphenhydramine and doxylamine are two antihistamines frequently used to produce drowsiness. Rationale 4: An herbal product with demonstrated efficacy in promoting relaxation is valerian root. Supplemental melatonin, 0.5?3.0 mg at bedtime, is alleged to decrease the time required to fall asleep and to produce a deep and restful sleep. Rationale 5: High doses of kava can damage the liver and should not be used unless recommended by a health care provider.

Question 31 Type: MCMA A patient who is complaining of anxiety and difficulty sleeping has asked what prescription medications would assist in getting to sleep. What would be appropriate responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Diphenhydramine (Benadryl) 2. Valerian root 3. Ramelteon (Rozerem) 4. Flurazepam (Dalmane) 5. Zolpidem (Ambien)

Correct Answer: 3,4,5 Rationale 1: Diphenhydramine (Benadryl) can be obtained over the counter and does not need a prescription to obtain. It does promote getting to sleep. Rationale 2: Valerian is an herbal product that does not need a prescription to obtain. It does promote getting to sleep. Rationale 3: Rozerem is a newer, nonbenzodiazepine hypnotic approved to treat chronic insomnia in people who have problems falling asleep. Rationale 4: Benzodiazepines are drugs of choice for generalized anxiety disorder and the short-term therapy of insomnia. Flurazepam (Dalmane) should be taken at bedtime because it quickly produces significant drowsiness. Rationale 5: Ambien is a sedative-hypnotic approved for short-term treatment of insomnia.

Question 15 Type: MCSA The patient is receiving clonazepam (Klonopin) for the treatment of panic attacks. What is an important medication outcome for this patient as it relates to safety? 1. The patient will verbalize the signs of developing Stevens-Johnson rash. 2. The patient will verbalize the importance of diet restrictions related to this drug. 3. The patient will verbalize the importance of having routine blood work done. 4. The patient will verbalize the consequences of stopping the drug abruptly.

Correct Answer: 4 Rationale 1: Abrupt discontinuation of clonazepam (Klonopin) can result in serious withdrawal symptoms. There arent any diet restrictions with the use of clonazepam (Klonopin). Routine blood work is not required with the use of clonazepam (Klonopin). Stevens-Johnson rash is not a side effect of clonazepam (Klonopin).

Question 25 Type: MCSA Which explanation best indicates why barbiturates are rarely used to treat anxiety and insomnia? 1. They have a greater associated cost. 2. They have a high risk of producing an allergic response. 3. They are seldom effective. 4. They produce many serious adverse effects.

Correct Answer: 4 Rationale 1: Barbiturates were the drug of choice for anxiety and insomnia prior to the discovery of safer drug alternatives. They can be effective, and are not necessarily more expensive. Allergic reactions can occur, but are rare, and are not a primary reason they are no longer used for anxiety and/or insomnia.

Question 14 Type: MCSA A client has been diagnosed with diabetes mellitus and must learn how to do his own finger stick blood sugar analysis as part of his treatment. The client has been sullen and uncommunicative since receiving the diagnosis. How can the nurse best increase the clients motivation to learn? 1. Demonstrating the finger stick on the nurse 2. Offering to do the procedure for the client each time it is scheduled 3. Teaching the clients support system how to perform the procedure 4. Encouraging the clients participation each time the procedure is performed

Correct Answer: 4 Rationale 1: Demonstrating the procedure on the nurse may or may not help the client become interested in the learning process. Rationale 2: Offering to do the procedure only allows the clients current state of mind to continue. Rationale 3: Giving the responsibility to someone else does not encourage the client to learn it. Rationale 4: Nurses can increase a clients motivation in several ways, including encouragement of self-direction and independence.

Question 12 Type: MCSA The patient is receiving zolpidem (Ambien) for treatment of short-term insomnia. What is the primary safety concern of the nurse when the patient takes this medication? 1. Dizziness and daytime sedation 2. Nausea and diarrhea 3. Nausea and gastrointestinal (GI) distress 4. Sleepwalking

Correct Answer: 4 Rationale 1: During sleepwalking, a patient may leave the home and cause injury to self. Nausea and gastrointestinal (GI) distress are common side effects of zolpidem (Ambien), and usually subside after a few days on the medication. Dizziness and daytime sedation are common side effects of zolpidem (Ambien), and usually subside after a few days on the medication. Nausea and diarrhea are common side effects of zolpidem (Ambien), and usually subside after a few days on the medication.

Question 3 Type: MCSA The nurse is instructing a client on self-administration of a subcutaneous injection. The nurse is using which theoretical construct of learning? 1. Thorndikes behaviorism 2. Skinners positive reinforcement 3. Pavlovs conditioning response 4. Banduras imitation

Correct Answer: 4 Rationale 1: Edward Thorndike originally advanced the theory of behaviorism and maintained that learning should be based on the learners behavior. Rationale 2: Skinner focused his work on conditioning behavioral responses to a stimulus that causes the response or behavior. Rationale 3: Pavlov focused his work on conditioning behavioral responses to a stimulus that causes the response or behavior. Rationale 4: Bandura claims that most learning comes from observation and instruction. Imitation is the process by which individuals copy or reproduce what they have observed.

Question 5 Type: MCSA The patient has generalized anxiety disorder. He asks the nurse, Will I need medication for this? My neighbor is very nervous and he takes medication. What is the best response by the nurse? 1. Medications are a way of life for patients with anxiety disorders. 2. Medication is necessary initially; later we will try therapy. 3. Probably not, but you shouldnt compare yourself to your neighbor. 4. Medication is necessary when anxiety interferes with your quality of life.

Correct Answer: 4 Rationale 1: It is more productive to identify and treat the cause of anxiety than to use medications. When anxiety becomes severe enough to significantly interfere with the patients quality of life, pharmacotherapy is indicated. Medications are not considered a way of life for patients with anxiety disorders; many patients can manage anxiety without medications. The nurse does not have enough information to tell the patient that medications will probably not be necessary. Medication combined with therapy is considered the best approach for treatment of anxiety disorders.

Question 17 Type: MCSA The most productive way of managing stress would be to 1. use a combined approach (drug use and nonpharmacological strategies). 2. use anxiolytics. 3. practice meditation. 4. determine the cause and address it accordingly.

Correct Answer: 4 Rationale 1: Stress is generally a symptom of an underlying disorder. It is more productive to uncover and address the cause than to treat the symptoms.

Question 15 Type: MCSA The nurse is working with a group of older clients through a community senior citizens center. Utilizing an understanding of health literacy, the nurse will make sure that 1. information given to this group is written at a third-grade level. 2. teaching includes a variety of approaches. 3. information includes pictures. 4. there is ample time for teaching.

Correct Answer: 4 Rationale 1: The average reading ability of many American adults is at the fifth-grade level. Information provided to this group should be presented at the fifth- to sixth-grade reading level. Rationale 2: A variety of approaches should be included regardless of the audience, as people learn by different methods. Rationale 3: A variety of approaches should be included regardless of the audience, as people learn by different methods. Rationale 4: When working with the older population, the nurse must realize that increased time for teaching is necessary because processing of information is slower. Health literacy skills are often limited in older adults.

Question 11 Type: MCSA A client with an incision necessitating a complex dressing change is being discharged and will require continued dressings at home. Which statement by the client indicates a need to postpone teaching? 1. Its going to take time for me to understand this whole thing. 2. Lets make sure my spouse is around before you start explaining. 3. I wish my doctor would have explained this more in depth. 4. Im feeling nauseous, but go ahead and start anyway.

Correct Answer: 4 Rationale 1: This statement shows interest as well as realism in attitude toward learning. The nurse should be attentive to cues that may enhance the learning experience, such as amount of time spent on the process. Rationale 2: This statement shows interest as well as realism in attitude toward learning. The nurse should be attentive to cues that may enhance the learning experience, such as having the spouse available to learn along with the client. Rationale 3: This statement shows interest as well as realism in attitude toward learning. The nurse should be attentive to cues that may enhance the learning experience, such as giving thorough explanations about the rationale for the treatment. Rationale 4: Learning can be inhibited by physiologic events such as illness, pain, or sensory deficits. The client must be able to concentrate and apply adequate energy to the learning or the learning itself will be impaired. If the client is experiencing nausea, the nurse should first try to reduce this symptom before beginning the teaching session.

Question 14 Type: MCSA The patient has been receiving escitalopram (Lexapro) for treatment of obsessive-compulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. Johns wort. The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurses assessment? 1. The patient is experiencing symptoms of St. Johns wort toxicity, as the medication was most likely outdated. 2. The patient has contracted a viral infection. Escitalopram (Lexapro) and St. Johns wort are safe to take together. 3. The patient has not been taking escitalopram (Lexapro) and is experiencing withdrawal. 4. The patient has combined two antidepressant medications and is experiencing serotonin syndrome.

Correct Answer: 4 Rationale 1: Use caution with herbal supplements such as St. Johns wort, which may increase the effects of escitalopram (Lexapro) and cause serotonin syndrome. The patients symptoms are consistent with serotonin syndrome, and there is no evidence that the patient has not been taking the escitalopram (Lexapro). The patients symptoms are consistent with serotonin syndrome, and there is no evidence that the patients St. Johns wort is outdated. The patients symptoms are consistent with serotonin syndrome. It is not considered safe to combine escitalopram (Lexapro) and St. Johns wort.