basic nursing FiNAL
A nurse is assisting a neurologist, who is assessing the norepinephrine (noradrenaline) level of a client who is reporting stress. Which function does norepinephrine perform?
heightens arousal and increases energy
A client who utilizes a portable oxygen device reports planning to attend an upcoming bonfire on the beach. What is the appropriate nursing response?
"Be sure to avoid the actual area of fire, and anyone who is smoking." ...
A middle-age client is reporting acute joint pain to a nurse who is assessing the client's pain in a clinic. Which question related to pain assessment should the nurse ask the client?
"Does your pain level change after taking medications?"
The nurse is providing home care for a client who traditionally drinks herbal tea to treat an illness. How should the nurse respond to a request for the herbal tea?
"Let me check with the doctor to make sure it is okay to drink the tea with your medicines."
While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain?
"Sometimes it seems like I can never get a moment to myself."
A nurse is caring for a client who is unable to breathe efficiently by himself. The physician has directed the nurse to put the client on oxygen therapy. The client is receiving a high concentration of oxygen to differentiate signs of inadequate oxygenation from early signs of delirium
4 L/min
A nurse uses a simple mask to administer oxygen to a client with nasal trauma who breathes through the mouth. What is the minimum amount of oxygen delivered to the client using a simple mask?
5 L/min
The nurse is caring for an older adult client who reports feeling dizzy when moving from sitting to standing. What teaching will the nurse provide?
Allow extra time to move from sitting to standing.
A nurse is caring for older adult clients. Which is the most important safety issue in older clients?
Accidental falls
A nurse is caring for a client who is an investment banker. The client is stressed because of the sudden fall of share prices in the stock exchange. Which stress reduction technique should the nurse use with this client?
Advocate on behalf of the client to others
A nurse is caring for an older adult client at risk of injury due to confusion. The client has a stable gait. Which method of restraining should the nurse use?
Alarm-activating bracelet
A client, while driving, hits a small child crossing the road. The child survives with some minor bruises and cuts. The client feels very stressed and is depressed when thinking of the child's injury. Which technique should the nurse implement in this case?
Alternative thinking
A client who tends to volunteer to complete major assessments (but forgets to complete his own work) is stressed because of this. The nurse suggests that the client prioritize the work, complete the difficult part of work first, and delegate the rest of the work to colleagues. In this case, what technique is the nurse asking the client to follow?
Alternitive behaviors
Which scenario is using a prospective payment plan to reimburse for services?
An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on predetermined price.
A male nurse is preparing to take the vital signs of a female client. Which ethnic group would consider this improper?
Arab Muslim
A client who was prescribed CPAP reports nonadherence to treatment. What is the priority nursing intervention?
Ask the client what factors contribute to nonadherence.
A client with a fractured leg and arm needs to be transferred to the x-ray unit. Which nursing guideline should be followed during client transfer?
Assess the client's strength and mobility.
A home care nurse provides health education to parents regarding the care of their toddler. Which precaution should the nurse suggest the parents take to protect the toddler from drowning?
Avoid unattended baths for the toddler.
All of the following are factors to consider when caring for clients with limited income. Which one is the most important?
Basic human needs may go unmet
After experiencing an ST-wave elevation myocardial infarction, a 64-year-old man has been admitted to the cardiac unit of the hospital for care. The nurse has completed a comprehensive assessment and s creating a plan of care that is holistic in its focus. How can the nurse best integrate the principles of holism into the client's care?
By intergrating each of the various dimensions of the client's identity into his care
A client is receiving treatment in the intensive care unit for sepsis. a systemic infection that poses a grave threat to the body's homeostasis. The body is adapting to numerous threats, a process that primarily involves the integration of what body system? (Select all that apply)
Centeral Nervous System Autonomic nervous system Endocrine system
The nurse is admitting a client from China to the medical-surgical unit. While doing the client's assessments, the client speaks of naturalistic beliefs related to health care and the importance of the yin/yang theory. The client is diagnosed with cancer, a condition that is considered a "cold" illness in the culture and her yin/yang beliefs. Which meal will the client most likely order for lunch?
Chicken noodle soup with crackers, fruit crisp, and hot tea
A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain?
Chronic pain has far-reaching effects on the client.
A nurse has entered the room of a resident at the care facility and discovered that the resident has lit some paper on fire in the trash can. What types of fire extinguisher are appropriate for putting out this fire? (Select all that apply.)
Class ABC
During the admission phase, the nurse is required to assess the client and collect information for the database. The nurse can also delegate some part of the work to other ancillary staff. Which of the following can the nurse delegate to the other staff?
Client's physical assessment
When keeping a client's personal belongings in a locker, the nurse should ensure that the envelope is sealed and signed by which of the following people?
Client, supervisor, and nurse
Despite the presence of a large number of elderly residents of Asian heritage, a long-term care facility has not integrated the Asian concepts of hot and cold into meal planning. Which of the following should the nurses at the facility recognize this as an example of?
Cultural blindness
When a nurse cares for an older adult if all of the following events have occurred recently, which one likely represents the greatest stressor?
Death of a spouse
A nurse is planning the care of a client who will soon begin radiotherapy for the treatment of breast cancer. The nurse has been identifying interventions that are rooted in the notion of holism, which state that:
Interactions between the mind and body can profoundly influence health
When the nurse interacts with a client, what coping mechanism is being demonstrated when a client refuses treatment she believes her breast biopsy indicating cancer is incorrect?
Denial
A nurse is caring for a client with neck pain. The nurse is explaining neck pain and some basic methods for pain management to the client. Which pain-management facts should the nurse mention to the client and the client's family?
Discuss pain-control methods with the physician.
A nurse engages in professional rituals as a means to standardize practice and ensure efficiency. In doing so, the nurse integrates an understanding of:
common and observable expressions of culture.
An unconscious client is brought to the emergency department after ingesting too much prescribed medication. What is the highest priority nursing intervention?
Establish a patent airway.
A client who has difficulty sleeping expresses to the nurse that watching television may help him relax and get sleep. The nurse disregards the client's concern and suggests drinking warm milk before going to bed. Which cultural characteristic is the nurse demonstrating?
Ethnocentrism
A nurse finds that a fire has broken out in a client's room at the health care facility. Which intervention is of the highest priority?
Evacuate the client.
A client admitted to the health care facility is assessed using a Minimum Data Set. How often is the Minimum Data Set repeated for a client?
Every 3 months
The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client?
Exhaustion Stage
A nurse is trying to calm an upset client who has been involved in an accident. The client escaped with minor bruises from the accident. What should the nurse do in order to calm the client?
Explain that things could have been worse
A client who is disabled due to stroke is discharged from a health care unit and an LPN is assigned to provide nursing care to the client at home. This is an example of which kind of care?
Extended Care
A nurse is caring for a client who has undergone a total hip replacement and is advised to undergo physiotherapy after discharge. Which level of care is the physiotherapy center?
Extended Care
A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which scale should the nurse use to assess the client's pain?
FACES scale
A child has been admitted to the medical center with severe depression and stress and has been avoiding going to school for these reasons. How should the nurse attempt to treat the child?
Find the factors that have caused stress and depression
During oxygen administration to the client, which pieces of equipment would enable the nurse to regulate the amount of oxygen delivered?
Flow meter
A client who has been lying prone reports shortness of breath and a sensation of choking. Into which position will the nurse place the client?
Fowlers
A nurse is caring for a client with a fracture in his hand. How should the nurse assist the client to change his clothes?
Gather the garment and work it up and over the body.
A nurse has become involved in political efforts to ensure that a greater percentage of Americans have access to affordable health care, regardless of their individual circumstances. This view of health is reflective of what belief?
Health is a right
A nurse on a home visit to a healthy elderly client finds that too much clutter has accumulated in the house. What is the most appropriate nursing diagnosis for the client?
Impaired home maintenance
A stable client is brought to the emergency department after ingesting too much-prescribed medication. What is the highest priority nursing intervention?
Induce vomiting.
A nurse is assessing an obese teenager who is unhappy and stressed out because she has not lost weight despite working out at the gym. The physician asks the nurse to try the modeling intervention for stress management for the client. Which action should the nurse perform when adhering to the modeling intervention. ?
Introduce the client to someone with a positive attitude
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse explains to the client that COPD is a chronic disease Why is COPD considered to be a chronic disease.
It has a gradual onset and lasts for a long time.
A nurse is caring for a client who is being administered oxygen through a liquid oxygen unit. What is the most common potential problem the nurse may face when using a liquid oxygen unit to administer oxygen?
It leaks during warm weather.
A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in educating parents about how to protect a toddler from unintentional poisoning?
Keep cleaning solutions locked up.
A nurse is educating a mother about caring for a newborn baby. What should the nurse teach the client as a precautionary measure to protect the infant from burns?
Keep hot substances away from the baby.
A client has been admitted to the health care facility for less than 24 hours for observation. The client has a gold ring, watch, reading glasses, and other personal belongings. What care should the nurse take with regard to these objects?
Keep the client's belongings secured in a locker.
Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance?
Know the client's cultural personal space preferences.
The nurse is obtaining a health history from a patient of Puerto Rican descent. Which of the following is most likely to be a health problem that has a cultural connection for this patient?
Lactose enzyme deficiency
A client of English descent reports to the primary health care facility with symptoms of fever, cough, and running nose. While interviewing the client, which point should the nurse keep in mind?
Maintain eye contact while talking.
A client admitted to a health care facility uses a walker for support. What is the nurse's responsibility with regard to the walker when admitting the client to the nursing unit?
Mark the client's walker with a large, easily readable label. ...
A nurse had learned that more than 8% of Americans are currently living with diabetes mellitus. This statistic represents what epidemiological concept?
Morbidity
The nurse is admitting a new client to the unit. The nurse notes that this client would need an alternate meal choice when the menu specified pork for a meal. Members of which cultural group might request an alternative meal choice?
Muslim
A nurse is caring for an asthmatic client who requires a low concentration of oxygen. Which delivery device should the nurse use in order to administer oxygen to the client?
Nasal cannula
Once a client is admitted and all the admission data are collected, the nurse is expected to develop an initial plan for the client's care. By what point after admission should the nurse develop the plan?
No later than 24 hours
A client who is a drug addict visits a health care facility for treatment. During counseling, he discloses that he took drugs because it helped him to deal with stressful situations. The nurse explains that he is not using the correct coping strategy to overcome his stress-related problems. What kind of strategy has the client used in this case?
Nontherapeutic coping strategy
A client who is an intravenous drug user visits a health care facility for treatment. During counseling, the client discloses that he initially took drugs because it helped him deal with stressful situations. The nurse recognizes that he is not using effective coping strategies to overcome his stress-related problems. What kind of strategy has the client used in this case?
Nontherapeutic coping strategy
The nurse manager is assessing the unit for proper work ergonomics. Which finding will require immediate intervention by the nurse manager?
Nurses and unit assistants use telephones with handsets.
In which way can nurses develop cultural self-awareness?
Objectively examine one's own beliefs, values, and practices.
A nurse is caring for a client who is receiving an intravenous therapy through an IV pump. Which intervention should the nurse implement to ensure electrical safety?
Obtain a three-prong grounded plug adapter.
The telehealth nurse receives a call from a caller who states that upon entering the home, two confused family members have been found with a bright cherry red skin color. They are reporting nausea and headache, and are unable to move. Which initial direction will the nurse provide?
Open doors and windows.
A nurse is caring for a client from Taiwan who constantly requests pain medication. What should the nurse consider when assessing the client's pain?
Pain is what the client says it is.
A nurse who works in a high-acuity setting is conscious of ensuring that clients' pain assessments and pain control regimens are highly individualized. Which statement about pain threshold is most accurate?
Pain thresholds tend to be the same among healthy people.
A nursing instructor has assigned a student to care for a client of Asian descent. The instructor reminds the student that personal space considerations vary among cultures. What personal space preferences are important for the student to consider when caring for this client?
People of Asian descent prefer some distance between themselves and others.
A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain?
Phantom pain
The nurse is teaching the caregiver of a 3-year old about safety. Which teaching will the nurse include?
Place all household cleaners out of reach.
A nurse is caring for a client who is to be transferred to another unit in the same facility. Which of the following is a responsibility of the nurse during the transfer of the client?
Provide a written review of the client's status. ...
A nurse is reading the goals stated in the Healthy People 2020 report. Which goal is targeted in the Healthy People 2020 report?
Providing free treatment to clients with cancer
A nurse responds to the call bell and finds another nurse evacuating the client from the room, which has caught fire. Which action should the nurse take?
Pull the fire alarm lever.
A nurse has rushed to the site of an accident where members of a family have suffered carbon monoxide poisoning. What is the highest priority action that must take place during carbon monoxide poisoning?
Remove the individual from the room.
A nurse is preparing discharge teaching for a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?
Restrain the baby in a car seat.
A nurse in a psychiatric care unit finds that a client with psychosis has become violent and is actively trying to harm another client in the unit. What action should the nurse take?
Restrain the client, as he is harmful to others.
A physician is examining the client during the client's initial physical examination. After collecting all the data, the physician writes R/O in the medical records and suggests some more tests and examinations. What does the physician mean by R/O?
Rule out
A client experiencing symptoms of a cold is referred to the specialist for diagnosis and consultation. Consultation and diagnostic tests are included in which level of the health care system?
Secondary Care
A client visits the medical unit with the client's father for a scheduled checkup. The clients father has been recently diagnosed with hypertension. The nurse suggests that the client get his blood pressure regularly checked to avoid possible problems. What level of prevention is the nurse following in this case?
Secondary level
A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics?
Sedation
A client visits a health care facility reporting work-related stress that alters his mood when he comes home. The nurse suggests that the client make changes to his home decor to include vibrant colors and bright lighting, and listen to soothing music when he returns home. Which stress-reducing technique is the nurse following in this case?
Sensory manipulation technique
The client in a rehabilitation unit is having a difficult time adjusting to the scheduled activities on the unit, as well as being dependent on others for meals and medications. Which word best describes what the client is experiencing?
Shock
An elderly client with a tracheostomy is to be discharged from a health care facility. Which of the following extended care facilities should the nurse suggest to the client for continued care until complete recovery?
Skilled nursing facility
Which characteristic is used to describe racial categories?
Skin color
A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors?
Social support
A nurse is conducting a morning assessment of an elderly client who is being rehabilitated after orthopedic surgery. In addition to vital signs, the nurse assesses the client's oxygenation by pulse oximetry. At what SpO2 reading should the nurse begin to consider additional respiratory assessments and interventions?
SpO2 89%
In a nursing unit, a physician is about to defibrillate a client. What is an appropriate action when the physician says "clear"?
Step away from the bed.
When a labor and delivery nurse tells a coworker that a client of Asian decent probably did not want any pain medication because "Asian women typically are stoic," the nurse is expressing a belief known as what?
Stereotype
The nurse is caring for a client who in confined to bed due to paralysis. The client has a medical history of stroke, hypertension, and diabetes mellitus for the past five years, besides having asthma since childhood. Which is a secondary illness seen in the client?
Stroke
A roller sheet has been placed under an elderly client who is receiving treatment for failure to thrive. When using a roller sheet in a client's care, the nurse must:
ensure that the roller sheet is kept dry and wrinkle-free.
A nurse needs to restrain a client who may be harmful to himself. What is the priority nursing action when applying restraints?
Take a physician's order for restraining.
When discussing his problem, a client tells the nurse that he is always doing small, petty jobs for everyone and he is not happy about it. Because of this, he is feeling stressed and has been getting into fights with his wife. What should the nurse suggest to help the client overcome this problem?
Take control of the situation
During a round at night, the nurse finds that a client is missing from his room. The client returns early the next morning. What procedure is followed by the health care facility with regard to this client?
The client needs to repeat the admission procedure.
A client states that the client is "fed up" with the care that the client has been receiving in the hospital and plans to leave immediately. What procedure is followed with regard to this client?
The client needs to sign a form releasing the physician and agency from responsibility.
An elderly client fell 2 days ago on the sidewalk near home and has been admitted to the hospital with a hip fracture. Since the subsequent surgery, the client he has been insistent on wearing their own sweater and cap. The nurse is aware that the client is not cold, has no cognitive deficits, and has participated cooperatively in all aspects of his treatment. What is the most plausible rationale for the client's action?
The client wishes to maintain and assert their personal identity.
A nurse is caring for a child with Huntington's Chorea, a hereditary condition. Which statement is true of hereditary conditions?
The condition is acquired from genes of one or both parents.
A 7-year old child is admitted to a health care facility. His parents explain that the child is not able to interpret what they say and so is not able to speak clearly. The child is also not able to remember anything he was taught in school. What should the nurse conclude about the part of the brain that is affected in this case?
The cortex is affected
An older adult woman of Chinese ancestry refuses to eat at the nursing home, stating, "I'm just not hungry." What factors should the staff assess for this problem?
The food served may not be culturally appropriate.
A client admitted for hernioplasty is discharged two days later than the calculated time due to postoperative complications. The client is insured through a capitation scheme. In the event of late discharge of the client, who is at loss?
The hospital
A home health nurse is visiting a client who is 60 years of age. During the initial visit, the client's husband answers all of the questions. What would the nurse assess based on this behavior?
The husband is the dominant member of the family.
A nurse is aware that clear and accurate communication is necessary whenever clients are transferred or referred. Which situation best demonstrates a referral?
The nurse arranges for a client with a diabetic foot ulcer to see a podiatrist in community.
A 40-year-old nurse is taking a health history from a Hispanic man aged 20 years. The nurse notes that he looks down at the floor when he answers questions. What should the nurse understand about this behavior?
This is culturally appropriate behavior.
When providing care on an Indian reservation, the nurse has prioritized assessments for diabetes and fetal alcohol syndrome when working with residents of the reservation. How should this nurse's practice be best understood?
The nurse is correct in assessing for health problems that have a higher incidence and prevalence among this population.
A nurse in a large metropolitan city enjoys working in a health clinic that primarily serves Russian clients. What does this statement imply about the nurse?
The nurse respects and values providing culturally competent care.
A client arrives at a health care facility complaining of pain in the abdomen and diarrhea. The physician diagnoses the client with colitis, an acute illness. Why is colitis considered an acute illness?
The onset is sudden
An 81-year-old resident of an intermediate care facility has been assessed and the nurse believes that a move to a skilled nursing facility may be justified. What aspect of the resident's health would warrant a move to a skilled nursing facility?
The resident has developed pressure ulcers on the backs of the heels.
A nurse is referring a client with a preferred provider organization (PPO) to a specialist. Which statement made by the nurse to the client demonstrated proper knowledge of PPO's?
The specialist should be in network
A client had an argument at work about his salary. The client has been consuming a lot of caffeine. The client suffers from insomnia and gets angry quickly. Which technique should the nurse promote to help the client?
Therapeutic coping strategy
A nurse in the hospital is caring for a Native American/First Nations male. Which statement should best guide the nurse's care?
There may be a role for a tribal medicine man in the client's care.
A nurse is caring for a client who had a stroke. The client is lying in a supine position and is unable to reach the foot board. What should the nurse do to prevent footdrop in the client?
Use a foot splint.
A client admitted to the health care facility for minor surgery is given a booklet by the nurse about the health care facility. Which of the following is the purpose of this booklet?
To orient the client to the facility
A nurse is caring for a client with impaired mobility. What is the purpose of the trochanter roll?
To prevent the legs from turning outward
A nurse is caring for a client whose injured cells are releasing chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing?
Transduction
An 80-year-old client has been transferred from the neurological unit to a rehabilitative unit during the client's recovery from a stroke. The client's nursing care plan includes Risk for Disuse syndrome. What intervention should be performed to address this risk?
Use a pressure-reducing device on the client's bed.
A nurse is caring for a client who is sensitive to latex. What is the simplest and most appropriate way to avoid exposing the client to latex?
Use nonlatex gloves for the client.
When providing nursing care to an African American individual, which of the following cultural factors should the nurse consider?
Values and beliefs are often present oriented.
The nurse is transferring a stroke client to a long-term care facility. The client lived at home prior to the illness, but now is aphasic and unable to provide independent care. Which action made by the nurse demonstrates appropriate completion of the client's medication reconciliation?
Verify current medications with the client's physician. ...
A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing?
Visceral pain
A middle-aged client is distraught at receiving a diagnosis of type 2 diabetes in spite of being conscientious about her health for the majority of her adult life. The client tells the nurse "I can't believe I no longer have my health" The nurse should be aware that the World Health Organization defines health as:
a state of physical, mental, and social well being
A middle-age client tells the nurse that the client's neck pain reduced considerably after the client underwent a treatment in which thin needles were inserted into the skin. What kind of pain relief treatment did the client undergo?
acupuncture
A nurse visits an older adult client at home and assesses the safety of the client's environment. Which article can be a threat to the client's safety?
area rugs kept on the stairs without carpet
A male client of Asian descent is operated on for gallstones. On the postoperative night, the nurse finds that the client is not sleeping and is tossing and turning. When asked about analgesics, the client denies having pain. Which nursing action is most appropriate?
assessing for nonverbal expressions of pain
The nurse enters the room and the client is grimacing and guarding the abdomen. The client reports, "I have pain." What is the nurse's first priority?
assessing the client's level of pain
Which nursing activity reflects care given on the tertiary level of healthcare delivery?
assisting with transplant surgery
An 18-year-old is brought to the emergency department with a head injury. The nurse knows that adolescents are vulnerable to injuries related to:
automobile accidents
When discussing his concerns with the nurse, the client discloses that hen he comes home from work, he plays with his pet dog and this makes him feel relaxed. His friends make fun of him because of this, however. The nurse explains that this is perfectly normal and is not a cause of worry. In this case, how is the client relieving stress?
by adopting an alternitive lifestyle
The client has been assessed by the emergency department physician and nurse. The physician wants the client to be observed overnight. The client refuses and wants to leave. What are the components of a properly executed against medical advice (AMA) discharge based on this scenario? (Select all that apply.)
capacity to refuse all risks disclosed medication reconciliation medication reconciliation consent properly documented
A physician has ordered a nurse to perform transcutaneous electrical nerve stimulation (TENS) for a client with back pain. Which candidate is most suitable for TENS?
client involved in sports activities
A nurse is caring for an older adult from a far eastern culture. How does the nurse demonstrate awareness of culturally competent care?
establishing effective communication
A client is discharged from the hospital 2 days post-appendectomy because of diagnostic-related groups (DRGs) What should the nurse be most concerned about?
continuity of care
A nurse is caring for a client who has undergone a surgical intervention in which the pain pathways in the spinal cord have been interrupted to control pain in his back. The nurse knows that the client has undergone which treatment?
cordotomy
Despite the presence of a large number of older adult residents of Asian heritage, a long-term care facility has not integrated the Asian concepts of hot and cold into meal planning. The nurses at the facility should recognize this as an example of:
cultural blindness.
A nurse is using a mechanical lift to assist an obese client with limited mobility. Which client will benefit the most from a mechanical lift?
heavy
During the physical assessment of a client who has been inactive due to a leg injury, the nurse notes that the client tends to breathe very shallowly. What technique should the nurse teach the client in order to breathe more efficiently?
deep breathing
The client is admitted to the hospital with pneumonia, along with various other signs and symptoms. Which is the priority for the nurse to manage?
difficulty breathing
A nurse is assessing a client with severe pain in the lower back. The client's breathing becomes shallow when the client is in pain. Which autonomic nervous system responses should the nurse look for in the client?
dilated pupils
A client with Chrohn's disease in remission is admitted to the nursing unit for follow-up care. The remission state is characterized by:
disappearance of signs and symptoms associated with the disease
The nurse is caring for a client with facial burns who also is prescribed oxygen. What delivery device will the nurse select that is most appropriate for this client?
face tent
Which client growth needs are included in the love and belonging level of Maslow's hierarchy? (Select all that apply).
family intimacy friendships
A client is admitted to the mental health center with attempted suicide. Which of the client's problems is priority for the nurse to manage?
freedom from harm
The nurse directs the UAP to assist a client with eating. Into which position will the nurse delegate the UAP to place the client?
high fowlers
The nurse is working in an acute care setting and performs primary, secondary and tertiary prevention. Which activity performed by the nurse is classified as tertiary prevention.
instructing a client how to use crutches
The client is a disabled veteran with bilateral above the knee amputations (AKA). The client frequently has tender, erythemic areas along bilateral incision lines. Which type of facility will provide appropriate care for this client?
intermediate
A nurse is caring for a middle-aged client with acute abdominal pain at a health care facility. The physician has asked the nurse to administer a prescribed dosage of narcotics to the client to relieve the pain. The client has a throat infection and is unable to take the medication orally. What other delivery route might the physician prescribe?
intramuscular route
A nurse needs to give a bath to a client with chronic back pain. Which ergonomic hazard is the nurse likely to face when caring for the client?
lifting heavy loads
The nurse is performing a comprehensive assessment of functional capability on a client that lives in a certified nursing home. What federally mandated process is the nurse completing?
minimum data set (MDS)
A nurse is caring for a client who is being administered oxygen through a transtracheal catheter. Which device should the nurse use to administer oxygen when cleaning the opening and the tube?
nasal cannula
A nurse is caring for a critically ill client who is receiving oxygen through a non-rebreather mask. The nurse should remember that which situation could lead to oxygen toxicity in the client?
oxygen concentration of more than 50% given for longer than 48 hours
The nurse is caring for a 3-year-old client who experienced smoke inhalation during a house fire, and now requires oxygen. What delivery device will the nurse select that is most appropriate for this client?
oxygen tent
The nurse is delegating inactive client positioning to a UAP. What directions will the nurse include?
placing the client in good alignment with joints slightly flexed
A nurse is explaining A1C diagnostic testing to a client with diabetes. What level of healthcare delivery does this test suggest?
primary
The nurse is caring for a client with multiple areas of skin breakdown on the back. In which position will the nurse choose to place the client to improve arterial oxygenation?
prone
A nurse is working with a client whose quality of life is impacted by the presence of numerous comorbid health problems. The nurse is aware that the client's body is attempting to maintain homeostasis, a process that primarily involves:
responding appropriately to internal and external influences
The nurse is caring for a client with incontinence who has been neglected in supine position at home for more than a week. Which priority nursing diagnosis will the nurse select?
risk for impaired skin integrity
The nurse is caring for a client who was had a percutaneous tracheostomy (PCT) following a motor vehicle accident, and has been prescribed oxygen. What delivery device will the nurse select that is most appropriate for this client?
simple mask
The client lives in a skilled nursing facility and has had an acute exacerbation of multiple sclerosis symptoms. What type of facility will provide the most appropriate care for this client?
skilled
A nurse is transferring a client with myocardial infarction (MI) to a tertiary care center. What referral information is most important for the nurse to relay to the receiving nurse so the client receives appropriate follow-up care?
summary of treatment started and current client condition
A nurse is conducting a focused respiratory assessment of a 21-year-old client who has been admitted to the hospital with a pneumothorax (collapsed lung). The nurse is aware that this client's diagnosis affects multiple aspects of the respiratory function, including external respiration. In what anatomical location does the external respiration take place?
the alveoli
A nurse is caring for a client with cancer who is experiencing pain. What would be the most appropriate assessment of the client's pain?
the client's pain based on a pain rating .
The focal point of nursing is the nurse-client interaction. What must nurses consider when conducting the necessary assessment of their clients and significant others?
their own cultural orientation
When caring for older adults with respiratory ailments, why is it imperative that the nurse carefully assess a client who demonstrates restlessness or confusion?
to differentiate signs of inadequate oxygenation from early signs of delirium
A public health nurse has been asked to participate in an initiative that is aimed at promoting the use of ergonomics. What is the most likely goal of this initiative?
to promote comfort and health in workplace settings
