FUNDAMENTALS

*Which caring intervention helps to provide comfort, dignity, respect, and peace to a client?*

*Relieving pain and suffering Relieving pain and suffering is not just about giving medications but providing comfort, dignity, respect, & peace to a client. Listening helps to obtain meaningful interactions with clients. Spiritual caring helps clients find balance between their own life values, goals, & belief systems. Providing presence helps to convey closeness and a sense of caring.

*A nursing student is listing the impact of applying the Roy adaptation model on improved functional status in clients with heart failure. Which step listed by the nursing student needs correction?*

*"Use of literature resources supports practical-based nursing interventions."* *When using a nursing theory like Roy's adaptation model, the nurse should remember that using literature resources supports theory-based nursing interventions. The nurse should remember that by applying the Roy adaptation model, clients may learn techniques to improve his or her ability to adapt to an illness or condition. When using Roy's adaptation model, the nurse should remember that involving a client's support system helps in increasing the client's ability to use adaptive techniques. When using Roy's adaptation model, the nurse should remember that nursing theories support theory-based nursing practices and define the specific interventions for clients.

*A client is dying. Hesitatingly, his wife says to the nurse, "I'd like to tell him how much I love him, but I don't want to upset him." Which is the best response by the nurse?*

*"You should share your feelings with him while you can." *It is difficult to work through a loss; however, encouraging the sharing of feelings helps both parties feel better about having to let go. The response, "You must keep up a strong appearance for him," impedes the work of acceptance of one's finality and the use of the remaining time to the best advantage. There is no evidence to suggest that the client cannot cope with these emotions; the response, "I think he'd have difficulty dealing with that now," denies that this is a time for closeness and honesty. The response, "Don't you think he knows that without you telling him?" is demeaning, closes off communication, and does not foster the expression of feelings.

*Which nursing intervention is most appropriate for a client in skeletal traction?*

*Assess the pin sites at least every shift and as needed.* *Nursing care for a client in skeletal traction may include assessing pin sites every shift and as needed. The needed weight for a client in skeletal traction is prescribed by the physician, not as desired by the client. The nurse also should ensure that the knots are not tied to the pulley and move freely. The performance of range of motion is indicated for all joints except the ones proximal and distal to the fracture because this area is immobilized by the skeletal traction to promote healing and prevent further injury and pain.

*According to the Centers for Disease Control and Prevention, compared to Caucasians, the syphilis rates among Hispanics are two times higher in 2011. What may be the reason for this?*

*Difference in the status of health literacy* *One cause of the higher rates of syphilis among Hispanic clients could be a lack of health literacy. Presence of equitable health care support would reduce, not cause a health disparity, as would availability of health care facilities. There is no known genetic predisposition to syphilis among any racial/ethnic group.

*Which professional standard does the nurse feel is most important for critical thinking?*

*Evaluation criteria* *An evaluation criterion is an important professional standard required for critical thinking. Logical thinking, accurate knowledge, and relevant information are important intellectual standards required for critical thinking.

*What principal components are associated with a nurse's time management skill? Select all that apply.*

*Goal setting, priority setting, and interruption control forms the principal components of time management. Autonomy is an important component in the decision-making process. Right communication is considered one of the rights of delegation. (Time analysis & evaluation are the other 2)

*Which theory describes the phenomenon of grief or caring?*

*Descriptive theories* *Descriptive theories describe a phenomenon such as grief or caring. Grand theories provide the structural framework for broad, abstract ideas about nursing. Prescriptive theories discuss interventions and expected outcomes for a specific phenomenon. They describe phenomena, speculate on why they occur, and describe their consequences. Middle-range theories have a more narrow scope than grand theories; these theories integrate theory-based research with nursing practices.

*Arrange in order how the items of personal protection equipment (PPE) should be removed after exiting a medical or surgical isolation area*

*Gloves, face shield, gown, mask *According to the Centers for Disease Control and Prevention, gloves should be removed first when exiting medical or surgical isolation in order to avoid those gloves touching and possibly contaminating other equipment outside of the isolation area. Next, the nurse removes the face shield, followed by the gown and then the mask. Handwashing is the next step that should occur after removing all personal protection equipment (PPE).Test-Taking Tip: In this Question Type, you are asked to prioritize (put in order) the options presented. For example, you might be asked the steps of performing an action or skill such as those involved in medication administration.

*The nurse is caring for a client who has an implanted port and is receiving intravenous fluids. To decrease the risk of infection, the nurse should change the noncoring needle how often?*

*7 days *Best practice guidelines indicate that noncoring needles be changed at least every 7 days to decrease risk of infection. Changing a noncoring needle every 3 to 5 days is too frequent and increases the risk for infection as well as client discomfort. Changing a noncoring needle every 9 days increases the risk of infection due to the prolonged length of time the needle is in place.

*A healthcare facility is using the "plan, do, study, act (PDSA)" cycle model for performing a quality improvement. Arrange the order in which quality improvement takes place based on this model.*

Correct1.Review available data. Correct2.Choose the appropriate intervention. Correct3.Evaluate the outcomes. Correct4.Incorporate new practices in daily performance *According to the "plan, do, study, act (PDSA)" model of quality improvement (QI), the first step is to review all available data in order to understand the current practice conditions and determine the need for change. The next step of QI is to "do." This step involves selecting and implementing an intervention based on the reviewed data. The next step is to 'study'. At this stage, the outcomes of the change are evaluated by the healthcare facility. The final step is to 'act'. If the change in the process has been successful and has yielded positive results, then the healthcare facility incorporates the new practices into its daily unit performance.

*Which statement is true about the nursing model "team nursing"?*

Hierarchical communication exists from charge nurse to charge nurse, charge nurse to team leader, and team leader to team members. *In team nursing, there is an existence of hierarchical communication from charge nurse to charge nurse, charge nurse to team leader, and team leader to team members. In the nursing model "total client care," the registered nurse is responsible for all aspects of client care, care can be delegated from the registered nurse to other healthcare team members, and the registered nurse works directly with the client, family members, and healthcare team members.

*Which healthcare system focuses solely on palliative care?*

Hospice *A hospice is a system of family-centered care that allows clients to live and remain at home with comfort, independence, and dignity while easing the pain of terminal illness. The focus of hospice care is palliative care, not curative treatment. Rehabilitation restores a person to his or her fullest physical, mental, social, vocational, and economic potential possible. Assisted living offers an attractive long-term care setting with an environment reminiscent of home and with some resident autonomy. An extended care facility provides intermediate medical, nursing, or custodial care to clients recovering from acute illnesses or clients with chronic illnesses or disabilities.

*Which statement made by a nursing student about Swanson's theory of caring needs correction?*

*

*A nurse should employ which technique to maintain surgical asepsis?*

*Change the sterile field after sterile water is spilled on it.* *A sterile field is considered contaminated when it becomes wet. Moisture can act as a wick and allow microorganisms to contaminate the sterile field. The outsides of containers and packages are not considered sterile and sterile gloves are considered contaminated when touching either of these items. Items on the sterile field should be no less than 1 inch from the outer border or edge of the sterile field; any less is not considered sterile. Surgical areas or wounds should be cleaned from the inside edges to the outside edges to prevent recontamination.

*A nurse is taking care of a client who is extremely confused and experiencing bowel incontinence. What measures can the nurse take to prevent skin breakdown in this client?*

*Check the client's buttocks at least every 2 hours; clean the client immediately after discovering incontinence* *The nurse should first reposition the client so that he or she is in a more comfortable position, and then the nurse should offer basic hygienic measures. The nurse should assist the client with the meal after repositioning. Health education should be provided after repositioning

*After changing a dressing that was used to cover a draining wound on a client with vancomycin-resistant enterococci (VRE), the nurse should take which step to ensure proper disposal of the soiled dressing?*

*Contact precautions must be used for clients with known or suspected infections transmitted by direct contact or contact with items in the environment; thus, the dressing should be placed in a red bag or hazardous materials bag. The soiled dressing should not be placed in a single bag and left in the trash can. Infection control is every healthcare worker's responsibility, not just Environmental Services'. The lab is not responsible for disposal of hazardous wastes that occur as a result of normal nursing activities.

*The mother of an 11-month-old infant reports that the baby has allergies. After an assessment, the primary healthcare provider also suspects anemia. Which questions would the primary healthcare provider most likely ask the mother? Select all that apply.*

*Do you use 2% cow's milk? *Do you use whole cow's milk? *Do you use alternate milk products? *The use of 2% or whole cow's milk in an infant younger than 12 months is not recommended because it may cause intestinal bleeding, anemia, and allergic reactions. Mothers should avoid using any alternate milk products because their use may cause complications in the infant. Breast feeding is recommended for the infant's nutrition because breast milk contains essential proteins, fats, carbohydrates, and immunoglobulins that help bolster the infant's ability to resist infection. An average infant of one month old should have 18 to 21 ounces of breast milk or formula per day.

*The nurse reviews a medical record and is concerned that the client may develop hyperkalemia. Which disease increases the risk of hyperkalemia?*

*End-stage renal disease* *One of the kidneys' functions is to eliminate potassium from the body; diseases of the kidneys often interfere with this function, and hyperkalemia may develop, necessitating dialysis. Clients with Crohn disease have diarrhea, resulting in potassium loss. Clients with Cushing disease will retain sodium and excrete potassium. Clients with gastroesophageal reflux disease are prone to vomiting that may lead to sodium and chloride loss with minimal loss of potassium.

*Which of the following statements about a case manager is correct?*

"A case manager has the ability to establish an appropriate care plan based on the assessment of clients and families." A case manager has the ability to establish an appropriate care plan based on the assessment of clients and families. A change agent helps identify and implement new and more effective approaches to problems. A counselor helps clients identify and clarify health problems and choose appropriate courses of action. A caregiver applies a critical thinking approach to ensure appropriate, individualized nursing care for clients and their families.

*After changing a dressing that was used to cover a draining wound on a client with vancomycin-resistant enterococci (VRE), the nurse should take which step to ensure proper disposal of the soiled dressing?*

*

*A nursing instructor asks a student to describe Betty Neuman's theory. Which statement by the student indicates the need for further education?*

*"Betty Neuman's theory outlines that the external environmental factors act as stressor."* *According to Betty Neuman's theory, both internal and external factors can act as stressors for the client. Betty Neuman's theory is based on five concepts that interact with one another. These five concepts are physiologic, psychologic, sociocultural, developmental, and spiritual. The Neuman systems model is based on stress and the client's reaction to the stressor. In this model, the client can be an individual, group, family, or community.

*A nurse is providing preoperative teaching for a client regarding use of an incentive spirometer and should include what instructions?*

*"Exhale completely; take a slow, deep breath; hold it as long as possible, and slowly exhale."* *The correct procedure to maximize use of an incentive spirometer is to exhale completely, then take a slow, deep breath through the spirometer and hold it as long as possible. This procedure will maximize inspiratory function by expanding the lungs. The client should practice using the incentive spirometer before surgery. When teaching clients, it is important to provide exact step-by-step instructions, thus not leaving out any critical points.

*A registered nurse is teaching a nursing student about how to safely use a urinary catheter. Which statement made by the nursing student indicates ineffective learning?*

*"I will avoid draining urine from the tubing before ambulation."* *Urine should be drained [1] [2] from the tubing into the drainage container before ambulation or exercise. Pooling of the urine in the tubing should be avoided because this action may increase the risk of infection. Prolonged clamping of the tubing should be avoided because intermittent clamping helps to maintain the bladder's capacity and tone. The drainage tube should not be raised above the level of the bladder; urine should flow freely by way of gravity.

*The nurse who is working during the 8:00 am to 4:00 pm shift must document a client's fluid intake and output. An intravenous drip is infusing at 50 mL per hour. The client drinks 4 oz of orange juice and 6 oz of tea at 8:30 am and vomits 200 mL at 9:00 am. At 10:00 am the client drinks 60 mL of water with medications; the client voids 550 mL of urine at 11:00 am. At 12:30 pm, 3 oz of soup and 4 oz of ice cream are ingested. The client voids 450 mL at 2:00 pm. Calculate the total intake for the 8:00 am to 4:00 pm shift. Record your answer using a whole number. ___mL&=*

*1 ounce = 30 mL; therefore the client ingested 120 mL of orange juice at 8:30 am, 180 mL of tea at 8:30 am, 60 mL of water with medications at 10:00 am, 90 mL of soup at 12:30 am, and 120 mL of ice cream at 12:30 pm (counted as a liquid because it melts at room temperature). The client received 400 mL of IV fluid (50 mL × 8 hours = 400). Total intake is 970 mL. Vomit and urine output should not be included in the client's intake.

*Alternative therapy measures have become increasingly accepted within the past decade, especially in the relief of pain. Which methods qualify as alternative therapies for pain? Select all that apply.*

*1.Prayer 2.Hypnosis 4.Aromatherapy 5.Guided imagery *Prayer is an alternative therapy that may relax the client and provide strength, solace, or acceptance. The relief of pain through hypnosis is based on suggestion; also, it focuses attention away from the pain. Some clients learn to hypnotize themselves. Aromatherapy can help relax and distract the individual and thus increase tolerance for pain, as well as relieve pain. Guided imagery can help relax and distract the individual and thus increase tolerance for pain, as well as relieve pain. Analgesics, both opioid and nonopioid, long have been part of the standard medical regimen for pain relief, so they are not considered an alternative therapy.

*A nursing student is evaluating different examples of quality and performance improvement. Which situation should the nurse consider to be an example of quality improvement?*

*A team of nurses identifies the possible reasons for the delays of client admission into special units.* *Quality improvement focuses on studying and improving the processes of providing healthcare services to clients. An example of this improvement is a team of nurses trying to determine the cause for delays of client admission into special units. Performance improvement focuses on evaluating current performance in order to initiate a qualitative change. A team designing a strategy for improving the performance of nurses when administering injections would be a performance improvement. Similarly, a team implementing a new system to improve the performance of nurses to prevent infections during wound debridement is an example of a performance improvement. Evaluating the effectiveness of weekly professional training programs is also an example of a performance improvement.

*A client has undergone a subtotal thyroidectomy. The client is being transferred from the postanesthesia care unit/recovery area to the inpatient nursing unit. What emergency equipment is most important for the nurse to have available for this client?*

*A tracheostomy tray* *The client who has undergone a subtotal thyroidectomy is at high risk for airway occlusion resulting from postoperative edema. With this in mind, emergency airway equipment such as a tracheostomy set and intubation supplies should be immediately available to the client. A defibrillator, an IV infusion pump, and an ECG monitor are equipment items that should be available to all postoperative clients.

*The nurse finds that a client with bilateral oral swelling, pain, and trismus had undergone a surgical extraction of an impacted tooth five days ago. What type of nursing diagnosis does the documentation of acute pain refer to?*

*Actual nursing diagnosis* *According to the given information, the pain is secondary to the surgical procedure. In this case, the nurse has sufficient assessment data to establish the nursing diagnosis. This is an example of an actual nursing diagnosis. A syndrome diagnosis is a clinical judgment describing a specific cluster of nursing diagnoses that occur together. A risk nursing diagnosis describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community. A health promotion nursing diagnosis is a clinical judgment of a person's, family's, or community's motivation, and readiness to increase well-being.

*A registered nurse is educating a nursing student about quality and performance improvement measures. Which activity mentioned by the nurse is an example of a performance improvement?*

*Analyzing the new technique for counting sponges and instruments in the operating room* *Performance improvement focuses on analyzing and evaluating the current performance of healthcare workers in order to bring about a qualitative change. In the given situation, a new technique for performing sponge and instrument counts in the operating room is being analyzed in order to help understand the degree of qualitative change in the system. This is an example of a performance improvement. Quality improvement focuses on the continuous study and improvement of the processes of providing healthcare services to clients. Installing new call bells, conducting client teaching programs before discharge and speeding up the process of obtaining are examples of quality improvements.

*The nurse is assessing a Latino-Caribbean client who was brought to the hospital by family members. The family reports the client started crying, shouting, trembling, had uncontrolled jerking of the extremities, and then fell into a trance-like state. What condition does the nurse suspect?*

*Ataque de nervios *Ataque de nervios is a Latino-Caribbean culture-bound syndrome that usually happens in response to specific stressors. This culture-bound syndrome is characterized by crying, uncontrollable spasms, trembling, shouting, dissociation, and trance-like states. Bulimia nervosa and anorexia nervosa are culture-bound syndromes in the form of eating disorders, but they are not characterized by crying, spasms, and shouting. Shenjing shuairuo is not associated with the Latino-Caribbean culture; instead, it is associated with Chinese culture.

*Which statement is true for attachment in the newborn*

*Attachment is the interaction between the parent and child *Attachment is the interaction between the parent and child. The nurse promotes the parents' and newborn's need for physical contact by encouraging breast feeding. Attachment is a process that evolves over the first 24 months. The newborn is awake and alert for the first half-hour after birth, during which parent-child interaction begins. Molding is the overlapping of the soft skull bones commonly seen in newborns that had vaginal births. Molding allows the fetal head to adjust to the various diameters of the maternal pelvis during birth.

*A nurse is changing the dressing of a postoperative client. The nursing assistant informs the nurse that another client has fallen down near the nursing station after losing consciousness. What is the best nursing action in this situation?*

*Attend to the client who lost consciousness.* *Loss of consciousness may pose a threat to the client's safety and survival, and is a high-priority need. Therefore, the nurse should attend to the unconscious client. The nursing assistant may not have the required knowledge and skills to perform a dressing change. The care of an unconscious client may need critical nursing assessments and clinical decision-making, and should not be delegated to the nursing assistant. Risk of infection is not a threat to survival, and is considered an intermediate need.

*How can nurses exhibit the concept of open-mindedness as a part of critical thinking behavior in their teams? Select all that apply.*

*By respecting the right of others to have different opinions* *By becoming sensitive to the possibility of their own prejudices* *Critical thinking behavior implies the nurse should respect the rights of others to have a different opinion. The nurse should exhibit the concept of open-mindedness by showing sensitivity to the possibility of his or her own prejudices. Being organized and focused reflects systematicity. Maturity requires the nurse to work with cognitive maturity. According to truth seeking, the nurse should seek the true meaning of a situation.

*After reviewing a client's reports, the primary healthcare provider suggests palliative care for the client. Which conditions would qualify the client for this type of care? Select all that apply.*

*Chronic renal failure *Congestive heart failure *Chronic obstructive lung disease

*A client has a platelet count of 49,000/mL (40 × 109/L). The nurse should instruct the client to avoid which activity?*

*Clients with thrombocytopenia are at a greater risk of excessive bleeding in response to minimal trauma. The nurse should instruct the client to avoid blowing the nose, because this activity can increase the risk of bleeding. Ambulation, visiting with children, and the semi-Fowler position are not contraindicated with thrombocytopenia.

*Which statement accurately describes correlational research?*

*Correlational research explores the relationships among variables of interest without any active intervention by the researcher. Correlational research explores the relationships among variables of interest without any active intervention by the researcher. Evaluation research tests how well a program, practice, or policy is working. Experimental research is a study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable. Descriptive research measures the characteristics of people, situations, or groups and the frequency with which certain events or characteristics occur.

*Which caring process is defined as "facilitating the other's passage through life transitions and unfamiliar events" according to Swanson's theory of caring?*

*Enabling *The enabling process facilitates another's passage through life transitions and unfamiliar events such as birth and death. The knowing process involves understanding an event in terms of what it means to the life of another. Doing for caring involves doing for others as one would want for oneself, if possible. The caring process "being with" is defined as being emotionally present for someone else.

*Which suggestion should the nurse offer to parents who are concerned about caring for their toddler?*

*Encourage the toddler to drink from two-handled cups.* *The rapid development of a toddler's skills leads to a sense of autonomy. The toddler should be encouraged to drink from two-handled cups with a spout to prevent spills during the learning process. The toddler should not have more than two to three cups of milk per day. Increasing in the consumption of milk reduces the toddler's appetite for essential solid foods, leading to inadequate iron intake. Parents should limit opportunities for the toddler to say no. The parents should be firm and ask the toddler to take medicine rather than offering choices. Parents should talk, read, or play with the toddler. Television should never be used in place of parent-child interaction.

**What nursing actions best promote communication when obtaining a nursing history? Select all that apply.

*Establishing eye contact *Paraphrasing the client's message *Using broad, open-ended statements *Eye contact indicates to the client that the nurse is listening and interested. Paraphrasing is an effective interviewing technique; it indicates to the client that the message was heard and invites the client to elaborate further. Open-ended statements provide a milieu in which people can verbalize their problems rather than be placed in a situation of providing a forced response. Asking "why" and "how" questions can be threatening to the client, who may not have the answer to these questions. False reassurance is detrimental to the nurse-client relationship and does not promote communication. Direct questions do not open or promote communication.

*What does the professional nurse consider to be the center of decision-making when providing client care?*

*Ethics of care* *A professional nurse always follows the ethics of care and considers caring to be the center of decision-making. The nurse must know what behavior is ethically appropriate while caring for a client. A nurse's effectiveness in performing tasks is important to client care; however, client satisfaction comes from the effective dimension of care. Because ethics of care are unique to each client, the nurse should not base decision-making only on analytical skills. The nurse should not provide client care based only on intellectual principles or research knowledge. Caring is the most important factor because it considers client preferences and values.

*An African man presents to the emergency department to obtain pain medication. The nurse behaves judgmentally and labels the client a drug abuser. What is the nurse demonstrating?*

*Ethnocentrism *Ethnocentrism is the tendency of a person to hold his or her own beliefs superior to those of other people. It causes biases and prejudices in regard to people from other groups. This practice is transmitted by cultural groups from one generation to another. In multiculturalism, two cultures coexist and are accepted by the individual. In a cultural encounter, part of cultural competence, a nurse engages in cross-cultural interactions for effective communication. Cultural imposition occurs when a nurse or health care provider ignores the differences between his or her own culture and others and imposes his or her beliefs on people of other cultures.

*A nurse is assigned to change a central line dressing. The agency policy is to clean the site with povidone-iodine and then cleanse with alcohol. The nurse recently attended a conference that presented information that alcohol should precede povidone-iodine in a dressing change. In addition, an article in a nursing journal stated that a new product was a more effective antibacterial than alcohol and povidone-iodine. The nurse has a sample of the new product. How should the nurse proceed?*

*Follow the agency's policy unless it is contradicted by a primary healthcare provider's prescription. *Agency policy determines procedures; if the procedure is out of date or problematic, the nurse should contact the primary healthcare provider for a change in the prescription. The nurse cannot use another product without a primary healthcare provider's prescription. The nurse will be risking liability if agency policy is not followed unless the prescription is changed by the primary healthcare provider.

*A client is receiving total parenteral nutrition (TPN) through a central venous access device. The nurse discovers that the TPN bag is empty and the next bag has not been received yet from the pharmacy. What is the most appropriate action for the nurse to take?*

*Hang a bag of 10% dextrose at the ordered TPN rate & place an urgent request for the next TPN bag.* *Clients receiving TPN require monitoring of blood glucose because the TPN solution contains a high concentration of dextrose. In response to the high-dextrose TPN solution, the pancreas increases production of insulin to meet the glucose demands. In this situation, the current TPN infusion is completed, and the nurse should infuse 10% dextrose to compensate for the loss while the next TPN bag is being prepared. If this action is not taken, the client could experience a profound hypoglycemic reaction. After beginning an infusion of 10% dextrose, the nurse may perform a finger stick glucose test and notify the healthcare provider if the results are abnormal. Discontinuing the infusion and flushing the line until the next TPN bag is ready is not recommended. Starting an infusion of 5% dextrose at keep vein open (KVO) until the next TPN is ready may not prevent hypoglycemia; the nurse manager does not need to be involved unless there is a negative client outcome that results.

*Arrange the steps involved in applying a surgical mask.*

*If a mask is properly applied, it fits the mouth and nose securely so that pathogens and body fluids cannot enter or escape through the sides. First, the mask's top edge should be identified and the mask should be held by its two strings. Then, the two top ties are tied at the back of the head, with the ties above the ears. The lower two ties are tied around the neck with the mask well around the chin. Then, the upper metal band should be pinched around the bridge of the nose.

*Which of these is a one-on-one communication between a nurse and another person?*

*Interpersonal communication* *Interpersonal communication is a one-on-one interaction between a nurse and another person that often occurs face to face. Small-group communication is interaction that occurs when a small number of people meet. Intrapersonal communication is a form of communication that occurs within an individual. Transpersonal communication is an interaction that occurs within a person's spiritual domain.

*Which theorist suggested that the goal of nursing is to use communication to help clients reestablish a positive adaptations to their environments?*

*King* *According to King's theory, the goal of nursing is to use communication to help the client reestablish a positive adaptation to his or her environment. According to Peplau's theory, the goal of nursing is to develop an interaction between nurse and client. According to Nightingale's theory, the goal of nursing is to facilitate the reparative processes of the body by manipulating a client's environment. According to Benner and Wrubel, the goal of nursing is to focus on a client's need for caring as a means of coping with stressors of illness.

*While undergoing a soapsuds enema, the client reports abdominal cramping. What action should the nurse take?*

*Lower the height of the enema bag. *Abdominal cramping during a soapsuds enema may be due to too rapid administration of the enema solution. Lowering the height of the enema bag slows the flow and allows the bowel time to adapt to the distention without causing excessive discomfort. Stopping the infusion is not necessary. Advancing the enema tubing is not appropriate. Clamping the tube for several minutes and then restarting the infusion may be attempted if slowing the infusion does not relieve the cramps.

*A student nurse is asking a registered nurse to suggest a database source to find information on studies related to allied health sciences. Which database would the registered nurse suggest?*

*MEDLINE* *The MEDLINE database includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. The National Guidelines Clearinghouse includes a repository for structured abstracts about clinical guidelines and their development. It also includes a condensed version of the guidelines. The Cochrane Database includes full text of regularly updated systematic reviews prepared by the Cochrane Collaboration as well as completed reviews and protocols.

*The Magnet Recognition Program for health care organizations is based on fourteen forces of magnetism related to five magnet model components. Which force of magnetism is assessed to review the structural empowerment of the organization?*

*Personnel policies and programs* *Health care organizations that apply for Magnet status must demonstrate innovations in professional practice. One of the forces of magnetism that impacts the structural empowerment of the organization is its personnel policies and programs. Personnel policies of an organization should provide an innovative environment in which the staff are developed and empowered. Empirical quality outcomes are reviewed by assessing the quality of care. New knowledge, innovations, and improvements are reviewed by assessing the quality improvement of the health care organization. Interdisciplinary relationships are assessed to review exemplary professional practice.

*A theory contains a set of components such as concepts, definitions, assumptions or propositions. What do these components help to explain?*

*Phenomenon *A theory contains a set of components such as concepts, definitions, assumptions or propositions that explain a phenomenon. The domain is the perspective of a profession. A paradigm is a pattern of thought that is useful in describing the domain of a discipline. Environment or situation includes all possible conditions affecting clients and the settings in which their health care needs occur.

*A staff nurse on a medical-surgical unit has been assigned to care for a number of clients. The nurse decides to review their individual records before client contact. Which phase of the nurse-client relationship does this represent?*

*Pre-interaction phase *The preinteraction phase is a preparatory phase of the planned therapeutic relationship. The working phase is the period in the relationship when individuals are occupied with achieving goals and sharing facts and feelings. The orientation phase is the initial period of the interaction; it is an introductory or exploratory phase. The termination phase is the period in the relationship when individuals are beginning to separate and move toward independent paths.

*A nurse notices that a child is playing with a doll and is practicing hygiene by brushing its hair and teeth. In which stage of Piaget's theory of cognitive development should the nurse expect this child to be considered*

*Preoperational stage* *According to Piaget's theory of cognitive development, in the preoperational stage, the child demonstrates animism. Animism is defined as the humanization of non-living things. During this stage, the child believes that inanimate objects have lifelike thoughts, wishes, and feelings. He or she brushes the doll's hair and teeth to foster cognitive development. In the sensorimotor stage, the child learns that he or she is separate from the environment. During the formal operations stage, an individual demonstrates feelings and behaviors characterized by self-consciousness. During the concrete operations stage, the child is able to perform mental operations.

*Which points have been correctly stated regarding prescriptive theories? Select all that apply.*

*Prescriptive theories address nursing interventions for a phenomenon. *Prescriptive theories describe the conditions under which the prescription occurs. *Prescriptive theories guide nursing research to develop and test specific nursing interventions. *Prescriptive theories address nursing interventions for a phenomenon. Prescriptive theories describe the conditions under which the prescription occurs. Prescriptive theories guide nursing research to develop and test specific nursing interventions. Prescriptive theories predict the consequences. Prescriptive theories are action-oriented and test the validity and predictability of a nursing intervention.

*Health promotion efforts for a chronically ill client should include interventions related to primary prevention. What should this include?*

*Primary prevention activities are directed toward promoting a healthful lifestyle and increasing the level of well-being. Performing yearly physical examinations is a secondary prevention. Emphasis is on early detection of disease, prompt intervention, and health maintenance for those experiencing health problems. Providing hypertension screening programs is a secondary prevention. Emphasis is on early detection of disease, prompt intervention, and health maintenance for those experiencing health problems. Teaching a person with diabetes how to prevent complications is a tertiary prevention. Emphasis is on rehabilitating individuals and restoring them to an optimal level of functioning.

*Which subdimension would form a part for the caring process "doing for" according to the Swanson's theory of caring? Select all that apply.*

*Protecting & Comforting* *Protecting and comforting are the subdimensions of "doing for" according to the Swanson's theory of caring. Focusing is the subdimension of the caring process "enabling." The subdimensions of "seeking cues" and "generating alternatives" are appropriate for the caring process "knowing."

*A nurse is caring for an elderly client who has constipation. Which independent nursing intervention helps to reestablish a normal bowel pattern?*

*Prune juice does not require a primary healthcare provider's order and helps to promote bowel movement because it contains sorbitol that increases water retention in feces. Administration of a mineral enema requires a prescription from a primary healthcare provider. Encouraging the client's fluid intake by offering 1 cup of fluid every hour is helpful in preventing constipation but not as effective in resolving constipation as prune juice. Removing impactions does not establish regular bowel patterns.

*Which interventions should the nurse perform when caring for an actively dying client? Select all that apply.*

*Reassure the client and family. .*Manage the client's symptoms. *The nurse should provide comfort care for a client who is actively dying by managing the client's symptoms and reassuring the client and family during the dying process. Reassuring the client and family by providing simple bits of information and using therapeutic communication during the dying process can help to reduce their emotional anxiety. Symptom management maximizes the client's quality of life and improves the client family experience with the dying process of a loved one. The client should not be admitted to hospice care while actively dying; there will likely not be enough time and this action could be traumatic for the client and family. A client is admitted to hospice care if they are not actively dying and death is expected within 6 months. The client does not require laboratory tests while actively dying. The client should be repositioned as needed for comfort; for example, placing the head of the bed in the highest position can facilitate breathing comfort.

*While a nurse is providing food to a client in traction, the client reports feeling uncomfortable from being in the same position. Which nursing intervention is priority in this situation?*

*Repositioning the client *The nurse should first reposition the client so that he or she is in a more comfortable position, and then the nurse should offer basic hygienic measures. The nurse should assist the client with the meal after repositioning. Health education should be provided after repositioning.

*A nurse is recollecting Sigmund Freud's psychoanalytical model of personality development. What are the characteristics of the genital stage according to this model? Select all that apply.*

*Sexual urges are directed outside the family circle. *Unresolved sexual conflicts resurface during this stage. *An individual may resolve the sexual conflicts at this stage. *According to Sigmund Freud's psychoanalytical model of personality development, an individual passes through five stages of psychosexual development. The last stage is the genital stage, which lasts from puberty to adulthood. At this stage, sexual urges are reawakened and directed towards people outside the family circle. In the adolescent period, unresolved previous sexual conflicts resurface. An individual may resolve these conflicts at this stage. Upon reaching the anal stage, the focus of a child's pleasure shifts to the anal area. When an individual reaches the anal stage, sexual urges from the oedipal stage are repressed and channeled into productive activities that are socially acceptable.

*What information should the nurse provide for a client who is discharged from the health care facility with a surgical wound? Select all that apply.*

*Skill to care for the surgical wound *Safe and effective use of medications *List of appropriate community resources *The nurse should teach the client and family how to care for the surgical wound while at home. The nurse should seek a return demonstration of the teaching to confirm the client has understood the teaching. The nurse should teach the client to take all medications as prescribed for effectiveness. The client may not be fully independent on discharge. Therefore the nurse should provide the client with information about community resources such as home health care service or home food services. The nurse should counsel the client about nutrition and modified diets including food-drug interactions. The primary health care provider refrains from prescribing any medication that can lead to drug-drug interactions. The nurse should teach the client to recognize the changes in the surgical area and report only if there is an unexpected change in the area.

*A client with a terminal illness is grateful for the care received in the hospital and has slowly started to come to terms with imminent death. The nurse recognizes that the client's behavior and attitude is most consistent with which cultural group?*

*Somalian culture *Terminally ill clients who belong to the Somalian culture may slowly accept their imminent death and have faith in God. Somalian clients will generally express their gratitude to the care received in the hospital. Clients who belong to the German and Ukrainian cultures may not accept their illness and may fight against the illness in them. Clients who belong to a more secular culture or are less identified by religious institutions may not accept their imminent death.

*Which statement made by a nursing student about Swanson's theory of caring needs correction?*

*Swanson's theory of caring provides a basis to help nurses understand how clients cope with uncertainty & the illness response *Swanson's theory of caring provides a basis for identifying and testing nurse caring behaviors to determine if caring will improve client health outcomes. Middle-range theories provide a basis to help nurses understand how clients cope with uncertainty and the illness response. The components of Swanson's theory of caring provide a foundation of knowledge for nurses to direct and deliver caring nursing practices. Swanson's theory of caring defines five components of caring: knowing, being with, doing for, enabling, and maintaining belief. Swanson's theory of caring was developed by Kristin Swanson by conducting extensive interviews with clients and their professional caregivers.

*The registered nurse coordinates with a dietician and a certified diabetes educator (CDE) while caring for a client recently diagnosed with diabetes. Which Quality and Safety Education for Nurses (QSEN) competency is involved in this intervention?*

*Teamwork and collaboration* *The nurse recognizes the contributions of other health team members and coordinates effectively with them to ensure quality care for the client. This intervention involves the QSEN competency of teamwork and collaboration. The nurse values his of her own role in providing safety by minimizing the risk of harm to clients and health care providers through system effectiveness. The nurse provides patient-centered care by recognizing the client as the source of control and full partner in health care. The nurse applies evidence-based practice by integrating best current evidence with clinical expertise and client preferences and values to deliver optimum health care.

*A client asks the nurse, "Should I tell my partner that I just found out I'm human immunodeficiency virus (HIV) positive?" What is the nurse's most appropriate response?*

*The correct response promotes an exploration of the client's dilemma; it encourages further communication. Although the decision is for the client to make, this response is not supportive and abandons the client. It is inappropriate for the nurse to give advice.

*A registered nurse instructs a nursing student to use knowledge and experience to choose proper strategies to use to care for clients. Which critical-thinking skill does the registered nurse refer to?*

*The critical-thinking skill of explanation involves using knowledge and experience to provide client care. The nursing practice of assessing whether the obtained data is true is called analysis. Using criteria such as expected outcomes, pain characteristics, and learning objectives to determine results of nursing actions is an evaluation skill. The nursing practice of being orderly in data collection and looking for patterns to categorize data refers to interpretation.

*A nursing student is taking down notes about paradigm. Which point noted down by the nursing student needs correction?*

*The domain is the perspective of a profession, not a paradigm. The paradigm of nursing includes four links: the person, health, environment and situation, and nursing. A paradigm links the knowledge of science, philosophy, and theories accepted and applied by a discipline. The elements of the nursing paradigm direct the activity of the nursing profession, including knowledge development, philosophy, theory, educational experience, research, and practice.

*A young adult tells the nurse, "Society needs to be educated regarding involving people affected with AIDS into the social sphere." According to Lawrence Kohlberg's Theory of Moral Development, what does the statement indicate?*

*The individual has reached the Social Contract Orientation stage.* *The young adult's statement indicates that the individual has reached the "Social Contract Orientation" stage. In this stage, an individual recognizes that the law needs to be changed in order to improve society. In the Society-Maintaining Orientation stage, an individual understands that certain actions are not done not because it can lead to punishment, but because the act is not right. In the Instrumental Relativist Orientation stage, a child understands that punishment is not a proof of being wrong, but is an action that one wants to prevent. In the Punishment and Obedience Orientation stage, a child thinks that he or she may get punished if he or she does not adhere to the rules and regulations.

*An adult child of a dying client says to the nurse in the nursing home, "I am so upset because my parent is always angry at me." What is the nurse's best initial response?*

*Understanding the stages leading to the acceptance of death may help the family member understand the client's moods and anger. The parent may not be frightened unless stated by the client; some clients welcome death as a release from pain. It is unlikely that the parent is attempting to reduce the family member's need for dependency; anger is one of the stages of accepting death. It is an assumption by the nurse that the parent is hurt that the family member will not provide physical care at home unless stated by the client.

*A client with a leg fracture is hospitalized. The registered nurse instructs the nursing student to interrogate the client to ascertain the reason for the injury. Which question would help to determine an extrinsic factor?*

*Were you wearing inappropriate shoes?* *Extrinsic factors include environmental hazards outside and within the home. Asking the client about his or her footwear will help to ascertain whether there was an extrinsic factor that may have caused the fall. Intrinsic factors include impaired vision, the taking of sedatives or hypnotics, and a history of a postural hypotension.

*A client with cancer has undergone treatment. The client's primary healthcare provider receives a record of the client's care from the oncologist. Which descriptions are given under the care summary received by the primary healthcare provider? Select all that apply.*

-information about treatment institutions and key providers -identification of a key point of contact and coordinate of care *In the client's care record, the primary healthcare provider collects information about treatment institutions and key providers and identifies the key point of contact and coordinators who provided care. During a follow-up care plan, a description about the cancer screening, information regarding the late-long term effects of treatments, and information about possible signs of recurrence should be considered.1