L1 Exam 2
A nurse is planning an in-service training session about nutrition. Which of the following statements should the nurse include in the teaching? "Fats provide energy." "Carbohydrates repair body tissues." "Fats regulate fluid balance." "Carbohydrates prevent interstitial edema."
"Fats provide energy."
A nurse is completing dietary teaching with a pt who has CHF and is prescribed a 2g sodium diet. Which of the following statements by the pt indicates an understanding of the teaching? "I should use salt sparingly while cooking." "I can have yogurt as a dessert." "I should use baking soda when I bake." "I should use canned vegetables instead of frozen."
"I can have yogurt as a dessert."
A nurse is providing discharge teaching to a pt who is postoperative following cataract surgery and has an intraocular lens implant. Which of the following statements by the pt indicates an understanding of the instructions? - "I will sleep on the affected side." - "I will avoid bending over." - "I will restrict caffeine in my diet." - "I will take aspirin to relieve my pain."
"I will avoid bending over."
A nurse is providing teaching to a pt who has COPD about maintaining proper nutrition. Which of the following statements by the client indicates an understanding of the teaching? "I will increase my fluid intake when I eat a meal." "I will eat more cold foods at meals rather than hot foods." "I will avoid high-fat foods like butter and gravies." "I will cook my meals instead of eating convenience foods."
"I will eat more cold foods at meals rather than hot foods." cold foods = less full feeling, can eat more
A nurse is educating a pt who is at 10 weeks gestation and reports frequent N&V. Which of the following statements should the nurse include in the teaching? "You should eat foods served at warm temperatures." "You should brush your teeth right after you eat." "You should try to eat sweet foods when you feel nauseated." "You should eat dry foods that are high in carbohydrates when you wake up."
"You should eat dry foods that are high in carbohydrates when you wake up."
When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (select all that apply) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.
1, 3, 4
A patient with a colostomy wants to learn how to irrigate a newly created colostomy. The nurse provides this teaching by developing a therapeutic nurse-patient relationship and implementing teaching strategies. Identify the statements that are included in the working stage of this therapeutic relationship. Select all that apply. 1. "How do you feel about doing this procedure?" 2. "Would you like to try to insert the cone yourself today?" 3. "You did a great job managing the instillation of fluid today." 4. "I am here to help you learn how to irrigate your colostomy." 5. "I'll arrange for a home care nurse to visit you in your home when you are discharged."
2. "Would you like to try to insert the cone yourself today?" 3. "You did a great job managing the instillation of fluid today."
A nurse is developing a therapeutic relationship with a patient with emotional needs. Which nursing interventions are essential during the working stage of the relationship? 1. Establish a formal or informal contract that addresses the patient's problems. 2. Implement nursing actions that are designed to achieve expected patient outcomes. 3. Develop rapport and trust so the patient feels protected and an initial plan can be identified. 4. Clearly identify the role of the nurse and establish the parameters of the professional relationship.
2. Implement nursing actions that are designed to achieve expected patient outcomes.
A nurse is presenting an in-service training session about nutrition. How many of the amino acids must be obtained from dietary intake? 6 9 11 15
9
A nurse is caring for a pt who is recovering at home after inpatient treatment for burn injuries. To increase the protein density of the pt's meals, which of the following recommendations should the nurse make to the client's caregiver? - Use sour cream instead of plain yogurt - Add honey to cooked cereals - Use salad dressing in place of mayonnaise - Add chopped hard-boiled eggs to soups and casseroles
Add chopped hard-boiled eggs to soups and casseroles
A nurse is planning dietary teaching for a pt who has diabetes. Which of the following actions should the nurse plan to take first? - Obtain sample menus from the dietitian to give to the pt - Ask the pt to identify the types of foods she prefers - Identify the recommended range of the pt's blood glucose level - Discuss long term complications that can result from non-adherence to the dietary plan
Ask the pt to identify the types of foods she prefers
The nurse is supervising a newly licensed nurse who is administering a controlled substance. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure? - Placing an unused portion of the medication in the sharps container - Asking another nurse to observe the disposal of an unused portion of the medication - Counting the inventory of the available narcotic after administering the medication - Ensuring that another nurse signs the control inventory form after disposal of an unused portion of medication
Asking another nurse to observe the disposal of an unused portion of the medication
A nurse is reviewing the lab reports of a pt who is receiving enteral feedings. Which of the following values indicates a complication of enteral feeding that the nurse should report to the provider? Sodium 143 mEq/L Potassium 4.3 mEq/L BUN 25 mg/dL Glucose 185 mg/dL
BUN 25 mg/dL- normal range 10-20 mg/dL, indicates dehydration
A nurse in a provider's office is teaching a pt about foods that are high in fiber. Which of the following food choices made by the pt indicate an understanding of the teacher? Select all that apply. Canned peaches White rice Black beans Whole-grain bread Tomato juice
Black beans Whole-grain bread
A nurse is caring for a group of pt's in a med-surg unit. Which of the following disorders should the nurse identify as increasing the pt's metabolic rate? Select all that apply. COPD Hypothyroidism Cancer Parkinson's Disease Major burns
COPD Cancer Parkinson's Disease Major burns
A nurse is performing a neurological assessment for a client. By asking the client to stick out his tongue, which of the following cranial nerves is the nurse testing? - Cranial nerve XII - Cranial nerve X - Cranial nerve VIII - Cranial nerve V
Cranial nerve XII
A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis (MG). Which of the following pieces of information should the nurse include? A. Use of enemas to treat constipation caused by daily medications B. Take a hot bath when muscles ache C. Eat a low calorie diet D. Set an alarm to ensure medication dosages are taken on time
D. Set an alarm to ensure medication dosages are taken on time
A nurse is caring for a pt who has acute renal failure. Which of the following assessments provides the most accurate measure of the pt's fluid status? Daily weight Blood pressure Specific gravity Intake and output
Daily weight
A nurse is reviewing the laboratory findings of a pt who has a protein-calorie malnutrition. Which of the following findings should the nurse expect? Decreased albumin Elevated hemoglobin Elevated lymphocytes Decreased cortisol
Decreased albumin
A nurse is caring for a pt from the middle east who has celiac disease.Which of the following actions should the nurse perform regarding the pt's diet? - Provide foods prepared according to the kosher dietary law - Ask the kitchen to prepare grits to meet the clients dietary needs for grains - Determine the pt's dietary preferences - Prepare a diet tray that includes vegetables and barley soup
Determine the pt's dietary preferences
A nurse is teaching a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? - Digesting fats - Producing chyme - Stimulating gastric acid secretion - Providing energy
Digesting fats
A nurse is conducting dietary teaching with a client who has a history of renal calculi. Which of the following instructions should the nurse include in the teaching? Consume foods containing vit C Drink 3.8 L (4 quarts) of water throughout the day Suggest almonds as a snack Limit sodium intake to 3g per day
Drink 3.8 L (4 quarts) of water throughout the day
A nurse is assessing a pt. Which of the following findings should the nurse identify as an indication of protein-calorie malnourishment? Select all that apply. Gingivitis Dry, brittle hair Edema Spoon-shaped nails Poor wound healing
Dry, brittle hair Edema Poor wound healing Gingivitis - manifestation of vitamin c deficiency Spoon-shaped nails - manifestation of iron deficiency
A nurse is reviewing the lab results of a pt who has end-stage renal disease and reports fatigue. The pt's hemoglobin is 8 g/dL. The nurse should expect a prescription for which of the following medications? Erythropoietin Erythromycin Filgrastim Calcitriol
Erythropoietin - stimulates the production of RBCs and is used to tx anemia associated with chronic
A nurse is caring for a pt who has had repeated middle ear infections. The pt reports that the provider said the infections are due to an obstruction of the structure that connects the middle ear to the throat. The nurse should identify that the provider was referring to which of the following structures? - Oval window - Auricle - Tympanic membrane - Eustachian tube
Eustachian tube
A nurse is caring for a pt who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? Fortified milk Ripe bananas Steamed broccoli Green leafy vegetables
Fortified milk *Vitamin D promotes calcium absorption!
A nurse is providing dietary teaching to a pt who has chronic renal failure. Which of the following food choices by the client indicates an understanding of the teaching? Canned soup Grilled fish Pastrami Peanut butter
Grilled fish
A nurse is teaching a group of parents to toddlers about measures to reduce the risk of choking. Which of the following foods increase the risk of choking in toddlers? (Select all that apply) - Hot dogs - Grapes - Bagels - Marshmallows - Graham crackers
Hot dogs Grapes Bagels Marshmallows
A nurse is presenting an in-service training session about nutrition. Which of the following simple sugars should the nurse identify as the carbohydrate found in milk? Lactose Sucrose Maltose Fructose
Lactose Sucrose - table sugar, found in fruits and vegetables Maltose - germinating cereals, such as barley Fructose - honey and fruit
The nurse is planning care for a pt who has anorexia and nausea due to cancer treatment. Which of the following interventions should the nurse include? Serve foods at warm or hot temperatures Offer the client low-density foods Make sure the client lies supine after meals Limit drinking liquids with food
Limit drinking liquids with food
A nurse in a providers office is collecting information from an older adult client who reports taking acetaminophen 500mg/day for severe joint pain. The nurse should instruct the client that large doses of acetaminophen could cause which of the following adverse effects? Constipation Gastric ulcers Respiratory depression Liver damage
Liver damage
A nurse on a mental health unit is preparing to terminate the nurse-patient relationship with a pt who no longer requires care. Which of the following concepts should the nurse and client discuss in the termination phase of the relationship? - Loss - Trust - Self-disclosure - Risk-taking
Loss
A nurse is providing dietary teaching to a pt who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? Avoid foods containing protein Drink liquids during each meal Eat foods that contain simple sugars Maintain a supine position after meals
Maintain a supine position after meals - slows gastric emptying
A nurse is caring for a pt who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. Which of the following dietary recommendations should the nurse share with the client? Eat with metal utensils Limit coffee Avoid citrus foods Offer mints
Offer mints
A nurse is planning an in-service training session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes plays a role in the digestion of protein? Amylase Lipase Steapsin Pepsin
Pepsin - secreted by gastric mucosa to break down protein into polypeptides Amylase - secreted by pancreas/intestine to break down starches into glucose Lipase - secreted by pancreas to break down triglycerides into monoglycerides Steapsin - secreted by gastric mucosa to
A nurse is monitoring a pt's lab results. Which of the following results should be reported to the HCP? - Sodium 140 mEq/L - Potassium 3.0 mEq/L - Chloride 100 mEq/L - Magnesium 2.0 mg/dL
Potassium 3.0 mEq/L Normal Ranges: Na+ = 135 - 145 mEq/L K+ = 3.5 - 5.0 mEq/L Cl = 96 - 108 mEq/L Mg = 1.6 - 2.6 mg/dL
A nurse is providing teaching to a female pt who has a new prescription for pravastatin to treat hyperlipidemia. Which of the following pieces of information should be included in the pt education? - Pravastatin can be taken with grapefruit juice - Pravastatin can be continued during pregnancy - Pravastatin should be taken with the morning meal - Lab testing to monitor WBC count is required
Pravastatin can be taken with grapefruit juice!!!
A nurse is conducting an admission interview with a pt. Which of the following pieces of assessment information should the nurse collect during the introductory phase of the interview? - Pt's level of comfort and ability to participate in the interview - Previous illnesses and surgeries Events surrounding the pt's recent illness - Sociocultural history
Pt's level of comfort and ability to participate in the interview
A nurse is caring for a pt who has peripheral edema. The nurse should identify which of the following nutrients regulates extracellular fluid volume? Sodium Calcium Potassium Magnesium
Sodium
A nurse is providing teaching to a pt who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? Select all that apply. Take allopurinol as prescribed Exercise several times a week Limit intake of foods high in purine Decrease daily fluid intake Avoid citrus juices
Take allopurinol as prescribed Exercise several times a week Limit intake of foods high in purine
The nurse is providing nutritional teaching to a group of clients. Which of the following definitions for the recommended dietary allowance (RDA) should the nurse include in the teaching? - The RDA is a comprehensive term that includes various dietary standards and scales. - The RDA defines the level of nutrient intake that meets the needs of healthy people in various groups. - The RDA defines the levels of nutrients that should not be exceeded to prevent adverse health effects. - The RDA is the daily percentage of energy intake values for fat, carbohydrate, and protein.
The RDA defines the level of nutrient intake that meets the needs of healthy people in various groups.
A nurse is caring for a pt who has a new dx of pernicious anemia. The nurse should expect the pt's provider to prescribe which of the following medications for this pt? Ferrous sulfate Epoetin alfa Vitamin B12 Folic acid
Vitamin B12
A verbally abusive partner has told a significant other many negative comments over the years. In the crisis center, the nurse would anticipate that the patient may have which self-concept deficits? a. Body image b. Role confusion c. Rigidity d. Yearning
a. Body image
A nurse is assessing a group of adolescents. Which person is most likely to have the highest self-esteem? a. Latino adolescent female who has strong ethnic pride. b. Caucasian boy who lives below federal poverty level. c. African-American adolescent male who has severe acne. d. Adolescent who was suspended twice from high school
a. Latino adolescent female who has strong ethnic pride.
A nurse is assessing a patient's self-concept. Which area should the nurse assess first? a. Role performance b. Vital signs c. Anxiety d. Morals
a. Role performance In assessing self-concept and self-esteem, first focus on each component of self-concept (identity, body image, and role performance). Self-concept is a psychological/emotional issue, not a physical issue for vital signs. Anxiety may be a stressors or a sign of low self-concept. Self-concept is not a moral issue
A male patient states, "I'm such a loser. I only had that job for a month." Which outcome criteria will the nurse add to the patient's care plan? a. The patient will verbalize two life areas in which he functions well. b. The patient will find new employment before the next clinic visit. c. The patient will confront a former boss about previous work problems. d. The patient will identify two reasons why he is considered a bad employee
a. The patient will verbalize two life areas in which he functions well.
__________ is a decrease in salivary production, leading to thicker mucous and dry mouth. a. xerostomia b. presbyopia c. myopia d. presbycusis
a. xerostomia
While gathering an adolescent's health history, the nurse recognizes that the patient began to act out behaviorally and engaged in risky behavior when the patient's parents divorced. Which information will the nurse gather to help in determining situational low self-esteem? a. How long the parents were married? b. How the patient views behaviors? c. Why the parents are divorcing? d. Why the patient is acting out of control?
b. How the patient views behaviors? A nurse can identify situational life stressors that can impact a person's self-concept. By asking about a patient's thoughts and feelings, the nurse will be able to use communication skills in a therapeutic manner. This will facilitate the patient's insight into behaviors and will enable the nurse to make referrals or provide needed health teaching. The length of time married and the reason for the parents' divorce do not explain the patient's behaviors. Why the patient is acting out of control is not as important as how the patient views actions when out of control
A charge nurse is observing a newly licensed nurse irrigate a client's ear, which is impacted with cerumen. Which of the following actions requires the charge nurse to intervene? a. Visualizing the eardrum before irrigating b. Instilling 50mL of fluid with each irrigation c. Using firm, continuous pressure while irrigating d. Warming the irrigation fluid
b. Instilling 50mL of fluid with each irrigation 5-10mL
__________ results from vestibular dysfunction, vertigo. a. dry eyes b. disequilibrium c. stroke d. glaucoma
b. disequilibrium
A nurse grimaces while changing a patient's colostomy bag. Which effect will the nurse's behavior most likely have on the patient? a. Assist recovery by using honest communication. b. Motivate the patient to increase physical activity. c. Promote development of a negative body image. d. Develop a kind nickname for the colostomy bag.
c. Promote development of a negative body image.
When caring for an older-adult patient, which technique will the nurse use to enhance an older-adult patient's self-concept? a. Discussing current weather b. Encouraging patients to sing c. Reviewing old photos with patients d. Allowing patients extra computer time
c. Reviewing old photos with patients
What is presbycusis? a. blurring of reading matter, distortion or loss of central vision and vertical lines b. build-up of earwax, causing conduction deafness c. progressive hearing disorder in older-adults d. decreased tear production that results in itching and burning
c. progressive hearing disorder in older-adults
A nurse is teaching a pt who has myopia about laser-assisted in situ keratomileusis (LASIK) surgery. Which of the following is an adverse effect of LASIK surgery? a. Eyelid twitching b. Photosensitivity c. Intraocular hemorrhage d. Dry eyes
d. Dry eyes
A nurse is reviewing the medical history of a pt who has presbyopia. With which of the following activities should the nurse expect the client to have difficulty? A. Finding the bathroom in the dark b. Driving at night c. Seeing numbers on highway signs d. Reading the newspaper
d. Reading the newspaper PresBYoptia = "bye bye", can see far , not close. MYopia = "my", can see close, not far.
