nur 352 exam 3 EAQ

A healthcare provider prescribes epoetin subcutaneously three times a week for an older adult with chronic lymphocytic leukemia (CLL) who lives alone. The nurse plans to teach the client about the medication. What should the nurse do first? <p>A healthcare provider prescribes epoetin subcutaneously three times a week for an older adult with chronic lymphocytic leukemia (CLL) who lives alone. The nurse plans to teach the client about the medication. What should the nurse do first?</p> Demonstrate the injection technique Assess the client's readiness to learn Explain how to perform sterile technique Encourage the client to contact a home healthcare agency

Assess the client's readiness to learn

What is the most important information the nurse can share with a client who is just diagnosed with hypertension? <p>What is the <b>most</b> important information the nurse can share with a client who is just diagnosed with hypertension?</p> "Continue with long-term follow-up care." "Monitor yourself for signs of hypertension." "Perform occasional blood pressure measurements." "Adjust your antihypertensive dose based on daily blood pressure results."

"Continue with long-term follow-up care."

A client has a mitral valve replacement, and the nurse provides health teaching to promote optimum health. Which client statement supports the nurse's conclusion that the client needs further teaching? <p>A client has a mitral valve replacement, and the nurse provides health teaching to promote optimum health. Which client statement supports the nurse's conclusion that the client needs further teaching?</p> "I should wear a Medic Alert bracelet." "I will start a vigorous aerobic exercise program." "I will take antibiotics when I have my teeth repaired." "I should go to the doctor when I get a respiratory infection."

"I will start a vigorous aerobic exercise program."

While teaching parents about the developmental milestones of a 15-month-old child, the nurse informs the parents about various activities that their child should be able to do. Which statement of the parent indicates effective learning? <p>While teaching parents about the developmental milestones of a 15-month-old child, the nurse informs the parents about various activities that their child should be able to do. Which statement of the parent indicates effective learning?</p> "My child can jump with both feet." "My child can walk up stairs with one hand held." "My child can creep up stairs and kneel without support." "My child goes up and down stairs alone with two feet on each step."

"My child can creep up stairs and kneel without support."

A registered nurse is teaching a nursing student about the third heart sound (S 3). Which statement given by the nursing student indicates a need for further education? <p>A registered nurse is teaching a nursing student about the third heart sound (S ₃). Which statement given by the nursing student indicates a need for further education?</p> "S 3 is heard in clients with heart failure." "S 3 is normal in pregnant women." "S 3 is abnormal in adults over 31 years of age." "S 3 is normal in children and young adults."

"S 3 is normal in pregnant women."

The nurse is teaching expectant parents about infant development. Which parental statements indicate the need for further education? Select all that apply. <p>The nurse is teaching expectant parents about infant development. Which parental statements indicate the need for further education? <b>Select all that apply.</b> </p> "My baby will enjoy sucking on a pacifier." "Toilet training is an expectation during infancy." "A chronic illness shouldn't impact my baby's development." "My baby will begin to realize that he or she is separate from me early in infancy." "If my wife experiences postpartum depression this could impact my baby's development."

"Toilet training is an expectation during infancy." "A chronic illness shouldn't impact my baby's development." "My baby will begin to realize that he or she is separate from me early in infancy."

A nurse is caring for a client who has been admitted with right-sided heart failure. The nurse notes that the client has dependent edema around the area of the feet and ankles. To characterize the severity of the edema, the nurse presses the medial malleolus area, noting an 8 mm depression after release. How should the edema be documented? <p>A nurse is caring for a client who has been admitted with right-sided heart failure. The nurse notes that the client has dependent edema around the area of the feet and ankles. To characterize the severity of the edema, the nurse presses the medial malleolus area, noting an 8 mm depression after release. How should the edema be documented?</p> 1+ 2+ 3+ 4+

4+

A nurse is planning to provide self-care health information to several clients. Which client should the nurse anticipate will be most motivated to learn? <p>A nurse is planning to provide self-care health information to several clients. Which client should the nurse anticipate will be <b>most </b>motivated to learn?</p> A 55-year-old client who had a mastectomy and is very anxious about her body image An 18-year-old client who smokes cigarettes and is in denial about the dangers of smoking A 56-year-old client who had a heart attack last week and is requesting information about exercise A 47-year-old client who has a long-leg cast after sustaining a broken leg and is still experiencing severe pain

A 56-year-old client who had a heart attack last week and is requesting information about exercise

A nurse identifies that a client who had a myocardial infarction is struggling with an alteration in self-concept. The nurse intervenes to promote client autonomy. Which behavior by the client demonstrates an increase in client autonomy? <p>A nurse identifies that a client who had a myocardial infarction is struggling with an alteration in self-concept. The nurse intervenes to promote client autonomy. Which behavior by the client demonstrates an increase in client autonomy?</p> Active participation in providing self-care Verbalizing realistic expectations of caregivers Discussing necessary lifestyle changes with family members Listing the indicators of recovery after a myocardial infarction

Active participation in providing self-care

A parent tearfully tells a nurse, "They think our toddler is developmentally delayed. We're investigating a preschool program for cognitively impaired children." What is the most appropriate response by the nurse? <p>A parent tearfully tells a nurse, "They think our toddler is developmentally delayed. We're investigating a preschool program for cognitively impaired children." What is the <b>most </b>appropriate response by the nurse?</p> Praising the parent for the decision and encouraging the plan Asking for more specific information related to the developmental delays Advising the parent to have the healthcare provider help choose an appropriate program Explaining that this action may be premature and that the developmental delays could disappear

Asking for more specific information related to the developmental delays

A staff member tells a nurse that an older client becomes irritable when asked to assist with activities of daily living. On what general information about older adults should the nurse base a response? Decreased ability to cope Loss of ability to cooperate Ambivalence toward authority Difficulty performing step procedures

Decreased ability to cope

After teaching a client about a low-fat diet, what is most important for the nurse to document? <p>After teaching a client about a low-fat diet, what is <b>most</b> important for the nurse to document?</p> Client's weight loss goals Client's ability to plan a low-fat meal Client's receptiveness to the education Education of family members/significant others as well as the client

Client's ability to plan a low-fat meal

Which characteristics influence the intrinsic factors that determine motivation? Select all that apply. <p>Which characteristics influence the intrinsic factors that determine motivation? <b>Select all that apply.</b> </p> Family Cultural values Cognitive level Self-confidence Emotional readiness

Cognitive level Self-confidence Emotional readiness

The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early Alzheimer dementia. The client lives alone. The client's adult children live nearby. According to the prescribed medication regimen, the client is to take medications six times throughout the day. What is the priority nursing intervention to assist the client with taking the medication? Contact the client's children and ask them to hire a private-duty aide who will provide round-the-clock care. Develop a chart for the client, listing the times the medication should be taken. Contact the primary healthcare provider and discuss the possibility of simplifying the medication regimen. Instruct the client and client's children to put medications in a weekly pill organizer.

Contact the primary healthcare provider and discuss the possibility of simplifying the medication regimen.

While communicating with a client, the nurse determines that the client has realized the harmful effects of alcohol consumption and plans to stop drinking within 6 months. To what stage of Transtheoretical Model of Change does the nurse correlate the client's behavior? <p>While communicating with a client, the nurse determines that the client has realized the harmful effects of alcohol consumption and plans to stop drinking within 6 months. To what stage of Transtheoretical Model of Change does the nurse correlate the client&#x2019;s behavior?</p> Action Preparation Maintenance Contemplation

Contemplation

A nurse assesses the lungs of a client and auscultates soft, crackling, bubbling breath sounds that are more obvious on inspiration. This assessment should be documented as what? <p>A nurse assesses the lungs of a client and auscultates soft, crackling, bubbling breath sounds that are more obvious on inspiration. This assessment should be documented as what?</p> Vesicular Bronchial Crackles Rhonchi

Crackles

The nurse is providing care for a client who is on bed rest. Which action will the nurse take to prevent skin breakdown for this client? <p>The nurse is providing care for a client who is on bed rest. Which action will the nurse take to prevent skin breakdown for this client?</p> Massage the bony prominences. Promote range-of-motion activities. Maintain a sheepskin pad under the client. Encourage the client to move in the bed as much as possible.

Encourage the client to move in the bed as much as possible.

Health promotion efforts for a chronically ill client should include interventions related to primary prevention. What should this include? <p>Health promotion efforts for a chronically ill client should include interventions related to primary prevention. What should this include?</p> Encouraging daily physical exercise Performing yearly physical examinations Providing hypertension screening programs Teaching a person with diabetes how to prevent complications

Encouraging daily physical exercise

The nurse recognizes that a common conflict experienced by older adults is the conflict between what? <p>The nurse recognizes that a common conflict experienced by older adults is the conflict between what?</p> Youth and old age Retirement and work Independence and dependence Wishing to die and wishing to live

Independence and dependence

A nurse is assessing the developmental level of a healthy 5-month-old infant. What behavior does the nurse expect the child to exhibit? Using the pincer grasp Sitting without support Crawling across the floor Grasping objects voluntarily

Grasping objects voluntarily

A client with a history of heart failure admits to the nurse that a salt-restricted diet has not been followed. The client reports increased ankle swelling and shortness of breath that is relieved by sitting up. For which other clinical indicators of fluid retention should the nurse monitor the client? Select all that apply. Headache Thready pulse Decreased blood pressure Dizziness when standing up Crackles on lung auscultation

Headache Crackles on lung auscultation

While assessing a client, the nurse finds bluish coloration of the skin. The nurse finds that this discoloration is due to cyanosis. Which condition may be suspected? <p>While assessing a client, the nurse finds bluish coloration of the skin. The nurse finds that this discoloration is due to cyanosis. Which condition may be suspected?</p> Anemia Liver disease Heart disease Autoimmune disease

Heart disease

A client complains of difficulty breathing. The nurse auscultates wheezing in the anterior bilateral upper lobes. What could be the possible reason for this sound? <p>A client complains of difficulty breathing. The nurse auscultates wheezing in the anterior bilateral upper lobes. What could be the possible reason for this sound?</p> Inflammation of the pleura Muscular spasms in the larger airways Sudden reinflation of groups of alveoli High velocity airflow through an obstructed airway

High velocity airflow through an obstructed airway

Which are extrinsic factors that determine motivation? Select all that apply. <p>Which are extrinsic factors that determine motivation? <b>Select all that apply.</b> </p> Fear of failure Educational level Human resources Community systems Accessibility of facilities

Human resources Community systems Accessibility of facilities

An unmarried pregnant client who has been attending a crisis intervention clinic has decided to keep the baby and is looking forward to motherhood. The nurse identifies the decision to attend prenatal childcare classes as an example of what? <p>An unmarried pregnant client who has been attending a crisis intervention clinic has decided to keep the baby and is looking forward to motherhood. The nurse identifies the decision to attend prenatal childcare classes as an example of what?</p> Intrinsic motivation Extrinsic motivation Operant conditioning Behavior modification

Intrinsic motivation

Which positioning should be avoided while assessing a client with a history of asthma? <p>Which positioning should be avoided while assessing a client with a history of asthma?</p> Sitting Supine Dorsal recumbent Lateral recumbent

Lateral recumbent

A nurse is teaching a client with hypertension about a sodium-restricted diet. Which information should the nurse emphasize? <p>A nurse is teaching a client with hypertension about a sodium-restricted diet. Which information should the nurse emphasize?</p> Using salt-free natural seasonings can taste the same as salt. Substituting table salt with potassium chloride can be done freely. Desiring the taste for salt is inherent but can be overcome with help. Liking the taste of table salt is learned, but it can be modified with practice.

Liking the taste of table salt is learned, but it can be modified with practice.

While assessing a client, a nurse finds adventitious breath sounds. Upon further evaluation, the nurse finds loud, low-pitched, rumbling coarse sounds during inspiration. This sound can be clearly heard while the client is coughing. What could be the reason behind these sounds? <p>While assessing a client, a nurse finds adventitious breath sounds. Upon further evaluation, the nurse finds loud, low-pitched, rumbling coarse sounds during inspiration. This sound can be clearly heard while the client is coughing. What could be the reason behind these sounds?</p> Inflammation of the pleura Reinflation of groups of alveoli Muscular spasms in the larger airways High-velocity airflow through an obstructed airway

Muscular spasms in the larger airways

During follow-up visits, the client's child reports to the nurse, "I tell my parent every day about what may happen if medications aren't taken as prescribed. Despite that, my parent does not take the medication regularly and is depressed." What can be inferred about the client's motivational level? <p>During follow-up visits, the client&#x2019;s child reports to the nurse, "I tell my parent every day about what may happen if medications aren&#x2019;t taken as prescribed. Despite that, my parent does not take the medication regularly and is depressed." What can be inferred about the client&#x2019;s motivational level?</p> Not motivated Intrinsically motivated Extrinsically motivated with self-determination Extrinsically motivated without self-determination

Not motivated

A 50-year-old client with a 30-year history of smoking reports a chronic cough and shortness of breath related to chronic obstructive pulmonary disease (COPD). The clinical data on admission are as follows: a heart rate of 100, a blood pressure of 138/82, a respiratory rate of 32, a tympanic temperature 36.8 °C, and an oxygen saturation of 80%. Which vital signs obtained by the nurse during the therapy indicates a positive outcome? Select all that apply. Radial pulse: 70 Temperature: 37 °C Respiratory rate: 14 Blood pressure: 110/70 Oxygen saturation: 92%

Respiratory rate: 14 Blood pressure: 110/70 Oxygen saturation: 92%

A 1-year-old infant is brought to the pediatric clinic for the first time. During the assessment the nurse suspects a developmental delay. What developmental milestone should have been achieved by this age? <p>A 1-year-old infant is brought to the pediatric clinic for the first time. During the assessment the nurse suspects a developmental delay. What developmental milestone should have been achieved by this age?</p> Saying six words Responding to peek-a-boo Building a tower of two cubes Pointing to things when they are named

Responding to peek-a-boo

The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. What is the pathophysiological reason for the excessive edema? <p> <div> The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. What is the pathophysiological reason for the excessive edema? </div> </p> Shift of fluid into the interstitial spaces Weakening of the cell wall Increased intravascular compliance Increased intracellular fluid volume

Shift of fluid into the interstitial spaces

A registered nurse (RN) is performing a physical examination of a client with chronic obstructive pulmonary disease. Which abnormal nail bed patterns can be expected in this client? <p>A registered nurse (RN) is performing a physical examination of a client with chronic obstructive pulmonary disease. Which abnormal nail bed patterns can be expected in this client?</p> Spoon-shaped nails Transverse depressions in nails Softening of nail beds and flat nails Red or brown linear streaks in nail bed

Softening of nail beds and flat nails

What should the nurse do when implementing a tertiary preventive program for cognitively impaired individuals? <p>What should the nurse do when implementing a tertiary preventive program for cognitively impaired individuals?</p> Teach children how to feed themselves. Encourage the use of birth control by women. Refer children for evaluation if they fail to meet developmental milestones. Use the Denver Developmental Screening Test to evaluate children attending well-child clinics.

Teach children how to feed themselves.

A client hospitalized for heart failure is receiving digoxin and will continue taking the drug after discharge. What should be included in the plan of care for the next few days? <p>A client hospitalized for heart failure is receiving digoxin and will continue taking the drug after discharge. What should be included in the plan of care for the next few days?</p> Monitoring vital signs and encouraging a vigorous aerobic exercise program Providing written material on the adverse effects of the medication Contacting Social Services for a home health nursing consultation Teaching the client how to count the pulse

Teaching the client how to count the pulse

A client reports that the client's family members are pressuring the client to attend physical therapy sessions. What does the nurse infer from this report? <p>A client reports that the client&#x2019;s family members are pressuring the client to attend physical therapy sessions. What does the nurse infer from this report?</p> The client is not motivated. The client is intrinsically motivated. The client is extrinsically motivated with self-determination. The client is extrinsically motivated without self-determination.

The client is extrinsically motivated without self-determination.

How does the nurse identify an illness as chronic? Select all that apply. <p>How does the nurse identify an illness as chronic? <b>Select all that apply.</b> </p> The illness is reversible and often severe. The illness persists for longer than six months. The client may develop life threatening relapse. The symptoms are intense and appear abruptly. The illness affects the functioning of one or more systems.

The illness persists for longer than six months. The client may develop life threatening relapse. The illness affects the functioning of one or more systems.

During a home visit, the nurse finds that a healthy elderly person is actively practicing laughing therapy to maintain good health without pressure or insistence from family members. What does the nurse infer from these findings? <p>During a home visit, the nurse finds that a healthy elderly person is actively practicing laughing therapy to maintain good health without pressure or insistence from family members. What does the nurse infer from these findings?</p> The patient is not motivated. The patient is intrinsically motivated. The patient is extrinsically motivated with self-determination. The patient is extrinsically motivated without self-determination.

The patient is intrinsically motivated.

A client with a history of type 1 diabetes is experiencing progressive problems with venous stasis. The client tells the nurse, "I bumped my leg a week ago, and now it has an open draining area just above the ankle." Which information is most important for the nurse to explore when collecting the client's health history? <p>A client with a history of type 1 diabetes is experiencing progressive problems with venous stasis. The client tells the nurse, "I bumped my leg a week ago, and now it has an open draining area just above the ankle." Which information is <b>most</b> important for the nurse to explore when collecting the client's health history?</p> The type of treatment and care the client is receiving What dosage and type of insulin the client is taking and how often The number of family members that are experiencing similar problems How many times a day the client voids and the frequency of bowel movements

The type of treatment and care the client is receiving

Why does the nurse establish "moderately hard" client-centered goals? Select all that apply. <p>Why does the nurse establish "moderately hard" client-centered goals? <b>Select all that apply.</b> </p> To decrease the cost of treatment during therapy To decrease the number of follow-up visits by the client To achieve the goal in a shorter period of time with less effort To prevent the client from quitting before the goal is achieved To prevent the client from losing motivation toward achieving the goal

To prevent the client from quitting before the goal is achieved To prevent the client from losing motivation toward achieving the goal

While performing a physical assessment of a female client, the nurse positions the client in Sims' position. Which body system will be assessed in this position? Select all that apply. <p>While performing a physical assessment of a female client, the nurse positions the client in Sims&#x2019; position. Which body system will be assessed in this position? <b>Select all that apply.</b> </p> Heart Vagina Rectum Female genitalia Musculoskeletal system

Vagina Rectum

A nurse teaches the parents of a 1-year-old infant that the primary developmental milestone to be accomplished between 12 and 15 months of age is which ability? <p>A nurse teaches the parents of a 1-year-old infant that the primary developmental milestone to be accomplished between 12 and 15 months of age is which ability?</p> Walk erect Climb stairs Use a spoon Say simple words

Walk erect