Uworld-Fundametals practice exam
A 55 yr old pt on a med surg unit has just received of pancreatic CA. The pt. says to the nurse, " is this disease going to kill me?" What is the best response by the nurse? a. hearing this diagnosis must have been difficult for you. what are you thoughts? b. we will do everything possible to prevent that from happening c. well were all going to die sometime d. you should concentrate on getting better rather than thinking about death
a
A HHNN visits with alzehemier disease. the caregiver appears frustrate and reports that the client has been persistently restless and agitated. which nursing action is the priority at this time? a. ask aout the clients recent bowel and bladder habits b. assess the home for sources of excessive noise c. provide info. about respite and adult day care d. review behavior-management techniques with caregiver
a
The nurse is Caring for a client newly prescribed crutches. which finding indicates the need for further teaching? a. the axillary pads are torn and show signs of wear b. the client has a 30 degree bend at the elbow when walking c. the crutches and injured food are moved simultaneously in a 3-point gait d. there is a 3 finger width spaced noted between the axilla and axillary pad
a
The nurse is caring for a pt. with a feeding tube that has been obstructed. which intervention should the nurse implement first to unclog the tube? a. flush and aspirate the tube with warm water b. install a digestive enzyme solution into the tube c. instill cola or cran. juice into the tube d. use a small barrel syringe to flush the tube
a
The unit implemented a quality improv. program to address pt. pain relief. which set of criteria is the best determinant that the goal has been met? a. chart audits found clients self-reported pain scores improved by 10% b. number of narcotics used on the unit increased by 20% c. positive comments on returned client satisfaction surveys increased by 30% d. survey found that 90% of the nurses believed clients has better pain control
a
a client who is 24 hrs post-op bowel resection is receiving IV opioids PRN for severe pain. The nurse reviews the HCP prescription to discontinue the continuous IV normal saline. what is the nurses most app. action? a. convert to saline lock b. removed the IV Cath. c. request a prescription for a saline lock d. slow the IV fluids to to a keep-vein-open rate
a
A client is brought to the ED with multiple drama injuries. The nurse sees the client's Jehovah witness identification card. as part of providing culturally competent care, the nurse would anticipate the clients accepting which of the following? SATA a. Epoetin alfa b. FFP c. homologous packed RBC d. normal saline e. platelet transfusion
a and d -Jehovahs witness: transfusions containing blood in any form are not acceptable. Witness do not accept transfusions of whole blood of any of its four major components (i.e: red cells, white cells, platlets, and plasma) -shock prevention: major concern in the setting of blood loss and can be accomplished with the use of non-blood volume expanders such as saline, LT, dextran, and hetastarch. These can be admin. safety to clients who refuse blood products
A CNA us aiding a client recovering from a right-sided CVA accident with resuming mild osopharageal dysphagia. the client has been placed on a dysphagia diet. Which actions require intervention by the RN? SATA a. the UAP adds milk to mashed potatoes to make the thinner b. the UAP encourages the client to occasionally turn the head to the left c. the UAP helps the client sit in an upright position d. the UAP places food on the wrong side of the clients mouth e. the UAP puts a straw in a fruit smoothi to prevent spilling
a and e
the nurse provides an in service for hospital staff on how to prevent pressure injuries in clients with limited mobility. which instructions are apporpriate for the nurse to include? SATA a. apply moisture barrier cream to dry skin b. clean perineal area after incontinent episodes c. massage bony prominences frequently d. place foam-padded seat cushions on chairs e. reposition clients in bed every 6 hrs.
a, b, and d
A post-op pt with obesity and diabetes mellitus has an abdominal incision and is at risk for poor wound healing. which interventions should the nurse include in the plan of care to promote wound healing and prevent dehiscence? SATA a. admin. decussate PO daily b. admin. ondansetron IV PRN for nausea c. apply an abdominal binder d. implement caloric restriction to promote wt. loss e. monitor BS to maintain tight glucose control
a, b, c, e,
a nurse is caring for client who is meeting with the palliative care team. after the meeting, the clients fam asks for clarification about palliative care. which statements about palliative care are accurate? a. palliative care focuses on quality of life and can be provided at any time b. palliative care is only possible with a terminal diagnosis of < 6 months c. palliative care is provided by a multidisciplinary team d. palliative care is another term for hospice care e. palliative care provides relief from symptoms associated with chronic illnesses
a, c and d
a nurse is providing postmortem care for a pt. who has diet after a long hospitalization. the client has a do not resuscitate prescription in place at the time of death. which of the following interventions should the nurse include during postmortem care in prep. for transfer to the funeral home? a. allow fam member to assist with care b. call the medical examiner for autopsy c. gently close the clients eyes d. place a pad under the perineum e. removed the clients dentures
a, c, d
which interventions does the nurse perform to promote normal rest and sleep patterns for a critical i'll client? SATA a. dimming the lights at night b. increasing the LOC IV sedation during nighttime hrs c. leaving the TV on for diversion at night d. opening the window blinds/ shades in the morn e. scheduling inter. and activities during the day when possible f. turning off equipment alarms in the clients room at night
a, d, e
A post-op pt who is receiving continuous enteral feedings via a Nasoenteric tube becomes dyspneic with a productive caught, and the nurse auculates crackles and diminished breath sounds in the lung bases. which action is app. at this time? a. admin a inhaled bronchodilator b. check marked insertion depth of the tube c. request a prescription for diuretic d. start the client on incentive spiormetry
b
As the nurse begins to assist with ambulation of a 9 yr. old who is one day post appendectomy, the child, cries out, "It hurts too much. I can't do it." what is the first action by the nurse? a. admin. an analgesic b. assess the Childs level of pain using a numeric rating scale c. come back later in the day d. tell the child, " get up and walk if you want to go home soon."
b
The client has a dislocated shoulder and the nurse is assisting the NCP with bedside procedural moderate sedation (conscious sedation). During the producdure, the client becomes restless and cries out, " Help me" what action should the nurse take first? a. admin. midazolam per protocol b. check the clients pulse ox c. give more morphine per protocol d. open the airway with head tilt-chin lift
b
a client with hospice home care is taking sips of water but refusing food. family members appear distressed and insist that the personal care worker, "force feed" the client. what is the priority nursing action? a. explain to the fam that this is a normal physiological response to dying b. explore the fam thoughts and concerns about the clients refusal of food c. recommend a feeding tube d. tell the fam, that "force feeding" the client could cause the client to choke on food
b
the nurse answers a call light on a pt not assigned to the nurse. the pt who has was just admitted from the ED, requests a cup of coffee. what is the appropriate intervention? a. allow a fam. mom. to bring the client a cup of coffee from the cafeteria b. ask the client to wait until the HCP prescriptions can be verified c. delegate the task to the CNA assigned to the client d. suggest water instead until admission assessment can be completed
b
the nurse learns that an orthodox jewish client has not started recently prescribed dilimiazem extended release capsules. The client states. " I cannot take the med in this form." what is the nurses first action? a. ask the HCP to prescribe a different CCB b. consult with the pharmacist to see if an alternate form of the drug is available c. open the capsule and sprinkle the med. in a cup of applesauce d. warm the client about the dangers of uncontrolled hypertension
b
The nurse is caring for a group of clients. which finding requires immediate action by the nurse? a. client schedules for discharge who has had a peripheral IV in place for 84 hours b. client with a do-not-resusciatet prescription who has swelling at the IV site c. client with a Saline Locke who has a scheduled IV saline flush due 15 mins ago d. client with a IV infusing at 20 ml/hr who has 100 mL fluid remaining in the bag
b Infilration characteristics: drainage, edema, discomfort, warmth, coolness, harness. Its a complication that occurs when solution infuses into the surrounding tissues of the infusion site. Interventions for infiltration - discontinue the IV line Immediately and start a new IV, preferably on the opposite extremity -continue to monitor the infiltration site for swelling or other abnormalities ( redness, warmth, coolness) -elevate the affected extremity to decrease swelling -notify HCP if severe complications (cellulitis, tissue necrosis, nerve damage) develop -applying a cold or warm, moist compress based on the solution infiltrated. Heat is avoided when extravasation of a vesicant (ie. drug capable of causing tissue necrosis) occurs.
In which position would the nurse place a client recovering from a right modified radical mastectomy who is admitted from the post-anesthesia unit? a. high flowers position with the affected sides arm resting on the bed b. semi fowlers position with the affected sides arm on several pillows c. supine with the affected sides arm on several pillows d. supine with the affected sides arm resting on the bed
b Immediately post mastectomy, the client is placed in a semi-fowlers position to promote ease of breathing. The affected sides arm and hand should be elevated on several pillows to promote drainage and prevent lymphatic pooling
The RN and LPN are caring for several clients. The RN delegates pt positioning to the LPN. While evaluating the deleageted task, the RN realizes that which pt. positions require intervention? SATA a. high flower position in prep for a paracentesis b. left side-lying position after percutaneous liver biopsy c. semi-fowler after cardiac Cath. via femoral entry d. sims during soap suds enema admin. e. supine position after a lumbar puncture
b and c a Paracentesis requires the client to be upright (semi or high Fowler) so that the fluid accumulates in the lower abdomen where the tracer will be inserted to drain it. before a lumbar puncture, pt are placed in the side-lying fetal position or hunched seated position to separate the vertebrae. Afterwards pt remain supine in bed for 4-12 hrs to minimize the risk of a post-puncture HA from loss of cerebrospinal fluid sims position: left side-lying with right hip and knee flexed, is best for enema admin. after a liver biopsy, pt are at r/x for internal bleeding due to vascular nature of the liver. place clients in the right side-lying position for >3 hours afterward to promote direct internal pressure of the liver against itself, which minimizes bleeding after a cardiac Cath via femoral entry, place clients flat or in low fowler position with the affected extremity straight for about 4-6 hrs to avoid pressure at the insertion site and prevent hemorrhage or hematoma
The nurse is caring for a client with marital hearing loss. which interventions would be app. to promote effective comm.? SATA a. dim lights to prevent overstimulation b. post a hearing impairment sign on the clients door c. raise voice to speak more loudly d. speak directly facing the client e. tell family to take hearing aids home so they will not be lost
b and d
the nurse initiates prescribed IV therapy on an 86 year old hospitalized pt. which life span concepts should be considered when initiating IV therapy and caring for an older adult receiving IV therapy? SATA a. avoid infusion devices in confused pt as alarms can be disruptive b. cardiac and renal changes may put the pt at risk for hypervolemia c. older adults may have more fragile veins, increase the risk of infiltration d. skin protections and nonporous tape are helpful in the reducing skin tears on fragile skin e. use a 30-40 degree angle on insertion because older adults have deeper veins that roll
b, c and d
A nurse is caring for a client with blindness due to diabetic retinopathy. Which interventions should the nurse implement for this client? SATA a. Ask a fam mem. about the clients preferences for room arrangement b. offer client an elbow to hold on, and walk a half-step ahead for guidance c.say "goodbye" when leaving the room to help orient the client d.speak slowly and slightly louder so the client can understand e. use a clock-face pattern to explain food arrangement on the clients meal tray
b, c, e Creating a therapeutic and safe environment for the patient who is blind while fostering independence as much as possible. Nursing interventions include the following: - offers the client an elbow for guidance while walking slightly ahead and describing the environment -announce room entry and exit to orient and avoid startling the client -describe the location of items (e.g. food, hygiene supplies) using a clock face orientation so the client can find them easily -instruct the client to use a cane with the dominant hand and to sweep areas in front from side to side for orientation -orient the client to the room and maintain this orientation for safety
a pt. is being discharged after having a coronary artery bypass grafting (CABG) x 5. the pt. asks questions about the care of chest and leg incision. which instructions should the RN include? a. report any itching, tingling or numbness around your incisions b. report any redness, swelling, warmth, or drainage from your incisions c. soak incisions in the tub once a week then clean with hydrogen peroxide and apply lotion d. wash incisions daily with soap and water in the shower and gently pat them dry e. wear an elastic compression hose on your legs and elevate them while sitting
b, d and e
The nurse is providing education to a group of GN what should she teach them regarding information on strokes? a. approach clients with visual impairment from the affected side when entering the room b. instruct clients with unilateral weakness to dress by donning clothes on the affected side first c. provide written instructions for activities of daily living to clients with receptive aphasia d. teach clients with left-sided neglect to turn their heads to scan the environment e. teach families of clients with right-sided stroke to expect impulsive behaviors
b, d, and e
the nurse is caring for a pt. with advanced Alzheimer disease. which techniques are appropriate when speaking with this client? SATA a. ask open-ended questions b. face the client while speaking c. speak in a loud voice d. turn the TV and close the door e. use simple statements and questions
b, d, and e
A HHN is visiting a 72-year old client who has coronary artery bypass Graft surgery 2 weeks ago. The client reports being forgetful and becoming teary easily. How should the nurse respond? a. don't worry, you'll feel better in a few weeks b. how well are you sleeping at night c. these symptoms can be common after major surgery. It will take 4-6 wks to completely heal and start to feel normal again d. you may be experiencing depression. I'll call the HCP and see if we can get a prescription for an antidepressant
c
A client is admitted to the hospital for chemotherapy compl. Lab results show an absolute neutrophil count of 450 cells/mm. What info. contained in the admission h/x of this client will need to be addressed during discharge education? a. eats steamed veggies daily b. enjoys eating grilled shrimp weekly c. gardens as hobby d. takes a bath daily and applies moisturizer
c
A pt. of the orthodox jewish faith with a h/x of type 2 diabetes mellitus is hospitalized, recovering from a total right hip arthroplasty. at noon, the pt. consumed a lean roast beef sandwich with lettuce, mustard, carrot and celery sticks and fresh fruit. What would be the most app. 2: 00 pm snack for this client? a. angel food cake and fresh strawberries b. crackers and low-fat cheese c. hard-boiled egg and blueberries d. nonfat plain yogurt
c
The client screams at the nurse, "you are all incompetent here! I have been waiting for 2 hrs!" How should the nurse respond initially? a. "I know you are upset, but I will have to call security if you continue to scream b. I see that you are frustrated, but the delay cannot be avoided c. It is upsetting to wait so long. How can I best help you? d. The wait is long today, but you will receive quality, unhurried care when it is you turn
c
The nurse admits an 81 yr old with gastroenteritis. Admission vital signs are temp. 101 F, BP 90/42 mmHG, pulse 118/min, and respirations 32/ min. Pulse oximetry shows 88%. The nurse suspects which of the following factors may be affecting accuracy of the pulse ox reading? a. dehydration b. elevated temp. c. hypotension d. tachypnea
c
The nurse enters a clients room and finds that the pt and spouse are crying. The pt. states that the HCP just diagnosed with client with Alzehmeier disease. What is the best response by the nurse/ a. Do you have any questions about the diagnosis b. there are meds available to treat alzehmeir disease c. this new diagnosis must be frightening for you d. we can help you make decisions about your care
c
The nurse is caring for a 83 year old bedridden client experiencing fecal incontinence. Which nursing intervention is the highest priority for this client? a. consult with the wound care nurse specialist b. insert a rectal tube to contain the feces c. provide perineal skin care with barrier cream d. use incontinence briefs to protect the skin
c
The nurse is reaching a client with insomnia about techniques to improve sleep habits. which statement by the client requires further teaching? a. I will avoid naps later in the day b. I will keep the bedroom temp. cool c. I will read in bed before trying to go to sleep d. I will try to go to bed and wake up at the same time each day
c
a pt calls the nurse to report exacerbation of chronic lower back pain after working in the yard all weekend. knowing that this worsened back pain is probably due to acute inflammation, the nurse recommends which non-pharm. interventions? a. heatings pad b. position for comfort c. rest from pain-aggravating activities d. stretching exercises
c
nurse is caring for a 50 yr old executive on the cardiac unity who has just been diagnosed with primary hypertension. which teaching strategy implement by the nurse is most likely to be effective for this client? a. leave diet pamphlets for the client to review at a later time b. refer the pt. to the nurse case manager to follow up with diet instructions c. sit with the pt. during meal selections and assist with identification of low NA options d. turn the TV on in the clients room to the pt. education channel to watch
c
The charge nurse is instructing a new graduate nurse on performning postmortem care. Which client situations might cause nurse nurses to delay or not perform postmortem care? SATA a. client died following a prolonged illness b. clients fam was. not present when death occurred c. clients religious background requires special ceremonial treatment of the body d. death occurred in the ED following a suicide attempt e. family requests a priest to perform last rites
c, d, e
The nurse is interviewing a non-english speaking client. Which best practices will the nurse use when working with a professional medical interpreter for clients of limited English proficiency? SATA a. address the interpreter directly b. ask the clients adult child to translate c. hold a pre-conference with the interpreter d. identify any genre preferences e. speak in short sentences
c, d, e
An adult client has developed diarrhea 24 hrs after the initiation of total enteral nutrition via NG tube. the client is receiving a hypertonic formula. what is the best nursing action? a. dilute the formula with water b. discontinue the tube feeding c. send a stool sample to the lab for culture and sensitivity d. slow the rate of administration of the feeding
d
The CNA r/p finding a reddened area on a pt. sacrum during a bath. what is the nurses priority action? a. direct the CNA to apply a protective foam dressing b. document results of the Braden scale in the ER c. notify the HCP d. perform an assessment on the clients skin
d
The nurse is providing first aid at an outdoor festival when a client reports dizziness and weakness. The client is flushed, sweating, nauseated, and slightly tachycardia. Which action is most appropriate at this time? a. call EMS and place ice packs on the clients axilla and groin b. encourage the pt. to leave the venue to visit HCP c. evaluate whether client may be intoxicated d. Move the client to an air-conditioned booth and provide a cool sports drink
d
a pt is being seen in the clinic after receiving an external breast prosthesis after a mastectomy. What question from the nurse best evaluates the effectiveness of the prosthesis on body image? a. do you feel you are able to engage in sexual activity with your prosthesis? b. do you wear the prosthesis all the time or only when out of the home c. how do you cope with feelings of self-consciousness? d. since receiving your prosthesis, how do you see yourself differently?
d
The nurse reviews the lab results for an adult male client admitted with septic shock. which value requires the most immediate action? EXHIBIT: hematocrit: 48% hemoglobin 16.2 g/dL creatine 1.1 mg/dL blood area nitrogen 44.4 mg/dL potassium 5.9 mEq/L a. Blood area nitrogen b. creatine c. hematocrit d. potassium
d Normal blood values: hematocrit: 39%-50% hemoglobin: 13.2-17.3 g/dL creatine : 0.6-1.3 mg/dL blood area nitrogen: 6-20 mg/dL potassium : 3.5-5.0
An elderly client with end-stage renal disease who has refused dialysis who has refused dialysis is admitted to a long-term care facility for rehab following hospitalization. The next day, the client becomes agitated and says to the nurse, "I've got to get back home to my things. I have so much to do." which is the most likely interpretation of this clients behavior? a. the client has been admitted to the facility w/o the clients consent b. the client is becoming delirious and should be assessed for infection c. the client is concerned that someone might steal possessions d. the client wants to take care of business before imminent death
d the patient with advanced renal failures who decides not to start dialysis treatments may have only a few weeks to live. Toxins will build up in the body and soon lead to increased weakness and cognitive. decline. the pt knows there is a limited time left to live and wants to ensure that possessions will be taken care of appropriately after the clients death
A legally blind client ti being prepared to ambulate 1 day after an appendectomy. What is the most app. action by the nurse? a. arrange for the clients service dog to come to the health care facility as soon as possible b. describe the enviornment in detail so the client can ambulate safely with a cane c. instruct the CNA to walk beside the client and lead by the hand d. walk slightly ahead of the client with the clients hand resting on the nurses elbow
d when ambulating a client who is legally blind, the nurse uses the sighted guide technique by walking slightly ahead with the client holding the nurses elbow
