Exam 4 Almost done

Question 1 of 45

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The team at PRH has decided to implement a new discharge class for all patients newly diagnosed with diabetes. After starting the program, several patient's wind up having complications relating to not recieving their insulin on time and it is determine that the reason was because the discharge class was during the 10:00am med pass and their insulin was delayed. The nurse manager would be demonstrating transformational leadership style by doing which of the following?

Select one of the following:

  • Ask nurse who made the suggestion to have the discharge class from 10am-12am why she suggested it and ask the team for better suggestions.

  • Use the sandwich method to find out why the nurses did not administer the insulin before the patient's were brought to the discharge class.

  • Take responsibility for this negative outcome and work with team to rectify it.

  • Reassign the workload so that an RN could be at the class to give insulin.

Question 2 of 45

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A hospital is instituting a new safety measure at thel, the nurses will now being using a fingerprint scanner to enter the dispensing machine that contains narcotics. The machines have been sent to replace 5 machines on med-surg floors out of the hospitals total of 70 dispensing machines. Which stage of Lewin's theory of change is taking place?

Select one of the following:

  • Force field anlysis

  • refreezing

  • unfreezing

  • movement

Question 3 of 45

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Incentives provided by CMS & HCAHPS would be directly effected by all of the following except?

Select one of the following:

  • TJC pt. safety goals

  • Clinical core measures

  • improvement & consistency

  • pt. survey measuring satisfaction with care

Question 4 of 45

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Select from the following, those two items most involved in safeguarding the public from nurses.

Select one or more of the following:

  • Nurse Practice Act

  • National Council of State Boards of Nursing (NCSBN)

  • National League of Nursing

  • Board of Nursing (BON)

  • American Nurses Association (ANA)

Question 5 of 45

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A traveling nurse arrives in Texas to begin her work at a community health clinic. She is told that they have a needle exchange facility on the hospital campus where nurses teach patient's harm reduction strategies to safely inject heroin. After deciding that she would be competent to complete the task, the best resource to find out if this is task is within the nursing scope of practice is?

Select one of the following:

  • Texas BON


  • ANA

  • NPA

Question 6 of 45

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The charge nurse notes that Kim left her patient on the commode for 35 minutes while going to obtain a suppository. The pt. was then given the suppository and got back in bed but had significant pain for the rest of the day. What is the best way for the charge nurse to communicate his feedback?

Select one of the following:

  • "Kim you probably were just busy but why did 304 get left on the commode for 35 minutes?"

  • " Kim, you have been overall very attentive to Mrs J. in 304. I did notice and am concerned that she was on the commode for 35 minutes earlier. It makes me uncomfortable that this happened because it is a safety issue. You are one of my most timely and attentive nurses. Tell me about what happened and how i can support you.

  • "Do you want me to give Mrs. J to someone else? I noticed she was on the commode for 35 minutes. That really makes me concerned and uncomfortable, it is a safety issue with her being elderly."

  • "Kim, leaving Mrs. J on the commode for such a long time is a safety issue and I can not have nurse's putting patient's at risk. Tell me why she was left there ?"

Question 7 of 45

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The best approach to problem solving to use for conflict negotiation is?

Select one of the following:

  • Compromise

  • Win-win

  • Closed-loop

  • sandwich method

Question 8 of 45

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A nurse you work with has been refusing to have a meaningful conversation with you, she also will not cosign any of your medications when you have asked. Today in handoff she said "Just write your handoff down and hand it to me, it will probably be easier to understand without you saying like every other word." This is an example of?

Select one of the following:

  • dominant style of interaction

  • bullying

  • contentious communication

  • Lateral violence

Question 9 of 45

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A nurse educator is going to be providing teaching on the root cause analysis. She is assessing nurses for knowledge regarding the theory, which nurse requires further teaching?

Select one of the following:

  • "It establishes cause and effect."

  • " It allows us to understand the problem, then we come up with a solution and implement Lewin's change theory."

  • "It includes assessing Equipment, process, and people."

  • "It is a STEP situation monitoring effort."

Question 10 of 45

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All of the following are clinical criteria for diagnosing Substance abuse in the DSM 5 except?

Select one of the following:

  • Repeated use leading to failure to fufill role obligations

  • desire to cut down

  • continued use despite social or interpersonal problems

  • repeated use leading to physically hazardous situations

Question 11 of 45

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A nurse is assessing the A in the CAGE tool when asking which question?

Select one of the following:

  • Do you feel alone because of your drinking problem?

  • Do you have access to supports to help you stop drinking?

  • Do you feel annoyed when people ask about your drinking?

  • Do you always drink more than you planned?

Question 12 of 45

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A patient who has made the statement "That is it, I don't want to drink anymore. I have lost my family, my life, my home. I am ready to not be a god damn drunk anymore, I need to be sober by Christmas." is in what stage of change?

Select one of the following:

  • Precontemplation

  • Preparation

  • Action

  • Maintenance

  • Relapse

  • Contemplation

Question 13 of 45

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What are the 5 As

Select one of the following:

  • Ask, assess, adapt, advise, arrange

  • Ask, allow, adapt, arrange, admit

  • Ask, assess, advise, arrange, admit

  • ask, advise, assess, assist, arrange

Question 14 of 45

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A pt. was brought to the ER by family, they say that the pt's last drink was at midnight. When should the nurse expect withdrawal symptoms to begin?

Select one of the following:

  • 24 hrs later

  • noon

  • 4am-6am

  • 6am-12pm

Question 15 of 45

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The inpatient psych nurse has been assigned a patient who is a longterm alcohol abuser with severe cirrhosis. The patient is on day 1 of detox and has a bp of 165/101, HR: 96, LFTs are elevated but all other vital signs are WNL. Which intervention should the nurse perform ?

Select one of the following:

  • Instruct the patient about completing 90 meetings in 90 days

  • Administer lorazepam (ativan) as ordered

  • Administer oxazepam (serax) as ordered

  • Encourage the pt to attend all groups

  • roleplay just say no activities

Question 16 of 45

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All of the following are assessed on the CINA based on observation except

Select one of the following:

  • goosebumps

  • nasal congestion

  • yawning

  • delirium tremens

Question 17 of 45

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Out of the patial agonist/antagonist's used for opiod addiction which medication has the least potential for OD?

Select one of the following:

  • Buprenex

  • Subutex

  • Suboxone

Question 18 of 45

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Risk factors for aggressive behaviors include all of the following except?

Select one of the following:

  • Past history of violence

  • Diagnosis

  • insomnia

  • Current behavior: prodromal

Question 19 of 45

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A client is very angry because staff can not locate an item that has been locked up when he was admitted. The best response by the nurse is?

Select one of the following:

  • "We put everything in the same place for each patient yours was not there."

  • "I know it mustbe frustrating that we can't find your things, I'm sorry we haven't been able to find it yet. Can you remember any details about when you came in so that i can help you more?"

  • "You really need to come down before i can continue looking. I can't help you when you are yelling at me."

  • "I'm sorry your so angry but we have done everything we can and need to get back to the other patients."

Question 20 of 45

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An instructor asks the class to yell out answers for characteristics of victims of intimate partner violence. The teacher selects which of the following to write on the board as correct answers?

Select one or more of the following:

  • grew up in abusive homes

  • pathologically jelous

  • pregnancy & moves towards independence increases violence

  • low self esteem

  • inadequate supports

  • likely to abuse drugs

Question 21 of 45

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Sheila tells the community nurse that her boyfriend has been abusive and she is afraid of him, but she doesn’t want to leave. The client asks the nurse for assistance. Which nursing interventions are appropriate in this situation? Select all that apply.

Select one of the following:

  • Help Sheila to develop a plan to ensure safety, including phone numbers for emergency help.

  • Reinforce concern for Sheila’s safety and her right to be free of abuse

  • Report the abuse to the authorities

  • Tell her to leave because things will not improve

Question 22 of 45

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A 19 year old male patient arrives on the unit he is in college and is catholic. He has a diagnosis of MDD and has no previous attempts of suicide in his history. He lives with his parents and has a diagnosis of cystic fibrosis. He has positive SI with a plan to hang himself with a belt, pt stated "just like Robin Williams, my favorite actor" How many risk factors for suicide does this patient exhibit?

Select one or more of the following:

  • 5

  • 7

  • 3

  • 4

Question 23 of 45

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A pt. who is being discharged the next day from the unit starts giving away a lot of his clothing and books to the other patients, he appears much happier than he has the last couple days. When asked about his plans for when he returns home by another pt. you hear him respond "dont worry about me George im going to a better place." What is the best response by the nurse?

Select one of the following:

  • Your not feeling suicidal with your discharge coming up are you?

  • Are you feeling okay Henry?

  • Henry it really looks like the medicine is working, you are so cheerful and giving. I am so happy you are doing better, good for you.

  • Sometimes people who are feeling suicidal give away things that matter to them, and their mood improves Henry, Do you feel this way? Tell me about it.

Question 24 of 45

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The most dangerous complication of bed rest is?

Select one of the following:

  • disuse osteoporosis

  • atelectasis

  • DVT

  • renal calculi & UTI

  • Decubitus ulcers

Question 25 of 45

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The mother of a pediatric patient with a congenital hip dysplasia shows that she needs further teaching when she states?

Select one of the following:

  • My baby will need to wear the pavlick harness continuously for 3-6 months

  • Im so glad that my baby had the barlow and ortolani tests before 3 months so that she could be diagnosed

  • If she needs surgery I want to wait till she is older and understands whats going on

  • I know its not my fault, its probably due to the fact that she was breech and a twin

Question 26 of 45

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Pts at risk for osteoporosis include all but who?

Select one of the following:

  • 65 year old asian male 30 pack year history

  • 70 year old thin sedentary white female

  • Obese 30 year old female pot smoker

  • Pt. on long term steroids for IBD, malabsorption

Question 27 of 45

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You would diagnose the condition that teriparatide (forteo) treats by all of the following except?

Select one of the following:

  • ANA

  • increased serum Ca

  • bone density scan

  • crush fractures in vertebrae, hip fractures, colles fractures

Question 28 of 45

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Gout diets exclude all of the following except?

Select one of the following:

  • red meat

  • seafood

  • leafy greens

  • alcohol

Question 29 of 45

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A pt. who has been chronically immobile would be at risk which complication related to mineral imbalance?

Select one of the following:

  • UTI

  • renal calculi

  • DVT

  • orthostatic hypotension

Question 30 of 45

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The hospitalist continues Mrs. M.'s risedronate (Actonel) from her home medications. He writes the order : 5mg with water at least 30 min before dinner daily. You know the incorrect part of this order to be?

Select one of the following:

  • 30min

  • 5mg

  • before

  • dinner

Question 31 of 45

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A client was infected with TB 10 years ago but never developed the disease. He’ began cancer treatment over 9 weeks ago. Which signs and symptoms would be indicative of active infection? Select all that apply (4)

Select one or more of the following:

  • initial dry cough that started 6 weeks ago and has grown productive

  • restlessness/apprehension

  • fatigue & malaise

  • CO2 retaining

  • low grade fever & night sweats

  • hemoptysis

Question 32 of 45

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You are providing teaching to a patient who had a 19mm PPD skin test and positive chest xray. He is being admitted to the hospital to obtain sputum cultures and start antibiotics immediately after. You know the patient needs further teaching when he says?

Select one of the following:

  • I will need to take four drugs must likely; isoniazid, rifampin, pyrazinamide, ethambutol

  • I will be on four drugs for the initial 8 weeks and then some other combination for 18 weeks.

  • I will be in a special room in the hospital and everyone that takes care of me will be wearing masks

  • as long as i take my meds i won't have the active disease and need to spit into the cup again

Question 33 of 45

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A pt. is on the med-surg floor after an esophagectomy and hemigastrectomy. This morning he was ambulating well in the halls, required only his scheduled pain medication and received a visitor. When you assess the patient after your lunch break he is exhibiting a heart rate of 135, respiratory rate of 40 with shallow depth and is complaining of chest pain and difficulty breathing. What is the very first thing the nurse should do being concerned that this patient has a tension pneumothorax?

Select one of the following:

  • check clamps on the chest tubes

  • call physician

  • call code blue

  • place pt in semifowlers to optimize expansion

Question 34 of 45

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When admitting a patient the nurse will assess the patient for all of the following risk factors for pulmonary embolism except?

Select one of the following:

  • pneumonia

  • DVT

  • smoking

  • Clotting d/o

  • oral contraceptives

  • surgery

Question 35 of 45

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When communicating in an SBAR to a resident about a pt with a positive D-Dimer. What should the nurse recommend?

Select one of the following:

  • I think we need to start IV heparin right away

  • We really should get a spiral ct scan

  • Would you like me to go ahead and book the V/Q scan?

  • I think we should do an ultrasound of the lower extremities and a spiral CT

Question 36 of 45

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All of the following are true about COPD except?

Select one of the following:

  • Lung sounds are often diminished in the absence of infection

  • emphysema and chronic bronchitis usually often coexist

  • blood vessels thicken

  • air flows in with difficulty but flows out with ease

  • PFTs can diagnose and monitor the progression of COPDS

  • AAT deficiency will make a pt present much earlier with COPD

  • O2 therapy 2-4L/min via NC or 40% venturi (retainers 1-2L/min)

Question 37 of 45

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Appropriate nursing interventions for a pediatric pt with Cystic fibrosis to optimize the clearance of secretions includes?

Select one of the following:

  • Working with respiratory therapy to schedule Chest PT before meals during the pt's favorite TV show

  • administering clindamycin via PICC line

  • placing the two CF patients at opposite ends of the unit to decrease transmission of super bugs

  • providing pancreatic enzyme replacement before each meal

  • offering frequent high calorie snacks of the child's favorite foods

Question 38 of 45

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A pt with COPD admitted for exacerbation has become short of breath at rest. Baseline blood gas show
ph: 7.34
paco2: 60
HCo3: 49.3
02: 79
What update in patient data would the nurse need to address first?

Select one of the following:

  • Patient in tripod position

  • Increased productiveness of cough

  • Arterial pH of 7.26

  • Arterial PaCO2 of 50

Question 39 of 45

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The nurse is monitoring a client who is receiving IV theophylline (aminophylline) for control of an acute episode of his chronic respiratory condition. What nursing observations would cause the nurse the most concern?

Select one of the following:

  • Blurred vision, halos surrounding lights, and diplopia

  • Hypokalemia, diarrhea, and bradycardia

  • Bradycardia, pulse oximetry of 90%, irregular respirations

  • Restlessness, tachycardia, nausea, and vomiting

Question 40 of 45

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On the first postoperative day after a right lower lobe (RLL) lobectomy, the client deep-breathes and coughs but has difficulty raising mucus. What nursing observation would indicate the client is not adequately clearing secretions?

Select one of the following:

  • Chest x-ray film showing right-sided pleural fluid

  • A few scattered crackles on RLL on auscultation

  • Increase in PaCO2 from 35 to 45 mm Hg

  • Decrease in forced vital capacity

Question 41 of 45

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What source of data provides the nurse with the most accurate assessment of the pulmonary status of a client being treated with a water-sealed chest drainage system?

Select one of the following:

  • volume of fluid drained

  • quality of breath sounds

  • chest xray

  • client's level of SOB

Question 42 of 45

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A client is confined to bed with a fracture of the left femur. He begins receiving subcutaneous heparin injections. What is the purpose of this medication?

Select one of the following:

  • prevent thrombophlebitis and pulmonary emboli associated with immobility

  • To decrease the incidence of fat emboli associated with long bone fractures

  • To prevent venous stasis, which promotes vascular complications associated with immobility

  • To promote vascular perfusion by preventing formation of microemboli in the left leg

Question 43 of 45

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The nursing instructor realizes that the teaching was effective about the differences between osteoarthritis and gouty arthritis when the student states?

Select one of the following:

  • Gouty arthritis requires immediate methotrexate therapy while osteoarthritis is treated just by symptom control

  • Osteoarthritis is autoimmune, gout is not

  • Gout is caused by increased uric acid levels and osteoarthritis is just a normal part of aging

  • Gouty arthritis has a pattern of acute attacks while osteoarthritis is a gradual onset involving weight bearing joints primarily

Question 44 of 45

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Thiamine, which is often ordered with folate would be ordered to prevent/ treat what condition in a chronic alcohol abuser?

Select one of the following:

  • Korsakoff's syndrome

  • Delirium tremens

  • Wernicke's encephalopathy

  • seizures

Question 45 of 45

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A patient on which drug must avoid substances such as hand sanitizer, nail polish remover, mouthwash, cold medicine as well as warfarin, metronidazole and cephalosporins while on the medication and for 2 weeks after d/c

Select one of the following:

  • chlordiazepoxide hydrochloride (librium)

  • disulfiram (antabuse)

  • acamprosate (campral)

  • naltrexone (revia)


Exam 4 Almost done

Tess Nicholson
Quiz by , created 11 months ago

Nursing great bay exam 4

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Tess Nicholson
Created by Tess Nicholson 11 months ago