Copy and Edit

fnd3

Description

Rococo!
Alan Alda
Quiz by Alan Alda, updated more than 1 year ago
Alan Alda
Created by Alan Alda over 4 years ago
145
0
0

Resource summary

Question 1

Question
A student nurse who works in a pediatric clinic is assisting with an assessment on a young child who is not yet walking. She knows that it is considered a delayed gross motor ability if the child does not walk by _____ months.
Answer
  • 16
  • 18
  • 20
  • 22

Question 2

Question
According to one growth and development theorist, individuals need to accomplish a particular task before successfully completing the stage of growth and development. Each task is framed with opposing conflicts, such as trust versus mistrust. Who developed this theory?
Answer
  • Sigmund Freud
  • Jean Piaget
  • Erik Erikson
  • Lawrence Kohlberg

Question 3

Question
This model of personality development is grounded in the belief that two internal biological forces drive the psychological change in a child: sexual (libido) and aggressive energies. Who is responsible for developing this theory?
Answer
  • Sigmund Freud
  • Jean Piaget
  • Erik Erikson
  • Lawrence Kohlberg

Question 4

Question
Which of the following people developed the theory of cognitive development that describes children’s intellectual organization and how they think, reason, and perceive the world?
Answer
  • Sigmund Freud
  • Jean Piaget
  • Erik Erikson
  • Lawrence Kohlberg

Question 5

Question
According to one theorist, moral development depends on the child’s ability to accept social responsibility and to integrate personal principles of justice and fairness. Which of the following individuals is responsible for the theory of moral development?
Answer
  • Sigmund Freud
  • Jean Piaget
  • Erik Erikson
  • Lawrence Kohlberg

Question 6

Question
A patient is experiencing incisional pain after an operation. When using Maslow’s hierarchy of needs, the nurse realizes that for the patient to return to a prehospitalized status, the patient needs to progress beyond which of the following?
Answer
  • Belonging
  • Self-esteem
  • Self-actualization
  • Safety and security

Question 7

Question
The nurse is providing prenatal education to a patient whose pregnancy has been confirmed. This is the patient’s first pregnancy and she is in her first trimester. The nurse instructs the patient that she should stop smoking, avoid alcohol, and avoid eating king mackerel because of the high mercury content in the fish. Although this advice should be followed during the entire pregnancy, the fetus is most vulnerable to adverse effects in the _____ trimester.
Answer
  • first
  • second
  • third
  • final

Question 8

Question
A pregnant teenager asks the clinic nurse why she cannot smoke during the first trimester. Remembering growth and development, what is the nurse’s best response?
Answer
  • “Smoking is a bad habit, but it probably won’t affect the baby.”
  • “Smoking may affect organ systems that are beginning to develop.”
  • “Smoking will only affect the baby in the third trimester.”
  • “Smoking mothers usually produce overweight babies”

Question 9

Question
A student nurse is in her community health clinical rotation. She is visiting a family with a new baby. Which of the following statements made by the mother of a 1-month-old infant indicates the need for client education?
Answer
  • “My baby should double his birth weight by the time he is 6 months old.”
  • “I shouldn’t give my baby any cow’s milk until he is at least a year old.”
  • “My baby has been fussy lately; I believe he is probably cutting his teeth.”
  • “I shouldn’t put my baby on a fluffy pillow to sleep.”

Question 10

Question
The mother of a toddler is concerned that her son is not eating enough, although he has not lost any weight. She tells the nurse that her son used to have a very good appetite, but now does not eat as much as he did a couple of months ago. What is the best response for the nurse to provide?
Answer
  • “You need to make him eat. At this stage, he is growing too fast to not eat.”
  • “I could show you a growth chart, but each child is different so it doesn’t mean much.”
  • “Toddlers have periods when they aren’t growing as fast and they don’t need to eat as much.”
  • “Make him eat with a spoon and don’t feed him snacks. He will be hungrier at meal time.”

Question 11

Question
A nurse is caring for a 5-year-old child who is hospitalized for stabilization of asthma. To provide age-specific care, which of the following is the most appropriate action by the nurse?
Answer
  • Allow the child to handle medical equipment.
  • Have a parental presence at all times.
  • Have the child lie flat and still during procedures.
  • Tell the child as little as possible about expectations and care.

Question 12

Question
The mother of an 8-year-old girl has brought her daughter to the health clinic for her annual check-up. She is concerned about the high blood pressure in her family and asks the nurse if there is some way to know if the child is at risk for hypertension. What is the nurse’s best response?
Answer
  • “Blood pressure elevation in childhood is the single best predictor of adult hypertension.”
  • “Well let’s take her blood pressure and see if it’s up. If it is, she has hypertension.”
  • “She looks pretty plump to me, and that indicates good health. As long as she’s eating, she should be OK.”
  • “If you think that she’s gaining weight, put her on an exercise program, but wait until she’s in her teens.”

Question 13

Question
A recent graduate nurse has been assigned to be a primary nurse on a geriatric unit. After completing a review of development and aging, the nurse recalls that changes during the climacteric signify which of the following?
Answer
  • A characteristic of young adulthood
  • The increased reproductive ability of the older adult
  • A time of significant change in cognitive performance in middle age
  • A decline of reproductive capacity caused by a decrease in sexual hormones

Question 14

Question
______ is the measurable aspect of a person’s increase in physical dimensions.
Answer
  • Growth
  • Development
  • Maturation
  • The latency stage of development

Question 15

Question
______ is an interaction of biological, sociological, and psychological forces.
Answer
  • Growth
  • Development
  • Maturation
  • The latency stage of development

Question 16

Question
A specific phase or period when the presence of a function or reasoning has its greatest effect on a specific aspect of development is referred to as:
Answer
  • Freud’s psychoanalytic model of personality.
  • a critical period of development.
  • Erikson’s stages of development.
  • Piaget’s theory of cognitive development.

Question 17

Question
Preconception counseling is a growing trend in health care with the goal being to secure the best outcome for mother, fetus, and significant others through good prenatal care and teaching that:
Answer
  • teratogens can affect fetal development during any trimester.
  • the placenta prevents teratogens from passing to the fetus.
  • teratogens are all man-made, preventable, and do not include viruses or bacteria.
  • smoking has been shown to have no effect on fetal development.

Question 18

Question
A nurse is caring for a group of 6 and 7 year olds. The nurse remembers that, according to Kohlberg, moral development is a component of psychosocial development. Moral development depends on the child’s ability to do which of the following? (Select all that apply.)
Answer
  • Accept social responsibility.
  • Respect the integrity and rights of others.
  • Integrate principles of justice and fairness.
  • Use symbols and objects on the way to abstract thinking.
  • Perform repetitive motion responses.

Question 19

Question
The patient has been diagnosed with progressive Alzheimer’s disease. Characteristics of this disease include which of the following? (Select all that apply.)
Answer
  • Delirium
  • Agnosia
  • Apraxia
  • Aphasia
  • Amnesia

Question 20

Question
A nurse is performing an admission assessment on a middle-age patient. A normal change seen in this age group includes which of the following? (Select all that apply.)
Answer
  • A progressive decrease in skin turgor
  • Decreased visual acuity
  • Decreased ability to solve practical problems
  • Decreased strength of abdominal muscles
  • Loss of accommodation

Question 21

Question
Which term should the nurse use to best describe the movement of air in and out of the patient’s lungs?
Answer
  • Ventilation
  • Diffusion
  • Respiration
  • Perfusion

Question 22

Question
The nurse is educating a patient who has recently been diagnosed with chronic obstructive pulmonary disease (COPD). The nurse explains how the gasses in the lungs move between the air spaces and the bloodstream. Which process is the nurse describing?
Answer
  • Ventilation
  • Diffusion
  • Respiration
  • Perfusion

Question 23

Question
The exchange of oxygen and carbon dioxide during cellular metabolism is best described as which of the following?
Answer
  • Ventilation
  • Diffusion
  • Respiration
  • Perfusion

Question 24

Question
When giving CPR, compressions are causing the heart to pump blood into and out of the lungs to the body’s organs. This movement of oxygenated blood is best described as which of the following?
Answer
  • Ventilation
  • Diffusion
  • Respiration
  • Perfusion

Question 25

Question
The patient is experiencing shortness of breath. Which of the following lab tests indirectly indicates the oxygen level in the blood system?
Answer
  • Hemoglobin
  • White blood cell count
  • Electrolytes
  • Creatinine

Question 26

Question
The nurse is admitting a patient with chronic obstructive pulmonary disease (COPD). During the initial head-to-toe assessment the patient’s pulse oximetry reading is 89% on room air. What is the nurse’s first priority?
Answer
  • Administer oxygen immediately @ 4L/NC.
  • Call the primary health care provider for an order for oxygen.
  • Assist the patient into a recumbent position.
  • Determine the patient’s normal pulse oximetry reading.

Question 27

Question
A 36-year-old patient diagnosed with meningitis has a fever of 102.3° F. A family member verbalizes a concern that the patient is “breathing fast.” Upon assessment, the nurse notes a respiratory rate of 20 breaths/min, pulse oximetry is 92% on 2L/O2, and lungs clear to auscultation. What is the best explanation for the rapid respiratory rate that the nurse can give the family member?
Answer
  • “He is most likely anxious because he is in the hospital.”
  • “His fever has increased his metabolic rate and is causing him to breathe faster.”
  • “He is hyperventilating because he needs more oxygen.”
  • “He has an acid-base imbalance, which is causing him to hyperventilate.”

Question 28

Question
What is the best indicator the nurse can use to determine the adequacy of a patient’s cardiac output?
Answer
  • Stroke volume
  • Myocardial contractility
  • Afterload
  • Cardiac index

Question 29

Question
A patient has been admitted to the cardiac unit with the diagnosis of bradycardia. The patient states “I am confused about what the doctor said is wrong with me, he said my pacemaker is not working. I don’t have a pacemaker.” What is the nurse’s best response?
Answer
  • “The sinoatrial node is the ‘pacemaker’ of your heart.”
  • “Myocardial contractility determines your heart rate.”
  • “The atrioventricular node is the ‘pacemaker’ of your heart.”
  • “The ventricular Purkinje network determines your heart rate.”

Question 30

Question
A 45-year-old patient was diagnosed with an anterior myocardial infarction. The patient asks the nurse why his chest hurt when he had his heart attack. What is the best response from the nurse?
Answer
  • “One of your heart valves wasn’t working properly and caused an obstructed blood flow.”
  • “One of your coronary arteries had a spasm, and your heart muscle wasn’t able to get enough blood.”
  • “Your heart muscle was deprived of oxygen, which caused chest pain.”
  • “The heart muscle is sensitive to changes in electrical conduction.”

Question 31

Question
A patient was admitted to the surgical unit after surgical removal of an abdominal tumor. As the nurse performs a postsurgical assessment, the patient’s blood pressure is 90/54, heart rate is 94, and respiratory rate is 22. Based on these values, the nurse should be most concerned with which of the following conditions?
Answer
  • Hypovolemia
  • Left-sided heart failure
  • Right-sided heart failure
  • Hypervolemia

Question 32

Question
The guardians of a premature infant who was delivered at 31-weeks’ gestation is expected to be discharged from the hospital within the next few days. The guardians have voiced concern regarding how to prevent respiratory syncytial virus (RSV) exposure to the baby. What is the best response from the nurse?
Answer
  • “You will need to limit the baby’s exposure to crowds of people.”
  • “You need to make sure that the car seat is facing backward in the back seat of your car.”
  • “You do not need to be concerned; the baby has a natural protection against this disease.”
  • “You must sterilize all the bottles for the first 6 months.”

Question 33

Question
A 3-month-old infant is being seen for a well-child check at the pediatric clinic. The nurse is assessing the guardian’s knowledge level about the infant’s growth and development. One of the topics that the nurse has chosen to address in this session is the risk for airway obstruction. What is the main reason that the nurse has chosen this topic?
Answer
  • Infants can have severe allergic reactions to food based on exposure to secondhand smoke.
  • Infants are prone to lower airway infections that can become obstructive.
  • Infants have a tendency to place foreign objects in their mouths.
  • Infants can have airway obstruction from excessive drooling associated with teething.

Question 34

Question
A patient on the surgical unit is 1 day postoperative for surgery to remove stomach cancer. In addition to the physiological stress this patient has undergone, the nurse recognizes that this patient will have to deal with the psychological stress of finding out that the cancer has metastasized to the liver. Which physiological change would the nurse expect to see as a response to stress?
Answer
  • Decreased heart rate
  • Increased hemoptysis output
  • Increased respiratory rate
  • Decreased cardiac output

Question 35

Question
A 47-year-old woman with a history of diabetes and hypertension calls the clinic complaining of epigastric pain and shortness of breath with activity. She has taken antacids with no relief. What type of pain is the patient experiencing?
Answer
  • Pericardial pain
  • Pleuritic chest pain
  • Musculoskeletal pain
  • Cardiac pain

Question 36

Question
A patient has been admitted to the pulmonary unit of the hospital with right lower lobe pneumonia and history of chronic obstructive pulmonary disease (COPD). During the initial assessment the nurse notes that the patient has a respiration rate of 18 with retractions, tachycardia, and complains of dyspnea and dizziness. The nurse identifies that these are clinical signs of which condition?
Answer
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Hemoptysis
  • Hypoxia

Question 37

Question
A health care worker received an annual tuberculosis test administered 56 hours ago. The injection site is very red and flat. The certified nurse who is reading the test should take which action?
Answer
  • Advise the health care worker another test must be done because the test was not read within the proper time.
  • Tell the health care worker the results are positive and cannot return to work.
  • Document the results as a negative reaction.
  • Measure the area in millimeters.

Question 38

Question
A patient with pulmonary congestion needs to cough to clear secretions. The nurse instructs the patient to inhale and perform a series of coughs during exhalation. What type of cough did the nurse teach the patient?
Answer
  • Quad
  • Huff
  • Cascade
  • Splinting

Question 39

Question
A patient presents with an acute myocardial infarction that resulted in right ventricular damage. The nurse needs to assess the patient for right-sided heart failure, which includes which of the following?
Answer
  • Crackles on auscultation
  • Jugular neck vein distention
  • Increased myocardial perfusion
  • Orthopnea

Question 40

Question
A patient reports chest pain. The nurse is attempting to assess the pain to differentiate the pain as cardiac, respiratory, or gastrointestinal. The nurse can properly identify the pain as cardiac in origin when the patient states that the cardiac pain:
Answer
  • does not occur with respiratory variations.
  • is peripheral and may radiate to the scapular areas.
  • is aggravated by inspiratory movements.
  • is nonradiating and occurs during inspiration.

Question 41

Question
A patient with a tracheostomy is experiencing thick and tenacious secretions. To maintain this patient’s airway, what is the most appropriate action for the nurse?
Answer
  • Tracheal suctioning
  • Oropharyngeal suctioning
  • Nasotracheal suctioning
  • Orotracheal suctioning

Question 42

Question
On entering the room, a nurse finds the patient sitting upright in bed with the upper torso resting on the over-bed table. The nurse assesses that this patient is experiencing acute hypoxemia. Which of the following are symptoms of acute hypoxemia? (Select all that apply.)
Answer
  • Cyanosis
  • Arrhythmias
  • Eupnea
  • Restlessness
  • Diaphoresis

Question 43

Question
The home care nurse is admitting a patient with COPD. The primary healthcare provider has ordered O2 /nasal cannula at 3 L/min. To promote safety, the nurse would instruct the patient on which of the following safety measures? (Select all that apply.)
Answer
  • Place “No smoking” signs in all areas where oxygen will be used.
  • Instruct family and visitors who smoke that they must smoke a minimum of 10 feet from the patient.
  • Store tanks in a small closet, trunk of a car, or near the hot water heater.
  • Oxygen tanks should stay a minimum of 6 feet from space heaters, fireplaces, and appliances with an electric motor.
  • Know the exit routes and where the fire extinguisher are located in the home.

Question 44

Question
An adult collapsed at the grocery store. Before being transported to the emergency department, an automated external defibrillator (AED) was used. The nurse remembers learning that the AED is effective in saving a life because of which factors? (Select all that apply.)
Answer
  • Use of an AED strengthens the chain of survival.
  • The AED can be used by nonmedical personnel.
  • The AED sends heart rhythm to the closest emergency room (ER) for the physician to analyze and give orders.
  • Every minute without defibrillation decreases the survival rate by 7% to 10%.
  • The AED will automatically deliver a shock to the victim after announcing, “Everyone stand back.”

Question 45

Question
A nurse who works for an oncology unit is preparing to bathe a patient who recently underwent surgery to remove an abdominal tumor. Before beginning the bath, the nurse explains the procedure. Which of the following best describes the nurse’s communication role?
Answer
  • Channel
  • Receiver
  • Message
  • Sender

Question 46

Question
A patient is being cared for by a nurse. The patient has questions regarding what time the surgery is scheduled. When the nurse responds to the question, the nurse is assuming which communication role?
Answer
  • Channel
  • Receiver
  • Message
  • Sender

Question 47

Question
A registered nurse is a new nurse manager who needs to council an employee regarding attendance. Because the nurse manager is new to the position, the nurse is rehearsing what is planning to say to the employee before the meeting. The nurse is using which form of communication?
Answer
  • Interpersonal
  • Intrapersonal
  • Public
  • Private

Question 48

Question
A nurse is working in a busy emergency department of an urban hospital. The family of a patient brought in by ambulance asks the nurse what the doctor meant when he or she said that the patient was coding. In this situation, the word coding is an example of which of the following?
Answer
  • Denotative meaning
  • Connotative meaning
  • Intonation
  • Pacing

Question 49

Question
A patient asked a nurse when the primary health care provider would make rounds. The nurse was taking another patient for a stat test and replied very quickly, “I have no idea.” The patient most likely interpreted the nurse as uncaring because of which factor?
Answer
  • Vocabulary
  • Pacing
  • Timing
  • Personal appearance

Question 50

Question
A 9-year-old patient who is hospitalized for bowel surgery appears very frightened. To appear less threatening to the child, which action should the nurse take?
Answer
  • Stand over the bed when talking to the patient.
  • Sit in a chair next to the bed when talking to the patient.
  • Maintain constant eye contact with the patient at all times.
  • Stay within 12 inches of the patient when talking to the patient.

Question 51

Question
A nurse went into a patient’s room at 0900, shortly after the patient was told that he or she had liver cancer. The patient asked the nurse to stay because he or she did not want to be alone. The nurse stood very close to the patient, held the patient’s hand, and told the patient that he or she had plenty of time. A few minutes later, the nurse thought to check the time on the wristwatch because the nurse was supposed to take another patient for a test at 0945. The patient saw the nurse look at the wrist watch and told the nurse it was now okay to be alone. What was the most likely reason the patient said it was okay for the nurse to leave?
Answer
  • Invasion of personal space
  • Verbal communication
  • Nurse’s gesture
  • Intonation

Question 52

Question
When caring for a patient from another culture, what is the best strategy for the nurse to use in communicating with the patient?
Answer
  • Using a cultural joke to break the ice
  • Stereotyping the patient within his or her culture
  • Considering the context of the patient’s background
  • Assuming the patient or the family member speaks English

Question 53

Question
A patient had a stroke that left the patient aphasic. A nurse is working on a plan of care. Which nursing diagnosis should the nurse use to describe the patient’s aphasia?
Answer
  • Impaired Verbal Communication
  • Anxiety
  • Impaired Social Interaction
  • Ineffective Coping

Question 54

Question
A nurse is spending time with a patient, who has recently been diagnosed with breast cancer. The patient states that he or she is frightened about the diagnosis and feels overwhelmed. The nurse responds, “It sounds to me like you are feeling very scared right now.” Which communication technique did the nurse use?
Answer
  • Sympathy
  • Empathy
  • Focusing
  • Self-disclosure

Question 55

Question
A patient has just been admitted to the hospital with a broken hip from a fall in the home. The nurse admitting the patient is practicing active listening. Which behavior best conveys to the patient that the nurse is using active listening?
Answer
  • Keeping arms crossed
  • Sitting facing the patient
  • Standing facing the patient
  • Leaning away from the patient

Question 56

Question
A nurse is assisting in the admission of a patient to the orthopedic unit of the hospital and is obtaining information for the database. Which technique is the best way for the nurse to obtain information from the patient?
Answer
  • Ask personal questions so as to show interest.
  • Use medical vocabulary to appear competent.
  • Ask why the patient waited so long to get treatment.
  • Use silence while the patient collects his or her thoughts.

Question 57

Question
A nurse gives a hand-off report to the oncoming staff nurse. Which type of communication does this illustrate?
Answer
  • Gossip
  • Validation
  • Interpersonal
  • Intrapersonal

Question 58

Question
A nurse is caring for a patient who cannot speak clearly. Which technique should the nurse use to enhance conversation with this patient?
Answer
  • Speak loudly.
  • Finish the patient’s sentences.
  • Ask question that require “yes” or “no” answers.
  • Avoid communication aids to prevent embarrassment.

Question 59

Question
A nurse forms a contract with the patient to specify roles during a therapeutic helping relationship. The nurse is in which phase of the therapeutic relationship?
Answer
  • Working
  • Termination
  • Pre-interaction
  • Orientation

Question 60

Question
Which technique should the nurse use when providing information to a patient with a health literacy level of fifth grade?
Answer
  • Use the passive voice of language.
  • Present the most important information first.
  • Shift from subject to subject until the patient responds.
  • Explain using jargon so the patient will understand others on the health care team.

Question 61

Question
Which technique by the nurse will facilitate communication with an older adult?
Answer
  • Have the TV play lightly in the background.
  • Ask several questions in a row.
  • Allow reminiscing.
  • Use long sentences.

Question 62

Question
A nurse has just admitted a 5-year-old child for suspected appendicitis. Which therapeutic communication techniques should the nurse use while communicating with this child? (Select all that apply.)
Answer
  • Avoid sudden movements or gestures.
  • Use simple, direct language.
  • Sit at the child’s eye level.
  • Tell the child exactly what can do.
  • Use drawing or toys as needed.

Question 63

Question
A nurse has been asked to prepare patient education for Spanish-speaking patients regarding diabetes. This information will be available to patients in the diabetes clinic. What is the primary goal for this patient education?
Answer
  • To reduce the legal liability of the clinic
  • To teach Spanish-speaking patients some English
  • To assist Spanish-speaking patients to reach optimal health
  • To provide information so they can make a decision between oral and injectable medications

Question 64

Question
A patient with newly diagnosed diabetes is being discharged from the hospital. The patient will be going to an outpatient diabetic center to learn more about diet, exercise, disease management, and insulin administration. Which statement made by the patient indicates that effective teaching can take place?
Answer
  • “I don’t want to get sick again so I will do what is needed.”
  • “I am so happy to be going home so I don’t have to eat hospital food anymore.”
  • “I will be glad when they find a cure for diabetes.”
  • “I don’t think I will need to take insulin for very long because I already feel better.”

Question 65

Question
The parents of a 3-month-old infant are preparing to take their child home from the hospital. Before being discharged, the parents must be educated on infant CPR. What is the most appropriate learning objective for this situation?
Answer
  • The parents will be able to understand CPR skills.
  • The parents will demonstrate infant CPR skills.
  • The infant will not require further hospitalization.
  • The parents will call the hospital for help.

Question 66

Question
Which finding will best indicate to the nurse that the teaching about a dressing change was successful?
Answer
  • The patient understands how to change an abdominal dressing.
  • The patient acknowledges the principles of an abdominal dressing change.
  • The patient correctly demonstrates an abdominal dressing change as taught.
  • The patient states, “Yes, I know how to change the dressing.”

Question 67

Question
A patient recently had a stroke and suffered right-sided weakness. The patient is being discharged from a rehabilitation hospital after learning to use a walker. Which learning domain was primarily used to teach the patient to be independent with the walker?
Answer
  • Psychomotor
  • Affective
  • Cognitive
  • Motivational

Question 68

Question
Which patient is the most likely to be motivated to learn?
Answer
  • A 23-year-old smoker being taught about weight control
  • A 45-year-old man being taught about importance of prostate cancer screening
  • A 63-year-old knee replacement patient being taught postsurgical knee rehabilitation
  • A 15-year-old girl being taught about safe sex

Question 69

Question
A postsurgical patient is being taught about wound care before being discharged from the hospital and is in a semiprivate room with another patient. The other patient is upset with a family member and is crying. The television is on to try to provide some distraction from the roommate. Which action should the nurse take to best facilitate patient education for wound care?
Answer
  • Explain to the patient that everything is in the handout.
  • Take the patient to a quiet area to do the patient teaching.
  • Ask the roommate to please be considerate of the patient because patient education is occurring.
  • Request that a home health nurse follow up with the patient at home to teach about wound care.

Question 70

Question
A patient who is a migrant farm worker did not graduate from high school and speaks English as a second language. The nurse will be providing discharge teaching after a hysterectomy. The nurse is concerned about the patient’s ability to understand the discharge instructions. Which of the following should be of most concern in this situation?
Answer
  • Motivation
  • Developmental stage
  • Health literacy
  • Psychomotor learning

Question 71

Question
A nurse who works in a diabetes clinic has been asked to help a 12-year-old male patient learn to give his own insulin injections. The nurse demonstrates the technique on a teaching manikin and then asks the patient to demonstrate the task on the manikin while providing assistance. Which teaching approach did the nurse use?
Answer
  • Entrusting
  • Telling
  • Participating
  • Reinforcing

Question 72

Question
A pediatric nurse who works evenings on a surgical floor in a children’s hospital has been working with a 5-year-old patient who has undergone abdominal surgery. The nurse gives the patient a sticker each time the incentive spirometer is used. What type of reinforcement did the nurse use?
Answer
  • Social
  • Material
  • Activity
  • Negative

Question 73

Question
An 8-year-old boy has been diagnosed with diabetes. A nurse is teaching his mother how to plan meals that are appropriate for him. The nurse asks the mother to put together a 24-hour meal plan for her son and then reviews the plan with her. What type of teaching method did the nurse use?
Answer
  • Simulation
  • Role-play
  • Analogy
  • Demonstration

Question 74

Question
A 75-year-old patient who is being discharged home after a stroke has no use of the right hand. Which teaching strategy is best for the nurse to use for this patient?
Answer
  • Provide all the teaching at once, immediately before going home so the patient will remember it.
  • Teach the patient with the aid of a computer to demonstrate that the discharge instructions are on the hospital webpage.
  • Teach the patient using generic patient discharge information about strokes.
  • Provide information based on the patient’s needs in frequent sessions.

Question 75

Question
A nurse needs to begin teaching about crutch walking with a 14-year-old patient. Which action should the nurse take first?
Answer
  • Motivate the patient to comply with the use of crutches.
  • Prevent diseases and learn good health promotion activities for crutch walking.
  • Allow the entire health care team to give the patient a variety of strategies for crutch walking.
  • Determine the patient’s level of knowledge and perception of the learning needed for crutch walking.

Question 76

Question
A patient needs to take daily injections of a blood thinner for 7 days after hospital discharge. The nurse observes the patient’s self-administration technique. What type of learning occurred?
Answer
  • Affective
  • Cognitive
  • Motivational
  • Psychomotor

Question 77

Question
A nurse is preparing to teach a patient about ostomy care. The patient appears anxious and is crying. What should the nurse do?
Answer
  • Let the patient know it is time to learn about ostomy care.
  • Postpone the teaching session about ostomy care.
  • Show a video about ostomy care.
  • Implement role-play.

Question 78

Question
A nurse tells a patient with a recent back injury that damage to the nerves is comparable to a water hose that has been pinched off and that time is needed to allow normal nerve transmission. Which technique did the nurse use?
Answer
  • Analogy
  • Discovery
  • Role-playing
  • Demonstration

Question 79

Question
A patient must learn to apply a lower leg orthotic device but has a minor paralysis of the right upper extremity. Before teaching this skill, the nurse must assess the patient’s physical capabilities. Which areas will the nurse assess? (Select all that apply.)
Answer
  • Size
  • Strength
  • Coordination
  • Sensory acuity
  • Learning environment

Question 80

Question
he nurse must teach grieving patients about future skills and knowledge. Which patients will most likely be ready to learn? (Select all that apply.)
Answer
  • A patient in denial
  • A patient in anger
  • A patient in bargaining
  • A patient in resolution
  • A patient in acceptance

Question 81

Question
A nurse wants learning to take place in the affective domain of learning. Which techniques should the nurse implement that are the best for this type of learning? (Select all that apply.)
Answer
  • Lecture
  • Practice
  • Discussion
  • Role play
  • Return demonstration

Question 82

Question
A patient is admitted to the trauma unit with the diagnosis of spinal cord injury resulting from an ATV accident. The health care provider has diagnosed the patient as a paraplegic. Which of the following is one of the most important topics for patient teaching to prevent further injury to the patient?
Answer
  • Reminding him that he can be injured and not feel pain below his waist
  • Suggesting that his parents purchase a motorized wheelchair to prevent arm muscle strain
  • Reminding the patient to decrease fluid intake due to lack of mobility
  • Reminding the patient to drink plenty of fluids to maintain hydration

Question 83

Question
A graduate nurse is working for a diabetes unit. The nurse manager has prepared a very thorough orientation, which includes check-offs for taking vital signs. The nurse manager has informed the graduate nurse that their hospital has adopted the Joint Commission’s pain standard and that they will be assessing five vital signs. The graduate nurse knows that the fifth vital sign is which of the following?
Answer
  • Arterial blood gasses
  • Blood sugar
  • Blood pressure
  • Pain

Question 84

Question
A registered nurse working for the emergency department sees a lot of patients who seek services because of pain. The nurse is aware that pain is which of the following?
Answer
  • Caused by a single physiological sensation
  • Caused by a specific stimulus
  • Subjective
  • Universally the same for everyone

Question 85

Question
A registered nurse, who has practiced for more than 20 years and has had a lot of experience caring for postsurgical patients, was questioned by a student nurse about why many nurses do not give the full amount of pain medication ordered by surgeons. The nurse replied that the literature shows that many nurses do not give the full amount of pain medication because they:
Answer
  • do not believe that the patient is experiencing that much pain.
  • do not want to contribute to pain medication addiction.
  • believe that limiting the amount of pain medication lowers costs.
  • are concerned about drug interactions with pain medication and other postsurgical medications.

Question 86

Question
When a person touches a hot stove, the resulting cellular damage causes a reaction that converts the stimuli into a pain impulse. What is the term for this conversion?
Answer
  • Transduction
  • Transmission
  • Perception
  • Modulation

Question 87

Question
The patient who has undergone triple cardiac bypass surgery 1 week ago is being seen for a follow up appointment at their health care facility. The incisions are healing well, but the patient is complaining of pain at the incision sites on his legs. The nurse knows that this is _____ pain.
Answer
  • acute
  • chronic/persistent noncancer
  • chronic episodic
  • idiopathic

Question 88

Question
A student nurse is caring for an elderly patient with rheumatoid arthritis. The patient states that he or she experiences constant pain, is having difficulty sleeping, and has lost weight over the past 2 months. The patient is very tearful and states, “I’m not sure how long I can keep going with this pain.” What is the most important question for the student nurse to ask the patient?
Answer
  • “Have you started a new diet?”
  • “Have you ever thought of suicide?”
  • “What are you taking for your pain?”
  • “Do you take naps during the day?”

Question 89

Question
An older adult nurse has been seeing a rheumatologist for the management of Rheumatoid Arthritis (RA). The patient also uses herbal remedies and seeks acupuncture for pain relief and reads the latest research regarding RA. This coping style is best described as a(n) ______ loci of control.
Answer
  • external
  • interior
  • internal
  • exterior

Question 90

Question
A student nurse is assessing the pain of a teenage patient with cancer. The student nurse ask the patient about precipitating factors, quality, relieving factors, where the pain is, the severity of pain, and the effect of the pain has on the patient. What is the other indicator that the student nurse should make part of this pain assessment?
Answer
  • Medications the patient is taking for pain
  • Timing of the pain
  • Side effects of the patient’s chemotherapy
  • The patient’s ability to take oral pain medication

Question 91

Question
A patient has a morphine sulfate patient controlled analgesia (PCA) to control postoperative pain. When the nurse enters the room, the patient complains of pain. The nurse’s first response is which of the following?
Answer
  • Stop the infusion.
  • Call the physician or health care provider immediately.
  • Ask the patient to describe the pain.
  • Speak to the patient in a calming tone to reduce anxiety.

Question 92

Question
A patient in sickle cell crisis states that the pain is lessened when watching television. The patient’s physiological response is best attributed to which of the following?
Answer
  • The perception of pain
  • Nociceptor stimulation
  • A negative protective reflex response
  • The application of the gate control theory

Question 93

Question
According to established standards, nurses must frequently assess patients experiencing pain. The most appropriate action for the nurse to take when assessing a patient’s pain is which of the following?
Answer
  • Ask what precipitates pain.
  • Question the patient about the location of the pain.
  • Offer the patient a pain scale to objectify the patient’s response.
  • Use closed-ended questions to find out about the patient’s sensations.

Question 94

Question
An adult patient has just undergone surgery for repair of a torn left knee anterior cruciate ligament (ACL). When informing the patient of several pain relief interventions, the nurse most appropriately urges the patient to select which of the following?
Answer
  • NSAIDs
  • Nonopioids
  • Adjuvant therapy
  • Patient-controlled analgesia pain management

Question 95

Question
A smiling and cooperative patient complains of severe pain. Nurses caring for patients who report pain need to recognize and avoid common misconceptions and myths about pain. To properly care for patients in pain, nurses need to remember which of the following?
Answer
  • Chronic pain is psychological in nature.
  • Patients are the best authority of their pain experience.
  • Regular use of narcotic analgesics leads to drug addiction.
  • The amount of tissue damage is reflected in the severity of the pain perceived.

Question 96

Question
Aspirin and ibuprofen are classified as:
Answer
  • narcotics.
  • nonopioids.
  • opioids.
  • nonsteroidal antiinflammatory analgesics.

Question 97

Question
A patient is started on morphine via patient-controlled analgesia (PCA) to control persistent cancer pain. The nurse knows that to prevent central nervous system (CNS) depression the patient should do which of the following?
Answer
  • Monitor IV site for patency.
  • Monitor the patient closely for the 15 minutes.
  • Record baseline blood pressure and respiratory rates before the start of the medication.
  • Give a small dose of naloxone prior to starting the morphine.

Question 98

Question
The hospice nurse is assessing the patient at home for the first time. The patient has a lot of questions regarding what the role hospice will have as the illness progresses. The patient states, “I don’t want to be in pain and kept alive, but I’m not ready to die either.” What is the best response that will educate the patient of the role hospice will play in his or her care?
Answer
  • Hospice will make sure you are pain free, how long you live is up to you and the doctor.
  • Hospice focuses on the quality of life, including pain management, rather than how long you will live.
  • Hospice will give you enough pain medication to keep you pain free. This is a higher priority than quality of life.
  • Hospice allows you time to get your affairs in order.

Question 99

Question
A patient presents to the emergency department with a large leg laceration received in a bicycle accident. The nurse knows that the physician or health care provider chose a local anesthetic because of which of the following? (Select all that apply.)
Answer
  • The patient appears very apprehensive.
  • It has very few side effects.
  • The potential for hemorrhage precludes the use of IV anesthesia.
  • It produces temporary loss of sensation by inhibiting nerve conduction.
  • It allows sedative effects to calm the patient.

Question 100

Question
The student nurse is working on the surgical floor. The student nurse is assigned to take care of a patient with hemiplegia and communication deficits from a previous stroke. The patient is 1-day postoperative from abdominal surgery. Which of the following interventions would promote comfort and help the patient remain pain free? (Select all that apply.)
Answer
  • Keep the bed sheet wrinkle free.
  • Only change wet dressings or bed linens once a shift.
  • Remove noxious stimuli from the room.
  • Continue to use the establish pain scale for this patient.
  • Give pain medication after ambulation down the hall.

Question 101

Question
The patient is being seen for chronic back pain. The patient states, “I’m always in pain, and I don’t like taking the pain medication because it makes me sleepy. I have to work to support my family.” The nurse is aware that this patient may be a candidate for cutaneous stimulation. Cutaneous stimulation includes which of the following? (Select all that apply.)
Answer
  • TENS unit
  • NSAIDs
  • Massage
  • Yoga
  • Ice bags

Question 102

Question
The nurse has had a nasal culture performed and has been found to be MRSA positive. Because the nurse has not been ill from the bacteria, the nurse’s nasal cavity can best be described as a:
Answer
  • susceptible host.
  • reservoir.
  • portal of entry.
  • mode of transmission.

Question 103

Question
The nursing assistive personnel (NAP) is working on a busy pediatric unit in a hospital. She has a cut on her hand that has not been kept covered. It hurts her to wash her hands or sanitize them, so she has been providing patient care without performing hand hygiene. Several of the patients on the pediatric unit have suffered hospital-associated infections of rotavirus. This was thought to be a result of the NAP’s lack of hand hygiene. This type of disease transmission can best be described as:
Answer
  • indirect.
  • natural active immunity.
  • direct.
  • natural passive immunity.

Question 104

Question
The nurse is working for a postsurgical unit. He is caring for four postsurgical patients, all of whom have been in the hospital for 3 days or more. Which of the following patients should he be most concerned about regarding a health care–associated infection?
Answer
  • An asymptomatic elderly patient with bacteria in his urine
  • A middle-aged woman with a white blood cell count of 10,000/mm3
  • A young adult woman who is 1 day postoperative with redness at incision site
  • A middle-aged man with temperature of 101.3° F and complaints of malaise

Question 105

Question
A patient with a history of poor nutrition and chronic illness is admitted to the medical unit. The nurse caring for this patient is preparing to provide the patient with a bed bath and recalls that normal body flora:
Answer
  • are only found on the skin surface.
  • are beneficially aided by the use of antibiotics.
  • are primary sources of infection when balanced.
  • help to maintain health.

Question 106

Question
An emergency department nurse is caring for a patient with a laceration on the lower leg that has become infected. On assessment the nurse realizes that a sign of an inflammatory response consists of:
Answer
  • wound blanching.
  • coolness at the site of injury.
  • a vascular reaction that delivers fluid, blood, and nutrients to the area.
  • decreased pain sensation.

Question 107

Question
There was an outbreak of Salmonella poisoning at a nursing home. Several residents were hospitalized as a result of their infections. What is the best term to describe this infection?
Answer
  • Exogenous infection
  • Endogenous infection
  • Community-acquired infection
  • Asepsis

Question 108

Question
A nurse is assigned to multiple patients on a busy surgical unit. To minimize the onset and spread of infection, the nurse should:
Answer
  • insert indwelling catheters to prevent incontinence.
  • use aseptic technique when performing procedures.
  • use barriers sparingly to reduce the patient’s sense of isolation.
  • keep mucus membranes dry to prevent maceration.

Question 109

Question
The infection control nurse is presenting an in-service presentation on infection prevention and control. A participating nurse identifies what patient as most susceptible to acquiring an infection?
Answer
  • An 81-year-old patient with a fractured hip
  • A 10-month-old patient with a first-degree burned hand
  • A 40-year-old patient with a recent uncomplicated laparoscopic cholecystectomy
  • A 16-year-old athlete with a repair of the medial collateral ligament

Question 110

Question
A senior nursing student is working on a community health project for the local homeless shelter. There are several indigent men who come to the shelter in cold weather to sleep for the night. The student nurse knows that these men do not bathe on a regular basis. One of the men has been sick several times recently with skin infections. Which of the following is the best way for the student nurse to explain the importance of personal hygiene to this individual?
Answer
  • “You don’t have to shower every day. You only need to take a shower when you feel like you’re going to be sick.”
  • “Take a shower. If you don’t take a shower, you will continue to get sick.”
  • “Showering regularly will remove germs that cause skin infections. What do you think we should do about these skin infections of yours?”
  • “Showering with warm water is enough to wash away bacteria. Soap is not needed if you don’t like it.”

Question 111

Question
The student nurse who is developing a plan of care for a postoperative patient who underwent abdominal surgery to remove a tumor. The student has chosen Risk for Infection as a nursing diagnosis. Which of the following is the most appropriate goal for this diagnosis?
Answer
  • The patient’s wound drainage will decrease in 2 days.
  • The patient will report decrease in incisional pain by discharge.
  • The progression of infection will be controlled or decreased.
  • The patient will describe signs/symptoms of wound infection.

Question 112

Question
The student nurse caring for a postsurgical patient who has developed a health care–acquired wound infection that has become systemic. Which of the following should be the student nurse’s top priority?
Answer
  • Providing emotional support
  • Managing vital signs
  • Providing patient education
  • Providing personal hygiene

Question 113

Question
A nursing student is working on a surgical unit in the hospital. Included in her job description is to assist in the cleaning and disinfection of equipment stored on the unit. Which of the following is the best explanation of disinfection?
Answer
  • Removing organic material
  • Removing inorganic material
  • Eliminating almost all pathogenic organisms
  • Destroying all forms of microbial life

Question 114

Question
A patient is admitted for treatment of a home-acquired pressure ulcer. The patient is incontinent of urine and has Alzheimer disease. A Foley catheter is inserted. The nurse recognizes that the best way to break the infection chain is to:
Answer
  • discontinue the Foley as soon as possible.
  • wear a mask when working with the patient if she or he has a cold.
  • wear sterile gloves if there is a chance of contact with blood.
  • use surgical asepsis when handling body fluids.

Question 115

Question
The nurse is very concerned about infection control in the Surgery Department. Recently she provided education to the surgery staff on ways to eliminate transient hand flora. The most precise description for this is hand:
Answer
  • hygiene.
  • washing.
  • antisepsis.
  • rub.

Question 116

Question
Standard precautions involve using personal protective equipment with all patients regardless of the presence of infections. Therefore when obtaining a blood sample, the nurse must wear:
Answer
  • a mask.
  • gloves.
  • gloves and a mask.
  • gloves, a mask, and a gown.

Question 117

Question
The nurse has noticed slight redness when washing her hands. She is concerned about developing a latex allergy. To prevent this, the nurse should:
Answer
  • wear only powdered gloves to help protect her skin.
  • wear gloves constantly to decrease the number of handwashings.
  • apply only oil-based hand care products to her hands.
  • report to employee health services and/or seek immediate medical care.

Question 118

Question
Which of the following situations is most likely to contribute to a health care–acquired infection?
Answer
  • A closed urinary drainage system
  • Use of aseptic technique during dressing changes
  • Foley catheter drainage bag touching the floor
  • Changing IV access site when site is red and warm

Question 119

Question
A nurse is concerned with the chain of infection when taking care of contaminated care items. Semicritical items that require disinfection include:
Answer
  • linens.
  • bedpans.
  • blood pressure cuffs.
  • gastrointestinal endoscopes.

Question 120

Question
A nurse is coaching a student on the proper method of applying surgical gloves. One step in the proper donning of sterile gloves requires the nurse to:
Answer
  • with thumb and first two fingers of nondominant hand, touch only the glove’s outer surface.
  • with gloved dominant hand, slip fingers inside the second glove and pull onto the nondominant hand.
  • carefully pull the glove over the dominant hand, leaving a cuff and being sure the cuff rolls up over the wrist.
  • carefully pull the glove over the dominant hand, leaving a cuff and being sure the cuff does not roll up over the wrist.

Question 121

Question
An 89-year-old patient who lives in a nursing home has been admitted to the hospital for observation after falling, and is exhibiting confusion and malaise in the nursing home. He had a urinary catheter inserted 2 weeks ago when he complained of difficulty urinating. Lab work was ordered and the nurse notes that his neutrophil count is elevated. She knows that this, combined with the other clinical signs and symptoms, most likely indicates what condition?
Answer
  • Tuberculosis
  • Parasitic infection
  • Acute bacterial infection
  • Viral infection

Question 122

Question
The nurse is admitting a patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection isolated in his stage III pressure ulcer. The nurse places the patient on:
Answer
  • contact precautions.
  • airborne precautions.
  • droplet precautions.
  • protective environment.

Question 123

Question
A nurse sets up a sterile field. A break in the sterile field occurs when the nurse does which of the following? (Select all that apply.)
Answer
  • Drops a sterile capped needle onto the sterile field
  • Spills solution onto the sterile field
  • Keeps the top of the table above waist level
  • Keeps sterile objects within a 1-inch border of the field

Question 124

Question
The assistive personnel reports that an older patient is complaining of shortness of breath and palpitations. The nurse connects the patient to an electrocardiogram monitor and analyzes the rhythm with normal P wave and normal QRS and T waves. The rate is 116 beats per minute and regular. The nurse identifies this rhythm as which of the following?
Answer
  • Sinus bradycardia
  • Ventricular tachycardia
  • Sinus tachycardia
  • Normal sinus rhythm

Question 125

Question
The nurse is evaluating a patient who has a chest tube. To properly maintain chest tube function, what is the nurse’s best action?
Answer
  • Strip the tube every hour to maintain drainage.
  • Place the device below the patient’s chest.
  • Double clamp the tubes except during assessments.
  • Remove the tubing from the drainage device to check for proper suctioning.

Question 126

Question
A nurse is being oriented to work for an intensive care unit. The hemodynamic data indicate that the patient has a decreased preload. Which information indicates the nurse has a correct understanding of the concept of preload?
Answer
  • It is the amount of blood ejected from the left ventricle each minute.
  • It is the amount of blood in the heart at the end of ventricular diastole.
  • It is the resistance to the ejection of blood from the left ventricle.
  • It is the rhythmic relaxation and contraction of the heart chambers.

Question 127

Question
A student nurse caring for a patient with a chest tube has been asked what equipment should be at the bedside to assess for an air leak. Which information indicates the student nurse has a correct understanding of the equipment needed?
Answer
  • Suction equipment wrapped in plastic to keep instrument clean
  • Hemostat covered with gauze to prevent penetration of the chest tube
  • Cup of water to place the end of the chest tube
  • Petroleum gauze to use as a dressing

Question 128

Question
The RN and nursing assistive personnel (NAP) are caring for six patients on the pulmonary unit. Which of the following tasks would be most appropriate for the nurse to delegate to the NAP?
Answer
  • Taking vital signs on a 56-year-old man with severe dyspnea
  • Suctioning a patient with hemoptysis
  • Encouraging a postoperative patient to use the incentive spirometer
  • Performing chest percussion on a patient with atelectasis

Question 129

Question
The nursing student is formulating a nursing care plan for a patient with pneumonia. The care plan is directed toward meeting the potential oxygenation needs of the patient. Which of the following examples would be the best way for the nursing student to write an expected outcome for the care plan?
Answer
  • “The patient will have less pain.”
  • “The patient will be able to breathe better.”
  • “The patient’s pulse oximetry reading will remain greater than 92%.”
  • “The patient’s interactions will be normal.”

Question 130

Question
When a person cuts a finger, nerve impulses travel to the spinal cord along afferent peripheral nerve fibers. What is this process?
Answer
  • Transduction
  • Transmission
  • Perception
  • Modulation

Question 131

Question
Pain impulses are sent to the brain, where the central nervous extracts information regarding location, duration and quality of the pain impulse. What is this process?
Answer
  • Transduction
  • Transmission
  • Perception
  • Modulation

Question 132

Question
When a person accidentally touches a hot pan, their protective reflex causes them to immediately withdraw their hand from the hot pan. This protective reflex is known as which of the following?
Answer
  • Transduction
  • Transmission
  • Perception
  • Modulation

Question 133

Question
A patient with developmental disabilities and poor verbal communication skills has been admitted for observation after a motor vehicle accident. The patient has been moaning, facial grimacing, and restless since being admitted to the floor. The nurse needs to first assess the patient for which of the following?
Answer
  • Safety, because the patient will not use the call light
  • Hydration, because the patient is not able to verbally communicate his or her needs
  • Bathroom privileges, because of lack of communication skills
  • Pain, because the patient is unable to communicate effectively

Question 134

Question
A terminally ill patient with cancer is experiencing increased pain. Nursing implications used to care for this patient include which of the following?
Answer
  • Giving medications as needed
  • Using the World Health Organization three-step approach
  • Using a holistic approach to pain management
  • Holding regular doses to prevent life-threatening side effects

Question 135

Question
An 11-year-old boy is being seen at the clinic for his annual check-up. As part of anticipatory guidance, the nurse instructs the boy’s father that accidents and injuries are major health problems affecting school-age children and that the number one cause of death is in this age group is which of the following?
Answer
  • Drowning
  • Motor vehicle accidents
  • Fire
  • Firearms

Question 136

Question
The transition from childhood to adulthood, in terms of the psychological maturation of the individual, is known as which of the following?
Answer
  • Puberty
  • Adolescence
  • Menarche
  • Preadolescence

Question 137

Question
The nurse is caring for an older adult who seems depressed and states that “I hate going to Bingo. I’d really like to get back in shape. Maybe if I could join a health club, I could get back to feeling like myself.” The nurse should do which of the following?
Answer
  • Inform the patient that at his age it’s probably not a good idea to join a health club.
  • Recommend that the patient have a complete physical examination.
  • Explain that physical impairments would prevent any worthwhile exercising.
  • Tell the patient that at his age he would probably hurt himself.

Question 138

Question
Postmenopausal women are at risk for skeletal changes. When developing a plan of care for postmenopausal women, a nurse should remember which of the following?
Answer
  • Exercise provides little benefit for the middle-age adult.
  • Middle-age women should avoid dietary calcium to prevent osteoporosis.
  • Exercise and fitness clubs have limited activities.
  • Physical activities help improve balance and coordination.

Question 139

Question
A 90-year-old patient constantly tells the nurse stories about life many years ago. The nurse encourages this behavior because reminiscence or life review is:
Answer
  • a technique that prepares the individual for the end of life.
  • a review of dispelling past experiences as meaningless.
  • helpful although it is unnatural in the older adult.
  • a way for the elderly to realize that conflicts cannot be reconciled.

Question 140

Question
Polypharmacy is:
Answer
  • the use of unprescribed medication for recreational use.
  • the prescription, use, or administration of more medications than are needed.
  • very rare in older adults.
  • rarely a problem as long as the medications are taken together.

Question 141

Question
The student nurse who is developing a plan of care for a postoperative patient who underwent abdominal surgery to remove a tumor. The student has chosen Risk for Infection as a nursing diagnosis. Which of the following is the most appropriate goal for this diagnosis?
Answer
  • The patient’s wound drainage will decrease in 2 days.
  • The patient will report decrease in incisional pain by discharge.
  • The progression of infection will be controlled or decreased.
  • The patient will describe signs/symptoms of wound infection.

Question 142

Question
A nurse will be teaching a prepared childbirth class for the first time at a neighborhood church. The nurse has gone to the church to determine which room would be best suited to teach a group of six couples. Which room configurations would be most appropriate for teaching this group?
Answer
  • A small carpeted room with no furniture
  • A large auditorium with a stage and theater-style seating
  • A lunchroom with stationary tables and chairs
  • A Sunday-school classroom with tables and chairs

Question 143

Question
A patient was recently diagnosed with heart failure. The health care provider has ordered a low-sodium diet. A nurse is planning patient education for diet instruction. Which information should the nurse present first?
Answer
  • How much daily intake of sodium is recommended
  • How to read food labels at the grocery store
  • How to understand the metric system of measurement
  • How to cook different meals with low-sodium foods

Question 144

Question
A nurse is preparing to take a 5-year-old child’s blood pressure. What is the best way for the nurse to reduce the child’s anxiety about this procedure?
Answer
  • Do nothing because the more fuss that is made about a procedure, the more anxiety it causes the patient.
  • Explain to the patient that the blood pressure is a vital sign that the doctor has ordered.
  • Tell the child that the blood pressure cuff will “hug” the arm.
  • Ask the child’s mother to step outside the room because children frequently do better when alone.

Question 145

Question
A nurse is discharging a patient who required teaching about how to change a foot dressing. The nurse wants to ensure that the patient understands the signs and symptoms of infection and is preparing written materials the patient can take home and refer to as needed. Because the nurse does not know the patient’s reading ability, at which grade level should the nurse prepare the written materials?
Answer
  • Fifth
  • Sixth
  • Eighth
  • Ninth

Question 146

Question
Which behavior by a new nurse will cause the nurse manager to intervene?
Answer
  • Initiates teaching of a patient
  • Uses discovery learning techniques with a patient
  • Assigns nursing assistive personnel to teach a patient
  • Implements the teach-back method to evaluate patient understanding

Question 147

Question
A registered nurse is caring for a postoperative patient who is experiencing respiratory distress after the administration of pain medication. The nurse called the patient’s primary health care provider immediately. The information regarding the patient was conveyed using the SBAR format. Which information did the nurse convey to the primary health care provider?
Answer
  • Situation, background, assessment, recommendation
  • STAT, background, assessment, requirement
  • Status, background, analysis, recommendation
  • Setting, belief, assessment, requirement

Question 148

Question
Which behavior by the nurse would be considered most professional?
Answer
  • Addressing a patient by “dear”
  • Wearing small earrings
  • Being task oriented
  • Avoiding troublesome patients

Question 149

Question
A patient is aphasic from a recent stroke. The nurse is taking a multidisciplinary approach to this patient’s care. Who would be most appropriate for the nurse to collaborate with regarding the patient’s aphasia?
Answer
  • Interpreter
  • Speech therapist
  • Physical therapist
  • Mental health nurse specialist

Question 150

Question
.A nurse is caring for a patient who is having abdominal pain and is experiencing difficulty sleeping. The nurse sits at the bedside of the patient and takes the patient’s hand. The patient quickly pulls back. How should the nurse interpret this patient’s behavior?
Answer
  • The patient is uncomfortable with being touched.
  • The patient is unable to express feelings.
  • The patient has impaired social skills with others.
  • The patient has difficulty with nonverbal communication.

Question 151

Question
A nurse is caring for a patient who is visually impaired. Which technique should the nurse use to facilitate communication?
Answer
  • Touch the patient before speaking.
  • Identify self when entering the room.
  • Quietly leave the room when finished.
  • Keep the room dimly lit for calmness.

Question 152

Question
A nurse enters a patient’s room and sees the patient grimacing with each movement. When the nurse asks in a normal tone of voice how the patient is feeling, the patient states that he or she “feels fine.” Which finding will the nurse classify as nonverbal communication?
Answer
  • The nurse’s tone of voice is normal.
  • The patient states that he or she “feels fine.”
  • The nurse asks how the patient is feeling.
  • The patient grimaces with each movement.

Question 153

Question
While a patent is being interviewed by the nurse, a family member states, “What my father really means is that he doesn’t know for sure what the physician meant about the medical diagnosis.” Which communication technique did the family member use?
Answer
  • Focusing
  • Clarifying
  • Summarizing
  • Sharing observations

Question 154

Question
The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs related to
Answer
  • anticipatory guidance.
  • low-risk adolescents.
  • physical development.
  • sexual development.

Question 155

Question
The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the expected stage of development for a preschooler is
Answer
  • concrete operational.
  • formal operational.
  • preoperational.
  • sensorimotor.

Question 156

Question
The school nurse talking with a high school class about the difference between growth and development would best describe growth as
Answer
  • processes by which early cells specialize.
  • psychosocial and cognitive changes.
  • qualitative changes associated with aging.
  • quantitative changes in size or weight.

Question 157

Question
The most appropriate response of the nurse when a mother asks what the Denver II does is that it
Answer
  • can diagnose developmental disabilities.
  • identifies a need for physical therapy.
  • is a developmental screening tool.
  • provides a framework for health teaching.

Question 158

Question
To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge of other physical development exemplars such as
Answer
  • cerebral palsy.
  • failure to thrive.
  • fetal alcohol syndrome.
  • hydrocephaly.

Question 159

Question
To plan early intervention and care for a child with a developmental delay, the nurse would consider knowledge of the concepts most significantly impacted by development, including
Answer
  • culture.
  • environment.
  • functional status.
  • nutrition.

Question 160

Question
A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to her toys and makes up stories. The mother wants her child to have a psychologic evaluation. The nurse’s best initial response is to
Answer
  • refer the child to a psychologist.
  • explain that playing make believe with dolls and people is normal at this age.
  • complete a developmental screening.
  • separate the child from the mother to get more information.

Question 161

Question
A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so needy and acting like a child. The best response of the nurse is that in the hospital, adolescents
Answer
  • have separation anxiety.
  • rebel against rules.
  • regress because of stress.
  • want to know everything.

Question 162

Question
The nurse is assessing a patient’s functional ability. Which activities most closely match the definition of functional ability?
Answer
  • Healthy individual, works outside the home, uses a cane, well groomed
  • Healthy individual, college educated, travels frequently, can balance a checkbook
  • Healthy individual, works out, reads well, cooks and cleans house
  • Healthy individual, volunteers at church, works part time, takes care of family and house

Question 163

Question
The nurse is assessing a patient’s functional performance. What assessment parameters will be most important in this assessment?
Answer
  • Continence assessment, gait assessment, feeding assessment, dressing assessment, transfer assessment
  • Height, weight, body mass index (BMI), vital signs assessment
  • Sleep assessment, energy assessment, memory assessment, concentration assessment
  • Healthy individual, volunteers at church, works part time, takes care of family and house

Question 164

Question
The nurse is assessing a patient with a mobility dysfunction and wants to gain insight into the patient’s functional ability. What question would be the most appropriate?
Answer
  • “Are you able to shop for yourself?”
  • “Do you use a cane, walker, or wheelchair to ambulate?”
  • “Do you know what today’s date is?”
  • “Were you sad or depressed more than once in the last 3 days?”

Question 165

Question
The nurse is developing an interdisciplinary plan of care using the Roper-Logan-Tierney Model of Nursing for a patient who is currently unconscious. Which interventions would be most critical to developing a plan of care for this patient?
Answer
  • Eating and drinking, personal cleansing and dressing, working and playing
  • Toileting, transferring, dressing, and bathing activities
  • Sleeping, expressing sexuality, socializing with peers
  • Maintaining a safe environment, breathing, maintaining temperature

Question 166

Question
The home care nurse is trying to determine the necessary services for a 65-year-old patient who was admitted to the home care service status after left knee replacement. Which tool(s) will assist with this determination?
Answer
  • Minimum Data Set (MDS)
  • Functional Status Scale (FSS)
  • 24-Hour Functional Ability Questionnaire (24hFAQ)
  • The Edmonton Functional Assessment Tool

Question 167

Question
The nurse is assessing a patient’s functional abilities and asks the patient, “How would you rate your ability to prepare a balanced meal?” “How would you rate your ability to balance a checkbook?” “How would you rate your ability to keep track of your appointments?” Which tool would be indicated for the best results of this patient’s perception of their abilities?
Answer
  • Functional Activities Questionnaire (FAQ)™
  • Mini Mental Status Exam (MMSE)
  • 24hFAQ
  • Performance-based functional measurement

Question 168

Question
A 65-year-old female patient has been admitted to the medical/surgical unit. The nurse is assessing the patient’s risk for falls so that falls prevention can be implemented if necessary. Select all the risk factors that apply from this patient’s history and physical. (Select all that apply.)
Answer
  • Being a woman
  • Taking more than six medications
  • Having hypertension
  • Having cataracts
  • Muscle strength 3/5 bilaterally
  • Incontinence

Question 169

Question
Critical Thinking: A patient states, “I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which response by the nurse would be an example of interpersonal therapeutic communication?
Answer
  • “It sounds as though you were uncomfortable with the content of your dream.”
  • “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
  • “So, all in all, you feel as though you had a rather poor night’s sleep?”
  • “Can you give me an example of what you mean by a ‘bad nightmare’?”

Question 170

Question
A patient states that everything has been going great; however, the nurse observe the patient biting his nails and fidgeting. What assessment can the nurse make? The patient’s communication type is
Answer
  • linguistic
  • paralinguistic.
  • explicit.
  • inadequate

Question 171

Question
The nurse is admitting a patient to the medical/surgical unit. Which communication technique would be considered appropriate for this interaction?
Answer
  • “I’ve also had traumatic life experiences. Maybe it would help if I told you about them.”
  • “Why do you think you had so much difficulty adjusting to this change in your life?”
  • “You will feel better after getting accustomed to how this unit operates.”
  • “I’d like to sit with you for a while to help you get comfortable talking to me.”

Question 172

Question
Critical Thinking: The nurse is seeking clarification of a statement that was made by a patient. What is the best way for the nurse to seek clarification?
Answer
  • “What are the common elements here?”
  • “Tell me again about your experiences.”
  • “Am I correct in understanding that…”
  • “Tell me everything from the beginning.”

Question 173

Question
A patient does not make eye contact with the nurse and is folding his arms at his chest. Which aspect of communication has the nurse assessed?
Answer
  • Nonverbal communication
  • A message filter
  • A cultural barrier
  • Social skills

Question 174

Question
A nurse is conducting a therapeutic session with a patient in the inpatient psychiatric facility. Which remark by the nurse would be an appropriate way to begin an interview session?
Answer
  • “How shall we start today?”
  • “Shall we talk about losing your privileges yesterday?”
  • “Let’s get started discussing your marital relationship.”
  • “What happened when your family visited yesterday?”

Question 175

Question
Critical Thinking: The nurse and the patient are conversing face to face. What communication technique is this?
Answer
  • linguistic
  • paralinguistic
  • explicit
  • metacommunication

Question 176

Question
A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate?
Answer
  • Interprofessional collaboration
  • Shared governance collaboration
  • Interorganizational collaboration
  • Mentoring collaboration

Question 177

Question
The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among health care team members?
Answer
  • The occurrence of a patient event resulting in death or serious injury
  • Decreased ability to document expenses of care provided
  • Longer time to begin surgical cases
  • Increased time to discharge patients to outpatient care

Question 178

Question
Which patient scenario describes the best example of professional collaboration?
Answer
  • The nurse, physician, and physical therapist have all visited separately with the patient.
  • The nurse, physical therapist, and physician have all developed separate care plans for the patient.
  • The nurse mentions to the physical therapist that the patient may benefit from a muscle strengthening evaluation.
  • The nurse and physician discuss the patient’s muscle weakness and initiate a referral for physical therapy.

Question 179

Question
Which statement correctly describes the nurses’ role in collaboration?
Answer
  • State boards of nursing mandate that collaboration can only occur in hospitals.
  • Collaboration should occur only with physicians.
  • Collaboration occurs only between nurses with the same level of education.
  • Collaboration may occur in health-related research.

Question 180

Question
A nurse manager has recently overheard several negative comments made by nurses on the unit about other nurses on the unit. The manager recognizes that the nurses are exhibiting what type of behavior that is detrimental to collaboration?
Answer
  • Vertical violence
  • Lateral violence
  • Descending violence
  • Personal violence

Question 181

Question
The nurse and physician are explaining the home care that will be needed by a patient after discharge. The patient’s spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse?
Answer
  • “Let me review what is needed again.”
  • “It is important that you do what the physician has prescribed.”
  • “What concerns do you have about the prescribed care?”
  • “I can come back after you talk with your spouse about the care.”

Question 182

Question
The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take?
Answer
  • Teach the patient muscle strengthening and stretching exercises.
  • Tell the patient to make plans to move to an assisted-living facility.
  • Discuss resources to help the patient and make appropriate referrals.
  • Ask the patient to come in for daily physical therapy.

Question 183

Question
A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement?
Answer
  • “I will have to do whatever the physician says I need to do.”
  • “Once a plan is developed, it cannot be changed.”
  • “My insurance will not pay if I don’t do what you want me to do.”
  • “We can work together to adjust my plan as we need to.”

Question 184

Question
The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first?
Answer
  • Post educational posters about how well collaboration is being performed
  • Highlight that no single profession can meet the needs of all patients
  • Provide meetings for each department on how their role affects patients
  • Begin implementing evaluations of collaborative skills on annual performance reviews

Question 185

Question
Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.)
Answer
  • Prescribing a new medication dose
  • Health promotion activities
  • End-of-life comfort decisions
  • Interpreting laboratory results
  • Lifestyle changes to improve health

Question 186

Question
The nurse is assigned a group of patients. Which patient would the nurse identify as being at increased risk for impaired gas exchange? A patient
Answer
  • with a blood glucose of 350 mg/dL
  • who has been on anticoagulants for 10 days
  • with a hemoglobin of 8.5 g/dL
  • with a heart rate of 100 beats/min and blood pressure of 100/60

Question 187

Question
The nurse is reviewing the patient’s arterial blood gas results. The PaO2 is 96 mm Hg, pH is 7.20, PaCO2 is 55 mm Hg, and HCO3 is 25 mEq/L. What would the nurse expect to observe on assessment of this patient?
Answer
  • Disorientation and tremors
  • Tachycardia and decreased blood pressure
  • Increased anxiety and irritability
  • Hyperventilation and lethargy

Question 188

Question
The nurse would identify which patient as having a problem of impaired gas exchange secondary to a perfusion problem? A patient with
Answer
  • peripheral arterial disease of the lower extremities
  • chronic obstructive pulmonary disease (COPD)
  • chronic asthma
  • severe anemia secondary to chemotherapy

Question 189

Question
The nurse is assessing a patient’s differential white blood cell count. What implications would this test have on evaluating the adequacy of a patient’s gas exchange?
Answer
  • An elevation of the total white cell count indicates generalized inflammation.
  • Eosinophil count will assist to identify the presence of a respiratory infection.
  • White cell count will differentiate types of respiratory bacteria.
  • Level of neutrophils provides guidelines to monitor a chronic infection.

Question 190

Question
The acid-base status of a patient is dependent on normal gas exchange. Which patient would the nurse identify as having an increased risk for the development of respiratory acidosis? A patient with
Answer
  • chronic lung disease with increased carbon dioxide retention
  • acute anxiety, hyperventilation, and decreased carbon dioxide retention
  • decreased cardiac output with increased serum lactic acid production
  • gastric drainage with increased removal of gastric acid

Question 191

Question
Which patient would the nurse identify as being at an increased risk for altered transport of oxygen? A patient with
Answer
  • hemoglobin level of 8.0
  • bronchoconstriction and mucus
  • peripheral arterial disease
  • decreased thoracic expansion

Question 192

Question
A 3-month-old infant is at increased risk for developing anemia. The nurse would identify which principle contributing to this risk?
Answer
  • The infant is becoming more active.
  • There is an increase in intake of breast milk or formula.
  • The infant is unable to maintain an adequate iron intake.
  • A depletion of fetal hemoglobin occurs.

Question 193

Question
Which clinical management prevention concept would the nurse identify as representative of secondary prevention?
Answer
  • Decreasing venous stasis and risk for pulmonary emboli
  • Implementation of strict hand washing routines
  • Maintaining current vaccination schedules
  • Prevention of pneumonia in patients with chronic lung disease

Question 194

Question
The nurse would identify which body systems as directly involved in the process of normal gas exchange? (Select all that apply.)
Answer
  • Neurologic system
  • Endocrine system
  • Pulmonary system
  • Immune system
  • Cardiovascular system
  • Hepatic system

Question 195

Question
The nurse is assessing a patient for the adequacy of ventilation. What assessment findings would indicate the patient has good ventilation? (Select all that apply.)
Answer
  • Respiratory rate is 24 breaths/min.
  • Oxygen saturation level is 98%.
  • The right side of the thorax expands slightly more than the left.
  • Trachea is just to the left of the sternal notch.
  • Nail beds are pink with good capillary refill.
  • There is presence of quiet, effortless breath sounds at lung base bilaterally.
Show full summary Hide full summary

Want to create your own Quizzes for free with GoConqr? Learn more.

Similar

Spanish Vocabulary- Beginner
PatrickNoonan
Cell Structure
daniel.praecox
OCR AS Biology - Lipids
Chris Osmundse
Ionic Bondic Flashcards.
anjumn10
FCE Practice Quiz - B2
miminoma
Hitler's Chancellorship
c7jeremy
Of Mice and Men - Themes
Hafsa A
Edexcel Additional Science Biology Topic 1
hchen8nrd
GCSE AQA Biology 2 DNA & Cell Division
Lilac Potato
Lesson Planning: 4 Organisational Tips for Teachers
miminoma
Get your grammar right!
Sarah Holmes
Browse Library