NSG 201 Saunders Review Test 2 (Nursing, The American, cognitive ability) GRADED A Questions and Answer solutions with rationale/ 100% CORRECT.

1.ID: 2 The nurse is caring for a woman who is starting medroxyprogesterone injections for birth control. What statements by the client would indicate a need for further teaching? Select al l that apply. A. “I may experience some weight gain.” Incorrect B. “I may not have regular periods while taking this medication.” C. “I should return in approximately 6 months for my next injection.” D. “Because it is highly effective, I can use this medication for many years.” E. “Depression is a side effect, and I should let my doctor know if I experience any mood changes.” Incorrect Rationale: Medroxyprogesterone is an injectable progestin given every 3 months to prevent ovulation and pregnancy. It suppresses ovulation for 15 weeks, and therefore, timing of the next injection is very important and should be no longer than exactly 3 months. Although medroxyprogesterone is highly effective, it should not be taken for more than 2 years due to the risk of osteoporosis. Weight gain, irregular periods, and depression are all known side effects. Test-Taking Strategy: Note the strategic words, “need for further teaching.” These words indicate a negative event query and the need to select the incorrect client statements. Specific knowledge about this medication is needed to answer correctly. Remember that it needs to be given every 3 months and should not be taken for more than 2 years due to the risk of osteoporosis. Review: medroxyprogesterone injections Level of Cognitive Ability: Evaluating Client Need: Health Promotion and Maintenance Integrated Process: Teaching and Learning Content Area: Pharmacology: Reproductive Medications Priority Concepts: Client Education, Reproduction HESI Concepts: Sexuality/Reproduction, Teaching and Learning/Patient Education Reference: Rosenjack Burchum, Rosenthal (2016), pp. 760-761. Awarded -1.0 points out of 2.0 possible points. 2.ID: 8 Following thyroid surgery, the nurse notes this response (refer to figure) when taking the client’s blood pressure. On further assessment, which laboratory finding would the nurse expect to find? A. Serum calcium of 8.4 mg/dL (2.1 mmol/L) B. Correct C. Sodium level of 138 mEq/L (138 mmol/L) D. Serum potassium of 5.1 mEq/L (5.1 mmol/L) E. F. Thyroid Stimulating Hormone (TSH) of 1.5 mU/L Incorrect Rationale: Hypocalcemia is characterized by tetany, or sustained muscle contractions. Chvostek’s sign is facial contractions seen after a light tap of the facial nerve in front of the ear. Trousseau’s sign is carpal contraction when a blood pressure cuff is inflated. These two signs are observed in hypocalcemia. Test-Taking Strategy: Focus on the subject, thyroid surgery and the signs of hypocalcemia. Use knowledge of signs of muscle contractions and its association with a low calcium level. Note that hypocalcemia is a known complication after thyroid surgery and serum calcium levels should be closely monitored. Review: hypocalcemia. Level of Cognitive Ability: Synthesizing Client Need: Physiological Integrity Integrated Process: Nursing Process/Analyzing Content Area: Fundamentals of Care: Fluids & Electrolytes Priority Concepts: Cellular Regulation, Fluid and Electrolytes HESI Concepts: Cellular Regulation, Fluids and Electrolytes Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing: Assessment and management of clinical problems (9th ed., pp. 298-299). St. Louis: Mosby. Awarded 0.0 points out of 1.0 possible points. 3.ID: 0 The charge nurse on a women’s health unit is making a client room assignment. Which clients would be least appropriate to assign to share a room with a woman who is pregnant? Select all that apply. A. A client with hepatitis B Correct B. A client with herpes zoster Correct C. A client with pyelonephritis Incorrect D. A client with hashimotos thyroiditis Incorrect E. A client with a urinary tract infection Rationale: Viral infections such as hepatitis B and herpes zoster can be very serious for the mother and fetus if exposed and clients with these conditions should not share a room with a pregnant client. Pyelonephritis, hashimotos thyroiditis, and urinary tract infections can all have adverse effects on a pregnant woman, however, these are not contagious conditions, and therefore clients with these conditions can safely room share with a pregnant woman. Test taking strategy: Focus on the strategic words least appropriate and select the clients that should not share a room with a pregnant female. Think about the infectious factors of each disorder in the options to answer correctly. Review: risks of pregnancy Level of Cognitive Ability: Creating Client Need: Safe and Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Maternity: Antepartum Priority Concepts: Care Coordination, Infection HESI Concepts: Care Coordination, Infection Reference: McKinney, E., James, S., Murray, S., Nelson, K. & Ashwill, J. (2013). Maternal-child nursing (4th ed., pp. 626-628). St. Louis: Elsevier. Awarded -1.0 points out of 2.0 possible points. 4.ID: 4 The home health nurse is caring for an older client recovering from pneumonia. A concerned family member believes that the client is no longer capable of caring for self effectively. The nurse conducts an assessment of the client’s basic activities of daily living (BADLs). What activities would the nurse assess? Select all that apply. A. Eating Correct B. Bathing Correct C. Cooking Incorrect D. Dressing Correct E. Taking medications Incorrect F. Balancing a checkbook Rationale: ADL’s are basic activities that assess functional ability. Daily activities such as eating, bathing, and dressing are considered basic every day needs. Activities such as cooking, taking medication, and balancing a checkbook are considered more complex, instrumental activities. Test-taking Strategy: Focus on the subject, basic activities of daily living. Select the answers that require the most basic care for completion. In addition, specific knowledge of those activities that are basic and those that are instrumental will assist in answering correctly. Review: Activities of Daily Living. Level of Cognitive Ability: Applying Client Need: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Fundamental Skills: Safety Priority Concepts: Functional Ability, Safety HESI Concepts: Functional Ability, Safety References: Giddens, J. (2013). Concepts for nursing practice. (p. 12). St. Louis, MO: Mosby. Potter, P., Perry, A. G., Stockert, P. A., & Hall, A. M. (2013). Fundamentals of nursing. (8th ed., pp. 259-260). St. Louis: Mosby. Awarded 1.0 points out of 3.0 possible points. 5.ID: 8 The nurse is caring for a client who has recently undergone a right-sided mastectomy for stage 3 breast cancer. When giving report to the next shift, what information would be essential to communicate to the oncoming nurse? Select all that apply. A. Elevate the right arm on a pillow. Correct B. Monitor skin color and for the presence of edema. Correct C. Educate that a medical alert bracelet is being worn. Correct D. Ensure the client refrains from any physical activity. Incorrect E. Take blood pressure measurements on the right side only. Incorrect Rationale: After a mastectomy, the nurse must assess for peripheral tissue perfusion. Therefore it is important to assess skin color and for the presence of edema. Elevation of the extremity will decrease venous pressure and decrease edema. A medical alert bracelet should be worn at all times. A medical alert bracelet should be worn to alert others and prevent anyone from using the affected extremity for blood pressure, intravenous (IV punctures), or blood draws because this could increase the likelihood of infection or decreased tissue perfusion. Although the client should avoid heavy lifting, activity should be encouraged and the client should participate in physical therapy unless contraindicated. Test-Taking Strategy: Note the strategic word essential when considering what information should be included in shift change report. Think about what information would be necessary for safe care of the client to help select the correct answer. Also noting the words, any and only in options 4 and 5 will assist in eliminating these options. Review: mastectomy Level of Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Communication and Documentation Content Area: Adult Health: Oncology Priority Concepts: Care Coordination, Tissue Integrity HESI Concepts: Care Coordination, Tissue Integrity Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing: Assessment and management of clinical problems (9th ed., p. ). St. Louis: Mosby. Awarded -1.0 points out of 3.0 possible points. 6.ID: 6 A client informs the nurse that she has recently started taking the herbal supplement black cohosh for her menopausal symptoms. When reviewing the client’s medical record, what finding would warrant the need for follow-up? Refer to chart. H i s t o r y a n d P h y s i c a l Laboratory Results M e di c at io n s R e n a l I n Thyroid Stimulating Hormone (TSH) 2.45 mIU/L Gl ipi zi de 5 m g s u f f i c i e n c y or al on ce da ily H e a r t f a i l u r e B-type natriuretic peptide (BNP) 204 pg/ml Si m va st at in 4 0 m g on ce da ily A. TSH result B. BNP result C. Heart failure D. Glipizide prescription Correct Rationale: Black cohosh is an herbal product used to treat hot flashes, irritability, and palpitations. It potentiates insulin, oral hypoglycemic agents, and anti- hypertensive agents. Therefore, follow-up would be necessary if the client was taking glipizide, a sulfonlyrea oral hypoglycemic agent. The TSH result is a normal finding. The BNP result would be expected with a known diagnosis of heart failure and additionally would not be affected by black cohosh. Test-Taking Strategy: Note the strategic words need for follow-up when considering what information provided in the chart is important. The options of heart failure and the BNP result are comparable or alike options, and therefore should be eliminated. Next, note that the TSH level is normal to eliminate this option. Review: interactions associated with black cohosh Level of Cognitive Ability: Synthesizing Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process: Analysis Content Area: Fundamental of Care: Safety Priority Concepts: Clinical Judgment, Safety HESI Concepts: Clinical Decision-Making/Clinical Judgment, Safety References: Hodgson, B., & Kizior, R. (2015). Saunders nursing drug handbook 2015. (p. 1317 ). St. Louis: Saunders. Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing: Assessment and management of clinical problems (9th ed., p. 1285). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 7.ID: 5 A client is admitted to hospital for treatment of a respiratory infection. The client was treated with an intravenous (IV) course of ampicillin and is ready to be discharged home on oral antibiotics. What information present in the chart would warrant the nurse to provide further teaching? Hist ory and Phy sica l Labo rator y and Diag nosti c Findi ngs Medi catio ns Ane Ches t X- Ray: norg esti mate mia cons olida tion in left uppe r lobe and ethin yl estra diol oral once daily Poly Cys Pota Metf tic ssiu ormi Ova m n rian level 500 Syn of mg dro 4.5 oral me meq/ twice (PC L daily OS) A. Anemia B. Potassium result C. Chest X-ray result Incorrect D. Norgestimate and ethinyl estradiol prescription Correct Rationale: Broad-spectrum antibiotics such as ampicillin are commonly used to treat upper respiratory infections. These medications can decrease the effectiveness of oral contraceptive medications and the client should be advised to use alternative birth control options. Anemia has no impact on the use of ampicillin. The chest x-ray results, although abnormal, are expected with a respiratory infection. Serum potassium level is within normal limits. PCOS and the use of metformin is not affected by the oral antibiotic. Test-Taking Strategy: Focus on the strategic words, provide further teaching. Use knowledge of board spectrum antibiotics to answer correctly. Remember that antibiotics can cause a decrease in the effectiveness of oral contraceptive pills. Review: broad spectrum antibiotics. Level of Cognitive Ability: Synthesizing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Analysis Content Area: Fundamentals of Care: Safety Priority Concepts: Client Education, Safety HESI Concepts: Safety, Teaching and Learning/Patient Education Reference: Rosenjack Burchum, Rosenthal (2016), pp. 1022, 1024. Awarded 0.0 points out of 1.0 possible points. 8.ID: 4 The charge nurse is making a client assignment for the upcoming shift. In order to create a safe assignment, the charge nurse plans to assign those clients requiring airborne precautions amongst different nurses. Which clients should be assigned to different nurses? Select all that apply. A. A client with measles. Correct B. A client with C. difficle. C. A client with influenza. Incorrect D. A client with pneumonia. E. A client with tuberculosis. Correct Rationale: Airborne precautions are used for those clients that are diagnosed with or suspected to have a condition spread through airborne transmission. Measles and tuberculosis are transmitted via airborne transmission. A client with influenza should be placed on droplet precautions. A client with C. difficile should be placed in contact and enteric precautions and a client with pneumonia only requires standard precautions. Test Taking Strategy: Focus on the subject of the question, airborne contact precautions. Think about how each disease identified in the options is transmitted in order to help select the correct option. Review: all types of transmission-based precautions Level of Cognitive Ability: Creating Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Fundamentals of Care: Infection Control Priority Concepts: Care Coordination, Infection HESI Concepts: Care Coordination, Infection References: Ignatavicius, D. M., & Workman, L. (2013). Medical-surgical nursing: Patient-centered collaborative care. (7th ed. p. 440). St. Louis, MO: W.B. Saunders Company. Perry, A., Potter, P., & Ostendorf, W. (2014). Clinical nursing skills & techniques (8th ed., p. 173). St. Louis: Mosby. Awarded 1.0 points out of 2.0 possible points. 9.ID: 0 The nurse at an outpatient clinic is performing a health assessment on a 67 year-old client. Her health history includes chronic obstructive pulmonary disorder (COPD) and diabetes mellitus and she currently has no complaints. On assessment, the client tells the nurse that she has not received any vaccinations other than a tetanus vaccine four years ago. Which routine vaccinations should be recommended given the client’s age? Select all that apply. A. Tetanus vaccine Incorrect B. Shingles vaccine Correct C. Influenza vaccine Correct D. Rotavirus vaccine Incorrect E. Pneumococcal vaccine Correct Rationale: The Centers for Disease Control (CDC) recommends that a healthy individual over the age of 65 years old should receive the shingles vaccine, an annual influenza vaccine, and a pneumococcal vaccine. Rotavirus is given to infants and the client is not due for a tetanus booster. Test-Taking Strategy: Focus on the data in the question and recall the recommended immunization schedule. Also focus on the client’s age to assist in answering. Review: immunization schedules Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Content Area: Developmental Stages: Health Assessment/Physical Exam Priority Concepts: Health Promotion, Immunity HESI Concepts: Health Promotion, Immunity Reference: Ignatavicius, D. M., & Workman, L. (2013). Medical-surgical nursing: Patient-centered collaborative care. (7th ed. p. 16). St. Louis, MO: W.B. Saunders Company. Awarded -1.0 points out of 3.0 possible points. 10.ID: 5 The nurse at a long-term care facility is conducting a medication review of a newly admitted older client with dementia, hypertension, diabetes mellitus, and depression. Which medication prescription would warrant the need to contact the health care provider? Select all that apply. A. Lisinopril 10 mg orally once daily. B. Furosemide 20mg orally once daily. C. Fluoxetine 20 mg orally once daily. Correct D. Metformin 500mg orally twice daily. E. Cyclobenzaprine 5mg every 8 hours as needed. Correct Rationale: A close review of medications is necessary for safe care of any client client but because the aging process affects physiological functioning, medication prescriptions for the older client need to be carefully monitored. The use of fluoxetine and cyclobenzaprine are considered inappropriate in the older client according to the Beers criteria and should not be used. All other medications listed would be appropriate. Test-Taking Strategy: Focus on the subject of this question, appropriate medication use in the elderly population. Think about physiological changes that occur with aging when selecting the correct option. Also, specific knowledge of medications in the Beers criteria and the classifications of the medications in the options will assist in answering correctly. Review: Beers criteria Level of Cognitive Ability: Synthesizing Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process/Analysis Content Area: Fundamental of Care: Medications and Administration Priority Concepts: Collaboration, Safety HESI Concepts: Collaboration, Safety References: Ignatavicius, D. M., & Workman, L. (2013). Medical-surgical nursing: Patient-centered collaborative care. (7th ed. p. 20-21). St. Louis, MO: W.B. Saunders Company. Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing: Assessment and management of clinical problems (9th ed., p. 74). St. Louis: Mosby. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, The American Geriatrics Society 2012 Beers Criteria Update Expert Panel;