ELSEVIER ADAPTIVE EOC EXAM SET QUESTIONS AND
ANSWERS GRADED A+
✔✔A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not
get along. It seems as though my spouse doesn't care about my diabetes." What is the
nurse's best response?
a. "You don't get along with your spouse."
b. "I'm sorry. What can I do to make you feel better?"
c. "It may be temporary because your spouse also needs time to adjust."
d. "You are unhappy. I wonder, have you tried to talk to your spouse?" - ✔✔d. "You are
unhappy. I wonder, have you tried to talk to your spouse?"
The response "You are unhappy. I wonder, have you tried to talk to your spouse?"
identifies the client's feelings and accepts them but also points out the responsibility of
the client to take action. Although the response "You don't get along with your spouse"
identifies one of the client's concerns, the identification of the underlying feeling is more
therapeutic. The response "I'm sorry. What can I do to make you feel better?" makes
the nurse responsible for changing the situation, which is not appropriate or therapeutic.
The response "It may be temporary because your spouse also needs time to adjust"
denies the client's feelings and provides false reassurance.
✔✔A client is admitted to the hospital with a possible diagnosis of Addison disease.
What is an important nursing responsibility during a 24-hour urine collection for this
client?
a. Keeping the client quiet and reducing stress
b. Assessing the client for signs and symptoms of edema
c. Monitoring the client for an elevation in blood pressure
d. Restricting the client's fluid intake during the day of the test - ✔✔a. Keeping the client
quiet and reducing stress
Stress and activity increase the secretion of adrenocorticotropic hormone (ACTH) and
adrenocortical hormones, elevating the urine values for the by-products of these
hormones, thus invalidating the test results. Clients with Addison disease chronically are
dehydrated and do not have edema. Because of fluid deficits, the client will be
hypovolemic, and the blood pressure will be decreased. Adequate fluid intake is
necessary for urine production; Addison disease involves salt wasting and dehydration,
which necessitates an increased fluid intake, not a restriction of fluid intake.
✔✔A 19-year-old woman, arrested for assault and robbery, has a history of truancy and
prostitution but is unconcerned that her behavior has caused emotional distress to
others. The diagnosis of antisocial personality disorder is made. According to
psychoanalytical theory, the client's lack of remorse and repetitive behavior probably are
related to what underdeveloped aspect of personality?
a. Id
b. Ego
c. Superego
,d. Limbic system - ✔✔c. Superego
Lack of remorse indicates a weak superego, the aspect of personality concerned with
prohibitions. The id is not underdeveloped in this person; the id acts to achieve self-
gratification. The ego is not related to acting-out behavior. The limbic system is not
underdeveloped; it is related to the achievement of pleasure.
✔✔When assisting an older adult (ages 65 to 75 years) in successfully completing
Erikson's task of this stage, the nurse should help the client with what task?
a. Investing creative energies in promoting social welfare
b. Redefining a role in society that offers something of value
c. Look to recapturing those opportunities that were not experienced
d. Feeling a sense of satisfaction when reflecting on past achievements - ✔✔d. Feeling
a sense of satisfaction when reflecting on past achievements
Feeling a sense of satisfaction when reflecting on past achievements encourages the
client to accept what life is or was and helps prevent feelings of despair. Although older
adults may invest creative energies in promoting social welfare, it is not the task
associated with Erikson's theory concerning older adults. According to Erikson's
developmental theory, redefining a role in society is the task of young adults. Looking to
recapture those opportunities that were not experienced is a desire that must come from
the client.
✔✔On which principle should the nurse's role be based in the maintenance or
promotion of the health of older adults?
a. There is a strong correlation between successful retirement and good health.
b. Thoughts of impending death are common and depressing to most older adults.
c. Some of the physiologic changes that occur as a result of aging are reversible.
d. Older adults can better accept the dependent state that chronic illness often causes. -
✔✔a. There is a strong correlation between successful retirement and good health.
Individuals who can reflect on life and accept it for what it was and who are able to
adjust and enjoy the changes retirement brings are less likely to experience health
problems, especially stress-related health problems. Most emotionally healthy older
adults do not focus on death. The changes of aging are usually not reversible.
Dependency often is more threatening to this age group.
✔✔Assessment data are collected on four different clients being assessed for safety
risks to themselves and others. Which client does the nurse identify as being at the
greatest risk for violent behavior?
a. *Client 1* History of being physically and sexually abused by family member from
ages 4 to 12 years; exhibits stress through hyperactivity
b. *Client 2* History of violent behavior when under the influence of alcohol; has been
abusing alcohol for 10 yrs
,c. *Client 3* Currently oriented but displays impaired memory; frequently unable to
recognize familiar caregivers
d. *Client 4* Currently paranoid; suspicious of "FBI agents" - ✔✔A history of physical or
sexual abuse coupled with the tendency to demonstrate hyperactive psychomotor
agitation puts this client at the highest risk for violence among the assessed clients. A
history of violence when inebriated is a low risk factor, regardless of how long the client
has been abusing alcohol. Memory impairment that includes poor recognition of familiar
individuals is a moderate risk for violence. Paranoid tendencies directed toward vague
individuals or situation pose a moderate risk for violence.
✔✔An unmarried pregnant client who is attending a crisis intervention group has finally
decided to go through with the pregnancy and keep the baby. What is the crisis
intervention nurse's primary responsibility at this time?
a. Confirming that this really is what the client wants to do
b. Exploring other problems that the client may be experiencing
c. Selecting a primary healthcare provider that the client can visit for prenatal care
d. Providing information about resources from which the client may receive assistance -
✔✔d. Providing information about resources from which the client may receive
assistance
After the client has made a decision, the nurse's main responsibility is to assist the client
in using the problem-solving process to explore other agencies, facilities, and services.
It is not appropriate to question the decision after it has been made. Exploring other
problems that the client may be experiencing is not part of the immediate goal during
the crisis; the client may be encouraged to seek help later for other problems. The client
must take primary responsibility for selecting a primary healthcare provider for prenatal
care.
✔✔A client asks the nurse, "Because I'm so comfortable talking with you, can we go out
for coffee and a movie after I get discharged?" To maintain the boundaries of a
therapeutic relationship, how will the nurse respond?
a. "I'm flattered, but that would be professionally unethical."
b. "You feel connected to me now; that will change once you are discharged."
c. "The attention I've been giving you is directed toward getting you better; it isn't
social."
d. "A social life is important, so as your nurse let's talk about how you can form
friendships." - ✔✔d. "A social life is important, so as your nurse let's talk about how you
can form friendships."
Clients often become socially interested in the nursing staff. When this occurs the nurse
should remind the client of the nursing role and take the opportunity to discuss the need
for friendships and how to achieve them best. Stating "I'm flattered, but that would be
professionally unethical"; "You feel connected to me now; that will change once you are
discharged"; and "The attention I've been giving you is directed toward getting you
better; it isn't social," although not untrue or inappropriate, do not best address the
nursing responsibility in this therapeutic role.
, ✔✔The nurse manager hears a conversation between a nurse and a client that is
focused on the details of their impending divorces. What is the nurse manager's
response?
a. Waiting until the conversation ends and then telling the nurse that such topics must
be discussed in strict privacy to ensure client confidentiality
b. Immediately asking to speak to the nurse privately and stating that sharing such
personal information is nontherapeutic and not tolerated
c. Immediately explaining to both nurse and client that such conversations are
inappropriate and that the nurse's assignment will be changed
d. Waiting until shift report and using that opportunity to discuss appropriate nurse-client
boundaries with the attending nursing staff - ✔✔b. Immediately asking to speak to the
nurse privately and stating that sharing such personal information is nontherapeutic and
not tolerated
The nurse-client relationship should always remain client focused. Discussing personal
issues with the client, even in an attempt to share similar experiences, is nontherapeutic
and should be discussed immediately by the nurse's supervisor. Although the ease with
which this conversation was overheard does raise concerns about the nurse's
understanding of the client's right to confidentiality and privacy, there is a greater issue
that needs immediate attention and should be addressed immediately. The nurse's
management of the nurse-client relationship should be discussed privately. It may not
be necessary to change the assignment. Although it may be useful to reinforce
information on privacy with the entire staff, the situation requires an immediate private
discussion between the nurse and the nurse manager to satisfactorily address the
problem for the individual nurse.
✔✔Before a treatment requiring informed consent can be performed, what information
must the client be given? Select all that apply.
a. The cost of the treatment
b. Alternative treatment options
c. The risks and benefits of the treatment
d. The risks involved in refusing the treatment
e. The nature of the problem requiring the treatment - ✔✔b. Alternative treatment
options
c. The risks and benefits of the treatment
d. The risks involved in refusing the treatment
e. The nature of the problem requiring the treatment
For consent to be legal it must be informed. The information provided to the client
includes the nature of the problem or condition, the nature and purpose of the proposed
treatment, and the risks and benefits of the treatment. Alternative treatment options, the
probability that the proposed treatment will be successful, and the risks involved in not
consenting to the treatment must also be provided. Cost of the treatment is not
considered relevant to informed consent.
ANSWERS GRADED A+
✔✔A client with recently diagnosed diabetes states, "I feel bad. My spouse and I do not
get along. It seems as though my spouse doesn't care about my diabetes." What is the
nurse's best response?
a. "You don't get along with your spouse."
b. "I'm sorry. What can I do to make you feel better?"
c. "It may be temporary because your spouse also needs time to adjust."
d. "You are unhappy. I wonder, have you tried to talk to your spouse?" - ✔✔d. "You are
unhappy. I wonder, have you tried to talk to your spouse?"
The response "You are unhappy. I wonder, have you tried to talk to your spouse?"
identifies the client's feelings and accepts them but also points out the responsibility of
the client to take action. Although the response "You don't get along with your spouse"
identifies one of the client's concerns, the identification of the underlying feeling is more
therapeutic. The response "I'm sorry. What can I do to make you feel better?" makes
the nurse responsible for changing the situation, which is not appropriate or therapeutic.
The response "It may be temporary because your spouse also needs time to adjust"
denies the client's feelings and provides false reassurance.
✔✔A client is admitted to the hospital with a possible diagnosis of Addison disease.
What is an important nursing responsibility during a 24-hour urine collection for this
client?
a. Keeping the client quiet and reducing stress
b. Assessing the client for signs and symptoms of edema
c. Monitoring the client for an elevation in blood pressure
d. Restricting the client's fluid intake during the day of the test - ✔✔a. Keeping the client
quiet and reducing stress
Stress and activity increase the secretion of adrenocorticotropic hormone (ACTH) and
adrenocortical hormones, elevating the urine values for the by-products of these
hormones, thus invalidating the test results. Clients with Addison disease chronically are
dehydrated and do not have edema. Because of fluid deficits, the client will be
hypovolemic, and the blood pressure will be decreased. Adequate fluid intake is
necessary for urine production; Addison disease involves salt wasting and dehydration,
which necessitates an increased fluid intake, not a restriction of fluid intake.
✔✔A 19-year-old woman, arrested for assault and robbery, has a history of truancy and
prostitution but is unconcerned that her behavior has caused emotional distress to
others. The diagnosis of antisocial personality disorder is made. According to
psychoanalytical theory, the client's lack of remorse and repetitive behavior probably are
related to what underdeveloped aspect of personality?
a. Id
b. Ego
c. Superego
,d. Limbic system - ✔✔c. Superego
Lack of remorse indicates a weak superego, the aspect of personality concerned with
prohibitions. The id is not underdeveloped in this person; the id acts to achieve self-
gratification. The ego is not related to acting-out behavior. The limbic system is not
underdeveloped; it is related to the achievement of pleasure.
✔✔When assisting an older adult (ages 65 to 75 years) in successfully completing
Erikson's task of this stage, the nurse should help the client with what task?
a. Investing creative energies in promoting social welfare
b. Redefining a role in society that offers something of value
c. Look to recapturing those opportunities that were not experienced
d. Feeling a sense of satisfaction when reflecting on past achievements - ✔✔d. Feeling
a sense of satisfaction when reflecting on past achievements
Feeling a sense of satisfaction when reflecting on past achievements encourages the
client to accept what life is or was and helps prevent feelings of despair. Although older
adults may invest creative energies in promoting social welfare, it is not the task
associated with Erikson's theory concerning older adults. According to Erikson's
developmental theory, redefining a role in society is the task of young adults. Looking to
recapture those opportunities that were not experienced is a desire that must come from
the client.
✔✔On which principle should the nurse's role be based in the maintenance or
promotion of the health of older adults?
a. There is a strong correlation between successful retirement and good health.
b. Thoughts of impending death are common and depressing to most older adults.
c. Some of the physiologic changes that occur as a result of aging are reversible.
d. Older adults can better accept the dependent state that chronic illness often causes. -
✔✔a. There is a strong correlation between successful retirement and good health.
Individuals who can reflect on life and accept it for what it was and who are able to
adjust and enjoy the changes retirement brings are less likely to experience health
problems, especially stress-related health problems. Most emotionally healthy older
adults do not focus on death. The changes of aging are usually not reversible.
Dependency often is more threatening to this age group.
✔✔Assessment data are collected on four different clients being assessed for safety
risks to themselves and others. Which client does the nurse identify as being at the
greatest risk for violent behavior?
a. *Client 1* History of being physically and sexually abused by family member from
ages 4 to 12 years; exhibits stress through hyperactivity
b. *Client 2* History of violent behavior when under the influence of alcohol; has been
abusing alcohol for 10 yrs
,c. *Client 3* Currently oriented but displays impaired memory; frequently unable to
recognize familiar caregivers
d. *Client 4* Currently paranoid; suspicious of "FBI agents" - ✔✔A history of physical or
sexual abuse coupled with the tendency to demonstrate hyperactive psychomotor
agitation puts this client at the highest risk for violence among the assessed clients. A
history of violence when inebriated is a low risk factor, regardless of how long the client
has been abusing alcohol. Memory impairment that includes poor recognition of familiar
individuals is a moderate risk for violence. Paranoid tendencies directed toward vague
individuals or situation pose a moderate risk for violence.
✔✔An unmarried pregnant client who is attending a crisis intervention group has finally
decided to go through with the pregnancy and keep the baby. What is the crisis
intervention nurse's primary responsibility at this time?
a. Confirming that this really is what the client wants to do
b. Exploring other problems that the client may be experiencing
c. Selecting a primary healthcare provider that the client can visit for prenatal care
d. Providing information about resources from which the client may receive assistance -
✔✔d. Providing information about resources from which the client may receive
assistance
After the client has made a decision, the nurse's main responsibility is to assist the client
in using the problem-solving process to explore other agencies, facilities, and services.
It is not appropriate to question the decision after it has been made. Exploring other
problems that the client may be experiencing is not part of the immediate goal during
the crisis; the client may be encouraged to seek help later for other problems. The client
must take primary responsibility for selecting a primary healthcare provider for prenatal
care.
✔✔A client asks the nurse, "Because I'm so comfortable talking with you, can we go out
for coffee and a movie after I get discharged?" To maintain the boundaries of a
therapeutic relationship, how will the nurse respond?
a. "I'm flattered, but that would be professionally unethical."
b. "You feel connected to me now; that will change once you are discharged."
c. "The attention I've been giving you is directed toward getting you better; it isn't
social."
d. "A social life is important, so as your nurse let's talk about how you can form
friendships." - ✔✔d. "A social life is important, so as your nurse let's talk about how you
can form friendships."
Clients often become socially interested in the nursing staff. When this occurs the nurse
should remind the client of the nursing role and take the opportunity to discuss the need
for friendships and how to achieve them best. Stating "I'm flattered, but that would be
professionally unethical"; "You feel connected to me now; that will change once you are
discharged"; and "The attention I've been giving you is directed toward getting you
better; it isn't social," although not untrue or inappropriate, do not best address the
nursing responsibility in this therapeutic role.
, ✔✔The nurse manager hears a conversation between a nurse and a client that is
focused on the details of their impending divorces. What is the nurse manager's
response?
a. Waiting until the conversation ends and then telling the nurse that such topics must
be discussed in strict privacy to ensure client confidentiality
b. Immediately asking to speak to the nurse privately and stating that sharing such
personal information is nontherapeutic and not tolerated
c. Immediately explaining to both nurse and client that such conversations are
inappropriate and that the nurse's assignment will be changed
d. Waiting until shift report and using that opportunity to discuss appropriate nurse-client
boundaries with the attending nursing staff - ✔✔b. Immediately asking to speak to the
nurse privately and stating that sharing such personal information is nontherapeutic and
not tolerated
The nurse-client relationship should always remain client focused. Discussing personal
issues with the client, even in an attempt to share similar experiences, is nontherapeutic
and should be discussed immediately by the nurse's supervisor. Although the ease with
which this conversation was overheard does raise concerns about the nurse's
understanding of the client's right to confidentiality and privacy, there is a greater issue
that needs immediate attention and should be addressed immediately. The nurse's
management of the nurse-client relationship should be discussed privately. It may not
be necessary to change the assignment. Although it may be useful to reinforce
information on privacy with the entire staff, the situation requires an immediate private
discussion between the nurse and the nurse manager to satisfactorily address the
problem for the individual nurse.
✔✔Before a treatment requiring informed consent can be performed, what information
must the client be given? Select all that apply.
a. The cost of the treatment
b. Alternative treatment options
c. The risks and benefits of the treatment
d. The risks involved in refusing the treatment
e. The nature of the problem requiring the treatment - ✔✔b. Alternative treatment
options
c. The risks and benefits of the treatment
d. The risks involved in refusing the treatment
e. The nature of the problem requiring the treatment
For consent to be legal it must be informed. The information provided to the client
includes the nature of the problem or condition, the nature and purpose of the proposed
treatment, and the risks and benefits of the treatment. Alternative treatment options, the
probability that the proposed treatment will be successful, and the risks involved in not
consenting to the treatment must also be provided. Cost of the treatment is not
considered relevant to informed consent.
