A patient comes to the emergency department complaining of nausea and vomiting.
What should the nurse ask the patient about first?
a. Family history of diabetes
b. Medications the patient is taking
c. Operations the patient has had in the past
d. Severity and duration of the nausea and vomiting
Give this one a try later!
Answer: D
In an emergent situation, the nurse initially focuses on the patient's chief
complaint to determine its cause. Before initiating care, the nurse gathers
information on the other topics.
Which action by a patient with a family history of macular degeneration would
demonstrate use of a prevention strategy that has been found to help prevent
deterioration of the macula?
,a. Using medicated eyedrops
b. Avoiding the use of sunglasses
c. Taking vitamin B6 and B12 supplements
d. Minimizing dietary intake of antioxidants
Give this one a try later!
Answer: C
Taking dietary supplements, including vitamins E, C, B6, B12, beta carotene,
zinc oxide, and copper, has been found to limit the development and
severity of macular degeneration. Wearing sunglasses outside is another
important recommended prevention strategy. Using medicated eyedrops
and avoiding dietary antioxidants are not indicated in the prevention of
macular deterioration.
Which nursing intervention is included for a patient experiencing diarrhea?
a. Limiting fluid intake to 1000 mL/day
b. Administering a cathartic suppository
c. Increasing fiber in the diet
d. Limiting exercise
Give this one a try later!
Answer: C
Fiber is encouraged in patients with diarrhea to add bulk to the stools. Fluid
intake and exercise should be encouraged. Cathartics would not be used
because they are strong laxatives used to soften the stool and evacuate
the bowels.
The nurse knows that the teaching for a patient who was recently diagnosed with
constipation has been effective if the patient's meal request specifies which food
choice?
a. Hot dog on a bun
b. Grilled chicken
,c. Tuna sandwich on white bread
d. Spinach salad with dressing
Give this one a try later!
Answer: D
Green leafy vegetables are high in fiber. None of the other options are high
in fiber but could be modified by using or adding whole-grain products.
The nurse can facilitate critical thinking through the use of which interpersonal skills?
(Select all that apply.)
a. Teamwork
b. Intuition
c. Judgment
d. Conflict management
e. Advocacy
f. Reasoning
Give this one a try later!
Answers: A, D, E
Interpersonal skills such as teamwork, conflict management, and advocacy
engage others in the process of critical thinking. Intuition, judgment, and
reasoning are intrapersonal aspects of critical thinking that the nurse may
use personally to better understand a situation.
The nurse is assigned the care of a patient for whom a cleansing enema has been
ordered. What information is most important for the nurse to know before
administration of the enema?
a. The proper way to position the patient
b. Signs and symptoms of intolerance to the procedure
c. Vital signs before the procedure
d. History of surgery of the anus or rectum
, Give this one a try later!
Answer: D
The most important item in preadministration assessment data is a history of
surgery to the anus or rectum, which may contraindicate enema
administration. The nurse needs to know the proper patient position for an
enema and must observe for signs of intolerance to the procedure, but
these are done during the procedure. Vital signs are not routinely obtained
before an enema.
Which ICNP nursing diagnosis is most appropriate for a young immigrant who
expresses concern for the safety of his family members who were unable to relocate
with him out of a war zone?
a. Risk for Spiritual Distress
b. Impaired Role Performance
c. Impaired Family Process
d. Difficulty Coping
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Answer: C
A key factor in Impaired Family Process is a situational crisis that causes a
change in communication and emotional and mutual support, which all are
present in this case. None of the information provided indicates a spiritual
crisis, ineffectiveness of coping, or impairment of role performance.
When assessing the patient for pain, which factors should the nurse consider? (Select
all that apply.)
a. Previous medical history
b. Physical appearance
c. Age, gender, and culture
d. Lifestyle and loss of appetite
e. Hair color and style
What should the nurse ask the patient about first?
a. Family history of diabetes
b. Medications the patient is taking
c. Operations the patient has had in the past
d. Severity and duration of the nausea and vomiting
Give this one a try later!
Answer: D
In an emergent situation, the nurse initially focuses on the patient's chief
complaint to determine its cause. Before initiating care, the nurse gathers
information on the other topics.
Which action by a patient with a family history of macular degeneration would
demonstrate use of a prevention strategy that has been found to help prevent
deterioration of the macula?
,a. Using medicated eyedrops
b. Avoiding the use of sunglasses
c. Taking vitamin B6 and B12 supplements
d. Minimizing dietary intake of antioxidants
Give this one a try later!
Answer: C
Taking dietary supplements, including vitamins E, C, B6, B12, beta carotene,
zinc oxide, and copper, has been found to limit the development and
severity of macular degeneration. Wearing sunglasses outside is another
important recommended prevention strategy. Using medicated eyedrops
and avoiding dietary antioxidants are not indicated in the prevention of
macular deterioration.
Which nursing intervention is included for a patient experiencing diarrhea?
a. Limiting fluid intake to 1000 mL/day
b. Administering a cathartic suppository
c. Increasing fiber in the diet
d. Limiting exercise
Give this one a try later!
Answer: C
Fiber is encouraged in patients with diarrhea to add bulk to the stools. Fluid
intake and exercise should be encouraged. Cathartics would not be used
because they are strong laxatives used to soften the stool and evacuate
the bowels.
The nurse knows that the teaching for a patient who was recently diagnosed with
constipation has been effective if the patient's meal request specifies which food
choice?
a. Hot dog on a bun
b. Grilled chicken
,c. Tuna sandwich on white bread
d. Spinach salad with dressing
Give this one a try later!
Answer: D
Green leafy vegetables are high in fiber. None of the other options are high
in fiber but could be modified by using or adding whole-grain products.
The nurse can facilitate critical thinking through the use of which interpersonal skills?
(Select all that apply.)
a. Teamwork
b. Intuition
c. Judgment
d. Conflict management
e. Advocacy
f. Reasoning
Give this one a try later!
Answers: A, D, E
Interpersonal skills such as teamwork, conflict management, and advocacy
engage others in the process of critical thinking. Intuition, judgment, and
reasoning are intrapersonal aspects of critical thinking that the nurse may
use personally to better understand a situation.
The nurse is assigned the care of a patient for whom a cleansing enema has been
ordered. What information is most important for the nurse to know before
administration of the enema?
a. The proper way to position the patient
b. Signs and symptoms of intolerance to the procedure
c. Vital signs before the procedure
d. History of surgery of the anus or rectum
, Give this one a try later!
Answer: D
The most important item in preadministration assessment data is a history of
surgery to the anus or rectum, which may contraindicate enema
administration. The nurse needs to know the proper patient position for an
enema and must observe for signs of intolerance to the procedure, but
these are done during the procedure. Vital signs are not routinely obtained
before an enema.
Which ICNP nursing diagnosis is most appropriate for a young immigrant who
expresses concern for the safety of his family members who were unable to relocate
with him out of a war zone?
a. Risk for Spiritual Distress
b. Impaired Role Performance
c. Impaired Family Process
d. Difficulty Coping
Give this one a try later!
Answer: C
A key factor in Impaired Family Process is a situational crisis that causes a
change in communication and emotional and mutual support, which all are
present in this case. None of the information provided indicates a spiritual
crisis, ineffectiveness of coping, or impairment of role performance.
When assessing the patient for pain, which factors should the nurse consider? (Select
all that apply.)
a. Previous medical history
b. Physical appearance
c. Age, gender, and culture
d. Lifestyle and loss of appetite
e. Hair color and style
