Nursing Comprehensive Study Guide
084 Questions with Verified Answers
1 Which of the following approaches is best to take when the psychiatric technician
discovers that a postoperative surgery client who practices Judaism is eating only the
fruit and bread on his food tray? Since the nurse cannot change the dietary beliefs of
the client, the nurse can help adjust their diet within their belief structures. Kosher eating
demands the following: - ANSWERSSeparate dishes or pans are used to prepare and
to serve meat and dairy foods. Meats must be slaughtered by a ritual method and only
the front quarter of the animal may be eaten/ Meat and dairy may not be eaten at the
same meal. Food must be prepared ahead of time for the Sabbath which is sundown
Friday to sundown Saturday. Pork products, rabbit, shellfish, and scavenger fish are
also not allowed. (363)
Which diet is best for a client with a diagnosis of cardiovascular disease? -
ANSWERSLow fat, low sodium, low calories (376-377) Think of some foods that would
be appropriate when answering the question on the exam.
3 What should be included when teaching about dietary restrictions for a client with
diagnosis of hypertension? - ANSWERSLow sodium, should consume no more than
1500 mg sodium per day. Encourage foods that are high in Potassium, such as leafy
green vegetables, fruit from vines, and root vegetables. (375). Again, think of foods that
are lowest in sodium when answering this question.
Which type of diets would be given to clients with a diagnosis of Spastic Quadriplegia
who has "dysphagia"? - ANSWERSSpeech therapist is often consulted; Diet ranges
from thick liquids only to solid and thick liquids. (371). Remember, the prescribed
consistency.
From test: solid to thick liquid to pudding consistency
5 Which foods should be omitted when doing meal planning with a client with a
diagnosis of gastric ulcer? - ANSWERSBland diets has often been prescribed for those
with ulcers, esophagitis. GERD, or heartburn, gastritis, hiatal hernia, or other disorders
of the gastrointestinal tract. Alcohol, Caffeine/Decaf, Red and black pepper, Chili
powder, Fried foods and foods high in fat, peppermint and spearmint oils should be
avoiding at on the bland diet. (374)
6 Which are some interventions that should be implanted for a client who experiences
"gastroesophageal reflux" (GERD) following meals? - ANSWERSShould be encouraged
to avoid other foods that may cause them discomfort. Instruct not to lie down for an hour
after meals; to maintain ideal weight, eat smaller, more frequently. Discourage smoking
and milk based diets (374).
,7 How can the PT assist when delivering the dinner tray to a client whose dominant arm
is in a cast elevated on two pillows? - ANSWERSAssist with spreading butter, pouring
pitcher of water into cup, slicing steak, etc. (370)
8 Which test is best for identifying correct placement of a newly inserted naso-gastric
tube? - ANSWERSX-ray (PowerPoint) is the "gold standard" for a newly inserted NG
tube. After that, auscultation and aspiration are used.
9 Which action is most important for the psychiatric technician to take when feeding a
client through a naso-gastric tube? - ANSWERSHead of bed should be elevated to
about 30 degrees to prevent aspiration of stomach contents (379) MOST important is to
check placement through auscultation and aspiration.
10 The psychiatric technician is preparing to administer nutrition (gavage) through a
naso-gastric tube. In which position should client be placed? - ANSWERSSitting
position aka Fowler's position and check placement prior to feeding (379).
11 What is a dangerous complication that may occur if a nasogastric tube feeding is
administered too quickly? - ANSWERSAspiration pneumonia d/t vomiting/regurgitation,
which may lead to client morbidity or mortality (379).
12. The psychiatric technician is assigned to teach a client with a diagnosis of Diabetes
Mellitus about recognizing the symptoms of hypoglycemia? Which are the signs and
symptoms? - ANSWERSSweating, shakiness, hunger, fatigue, confusion, seizure and
loss of consciousness. 374
13. Which interventions should be done IMMEDIATELY to relieve the signs and
symptoms of hypoglycemia? - ANSWERS4 ounces of any available juice 376
14. A Client with a diagnosis of Diabetes Mellitus is put on a 1600-calorie ADA diet.
What is the goal of her diet teaching? - ANSWERSShe will eat three regularly
scheduled meals plus snacks. 376
15 What is the generally accepted as the "normal" range for serum blood glucose? -
ANSWERS60mg/dl - 110mg/dl. Pharmacology lecture
16 What is the most likely time for a client to experience an insulin reaction if 10 units of
regular insulin had been recieved at 0730? (Review Drug card for this information) -
ANSWERSReaction time is between 8:00 and 9:15. (Basic Injection Skill p.17) Onset is
different from Reaction time also called PEAK time. The question is asking for peak
time. That is when the insulin is exerting its greatest effect - usually 2-5 hours after
administration for Regular Insulin which is fast acting. Therefore, between 9 - 11 am is
when the PT needs to monitor the client very carefully for the symptoms described in
answer 12. (We need to discuss this in class).
, 17 What will be the most likely time for a client to experience an insulin reaction if the
client had recieved NPH insulin at 0730? (Review Drug Card for this information) -
ANSWERSThe reaction time is between 8:30 to 9:30. (Basic Injection Skill p.17) Onset
is different from Reaction time also called PEAK time. The question is asking for peak
time. That is when the insulin is exerting its greatest effect - usually 6-12 hours after
administration for NPH Insulin which is intermediate acting. Therefore, between 2 - 7 pm
is when the PT needs to monitor the client very carefully for the symptoms described in
answer 12. (We need to discuss this in class).
18 What is the rationale for keeping a client NPO before surgery for approximately 8 to
10 hours? - ANSWERSClients are kept NPO before surgery to avoid "Aspiration" -
prevent stomach contents from entering lungs due to vomiting that may be brought on
by the anesthesia. 954
19 You are assigned to a patient with asthma. The doctor wrote the following orders:
Vital signs every 2 hours, respiratory treatments every 4 hours as needed, and I&O
every shift. Based on this information, when should the nurse perform assessments on
this client? 359 - ANSWERSEvery two hours.
20. What are the BEST type of questions to ask when obtaining a nursing history from a
client? 367 - ANSWERSWhy did you come to this facility today?; Are you allergic to any
medicine? What is your level of pain now? 397
21A What is the timeline for the creation of a nursing care plan? - ANSWERSWithin 12
to 24 hrs. 407
21B. How often is NCP updated? - ANSWERSNCP is updated regularly as the client's
condition changes. 406
21C. What is the determining factor in the revision of a NCP? - ANSWERSRevisions
are done to the NCP when there is change in the client conditions OR when the plan is
not working. 400
22A. A patient is admitted to the hospital with complaints of numbness in her legs
alternating with weakness. What questions would be a PRIORITY for the nurse to ask?
- ANSWERSDo you need assistance walking? Do you have trouble breathing? What, if
anything, relieve the numbness? 397
22b. A client is admitted to the hospital with complaints of chest pain during exercise.
What questions would be a priority for the nurse to ask? - ANSWERSDo you have
difficulty breathing? How often do you have this pain and how long it last. 397
ACTUAL ANSWER: How can I help relieve your pain?
23. What are examples of a Subjective Data? - ANSWERSClient said: "My head hurt"
"my stomach hurts" 399
084 Questions with Verified Answers
1 Which of the following approaches is best to take when the psychiatric technician
discovers that a postoperative surgery client who practices Judaism is eating only the
fruit and bread on his food tray? Since the nurse cannot change the dietary beliefs of
the client, the nurse can help adjust their diet within their belief structures. Kosher eating
demands the following: - ANSWERSSeparate dishes or pans are used to prepare and
to serve meat and dairy foods. Meats must be slaughtered by a ritual method and only
the front quarter of the animal may be eaten/ Meat and dairy may not be eaten at the
same meal. Food must be prepared ahead of time for the Sabbath which is sundown
Friday to sundown Saturday. Pork products, rabbit, shellfish, and scavenger fish are
also not allowed. (363)
Which diet is best for a client with a diagnosis of cardiovascular disease? -
ANSWERSLow fat, low sodium, low calories (376-377) Think of some foods that would
be appropriate when answering the question on the exam.
3 What should be included when teaching about dietary restrictions for a client with
diagnosis of hypertension? - ANSWERSLow sodium, should consume no more than
1500 mg sodium per day. Encourage foods that are high in Potassium, such as leafy
green vegetables, fruit from vines, and root vegetables. (375). Again, think of foods that
are lowest in sodium when answering this question.
Which type of diets would be given to clients with a diagnosis of Spastic Quadriplegia
who has "dysphagia"? - ANSWERSSpeech therapist is often consulted; Diet ranges
from thick liquids only to solid and thick liquids. (371). Remember, the prescribed
consistency.
From test: solid to thick liquid to pudding consistency
5 Which foods should be omitted when doing meal planning with a client with a
diagnosis of gastric ulcer? - ANSWERSBland diets has often been prescribed for those
with ulcers, esophagitis. GERD, or heartburn, gastritis, hiatal hernia, or other disorders
of the gastrointestinal tract. Alcohol, Caffeine/Decaf, Red and black pepper, Chili
powder, Fried foods and foods high in fat, peppermint and spearmint oils should be
avoiding at on the bland diet. (374)
6 Which are some interventions that should be implanted for a client who experiences
"gastroesophageal reflux" (GERD) following meals? - ANSWERSShould be encouraged
to avoid other foods that may cause them discomfort. Instruct not to lie down for an hour
after meals; to maintain ideal weight, eat smaller, more frequently. Discourage smoking
and milk based diets (374).
,7 How can the PT assist when delivering the dinner tray to a client whose dominant arm
is in a cast elevated on two pillows? - ANSWERSAssist with spreading butter, pouring
pitcher of water into cup, slicing steak, etc. (370)
8 Which test is best for identifying correct placement of a newly inserted naso-gastric
tube? - ANSWERSX-ray (PowerPoint) is the "gold standard" for a newly inserted NG
tube. After that, auscultation and aspiration are used.
9 Which action is most important for the psychiatric technician to take when feeding a
client through a naso-gastric tube? - ANSWERSHead of bed should be elevated to
about 30 degrees to prevent aspiration of stomach contents (379) MOST important is to
check placement through auscultation and aspiration.
10 The psychiatric technician is preparing to administer nutrition (gavage) through a
naso-gastric tube. In which position should client be placed? - ANSWERSSitting
position aka Fowler's position and check placement prior to feeding (379).
11 What is a dangerous complication that may occur if a nasogastric tube feeding is
administered too quickly? - ANSWERSAspiration pneumonia d/t vomiting/regurgitation,
which may lead to client morbidity or mortality (379).
12. The psychiatric technician is assigned to teach a client with a diagnosis of Diabetes
Mellitus about recognizing the symptoms of hypoglycemia? Which are the signs and
symptoms? - ANSWERSSweating, shakiness, hunger, fatigue, confusion, seizure and
loss of consciousness. 374
13. Which interventions should be done IMMEDIATELY to relieve the signs and
symptoms of hypoglycemia? - ANSWERS4 ounces of any available juice 376
14. A Client with a diagnosis of Diabetes Mellitus is put on a 1600-calorie ADA diet.
What is the goal of her diet teaching? - ANSWERSShe will eat three regularly
scheduled meals plus snacks. 376
15 What is the generally accepted as the "normal" range for serum blood glucose? -
ANSWERS60mg/dl - 110mg/dl. Pharmacology lecture
16 What is the most likely time for a client to experience an insulin reaction if 10 units of
regular insulin had been recieved at 0730? (Review Drug card for this information) -
ANSWERSReaction time is between 8:00 and 9:15. (Basic Injection Skill p.17) Onset is
different from Reaction time also called PEAK time. The question is asking for peak
time. That is when the insulin is exerting its greatest effect - usually 2-5 hours after
administration for Regular Insulin which is fast acting. Therefore, between 9 - 11 am is
when the PT needs to monitor the client very carefully for the symptoms described in
answer 12. (We need to discuss this in class).
, 17 What will be the most likely time for a client to experience an insulin reaction if the
client had recieved NPH insulin at 0730? (Review Drug Card for this information) -
ANSWERSThe reaction time is between 8:30 to 9:30. (Basic Injection Skill p.17) Onset
is different from Reaction time also called PEAK time. The question is asking for peak
time. That is when the insulin is exerting its greatest effect - usually 6-12 hours after
administration for NPH Insulin which is intermediate acting. Therefore, between 2 - 7 pm
is when the PT needs to monitor the client very carefully for the symptoms described in
answer 12. (We need to discuss this in class).
18 What is the rationale for keeping a client NPO before surgery for approximately 8 to
10 hours? - ANSWERSClients are kept NPO before surgery to avoid "Aspiration" -
prevent stomach contents from entering lungs due to vomiting that may be brought on
by the anesthesia. 954
19 You are assigned to a patient with asthma. The doctor wrote the following orders:
Vital signs every 2 hours, respiratory treatments every 4 hours as needed, and I&O
every shift. Based on this information, when should the nurse perform assessments on
this client? 359 - ANSWERSEvery two hours.
20. What are the BEST type of questions to ask when obtaining a nursing history from a
client? 367 - ANSWERSWhy did you come to this facility today?; Are you allergic to any
medicine? What is your level of pain now? 397
21A What is the timeline for the creation of a nursing care plan? - ANSWERSWithin 12
to 24 hrs. 407
21B. How often is NCP updated? - ANSWERSNCP is updated regularly as the client's
condition changes. 406
21C. What is the determining factor in the revision of a NCP? - ANSWERSRevisions
are done to the NCP when there is change in the client conditions OR when the plan is
not working. 400
22A. A patient is admitted to the hospital with complaints of numbness in her legs
alternating with weakness. What questions would be a PRIORITY for the nurse to ask?
- ANSWERSDo you need assistance walking? Do you have trouble breathing? What, if
anything, relieve the numbness? 397
22b. A client is admitted to the hospital with complaints of chest pain during exercise.
What questions would be a priority for the nurse to ask? - ANSWERSDo you have
difficulty breathing? How often do you have this pain and how long it last. 397
ACTUAL ANSWER: How can I help relieve your pain?
23. What are examples of a Subjective Data? - ANSWERSClient said: "My head hurt"
"my stomach hurts" 399
