NUR 6111 Advanced Practice Nursing I Exam 3 Practice Exam 100 Questions With Answers & Rationales Updates

A patient who was diagnosed with senile dementia has become incontinent of urine. The patient's daughter asks the nurse why this is happening. What is the nurse's best response? - ANS patient is losing sphincter control due to the dementia The nurse is caring for a patient who has suffered a spinal cord injury and is concerned about the patient's elimination status. What is the nurse's best action? - ANS Establish a bowel and bladder program for the patient The process of digestion is important for every living organism for the purpose of nourishment. Where does most digestion take place in the body? - ANS The small intestine The nurse is listening for bowel sounds in a postoperative patient. The bowel sounds are slow as they are heard only every 3-4 minutes. The patient asks the nurse why this is happening. What is the nurse's best response? - ANS "Anesthesia during surgery and pain medication after surgery may slow peristalsis in the bowel" What is a primary prevention tool used for color cancer screening? - ANS occult blood testing During an assessment, the patient states that his bowel movements cause discomfort because the stool is hard and difficult to pass. As the nurse, you make which of the following suggestions to assist the patient with improving the quality of his bowel movement? - ANS -increase fiber intake -increase water consumption When conducting a health history assessment, the nurse would want to know what most important information about the patient's elimination status? - ANS - Recent changes in elimination patterns -Changes in color, consistency, or odor of stool or urine -Discomfort or pain with elimination -List of medications taken by patient The nurse is assigned a group of patients. Which patient finding would the nurse identify as a factor leading to increased risk for impaired gas exchange? - ANS hemoglobin of 8.5 g/dL 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 might the nurse expect to observe on assessment of this patient? - ANS disorientation and tremors The nurse would identify which patient condition as a problem of impaired gas exchange secondary to a perfusion problem? - ANS peripheral arterial disease of the lower extremities 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? - ANS an elevation of the total white cell count indicates generalized inflammation 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? - ANS chronic lung disease with increased carbon dioxide retention Which patient finding would the nurse identify as being a risk factor for altered transport of oxygen? - ANS hemoglobin level of 8.0 A 3-month old infant is at increased risk for developing anemia. The nurse would identify which principle contributing to this risk? - ANS a depletion of fetal hemoglobin occurs Which clinical management prevention concept would the nurse identify as representative of secondary prevention? - ANS prevention of pneumonia in patients with chronic lung disease The nurse would identify which body systems as directly involved in the process of normal gas exchange? - ANS -neurologic system -pulmonary system -cardiovascular system The nurse is assessing a patient for the adequacy of ventilation. What assessment findings would indicate the patient has good ventilation? - ANS -oxygen saturation level is 98% -nail beds are pink with good capillary refill -there is presence of quiet, effortless breath sounds as lung base bilaterally The nurse is caring for a patient who is being discharged home after a splenectomy. What information on immune function needs to be included in this patient's discharge planning? - ANS basic infection control techniques An 18 month old female patient is diagnosed with her fifth ear infection in the past 10 months. The physician notes that the child's growth rate has decreased from the 60th percentile for height and weight to the 15th percentile over the same time period. The child has been treated for thrush consistently since the third ear infection. The nurse understands that the patient is at risk for which condition? - ANS primary immunodeficiency The nurse is caring for a postoperative patient who had an open appendectomy. The nurse understands that this patient should have some erythema and edema at the incision site 12 to 24 hours post operation dependent on which condition? - ANS his immune system is functioning properly While caring for a patient preparing for a kidney transplant, the nurse knows that the patient understands teaching on immunosuppression when she makes which statement? - ANS "the medications that I take will help prevent my body from attacking my new kidney" The nurse is caring for a patient who was started on intravenous antibiotic therapy earlier in the shift. As the second dose is being infused, the patient reports feeling dizzy and having difficulty breathing and talking. The nurse notes that the patient's respirations are 26 breaths/min with a weak pulse of 112 beats/min. the nurse suspects that the patient is experiencing which condition? - ANS anaphylactic reaction The nurse is preparing to administer medications to a patient with rheumatoid arthritis (RA). The nurse should explain which goal of treatment to the patient? - ANS control inflammation The parents of a newborn question the nurse about the need for vaccinations. "Why does our baby need all these shots? He's so small, and they have to cause him pain" The nurse can explain to the parents that which of the following are true about vaccinations? - ANS -Are part of primary prevention for system disorders -Help protect individuals and communities -Are recommended by the Centers for Disease Control and Prevention (CDC) A nurse is instructing her patient with ulcerative colitis regarding the need to avoid enteric coated medications. The nurse knows that the patient understands the reason for this teaching when he states which of the following? - ANS "Enteric coated medications are absorbed lower in the digestive tract and can be irritating to my intestines or inadequately absorbed by my inflamed tissue" A patient is diagnosed with a sprain to her right ankle after a fall. The patient asks the nurse about using ice on her injured ankle. What is the nurse's best response? - ANS Ice should be applied for 15-20 minutes every 2-3 hours over the next 1-2 days A patient is being treated with an antibiotic for an infected orthopedic injury. What explanation should the nurse give to the patient about this medication? - ANS An antibiotic helps to kill the infection causing the inflammation On admission to the clinic, the nurse notes a moderate amount of serous exudate leaking from the patient's wound. The nurse realizes what information about this fluid? - ANS Contains the materials used by the body in the initial inflammatory response. The nurse review the patient's complete blood count (CBC) results and notes that the neutrophil levels are elevated, but monocytes are still within normal limits. This indicates what type of inflammatory response? - ANS Early stage acute A patient comes to the clinic with a complain of painful, itchy feet. On interview, the patient tells the nurse that he is a college student living in a dormitory apartment that he shares with five other students. What teaching should the nurse provide for this patient? - ANS avoid sharing razors and other personal items The nurse assesses the patient and notes all of the following. Select all of the findings that indicate the systemic manifestations of inflammation - ANS -Oral temperature 38.6 C / 101.5F -WBC 20 cells / McL X 10^9th/ L -Patient reports, "I'm tired all the time. I haven't felt like myself in days" The nurse is working on a plan of care with her patient which includes turning and positioning and adequate nutrition to help the patient maintain intact skin integrity. The nurse helps the patient to realize that this break the chain of infection by elimination which element? - ANS portal of entry While reviewing the complete blood count (CBC) of a patient on her unit, the nurse notes elevated basophil and eosinophil readings. The nurse realizes that this is most indicative of which type of infection? - ANS parasitic Which set of assessment data is consistent for a patient with seer infection that could lead to system failure? - ANS BP 90/48, P 112 beats/min, RR 26 breaths/min, urine output 240 mL in the past 24 hours A nurse is teaching a group of business people about disease transmission. He knows that he needs to reeducate when one of the participants states which of the following? - ANS "If I don't feel sick, then I don't have to worry about transmitted diseases" In order to provide the best intervention for a patient, the nurse is often responsible for obtaining a sample of exudate for culture. What information will this provide? - ANS What specific type of pathogen is causing an infection The nurse is caring for a patient with a diagnosed case of Clostridium difficile. The nurse expects to implement which of the following interventions? - ANS -Use of personal protective equipment -Patient teaching on methods to inhibit transmission -Administration of intravenous fluids -Strict monitoring of intake and output Individuals of low socioeconomic status are at an increased risk for infection because of which of the following? - ANS -Uninsured or underinsured status -High cost of medications -Inadequate nutrition An older patient presents to the outpatient clinical with a chief complain of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient's chief complaint? - ANS The patient has recently lost her spouse and needed to move in with her daughter A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. Which action should the nurse take? - ANS Plan to reinforce and repeat teaching about diabetes management. A diabetic patient who is hospitalized tells the nruse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate? - ANS "stressors such as illness cause the release of hormones that increase blood sugar" A patient has not been sleeping well because he is worried about losing his job and not be able to support his family. The nurse takes the patient's vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first? - ANS Slow and deepen breathing via use of a positive, repeated word The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function? - ANS Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode A patient tells the nurse, I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response? - ANS "Let's talk about what is going on in your life and then look at possible options" A patient tells the nurse "my doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to earn a new way of thinking." Which response would be in keeping with the doctor's recommendations? - ANS Teaching the patient to recognize, reconsider, and reframe irrational thoughts A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress? - ANS His systolic blood pressure has gone from the 140s to the 120s Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? - ANS -Ask about epigastric pain -Observe for increased appetite -Check for elevated blood glucose levels The nurse is working with a patient who recently lost her spouse after a lengthy illness. The patient shares that she would like to sell her home and move to another state now that her spouse has passed away. Which of the following interventions would be considered a priority for this patient? - ANS -Suggest that the patient consider a support group for widows -Suggest that the patient learn stress reduction breathing exercises -Assist the patient in identifying support systems The nurse is reviewing the care plan for a patient experiencing difficulty coping with stress. The nurse recognizes that an example of initiating a cognitive restricting intervention to enhance coping abilities is known as which of the following? - ANS Identifying the cause of fear The nurse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy? - ANS Identifying a confident to share feelings The school nurse is assessing coping skills of high school students who attend an alternative school for students at high risk to not graduate. What is the priority concern that the nurse has for this student population? - ANS increased risk for suicide A patient is the primary caregiver for a disabled family member at home, and has now been unexpectedly hospitalized for surgery. What action can the nurse take to enhance the coping ability of the patient? - ANS Ask if there is another family member who can help at home while the patient is in the hospital After a management decision to admit terminal care patients to a medical unit, the nursing manager notes that nursing staff on the unit appear tired and anxious. Staff absences from work are increasing. The nurse manager is concerned that staff may be experiencing stress and burnout at work. What action would be best for the manager to take that will help the staff? - ANS Have training sessions to help the staff understand their new responsibilities The nurse has been asked to administer a coping measurement instrument to a patient. What education would the nurse present to the patient related to this tool? - ANS This tool will help assess recent positive and negative events you are experiencing. The nurse is assessing the coping patterns of a newly admitted patient. What will the nurse include in this assessment? - ANS -Current stressors as perceived by the patient -Use of drugs or alcohol -Recent weight changes A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, "this medication isn't working, I don't feel any different." What is the best response by the nurse. - ANS It usually takes a few weeks for you to notice improvement from this medication. A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understand that the goal of cognitive therapy will be met when what is reported by the patient? - ANS I will tell myself that I am a good person when things don't go well at work A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient? - ANS Eating foods such as blue cheese or red wine will cause side effects A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient? - ANS specific assessment for suicide plan must be evaluated A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient? - ANS 1.5 or higher mEq/L A patient newly diagnosed with depression states, "I have had other people in my family say that they have depression. Is this an inherited problem?" Serum levels within the normal range of 0.8 - 1.4 mEq/L are not likely to cause signs of toxicity. - ANS "Members of the same family may have the same biological predisposition of experiencing mood disorders. Neurotransmitters in the brain are more directly linked to mood disorders. As a nurse in the emergency department, you are caring for a patient who is exhibiting signs of depression. What is a priority nursing intervention you should perform this patient? - ANS Assess for depression and ask directly about suicide thoughts An older adult has experienced severe depression for many years and is unable to tolerate most antidepressant medications due to adverse effects of the medications. He is scheduled for electroconvulsive therapy (ETC) as a treatment for his depression. What teaching should the nurse give the patient regarding this treatment? - ANS Common sides effects include headache and short-term memory loss A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? - ANS -Risk for injury -Imbalanced nutrition, less than body requirements -Sleep deprivation A patient complains of insomnia during his stay in the hospital. Which nursing diagnosis would be a top priority for this patient? - ANS anxiety related to hospitalization A female patient is anxious after receiving the news that she needs a breast biopsy to rule out breast cancer. The nurse is assisting with a breast biopsy. Which relaxation technique will be best to use at this time? - ANS relaxation breathing The nurse is teaching a hospitalized patient to use mindfulness to reduce anxiety. Which statement by the nurse is appropriate? - ANS how do you feel about what is going on right now? The nurse is assessing the social support of a patient who is recently divorced and has moved from their hometown to the city due to change in jobs. Which response related to social support would be most therapeutic? - ANS Discuss how divorce support groups could increase coping and social support A patient reports that he is overwhelmed with anxiety. Which question would be most important to use in assessing the patient during your first meeting? - ANS What kinds of things do you do to reduce or cope with your stress? A patient is newly diagnosed with anxiety and placed on a selective serotonin reuptake inhibitors (SSRIs). The nurse is developing the plan of care for this patient. How long will it take for this medication to become effective? - ANS The medication may take up to 12 weeks to become effective The nurse knows that which of the following medical conditions are most commonly associated with anxiety? - ANS -cancer -hypothyroidism -dysrhythmias -encephalitis -hyperthyroidism The nurse wishes to use guided imagery to help an anxious patient relax. Which comment would be appropriate to include in the guided imagery script? - ANS -With each breath, you are feeling calmer, more relaxed, almost as if you are floating -You are alone on a beach, the sun is warm, and you hear the sound of the surf -You have grown calm,, your mind is still; there is nothing to disturb your well-being The scope of professional nursing practice is determined by the rules promulgated by which organization? - ANS State Board of Nursing A new registered nurse asks the registered nurse preceptor what could be done to become more professional. What is the preceptor's best response? - ANS Attend Nursing educational meetings The qualities of leadership, clinical expertise and judgment, mentorship, and lifelong learning would best describe which type of nurse? - ANS professional The American Nurse's Association (ANA) outlines expectations of the nursing profession in which type of documentation? - ANS social policy statement What nursing recommendations are published in the Institute of Medicine (IOM's) report The Future of Nursing: Leading change, advancing health? - ANS teach advocate assess nurture Nursing demonstrates dedication to improving public health through which avenue? - ANS scope of practice Components of a professional identity in nursing include which attributes? - ANS accountability advocacy autonomy competence What is the most appropriate resource to include when planning to provide patient education related to a goal in the psychomotor domain? - ANS Manikin practice sessions The nurse educator would identify a need for further teaching when the student lists which example as a type of learning? - ANS self-directed when describing patient education approaches, the nurse educator would explain that informal teaching is an approach that involves which quality? - ANS often occurs one-to-one Barriers to patient education the nurse considers in implementing a teaching plan include which factor? - ANS hunger and pain Strategies to include in a teaching plan for an adult who has repeatedly not followed the written discharge instructions would include which information source? - ANS instructional videos When planning to evaluate a patient's satisfaction with a teaching activity, what is the most appropriate strategy? - ANS include a survey instrument Interrelated concepts to the professional nursing role a nurse manager would consider when addressing concerns about the quality of patient education include which factor? - ANS technology The new nurse correctly defines a law when stating which information? - ANS Law's rule is enacted by a government agency that defines what must be done in a given circumstance Which of the following is true about health care legislation? - ANS The power of the US Constitution does not have a direct relationship to health care and reserves most of the power to the states Which is an example of the regulatory power to make law? - ANS Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals what is one of the major attributes of health care law - ANS it defines the expected behavior of persons in the business of health care the admission personnel working to comply with the Patient Self Determination Act of 1991 would do which of the following? - ANS ask the patient or representative if the patient has an advanced directive and inform them of their right to participate in their medical decisions which of the following is an example of a nurse violating the Health Insurance Portability and Accountability Act (HIPPA) of 1996? - ANS the nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital in which of the following answers is the hospital in compliance with the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986? (EMTALA) - ANS a patient with chest pain is triaged directly to a room for evaluation and registration information is obtained after the patient is stabilized which fo the following is false regarding state licensure laws? - ANS licensure is not necessary if the individual has completed training a patient suffered a brain injury from a motor vehicle accident and has no brain activity. the patient has a living will which states no heroic measures. the family requests that no additional heroic measures be instituted for their son. the nurse respects this decision in keeping with which principle? - ANS autonomy a male patient suffered a brain injury from a motor vehicle accident and has no brain activity. the spouse has come up to see the patient every day for the past 2 months. she asks the nurse, "Do you think when he moves his hand he is responding to my voice?" the nurse feels bad because she believes the movements are involuntary, and the prognosis is grim for this patient. She states, "he can hear you, and it appears he did respond to your voice." the nurse is violating which principle of ethics? - ANS veracity the nurse is faced with an ethical issue. when assessing the ethical issue, which action should the nurse perform first? - ANS ask, "what is the issue?" a nursing student is conducting a survey of fellow nursing students. which ethical concept is the student following when calculating the risk-to-benefit ratio and concluding that no harmful effects were associated with a survey? - ANS benefience a nurse on the unit makes an error in the calculation of the dose of medication for a critically ill patient. the patient suffered no consequences from the administration. the nurse decides not to report the error or file an incident report. the nurse is violating which principle of ethics? - ANS fidelity an unconscious patient is treated in the emergency department for head trauma. the patient is unconscious and on life support for 2 weeks prior to making a full recovery. the initial actions of the medical team are based on which ethical principle? - ANS deontology a drug-addicted nurse switches a patient's morphine injection with normal saline so that the nurse can use the morphine. the nurse is violating which principles of ethics? - ANS autonomy utilitarianism beneficence veracity