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with correct answers |\ |\
Because of difficulties with hemodialysis, peritoneal
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dialysis is initiated to treat a client's uremia. Which
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finding during this procedure signals a significant
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problem?
A. Hematocrit (HCT) of 35%.
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B. White blood cell count (WBC) of 20,000/mm3 (0.02 L)
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C. Blood glucose level of 200 mg/dl (11.1 mmol/L)
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D. Potassium level of 3.5 mEq/L (3.5 mmol/L) - CORRECT
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ANSWERS ✔✔B. White blood cell count (WBC) of |\ |\ |\ |\ |\ |\ |\
20,000/mm3 (0.02 L)
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A nurse is teaching a client with a leg ulcer about tissue
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repair and wound healing. Which statement by the client
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indicates understanding? |\
A. "Increase in redness of the ulcer means better blood
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flow."
B. "Increase in redness of the ulcer means better blood
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flow."
C. "I'll eat plenty of fruits and vegetables."
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D. "I'll make sure that I keep the site covered at all
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times." - CORRECT ANSWERS ✔✔C. "I'll eat plenty of fruits
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and vegetables."
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,A client is admitted with severe abdominal pains and the
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diagnosis of acute pancreatitis. The nurse should develop
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a plan of care during the acute phase of pancreatitis that
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will involve interventions to manage which of the
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following problems? |\
A.Risk for injury. |\ |\
B. Ineffective airway clearance.
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C. Severe pain.
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D. Drug and alcohol abuse. - CORRECT ANSWERS ✔✔C.
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Severe pain. |\
A client with pancreatitis has been receiving total
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parenteral nutrition (TPN) for the past week. Which |\ |\ |\ |\ |\ |\ |\ |\
nursing intervention helps determine if TPN is providing
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adequate nutrition? |\
A. Recording fluid intake and output
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B. Ensuring that the TPN tubing has an in-line filter
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C. Ensuring that the TPN tubing has an in-line filter
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D. Monitoring the client's weight every day - CORRECT
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ANSWERS ✔✔D. Monitoring the client's weight every day |\ |\ |\ |\ |\ |\ |\
A manager who is reviewing the nurses' notes in a
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patient's medical record finds the following entry,
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"Patient is difficult to care for, refuses suggestion for
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improving appetite." Which of the following directions |\ |\ |\ |\ |\ |\ |\
does the manager give to the staff nurse who entered the
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note?
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A. Avoid rushing when charting an entry.
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,B. Use correction fluid to remove the entry
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C. Draw a single line through the statement and initial it.
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D. Enter only objective and factual information about the
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patient. - CORRECT ANSWERS ✔✔D. Enter only objective
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and factual information about the patient.
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Reasoning: Nurses should enter only objective and factual |\ |\ |\ |\ |\ |\ |\
information about patients. Opinions have no place in the
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medical record. Because the information has already
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been entered and is not incorrect, it should be left on the
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record. Never use correction fluid in a written medical
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record.
A new graduate nurse is providing a telephone report to a
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patient's health care provider and accepting telephone
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orders from the provider. Which of the following actions
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requires the new nurse's preceptor to intervene? The new
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nurse:
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A. Uses SBAR (Situation-Background-Assessment-
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Recommendation) as a format when providing the report. |\ |\ |\ |\ |\ |\ |\
B. Gives a newly ordered medication before entering the
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order in the patient's medical record.
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C. Reads the orders back to the health care provider after
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receiving them and verifies their accuracy.
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D. Asks the preceptor to listen in on the phone
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conversation. - CORRECT ANSWERS ✔✔B. Gives a newly |\ |\ |\ |\ |\ |\ |\ |\
ordered medication before entering the order in the
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patient's medical record. |\ |\
, Reasoning: Nurses enter orders into the computer or |\ |\ |\ |\ |\ |\ |\ |\
write them on the order sheet as they are being given to
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allow the read-back process to occur.
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As you enter the patient's room, you notice that he is
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anxious to say something. He quickly states, "I don't
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know what's going on; I can't get an explanation from my
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doctor about my test results. I want something done
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about this." Which of the following is the most
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appropriate documentation of the patient's emotional |\ |\ |\ |\ |\ |\
status?
A. The patient has a defiant attitude and is demanding his
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test results.
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B. The patient appears to be upset with his nurse because
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he wants his test results immediately.
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C. The patient is demanding and complains frequently
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about his doctor. |\ |\
D.The patient stated that he felt frustrated by the lack of
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information he received regarding his tests. - CORRECT |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔D.The patient stated that he felt frustrated
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by the lack of information he received regarding his tests.
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Reasoning: This is a nonjudgmental statement regarding |\ |\ |\ |\ |\ |\ |\
the nurse's observations about the patient. Documenting
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that the patient had a defiant attitude or was demanding
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and frequently complaining is judgmental, and
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information in the medical record should be factual and |\ |\ |\ |\ |\ |\ |\ |\ |\
nonjudgmental. Documenting that the patient appears |\ |\ |\ |\ |\ |\
upset needs to be more specific regarding the reason for
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the patient's concern.
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