NUR 131 Exam 4 with precise detailed answers ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The nurses notes on the admission form that the patient has indication "no religious
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
preference." What does this indicate to the nurse about the patient? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) does not follow the tenets of a specific faith
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) is in denial about his religious beliefs
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) doesn't believe in God or a "higher power"
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) will not want to pray or visit with the chaplain - correct answer✔✔a) does not follow the
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tenets of a specific faith ||\\//|| ||\\//|| ||\\//|| ||\\//||
Your pt is a 17 year old who lost her right lef in a MVA. After her parents leave, she asks
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you, "Why did God let this happen to me? I have always followed his commandments."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Which action best depicts the "caring" aspect of SENC? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) "Let me call your parents back to support you."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) I think the chaplain can provide the support you need."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) cry with the pt as you hug her
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) hold her hand, sit with her, & listen - correct answer✔✔d) hold her hand, sit with her, &
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
listen
The student nurse has earned A's in all of her prerequisite courses. For the first exam in a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
nursing course, she earns a D and now feels that she may not be smart enough to become a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
nurse. What type of "loss" is the student experiencing?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) actual ||\\//||
b) external ||\\//||
,c) physical
||\\//|| ||\\//||
d) perceived - correct answer✔✔d) perceived
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Your 55 year old pt was just informed that she has metastatic pancreatic cancer and has 4
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
months to live. After the provider leaves, she says to you, "I don't want my family to know.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
But they have to know. Please don't tell them. Please tell me what to do, help me." What is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
your best response? ||\\//|| ||\\//||
a) "I know this is difficult for you. Take time to thin about it."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) "You should get a second opinion before you alarm your family."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) "Let me hold your hand to make you feel better."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) "Tell me how you are feeling right now." - correct answer✔✔d) "Tell me how you are
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
feeling right now" ||\\//|| ||\\//||
The pt is dying of cancer and can no longer swallow. the son states to the nurse, "You MUST
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give dad some water, he always drank a lot of water." The nurse's best response is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) "You sound very upset. Tell me more about your dad."
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b) "Your father is dying from cancer and water will not stop this process."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) "Research shows that withholding oral fluids decreases edema."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) "I will call the provider & get a prescription to insert a NG tube for the water." - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔a) "You sound very upset. Tell me more about your dad." ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The hospitalized pt states, "I need to know when I'm going to be discharged. I'm so upset &
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
worried that I'm missing work." The nurse knows: ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) this is an example of "eustress" & no intervention is necessary
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) this is an example of psychological stress & the pt should be placed on antidepressants
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,c) this is an example of developmental stress & the pt should talk to someone his own age
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) this is an example of distress & could affect the pt's health status - correct answer✔✔d)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
this is an example of distress & could affect the pt's health status
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
A pt who is taking atenolol (Tenormin) may not exhibit a rise in blood pressure & pulse
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
during the alarm stage of the general adaptation syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) true ||\\//||
b) false - correct answer✔✔a) true
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Tenormin is a beta-blocker (or otherwise a anti-hypertensive medication) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The nurse should assess every pt to determine if stress reduction interventions should be
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
part of the plan of care. The rationale for this action is that:
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) there are more persons experiencing mental illness now than in the past
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b) life is so much more stressful than it has ever been
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) the occurrence of stress in pts is unpredictable
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) pts often develop maladaptive coping strategies - correct answer✔✔c) the occurrence of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
stress in pts is unpredictable ||\\//|| ||\\//|| ||\\//|| ||\\//||
Mr. Arbor complains to the nurse that he is feeling anxious. He states, "I'm just so tired of all
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these tests they are doing, and it's so noisy here at night." Mr. Arbor's pulse is 110 bpm and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
his blood pressure is 140/70 mmHg. Nursing actions should include which of the following?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) turn on the TV to provide distraction
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b) ask the pt if he would like to discuss his anxiety further
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) close the blinds, dim the lights, and ask the pt what other measures would help him rest
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, d) call the physician and obtain an order for an anti-anxiety medication for PRN use - correct
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answer✔✔c) close the blinds, dim the lights, and ask the pt what other measures would ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
help him rest ||\\//|| ||\\//||
For any patient with an altered level of consciousness, the Glasgow Coma Scale score will
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help the nurse in planning care. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) true
||\\//||
b) false - correct answer✔✔a) true
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
GCS correlates to the patient's ability to function. The lower the score, the more nursing
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intervention required. ||\\//||
When conducting a weekly home visit with an older pt, the nurse realized the pt has not
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been adhering to his recommended medication schedule. What should the nurse do next?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) investigate why
||\\//|| ||\\//||
b) reprimand the pt for being noncompliant and explain how important it is to not miss
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dosages of medications ||\\//|| ||\\//||
c) explain the effects of missing dosages of certain medications
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) evaluate the medication schedule - correct answer✔✔a) investigate why
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
It's important to understand why the pt hasn't been adhering to the scheduled med
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
schedule
Issues like vision, literacy, & side effects could be easily rectified if investigated
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
A 4 year old patient resists going to sleep. To assist this pt, the best action to take would be:
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The nurses notes on the admission form that the patient has indication "no religious
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
preference." What does this indicate to the nurse about the patient? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) does not follow the tenets of a specific faith
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) is in denial about his religious beliefs
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) doesn't believe in God or a "higher power"
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) will not want to pray or visit with the chaplain - correct answer✔✔a) does not follow the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
tenets of a specific faith ||\\//|| ||\\//|| ||\\//|| ||\\//||
Your pt is a 17 year old who lost her right lef in a MVA. After her parents leave, she asks
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
you, "Why did God let this happen to me? I have always followed his commandments."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Which action best depicts the "caring" aspect of SENC? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) "Let me call your parents back to support you."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) I think the chaplain can provide the support you need."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) cry with the pt as you hug her
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) hold her hand, sit with her, & listen - correct answer✔✔d) hold her hand, sit with her, &
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
listen
The student nurse has earned A's in all of her prerequisite courses. For the first exam in a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
nursing course, she earns a D and now feels that she may not be smart enough to become a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
nurse. What type of "loss" is the student experiencing?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) actual ||\\//||
b) external ||\\//||
,c) physical
||\\//|| ||\\//||
d) perceived - correct answer✔✔d) perceived
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Your 55 year old pt was just informed that she has metastatic pancreatic cancer and has 4
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
months to live. After the provider leaves, she says to you, "I don't want my family to know.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
But they have to know. Please don't tell them. Please tell me what to do, help me." What is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
your best response? ||\\//|| ||\\//||
a) "I know this is difficult for you. Take time to thin about it."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) "You should get a second opinion before you alarm your family."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) "Let me hold your hand to make you feel better."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) "Tell me how you are feeling right now." - correct answer✔✔d) "Tell me how you are
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
feeling right now" ||\\//|| ||\\//||
The pt is dying of cancer and can no longer swallow. the son states to the nurse, "You MUST
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
give dad some water, he always drank a lot of water." The nurse's best response is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) "You sound very upset. Tell me more about your dad."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) "Your father is dying from cancer and water will not stop this process."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c) "Research shows that withholding oral fluids decreases edema."
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) "I will call the provider & get a prescription to insert a NG tube for the water." - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔a) "You sound very upset. Tell me more about your dad." ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The hospitalized pt states, "I need to know when I'm going to be discharged. I'm so upset &
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
worried that I'm missing work." The nurse knows: ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) this is an example of "eustress" & no intervention is necessary
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b) this is an example of psychological stress & the pt should be placed on antidepressants
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,c) this is an example of developmental stress & the pt should talk to someone his own age
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d) this is an example of distress & could affect the pt's health status - correct answer✔✔d)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
this is an example of distress & could affect the pt's health status
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A pt who is taking atenolol (Tenormin) may not exhibit a rise in blood pressure & pulse
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during the alarm stage of the general adaptation syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) true ||\\//||
b) false - correct answer✔✔a) true
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Tenormin is a beta-blocker (or otherwise a anti-hypertensive medication) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The nurse should assess every pt to determine if stress reduction interventions should be
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part of the plan of care. The rationale for this action is that:
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a) there are more persons experiencing mental illness now than in the past
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b) life is so much more stressful than it has ever been
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c) the occurrence of stress in pts is unpredictable
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d) pts often develop maladaptive coping strategies - correct answer✔✔c) the occurrence of
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stress in pts is unpredictable ||\\//|| ||\\//|| ||\\//|| ||\\//||
Mr. Arbor complains to the nurse that he is feeling anxious. He states, "I'm just so tired of all
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these tests they are doing, and it's so noisy here at night." Mr. Arbor's pulse is 110 bpm and
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his blood pressure is 140/70 mmHg. Nursing actions should include which of the following?
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a) turn on the TV to provide distraction
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b) ask the pt if he would like to discuss his anxiety further
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c) close the blinds, dim the lights, and ask the pt what other measures would help him rest
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, d) call the physician and obtain an order for an anti-anxiety medication for PRN use - correct
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answer✔✔c) close the blinds, dim the lights, and ask the pt what other measures would ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
help him rest ||\\//|| ||\\//||
For any patient with an altered level of consciousness, the Glasgow Coma Scale score will
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help the nurse in planning care. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a) true
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b) false - correct answer✔✔a) true
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GCS correlates to the patient's ability to function. The lower the score, the more nursing
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intervention required. ||\\//||
When conducting a weekly home visit with an older pt, the nurse realized the pt has not
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been adhering to his recommended medication schedule. What should the nurse do next?
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a) investigate why
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b) reprimand the pt for being noncompliant and explain how important it is to not miss
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dosages of medications ||\\//|| ||\\//||
c) explain the effects of missing dosages of certain medications
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d) evaluate the medication schedule - correct answer✔✔a) investigate why
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It's important to understand why the pt hasn't been adhering to the scheduled med
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schedule
Issues like vision, literacy, & side effects could be easily rectified if investigated
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A 4 year old patient resists going to sleep. To assist this pt, the best action to take would be:
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