Examsrevision

MULTIPLE CHOICE 1. The nurse is caring for a Asian patient using the teach-back technique. Which action by the nurse indicates successful implementation of this technique? a. Asks, “Does this make sense?” b. Asks, “Do you think you can do this at home?” c. Asks, “What will you tell your spouse about changing the dressing?” d. Asks, “Would you tell me if you don’t understand something, so we can go over it?” ANS: C The teach-back technique asks open-ended questions,...

MULTIPLE CHOICE 1. The nurse is caring for a patient who is undergoing chemotherapy and radiation for cancer. The patient asks the nurse about the value of cancer screening when therapy is over. What is the nurse’s best response? a. “It will allow for early detection of additional cancers.” b. “It is not something that should be discussed right now.” c. “It probably will not be needed since the cancer has been cured.” d. “It usually is not done but can be done if the patie...

MULTIPLE CHOICE 1. Upon assessment, the nurse notices that the patient’s respirations have increased, and the tip of the nose and earlobes are becoming cyanotic. The nurse finds that the patient’s pulse rate is over 100 beats per minute. According to Maslow’s hierarchy of needs, which patient need should the nurse address first? a. Self-esteem b. Physiological c. Self-actualization d. Love and belonging ANS: B Maslow’s hierarchy is useful in setting patient priorities. Basic...

MULTIPLE CHOICE 1. The patient is admitted to the emergency department of the local hospital from home with reports of chest discomfort and shortness of breath. The patient is placed on oxygen, has labs and blood gases drawn, and is given an electrocardiogram and breathing treatments. Which level of preventive care is this patient receiving? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: B Secondary prevention focuses on individuals who...

MULTIPLE CHOICE 1. The nurse uses a PICOT question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more evidence than is available at this time. What is the nurse’s best option? a. Conduct a pilot study to investigate findings. b. Drop the idea of making the change at this time. c. Insist that management hire the needed staff to facilitate the change. d. Seek employment in ano...

MULTIPLE CHOICE 1. A patient is scheduled for surgery. When getting ready to obtain the informed consent, the patient tells the nurse, “I have no idea what is going to happen. I couldn’t ask any questions.” The nurse does not allow the patient to sign the permit and notifies the health care provider of the situation. Which role is the nurse displaying? a. Manager b. Patient educator c. Patient advocate d. Clinical nurse specialist ANS: C As a patient advocate, the nurse protec...

MULTIPLE CHOICE 1. A nurse observes an outbreak of lice in a certain school district. The nurse collects data and identifies a common practice of sharing lockers, caps, and hairbrushes. The nurse shares the information with the school. Which community-based nursing competency did the nurse use? a. Educator b. Caregiver c. Case manager d. Epidemiologist ANS: D As an epidemiologist, you are involved in case finding, health teaching, and tracking incident rates of an illness (outbreak ...

MULTIPLE CHOICE 1. An older-adult patient has extensive wound care needs after discharge from the hospital. Which facility should the nurse discuss with the patient? a. Hospice b. Respite care c. Assisted living d. Skilled nursing ANS: D An intermediate care or skilled nursing facility offers skilled care from a licensed nursing staff. This often includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation. A hospice is a system of f...

Chapter 47: Bowel Elimination Chapter 48: Skin Integrity and Wound Care Chapter 49: Sensory Alterations Chapter 50: Perioperative Nursing Care

MULTIPLE CHOICE 1. An adult client reports to the nurse that she has been experiencing constipation recently and is interested in any suggestions regarding dietary changes she might make. Which of the following suggestions provided by the nurse is most likely to minimize the clients complaint? A. Have you tried foods like prunes and bran? B. You might find the new flavored bulk laxatives helpful. C. What have you tried in the past that hasn’t been helpful? D. Increase your fluid intake;...

MULTIPLE CHOICE 1. Which of the following statements made by a nurse reflects the greatest insight into the responsibility an ambulatory care nurse has to the clients family? A. A clients family deserves the attention of the nursing staff. B. Family is important to my client, and so family is important to me. C. I consider myself as having several clients: the surgical client and all the family thats present. D. I am responsible for keeping the family informed of the status of their loved...

MULTIPLE CHOICE 1. The nurse is visiting the day care center for routine assessment of the children. After spending time with the children in one of the playrooms, the nurse suspects that a child has a visual deficit as a result of observing: A. Poor balance and gait B. An increase in weight C. Sitting and rocking back and forth D. A failure to respond when touched ANS: C Behaviors of children indicating a possible visual deficit include self-stimulation such as eye rubbing, body ro...

MULTIPLE CHOICE 1. The nurse uses the Norton scale in the extended care facility to determine the clients risk for pressure ulcer development. Which one of the following scores, based on this scale, places the client at the highest level of risk? A. 6 B. 8 C. 15 D. 19 ANS: A According to the Norton scale, a lower score indicates a higher risk for pressure ulcer development. The total score ranges from 5 to 20. The client at highest risk would be the client with a score of 6. DIF:...

Chapter 41: Oxygenation Chapter 42: Fluid, Electrolyte, and Acid-Base Balance Chapter 43: Sleep Chapter 44: Pain Management Chapter 45: Nutrition

MULTIPLE CHOICE 1. The nurse is aware that there are medications that are taken that alter the clients taste and may influence the dietary intake. In reviewing the medications taken by the clients on the unit, the nurse will consult with the nutritionist to develop a palatable meal plan for the client taking: A. Ampicillin B. Morphine C. Furosemide D. Acetaminophen ANS: A Ampicillin may cause an alteration in taste. Opiates, such as morphine, cause decreased peristalsis and may resu...

MULTIPLE CHOICE 1. The nurse is completing a physical examination for a client who is anemic. In assessing the clients eyes, a sign assessed by the nurse that is consistent with the diagnosis is: A. Xanthelasma B. Petechiae C. Corneal arcus D. Pale conjunctiva ANS: D Pale conjunctiva is an assessment finding consistent with the diagnosis of anemia. Xanthelasma is caused by hyperlipidemia. Petechiae appear on the skin in clients with platelet deficiency (thrombocytopenia). Petechiae ...

MULTIPLE CHOICE 1. Which of the following statements made by a nurse caring for a client reporting severe pain expresses the most insight into how pain impacts a clients energy reserves? A. If I can’t get his pain under control, his recovery will take a lot longer. B. Pain certainly interferes with the clients ability to rest and recuperate. C. I’m going to call for another pain prescription so he can get some rest. D. Trying to cope with pain is using up the energy that his recovery ...

MULTIPLE CHOICE 1. A client is discussing his recent restlessness and increased irritability. Which of the following assessment questions is likely to be most helping in determining the cause of these complaints? A. When did you start noticing these changes? B. Has anything caused you to change your usual routine lately? C. Do you have any idea what might be causing these problems? D. What makes you think that you are more irritable than is normal for you? ANS: B When the sleep-wake...

MULTIPLE CHOICE 1. A client is prescribed 0.9% sodium chloride (normal saline), which is an isotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to: A. Expand the volume of fluid in the vascular system B. Pull fluid from the cells C. Keep protein levels normal D. Move fluid into the cells ANS: A Isotonic solutions such as normal saline, 0.9% sodium chloride, expand the bodys fluid volume without causing a fluid shift from one compartment to another...

Chapter 36: Loss and Grief Chapter 37: Stress and Coping Chapter 38: Activity and Exercise Chapter 39: Immobility Chapter 40: Hygiene