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NCLEX questions Med/Surg Chapters 1-12

Nclex Questions Med/surg Chapters 1-12

by Tiffany-Hammond, May 2014

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61 Cards in this Set

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	When the nurse encourages a patient with heart failure to alternate rest and activity periods to reduce cardiac workload, what phase of the nursing process is being used? Planning Diagnosis Evaluation Implementation	Implementation
	When planning care for a patient, the nurse may use a visual diagram of patient problems and interventions to illustrate the relationships among pertinent clinical data. What is this format called? Concept map Critical pathway Clinical pathway Nursing care plan	Concept map
	A nurse is providing care for a patient who had transurethral resection of his prostate this morning. The patient is receiving continuous bladder irrigation, but his urinary catheter is now occluded. The nurse is now planning to phone the patient's health care provider and communicate using the SBAR (Situation-Background-Assessment-Recommendation) format. Which statement is a component of communication using SBAR? "What do you think could be causing this occlusion?" "I think that we should manually irrigate his catheter." "What do you know about this patient and his history?" "Could you please provide some direction for his care?"	"I think that we should manually irrigate his catheter."
	What factor has been most clearly identified as an influence on the future of nursing practice? Aging of the American population and increases in chronic illnesses Increasing birth rates coupled with decreased average life expectancy Increased awareness of determinants of health and improved self-care Apathy around health behaviors and the relationship of lifestyle to health	Aging of the American population and increases in chronic illnesses
	A group of nurses have a plan to implement evidence-based practice (EBP) for care of patients with pressure ulcers. What will this change in practice encompass (select all that apply)? Consulting with the wound care and ostomy nurse The preferences of patients and their particular circumstances Nurses' expertise and their bodies of experience and knowledge The traditions that surround pressure ulcer practices on the unit Journal articles that address the care of patients with pressure ulcers	Consulting with the wound care and ostomy nurse The preferences of patients and their particular circumstances Nurses' expertise and their bodies of experience and knowledge Journal articles that address the care of patients with pressure ulcers
	A registered nurse (RN) has delegated the administration of IV medications to a licensed practical/vocational nurse (LPN/LVN). Which statement accurately describes delegation? The RN should first teach the LPN how to administer IV medications. Ultimate responsibility for the execution of the task now lies with the LPN. The RN is still accountable for the quality of care and procedures that the patient receives. The RN is responsible for observing and evaluating the administration of IV medications by the LPN.	The RN is still accountable for the quality of care and procedures that the patient receives.
	Nurses deliver patient-centered care in collaboration with the interdisciplinary health care team within the framework of a care delivery model. In which care delivery model does the nurse plan and coordinate the aspects of patient care with other disciplines with a focus on continuity of care and interdisciplinary collaboration even when the nurse is absent? Team nursing model Primary nursing model Total patient care model Case management nursing model	Primary nursing model
	Which interventions are independent nursing actions (select all that apply)? IV reinsertion Assessing lung sounds Medication administration First postoperative dressing change Obtaining informed consent from the patient	IV reinsertion Assessing lung sounds
	Telehealth includes using devices to provide which types of care for the patient (select all that apply)? Administering medications Evaluation of weight loss Video assessment of wounds Monitoring peak flow meter results Real-time blood pressure assessment	Evaluation of weight loss Video assessment of wounds Monitoring peak flow meter results Real-time blood pressure assessment
	Which individual is most likely to experience health care disparities? A 65-year-old upper class Hispanic male living in the city A 78-year-old Native American male living on a reservation A 50-year-old middle-class white female living in a rural area A 72-year-old African American retired attorney living in a condo	A 78-year-old Native American male living on a reservation
	The nurse identifies a patient at high risk for health care disparities. What should be included as important nursing interventions to reduce health care disparities (select all that apply)? Passive listening Relationship building Taking foreign language classes Participating in cross-cultural education Using standardized evidence-based guidelines	Relationship building Participating in cross-cultural education Using standardized evidence-based guidelines
	When obtaining an admission history on a Mexican American older male patient, which cultural value would the nurse recognize as most likely to be important to this patient? Patriarchal Self-reliance Science-based Harmony with nature	Patriarchal
	Culturally competent nursing care for a Jewish patient would include which diet? Kosher Vegetarian Word of wisdom Low carbohydrate	Kosher
	Which nursing action is most indicative of stereotyping? The nurse advocates for bronchodilators to be prescribed for all newly admitted African American patients. The nurse helps a recent immigrant to explore ways to pay for her newly prescribed antihypertensive medications. The nurse prioritizes the assessment of obesity when providing care for African American and Mexican American women. The nurse arranges for translation services to be provided for a patient who has recently emigrated from Sri Lanka and does not speak English.	The nurse advocates for bronchodilators to be prescribed for all newly admitted African American patients.
	The nurse is performing an assessment of a 78-year-old Chinese American woman who wears a jade bracelet on her left wrist. The nurse asks the patient about the significance of the bracelet and whether it can be removed prior to the patient's scheduled diagnostic procedure. What has the nurse demonstrated? Diversity Stereotyping Ethnocentrism Cultural competence	Cultural competence
	The adult children of a male patient who is Hindu have requested a vegetarian diet for their father. What is the nurse's most appropriate response? Order a vegetarian diet for the patient. Assess the family's rationale for choosing this particular diet. Teach the family about the relationship between protein intake and wound healing. Explore the benefits of a low-meat, high-protein diet with the family and the dietitian.	Order a vegetarian diet for the patient
	A 72-year-old Nigerian man comes to the United States to visit his adult son. The son tries to encourage his father to have the testing and treatment for a chronic productive cough. The adult son has a positive attitude and believes in the American medical treatment because what has happened to the child while living in the United States? Acculturation Ethnocentrism Race awareness Cultural imposition	Acculturation
	The nurse is interested in developing her cultural competence. What roles can she take to do so? Develop understanding of all ethnic groups. Identify the one culture about which she is interested in being competent. Have extended contact with a cultural group to enhance understanding of its values and beliefs. Understand the specific information about the patient's culture so the understanding can be applied to caring for the patient.	Have extended contact with a cultural group to enhance understanding of its values and beliefs.
	During an admission history and physical assessment, the patient describes symptoms to the nurse. What should these descriptions be documented as? Objective data Subjective data Generalized data Comprehensive data	Subjective
	The nurse would place assessment findings related to vision and hearing under which functional health pattern? Activity-rest pattern Cognitive-perceptual pattern Self-perception/self-concept pattern Health-perception/health-management pattern	Cognitive-perceptual pattern
	Which action most clearly demonstrates a nursing focus rather than a medical focus? The nurse recommends a change to the patient's insulin sliding scale. The nurse interprets the results of the patient's most recent glucose tolerance test. The nurse assesses the benefits of changing the patient to a new oral antihyperglycemic. The nurse assesses the effect that a recent diagnosis of diabetes has on the patient's lifestyle and routines.	The nurse assesses the effect that a recent diagnosis of diabetes has on the patient's lifestyle and routines.
	A 72-year-old woman has sought care for restless legs syndrome, a problem that has been causing her increasing loss of sleep in recent weeks. The woman states that she attributes the problem to inadequate calcium intake, and she has responded by integrating more dairy products into her diet. Which aspects of symptom investigation does the nurse recognize as present in this situation (select all that apply)? Quality Timing Severity Radiation Precipitating and palliative	Timing Radiation Precipitating and palliative
	During the nurse's initial health assessment of an older adult patient, the nurse notes that the patient often makes self-deprecating statements, saying that "I'm just a nuisance to my children now" and "It would be easier for everyone if I didn't have to be such a burden to them." The nurse would document a problem in which functional health pattern? Value-belief pattern Cognitive-perceptual pattern Coping–stress tolerance pattern Self-perception/self-concept pattern	Self-perception/self-concept pattern
	In which situation would the nurse most likely conduct a comprehensive assessment? When performing resuscitation on a trauma patient When assessing the progression of a patient's ascites and edema When admitting a patient to a medical unit from the emergency department When assessing a patient who has been receiving rehabilitation following a stroke	When admitting a patient to a medical unit from the emergency department
	Indicate which data would be classified as objective data (select all that apply). Earache Dizziness Pitting edema Cyanosis of lips Shortness of breath Hyperactive peristalsis	Pitting edema Cyanosis of lips Hyperactive peristalsis
	Before counting the apical heart rate, which nursing assessment technique should the nurse use to find the correct place to listen to the point of maximal impulse (PMI)? Inspection Percussion Auscultation Light palpation	Light palpation
	The patient was admitted via the emergency department (ED) with respiratory distress. What statement best describes the initial assessment of the patient on the medical-surgical unit? An emergency assessment should be performed to ensure the patient's safety. A focused assessment should be performed to be sure the ED did not miss anything. A focused assessment should be performed to determine if new problems have arisen. A comprehensive assessment should be performed to determine the patient's response to the	A comprehensive assessment should be performed to determine the patient's response to the respiratory distress and treatment
	Which techniques would be most appropriate to enhance patient learning (select all that apply)? Obtain frequent feedback. Have a quiet environment. Explain information in great detail. Involve the patient and caregiver in the process. Emphasize relevancy of the information to the patient's lifestyle.	Obtain frequent feedback. Have a quiet environment. Involve the patient and caregiver in the process. Emphasize relevancy of the information to the patient's lifestyle.
	What would be one method of individualizing learning for a patient's unique needs? Use prepackaged learning materials. Only teach the patient "need-to-know" information. Have the patient arrange topic cards in order of priority. Have the patient watch a video and then read a pamphlet.	Have the patient arrange topic cards in order of priority.
	Which actions best demonstrate the nurses' awareness of learning styles and the role that they play in patient and caregiver teaching (select all that apply)? Assess patients' learning styles prior to teaching. Use materials that appeal to a variety of learning styles. Prioritize the learning style with which he or she is most familiar and comfortable. Provide written instructions to younger patients while using visual and audio aids when teaching older patients. Provide visual and audio aids to younger patients while using written instructions when teaching older patients.	Assess patients' learning styles prior to teaching. Use materials that appeal to a variety of learning styles.
	The nurse notes that a male patient regularly asks about the purpose and potential side effects of each oral medication that he has received during his time in the hospital. How should the nurse best interpret the patient's questions? The patient has an auditory learning style. The patient is identifying his learning needs. The patient is exhibiting a high level of health literacy. The patient is experiencing anxiety related to his diagnosis and treatment.	The patient is identifying his learning needs.
	A 44-year-old female patient with a long-standing history of type 1 diabetes has brought a number of printouts from websites to her most recent visit with her primary care provider. What direction should the nurse provide to the patient regarding health information on the Internet? "It is best to make sure that you avoid websites that are not associated with a government agency." "You may have some good information there, but it is best to focus only on the information the doctor provides to you." "There is a great deal of misinformation on the Internet, so it is best to focus on printed material rather than electronic sources." "I encourage you to find websites that are credible and reliable, and I can give you some information on making those decisions if you like."	"I encourage you to find websites that are credible and reliable, and I can give you some information on making those decisions if you like."
	The nursing student is assigned to use motivational interviewing to motivate the patient to change dietary eating behaviors. Which statement shows the use of this technique? "Tell me about the concerns you have about changing your diet." "You have a big weakness for ice cream; we will need to change that." "I feel sorry for you, but you must change your diet if you plan to feel better." "I would not want to change my diet, but I would sure do it instead of getting sicker."	"Tell me about the concerns you have about changing your diet."
	The patient says she prefers to watch how things are done rather than to read the information or instructions to learn about how to take care of herself. Which teaching strategy would be best for this patient? Watch a DVD. Read the pamphlet. Talk about it with the nurse. Use the Internet to read about it.	Watch a DVD.
	Which teaching strategy would be best to offer to a 20-year-old patient? Lecture or books Websites or podcasts Television or pamphlets Role play or support group	Websites or podcasts
	Which question elicits additional information to evaluate the patient's understanding? "Can you show me how to change your dressing?" "Do you understand how to change your dressing?" "Do you think you can change your dressing at home?" "What will you do if the dressing has excess drainage?"	"What will you do if the dressing has excess drainage?"
	Based on adult learning principles, which situation indicates that the patient is ready to learn about taking enoxaparin (Lovenox) injections at home? The patient is requesting pain medication. The patient is too tired to stay awake to watch the teaching DVD. The patient wants to practice before actually injecting himself with the needle. The patient is nervous and says he cannot do it when he picks up the bottle of medication.	The patient wants to practice before actually injecting himself with the needle.
	What is most appropriate for the nurse to do when interviewing an older patient? Ensure all assistive devices are in place. Interview the patient and caregiver together. Perform the interview before administering analgesics. Move on to the next question if the patient does not respond quickly.	Ensure all assistive devices are in place.
	Which assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? Agitation Depression Weight gain Weight loss Hypernatremia	agitation depression weight loss
	A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which tasks of the chronically ill is the woman demonstrating (select all that apply)? Controlling symptoms Preventing social isolation Preventing and managing a crisis Denying the reality of the problem Adjusting to changes in the course of the disease	Preventing and managing a crisis Controlling symptoms

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