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63 Cards in this Set
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A client with ovarian cancer asks the nurse, "What is the cause of this cancer?" Which is the most accurate response by the nurse? a) Use of oral contraceptives increases the risk of ovarian cancer. b) Women who have had at least two live births are protected from ovarian cancer. c) The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. d) There is less chance of developing ovarian cancer when one lives in an industrialized country. |
c) The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. Explanation: A definitive cause of carcinoma of the ovary is unknown, and the disease is multifactorial. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. The highest incidence is in industrialized Western countries. Endocrine risk factors for ovarian cancer include women who are nulliparous. Use of oral contraceptives does not increase the risk for developing ovarian cancer, but may actually be protective. |
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A client with cirrhosis should be encouraged to follow which diet? a) Well-balanced normal nutrients, low-sodium diet. b) Bland, low-protein, low-sodium diet. c) High-calorie, restricted protein, low-sodium diet. d) High-protein, high-calorie, high-potassium diet. |
a) Well-balanced normal nutrients, low-sodium diet. Explanation: Cirrhosis is a slowly progressive disease. Inadequate nutrition is the primary ongoing problem. Clients are encouraged to eat normal, well-balanced diets and to restrict sodium to prevent fluid retention. Protein is not restricted until the liver actually fails, which is usually late in the disease. It is not necessary to restrict protein or eat a bland diet. |
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A client appears flushed and has shallow respirations. The arterial blood gas report shows the following: pH, 7.24; partial pressure of arterial carbon dioxide (PaCO2), 49 mm Hg (6.5 kPa); bicarbonate (HCO3-), 24 mEq/L (24 mmol/L). These findings are indicative of which of the following acid-base imbalances? a) Respiratory alkalosis. b) Metabolic alkalosis. c) Metabolic acidosis. d) Respiratory acidosis. |
d) Respiratory acidosis. The pH of 7.24 indicates that the client is acidotic. The PaCO2 value of 49 mm Hg (6.5 kPa) is elevated. The HCO3- value of 24 mEq/L (24 mmol/l) is normal. The client is in uncompensated respiratory acidosis. Hypoventilation and a flushed appearance are additional clinical manifestations of respiratory acidosis. |
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A nurse gives a client the wrong medication. After assessing the client, the nurse completes an incident report. Which statement describes what will happen next? a) The facility will report the incident to the state board of nursing for disciplinary action. b) The nurse will be suspended and, possibly, terminated from employment at the facility. c) The incident will be documented in the nurse's personnel file. d) The incident report will provide a basis for promoting quality care and risk management. |
d) The incident report will provide a basis for promoting quality care and risk management. Explanation: Incident reports document unusual occurrences and deviations from care. Facilities use the internal documents to evaluate care, determine potential risks, or discover system problems that might have contributed to the error. This type of error won't result in a report to the state board of nursing or in the nurse's suspension. Some facilities do track the number of errors a nurse or a particular unit makes; the purpose of tracking errors is to provide appropriate education and to improve the nursing process. |
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A physician orders hourly urine output measurement for a postoperative client with an indwelling catheter. The nurse records the following amounts of output for 2 consecutive hours: 8 a.m. (0800): 50 ml; 9 a.m. (0900): 60 ml. Based on these amounts, which action should the nurse take? a) Continue to monitor and record hourly urine output. b) Irrigate the indwelling urinary catheter. c) Increase the I.V. fluid infusion rate. d) Notify the physician. |
a) Continue to monitor and record hourly urine output. Normal urine output for an adult with an indwelling catheter is at least 30 ml/hour. Therefore, this client's output is normal. Beyond continued evaluation, no nursing action is warranted. |
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A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? a) Elevating the head of the bed 30 degrees b) Encouraging increased fluid intake c) Turning the client every 2 hours d) Maintaining a cool room temperature |
b) Encouraging increased fluid intake Increasing the client's intake of oral or I.V. fluids helps liquefy thick, tenacious secretions and ensures adequate hydration. Turning the client every 2 hours would help prevent pressure ulcers but wouldn't help with the secretions. Elevating the head of the bed would reduce pressure on the diaphragm and ease breathing but wouldn't help the client with secretions. Maintaining a cool room temperature wouldn't help the client with secretions. |
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A registered nurse (RN) and licensed practical nurse (LPN) are administering medications on the neurologic floor. The LPN prepares to administer phenytoin to a client with a history of seizures. As the LPN walks into the room, she hands the medication to a nursing assistant. The LPN asks the nursing assistant to give the client the medication after completing the client's morning care. What should the registered nurse do? a)Allow the nursing assistant to administer this dose and tell the LPN later that it's her responsibility to administer the medication. b)Do nothing because the client has been taking the medication for a long time. c)Take the medication from the nursing assistant and administer it. d)Remind the LPN that she must administer the medications herself. |
d)Remind the LPN that she must administer the medications herself. The RN should intervene immediately by reminding the LPN that it's her responsibility to administer the medications. The RN should reinforce to the LPN that medication administration is beyond the scope of practice for a nursing assistant, and that allowing the nursing assistant to administer medications could lead to client injury. Although the client has been taking the medication for a long time, the responsibility for medication administration lies with the RN and LPN, not the nursing assistant. It's important for the nurse to intervene at the time of the incident to prevent injury. The registered nurse shouldn't administer the medication because she didn't prepare the medication for administration herself. |
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Which of the following denotes the primary reason that the nurse inserts an indwelling urinary (Foley) catheter in a child with severe burns? a) Monitoring for a urinary tract infection. b) Assessing urine specific gravity. c) Preventing urinary retention. d) Measuring urine output accurately. |
d) Measuring urine output accurately. Accurate determination of urine output is a crucial factor in the care of a burn victim. The benefits of using an indwelling catheter to measure urine output to the nearest milliliter outweigh the risk of infection and other problems associated with use. An indwelling urinary catheter is inserted for the child with severe burns to ensure accurate urinary output measurement. Urinary tract infection usually is not a problem. However, insertion of the catheter may predispose the child to a urinary tract infection. Unless the burns cover the perineal area and make urination painful, urinary retention is usually not a problem. Determining urine specific gravity can be done to assess hydration, but this is not the primary rationale for inserting an indwelling urinary catheter. |
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A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles (1,207 km) away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with: a) Denial as a primary coping mechanism. b) Transportation and money for the boys. c) Support systems and coping strategies. d) Decision-making abilities. |
c) Support systems and coping strategies. The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations. The nurse may be concerned with the client's use of denial, decision-making abilities, and ability to pay for transportation; however, the client's support systems will be of more importance in this situation. |
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A client with lung cancer has developed an intractable, nonproductive cough that is unrelieved by nonopioid antitussive agents. The physician orders codeine, 10 mg P.O. every 4 hours. Which statement accurately describes codeine? a) It's a centrally-acting antitussive and can cause dependence. b) It's a peripherally-acting antitussive and can cause dependence. c) It's a peripherally-acting antitussive and doesn't cause dependence. d) It's a centrally-acting antitussive and doesn't cause dependence. |
a) It's a centrally-acting antitussive and can cause dependence. As a centrally-acting antitussive, codeine suppresses the cough reflex by directly affecting the sensitivity of the cough center in the medulla to incoming stimuli. Because codeine is an opioid, it can cause dependence. |
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A nurse is teaching the family of an 8-year-old boy with acute lymphocytic leukemia about appropriate activities. Which recommendation should the nurse make? a) restriction from participating in athletic activities b) being treated as "normal" as much as possible c) avoiding trips to the shopping mall d) home schooling |
b) being treated as "normal" as much as possible Any child with a chronic illness should be treated as normally as possible. Unless the child has severe bone marrow depression, he should be allowed to go to school with others and can go to the mall. If the child is in remission, athletic activities are allowed. |
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A 37-week gestation client is on bed rest for gestational hypertension. The nursing student and nurse are visiting the client in her home and need to perform external fetal monitoring (EFM). The student nurse asks the nurse if he/she is allowed to perform this skill. What is the nurse’s most appropriate response? a) "Yes, but I will demonstrate it once and then supervise you while you perform the procedure." b) "Yes, but only after you read about the procedure in the regional policy and procedure manual." c) "No, as per policy, you need to demonstrate this skill successfully in the hospital setting first." d) "No, only certified registered nurses can perform this skill." |
a) "Yes, but I will demonstrate it once and then supervise you while you perform the procedure." This method of instruction facilitates student learning by demonstration. The nurse is accountable for delegating nursing interventions to student learners. Experiential learning is an effective method of developing psychomotor tasks and critical thinking skills. EFM is not a certifiable skill specific to registered nursing practice and does not require that it be practiced in an acute care setting prior to practicing it in a community setting. It is critical that the nurse first demonstrates and then supervises the skill to ensure student learning and client safety. |
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Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? a) "Because I had a previous reaction to the test, this time I need to get a chest X-ray." b) "I will avoid contact with my family until I am done with the test." c) "If the test area turns red that means I have tuberculosis." d) "I will come back in 1 week to have the test read." |
a) "Because I had a previous reaction to the test, this time I need to get a chest X-ray." A client who previously had a positive PPD test (a reaction to the antigen) can't receive a repeat PPD test and must have a chest X-ray done instead. The test should be read 48 to 72 hours after administration. Redness at the test area doesn't indicate a positive test; an induration of greater than 10 mm indicates a positive test. The client doesn't need to avoid contact with people during the test period. |
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A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is: a) inappropriate because irrigation requires strict sterile technique. b) appropriate because the irrigation just checks for patency. c) inappropriate because the sterile drape must be cloth, not paper. d) appropriate because the irrigation set will be used only during an 8-hour period. |
a) inappropriate because irrigation requires strict sterile technique. Irrigating a nephrostomy tube requires strict sterile technique; therefore, reusing the irrigation set (even if covered by a sterile drape) is inappropriate. Bacteria can proliferate inside the syringe and irrigation container. Although this procedure checks patency, it requires sterile technique to prevent the introduction of bacteria into the kidney. The material of which the sterile drape is made is irrelevant because a sterile drape doesn't deter bacterial growth in the irrigation equipment. |
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Which client is at greatest risk for coronary artery disease? a) a 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin b) a 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L) c) a 43-year-old male with a family history of CAD and cholesterol level of 158 (8.8 mmol/L) d) a 32-year-old female with mitral valve prolapse who quit smoking 10 years ago |
b) a 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L) The woman who is 65 years old, overweight, and has an elevated LDL is at greatest risk. Total cholesterol greater than 200 (11.1 mmol/L), LDL greater than 100 (5.5 mmol/L), HDL less than 40 (2.2 mmol/L) in men, HDL less than 50 (2.8 mmol/L) in women, men 45 years and older, women 55 years and older, smoking and obesity increase the risk of CAD. Atorvastatin reduces LDL and decreases risk of CAD. The combination of postmenopausal, obesity, and high LDL places this client at greatest risk. |
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Several hours into a shift, a nurse on a very busy medical-surgical unit privately asks the charge nurse to change her assignment. She is frustrated because she has had to devote so much time and energy to helping a newly licensed nurse provide discharge teaching for clients with diabetes mellitus. The charge nurse should: a) insist that the nurse follow through with the assignment. b) try to provide the staff member with a float nurse. c) offer to assist with the discharge teaching needs. d) reassign the new graduate to another staff member. |
c) offer to assist with the discharge teaching needs. Staff members need to know the charge nurse is a supportive leader who respects their honesty and stands behind them. By offering to help with discharge teaching, the charge nurse is actively engaging with her staff at a time of need. Changing all the assignments on this extremely busy floor would be counterproductive. Insisting that the staff member follow through with her assignment disrespects her request and genuine need. Providing a float nurse could help, but there are no guarantees a float nurse is available. |
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A nurse notices the smell of marijuana on a nursing colleague upon return from lunch break. The colleague is having difficulty drawing up a dose of insulin, appears uncoordinated, and is unaware that the needle has been contaminated. What is the best action for the nurse to take? a) Take the syringe and insulin vials, draw up the insulin, and instruct the colleague to focus more clearly when giving the injection. b) Reassign the responsibilities, and inform the colleague that the unit manager will be notified if it occurs again. c) Take the insulin vials and needle, draw up the insulin, and administer it. Ask a colleague to observe the nurse for the remainder of the shift. d) Stop the colleague from drawing up the insulin. Notify the supervisor about the incident, and document the observations. |
d) Stop the colleague from drawing up the insulin. Notify the supervisor about the incident, and document the observations. Acknowledging that there is a problem and protecting the client is a professional responsibility. Calling the supervisor is important so the client can be reassigned and the supervisor can deal with the problem. Taking over the nurse’s responsibilities is not appropriate. The problem then will not be addressed. The incident needs to be reported because client care is in jeopardy. |
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The nurse is teaching a group of unlicensed personnel new to psychiatry about balance in a therapeutic milieu. Which of the following statements by a member of the group indicates the need for further teaching? a) “Controlling clients helps them feel more comfortable.” b) “We need to think of patients’ rights when working with clients.” c) “Balance includes safe and effective treatment for all clients.” d) "We don’t fix clients but help them solve their problems.” |
a) “Controlling clients helps them feel more comfortable.” The statement, “Controlling clients helps them feel more comfortable,” does not reflect an understanding of the concept of balance in a therapeutic milieu. Balance is the careful negotiation of the conflict between dependency and independency in a therapeutic milieu. Clients are dependent when admitted to care but are allowed and encouraged to become independent as they are able to assume responsibility for self. Staff may find it easier to care for the client when they can control the client and may feel needed when the client is dependent on them. In a therapeutic milieu, staff do not solve the clients’ problems for them. Rather, they work with the clients to gradually allow independent behaviors and decision making. Understanding clients’ rights, legal issues, and ethical concerns is crucial for the skilled use of balance. |
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A 24-year-old primipara decides to breast-feed her baby but says, "I'm worried that I won't be able to breast-feed my baby because my breasts are so small." Which of the following would the nurse include in the explanation to the client? a) The woman's motivation to breast-feed is more important than breast size. b) Breast milk can be enhanced by occasional formula feeding. c) Because her breasts are small, she will have to feed the baby more often. d) Breast size poses no influence on a woman's ability to breast-feed a baby. |
d) Breast size poses no influence on a woman's ability to breast-feed a baby. Breast size is not important as long as there is glandular tissue to secrete the milk, although various factors can influence milk supply, such as suckling, emptying of the breasts, diet, exercise, rest, level of contentment, and stress. The fat in breast tissue plays no role in milk production. Breastfeeding and formula feeding at the same time can result in nipple confusion. The client's belief in her ability to breast-feed is important because women who lack motivation are more likely to discontinue breast-feeding. Women with small breasts do not produce less milk. Also, the size of the breast does not influence the neonate's ability to grasp the nipple. The frequency of feeding is determined by the baby's needs, not the size of the mother's breasts. |
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A 75-year-old male client has a history of macular degeneration. While in the hospital, the priority nursing goal will be to: a) Provide health care related to monitoring his eye condition. b) Promote a safe, effective care environment. c) Improve vision. d) Provide education regarding community services for clients with adult macular degeneration (AMD). |
b) Promote a safe, effective care environment. AMD generally affects central vision. Confusion may result related to the changes in the environment and the inability to see the environment clearly. Therefore, providing safety is the priority goal in the care of this client. Educating him regarding community resources or monitoring his AMD may have been done at an earlier date or can be done after assessing his knowledge base and experience with the disease process. Improving his vision may not be possible. |
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A client’s intravenous catheter has become occluded. The nurse knows that the reason for the occlusion is which of the following? a) Thrombosis at the site b) Dressing and tape above the IV insertion site c) Localized infection d) An IV infusion rate of 75 mL per hour |
a) Thrombosis at the site The catheter occlusion may have been caused by inadequate flushing. It is usually a lipid build use, not particulate matter. The other choices are incorrect because they are not common causes. The IV rate is appropriate, infection is not the most common cause of catheter occlusion if the catheter is changed per hospital protocol, and dressing and tape should not occlude flow. |
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A student nurse has observed the behavior of a client who was admitted to an inpatient psychiatric unit. The client attempts to get the student’s attention during the shift and during lunch tries to regain the nurse’s attention by shouting, “You’re just like my mother. You pay attention to everyone else but me!” Which of the following would indicate to the nursing instructor that the student correctly identified the client’s behavior? a) A demonstration of resistance to therapy b) Evidence of family abuse c) Evidence that the nursing staff is failing to meet the client’s needs d) A demonstration of transference |
d) A demonstration of transference The unconscious transfer of qualities originally associated with another relationship to a nurse or therapist is referred to as transference. Quite often these qualities are those of a parent, family member, or authority figure, and may provoke responses that are not appropriate to the new situation to which they are ascribed. Resistance is also unconscious, but has to do with the discomfort over the possible change that may result from therapy. Defense mechanisms and transference are expected aspects of therapy and arise in the client himself/herself, not because the nurse is failing to meet client needs or as a result of previous family abuse. |
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A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? a) Client teaching about the cause of TB b) Developing a list of people with whom the client has had contact c) Client teaching about the importance of TB testing d) Reviewing the risk factors for TB |
b) Developing a list of people with whom the client has had contact To lessen the spread of TB, everyone who had contact with the client must undergo a chest X-ray and TB skin test. Testing will help determine if the client infected anyone else. Teaching about the cause of TB, reviewing the risk factors, and the importance of testing are important areas to address when educating high-risk populations about TB before its development. |
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A client who had a total hip replacement two days ago has developed an infection with a fever. The nursing diagnosis of fluid volume deficit related to diaphoresis is made. Which of the following is the most appropriate outcome? a) The client drinks 2000 ml of fluid per day. b) The client's skin remains cool throughout hospitalization. c) The client's bed linens are changed as needed. d) The client understands how to manage the incision. |
a) The client drinks 2000 ml of fluid per day. An average adult requires approximately 1100-1400 ml of fluids per day. In some instances, such as when a person has an increase in body temperature or has increased perspiration, additional water may be necessary. With an increase in body temperature, there is also an increase in insensible fluid loss. The increased loss of fluid causes an increased need for fluid replacement. If the loss is significant and/or goes untreated, an individual's intake will not be balanced with output. Managing the incision, changing the bed linens, or keeping the client's skin cool are not outcomes indicative of resolution of a fluid volume deficit. |
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Which of the following families should the nurse determine as most in need of follow-up? a) A single parent with a toddler who has third-degree burns over 20% of the body. b) A two-parent family with a foster child who has a history of caustic liquid ingestion. c) A single mother with a 7-month-old child whose immunizations are delayed. d) A two-parent family whose 3-year-old has a fractured leg from an automobile accident. |
a) A single parent with a toddler who has third-degree burns over 20% of the body. Toddlers receive burns usually as the result of not being closely supervised. Toddlers are very inquisitive and need constant supervision; therefore, close follow-up is necessary. In addition, the child probably will need some type of wound care requiring involvement of the parent and possibly others. The amount of support available to the single parent of the 7-month-old child is not known. Although immunization schedules need to be adhered to, it is very possible for a 7-month-old to be delayed in receiving immunizations because of illness or other conflicts. An automobile accident can happen to anyone and does not indicate a lack of safety or supervision. A history of caustic liquid ingestion in a foster child may have been from a time before the child began living with the foster parents; it does not indicate a lack of safety or supervision. |
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The mother of a child with newly diagnosed Duchenne's muscular dystrophy asks how her child developed the disease. The nurse gives a response incorporating which of the following statements about its transmission? a) It is a disorder primarily transmitted by males in the family. b) It is a disorder usually carried by females and transmitted to male children. c) It is a genetic disorder carried by males and transmitted to male children. d) It is an autosomal recessive genetic disorder. |
b) It is a disorder usually carried by females and transmitted to male children. The gene for Duchenne's muscular dystrophy is carried by women and transmitted to their male children. It involves an X-linked inheritance pattern. About one-third of new cases involve mutations. |
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An adolescent is being nursed with a skeletal traction for a fractured femur. Which is the most appropriate nursing intervention for this client? a) Put all the joints through range of motion every shift. b) Assess pin sites every shift and as needed. c) Ensure that the rope knots catch on the pulley. d) Add and remove weights at the adolescent's request. |
b) Assess pin sites every shift and as needed. Nursing care for a client in traction includes assessing pin sites every shift and as needed and ensuring that the knots in the rope don't catch on the pulley. The nurse should add and remove weights at the physician's order, not at the adolescent's request. All joints, except those immediately proximal and distal to the fracture, should be put through range of motion every shift. |
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A client with antisocial personality disorder smokes in prohibited areas and refuses to follow other unit and facility rules. The client persuades others to do his laundry and other personal chores, splits the staff, and will work only with certain nurses. The care plan for this client should focus primarily on: a) using behavior modification to decrease negative behavior by using negative reinforcement. b) engaging in power struggles with the client to minimize manipulative behavior. c) isolating the client to decrease contact with easily manipulated clients. d) consistently enforcing unit rules and facility policy. |
d) consistently enforcing unit rules and facility policy. Firmness and consistency regarding rules are the hallmarks of a care plan for a client with a personality disorder. Isolation is inappropriate and violates the client's rights. Power struggles should be avoided because the client may try to manipulate people through them. Behavior modification usually fails because of staff inconsistency and client manipulation. |
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A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Temperature of 99.2° F (37.3° C) b) Serum sodium level of 135 mEq/L c) Serum potassium level of 4.9 mEq/L d) Urine output of 20 ml/hour |
d) Urine output of 20 ml/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings. |
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The nurse is caring for a client with Clostridium difficile infection. Upon entering the room, which of the following steps should the nurse take? a) Take antiseptic wipes into the room. b) Put on an isolation gown and gloves. c) Wear a face mask and goggles. d) Use sterile gloves and foot protection. |
b) Put on an isolation gown and gloves. Contact precautions should be implemented when a client has, or is suspected of having, an organism that can be transmitted by direct contact. This can occur when a nurse provides direct care or indirect contact where the organism is transferred to an object and then touched by a person. Contact precautions require that the nurse wear an isolation gown and gloves when entering the room. |
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An experienced nurse is precepting a new nurse in a psychiatric emergency room and is discussing criteria for involuntary commitment. Which client would signal to the experienced nurse that the new nurse understands the criteria? a) A client with schizophrenia who can manage activities of daily living but has grandiose delusions b) A woman with depression who says she is tired of living and does not have a suicidal plan c) The parent who leaves her minor children unattended and stays out all night snorting cocaine d) A man who threatens to kill his wife of 38 years |
d) A man who threatens to kill his wife of 38 years One of the criteria for involuntary commitment is an emergency in which the client is a threat to himself or others. A parent might have a child removed from the home because of neglect, but that doesn't meet the criteria for involuntary commitment. Many individuals with schizophrenia can learn to live with hallucinations and delusions and don't require hospitalization. To meet criteria for involuntary commitment, a depressed individual must have a suicide plan and be a direct threat to himself. |
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The client is started on simvastatin as a component of cholesterol management. Which of the following laboratory tests needs to be monitored while on this therapy? a) Serum glucose. b) Total protein. c) Complete blood count. d) Liver function tests. |
d) Liver function tests. Liver function tests, including aspartate transaminase (AST) should be monitored before therapy, 6 to 12 weeks after initiation of therapy or after dose elevation, and then every 6 months. If AST levels increase to three times normal, therapy should be discontinued. Simvastatin does not influence serum glucose, complete blood count, or total protein. Serum cholesterol and triglyceride levels should be evaluated before initiating therapy, after 4 to 6 weeks of therapy, and periodically thereafter. |
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A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should: a) have the client wear two briefs at a time to ensure absorption of incontinent urine. b) ask the physician to order sedation to allow the client to rest. c) ask the physician to order restraints to prevent wandering. d) incorporate the client's toileting schedule into the pattern of his wandering. |
d) incorporate the client's toileting schedule into the pattern of his wandering. Incorporating the client's toileting schedule into his wandering assists with elimination and increases the chance of continent episodes. Sedation and restraints will decrease the client's mobility but won't decrease the number of incontinent episodes. Wearing two briefs at a time won't ensure urine absorption and won't address the incontinence issue. |
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Students in a health class are discussing birth control and prevention of sexually transmitted disease. The school nurse would know that teaching has been effective if the students state which of the following? a) “Safe sex means preventing pregnancy through use of birth control.” b) “Responsible sex involves using condoms and spermicides for protection and birth control.” c) “The rhythm method means not having sex just before menstruation.” d) “The intrauterine device is the most effective way to prevent pregnancy.” |
b) “Responsible sex involves using condoms and spermicides for protection and birth control.” This comment indicates an understanding of ways to lessen the incidence of sexually transmitted illnesses by condom use. It also indicates that use of a spermicide and condom will help to prevent unwanted pregnancies. The other choices are not accurate examples of safer sex |
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Which nursing action is most important in preventing cross-contamination? a) wearing protective coverings b) changing gloves immediately after use c) speaking minimally when in the room d) standing 2 feet (61 cm) from the client |
b) changing gloves immediately after use Bedside rails, call bells, drug-administration controls operated by the client, and other surface areas are frequently touched by caregivers with used gloves. Changing gloves immediately after use protects the client from contamination by organisms. Cross-contamination is a break in technique of serious consequence to the severely compromised client. Standing 2 feet (61 cm) from the client, speaking minimally, and wearing protective covering shirts are not required in standard interventions for risk of infection. |
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A nurse is caring for a 19-month-old infant with dehydration and weight loss. The infant's mother states that her son doesn't like to eat and that she hates to make him eat. The nurse should: a) contact the physician to have the child put in isolation. b) request that a dietitian talk with the parent about infants and nutrition. c) contact the social worker on duty and give her information about the situation. d) contact the local police department to report suspected child abuse. |
b) request that a dietitian talk with the parent about infants and nutrition. The infant's mother needs assistance in maintaining her child's diet. Requesting that a dietitian speak with the mother about the child's diet is within the nurse's scope of practice. The nurse shouldn't call the local police or the social worker on duty because there is no evidence of child abuse or neglect. Many infants are picky eaters and choose not to eat or drink. The nurse doesn't need to call the physician to have the infant put in isolation. Isolation isn't indicated for dehydration. |
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When developing the teaching plan for the mother of a 2-year-old child diagnosed with scabies, what information should the nurse expect to include? a) The floors of the house should be cleaned with a damp mop. b) The entire family should be treated. c) The child should be held frequently. d) Itching should cease in a few days. |
b) The entire family should be treated. Scabies is caused by the scabies mite, Sarcoptes scabiei. The mite burrows into the stratum corneum of the epidermis, where the female deposits eggs and fecal material. These burrows are linear. Scabies is highly contagious. The length of time from infestation to physical symptoms is 30 to 60 days, so everyone in close contact with the child will need to be treated. The bed linens and the child’s clothing should be washed in hot water and dried on the hot setting. It is not necessary to damp mop the floors to prevent the spread of scabies. The child should be held minimally until treatment is completed. Family members should wash their hands after contact with the child. Itching lasts for 2 to 3 weeks until the stratum corneum is replaced. |
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Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use? a) Providing documentation of previous certification b) Demonstrating correct technique c) Verbalizing an understanding of blood glucose meter use d) Documenting a normal blood glucose level |
b) Demonstrating correct technique The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use. |
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When assessing an 18-year-old primipara who gave birth to a viable neonate under epidural anesthesia 24 hours ago, the nurse determines that the fundus is firm but to the right of midline. Based on this finding, the nurse should further assesses for: a) Paralytic ileus. b) Perineal hematoma. c) Urinary retention. d) Uterine inversion. |
c) Urinary retention. A full bladder is likely to push the uterus to the right of midline, so the nurse should further assess for symptoms of urinary retention. A full bladder can prevent the uterus from contracting properly (uterine atony), possibly leading to hemorrhage. When the bladder is empty, it normally is nonpalpable and lies about in the midline. Uterine inversion occurs when the pressure from palpation pushes the uterus outside the vagina. Abdominal distention, constipation, and pain are commonly associated with a paralytic ileus, which may occur after a cesarean birth. Perineal hematoma may result from an episiotomy. It has no relation to the fundus being to the right of midline. |
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A registered nurse (RN) is working with the licensed practical nurse (LPN) to care for a group of clients in a nursing home. How should the RN expect the LPN to communicate changes in the clients' wound status? a) The RN communicates daily with the LPN about the condition of each resident. b) The LPN informs the RN only if a wound worsens. c) The LPN informs the RN when a wound heals. d) The LPN speaks directly to the physician. |
a) The RN communicates daily with the LPN about the condition of each resident. It's within the scope of LPN practice to communicate with the physician; however, the RN should communicate daily with the LPN about the condition of each nursing home resident. The RN should be kept abreast of all changes in clients' conditions as they occur. |
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A client diagnosed with borderline personality disorder has self-inflicted cuts on her arms. The nurse is assessing the client for the risk of suicide. What should the nurse ask the client first? a) why she cut herself b) if she has a suicide plan c) if she is taking antidepressants d) about medications she has taken recently |
b) if she has a suicide plan The client is at risk for suicide, and the nurse should determine how serious the client is, including if she has a plan and the means to implement the plan. While medication history may be important, the nurse should first attempt to determine suicide risk. Asking the client why she cut herself will likely cause the client to respond with insufficient information to determine suicide risk |
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The charge nurse is making client care assignments for the evening shift. One of the licensed practical nurses (LPNs) is a new graduate in orientation. Which of the following clients would be an appropriate care assignment for this nurse? a) A 5-year-old client with Kawasaki’s disease. b) A 32-year-old client hospitalized for chemotherapy treatment. c) A 72-year-old client with diverticulitis. d) A 41-year-old client with unstable angina. |
c) A 72-year-old client with diverticulitis. The client with diverticulitis will need care that the LPN should be able to provide safely. The client with angina is unstable and requires a registered nurse for continuous assessment. The client receiving chemotherapy treatment requires a registered nurse who is certified in chemotherapy administration. A child with Kawasaki’s disease must be watched closely for cardiac complications, and it would be best to assign the child to an experienced pediatric nurse, not a new graduate. |
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Which action initiated by the parents of an 8-month-old indicates they need further teaching about preventing childhood accidents? a) inspecting toys for loose parts b) placing toxic substances out of reach or in a locked cabinet c) placing a fire screen in front of the fireplace d) placing a car seat in a front-seat, front-facing position placing a car seat in a front-seat, front-facing position |
d) placing a car seat in a front-seat, front-facing position placing a car seat in a front-seat, front-facing position It is recommended that children up to 2 years of age ride in a rear-facing car seat. The middle of the back seat is considered the safest area of the car. Burns are a major cause of childhood accidents, and using fire screens in front of fireplaces can help prevent children from getting too close to a fire in a fireplace. Toys that contain loose parts or plastic eyes that can be swallowed or aspirated by small children should be avoided. Parents should inspect all toys for these parts before giving one to a child. Poisonings are most commonly caused by improper storage of a toxic substance. Keeping toxic substances in a childproof container in a locked cabinet and continually observing the child’s activities can prevent most poisonings. |
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A client in a double hip spica cast is constipated. The surgeon cuts a window into the front of the cast. Which outcome is intended? a) The window will allow the nurse to palpate the superior mesenteric artery. b) The window will allow the surgeon to manipulate the fracture site. c) The window will allow the nurses to reposition the client. d) The window will provide some relief from pressure due to abdominal distention as a result of constipation. |
d) The window will provide some relief from pressure due to abdominal distention as a result of constipation. The hip spica cast is used for treatment of femoral fractures; it immobilizes the affected extremity and the trunk securely. It extends from above the nipple line to the base of the foot of both extremities in a double hip spica. Constipation, possible due to lack of mobility, can cause abdominal distention or bloating. When the spica cast becomes too tight due to distention, the cast will compress the superior mesenteric artery against the duodenum. The compression produces abdominal pain, abdominal pressure, nausea, and vomiting. To relieve the compression, the surgeon can cut a “window” in the cast. The nurse should assess the abdomen for decreased bowel sounds, not the superior mesenteric artery. The surgeon cannot manipulate a fracture through a small window in a double hip spica cast. The nurse cannot use the window to aid in repositioning because the window opening can break and negate the effect of the cast. |
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A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision? a) Fidelity b) Autonomy c) Veracity d) Nonmaleficence |
b) Autonomy Autonomy refers to an individual's right to make his own decisions. Fidelity is equated with faithfulness. Nonmaleficence is the duty to "do no harm." Veracity refers to telling the truth. |
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A client is being admitted with a nursing home–acquired pneumonia. The unit has four empty beds in semiprivate rooms. The room that would be most suitable for this client is the one with a: a) 45-year-old client with abdominal hysterectomy. b) 24-year-old client with non-Hodgkin's lymphoma. c) 60-year-old client admitted for investigation of transient ischemic attacks. d) 55-year-old client with alcoholic cirrhosis. |
c) 60-year-old client admitted for investigation of transient ischemic attacks. The client with a possible transient ischemic attack is the only client who has not had surgery and is not immunocompromised. The client with a recent surgery and incision should not be exposed to a client with infection. Clients with cancer or alcoholic cirrhosis are very susceptible to infection, and it would not be safe to expose them to a client with a respiratory infection |
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A postmenopausal client is scheduled for a bone-density scan. The nurse should instruct the client to: a) consume foods and beverages with a high content of calcium for 2 days before the test. b) report any significant pain to the health care provider (HCP) at least 2 days before the test. c) ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. d) remove all metal objects on the day of the scan. |
d) remove all metal objects on the day of the scan. Metal will interfere with the test. Metallic objects within the examination field, such as jewelry, earrings, and dental amalgams, may inhibit organ visualization and can produce unclear images. Ingesting foods and beverages days before the test will not affect bone mineral status. Short-term calcium gluconate intake will also not influence bone mineral status. The client may already have had chronic pain as a result of a bone fracture or from osteoporosis. |
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A client with cirrhosis of the liver is in the hospital. The nurse involves the client in developing a plan of care. What would be important aspects to include in this plan? a) Identifying nursing goals and explaining the importance of following these goals b) Identifying the potential and actual problems, informing the client about options, and arranging for the client to attend Alcoholics Anonymous c) Informing the client of the extent of damage to the liver and drawing up a contract to start the rehabilitative process d) Discussing collaborative goals and involving the client in identifying and prioritizing important interventions |
d) Discussing collaborative goals and involving the client in identifying and prioritizing important interventions Involvement of the client in determining the goals and interventions is very important to enhance the client’s compliance with the care measures. The other choices do not directly address the goals and a plan of care |
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The nurse unit manager is making rounds on a team of clients and notices a client who is wearing red slipper socks and a color-coded armband that indicates the client is at risk for falling walking down the hall unassisted. The client is already at the end of the hallway farthest from the client’s room, but is not tired. What should the nurse do first? a) Instruct the client to walk only in his room at this time. b) Walk with the client back to his room, and assist him to get in bed. c) Obtain a wheel chair, and take the client back to the room. d) Locate an unlicensed nursing personnel (UAP) to walk with the client back to the room. |
b) Walk with the client back to his room, and assist him to get in bed. The client is identified as being at risk for falling, and a staff member or family member should accompany the client when walking. The nurse should first accompany the client back the room. Because the client is not fatigued, the client does not need a wheel chair, but must have assistance. The nurse can delegate the task of ambulating the client to the UAP, but it may take a while to locate one that it available at this time. Walking only in the room will not provide an opportunity for the client to gain strength and improve ambulation, but the nurse should remind the client to have assistance |
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As a representative of the treatment team, a nurse is reviewing results of diagnostic studies with the family of an adolescent with anorexia nervosa. What explanation should the nurse give the family about the client's abnormal blood urea nitrogen (BUN) value?
a) "The BUN is elevated because your daughter has hypoglycemia." b) "The BUN is elevated because your daughter is dehydrated." c) "The BUN is decreased because your daughter is hypertensive." d) "The BUN is decreased because your daughter has developed hypothyroidism." |
b) "The BUN is elevated because your daughter is dehydrated." A client with anorexia nervosa will have an elevated BUN as a result of dehydration. A decreased BUN isn't associated with anorexia nervosa or with hypothyroidism. An elevated BUN isn't associated with hypoglycemia. A client with anorexia nervosa will have hyperglycemia related to a drastic decrease in nutritional intake. A decreased BUN value isn't associated with anorexia nervosa or with hypertension. A client with anorexia nervosa will have hypotension caused by impaired cardiac functioning. |
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After administering an I.M. injection, a nurse notices there isn't a sharps-disposal container nearby. Which action should the nurse take? a) Hold the barrel of the syringe in one hand. With the other hand, push the cap into place over the needle. b) Hold the barrel of the syringe in one hand. With the other hand, push the cap into place over the needle. Carry the syringe to the closest sharps-disposal container. c) With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest sharps-disposal container. d) With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest trash container. |
c) With one hand, use the needle to scoop up the cap. Holding the barrel in one hand, carry the syringe to the closest sharps-disposal container. When a sharps-disposal container isn't nearby, a nurse should use the one-handed scoop technique to prevent needle-stick injury while transporting the needle to a sharps-disposal container. Scooping the needle and pushing the cap on isn't a one-handed method. The needle could puncture the cap, causing a needle-stick injury. A needle should never be disposed of in a trash container. |
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While caring for a primigravid client with class II heart disease at 28 weeks' gestation, the nurse would instruct the client to contact her primary health care provider (HCP) immediately if the client experiences which symptom? a) mild ankle edema b) weight gain of 1 lb (0.45 kg) in 1 week c) emotional stress on the job d) dyspnea at rest |
d) dyspnea at rest Clients with class II heart disease have dyspnea upon exertion but not at rest. Dyspnea at rest would indicate a change in condition that must be reported immediately because it may be indicative of increasing congestive heart failure. Mild ankle edema in the third trimester is a common finding. However, generalized or pitting edema, suggesting increasing congestive heart failure, must be reported immediately. Emotional stress on the job increases cardiac demand. However, it needs to be reported only if the client experiences symptoms, such as palpitations or irregular heart rate, indicating heart failure related to the increased stress. Weight gain of 1 lb (0.45 kg) per week is a normal finding during the third trimester. |
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A child with a cardiac defect assumes a squatting position. The nurse should determine that the position is effective for the child by noting: a) Improved muscle tone. b) Relief of abdominal pressure. c) Less dyspnea. d) Less energy required to play with toys on the floor |
c) Less dyspnea. A child with a cardiac defect finds that squatting decreases venous return and workload to the heart and increases comfort and blood flow to the lungs. Squatting traps blood in the lower extremities so less blood is returned to the right atrium. Squatting does no make it easier for the child to play with toys. Squatting does not relieve abdominal pressure; it may even increase it slightly. Squatting has no effect on muscle tone. When done by a child with a cardiac defect, it is not meant as an exercise but is a compensatory process used to reduce dyspnea |
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A child, who uses an inhaled bronchodilator only when needed for asthma, has a best peak expiratory flow rate is 270 L/min. The child’s current peak flow reading is 180 L/min. How does the nurse interpret this reading? a) The child needs to use a short-acting inhaled beta2-agonist medication. b) The child needs to use inhaled cromolyn sodium. c) This is a medical emergency requiring a trip to the emergency department for treatment. d) The child's asthma is under good control, so the routine treatment plan should continue. |
a) The child needs to use a short-acting inhaled beta2-agonist medication. The peak flow of 180 L/min is in the yellow zone, or 50% to 80% of the child’s personal best. This means that the child’s asthma is not well controlled, thereby necessitating the use of a short-acting beta2-agonist medication to relieve the bronchospasm. A peak flow reading greater than 80% of the child’s personal best (in this case, 220 L/min or better) would indicate that the child’s asthma is in the green zone or under good control. A peak flow reading in the red zone, or less than 50% of the child’s personal best (135 L/min or less), would require notification of the health care provider (HCP) or a trip to the emergency department. Cromolyn sodium is not used for short-term treatment of acute bronchospasm. It is used as part of a long-term therapy regimen to help desensitize mast cells and thereby help to prevent symptoms. |
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A nurse needs to obtain an accurate blood pressure on a client. Which of the following is the most important action for the nurse to take to ensure an accurate reading? a) Have the client lie in a supine position while the blood pressure is taken. b) Raise the client’s arm above the level of the heart prior to taking the blood pressure. c) Encourage the client to make a fist several times before taking the blood pressure. d) Palpate the brachial artery and then place the arrow on the cuff over the palpated artery. |
d) Palpate the brachial artery and then place the arrow on the cuff over the palpated artery. The arrow on the cuff should be placed over the area where the brachial artery has been palpated. This is the most important step in obtaining an accurate blood pressure. |
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A nurse is teaching accident prevention to the parents of a toddler. Which instruction is appropriate for the nurse to tell the parents? a) Place locks on cabinets containing toxic substances. b) Don't allow the toddler to use pillows when sleeping. c) The toddler should wear a helmet when roller blading. d) Teach the toddler water safety. |
a) Place locks on cabinets containing toxic substances. The nurse should tell parents to place locks on cabinets containing toxic substances because a toddler's curiosity and the ability to climb and open doors and drawers make poisoning a concern in this age-group. Roller blading isn't an appropriate activity for toddlers even if the toddler wears a helmet. Toddlers lack the cognitive development to understand water safety. Pillows shouldn't be placed in the crib of an infant to avoid suffocation; however, toddlers may use them. |
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A primigravid client at 38 weeks’ gestation diagnosed with mild preeclampsia calls the clinic nurse to say she has had a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. The nurse should tell the client: a) "Take two acetaminophen tablets. They are not as likely to upset your stomach." b) "I'll ask the health care provider to call in a prescription for nausea medications. What is your pharmacy's number?" c) "You need to lie down and rest. Have you tried placing a cool compress over your head?" d) "I think the health care provider should see you today. Can you come to the clinic this morning?"
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d) "I think the health care provider should see you today. Can you come to the clinic this morning?" A client with preeclampsia and a continuous headache for 2 days should be seen by a health care provider (HCP) immediately. Continuous headache, drowsiness, and mental confusion indicate poor cerebral perfusion and are symptoms of severe preeclampsia. Immediate care is recommended because these symptoms may lead to eclampsia or seizures if left untreated. Advising the client to take two acetaminophen tablets would be inappropriate and may lead to further complications if the client is not evaluated and treated. Although the application of cool compresses may ease the pain temporarily, this would delay treatment. Treatment for nausea may be indicated, but only after the primary care primary provider has seen the client and determined if the preeclampsia requires further treatment. |
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A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? a) Diaphoresis, fever, and decreased sweating b) Weight loss, nervousness, and tachycardia c) Exophthalmos, diarrhea, and cold intolerance d) Weight gain, constipation, and lethargy |
b) Weight loss, nervousness, and tachycardia Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism. |
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A client is to have radiation therapy after a modified radical mastectomy. The nurse should teach the client to care for the skin at the site of therapy by: a) applying an ointment to the area. b) using talcum powder on the area. c) washing the area with water. d) exposing the area to dry heat. |
c) washing the area with water. A client receiving radiation therapy should avoid lotions, ointments, and anything that may cause irritation to the skin, such as exposure to sunlight, heat, or talcum powder. The area may safely be washed with water if it is done gently and if care is taken not to injure the skin. |
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Which statement by the parent of an 18-month-old child indicates to the nurse that the child needs laboratory testing for lead levels? a) "My child drinks two cups of milk every day." b) "My child does not always wash after playing in the dirt." c) "My child is smaller than other kids of the same age." d) "My child has more temper tantrums than other kids." |
b) "My child does not always wash after playing in the dirt." Eating with dirty hands, especially after playing outside, can cause lead poisoning because lead is often present in soil surrounding homes. Also, children who eat lead-containing paint chips commonly develop lead poisoning. Milk is a major source of calcium, and diets high in calcium help prevent lead poisoning. Temper tantrums are characteristic of 18-month-old children as they try to assert themselves. Determining whether the child is smaller than other children the same age requires measuring height and weight and plotting them on growth charts. In addition, inadequate growth could be a result of numerous causes, such as genetics, chronic illness, or chronic drug use (e.g., prednisone) |
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A client refuses his evening dose of haloperidol and then becomes extremely agitated in the day room while other clients are watching television. He begins cursing and throwing furniture. The nurse's first action is to: a) call the physician and report the behavior. b) check the client's medical record for an order for an as-needed dose of medication for agitation. c) remove all other clients from the day room. d) place the client in full leather restraints. |
c) remove all other clients from the day room. The nurse's first priority is to consider the safety of the clients in the therapeutic setting. Checking for an as-needed drug order and calling the physician are appropriate responses after ensuring the safety of other individuals. Because the client poses a danger to himself and others, restraints may be used; however, less restrictive interventions should be attempted first. |
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A client who's scheduled for open-heart surgery in 2 days has been having circulation problems in the feet and legs. The physician orders antiembolism stockings. The nurse is teaching the client about this treatment. What is the purpose of antiembolism stockings? a) To reduce or prevent edema of the legs and feet b) To maintain warmth in the legs c) To decrease arterial blood circulation to the legs and feet d) To decrease venous blood circulation from the legs and feet |
a) To reduce or prevent edema of the legs and feet Made of elastic material, antiembolism stockings are designed to reduce or prevent edema of the legs or feet by promoting venous return. They do this by increasing — not decreasing — arterial and venous blood circulation to the legs and feet. They don't maintain warmth in the legs. Blankets can be used for this purpose. |
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A nurse is teaching the mother of a 5-month-old infant diagnosed with bronchiolitis. Which statement by the mother indicates that teaching has been effective? a) "I hope my baby will come home from the hospital." b) "My baby has been sick. A machine will help him breathe." c) "I know that this disease is serious and can lead to asthma." d) "My baby needs to be cured this time so it won't happen again." |
c) "I know that this disease is serious and can lead to asthma." By saying bronchiolitis places the child at risk for developing asthma, the mother demonstrates understanding of her infant's condition. If diagnosed and treated promptly, most infants recover from the illness and return home. Infants typically don't have recurrences of bronchiolitis. Infants diagnosed with bronchiolitis rarely require mechanical ventilation. |
