Review Questions from textbook and slides all chapters

1. You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation, you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which statement best describes this code?

1. Improves self-health

2. Protects patient confidentiality

3. Ensures identical care to all patients

4. Defines the principles of right and wrong to provide patient care

4

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the operation to the family and discusses the patient’s wishes with them. The nurse is acting as the patient’s:

1. Educator

2. Advocate

3. Caregiver

4. Communicator

2

Contemporary nursing requires that the nurse have knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples of these roles and responsibilities? Select all that apply.

1. Caregiver

2. Autonomy

3. Patient advocate

4. Health promotion

5. Genetic counselor

1,2,3,4

Match the advanced practice nurse specialty with the statement about the role.

___1. Clinical nurse specialist

___2. Nurse anesthetist

___3. Nurse practitioner

___4. Nurse-midwife

a. Provides independent care, including pregnancy and gynecological services

b. Expert clinician in a specialized area of practice such as adult diabetes care

c. Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions

d. Plans and delivers anesthesia and pain management to patients across the life span

1 b

2 d

3 c

4 a

A critical care nurse is using a new research-based intervention to correctly position patients who are on ventilators to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which of the following?

1. Person-centered care

2. Evidence-based practice

3. Teamwork and collaboration

4. Quality improvement

2

Which activities will the nurse perform while participating in primary care? Select all that apply.

1. Providing prenatal teaching on nutrition to a pregnant patient during the first trimester

2. Assessing the nutritional status of older adults who come to the community center for lunch

3. Working with patients in a cardiac rehabilitation program

4. Providing home wound care to a patient

5. Teaching a class to parents at the local elementary school about the importance of immunizations

1,2,5

The nurse works in a tertiary care setting. Which activity does the nurse perform while providing tertiary care?

1. Conducting blood pressure screenings at a local food bank

2. Administering influenza vaccines for older adults at a local senior center

3. Inserting an indwelling catheter for a patient on a medical-surgical unit

4. Performing endotracheal suctioning for a patient on a ventilator in a medical ICU

4

The nurse provides restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient’s restorative care?

1. Patient will be able to walk 200 feet without shortness of breath.

2. Wound will heal without signs of infection.

3. Patient will express concerns related to return to home.

4. Patient will identify strategies to improve sleep habits.

1

A nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. Which discharge planning action by the nurse has not been addressed correctly?

1. Patient and family involvement in the referral

2. Timing of the referral

3. Incorporation of referral discipline recommendations into the plan of care

4. Determination of a discharge date

2

The nurse recognizes which of the following as common barriers to effective discharge planning? Select all that apply.

1. Ineffective communication among providers

2. Lack of role clarity among health care team members

3. Number of hospital beds to manage patient volume

4. A patient’s long-term disabilities

5. A patient’s cultural background

1,2

A nurse in a clinic is interviewing a patient who will undergo diagnostic testing. The nurse should ask about a patient’s potential allergies during which phase of the nursing process?

A. Planning

B. Evaluation

C. Assessment

D. Implementation

C

A nurse is documenting in a patient’s chart using the subjective, objective, assessment and plan SOAP charting model. Which of the following information should be included in the subjective component?

A Patient reports chest pain after mowing lawn this morning

B patient’s skin is pale and diaphoretic

C Patient’s blood pressure is 182/92

D Patient administered nitroglycerin 0.3 mg SL for chest pain

A

A nurse is instructing a newly licensed nurse about the scope and standard of nursing practice. Which of the following describes standards or practice?

A establishes a protocol for care to provide for a specific health problem

B Lists a set of skills that all nurses should be competent performing. Outlines responsibilities that every nurse is expected to provide regardless of their role

C Specifies the nurse provide care that reflects current practices current practice competent level of behavior when providing patient care

D Provides competencies for the nurse to achieve before licensure

B

Upon completing a history, the nurse finds that a patient has risk factors for developing lung disease. How should the nurse interpret this finding?

A a person with the risk factors will get the disease

B The chances of getting the disease are increased

C Risk modification will have no effect on disease prevention

D. The disease is guaranteed not to develop if the risk factor is controlled

B

A nurse is using a guide that provides principles of right and wrong to provide care to patients. Which guide is the nurse using?

A code of ethics

B standards of practice

C Standards of professional practice

D Quality and safety for nurses

A

After licensure, the nurse wants to stay current in knowledge and skills. Which program is the most common way nurses can do this? Select all that apply

A. Master degree

B doctoral preparation

C continuing education

D inservice education

E national council licensure examination dates

C,D

The nurse caring for a patient of Hispanic decent who speaks no English, is working with an interpreter. Which action should the nurse take?

A use long sentences when talking

B look at the patient when talking

C use breaks in sentences when talking

D look at only nonverbal behaviors when talking

B

The nurse is gathering data on a patient. Which data will the nurse report as objective data?

A states doesnt feel good

B reports a headache

C RR of 16

D Nauseated

C

A patient presents to the emergency department following a motor vehicle crash that causes a right femur fracture. The leg is stabilized in a full leg cast. Otherwise, the patient has no other major injuries, is in good health, and reports only moderates discomfort. Which is the most pertinent nursing diagnosis the nurse will include in the plan of care?

A Post trauma syndrome

B constipation

C acute oain

d anxiety

C

Which phrases are most appropriate to use to connect the parts of a patient problem statement?

A. “Related to” and “due to”

B. “Due to” and “as evidenced by”

C. “Related to” and “as evidenced by”

D. “Due to” and “as evidenced by”

C

A patient has a bacterial infection in the left lower leg. Which nursing diagnosis will the nurse add to the patient's care plan?

A. Staphylococcal leg infection

B. Impaired skin integrity

C. Risk for infection

D. Infection

B

A patient is being discharged home. What information should the nurse include?

The end of the question is obscured in the photo; the wording above is reconstructed from the visible portion.

A. Acuity level

B. Community resources

C. Standardized care plan

D. Signature for verbal order

B

A nurse preceptor is working with a student nurse. Which behavior by the student nurse will require the nurse preceptor to intervene?

A. Reading the patient's plan of care

B. Reviewing the patient's medical record

C. Sharing patient information with another student

D. Documenting medication administered to the patient

C

A nurse is engaged in therapeutic communication with a patient. Which technique will the nurse use to ensure effective communication?

A. Interpersonal communication to change negative self-talk to positive self-talk

B. Small group communication to present information to an audience of children

C. Electronic communication to communicate with the health care provider

D. Intrapersonal communication to build strong teams

C

The nurse asks a patient where their pain is located, and the patient responds by pointing to the area of pain. Which form of communication did the patient use?

A. Verbal

B. Nonverbal

C. Intonation

D. Vocabulary

B

A nurse is determining if teaching is effective. Which finding BEST indicates learning has occurred?

A. A nurse presents information about diabetes

B. A patient demonstrates how to inject insulin

C. A family member listens to a lecture about diabetes

D. A primary care provider hands a diabetes pamphlet to the patient

B

After a teaching session with a nurse, a patient learns that a normal adult heartbeat is 60 to 100 beats/min. In which domain did learning take place?

A. Kinesthetic

B. Affective

C. Psychomotor

D. Cognitive

D

The patient reports to the nurse of being afraid to speak up regarding a desire to end care for fear of upsetting spouse and children. Which principle in the nursing code of ethics ensures that the nurse will promote the patient's cause?

A. Advocacy

B. Responsibility

C. Confidentiality

D. Accountability

A

During a severe respiratory epidemic, the local health care organizations decide to give health care workers priority access to ventilators over other members of the community who also need that resource. Which philosophy would give the strongest support for this decision?

A. Deontology

B. Utilitarianism

C. Ethics of Care

D. Feminist Care

B

You are the nurse caring for a patient who is on contact precautions and is infected with C.Diff. what actions should you as the nurse implement when caring for this patient

1. Wash hands with a gel based hand sanitizer

2. Wash hands with soap and water before entering the patient’s room

3. Wash hands with soap and water after contacting with the patient

4. Wear an N95 mask when caring for the patient

C

You are caring for a patient in a protective environment. They recently had a kidney transplant. What actions should you as the nurse implement when caring for this patient?

1. Wash hands with a gel based hand sanitizer

2. Wash hands with soap and water before entering the patient’s room

3. Wash hands with soap and water after contacting with the patient

4. Wear an N95 mask when caring for the patient

2

A nurse is assessing a patient’s radial pulse and notices it is irregular and difficult to count. What should the nurse do next?

1. Continue counting the radial pulse for a full minute

2. Assess the apical pulse using a stethoscope

3. Immediately notify the physician

4. Switch to assessing the carotid pulse

B

A recent immigrant who does not speak English is alert but requires hospitalization. What is the initial action that the nurse must take to enable informed consent to be obtained?

A. Ask a family member to translate what the nurse is saying

B. Request an official interpreter to explain the terms of the consent

C. Notify the nursing manager that the patient doesn't speak English

D. Use hand gestures and medical equipment while explaining in English

B

A nurse is preparing to enter a patient's room on contact precautions. Which of the following sequences describes the correct order of donning PPE?

A. Hand hygiene – Gloves – Gown – Mask – Goggles

B. Hand hygiene – Gown – Mask – Goggles – Gloves

C. Hand hygiene – Mask – Gloves – Gown – Goggles

D. Hand hygiene – Goggles – Mask – Gown – Gloves

B

A nurse manager implements a new bedside shift report process to improve patient safety. She meets with staff to explain the vision behind the change, encourages feedback, recognizes innovative ideas from team members, and mentors nurses who are struggling with the transition.

A. Autocratic leadership

B. Transactional leadership

C. Transformational leadership

D. Laissez-faire leadership

C

he registered nurse is teaching a nursing student about respiratory assessment. Which statement by the nursing student indicates the need for further learning?

A. "I should assess the patient's wrist as it rests over the chest."

B. "I should let the patient know that I am assessing respiration."

C. "I should assess respiration immediately after measuring pulse rate."

D. "I should assess respiration while keeping in mind the patient's usual ventilation rate and pattern."

B

A nurse is measuring a client's oral temperature. The client informs the nurse that he has just eaten some ice chips. Which of the following actions should the nurse take?

A. Wait 30 min and return to measure the oral temperature.

B. Provide the client a sip of warm water, wait 5 min, and measure the temperature.

C. Document that the nurse was unable to measure the client's temperature.

D. Proceed to measure the oral temperature.

A

A nurse is teaching a newly licensed nurse about orthostatic hypotension. Which of the following information should the nurse include?

A. Orthostatic hypotension increases a client's risk of a pulmonary emboli.

B. Orthostatic hypotension is indicated by a decrease in systolic blood pressure of 10 mm Hg.

C. Orthostatic hypotension is indicated by a decrease in diastolic blood pressure of 5 mm Hg.

D. Orthostatic hypotension increases a client's risk of a fall.

D

A nurse is caring for a 35-year-old patient who recently started taking antidepressants after repeated failed attempts at fertility treatment. The patient tells the nurse, "I feel happier, but my sex drive is gone." Which nursing diagnosis has the highest priority?

1. Sexual dysfunction

2. Difficulty coping

3. Risk for self-directed violence

4. Deficient knowledge about contraception

1

The school nurse is urgently called to the gymnasium regarding an injured student. The student is crying in severe pain with a malformed fractured lower leg. Which proper sequence will the nurse follow to perform the initial assessment?

1. Light palpation, deep palpation and inspection

2. Inspection, light palpation and deep palpation

3. Auscultation and light palpation

4. Inspection and light palpation

4

Which nursing assessments are appropriate for a patient at risk for deep vein thrombosis? Select all that apply.

A. Use a positive Homans sign as the primary assessment finding

B. Assess only the symptomatic leg and omit comparison with the opposite limb

C. Massage the painful area to improve venous circulation

D. Measure and document bilateral calf circumference daily using the same anatomical landmarks

E. Assess for dyspnea, tachycardia, crackles, or respiratory distress

F. Compare the color, warmth, circumference, and pulses of the affected extremity

D,E,F

Which statements accurately describe normal and abnormal jugular vein findings? Select all that apply.

A. Jugular venous distention indicates decreased right-sided venous pressure.

B. Persistent neck vein distention while sitting is an abnormal finding.

C. The internal jugular vein lies superficially just above the clavicle.

D. Jugular veins normally flatten when the patient sits or stands.

E. The external jugular vein may normally become visible in the supine position.

F. Jugular venous distention may indicate right-sided heart failure.

B,D,E,F

During a routine physical examination of a 70-year-old patient, a blowing sound is auscultated over the carotid artery. Which assessment finding will the nurse report to the health care provider?

1. Bruit

2. Thrill

3. Phlebitis

4. Right-sided heart failure

1

Which patient comment should the nurse identify as a demonstration of faith?

1. I go to church every Sunday.

2. I believe in life after death.

3. I have something to look forward to each day.

4. I get a feeling of awe when looking at the sunset.

2

The nurse is caring for a patient diagnosed with a chronic illness who is having conflicts with beliefs. Which health care team member will the nurse ask to see this patient?

1. Clergy

2. Psychiatrist

3. Social worker

4. Occupational therapist

1

The nurse caring for a terminally ill patient sits down and lightly touches the patient's hand. Which technique is the nurse using?

1. "Doing for"

2. Establishing presence

3. Offering transcendence

4. Providing health promotion

2

The nurse is caring for a patient who has been diagnosed with a terminal illness. The patient states, "I just don't feel like going to work. I have no energy, and I can't eat or sleep." The patient shows no interest in taking part in the care by saying, "What's the use?" Which response by the nurse is best?

1. "It sounds like you have lost hope."

2. "It sounds like you have lost energy."

3. "It sounds like you have lost your appetite."

4. "It sounds like you have lost the ability to sleep."

1

Spiritual distress has been identified in a patient who has been diagnosed with a chronic illness. Which interventions will the nurse add to the care plan? (Select all that apply.)

1. Being supportive of a patient's wish to pray

2. Encouraging time with a support group

3. Arranging clergy member to visit the patient

4. Developing activities to heal body, mind and spirit

5. Teaching relaxation, guided imagery and meditation

1,3,4,5

A severely depressed patient cannot state any positive attributes to life. The nurse patiently sits with this patient and assists the patient to identify several activities the patient is actually looking forward to in life. Which spiritual concept is the nurse trying to promote?

1. Time management

2. Reminiscence

3. Hope

4. Faith

3

A veteran is hospitalized after surgical amputation of both lower extremities owing to injuries sustained during military service. Which type of loss will the nurse focus the plan of care on for this patient?

1. Perceived loss

2. Situational loss

3. Maturational loss

4. Uncomplicated loss

2

The paramedics transport an adult involved in a motor vehicle accident to the emergency department. On physical examination, the patient's level of consciousness is reported as opening eyes to pain and responding with inappropriate words and flexion withdrawal to painful stimuli. Which value will the nurse report for the patient's Glasgow Coma Scale score?

1. 5

2. 7

3. 9

4. 11

3

The patient has been diagnosed with diabetes. When admitted, the patient is unkempt and needs a bath and foot care. When questioned about hygiene habits, the nurse learns the patient takes a bath once a week and a sponge bath every other day. To provide ultimate care for this patient, which principle should the nurse keep in mind?

1. Patients who appear unkempt place little importance on hygiene practices.

2. Personal preferences determine hygiene practices and are unchangeable.

3. The patient's illness may require teaching of new hygiene practices.

4. All cultures value cleanliness with the same degree of importance.

3

A nurse is assessing a patient's skin. Which patient is most at risk for impaired skin integrity?

1. A patient that is afebrile

2. A patient that is diaphoretic

3. A patient with strong pedal pulses

4. A patient that is adequate skin turgor

2

A nurse is providing perineal care to a female patient. Which washing technique will the nurse use?

1. Cleansing from back to front

2. Washing using a circular motion

3. Cleansing from pubic area to rectum

4. Cleansing upwards from rectum to pubic area

3

The nurse is caring for a patient experiencing respiratory problems. Which assessment finding indicates a late sign of hypoxia?

1. Elevated blood pressure

2. Increased pulse pressure

3. Restlessness

4. Cyanosis

4

A patient has a decreased gag reflex, left-sided weakness, and drooling. Which action will the nurse take when feeding this patient?

1. Position in semi-Fowler's

2. Flex head with chin down

3. Place food on the left side

4. Offer fruit juice

2

In providing prenatal care to a pregnant patient, what does the nurse teach the expectant mother?

1. Calcium intake is especially important in the first trimester.

2. Protein intake needs to decrease to preserve kidney function.

3. Folic acid is needed to help prevent birth defects and anemia.

4. Extra vitamins and minerals should be taken as much as possible.

3

Which patient diagnosis increases the risk for developing neurogenic dysphagia?

1. Benign peptic stricture

2. Muscular dystrophy

3. Myasthenia gravis

4. Stroke

4

Which statement describes the strength of a pulse when the nurse rates it as 1?

1. Absent, not palpable

2. Full, increased

3. Bounding, aneurysmal

4. Diminished, barely palpable

4

A co-worker asks the nurse to explain spirituality. What is the nurse's best response?

1. It has a minor effect on health.

2. It is awareness of one's inner self.

3. It is not as essential as physical needs.

4. It refers to fire or giving of life to a person.

2

A nurse is teaching a class about spirituality in clients who are near the end of life. Which of the following information should the nurse include?

1. Spirituality can increase depression.

2. Spirituality can increase the quality of life.

3. Spirituality can increase feelings of hopelessness.

4. Spirituality can increase the desire to hasten death.

2

A nurse is teaching a class about factors that influence a client's perception of death. Which of the following factors should the nurse include?

1. Education level

2. Cultural practices

3. Gender

4. Financial concerns

5. Religious beliefs

1,2,3,4,5

A nurse is preparing to teach a patient how to safely ambulate using crutches. Which of the following nursing actions should the nurse prioritize to ensure safe and effective crutch use? (Select all that apply.)

A. Ensure the crutch pads are positioned 1 to 2 inches below the axilla to prevent nerve injury.

B. Demonstrate standing up from a seated position by holding both crutches in one hand and pushing up with the other hand on a stable surface.

C. Suggest the patient store crutches behind a door to keep them out of the way when not in use.

D. Instruct the patient to keep elbows slightly flexed at approximately 15 to 30 degrees when holding the crutch handles.

E. Advise the patient to advance the crutches about 6 to 10 inches ahead and then move the affected leg forward during the four-point gait.

F. Instruct the patient to look downward constantly while walking to ensure foot placement accuracy.

G. Tell the patient to rest body weight on the crutch axillae when standing for prolonged periods.

H. Tell the patient to increase speed quickly when ambulating with crutches to improve gait coordination.

I. Encourage the patient to swing both crutches forward simultaneously and then bring both feet forward in the swing-through gait only if they can bear full weight on both legs.

A,B,D

Which strategy would the nurse use when communicating with a patient with a bilateral hearing impairment? Select all that apply. One, some, or all responses may be correct.

A. Speak loudly toward the patient's better ear.

B. Avoid sitting at the same level as the patient.

C. Avoid eating or chewing while speaking.

D. Use a normal tone of voice and normal inflections of speech.

E. Use written information to enhance the spoken word.

Correct Answers: C, D, E

Which occupation places a patient at risk for noise-induced hearing loss?

A. Airport worker

B. Welder

C. Nail technician

D. Professional football player

A

Which approach would the nurse take to best support a patient who is experiencing sensory overload and confusion?

A. Calmly tell the patient, "You are in the hospital. It is Monday, and I am your nurse."

B. Ask family members to reorient the patient when they forget where they are.

C. Turn off the TV and turn off equipment that isn't being used to minimize excess noise.

D. Prompt the patient to discuss their daily routines.

C

Match the components of PICO using the question “In older adults, does the use of a phone tracking app compared with use of a standard exercise log over a 6-month period affect weekly exercise minutes?”

_____ (P) Patient/population

a. Using standard exercise log

_____ (I) Intervention

b. Weekly exercise minutes

_____ (C) Comparison

c. 6 months

_____ (O) Outcome

d. Using phone tracking app

_____ (T) Time

e. Older adults

E, D, A, B, C

Place the steps of the EBP process in the appropriate order.

1. Critically appraise the evidence you gather.

2. Ask the clinical question in PICOT format.

3. Evaluate the outcomes of the practice decision or change.

4. Search for the most relevant and best evidence.

5. Cultivate a spirit of inquiry.

6. Integrate the evidence.

7. Communicate the outcomes of the EBP change.

5, 2, 4, 1, 6, 3, 7

The nurse identifies which of the following as outcomes measurements? Select all that apply.

1. A nurse teaches a patient how to administer an injection and then watches the patient perform a return demonstration.

2. A nurse implements a new pain-management protocol and checks patients’ charts to confirm whether interventions are being provided.

3. A nursing unit adopts a set of strategies for reducing pressure injuries, and the unit practice committee (UPC) members use direct observation of the skin to measure the incidence of pressure injuries.

4. A nursing unit implements a new fall prevention protocol and checks the monthly performance data for the incidence of falls on the unit.

5. A nursing unit implements a patient rounding program, and the charge nurse watches the assistive personnel to see whether hourly rounding is being performed on patients.

1, 3, 4

Nurses in a community clinic are conducting an EBP project focused on improving the outcomes of children with asthma. The PICO question asked by the nurses is, “In school-age children, does the use of an electronic gaming education module versus an educational book affect the use of inhalers?” In the question, what is the “O”?

1. School-age children

2. Educational book

3. Use of inhalers

4. Electronic gaming education

3

A nurse researcher is explaining a research study to a patient. The patient is interested in participating in the research study. The nurse researcher reviews the informed consent with the patient. The patient asks the nurse why they must sign the consent to participate in the study. What is the nurse’s best response(s) to the patient’s question? Select all that apply.

1. “The informed consent (IC) provides you with complete information on the research study.”

2. “By reviewing the consent with you, I can make sure that you understand the study and what it means for you to participate.”

3. “The informed consent provides details on the limitations of the study.”

4. “The informed consent provides your voluntary agreement to participate in the research study.”

5. “The informed consent explains how the data collected from you will be kept confidential during and after the study.”

1, 2, 4, 5

A nurse working on a medical patient care unit states, “I am having trouble sleeping, and I eat nonstop when I get home. All I can think of when I get to work is how I can’t wait for my shift to be over. I wish I felt happy again.” What are the best responses from the nurse manager? Select all that apply.

1. “I’m sure this is just a phase you are going through. Hang in there. You’ll feel better soon.”

2. “I know several nurses who feel this way every now and then. Tell me about the patients you have cared for recently. Did you find it difficult to care for them?”

3. “You can take diphenhydramine over the counter to help you sleep at night.”

4. “Describe for me what you do with your time when you are not working.”

5. “The hospital just started a group in which nurses get together to talk about their feelings. Would you like me to e-mail the schedule to you?”

2, 4, 5

A 41-year-old patient has been laid off from a construction job and has many unpaid bills. The patient is going through a divorce from a 15-year marriage and has been praying daily to help get through this difficult time. The patient does not have a primary health care provider because the patient has never really been sick and wasn’t taken to a physician as a child. Which external variables influence the patient’s health practices? Select all that apply.

1. Difficulty paying bills

2. Praying daily

3. Age of the patient (46 years)

4. Stress from the divorce and the loss of a job

5. Family practice of not routinely seeing a health care provider

1, 4, 5

Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity.

1. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school.

2. Eight months after beginning walking, the individual participates with his wife in a local 5K race.

3. The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 pounds.

4. The individual walks 2 to 3 miles, 5 nights a week, with his wife.

5. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan.

3, 1, 5, 4, 2

Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? Select all that apply.

1. Regular participation in a book club

2. Lack of interest in exercise

3. Difficulty falling asleep

4. Lack of desire to go to work

5. Anxiety while working

2, 3, 4, 5

1. A nurse encounters the patient’s wife, who is tearful and worried. Her husband was just transferred from his room to the operating room for a complex cardiovascular surgery. The nurse brings the wife a glass of water and encourages her to talk about her fears. The nurse remains in the room while the patient’s wife talks. Which caring behaviors is the nurse demonstrating? Select all that apply.

1. Touching

2. Listening

3. Knowing

4. Providing presence

5. Spiritual care

2,4

. A nurse needs to use clinical judgment before planning and implementing any touch interventions. What does the nurse need to understand about the use of touch? Select all that apply.

1. Some cultures may have specific restrictions about non–skill-based touch.

2. Touch is a form of nonverbal communication.

3. Touch reduces only physical pain.

4. Touch can successfully influence a patient’s level of comfort.

5. There is never a problem with using touch at any time.

1,2,4

A nurse is caring for a patient recently diagnosed with metastatic liver cancer who just transferred from an intensive care unit following extensive surgery. Because of the complexity of this patient’s care, the family is feeling overwhelmed and expresses concern they do not feel as though they are a part of the care team. Which interventions will most likely demonstrate the nurse’s care for the patient and the family? Select all that apply.

1. Have the family provide the patient’s bath and change the sheets on the patient’s bed.

2. Ask the family what activities (e.g., praying, reading, listening to music) are comforting to the patient.

3. Make all the decisions about the patient’s care without consulting with the patient or the family to reduce their stress.

4. Explore the family’s concerns and fears.

5. Request a social worker consult when the patient and family state they would like to discuss advance directives.

2,4,5

A hospice nurse sits at the bedside of a young male patient in the final stages of cancer. He and his parents made the decision that he would move home, and they would help him in the final stages of his illness. The family participates in his care, but lately the nurse has increased the amount of time spent with the family. Whenever the nurse enters the room or approaches the patient to give care, the nurse touches his shoulder and states, “I am your nurse, and I am here for you.” This is an example of which type of touch?

1. Caring touch

2. Protective touch

3. Task-oriented touch

4. Interpersonal touch

1

Match the following caring behaviors with a nursing action.

___1. Knowing

a. Encouraging a patient or family to use resources and trust previous decisions that have helped resolve issues

___2. Being with

b. Asking a patient to talk about what the loss of a loved one means for the patient and family

___3. Doing for

c. Telling a family that you understand their anger about the side effects of chemotherapy

___4. Maintaining belief

d. Providing an opportunity for a patient’s specific religious practice as the patient would do it

1.b 2.c 3.d 4.a

A nurse is seeing all of the patients in the community health clinic. The nurse identifies which patient(s) as having a health disparity? Select all that apply.

1. A patient who has a homosexual sexual preference

2. A patient who is unable to access primary care services

3. A patient living with chronic schizophrenia

4. A family who relies on a family member for transportation

5. A patient who has a history of hypertension

1,2,3

A 35-year-old female patient has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this patient’s health? Select all that apply.

1. Medicaid insurance

2. Annual screening

3. Mother’s history of breast cancer

4. Lack of transportation

5. Patient’s age

1,4,5

A nurse is conducting a nursing history and physical assessment on a patient. Which findings alert the nurse to assess for health literacy needs? Select all that apply.

1. Patient has difficulty completing a registration form at a medical office

2. Patient asks for written information about a health topic

3. Patient speaks Spanish as a primary language

4. Patient states unfamiliarity with a newly ordered medicine

1,3

A nurse desires to communicate with a young female patient who is from a culture different from the nurse’s. The patient has limited experience with being in a hospital. The nurse has 10 years of experience caring for patients from this culture. The patient was admitted for a serious pregnancy complication. Apply the LEARN model, and match the nurse’s behaviors with each step of the model.

____ 1. L

a. The nurse learned that fathers can visit mothers at any time in the patient’s own country and the United States.

____ 2. E

b. The nurse shares own perception of the woman’s experiences as a patient.

____ 3. A

c. The nurse asks the patient to explain how to maintain bed rest upon returning home.

____ 4. R

d. The nurse actively listens to the patient’s explanations about hospitals in the patient’s country.

____ 5. N

e. The nurse involves the patient in a discussion of the treatment options available for the patient’s condition.

1d 2b 3a 4e 5c

The nurse educator is working with a group of nurses on continuing education. Which statements made by a nurse about the teach-back technique show understanding of the technique? Select all that apply.

1. “After teaching a patient how to use an inhaler, I need to use the teach-back technique to evaluate my patient’s ability to use the inhaler correctly.”

2. “The teach-back technique is an ongoing process of asking patients for feedback.”

3. “Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand.”

4. “Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique.”

5. “When doing my patient teaching, I will use plain language to make the material easier to understand for the patient.”

1, 2, 3, 4, 5

A nurse is completing an assessment on a 27-year-old female patient. Which questions best assess the psychosocial aspects of this young woman’s health? Select all that apply.

1. Do you feel safe in your home and at work?

2. How many fruits and vegetables do you typically eat every day?

3. Describe your relationship with your family.

4. Have you had the vaccine to prevent HPV?

5. What are your long-term career goals?

1,3,5

When assessing the health-related knowledge base of both a middle-age patient with a chronic illness and the family, the assessment should include which of the following? Select all that apply.

1. Medical course of the illness

2. Prognosis for the patient

3. Coping mechanisms of the patient and family

4. Socioeconomic status

5. Need for community and social services

1,2,3,5

You are caring for a young female patient who is currently homeless. You believe she is experiencing IPV. Your assessment of the patient reveals several socioeconomic factors. Which ones are linked to IPV? Select all that apply.

1. History of smoking marijuana

2. Income below poverty level

3. Low self-esteem

4. High school education

5. Unemployment

1,2,3,5

A 48-year-old patient visiting the primary health clinic presents with fatigue and recent weight loss. It is the patient’s first visit to the clinic in 2 years. The patient has a family history of cancer and heart disease. During assessment, the nurse finds that the patient has two jobs and works about 12 to 14 hours every weekday. The patient drinks three or four alcoholic drinks a day, relies on fast foods or prepared foods at work, sleeps only 4 to 6 hours a day, and exercises infrequently. The patient takes a nonsteroidal antiinflammatory drug (NSAID) daily for knee pain. Which of the following places this patient at risk for development of a chronic illness later in life? Select all that apply.

1. Working 10 to 12 hours a day

2. Eating high-calorie and fatty foods

3. Exercising infrequently

4. Taking a daily analgesic

5. Excessive alcohol consumption

2,3,5

A nurse is completing an assessment on a male patient, age 24. Following the assessment, the nurse notes that his family history is not significant for chronic illnesses, and his physical and laboratory findings are within normal limits. Because of these findings, nursing interventions are directed toward activities related to which of the following? Select all that apply.

1. Instructing him to return in 2 years

2. Instructing him in secondary prevention

3. Instructing him in health promotion activities

4. Instructing him about routine screenings

5. Instructing him about proper vaccinations

3,4,5

A nurse conducted an assessment of a new male patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing:

1. Dementia.

2. Depression.

3. Delirium.

4. Anxiety.

2

A nurse is completing a health history with the daughter of a newly admitted female patient who is confused and agitated. The daughter reports that her mother was diagnosed with Alzheimer disease 1 year ago but became extremely confused last evening and was hallucinating. She was unable to calm her, and her mother thought she was a stranger. On the basis of this history, the nurse suspects that the patient is experiencing:

1. Normal aging.

2. Delirium.

3. Depression.

4. Worsening dementia.

2

A 78-year-old male is going through preoperative screening and preparation for his surgery in 1 week. His wife is with him, and initially they both appear anxious. He will be undergoing a colon resection for colon cancer and will have a permanent colostomy. The nurse knows the patient’s age and developmental status will affect how the assessment is conducted. The nurse wants to provide a database that will be useful to the nurses in the hospital and therefore applies clinical judgment appropriately through which of the following: Select all that apply.

1. While examining the patient, the nurse notes that the decreased bowel sounds, dry mouth, and reduced skin elasticity are physical changes likely related to the cancer.

2. When the patient has difficulty remembering current medications, the nurse asks the wife to supplement information.

3. The nurse anticipates the effect of the colostomy on functioning and asks the patient how he perceives life with a colostomy.

4. While gathering the history of the patient’s illness, the nurse anticipates him having the classic signs of fatigue and unexplained weight loss.

5. Knowing that elderly patients have less interest in sexual intimacy, the nurse does not ask about the impact the patient thinks his surgery will have on sexual function.

2,3,4

A nurse is assessing an older adult female brought to the emergency department following a fall and wrist fracture. The patient lives with her son, is very thin and unkempt, has a stage 3 pressure injury on her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son, who accompanied her to the hospital. What is the nurse’s next step?

1. Call social services to begin nursing center placement.

2. Ask the son to step out of the room so that she can complete her assessment.

3. Call Adult Protective Services because you suspect elder mistreatment.

4. Assess the patient’s cognitive status.

2

. A daughter is beginning to assume caregiver responsibility for her 90-year-old widowed father. Her father has hypertension, coronary artery disease, and type 2 diabetes mellitus. Home health services are set for once a week. During the first visit, the daughter expresses concern about all the medications that her father has been prescribed by different doctors and that he has obtained from different pharmacies. The daughter states that her father cannot really tell her what each medication is for or when he should take them. From this initial information the nurse suspects polypharmacy. What medication assessment data are needed? Select all that apply.

1. Review of all medication prescriptions.

2. Match medication prescriptions with the patient’s medication bottles or unit-dose blister packs.

3. Identify involvement of the caregiver in helping with medication administration.

4. Identify and delete duplicate medications.

5. Obtain a listing of any over-the-counter medications.

1,2,3,5

While beginning a shift, the nurse assesses a patient’s condition following a blood transfusion. The nurse cared for the patient on the previous day as well. The patient wishes to share several issues with the nurse, who takes time to explore each issue. The nurse also assesses the patient and finds no signs or symptoms of a reaction to the blood product. The nurse observed the patient the prior day and sees a change in behavior—a reluctance to get out of bed and ambulate. Which of the following actions will improve the nurse’s ability to make clinical decisions about this patient? Select all that apply.

1. Working the same shift each day

2. Spending time during the patient assessment

3. Knowing the early mobility protocol guidelines

4. Caring for the patient on consecutive days

5. Knowing the pattern of patient behavior about ambulation

2,4,5

A nurse has seen many patients diagnosed with cancer struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of:

1. Creativity

2. Fairness

3. Clinical reasoning

4. Applying ethical criteria

4

The REFLECT model can improve learning after providing patient care. Place the steps of this model in the correct order:

1. Think about your thoughts and actions at the time of a situation.

2. Review the knowledge you gained from the experience.

3. Review the facts of the situation.

4. Set a schedule for completing your plan of action.

5. Consider options for handling a similar situation in the future.

6. Recall any feelings you had at the time of the situation.

7. Create a plan for future situations.

3,1,6,2,5,7,4

Match the concepts for a critical thinker on the left with the application of the term on the right.

Concepts for Critical Thinkers Term Application

___ 1. Truth seeking

___ 2. Open-mindedness

___ 3. Analyticity

___ 4. Systematicity

a. Anticipate how a patient might respond to a treatment.

b. Organize assessment on the basis of patient priorities.

c. Be objective in asking patient questions.

d. Be tolerant of the patient’s views and beliefs.

1c, 2d, 3a, 4b