Test 2 - Foundations Of - Flashcards

question

A nurse is caring for a 19-year-old client who is sexually active and has come to the college health clinic for the first time for a checkup. Which of the following interventions should the nurse perform first to determine the client's need for health promotion and disease prevention? A. Measure the client's vital signs. B. Encourage HIV screening. C. Determine the client's risk factors. D. Instruct the client to use condoms.

answer

C

question

A nurse in a health clinic is caring for a 21-year-old client who reports a sore throat. The client tells the nurse that he has not seen a doctor since high school. Which of the following health screenings should the nurse expect the provider to perform for this client? A. Testicular examination B. Blood glucose C. Fecal occult blood D. Prostate-specific antigen

answer

A

question

A nurse at a provider's office is talking with a 45-year-old client who has no specific family history of cancer or diabetes mellitus about planning her routine screeings. Which of the following client statements indicates that the client understands how to proceed? A. "So I don't need the colon cancer procedure for another 2 or 3 years." B. "For now, I should continue to have a mammogram each year." C. "Because the doctor just did a Pap smear, I'll come back next year for another one." D. "I had my blood glucose test last year, so I won't need it again till next year."

answer

B

question

A nurse is talking with a client who recently attended a cholesterol screening event and a heart-healthy nutrition presentation at a neighborhood center. His total cholesterol result from the screening was 248 mg/dL, so he saw his provider and received a medication prescription to improve his cholesterol level. The client was later hospitalized for severe chest pain, and subsequently enrolled in a cardiac rehabilitation program. Which of the following activities of this client is an example of primary prevention? A. Cholesterol screening B. Nutrition presentation C. Medication therapy D. Cardiac rehabilitation

answer

B

question

A nurse in a clinic is caring for a client who has multiple risk factors for cardiovascular disease. When planning health promotion and disease prevention strategies for this client, which of the following interventions should the nurse include? (Select all that apply.) A. Help the client see the benefits of her actions. B. Identify the client's support systems. C. Suggest and recommend community resources. D. Devise and set goals for the client. E. Teach stress management strategies.

answer

A, B, C, E

question

When a nurse is observing a client drawing up and mixing insulin injections, which of the following best demonstrates that psychomotor learning has taken place? A. The client is able to discuss the appropriate technique. B. The client is able to demonstrate the appropriate technique. C. The client states that he understands. D. The client is able to write the steps on a piece of paper.

answer

B

question

A nurse in a provider's office is collecting data from the mother of a 1-year-old child. The client states that her child is old enough for toilet training. Following an educational session by the nurse, the client now states that her earlier ideas have changed. She is now willing to postpone toilet training until the child is older. Learning has occurred in which of the following domains? A. Cognitive B. Affective C. Psychomotor D. Kinesthetic

answer

B

question

A nurse is providing preoperative teaching for a client who is scheduled for a mastectomy the next day. Which of the following client statements indicates that the client is ready to learn? A. "I don't want my spouse to see my incision." B. "Will you be able to give me pain medicine after the surgery?" C. "Can you tell me about how long the surgery will take?" D. "My roommate listens to everything I say."

answer

C

question

A nurse is preparing an instructional session about managing stress incontinence for an older adult. Which of the following actions should the nurse take first when meeting with the client? A. Encourage the client to participate actively in learning. B. Select instructional materials appropriate for the older adult. C. Identify goals the nurse and the client agree are reasonable. D. Determine what the client knows about stress incontinence.

answer

D

question

A nurse is evaluating how well a client learned the information presented in an instructional session about following a heart-healthy diet. The client states that she understands what to do now. Which of the following actions by the nurse should assist the nurse in evaluating the client's learning? A. Encourage the client to ask questions. B. Ask the client to explain how to select or prepare meals. C. Encourage the client to fill out an evaluation form. D. Ask the client if she has resources for further instruction on this topic.

answer

B

question

A nurse is talking with the parents of a 6-month-old infant about gross motor development. Which of the following gross motor skills are expected findings in the next 3 months? (Select all that apply.) A. Rolls from back to front B. Bears weight on legs C. Walks holding onto furniture D. Sits unsupported E. Sits down from a standing position

answer

A, B, D

question

A nurse is cautioning the mother of an 8-month-old infant about safety. Which of the following statements by the mother indicates an understanding of safety for the infant? A. "My baby loved to play with his crib gym, but I took it away from him." B. "I just bought a soft mattress so my baby will sleep better." C. "My baby really likes sleeping on the fluffy pillow we just got for him." D. "I just bought a child-safety gate that folds like an accordion."

answer

A

question

A nurse is reviewing car-seat safety with parents of a 1-month-old infant. When reviewing car-seat use, which of the following instructions should the nurse include? A. Use a car seat that has a three-point harness system. B. Position the car seat so that the infant is rear-facing. C. Secure the car seat in the front passenger seat of the vehicle. D. Put soft padding in the car seat behind the infant's back and neck.

answer

B

question

The mother of a 7-month-old infant tells the nurse at the pediatric clinic that her baby has been fussy with occasional loose stools since she started feeding him fruits and vegetables. Which of the following responses by the nurse are appropriate? (Select all that apply.) A. "It might be good to add bananas, as they can help with loose stools." B. "Let's make a list of the foods he is eating so we can spot any problems." C. "Did the changes begin after you started one particular food?" D. "Has he been vomiting since he started these new foods?" E. "Most babies react with a little indigestion when you start new foods."

answer

B, C, D

question

A parent brings a 5-month-old infant to the clinic for a well-infant check. The infant weighed 3.2 kg (7 lb) at birth. If the infant has followed the usual pattern of growth for 5 months, how much should the infant weigh? (Round the answer to the nearest tenth.) A. 13.7 lb B. 14.5 lb C. 16.3 lb D. 10.1 lb

answer

B

question

A nurse is giving a presentation about accident prevention to a group of parents of toddlers. Which of the following accident-prevention strategies should the nurse include? (Select all that apply.) A. Keep toxic agents in locked cabinets. B. Keep toilet seats up. C. Turn pot handles toward the back of the stove. D. Place safety gates across stairways. E. Make sure balloons are fully inflated.

answer

A, C, D

question

A nurse is planning diversionary activities for children on an inpatient unit. Which of the following should the nurse incorporate as appropriate play activities for a toddler? (Select all that apply.) A. Building simple models B. Working with clay C. Filling and emptying containers D. Playing with blocks E. Looking at books

answer

C, D, E

question

A nurse is talking with the parents of toddler. Which of the following should the nurse suggest regarding discipline? A. Establish consistent boundaries. B. Place him in a room with the door closed. C. Have him learn by trial and error. D. Use favorite snacks as rewards.

answer

A

question

A mother tells the nurse that her 2-year-old child has temper tantrums. The child says "no" every time the mother tries to help her get dressed. The nurse explains that, developmentally, the toddler is A. trying to increase her independence. B. developing a sense of trust. C. manifesting an anger management problem. D. attempting to finish a project she started.

answer

A

question

A nurse is reviewing nutritional guidelines with the parents of a 2-year-old toddler. Which of the following parents' statements should indicate to the nurse that they understand the feeding guidelines for this age group? A. "I should keep feeding my son whole milk until he is 3 years old." B. "It's okay for me to give my son a cup of apple juice with each meal." C. "I'll give my son about 2 tablespoons of each food at mealtimes." D. "My son loves popcorn, and I know it is better for him than sweets."

answer

C

question

A nurse is talking with the father of a 4-year-old child who states that his daughter goes to bed at 8:30 p.m. and wakes up at about 7:30 a.m., but she often lies in bed talking to herself or gets up a few times before falling asleep 40 min later. At her preschool, the children take a 2-hr afternoon nap. Which of the following recommendations should the nurse make to help improve the child's sleep behavior? A. Offer the child a snack of her favorite treat right before bedtime. B. Allow the child to watch an extra 30 min of TV in the evening. C. Change the child's bedtime to 9 p.m. on days she napped. D. Request that the preschool staff limit her nap time to 1 hr.

answer

C

question

A nurse is planning diversionary activities for children on an inpatient pediatric unit. Which of the following should the nurse incorporate as appropriate play activities for preschoolers? (Select all that apply.) A. Assembling puzzles B. Pulling wheeled toys C. Using musical toys D. Using finger paints E. Coloring with crayons

answer

A, C, E

question

A nurse is caring for a 5-year-old client whose parents report that she fears painful procedures, such as injections. Which of the following strategies should the nurse use to try to help ease the child's fear? (Select all that apply.) A. Invite the child to assist with mealtime activities. B. Cluster invasive procedures whenever possible. C. Assign caregivers with whom the child is familiar. D. Have the parents bring in a favorite toy from home. E. Engage the child in pretend play with a toy medical kit.

answer

A, D, E

question

A nurse is reviewing the Centers for Disease Control and Prevention's (CDC's) immunization recommendations with the parents of two preschoolers. Which of the following recommendations should the nurse include in this discussion? (Select all that apply.) A. Haemophilus influenzae type b B. Varicella C. Polio D. Hepatitis A E. Seasonal influenza

answer

B, C, E

question

A nurse is talking with parents of a preschooler who describe several issues that concern them. Which of the following problems the parents verbalized should the nurse identify as the priority for further assessment and intervention? A. "Our son will only eat a few things, like burgers and bananas, and pretty much refuses everything else." B. "Our son has these temper tantrums every time we tell him to do something he doesn't want to do." C. "We think our son truly believes that his toys have personalities and talk to him, especially at night." D. "We feel bad when we see our son trying so hard to button his shirt. We just tell him this is something he'll just have to learn to do."

answer

B

question

A nurse is talking with parents of a school-age child who describe several issues that concern them. Which of the following problems the parents verbalized should the nurse identify as the priority for further assessment and intervention? A. "We just don't understand why our son can't keep up with the other kids in simple activities like running and jumping." B. "Our son keeps trying to find ways around our household rules. He always wants to make deals with us." C. "We think our son is trying too hard to excel in math just to get the top grades in his class." D. "Our son is always afraid the kids in school will laugh at him because he likes to sing and write little poems."

answer

A

question

A nurse is planning diversionary activities for children on an inpatient pediatric unit. Which of the following should the nurse incorporate as appropriate play activities for school-age children? (Select all that apply.) A. Building models B. Playing video games C. Reading books D. Using toy carpentry tools E. Shaping modeling clay

answer

A, B, C

question

A nurse is reviewing nutritional guidelines with the parents of an 11-year-old child. Which of the following parents' statements should indicate to the nurse that they understand the guidelines for school‑age children? A. "She wants to eat as much as we do, but we're afraid she'll soon be overweight." B. "She skips lunch sometimes, but we figure it's okay as long as she has a healthy breakfast and dinner." C. "We limit fast-food restaurant meals to three times a week now." D. "We reward her school achievements with a point system instead of a pizza or ice cream."

answer

D

question

A nurse is talking with the parents of a 10-year-old child who express concern that their son is suddenly becoming secretive, for example, closing the door when he showers, dresses, and does his homework in his room. Which of the following responses by the nurse is appropriate? A. "Perhaps you should try to find out what he is doing behind those closed doors." B. "Suggest that he leave the door ajar for his own safety." C. "At this age, children tend to become more modest and value their privacy." D. "Tell him it's okay to close the door when he is undressed, but he has to do his homework where you can see him."

answer

C

question

A nurse at an elementary school is planning a health promotion and primary prevention class. Which of the following topics are appropriate to include for the parents of school-age children? (Select all that apply.) A. Childhood obesity B. Substance use disorders C. Scoliosis screening D. Front-seat seatbelt use E. Stranger awareness

answer

A, B, C, E

question

A nurse is talking with the father of a 12-year-old boy who is concerned that he hasn't observed any indications that his son is approaching puberty. The nurse should explain that the first sign of sexual maturation in boys is A. the appearance of downy hair on the upper lip. B. hair growth in the axillae. C. enlargement of the testes and the scrotum. D. deepening of the voice.

answer

C

question

A nurse on a pediatric unit is caring for an adolescent who has multiple fractures. Which of the following interventions are appropriate for this client? (Select all that apply.) A. Suggest that his parents room in with him. B. Provide a television and DVDs for him to watch. C. Limit visitors to immediate family. D. Devise a regular schedule for inpatient routines. E. Allow him to perform his own morning care.

answer

B, E

question

A nurse is talking with an adolescent who describes having difficulty dealing with several issues. Which of the following problems the client verbalized should the nurse identify as the priority for further assessment and intervention? A. "I kind of like this girl in my class. She doesn't like me back, though, not that way." B. "I like hanging out with the guys in the science club, but the jocks pick on them." C. "I just don't seem to be any good at anything. I can't play any sports at all." D. "My dad wants me to be a lawyer like him, but I don't want to learn all that stuff."

answer

C

question

A nurse is reviewing the Centers for Disease Control and Prevention's (CDC's) immunization recommendations with the parents of an adolescent. Which of the following recommendations should the nurse include in this discussion? (Select all that apply.) A. Rotavirus B. Varicella C. Herpes zoster D. Human papilloma virus E. Seasonal influenza

answer

B, D, E

question

A nurse is preparing a wellness presentation for families at a community center. When discussing health screenings for adolescents, which of the following information about scoliosis should the nurse include? (Select all that apply.) A. Scoliosis is more common among girls than it is among boys. B. Loss of height is often the first sign of scoliosis. C. Scoliosis screening is essential during the adolescent growth spurt. D. Slouching is a common cause of scoliosis, especially in adolescents. E. Scoliosis is a forward curvature of the spine.

answer

A, C

question

A nurse is teaching a young adult client about health promotion and illness prevention. Which of the following statements by the client indicates an understanding of the teaching? A. "I already had my immunizations as a child, so I'm protected in that area." B. "It is important to schedule routine health care visits even if I am feeling well." C. "If I am having any discomfort, I'll just go to an urgent care center." D. "If I am feeling stressed, I will remind myself that this is something I should expect."

answer

B

question

A nursing instructor is explaining the various stages of the lifespan to a group of nursing students. The nurse should offer which of the following behaviors by a young adult as an example of appropriate psychosocial development? A. Becoming actively involved in providing guidance to the next generation B. Adjusting to major changes in roles and relationships due to losses C. Devoting a great deal of time to establishing an occupation D. Finding oneself "sandwiched" in between and being responsible for two generations

answer

C

question

A nurse is counseling a young adult who describes having difficulty dealing with several issues. Which of the following problems the client verbalized should the nurse identify as the priority for further assessment and intervention? A. "I have my own apartment now, but it's not easy living away from my parents." B. "It's been so stressful for me to even think about having my own family." C. "I don't even know who I am yet, and now I'm supposed to know what to do." D. "My girlfriend is pregnant, and I don't think I have what it takes to be a good father."

answer

C

question

A nurse is reviewing safety precautions with a group of young adults at a community health fair. Which of the following recommendations should the nurse include specifically for this age group? (Select all that apply.) A. Install bath rails and grab bars in bathrooms. B. Wear a helmet while skiing. C. Install a carbon monoxide detector. D. Secure firearms in a safe location. E. Remove throw rugs from the home.

answer

B, C, D

question

A nurse is reviewing the Centers for Disease Control and Prevention's (CDC's) immunization recommendations with a young adult client. Which of the following recommendations should the nurse include in this discussion? (Select all that apply.) A. Human papillomavirus B. Measles, mumps, rubella C. Varicella D. Haemophilus influenzae type b E. Polio

answer

A, B, C

question

A nursing instructor is explaining the various stages of the lifespan to a group of nursing students. The nurse should offer which of the following behaviors by a young adult as an example of accomplishing Erikson's tasks for psychosocial development during middle adulthood? A. The client evaluates his behavior after a social interaction. B. The client states he is learning to trust others. C. The client wishes to find meaningful friendships. D. The client expresses concerns about the next generation.

answer

D

question

A nurse is collecting data to evaluate a middle adult's psychosocial development. The nurse should expect middle adults to demonstrate which of the following capabilities? (Select all that apply.) A. Develop an acceptance of diminished strength and increased dependence on others. B. Feel frustrated that time is too short for attempting to start another life. C. Welcome opportunities to be creative and productive. D. Commit to finding friendship and companionship. E. Become involved with community issues and activities.

answer

C, E

question

A nurse is collecting history and physical examination data from a middle adult. The nurse should expect to find decreases in which of the following physiologic functions? (Select all that apply.) A. Metabolism B. Ability to hear low-pitched sounds C. Gastric secretion D. Far vision E. Glomerular filtration

answer

A, C, E

question

A nurse is reviewing the Centers for Disease Control and Prevention's (CDC's) immunization recommendations with a middle adult client. Which of the following recommendations should the nurse include in this discussion? (Select all that apply.) A. Haemophilus influenzae type b B. Varicella C. Herpes zoster D. Human papilloma virus E. Seasonal influenza

answer

B, C, E

question

A nurse is counseling a middle adult who describes having difficulty dealing with several issues. Which of the following problems the client verbalized should the nurse identify as the priority for further assessment and intervention? A. "I am struggling to accept that my parents are aging and need so much help." B. "It's been so stressful for me to think about having intimate relationships." C. "I know I should volunteer my time for a good cause, but maybe I'm just selfish." D. "I love my grandchildren, but my son expects me to relive my parenting days."

answer

B

question

A nurse is counseling an older adult who describes having difficulty dealing with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority for further assessment and intervention? A. "I spent my whole life dreaming about retirement, and now I wish I had my job back." B. "It's been so stressful for me to have to depend on my son to help around the house." C. "I just heard my friend Al died. That's the third one in 3 months." D. "I'm struggling with helping out in my community. I just don't know what I can do."

answer

D

question

A nurse is admitting an older adult client who has lost 4.5 kg (9.9 lb) since his last admission 6 months ago. Which of the following questions should the nurse ask to investigate the source of his weight loss? (Select all that apply.) A. "Do you eat alone or with someone?" B. "Do you watch television while eating your meals?" C. "Have you started any new medications in the past 6 months?" D. "What foods have you eaten within the past 24 hours?" E. "Are you on a fixed income?"

answer

A, C, D, E

question

A nurse is planning a presentation to a group of older adults at a senior community center about the essential screening tests and preventive procedures during this stage of life. Which of the following should the nurse include? (Select all that apply.) A. Human papilloma virus (HPV) immunization B. Pneumococcal immunization C. Eye examination D. Mental health screening E. Dual-energy x-ray absorptiometry (DEXA) scanning

answer

B, C, D, E

question

A nurse is talking with an older adult client about improving her nutritional status. Which of the following interventions should the nurse recommend? (Select all that apply.) A. Increase iron intake to prevent anemia. B. Decrease fluid intake to prevent urinary incontinence. C. Increase calcium intake to prevent osteoporosis. D. Limit sodium intake to prevent edema. E. Increase fiber intake to prevent constipation.

answer

C, D, E

question

A nurse is collecting data from an older adult client as part of a comprehensive physical examination. Which of the following findings should the nurse expect as changes associated with aging? (Select all that apply.) A. Skin thickening B. Decreased height C. Increased saliva production D. Nail thickening E. Decreased bladder capacity

answer

B, D, E

question

A nurse is caring for an 82-year-old client in the emergency department who has an oral body temperature of 38.3° C (101° F), a pulse rate of 114/min, and a respiratory rate of 22/min. He is restless and his skin is warm. Which of the following are appropriate nursing interventions for this client? (Select all that apply.) A. Obtain culture specimens before initiating antimicrobials. B. Restrict the client's oral fluid intake. C. Encourage the client to limit activity and rest. D. Allow the client to shiver to dispel excess heat. E. Assist the client with oral hygiene frequently.

answer

A, C, E

question

A nurse is instructing an assistive personnel (AP) in caring for a client who has a low platelet count as a result of chemotherapy. Which of the following is the nurse's priority instruction for measuring vital signs for this client? A. "Do not measure the client's temperature rectally." B. "Count the client's radial pulse for 30 seconds and multiply it by 2." C. "Do not let the client know you are counting her respirations." D. "Let the client rest for 5 minutes before you measure her blood pressure."

answer

A

question

A nurse is instructing a group of nursing students in measuring a client's respiratory rate. Which of the following guidelines should the nurse include? (Select all that apply.) A. Place the client in semi-Fowler's position. B. Have the client rest an arm across the abdomen. C. Observe one full respiratory cycle before counting the rate. D. Count the rate for 1 min if it is regular. E. Count and report any sighs the client demonstrates.

answer

A, B, C

question

A nurse who is admitting a client who has a fractured femur obtains a blood pressure (BP) reading of 140/94 mm Hg. The client denies any history of hypertension. Which of the following actions should the nurse take next? A. Request a prescription for an antihypertensive medication. B. Ask the client if she is having pain. C. Request a prescription for an anti-anxiety medication. D. Return in 30 min to recheck the client's BP.

answer

B

question

A nurse is performing an admission assessment on a client. When measuring her vital signs, the nurse finds that her radial pulse rate 68/min and her simultaneous apical pulse rate is 84/min. What is the client's pulse deficit? A. 15/min. B. 16/min. C. 17/min. D. 18/min.

answer

B

question

A nurse in a provider's office is preparing to test a client's cranial nerve function. Which of the following directions should she include when testing cranial nerve V? (Select all that apply.) A. "Close your eyes." B. "Tell me what you can taste." C. "Clench your teeth." D. "Raise your eyebrows." E. "Tell me when you feel a touch."

answer

A, C, E

question

A client asks the nurse what her Snellen eye test results mean. Her visual acuity is 20/30. Which of the following responses is appropriate? A. "Your eyes see at 20 feet what visually unimpaired eyes see at 30 feet." B. "Your right eye can see the chart clearly at 20 feet, and your left eye can see the chart clearly at 30 feet." C. "Your eyes see at 30 ft what visually unimpaired eyes see at 20 ft." D. "Your left eye can see the chart clearly at 20 feet, and your right eye can see the chart clearly at 30 feet."

answer

A

question

A nurse is assessing a client's thyroid gland as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Palpating the thyroid in the lower half of the neck B. Visualizing the thyroid on inspection of the neck C. Hearing a bruit when auscultating the thyroid D. Feeling the thyroid ascend as the client swallows E. Finding symmetric extension of the trachea on both sides of the midline

answer

A, D, E

question

A nurse is assessing an adult client's internal ear canals with an otoscope as part of a head and neck examination. Which of the following actions are appropriate? (Select all that apply.) A. Pull the auricle down and back. B. Insert the speculum slightly down and forward. C. Insert the speculum 2 to 2.5 cm (0.8 to 1 in). D. Make sure the speculum does not touch the ear canal. E. Use the light to visualize the tympanic membrane in a cone shape.

answer

B, D, E

question

A nurse is performing a head and neck examination for an older adult client. Which of the following age-related findings should the nurse expect? (Select all that apply.) A. Reddened gums B. Lowered vocal pitch C. Tooth loss D. Glare intolerance E. Thickened eardrums

answer

C, D, E

question

A nurse in a provider's office is preparing to perform a breast examination for an older adult who is postmenopausal. Which of the following findings should the nurse expect? (Select all that apply.) A. Smaller nipples B. Less adipose tissue C. Nipple discharge D. More pendulous E. Nipple inversion

answer

A, D, E

question

A nurse in a provider's office is preparing to auscultate and percuss a client's thorax as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Rhonchi B. Crackles C. Resonance D. Tactile fremitus E. Bronchovesicular sounds

answer

C, D, E

question

During an abdominal examination, a nurse in a provider's office determines that a client has abdominal distention. The protrusion is at midline, the skin over the area is taut, and the nurse notes no involvement of the flanks. Which of the following possible causes of distention should the nurse suspect? A. Fat B. Fluid C. Flatus D. Hernias

answer

C

question

During a cardiovascular examination, a nurse in a provider's office places the diaphragm of the stethoscope on the left midclavicular line at the fifth intercostal space. Which of the following heart sounds is the nurse attempting to auscultate? (Select all that apply.) A. Ventricular gallop B. Closure of the mitral valve C. Closure of the pulmonic valve D. Closure of the tricuspid valve E. Murmur

answer

B, D

question

A nurse in a provider's office is preparing to auscultate and percuss a client's abdomen as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Tympany B. High-pitched clicks C. Borborygmi D. Friction rubs E. Bruits

answer

A, B

question

A nurse in a provider's office is preparing to assess a client's skin as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. Capillary refill in 2 seconds B. 1+ pitting edema in both feet C. Pale nail beds in both hands D. Thick skin on the soles of the feet E. Numerous light brown macules on the face

answer

A, D, E

question

A nurse's assessment of an older adult client identifies significant tenting of the skin over his forearm. Which of the following can explain this finding? (Select all that apply.) A. Thin, parchment-like skin B. Loss of adipose tissue C. Dehydration D. Diminished skin elasticity E. Excessive dryness and wrinkling

answer

B, C, D

question

A nurse is caring for a client who is postoperative following knee surgery. Which of the following should the nurse examine to assess the client's peripheral vascular system? (Select all that apply.) A. Range of motion B. Skin color C. Edema D. Skin lesions E. Skin temperature

answer

B, C, E

question

A nurse is reviewing the various types of lesions nursing students might encounter when performing integumentary assessments for their clients. Which of the following lesions should the nursing students recognize as vesicles? (Select all that apply.) A. Acne B. Warts C. Psoriasis D. Herpes simplex E. Varicella

answer

D, E

question

A nurse is instructing a group of nursing students in the priorities of care in performing an integumentary assessment for their clients. Which of the following findings should the students recognize as requiring immediate intervention? A. Pallor B. Cyanosis C. Jaundice D. Erythema

answer

B

question

A nurse in a provider's office is preparing to assess a young adult male client's musculoskeletal system as part of a comprehensive physical examination. Which of the following findings should the nurse expect? (Select all that apply.) A. A concave thoracic spine posteriorly B. An exaggerated lumbar curvature C. A concave lumbar spine posteriorly D. An exaggerated thoracic curvature E. Muscles slightly larger on his dominant side

answer

C, E

question

A nurse is evaluating a client's neurosensory system. To evaluate stereognosis, she should ask the client to close his eyes and identify which of the following items? A. A word she whispers 30 cm from his ear B. A number she traces on the palm of his hand C. The vibration of a tuning fork she places on his foot D. A familiar object she places in his hand

answer

D

question

A nurse is assessing a client who reports pain when the nurse evaluates the internal rotation of her right shoulder. Which of the following activities is this problem likely to affect? A. Mopping her floors B. Brushing the back of her hair C. Fastening her bra behind her back D. Reaching into a cabinet above her sink

answer

C

question

A nurse is performing a neurosensory examination for a client. Which of the following tests should the nurse perform to test the client's balance? (Select all that apply.) A. Romberg test B. Heel-to-toe walk C. Snellen test D. Spinal accessory function E. Rosenbaum test

answer

A, B

question

A nurse is collecting data from an older adult client as part of a neurosensory examination. Which of the following findings should the nurse expect as changes associated with aging? (Select all that apply.) A. Slower light touch sensation B. Some vision and hearing decline C. Slower fine finger movement D. Some short-term memory decline E. Slower superficial pain sensation

answer

B, C, D

question

A nurse is caring for a client who states, "I have to check with my wife and see if she thinks I am ready to be discharged." The nurse replies, "How do you feel about going home today?" Which clarifying technique is the nurse displaying to enhance communication between the nurse and the client? A. Pacing B. Reflecting C. Paraphrasing D. Restating

answer

B

question

A nurse is caring for a client who is concerned about being discharged home with a new colostomy because he is an avid swimmer. Which of the following statements made by the nurse indicates use of an effective communication technique? (Select all that apply.) A. "You will do great! You just have to get used it." B. "Why are you worried about going home?" C. "Your daily routines will be different when you get home." D. "Tell me about your support system when you leave the hospital." E. "Let me tell you about a friend of mine with a colostomy who also enjoys swimming."

answer

C, D, E

question

A nurse recognizes that a helping relationship is established with a client if the communication A. is equally reciprocal between the nurse and the client. B. encourages the client to express his thoughts and feelings. C. has no time limits. D. occurs spontaneously throughout the nurse-client relationship.

answer

B

question

A nurse is caring for a school-age child who is seated. In order to facilitate effective communication, the nurse should A. touch the child. B. sit at eye level with the child. C. stand facing the child. D. stand with a relaxed posture.

answer

B

question

Which of the following are behaviors of active listening? (Select all that apply.) A. Maintaining an open posture B. Writing down what the client says so that details are not forgotten C. Establishing and maintaining eye contact D. Nodding in agreement with the client throughout the conversation E. Responding positively when giving feedback

answer

A, C, E

question

A nurse is caring for a client whose partner passed away 4 months ago and who has been recently diagnosed with diabetes mellitus. He is tearful and states, "How could you possibly understand what I am going through?" Which of the following is an appropriate response by the nurse? A. "It takes time to get over the loss of a loved one." B. "You are right; I cannot really understand. Perhaps you'd like to tell me more about what you're feeling." C. "Why don't you try something to take your mind off your troubles, like watching a funny movie." D. "I might not share your exact situation, but I do know what people go through when they deal with a loss."

answer

B

question

A nurse is caring for a client awaiting transport to the surgical suite for a coronary artery bypass graft. Just as the transport team arrives, the nurse takes the client's vital signs and notes an elevation in blood pressure and heart rate. The nurse should recognize this response as which part of the general adaptation syndrome (GAS)? A. Exhaustion stage B. Resistance stage C. Alarm reaction D. Recovery reaction

answer

C

question

A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions for stress, coping, and adherence to the treatment plan would be appropriate at this time? (Select all that apply.) A. Suggest coping skills for the client to utilize in this situation. B. Allow the client to provide input in the treatment plan. C. Assist the client with time management, and address the client's priorities. D. Provide extensive instructions on the client's treatment regimen. E. Encourage the client in the expression of feelings and concerns.

answer

B, C, E

question

A nurse is caring for a client who has left-sided hemiplegia resulting from a cerebrovascular accident. The client works as a carpenter and is now experiencing a situational role change based on physical limitations. The client is the primary wage earner in the family. Which of the following best describes the client's role problem? A. Role conflict B. Role overload C. Role ambiguity D. Role strain

answer

A

question

Which of the following approaches should the nurse use when working with a family using an open structure for coping with crisis? A. Prescribing tasks unilaterally B. Delegating care to one member C. Speaking to the primary client privately D. Convening a family meeting

answer

D

question

A nurse in an ambulatory care clinic is caring for a client who had a mastectomy 6 months ago. The client tells the nurse that she has not had much desire for sexual relations since her surgery, stating, "My body is so different now." Which of the following is an appropriate response by the nurse? A. "Really, you look just fine to me. There's no need to feel undesirable." B. "I'm interested in finding out more about how your body feels to you." C. "Consider an afternoon at a spa. A facial will make you feel more attractive." D. "It's still too soon to expect to feel normal. Give it a little more time."

answer

B

question

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following clients are at high risk for body image disturbances? (Select all that apply.) A. 30-year-old male following laparoscopic appendectomy B. 45-year-old female following mastectomy C. 20-year-old female following left above-the-knee amputation D. 65-year-old male following cardiac catheterization E. 55-year-old male following stroke with right-sided hemiplegia

answer

B, C, E

question

A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation as a result of a motor vehicle crash. Which of the following client statements indicates to the nurse that the client has a distorted body image? A. "I'll be able to function exactly as I did before the accident." B. "I just can't stop crying." C. "I am so mad at that guy who hit us. I wish he lost a leg." D. "I don't even want to look at my leg. You can check the dressing."

answer

D

question

A nurse is caring for a client who is recovering from a myocardial infarction and a cardiac catheterization. The client states, "I am concerned that things might be a little, you know, 'different' with my wife when I get home." Which of the following statements is an appropriate response by the nurse? A. "Sounds like something you should discuss with her when you get home." B. "It sounds like you are concerned about sexual functioning. Let's discuss your concerns." C. "Oh, I wouldn't be too concerned. Things will be fine as soon as we get you home." D. "Just make sure you take your medication as directed, and you should be fine."

answer

B

question

A nurse is teaching a group of clients how to care for their colostomies. Which of the following statements should alert the nurse that one of the clients is having an issue with self-concept? A. "I was having difficulty with attaching the appliance at first, but my wife was able to help." B. "I'll never be able to care for this at home. Can't you just send a nurse to the house?" C. "I met a neighbor who also has a colostomy, and he taught me a few things." D. "It may take me a while to get the hang of this. I have to admit, I am pretty nervous."

answer

B

question

What is the major cause of death in all age groups? A. Disease B. Abuse C. Accidents D. Natural Causes with age

answer

C

question

What type of nursing approach ensures that a care plan will meet the needs of the child and the family? A. An organized, systematic approach. B. A developmental approach. C. A direct, all business approach. D. A laid back, only provide what the family asks for approach.

answer

A

question

What type of nursing approach helps nurses plan and organize care according to the child's developmental stage. A. An organized, systematic approach. B. A developmental approach. C. A direct, all business approach. D. A laid back, only provide what the family asks for approach.

answer

B

question

At what stage of development is a child most vulnerable? A. Pre-embryonic stage = First 14 days B. Embryonic stage, Embryo = Day 15 through week 8 C. Fetal stage, Fetus = End of week 8 until birth D. Infancy = post birth

answer

B

question

What is the number one way to protect a newborns immune system? A. Immunization B. Breast Feeding C. AGBAR D. Hand Washing

answer

D

question

What % of body weight do neonates lose in the first few days of life? A. 5% B. 10% C. 7% D. 3%

answer

B

question

What type of assessment is not done on a neonate at birth? A. Physical assessment. B. Gestational age assessment. C. Familial attachment assessment. D. Psychosocial assessment.

answer

D

question

What is usually palpable on a neonate at birth? A. The sutures and fontanels. B. Femurs C. Internal genitals D. Spleen

answer

A

question

Which is not a normal observable reflex in a neonate? A. Blinking in response to bright lights B. Laughing C. Suckling D. Grasping

answer

B

question

A nurse is performing parent teaching for a neonate in her care. Which of the following demonstrates she understands this developmental period well? A. "I will teach the parents to let their baby cry. They shouldn't be picked up all the time." B. "I will teach the parents that a baby doesn't really communicate their needs until they learn to speak." C. "I will teach parents about the importance of providing sensory stimulation such as talking to their babies and holding them to see their faces. D. "I will teach the parents to feed, change diapers and bath their baby on a set schedule, because that is all they need to take care of them."

answer

C

question

Which of the following are health promotion educational opportunities that nurses are responsible for with parents of neonates? (Select all that apply). A. Screening (hearing, inborn errors of metabolism [IEMs]) B. Car seats (federally approved; properly fitted) C. Crib safety (slats no more than 2.4″ apart; snug-fitting mattress; new standards—NO drop side rails) D. Pet safety (neonates should not be around animals with fur, claws or teeth) E. Sleep (on their backs) F. Avoid smoking around the infant.

answer

A, B, C, E, F

question

What developmental age group exhibits increases in height and weight, development of sight, hearing, fine and gross motor movements, language and memory development, a separation of self from others and purposeful smiling? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

A

question

What developmental age group exhibits growth and development; fine and gross motor movements, memory, language, sense of autonomy & parallel play? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

B

question

What developmental age group has a health risk of injury prevention and child maltreatment with a health promotion of nutrition, immunizations and sleep? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

A

question

What developmental age group has a health risk of poisoning, drowning and motor vehicle accidents with a health promotion of nutrition and toilet training? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

B

question

What developmental age group exhibits slowed but continued growth, continued large and fine motor movement development, Curiosity abounds: "Why?", Understanding is linked to concrete experiences and an increase in social interaction, play? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

C

question

What developmental age group has a health risk of injury prevention with home safety & bicycle helmets with a health promotion of nutrition, sleep and vision? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

C

question

What developmental age group exhibits consistent growth, improved coordination, psychosocial changes: self-concept, peer relationships, sexual identity and stress? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

D

question

What developmental age group has a health risk of accidents, infections with a health promotion of perceptions, health education, health maintenance, safety and nutrition? A. Infant (1 month old to 1 year old) B. Toddler (12 to 36 months) C. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old)

answer

D

question

Which developmental age group exhibits increased rate of growth, sex-specific changes (shoulder and hip width, menarche), distribution of muscle & fat and development of reproductive system, has ability to think rationally, communication skills in situations, search for personal identity, development of ethical system and consideration of future? A. Preschooler (3 to 5 years old) D. School-Aged (6 to 12 years old) C. Adolescents (13 to 20 years old) D. Young Adult (21 to 30 years old)

answer

C

question

Which is not a good communication method with adolescents? A. Avoid discussing sensitive issues or asking questions about sex, drugs, and school opens the channels for further discussion. B. Ask open-ended questions. C. Look for the meaning behind the child's words or actions. D. Be alert to clues to their emotional state. E. Involve other individuals and resources when necessary.

answer

A

question

Which is not a health risk for an adolescent? A. Accidents = Leading cause of death B. Violence and homicide C. Chronic disease D. Suicide E. Substance abuse F. Eating disorders G. STIs H. Pregnancy

answer

C

question

In recent years, young adults between the ages of 18 and 29 have been referred to as part of what? A. Generation X B. Millennial generation C. Sandwich generation D. Generation Y

answer

B

question

This group is faced with working, maybe raising families while caring for aging parents, facing potential problems with employment, dealing with changes in the economy, and dealing with their own developmental needs. A. Middle Adults B. Adolescents C. Older Adults D. Young Adults

answer

D

question

This group ranges from the 30s through the 60s and is the stage where people become aware of changes in reproductive organs and physical abilities. They also deal with potential changes in their goals. They oftentimes reassess life situations. A. Middle Adults B. Adolescents C. Older Adults D. Young Adults

answer

A

question

Young adults are in a stable period of physical development, except for changes related to pregnancy. Which is not something that this age group deals with most often? A. Severe health issues B. Changes in the home and workplace C. Health concerns can revolve around pregnant women and childbearing D. Adapting to parenthood

answer

A

question

Which is not a risk factor for young adults? A. Substance Abuse B. Family history C. Chronic Illness D. Personal hygiene E. Violence F. Unplanned pregnancies G. Sexually transmitted infections (STIs) H. Work-related hazards

answer

C

question

If a young adult suffers an acute or chronic illness what should the nursing intervention relate to? A. Sense of identify, establishment of independence, reorganization of relationships, and launching a chosen career. B. A caring, respectful and non-judgmental encounter. C. Enhance quality of life and maximize functional performance by improving cognition, mood, and behavior. D. Need to help with decisions regarding which type of healthcare services are appropriate for them.

answer

A

question

Which of the following is not a physical change that Middle Adults (mid 30s and lasts through the late 60s) would likely experience? A. Graying of the hair B. Wrinkling of the skin C. Thickening of the waist D. Muscle buildup E. Decreases in hearing and visual acuity

answer

D

question

What are some of the psychosocial changes that the Middle Age group encounter? (Select all that apply). A. Sandwich generation B. Empty nest C. Child birth D. Work place changes

answer

A, B, D

question

Assessment of health promotion needs for the middle adult includes all of the following except? A. Domestic violence B. Adequate rest C. Leisure activities & regular exercise D. Good nutrition E. Reduction or cessation in the use of tobacco or alcohol F. Regular screening examinations.

answer

A

question

When you assess older adults, what should you consider when developing a plan of care? (Select all that apply). A. Their strengths B. Financial ability C. Their weaknesses D. Their abilities

answer

A, C, D

question

Which is not a miss-guided idea that demonstrates ageism with older adults? A. They are all ill, disabled, and unattractive B. They are interested in sex or sexual activities C. They are forgetful, confused, rigid, boring, and unfriendly D. They are unable to learn and understand new information

answer

B

question

Which theory on the Older adults aging process views aging as a result of random cellular damage that occurs over time. Accumulated damage leads to the physical changes that we see as the aging process. A. Disengagement Theory B. Activity Theory C. Continuity or developmental Theory D. Theory of Gerotranscendence E. Stochastic Theory F. Nonstochastic Theory

answer

E

question

Which theory on the Older adults aging process as genetically programmed physiological mechanisms within the body control the aging process. A. Disengagement Theory B. Activity Theory C. Continuity or developmental Theory D. Theory of Gerotranscendence E. Stochastic Theory F. Nonstochastic Theory

answer

F

question

Which theory on the Older adults aging process suggests the aging individual withdraws from roles and engages in more introspective, self-focused activities. A. Disengagement Theory B. Activity Theory C. Continuity or developmental Theory D. Theory of Gerotranscendence E. Stochastic Theory F. Nonstochastic Theory

answer

A

question

Which theory on the Older adults aging process considers the continuation of activities performed during middle age as necessary for successful aging. A. Disengagement Theory B. Activity Theory C. Continuity or developmental Theory D. Theory of Gerotranscendence E. Stochastic Theory F. Nonstochastic Theory

answer

B

question

Which theory on the Older adults aging process states that personality remains the same and behavior becomes more predictable as people age. A. Disengagement Theory B. Activity Theory C. Continuity or developmental Theory D. Theory of Gerotranscendence E. Stochastic Theory F. Nonstochastic Theory

answer

C

question

Which theory on the Older adults aging process proposes that the older adult experiences a shift in perspective with age. The person moves from a materialistic and national view of the world to a more cosmic and transcendent one, causing an increase in overall life satisfaction, although this theory has been criticized as being too simplistic. A. Disengagement Theory B. Activity Theory C. Continuity or developmental Theory D. Theory of Gerotranscendence E. Stochastic Theory F. Nonstochastic Theory

answer

D

question

What techniques should a nurse use when interviewing an older adult? (Select all that apply). A. Sit or stand at eye level, in front of the patient in full view. B. Face computer screen or paperwork while speaking; cover your mouth. Speak fast. C. Provide diffuse, bright, nonglare lighting. D. Encourage the older adult to use his or her familiar assistive devices such as glasses or magnifiers.

answer

A, C, D

question

The classic signs and symptoms of diseases are sometimes absent, blunted, or atypical in older adults. Which of the following is not a change in an older adult that a nurse would want to watch for? A. Changes in mental status B. Increase in activity level C. Dehydration D. Decrease in appetite E. Dizziness and incontinence

answer

B

question

Is a potentially reversible cognitive impairment that often has a physiological cause. Acute confusional state. A. Disorientation B. Delirium C. Dementia D. Depression

answer

B

question

Is characterized by a gradual, progressive, irreversible cerebral dysfunction. It interferes with social and occupational activities and is an umbrella term for many conditions, including Alzheimer's. A. Disorientation B. Delirium C. Dementia D. Depression

answer

C

question

Is the most common, yet most undetected and untreated, impairment in older adulthood. Suicide in older adults accounts for 20% of all suicides. A. Disorientation B. Delirium C. Dementia D. Depression

answer

D

question

Which health promotion skill enables the nurse to perceive and respect the older adult's uniqueness and health care expectations? A. Touch B. Validation therapy C. Body image interventions D. Therapeutic communication E. Reality orientation F. Reminiscence

answer

D

question

Which health promotion skill provides sensory stimulation, induces relaxation, provides physical and emotional comfort, orients the person to reality, shows warmth, and communicates interest? A. Touch B. Validation therapy C. Body image interventions D. Therapeutic communication E. Reality orientation F. Reminiscence

answer

A

question

Which health promotion skill makes an older adult more aware of time, place, and person? A. Touch B. Validation therapy C. Body image interventions D. Therapeutic communication E. Reality orientation F. Reminiscence

answer

E

question

Which health promotion skill is an alternative approach to communication with a confused older adult. Reality orientation insists that the confused older adult agree with your statements of time, place, and person; validation therapy accepts the description of time and place as stated by the confused older adult? A. Touch B. Validation therapy C. Body image interventions D. Therapeutic communication E. Reality orientation F. Reminiscence

answer

B

question

Which health promotion skill uses the recollection of the past to bring meaning and understanding to the present and to resolve current conflicts? A. Touch B. Validation therapy C. Body image interventions D. Therapeutic communication E. Reality orientation F. Reminiscence

answer

F

question

Which health promotion skill influences the older adult's appearance by helping with grooming and hygiene? A. Touch B. Validation therapy C. Body image interventions D. Therapeutic communication E. Reality orientation F. Reminiscence

answer

C

question

Older adults in acute care settings are at greater risk for which of the following adverse events? (Select all that apply). A. Delirium B. Dehydration C. Increased nutrition D. Health care-associated infections E. Urinary incontinence F. Decreased risk in falls

answer

A, B, D, E

question

Which is not an example of patient education topics for a nurse to cover regarding maintenance and promotion of health and illness prevention? A. First aid B. Long term care C. Smoking/alcohol/substance abuse D. Stress management E. Nutrition & exercise F. Health screenings

answer

B

question

Which is not an example of patient education topics for a nurse to cover regarding restoration of health? A. Smoking/alcohol/substance abuse B. Anatomy and physiology of body system C. Medications D. Nutrition E. Diagnostic examinations F. Surgery

answer

A

question

Which is not an example of patient education topics for a nurse to cover regarding coping with impaired functions? A. Home care B. Self-care C. Anatomy and physiology of body system D. Physical, occupational, & speech therapy E. Prevention of complications F. Environmental alterations

answer

C

question

What learning domain is the knowledge the patient needs to acquire. It includes acquisition of knowledge, comprehension or ability to understand, application, analysis, relating ideas in an abstract manner, synthesis, recognizing parts of a whole, and evaluation. A. Cognitive B. Affective C. Psychomotor

answer

A

question

What learning domain deals with expression of feelings and acceptance of attitudes, opinions, or values? A. Cognitive B. Affective C. Psychomotor

answer

B

question

What learning domain deals with skills. Where the patient needs to have the knowledge, physical ability, and attitude to learn the skills.? A. Cognitive B. Affective C. Psychomotor

answer

C

question

A patient newly diagnosed with diabetes needs to learn how to use a glucometer. Use of a glucometer constitutes what learning domain? A. Affective learning. B. Cognitive learning. C. Motivational learning. D. Psychomotor learning.

answer

D

question

Which learning domain is best addressed by discussion (one-on-one or group), lecture, question-and-answer session, role play, discovery, independent project, field experience? A. Affective learning. B. Cognitive learning. C. Motivational learning. D. Psychomotor learning.

answer

B

question

Which learning domain is best addressed by role play, discussion (one-on-one or group)? A. Affective learning. B. Cognitive learning. C. Motivational learning. D. Psychomotor learning.

answer

A

question

Which learning domain is best addressed by demonstration, practice, return demonstration, independent projects, games? A. Affective learning. B. Cognitive learning. C. Motivational learning. D. Psychomotor learning.

answer

D

question

Which of the following does not affect a patients learning style? A. Cultural influence B. Motivation to learn C. Ability to learn D. Learning environment

answer

A

question

Self-efficacy is what? A. Use of theory to enhance motivation and learning. B. A person's perceived ability to successfully complete a task. C. The mental state that allows the learner to focus on and comprehend a learning activity. D. A force that acts on or within a person (e.g., idea, emotion, physical need) to cause the person to behave in a particular way.

answer

B

question

At what stage of grieving is a person ready to learn? A. Anger B. Denial C. Acceptance D. Depression

answer

C

question

The ideal setting helps the patient focus on the learning task. What are some positive factors you want for an environment conducive to learning? (Select all that apply). A. Dim lighting to calm the patient B. Appropriate furniture C. Quiet D. Good ventilation E. Cool temperature to keep everyone alert F. Private

answer

B, C, D, F

question

In the nursing process, assessment for patient teaching includes all of the following considerations except: A. Assess the patient's learning needs. B. Ask questions to identify motivation to learn. C. Determine the patient's physical and cognitive ability to learn. D. Provide patient teaching when & where your schedule allows. E. Assess the readiness and ability of a family caregiver or other learning resource. F. Assess health literacy/learning disabilities.

answer

D

question

Health literacy: the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. Which of the following skills should the nurse consider when preparing to teach their patient? (Select all that apply). A. Reading and mathematics skills B. Motor skills C. Comprehension and decision-making D. Functioning skills with regard to health care.

answer

A, C, D

question

Which of the following would not be a nursing diagnosis that best reflects the patient's learning needs? A. Deficient knowledge (affective, cognitive, psychomotor) B. Ineffective health maintenance C. Impaired home maintenance D. Ineffective family therapeutic regimen management E. Effective self-health management

answer

E

question

During a teaching session, the nurse tells a patient with a recent neck injury that damage to the nerves is comparable to a water hose that has been pinched off. During this teaching session, the nurse is using the process of A. Analogy. B. Discovery. C. Role playing. D. Demonstration.

answer

A

question

Which is not one of the standard measurements that are included in vital signs? A. Temperature B. Weight C. Pulse D. Respiratory rate E. Blood pressure F. Pain and sometimes Oxygen saturation

answer

B

question

What is an acceptable temperature range in an average adult? A. 98.6° F to 100.4° F or 36° C to 38° C A. 96.8° F to 100.4° F or 34° C to 38° C A. 94.6° F to 101.4° F or 32° C to 39° C A. 99° F to 101.4° F or 37° C to 39° C

answer

A

question

Select all the typical sites for measurement of body temperature: (Select all that apply) A. Oral B. Dorsal C. Rectal D. Axillary E. Sympathetic membrane F. Tympanic membrane G. Esophageal H. Pulmonary artery

answer

A, C, D, F, G, H

question

Which of the following is not a factor that effects body temperature? A. Age B. Environment C. Hormonal level D. Family history E. Exercise F. Circadian rhythm

answer

D

question

At what time of day does body temperature reach it's lowest normally? A. Late night B. Early afternoon C. Mid morning D. Early morning

answer

D

question

1.You have delegated vital signs to assistive personnel. The assistant informs you that the patient has just finished a bowl of hot soup. The nurse's most appropriate advice would be to A. Take a rectal temperature. B. Take the oral temperature as planned. C. Advise the patient to drink a glass of cold water. D. Wait 30 minutes and take an oral temperature.

answer

D

question

Which of the following are not appropriate sites to assess a pulse? (Select all that apply). A. Temporal B. Jugular C. Carotid D. Apical E. Brachial F. Radial G. Ulnar H. Femoral I. Popliteal J. Abdominal K. Posterior tibial L. Dorsalis pedis

answer

B, J

question

How should you describe the character of pulse in nursing documentation? (Select all that apply). A. Time B. Rate C. Rhythm D. Flow E. Strength F. Equality

answer

B, C, E, F

question

Lub-dubs per minute, Bradycardia, Tachycardia and Pulse deficit describes what characteristic of the pulse? A. Rate B. Rhythm C. Strength D. Equality

answer

A

question

Dysrhythmia: regularly or irregularly irregular describes what characteristic of the pulse? A. Rate B. Rhythm C. Strength D. Equality

answer

B

question

4+, 3+, 2+ (normal), 1+, 0 describes what characteristic of the pulse? A. Rate B. Rhythm C. Strength D. Equality

answer

C

question

Assessing the radial pulses on both sides of the peripheral vascular system, comparing the characteristics of each describes what characteristic of the pulse? A. Rate B. Rhythm C. Strength D. Equality

answer

D

question

You notice that a teenager has an irregular pulse. The best action you should take includes A. Reading the history and physical. B. Assessing the apical pulse rate for 1 full minute. C. Auscultating for strength and depth of pulse. D. Asking whether the patient feels any palpitations or faintness of breath.

answer

B

question

When assessing respiration, ventilatory movements are described as all of the following except: A. Deep B. Rapid C. Normal D. Shallow.

answer

B

question

What value range is normal and acceptable when accessing SaO2 levels? A. 95% - 100% B. 90% - 100% C. 92% - 100% D. 98% - 100%

answer

A

question

Which of the following is not a factor that could affect respiratory levels? A. Exercise B. Anxiety C. Lack of Sleep D. Pain E. Smoking F. Medications

answer

C

question

A postoperative patient is breathing rapidly. You should immediately A. Call the physician. B. Count the respirations. C. Assess the oxygen saturation. D. Ask the patient if he feels uncomfortable.

answer

C

question

Which of the following are not factors that influence blood pressure? A. Age B. Stress C. Height D. Ethnicity E. Gender F. Medication G. Smoking H. Weight & Activity level

answer

C

question

Modifiable risk factors for hypertension include: (Select all that apply). A. Obesity B. Smoking C. Family history D. Alcohol consumption E. Sodium intake F. Ethnicity

answer

A, B, D, E

question

Which of the following patient conditions is appropriate for electronic blood pressure measurement? A. Irregular heart rate B. Peripheral vascular obstruction Shivering C. Seizures D. Cooperative E. Excessive tremors F. Blood pressure less than 90 mm Hg systolic

answer

D

question

When assessing the blood pressure of a school-aged child, using an adult cuff of normal size will affect the reading and produce a value that is A. Accurate. B. Indistinct. C. Falsely low. D. Falsely high.

answer

D

question

When meeting a patient for the first time, it is important to establish a baseline assessment that will enable a nurse to refer back to A. Physiological outcomes of care. B. The normal range of physical findings. C. A pattern of findings identified when the patient is first assessed. D. Clinical judgments made about a patient's changing health status.

answer

C

question

A patient complains of thirst and headache. The patient appears emaciated. Upon initial examination, you find that the skin does not return to normal shape. This finding is consistent with A. Pallor. B. Edema. C. Erythema. D. Poor skin turgor.

answer

D

question

A patient is admitted with pneumonia. When auscultating the patient's chest, you hear low-pitched, continuous sounds over the bronchi. These sounds are labeled as A. Crackles. B. Rhonchi. C. Wheezes. D. Pleural rub.

answer

B

question

When conducting an abdominal assessment, the first skill a nurse puts to use is A. Auscultation. B. Inspection. C. Palpation. D. Percussion.

answer

B

question

Which of the following is not a component of self-concept? A. Identity B. Body Image C. Role Performance D. Feelings

answer

D

question

You are assigned to care for a patient who has just undergone a mastectomy for a malignant tumor. You would most appropriately classify this self-concept component as A. Identity stressor. B. Sexuality stressor. C. Body image stressor. D. Role performance stressor.

answer

C

question

You are caring for an adolescent patient who has undergone a gastric banding procedure 6 months previously. This adolescent tells you, "There is still a fat person inside of me." This type of statement illustrates a flaw in the self-concept of A. Identity. B. Self-esteem. C. Body image. D. Role performance.

answer

C

question

You are assigned to care for a patient who retired 6 months ago. While providing care, you identify that this patient is struggling emotionally with change. This situation is most likely associated with the self-concept component of A. Identity stressor. B. Sexuality stressor. C. Body image stressor. D. Role performance stressor.

answer

D

question

When assessing, observe for behaviors that suggest an alteration in the patient's self-concept. Which of the below behaviors do not indicate the nurse should be concerned with the patients self-concept. A. Avoidance of eye contact B. Erect posture C. Unkempt appearance D. Overly apologetic E. Hesitant speech F. Happy and cooperative G. Frequent or inappropriate crying

answer

B, F

question

Abstinence, barrier methods, spermicide, rhythm are examples of what type of contraceptive? A. Nonprescription B. Prescriptive

answer

A

question

Hormonal contraception, intrauterine device (IUD), diaphragm, cervical cap, sterilization (tubal ligation or vasectomy) are examples of what type of contraceptive? A. Nonprescription B. Prescriptive

answer

B

question

Primary routes of transmission include contaminated IV needles, anal intercourse, vaginal intercourse, oral-genital sex, and transfusion of blood and blood products. A. Human immunodeficiency virus (HIV) B. Human papillomavirus infection (HPV) C. Chlamydia (bacterial)

answer

A

question

Most common STI in United States; aka genital warts; spread through direct contact with warts, semen, or other fluids A. Human immunodeficiency virus (HIV) B. Human papillomavirus infection (HPV) C. Chlamydia (bacterial)

answer

B

question

Causes infertility, pelvic inflammatory disease (PID), and neonatal complications A. Human immunodeficiency virus (HIV) B. Human papillomavirus infection (HPV) C. Chlamydia (bacterial)

answer

C

question

Which of the following populations have the highest incidence of STI? (Select all that apply.) A. Hispanic women aged 15 to 24 B. African American men aged 15 to 24 C. Caucasian men aged 50 to 58 D. Caucasian women aged 42 to 53

answer

A, B

question

Upon admission, when gathering a patient's sexual history, nurses should A. Focus only on physical factors that affect sexual functioning. B. Discuss sexual concerns only if the patient raises questions or concerns. C. Use emotionally laden terms when discussing sexual concepts. D. Include questions related to sexual function.

answer

D

question

You are a nurse working in the college student health center. You receive a call that an athlete has just fallen and has been injured. You know that according to the general adaptation syndrome, the athlete will be exhibiting A. An increased appetite. B. An increased heart rate. C. A decrease in perspiration. D. A decrease in respiratory rate.

answer

B

question

An immediate physiological response of the whole body to stress; involves several body systems, especially the autonomic nervous and endocrine systems, and includes immunological changes: A. Autoimmune Disorder B. Hypoglycemia C. Cardiovascular Disease D. General Adaptation Syndrome (GAS)

answer

D

question

A patient comes into the emergency department complaining of chest pain. When discussing possible reasons why the chest pain has occurred, the nurse learns that the patient is depressed because of the loss of a job. This type of crisis can be classified as A. Maturational. B. Situational. C. Sociocultural. D. Posttraumatic.

answer

B

question

What is "Assessing"? A. The systematic and continuous collection, validation, analysis, and communication of patient data. B. Information; will reflect how health functioning is enhanced by health promotion or compromised by illness and injury. C. Includes all the pertinent patient information collected by the nurse and other healthcare professionals. D. Identifies the patient's health status, strengths, health problems, health risks, and need for nursing care.

answer

A

question

What is "Data"? A. The systematic and continuous collection, validation, analysis, and communication of patient data. B. Information; will reflect how health functioning is enhanced by health promotion or compromised by illness and injury. C. Includes all the pertinent patient information collected by the nurse and other healthcare professionals. D. Identifies the patient's health status, strengths, health problems, health risks, and need for nursing care.

answer

B

question

What is a Database? A. The systematic and continuous collection, validation, analysis, and communication of patient data. B. Information; will reflect how health functioning is enhanced by health promotion or compromised by illness and injury. C. Includes all the pertinent patient information collected by the nurse and other healthcare professionals. D. Identifies the patient's health status, strengths, health problems, health risks, and need for nursing care.

answer

C

question

Define Nursing history: A. The systematic and continuous collection, validation, analysis, and communication of patient data. B. Information; will reflect how health functioning is enhanced by health promotion or compromised by illness and injury. C. Includes all the pertinent patient information collected by the nurse and other healthcare professionals. D. Identifies the patient's health status, strengths, health problems, health risks, and need for nursing care.

answer

D

question

4 types of nursing assessments are: A. Initial comprehensive B. Objective C. Focused D. Subjective E. Emergency F. Time-lapsed

answer

A, C, E, F

question

Preformed shortly after patient admission to a healthcare agency or service. A. Initial comprehensive Assessment B. Focused Assessment C. Emergency Assessment D. Time-Lapsed Assessment E. Medical Assessment F. Nursing Assessment

answer

A

question

Gathering data about a specific problem that has already been identified. A. Initial comprehensive Assessment B. Focused Assessment C. Emergency Assessment D. Time-Lapsed Assessment E. Medical Assessment F. Nursing Assessment

answer

B

question

Identify life-threatening problems. A. Initial comprehensive Assessment B. Focused Assessment C. Emergency Assessment D. Time-Lapsed Assessment E. Medical Assessment F. Nursing Assessment

answer

C

question

Scheduled to compare a patient's current status to baseline data obtained earlier. A. Initial comprehensive Assessment B. Focused Assessment C. Emergency Assessment D. Time-Lapsed Assessment E. Medical Assessment F. Nursing Assessment

answer

D

question

Target data pointing to pathologic conditions. A. Initial comprehensive Assessment B. Focused Assessment C. Emergency Assessment D. Time-Lapsed Assessment E. Medical Assessment F. Nursing Assessment

answer

E

question

Focus on the patient's response to health problems. A. Initial comprehensive Assessment B. Focused Assessment C. Emergency Assessment D. Time-Lapsed Assessment E. Medical Assessment F. Nursing Assessment

answer

F

question

Observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing them. A. Objective Data B. Subjective Data C. Characteristics of Data D. 2 types of sources of patient data

answer

A

question

Information perceived only by the affected person. A. Objective Data B. Subjective Data C. Characteristics of Data D. 2 types of sources of patient data

answer

B

question

Purposeful, complete, factual and accurate, relevant. A. Objective Data B. Subjective Data C. Characteristics of Data D. 2 types of sources of patient data

answer

C

question

Primary source and indirect data. A. Objective Data B. Subjective Data C. Characteristics of Data D. 2 types of sources of patient data

answer

D

question

What is the primary source of information? A. Lab results B. Indirect Data C. The patient

answer

C

question

Which is not a source of Indirect data? A. Family and significant others B. The patient C. Patient record D. Other healthcare professionals E. Nursing and other healthcare literature

answer

B

question

Which is not a method of data collection? A. Asking the patients family for information B. Observation C. Nursing history D. Physical assessment

answer

A

question

What is a key nursing skill? A. Prioritization B. Organization C. Time Management D. Observation

answer

D

question

What are the 4 phases of a nursing interview? A. Triage B. Preparatory phase C. Introduction D. Working phase E. Verification phase F. Termination

answer

B, C, D, F

question

Reviewing the chart is which phase of the nursing interview process? A. Preparatory phase B. Introduction C. Working Phase D. Intervention E. Termination

answer

A

question

Clarifying roles, Stating name, Stating purpose are parts of which phase of the nursing interview process? A. Preparatory phase B. Introduction C. Working Phase D. Intervention E. Termination

answer

B

question

Gathering of data is part of which phase of the nursing interview process? A. Preparatory phase B. Introduction C. Working Phase D. Intervention E. Termination

answer

C

question

Advising the patient that the interview is over is part of which phase of the nursing interview process? A. Preparatory phase B. Introduction C. Working Phase D. Intervention E. Termination

answer

E

question

Which is not a purpose of the nursing physical assessment? A. Appraisal of health status B. Identification of health problems C. Determination of medications the patient is currently taking. D. Establishment of a database for nursing intervention

answer

C

question

The act of confirming or verifying: A. Justification B. Formulation C. Validation

answer

C

question

What is the purpose of validating data? A. To prevent other healthcare staff from writing incident reports. B. To insure that the insurance companies will pay for the medical treatment. C. To build the patients confidence that we know what we are doing. D. To keep data as free from error, bias, and misinterpretation as possible (invalid information can lead to inappropriate nursing care).

answer

D

question

In an interview with a pregnant patient, the nurse discussed the three risk factors that have been cited as having a possible effect on prenatal development. They are: A. Nutrition, stress, and mother's age. B. Prematurity, stress, and mother's age. C. Nutrition, mother's age, and fetal infections. D. Fetal infections, prematurity, and placenta previa.

answer

A

question

A parent has brought her 6-month-old infant in for a well-child check. Which of her statements indicates a need for further teaching? A. "I can start giving her whole milk at about 12 months." B. "I can continue to breastfeed her for another 6 months." C. "I've started giving her plenty of fruit juice as a way to increase her vitamin intake." D. "I can start giving her solid food now."

answer

C

question

The type of injury a child is most vulnerable to at a specific age is most closely related to which of the following? A. Provision of adult supervision. B. Educational level of the parent. C. Physical health of the child. D. Developmental level of the child.

answer

D

question

Which approach would be best for the nurse to use with a hospitalized toddler? A. Always give several choices. B. Set few limits to allow for open expression. C. Use noninvasive methods when possible. D. Gain cooperation before attempting treatment.

answer

D

question

The nurse is providing information on prevention of sudden infant death syndrome (SIDS) to the mother of a young infant. Which of the following statements indicates that the mother has a good understanding? (Select all that apply.) A. "I won't use a pacifier to help my baby sleep." B. "I'll be sure my baby does not spend any time on her abdomen." C. "I'll place my baby on her back for sleep." D. "I'll be sure to keep my baby's room cold."

answer

C, D

question

In evaluating the gross-motor development of a 5-month-old infant, which of the following would the nurse expect the infant to do? A. Roll from abdomen to back. B. Move from prone to sitting unassisted. C. Sit upright without support. D. Turn completely over.

answer

A

question

Parents are concerned about their toddler's negativism and ask the nurse for guidance. Which is the most appropriate recommendation? A. Provide more attention. B. Reduce opportunities for a "no" answer. C. Be consistent with punishment. D. Provide opportunities for the toddler to make decisions.

answer

B

question

When nurses are communicating with adolescents, they should: A. Be alert to clues to their emotional state. B. Ask closed-ended questions to get straight answers. C. Avoid looking for meaning behind adolescents' words or actions. D. Avoid discussing sensitive issues such as sex and drugs.

answer

A

question

Which of the following statements is most descriptive of the psychosocial development of school-age children? A. Boys and girls play equally with each other. B. Peer influence is not yet an important factor to the child. C. They like to play games with rigid rules. D. Children frequently have "best friends".

answer

D

question

You are caring for a 4-year-old child who is hospitalized for an infection. He tells you that he is sick because he was "bad". Which is the most correct interpretation of his comment? A. Indicative of extreme stress. B. Representative of his cognitive development. C. Suggestive of excessive discipline at home. D. Indicative of his developing sense of inferiority.

answer

B

question

At a well-child examination, the mother comments that her toddler eats little at mealtime, will only sit briefly at the table, and wants snacks all the time. Which of the following should the nurse recommend? A. Provide nutritious snacks. B. Offer rewards for eating at mealtimes. C. Avoid snacks so she is hungry at mealtime. D. Explain to her firmly why eating at mealtime is important.

answer

A

question

An 8-year-old child is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which of the following will most help her adjust to the hospital? A. Explain hospital routines such as meal times to her. B. Use terms such as "honey" and "dear" to show a caring attitude. C. Explain when her parents can visit and why siblings cannot come to see her. D. Since she is young, orient her parents to her room and hospital facility.

answer

A

question

The school nurse is counseling an obese 10-year-old child. What factor would be important to consider when planning an intervention to support the child's health? A. Concentrate on the child only rather than the family since it is the child's responsibility. B. Consider the use of medications to suppress the appetite. C. First plan for weight loss through dieting and then add activity as tolerated. D. Plan food intake to allow for growth.

answer

D

question

You are working in an adolescent health center when a 15-year-old patient shares with you that she thinks she is pregnant and is worried that she may now have a sexually transmitted infection (STI). Her pregnancy test is negative. What is your next priority of care? A. Contact her parents to alert them of her need for birth control. B. Refer her to a primary health care provider to obtain a prescription for birth control. C. Counsel her on safe sex practices. D. Ask her to have her partner come to the clinic for STI testing.

answer

C

question

While working in the high-school clinic, one of the students tells you that she is worried about her friend who has started to refuse to participate in group activities, no longer cares about how she looks at school, and is not going to all of her classes. Your assessment of these symptoms may indicate that : A. She has just broken up with her boyfriend and time will heal all. B. You will need to observe her over time to see if symptoms persist. C. School may be too difficult for her right now. D. She may be at increased risk for suicide.

answer

D

question

The mother of a 2-year-old expresses concern that her son's appetite has diminished and that he seems to prefer milk to other solid foods. Which response by the nurse reflects knowledge of principles of communication and nutrition? A. "Have you considered feeding him when he doesn't seem interested in feeding himself?" B. "Oh, I wouldn't be too worried; children tend to eat when they're hungry. I just wouldn't give him dessert unless he eats his meal." C. "That is not uncommon in toddlers. You might consider increasing his milk to 2 quarts per day to be sure he gets enough nutrients." D. "A toddler's rate of growth normally slows down. It's common to see a toddler's appetite diminish in response to decreased calorie needs."

answer

D

question

To stimulate cognitive and psychosocial development of the toddler, it is important for parents to: A. Set firm and consistent limits. B. Foster sharing of toys with playmates and siblings. C. Provide clarification about what is right and wrong. D. Limit confusion by restricting exploration of the environment.

answer

A

question

Which of the following is true of the development behaviors of school-age children? A. Fears center on the loss of self-control. B. Positive feedback from parents and teachers is crucial to development. C. Formal and informal peer group membership is the key in forming self-esteem. D. A full range of defense mechanisms is used, including rationalization and intellectualization.

answer

A

question

Adolescents have mastered age-appropriate sexuality when they feel comfortable with their sexual: A. Choices. B. Behaviors. C. Relationships. D. All of the above.

answer

D

question

The greatest cause of illness and death in the young adult population is: A. Violence. B. Substance abuse. C. Cardiovascular disease. D. Sexually transmitted disease.

answer

A

question

Which physiological change would be a normal assessment finding in a middle adult? A. Increased breast size. B. Reduced auditory acuity C. Thickening of the waistline. D. Increased anteroposterior diameter of the thorax

answer

C

question

In planning patient education for Mrs. Smith, a 45-year-old woman who had an ovarian cyst removed, which of the following facts is true about the sexuality of middle-age adults? A. Menstruation ceases after menopause. B. Estrogen is produced after menopause. C. With removal of the ovarian cyst, pregnancy cannot occur. D. After reaching climacteric, a man is unable to father a child.

answer

A

question

With the exception of pregnant or lactating women, the young adult has usually completed physical growth by the age of: A. 18 B. 20 C. 25 D. 30

answer

B

question

The nurse is completing an assessment on a male patient, age 24. Following the assessment, the nurse notes that his physical and laboratory findings are within normal limits. Because of these findings, nursing interventions are directed toward activities related to: A. Instructing him to return in 2 years. B. Instructing him in secondary prevention. C. Instruction him in health promotion activities. D. Implementing primary prevention with vaccines.

answer

C

question

When determining the amount of information that a patient needs to make decisions about the prescribed course of therapy, many factors affect the patient's compliance with the regimen, including educational level and socioeconomic factors. Which additional factor affects compliance? A. Gender B. Lifestyle C. Motivation D. Family History

answer

C

question

A patient is laboring with her first baby, which is coming 2 weeks early. Her husband is in the military and might not bet back in time, and both families are unable to be with her during labor. The doctor decides to call in which of the following people employed by the birthing area to be a support person to be present during labor? A. Nurse B. Midwife C. Assistant D. Lay Doula

answer

D

question

A single young adult female interacts with a group of close friends from college and work. They celebrate birthdays and holidays together. In addition, they help one another through many stressors. She views these individuals as: A. Family. B. Siblings. C. Substitute Parents. D. Alternative Family Structure.

answer

A

question

Sharing eating utensils with a person who has a contagious illness increases the risk of illness. This type of health risk arises from: A. Lifestyle. B. Community. C. Family History. D. Personal Hygiene habits.

answer

D

question

A 50-year-old woman has elevated cholesterol profile values that increase her cardiovascular risk factor. One method to control this risk factor is to identify current diet trends and describe dietary changes to reduce the risk. This nursing activity is a form of: A. Referral B. Counseling C. Health Education D. Stress Management Techniques

answer

C

question

A 34-year-old female executive has a job with frequent deadlines. She notes that, when the deadlines appear, she has a tendency to eat high-fat, high-carbohydrate foods. She also explains that she gets frequent headaches and stomach pain during these deadlines. The nurse provides a number of options for the executive, and she chooses yoga. In this scenario yoga is used as a(n): A. Outpatient referral B. Counseling technique C. Health promotion activity D. Stress-management technique

answer

D

question

A 50-year-old male patient is seen in the clinic. He tells the nurse that he has recently lost his job and his wife of 26 years has asked for a divorce. He has a flat affect. Family history reveals that his father committed suicide at the age of 53. The nurse should assess for the following: A. Cardiovascular disease B. Depression C. Sexually transmitted infection D. Iron deficiency anemia

answer

B

question

Middle-age adults frequently find themselves trying to balance responsibilities related to employment, family life, care of children, and care of aging parents. People finding themselves in this situation are frequently referred to as being a part of: A. The sandwich generation B. The millennial generation C. Generation X D. Generation Y

answer

A

question

Intimate partner violence (IPV) is linked to which of the following factors? (Select all that apply.) A. Alcohol abuse B. Pregnancy C. Unemployment D. Drug use

answer

A, B, C, D

question

Sexually transmitted infections (STIs) continue to be a major health problem in young adults. Men ages 20 to 24 years have the highest rate of which STI? A. Chlamydia B. Syphilis C. Gonorrhea D. Herpes Zoster

answer

A

question

Formation of positive health habits may prevent the development of chronic illness later in life. Which of the following are examples of positive health habits? (Select all that apply.) A. Routine screening and diagnostic tests. B. Unprotected sexual activity. C. Regular exercise. D. Excess alcohol consumption.

answer

A, C

question

Chronic illness (e.g., diabetes mellitus, hypertension, rheumatoid arthritis) may affect a person's roles and responsibilities during middle adulthood. When assessing the knowledge base of both the middle-age patient with a chronic illness and his family, the assessment should include which of the following? (Select all that apply.) A. The medical course of the illness. B. The prognosis for the patient. C. Coping mechanisms of the patient and the family. D. The need for community and social services.

answer

A, B, C, D

question

A 45-year-old obese woman tells the nurse that she wants to lose weight. After conducting a thorough assessment, the nurse concludes that which of the following may be contributing factors to the woman's obesity? (Select all that apply.) A. The woman works in an executive position that is very demanding. B. The woman works out at the corporate gym at 5am two mornings a week. C. The woman says that she has little time to prepare meals at home and eats out at least 4 nights a week. D. The woman says that she tries to eat "low cholesterol" foods to help lose weight.

answer

A, C

question

A student nurse is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature was 37.1C (98.8F). The student reports her recent assessment to the registered nurse (RN): The patients temp is 37.2C (99F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend first? A. Tell the student that temporary confusion is normal and simply requires reorientation. B. Tell the student to increase the patient's fluid intake since the urine is concentrated. C. Tell the student that her assessment findings are normal for an older adult. D. Tell the student that he will notify the physician of the findings.

answer

D

question

A patient's family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.) A. The center should be clean, and rooms should look like a hospital room. B. There should be adequate staffing on all shifts. C. Social activities should be available for all residents. D. Three meals should be served daily with a set menu and serving schedule. E. Family involvement in care planning and assisting with physical care is necessary.

answer

B, C, E

question

A nurse has conducted an assessment of a new patient who has come 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 nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: A. Dementia B. Depression C. Delirium D. Disengagement

answer

B

question

A major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis could precipitate: A. Dementia B. Delirium C. Depression D. Stroke

answer

C

question

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult? A. When the sexual partner passes away, the survivor no longer feels sexual. B. A decrease in an older adult's libido occurs. C. Any outward expression of sexuality suggests that the older adult is having a developmental problem. D. All older adults, whether healthy or frail, need to express sexual feelings.

answer

D

question

Older adults experience a change in sexual activity. Which best explains this change? A. The need to touch and be touched is decreased. B. The sexual preferences of older adults are not as diverse. C. Physical changes usually do not affect sexual functioning. D. Frequency and opportunities for sexual activity may decline.

answer

D

question

You see a 76-year-old woman in the outpatient clinic. Her chief complaint is vision. She states she has really noticed glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. You suspect that she may have: A. Presbyopia B. Disengagement C. Cataract(s) D. Depression

answer

C

question

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before discharge. What can you do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.) A. Speak loudly so the patient can hear you. B. Sit facing the patient so he is able to watch your lip movements and facial expressions. C. Present one idea or concept at a time. D. Send a written copy of the instructions home with him and tell him to have the family review them. E. Include the family caregiver in the teaching session.

answer

B, C, E

question

Taste buds atrophy and lose sensitivity, and appetite may decrease. As a result, the older adult is less able to discern: A. Spicy and bland foods. B. Salty, sour, and bitter tastes. C. Hot and cold food temperatures. D. Moist and dry food preparations.

answer

B

question

Kyphosis, a change in the musculoskeletal system, leads to: A. Decreased bone density in the vertebrae and hips. B. Increased risk for pathological stress fractures in the hips. C. Changes in the configuration of the spine that affect the lungs and thorax. D. Calcification of the bony tissues of the long bones such as in the legs and arm.

answer

C

question

A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are your major concerns for this patient? (Select all that apply.) A. The loss of his work role. B. The risk of social isolation. C. A determination if the wife will need to start working. D. How the wife expects household tasks to be divided in the home in retirement. E. The age the patient chose to retire.

answer

A, D

question

During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? (Select all that apply.) A. Taking two medications for hypertension B. Taking a total of 8 different medications during the day. C. Having one physician who reviews all medications. D. Patient's health history E. Involvement of the caregiver in assisting with medication administration.

answer

B, D

question

You are caring for an 80-year-old man who recently lost his wife. He shares with you that he has been drinking more than he ever did in the past and feels hopeless without his wife. He reports that he rarely sees his children and feels isolated and alone. This patient is at risk for: A. Dementia B. Liver Failure C. Dehydration D. Suicide

answer

D

question

You are working with an older adult after an acute hospitalization. Your goal is to help this person be more in touch with time, place, and person. What might you try? A. Reminiscence B. Validation therapy C. Reality orientation D. Body image interventions

answer

C

question

A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable around 130/70. The patient does not exercise regularly and complains of weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.) A. Presence of a chronic disease. B. Impaired vision C. Residence design D. Blood pressure E. Leg weakness F. Exercise history

answer

B, E, F

question

Mr. DeLone states that he is worried about his parents' plans to retire. All of the following would be appropriate responses regarding retirement of older adults except: A. Retirement may affect an individual's physical and psychological functioning. B. Positive adjustment is often related to how much a person planned for the retirement. C. Reactions to retirement are influenced by the importance that has been attached to the work role. D. Retirement for most persons represents a sudden shock that is irreversibly damaging to self-image and self-esteem.

answer

D

question

Ms. Dale states that she does not need the TV turned on because she cannot see very well. Normal visual changes in older adults include all of the following except: A. Double vision B. Sensitivity to glare C. Decreased visual acuity D. Decreased accommodations to darkness

answer

A

question

Nutritional needs of older adults: A. Include increased proteins and carbohydrates. B. Are exactly the same as those of young and middle adults. C. Include increased amounts of vitamin C, A, and calcium. D. Include increased kilocalories to support metabolism and activity.

answer

C

question

Which statement describing delirium is correct? A. Symptoms of delirium are irreversible. B. The onset of delirium is slow and insidious. C. Symptoms of delirium are stable and unchanging. D. Causes include electrolyte imbalances and cerebral anoxia.

answer

D

question

An internal impulse that causes a person to take action is: A. Anxiety B. Motivation C. Adaptation D. Compliance

answer

B

question

Demonstration of the principles of body mechanics used when transferring patients from bed to chair would be classified under which domain of learning? A. Social B. Affective C. Cognitive D. Psychomotor

answer

D

question

Which of the following patients is most ready to begin a patient-teaching session? A. Ms. Hernandez, who is unwilling to accept that her back injury may result in permanent paralysis. B. Mr. Frank, who is newly diagnosed with diabetes, who is complaining that he was awake all night because of his noisy roommate. C. Mrs. Brown, a patient with irritable bowl syndrome, who has just returned from a morning of testing in the gastrointestinal lab. D. Mr. Jones, a patient who had a heart attack 4 days ago and now seems somewhat anxious about how this will affect his future.

answer

D

question

The nurse works with pediatric patients who have diabetes. Which is the youngest age group to which the nurse can effectively teach psychomotor skills such as insulin administration? A. Toddler B. Preschool C. School Age D. Adolescent

answer

C

question

Which of the following is an appropriately stated learning objective for Mr. Ryan, who is newly diagnosed with diabetes? A. Mr. Ryan will understand diabetes. B. Mr. Ryan will be taught self-administration of insulin by 5/2. C. Mr. Ryan will know the signs and symptoms of low blood sugar by 5/5. D. Mr. Ryan will perform blood glucose monitoring with the EZ-Check Monitor by the time of discharge.

answer

D

question

A patient needs to learn to use a walker. Which domain is required for learning this skill? A. Affective domain B. Cognitive domain C. Attentional domain D. Psychomotor domain

answer

D

question

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room. B. When the patient's pain medications are working. C. Just before lunch, when the patient is most awake and alert. D. When the patient is talking about current stressors in his or her life.

answer

B, C

question

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A. Teach the patient's spouse. B. Focus on knowledge the patient will need in a few weeks. C. Provide only the information that the patient needs to go home. D. Convince the patient that learning about her health is necessary.

answer

C

question

The school nurse is about to teach a freshmen-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A. Provide information using a lecture. B. Use simple words to promote understanding. C. Develop topics for discussion that require problem solving. D. Complete an extensive literature search focusing on eating disorders.

answer

C

question

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self-examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

answer

C

question

A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation? A. Telling approach B. Selling approach C. Entrusting approach D. Participating approach

answer

A

question

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A. Role Play B. Discovery C. An Analogy D. A Demonstration

answer

A

question

An older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: A. Speaks loudly B. Presents the information once. C. Expects the patient to understand the information quickly. D. Allows the patient time to express himself or herself and ask questions.

answer

D

question

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin. B. Expressing the importance of learning the skill correctly. C. Being able to see and understand the markings on the syringe. D. Having the dexterity needed to prepare and inject the medication.

answer

B

question

A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? A. Simulation B. Demonstration C. Group instruction D. One-on-One discussion

answer

B

question

When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A. Telling B. Analogy C. Demonstration D. Simulation

answer

B

question

A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A. How to use an inhaler during an asthma attack. B. The need to avoid people who smoke to prevent asthma attacks. C. Where to purchase a medical alert bracelet that says she has asthma. D. The importance of maintaining a healthy diet and exercising regularly.

answer

A

question

A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A. Simulation B. Restoring health C. Coping with impaired function D. Health promotion and illness prevention

answer

D

question

A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A. A teaching plan B. A learning objective C. Reinforcement of content. D. Enhancing the children's self-efficacy.

answer

B

question

A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A. Cognitive B. Affective C. Adaptation D. Psychomotor

answer

A

question

A constant body temperature continuously above 38C (104F) that has little fluctuation: A. Sustained B. Intermittent C. Remittent D. Relapsing

answer

A

question

Fever spikes interspersed with usual temperature levels (temperature returns to acceptable value at least once in 24 hours.): A. Sustained B. Intermittent C. Remittent D. Relapsing

answer

B

question

Fever spikes and falls without a return to normal temperature levels: A. Sustained B. Intermittent C. Remittent D. Relapsing

answer

C

question

Periods of febrile episodes and periods with acceptable temperature values (Febrile episodes and periods of normothermia are often longer than 24 hours.): A. Sustained B. Intermittent C. Remittent D. Relapsing

answer

D

question

The formula to covert Celsius to Fahrenheit is: A. C=F-(32X5/9) B. C=(F-32) x 5/9 C. C= (9/5 X F) + 32 D. C=32-(Fx9/5)

answer

B

question

The formula to convert Fahrenheit to Celsius is: A. F=C-(32X5/9) B. F=(C-32) x 5/9 C. F= (9/5 X C) + 32 D. F=32-(Cx9/5)

answer

C

question

Heatstroke is defined as the body temperature of what or higher? A. 38C/100.4F B. 36C/96.8F C. 40C/104F D. 45C/113F

answer

C

question

Which of the following are not signs/symptoms of heatstroke? (Select all that apply) A. Giddiness B. Confusion C. Sneezing D. Delirium E. Excessive Thirst F. Nausea G. Muscle Cramps H. Visual disturbances I. Hiccups J. Incontinence

answer

C, I

question

What is the most important sign/symtom of heatstroke? A. Excessive Thirst B. Hot, dry skin C. Sweating D. Shivers

answer

B

question

Standard thermometers do not read below what temperature? A. 34.4C/94F B. 35C/95F C. 30C/86F D. 36C/96.8F

answer

B

question

When is a patients temperature usually lowest if at normal levels, with their circadian rhythm? A. Just before dinner B. Between 1-4am C. Around 4pm D. Just after breakfast

answer

B

question

Body temperture, pulse, respiration, blood pressure, and pain are part of what? A. Vital Signs B. Phisological balance C. Circadian Rhythm D. Assessments

answer

A

question

Reflects the balance between the heat production and the heat lost from the body: A. Body Temperature B. Core Temperature C. Surface Temperature D. Heat Balance

answer

A

question

What is the temperature of the deep tissues of the body, such as abdominal & pelvic cavity- remains relatively constant? A. Body Temperature B. Core Temperature C. Surface Temperature D. Heat Balance

answer

B

question

What is the temperature of the skin the subcutaneous tissue & fat-rises and falls with environment? A. Body Temperature B. Core Temperature C. Surface Temperature D. Heat Balance

answer

C

question

What is it called when the amount of heat produced by the body equals the amount of heat lost? A. Body Temperature B. Core Temperature C. Surface Temperature D. Heat Balance

answer

D

question

The rate of energy utilization in the body required to mainain essential activites- factor that affects heat production: A. Basal metabolic rate (BMR) B. Radiation C. Conducton D. Convection E. Evaporation

answer

A

question

The transfer of heat from the surface of one object to surface of another without contact between the two objects mostly in the form of infrared rays: A. Basal metabolic rate (BMR) B. Radiation C. Conducton D. Convection E. Evaporation

answer

B

question

The transfer of heat from one molecule to a molecule of lower temperature: A. Basal metabolic rate (BMR) B. Radiation C. Conducton D. Convection E. Evaporation

answer

C

question

The dispersion of heat by air currents-the use of a fan: A. Basal metabolic rate (BMR) B. Radiation C. Conducton D. Convection E. Evaporation

answer

D

question

What is continuous vaporization of moisture from the respiratory tract mouth & skin? A. Basal metabolic rate (BMR) B. Radiation C. Conducton D. Convection E. Evaporation

answer

E

question

Continuous & unnoticed water loss from evaporation: A. Insensible water loss B. Insensible heat loss C. Pyrexia D. Hyperpyrexia E. Afebrile F. Febrile

answer

A

question

Accompanying heat loss from evaporation: A. Insensible water loss B. Insensible heat loss C. Pyrexia D. Hyperpyrexia E. Afebrile F. Febrile

answer

B

question

A body temperature above the usual range (96.8-100.4) also known as fever, hyperthermia: A. Insensible water loss B. Insensible heat loss C. Pyrexia D. Hyperpyrexia E. Afebrile F. Febrile

answer

C

question

A very high fever above of 105: A. Insensible water loss B. Insensible heat loss C. Pyrexia D. Hyperpyrexia E. Afebrile F. Febrile

answer

D

question

A client with NO fever: A. Insensible water loss B. Insensible heat loss C. Pyrexia D. Hyperpyrexia E. Afebrile F. Febrile

answer

E

question

A client with a fever: A. Insensible water loss B. Insensible heat loss C. Pyrexia D. Hyperpyrexia E. Afebrile F. Febrile

answer

F

question

The body temperature alternates at regular intervals between periods of fever & normal or subnormal temperaures: A. Intermittent Fever B. Remittent Fever C. Constant Fever D. Fever Spike E. Heat exhaustion F. Heatstroke

answer

A

question

Wide range of temperature fluctuations over a 24 hour period all above normal: A. Intermittent Fever B. Remittent Fever C. Constant Fever D. Fever Spike E. Heat exhaustion F. Heatstroke

answer

B

question

A body temperature fluctuates minimally but always remains above normal: A. Intermittent Fever B. Remittent Fever C. Constant Fever D. Fever Spike E. Heat exhaustion F. Heatstroke

answer

C

question

A temperature the rises to fever level rapidly following normal temperature & returns to normal in a few hours: A. Intermittent Fever B. Remittent Fever C. Constant Fever D. Fever Spike E. Heat exhaustion F. Heatstroke

answer

D

question

Elevated temperature due to excessive heat & dehydration: A. Intermittent Fever B. Remittent Fever C. Constant Fever D. Fever Spike E. Heat exhaustion F. Heatstroke

answer

E

question

Warm flushed skin, do not sweat, very high temperature maybe delirious, unconscious: A. Intermittent Fever B. Remittent Fever C. Constant Fever D. Fever Spike E. Heat exhaustion F. Heatstroke

answer

F

question

The core body temperature is below the lower limit of normal: A. Hypothermia B. Hyperthermia C. Fever D. Frost bite

answer

A

question

What is a pulse located away from the heart (ex. foot/wrist)? A. Peripheal Pulse B. Apical Pulse C. Tachycardia D. Bradycardia E. Pulse Rhythm

answer

A

question

What is a central pulse, located it at the apex of the heart--also known as Point of Maximal Impulse (PMI)? A. Peripheal Pulse B. Apical Pulse C. Tachycardia D. Bradycardia E. Pulse Rhythm

answer

B

question

Exessively fast heart rate over 100 beats per miniute: A. Peripheal Pulse B. Apical Pulse C. Tachycardia D. Bradycardia E. Pulse Rhythm

answer

C

question

Heart beat less than 60 beats per minitue: A. Peripheal Pulse B. Apical Pulse C. Tachycardia D. Bradycardia E. Pulse Rhythm

answer

D

question

What is the pattern of the beats and the intervals between the beats? A. Peripheal Pulse B. Apical Pulse C. Tachycardia D. Bradycardia E. Pulse Rhythm

answer

E

question

An irregular heart rhythm: A. Arrhythmia B. Dysrhythmia C. Pulse Deficit D. Apical-Radial Pulse

answer

A

question

A pulse with an irregular rhythm: A. Arrhythmia B. Dysrhythmia C. Pulse Deficit D. Apical-Radial Pulse

answer

B

question

Any discrepancy between the two pulse rates: A. Arrhythmia B. Dysrhythmia C. Pulse Deficit D. Apical-Radial Pulse

answer

C

question

Measurement of the apical & radial pulse simultaneously--any differnece between the two is a pulse deficit- apical may be higher than radial but never the other way around. A. Arrhythmia B. Dysrhythmia C. Pulse Deficit D. Apical-Radial Pulse

answer

D

question

The act of breathing: A. Respiration B. Inhalation / Inspiration C. Exhalation / Expiration D. Ventilation E. Costal (thoracic) Breathing F. Diaphragmatic (abdominal) Breathing

answer

A

question

Refers to the intake of air into the lungs: A. Respiration B. Inhalation / Inspiration C. Exhalation / Expiration D. Ventilation E. Costal (thoracic) Breathing F. Diaphragmatic (abdominal) Breathing

answer

B

question

Refers to the act of breathing out: A. Respiration B. Inhalation / Inspiration C. Exhalation / Expiration D. Ventilation E. Costal (thoracic) Breathing F. Diaphragmatic (abdominal) Breathing

answer

C

question

Used to refer to the movement of air in & out of the lungs: A. Respiration B. Inhalation / Inspiration C. Exhalation / Expiration D. Ventilation E. Costal (thoracic) Breathing F. Diaphragmatic (abdominal) Breathing

answer

D

question

Involves the external intercostal muscles observed by the movement of the chest: A. Respiration B. Inhalation / Inspiration C. Exhalation / Expiration D. Ventilation E. Costal (thoracic) Breathing F. Diaphragmatic (abdominal) Breathing

answer

E

question

Involves the contraction & relaxation of the diaphragm observed by movement of the abdomen: A. Respiration B. Inhalation / Inspiration C. Exhalation / Expiration D. Ventilation E. Costal (thoracic) Breathing F. Diaphragmatic (abdominal) Breathing

answer

F

question

Abnormally slow respirations: A. Bradypnea B. Tachypnea C. Apnea D. Tidal Volume

answer

A

question

Abnormally fast respirations: A. Bradypnea B. Tachypnea C. Apnea D. Tidal Volume

answer

B

question

The absence of breathing: A. Bradypnea B. Tachypnea C. Apnea D. Tidal Volume

answer

C

question

Normal inspiration & expiration of 500mL for an adult, Amount of air that moves in and out of the lungs during a normal breath: A. Bradypnea B. Tachypnea C. Apnea D. Tidal Volume

answer

D

question

Very deep, rapid respiration: A. Hyperventilation B. Hypoventilation C. Repiratory Rhythm D. Respiratory Quality / Character

answer

A

question

Refers to very shallow respiration: A. Hyperventilation B. Hypoventilation C. Repiratory Rhythm D. Respiratory Quality / Character

answer

B

question

Refers to the regularity of the expirations & the inspirations: A. Hyperventilation B. Hypoventilation C. Repiratory Rhythm D. Respiratory Quality / Character

answer

C

question

Refers to those aspects of breathing that are different from normal effortless breathing: A. Hyperventilation B. Hypoventilation C. Repiratory Rhythm D. Respiratory Quality / Character

answer

D

question

Measure of the pressure exerted by the blood as it flows through the arteries: A. Arterial blood Pressure B. Systolic Pressure C. Diastolic Pressure D. Pulse Pressure

answer

A

question

Pressure of the blood as a result of contracion of the ventricles - Height of Blood Wave: A. Arterial blood Pressure B. Systolic Pressure C. Diastolic Pressure D. Pulse Pressure

answer

B

question

Pressure when the ventricles are at rest--Lower pressure: A. Arterial blood Pressure B. Systolic Pressure C. Diastolic Pressure D. Pulse Pressure

answer

C

question

The difference between the diastolic/systolic pressure: A. Arterial blood Pressure B. Systolic Pressure C. Diastolic Pressure D. Pulse Pressure

answer

D

question

Arteries lose their ability to constrict & dilate: A. Arteriosclerosis B. Hematocrit C. Hypertension D. Hypotension E. Orthostatic Hypotension

answer

A

question

The proportion of red blood cells to the total blood volume: A. Arteriosclerosis B. Hematocrit C. Hypertension D. Hypotension E. Orthostatic Hypotension

answer

B

question

Blood pressure that is persistently above normal: A. Arteriosclerosis B. Hematocrit C. Hypertension D. Hypotension E. Orthostatic Hypotension

answer

C

question

What is blood pressure that is below normal called? A. Arteriosclerosis B. Hematocrit C. Hypertension D. Hypotension E. Orthostatic Hypotension

answer

D

question

What is blood pressure that falls when the client sits or stands called? A. Arteriosclerosis B. Hematocrit C. Hypertension D. Hypotension E. Orthostatic Hypotension

answer

E

question

Indicates the pressue of the air within the bladder of a blood pressure cuff: A. Sphygmomanometer B. Korotkoff's Sounds C. Auscultatory Gap

answer

A

question

The five phases of blood pressure sounds: A. Sphygmomanometer B. Korotkoff's Sounds C. Auscultatory Gap

answer

B

question

The temporary disapperance of sounds normally heard over the brachial artery when the sphygmomanometer cuff pressure is high followed by the reapperance of sounds at a lower level. A. Sphygmomanometer B. Korotkoff's Sounds C. Auscultatory Gap

answer

C

question

A noninvasive device that estimates a clients arterial blood oxygen saturation by means of a sensor attached to the clients finger: A. Pulse oximeter B. Oxygen Saturation (SaO2) C. Pulse Volume D. Tidal Volume

answer

A

question

The present of all hemoglobin binding site that are occupied by oxygen: A. Pulse oximeter B. Oxygen Saturation (SaO2) C. Pulse Volume D. Tidal Volume

answer

B

question

The force of blood with each beat: A. Pulse oximeter B. Oxygen Saturation (SaO2) C. Pulse Volume D. Tidal Volume

answer

C

question

A body temperature above the usual range: A. Hypothermia B. Hyperthermia C. Fever D. Frost bite

answer

B

question

Continuous and unnoticed water loss through the respiratory tract and from the mucosa of mouth and skin: A. Evaporization B. Absorbtion C. Vaporization D. Diffusion

answer

A

question

The normal volume of air taken in with respiration: A. Pulse oximeter B. Oxygen Saturation (SaO2) C. Pulse Volume D. Tidal Volume

answer

D

question

Bradycardia is defined as heart rate of: A. Less than 100 bpm B. Less than 50 bpm C. Less than 75 bpm D. Less than 60 bpm

answer

D

question

A medication that reduces fever such as acetaminophen: A. Antipyretics B. Pyretics C. Anticoagulants D. Diaretics

answer

A

question

Normal body temperature range for adults: A. 35C (95F) - 37C (98.6F) B. 36C (96.8F) - 38C (100.4F) C. 37C ( 98.6F) - 39C (102.2F)

answer

B

question

Normal Pulse rate for adults: A. 50 - 70 beats/min. B. 60 - 80 beats/min. C. 70 - 90 beats/min. D. 60 - 100 beats/min.

answer

D

question

Normal Respirations per minute for an adult are: A. 5 - 10 B. 10 - 15 C. 12 - 20 D. 15 - 25

answer

C

question

Normal Blood Pressure for an average adult is: A. <120/<80 mm Hg B. <100/130/>100 mm Hg

answer

A

question

Tachycardia is defined as a heart rate of: A. More than 100 bpm B. More than 75 bpm C. More than 125 bpm D. More than 50 bpm

answer

A

question

Normal Respiration for an average adult is between: A. 5 - 6 breaths/min. B. 12-18 breaths/min. C. 20 - 25 breaths/min. D. 8 - 15 breaths/min.

answer

B

question

Bradypnea is defined as respirations of less than: A. 12 bpm B. 20 bpm C. 8 bpm D. 30 bpm

answer

B

question

Tachypnea is defined as respirations of more than: A. 13 bpm B. 17 bpm C. 20 bpm D. 10 bpm

answer

C

question

Normal Oxygen Saturation (O2) levels are: A. 98% to 100% B. 90% to 100% C. 85% to 100% D. 95% to 100%

answer

D

question

Below what Oxygen Saturation (O2) level is life threatening? A. 70% B. 75% C. 80% D. 85%

answer

A

question

A 52-year-old woman is admitted with dyspnea and discomfort in her left chest with deep breaths. She has smoked for 35 years and recently lost over 10 pounds. Her vital signs on admission are: HR 112, BP 138/82, RR 22, tympanic temperature 36.8C (98.2F), and oxygen saturation 94%. She is receiving oxygen at 2 L via a nasal cannula. Which vital sign reflects a positive outcome of the oxygen therapy? A. Temperature: 37C (98.6F) B. Radial Pulse: 112 C. Respiratory rate: 24 D. Oxygen Saturation: 94% E. Blood Pressure: 134/78

answer

D

question

The licensed practice nurse (LPN) provides you with the change-of-shift vital signs on four of your patients. Which patient do you need to access first? A. 84-year-old man recently admitted with pneumonia, RR 28, SpO2 89%. B. 54-year-old woman admitted after surgery for fractured arm, BP 160/86 mm Hg, HR 72. C. 63-year-old man with venous ulcers from diabetes, temperature 37.3 C (99.1F), HR 84. D. 77-year-old woman with left mastectomy 2 days ago, RR 22, BP 148/62.

answer

A

question

A 56-year-old patient with diabetes admitted for community-acquired pneumonia has a temperature of 38.2 C (100.8F) via the temporal artery. Which additional assessment data are needed in planning interventions for the patient's infection? (Select all that apply.) A. Heart rate B. Presence of diaphoresis C. Smoking history D. Respiratory rate E. Recent bowel movement F. Blood pressure in right arm G. Patient's normal temperature H. Blood pressure in distal extremity

answer

A, B, D, G

question

A 55-year-old widowed patient was in a motor vehicle accident and is admitted to a surgical unit after repair of a fractured left arm and left leg. She also has a laceration on her forehead. An intravenous (IV) line is infusing in the right antecubial fossa and pneumatic compression stockings are on the right lower leg. She is receiving oxygen via a simple face mask. What sites do you instruct the nursing assistant to use for obtaining the patient's blood pressure and temperature? A. Right antecubital and tympanic membrane B. Right popliteal and right axillae C. Left antecubital and oral D. Left popliteal and temporal artery

answer

B

question

A patient has been transferred to your unit from the respiratory intensive care unit, where he has been for the past 2 weeks recovering from pneumonia. He is receiving oxygen via 4 L nasal cannula. His respiratory rate is 26 breaths/min, and his oxygen saturation is 92%. In planning his care, which information is most helpful in determining your priority nursing interventions? A. Activity order B. Medication list C. Baseline vital signs D. Patient's perception of dyspnea

answer

C

question

During a patient's routine annual physical, she tells you that she has noted that her heart feels like it's "racing", usually in the later morning, early afternoon, or just before she goes to bed. Her radial pulse rate is 68 beats/min and regular; her blood pressue is 134/82 mm Hg. What additional information is helpful in evaluating the patient's racing heart? (Select all that apply.) A. Dietary habits B. Medication list C. Exercise regimen D. Age, weight, and height

answer

A, B

question

You observe a nursing student taking a blood pressure (BP) on a patient. The patient's BP range over the past 24 hours is too narrow for patient. Which of the following BP readings made by the student is most likely caused by the incorrect choice of BP cuff? A. 96/40 mm Hg B. 110/66 mm Hg C. 130/70 mm Hg D. 156/82 mm Hg

answer

D

question

As you are obtaining the oxygen saturation on a 19-year-old college student with severe asthma, you note that she has black nail polish on her nails. You remove the polish from one nail, and she asks you why her nail polish had to be removed. Your best reply is: A. Nail polish attracts microorganisms and contaminates the finger sensor. B. Nail polish increases oxygen saturation. C. Nail polish interferes with sensor function. D. Nail polish creates excessive heat in sensor probe.

answer

C

question

A patient has been hospitalized for the past 48 hours with a fever of unknown origin. His medical record indicates tympanic temperatures of 38.7 C (101.6F) (0400), 36.6 C (97.9F) (0800), 36.9 C (98.4F) (1200), 37.6 C (99.3F) (1600), and 38.3 C (100.9F) (2000). How would you describe this pattern of temperature measurements? A. Usual range of circadian rhythm measurements B. Sustained fever pattern C. Intermittent fever pattern D. Resolving fever pattern

answer

C

question

A patient presents in the clinic with dizziness and fatigue. The nursing assistant reports a very slow radial pulse of 44. What is your priority intervention? A. Request that the nursing assistant repeat the pulse check. B. Call for a stat electrogardiogram (ECG) C. Assess the patient's apical pulse and evidence of a pulse deficit. D. Prepare to administer cardiac-stimulating medications.

answer

C

question

Which of the following patients is most at risk for tachycardia? A. A healthy professional tennis player B. A patient admitted with hypothermia C. A patient with a fever of 39.4 C (103F) D. A 90-year-old male taking beta blockers

answer

C

question

Which of the following patients is at most risk for tachypnea? (Select all that apply.) A. Patient just admitted with four rib fractures B. Woman who is 9 months pregnant C. Adult who has consumed alcoholic beverages D. Adolescent awaking from sleep.

answer

A, B

question

The following blood pressures, taken 6 months apart, were recorded from patients screend by the nurse at the assisted living facility. Which patient should be referred to the health care provider for hypertension evaluation? A. 120/80, 118/78, 124/82 B. 128/84, 124/86, 128/88 C. 148/82, 148/78, 134/86 D. 154/78, 118/76, 126/84

answer

C

question

A patient is admitted for dehydration caused by pneumonia and shortness of breath. He has a history of heart disease and cardiac dysrhythmias. The nursing assistant tells you his admitting vital signs. Which measurement should you reassess? (Select all that apply.) A. Right arm BP: 120/80 B. Radial pulse rate: 72 and irregular C. Temporal temperature: 37.4 C (99.3F) D. Respiratory rate: 28 E. Oxygen Saturation: 99%

answer

B, D, E

question

A patient returns to your postoperative unit following surgery for right shoulder rotator cuff repair. The licensed practical nurse (LPN) reports that she had difficulty obtaining the patient's heart rate from his right radial pulse. What is your best response? A. Assess the patient's apical pluse to obtain the heart rate. B. Obtain the heart rate from right and left radial sites. C. Obtain the heart rate using the oximeter probe. D. Perform a complete assessment of all pulses.

answer

D

question

The skin plays a role in temperature regulation by: A. Insulating the body B. Constricting blood vessels C. Sensing external temperature variations D. All of the above.

answer

D

question

The nurse bathes the patient who has a fever with cool water. The nurse does this to increase heat loss by means of: A. Radiation B. Convection C. Conduction D. Condensation

answer

C

question

The nurse is assessing a patient who she suspects has the nursing diagnosis hyperthermia related to vigorous exercise in hot weather. In reviewing the data, the nurse knows that the most important sign of heatstroke is: A. Confusion B. Excess thirst C. Hot/dry skin D. Muscle cramps

answer

C

question

The nurse is auscultating Mrs. McKinnon's blood pressure. The nurse inflates the cuff to 180 mm Hg. At 156 mm Hg, the nurse hears the onset of a tapping sound. At 130 mm Hg, the sound changes to a murmur or swishing. At 100 mm Hg, the sound momentarily becomes sharper, and at 92 mm Hg, it becomes muffled. At 88 mm Hg, the sound disappears. Mrs. McKinnon's blood pressure is: A. 130/88 mm Hg B. 156/88 mm Hg C. 180/92 mm Hg D. 180/130 mm Hg

answer

B

question

Abnormal lung sounds heard with auscultation: A. Adventitious sounds B. Alopecia C. Aphasia D. Apical impulse or point of maximal impulse E. Arcus Senilis

answer

A

question

Partial or complete loss of hair; baldness: A. Adventitious sounds B. Alopecia C. Aphasia D. Apical impulse or point of maximal impulse E. Arcus Senilis

answer

B

question

Abnormal neurological condition in which language function is defective or absent; related to injury to speech center in cerebral cortex, causing receptive or expressive aphasia. A. Adventitious sounds B. Alopecia C. Aphasia D. Apical impulse or point of maximal impulse E. Arcus Senilis

answer

C

question

Location at which the apex (bottom tip) of the heart touches the anterior chest wall; approximately the fourth to fifth intercostal space just medial to the left midclavicular line. A. Adventitious sounds B. Alopecia C. Aphasia D. Apical impulse or point of maximal impulse E. Arcus Senilis

answer

D

question

Opaque ring, gray to white in color, that surrounds the periphery of the cornea. The condition is caused by deposits of fat granules in the cornea. Occurs primarily in older adults. A. Adventitious sounds B. Alopecia C. Aphasia D. Apical impulse or point of maximal impulse E. Arcus Senilis

answer

E

question

Wasted or reduced size or physiological activity of a part of the body caused by disease or other influences. A. Atrophied B. Auscultation C. Borborygmi D. Bruit

answer

A

question

Method of physical examination; listening to the sounds produced by the body, usually with a stethoscope. A. Atrophied B. Auscultation C. Borborygmi D. Bruit

answer

B

question

Audible abdominal sounds produced by hyperactive intestinal peristalsis. A. Atrophied B. Auscultation C. Borborygmi D. Bruit

answer

C

question

Abnormal sound or murmur heard while auscultating an organ, gland, or artery. A. Atrophied B. Auscultation C. Borborygmi D. Bruit

answer

D

question

Yellowish or brownish waxy secretion produced by sweat glands in the external ear. A. Cerumen B. Clubbing C. Conjunctivitis D. Cyanosis

answer

A

question

Bulging of the tissues at the nail base caused by insufficient oxygenation at the periphery, resulting from conditions such as chronic emphysema and congenital heart disease. A. Cerumen B. Clubbing C. Conjunctivitis D. Cyanosis

answer

B

question

Highly contagious eye infection. The crusty drainage that collects on eyelid margins can easily spread from one eye to the other. A. Cerumen B. Clubbing C. Conjunctivitis D. Cyanosis

answer

C

question

Bluish discoloration of the skin and mucous membranes caused by an excess of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. A. Cerumen B. Clubbing C. Conjunctivitis D. Cyanosis

answer

D

question

Swelling: A. Distention B. Dysrhythmia C. Ectropion D. Entropion E. Edema

answer

A

question

Deviation from the normal pattern of the heartbeat. A. Distention B. Dysrhythmia C. Ectropion D. Entropion E. Edema

answer

B

question

Eversion of the eyelid that exposes the conjunctival membrane and part of the eyeball. A. Distention B. Dysrhythmia C. Ectropion D. Entropion E. Edema

answer

C

question

Condition in which the eyelid turns inward toward the eye. A. Distention B. Dysrhythmia C. Ectropion D. Entropion E. Edema

answer

D

question

Abnormal accumulation of fluid in interstitial spaces of tissues. A. Distention B. Dysrhythmia C. Ectropion D. Entropion E. Edema

answer

E

question

Redness or inflammation of the skin or mucous membranes that is a result of dilation and congestion of superficial capillaries; sunburn is an example. A. Erythema B. Excoriation C. Goniometer D. Hypertonicity D. Hypotonicity

answer

A

question

Injury to the surface of the skin caused by abrasion. A. Erythema B. Excoriation C. Goniometer D. Hypertonicity D. Hypotonicity

answer

B

question

Measures the precise degree of motion in a particular joint. Used frequently by physical and occupational therapists. Mainly for patients who have a suspected reduction in joint movement. A. Erythema B. Excoriation C. Goniometer D. Hypertonicity D. Hypotonicity

answer

C

question

Excessive tension of the arterial walls or muscles. A. Erythema B. Excoriation C. Goniometer D. Hypertonicity D. Hypotonicity

answer

D

question

Reduced tension of the arterial walls or muscles. A. Erythema B. Excoriation C. Goniometer D. Hypertonicity E. Hypotonicity

answer

E

question

Hardening of a tissue, particularly the skin, because of edema or inflammation. A. Induration B. Inspection C. Integumentary System D. Jaundice

answer

A

question

Method of physical examination by which the patient is visually systematically examined for appearance, structure, function, and behavior. A. Induration B. Inspection C. Integumentary System D. Jaundice

answer

B

question

Skin, hair, scalp, and nails. A. Induration B. Inspection C. Integumentary System D. Jaundice

answer

C

question

Yellow discoloration of the skin, mucous membranes, and sclera caused by greater-than-normal amounts of bilirubin in the blood. A. Induration B. Inspection C. Integumentary System D. Jaundice

answer

D

question

Exaggeration of the posterior curvature of the thoracic spine. A. Kyphosis B. Lordosis C. Malignancy D. Murmurs

answer

A

question

Increased lumbar curvature. A. Kyphosis B. Lordosis C. Malignancy D. Murmurs

answer

B

question

The state or presence of a malignant tumor; cancer. A. Kyphosis B. Lordosis C. Malignancy D. Murmurs

answer

C

question

Blowing or whooshing sounds created by changes in blood flow through the heart or abnormalities in the valve closure. A. Kyphosis B. Lordosis C. Malignancy D. Murmurs

answer

D

question

An involuntary, rhythmical oscillation of the eyes. A. Nystagmus B. Olfaction C. Orthopnea D. Osteoporosis E. Ototoxic

answer

A

question

The sense of smell. Helps to detect abnormalities that cannot be recognized by any other means. A. Nystagmus B. Olfaction C. Orthopnea D. Osteoporosis E. Ototoxic

answer

B

question

Abnormal condition in which a person must sit or stand to breathe comfortably. A. Nystagmus B. Olfaction C. Orthopnea D. Osteoporosis E. Ototoxic

answer

C

question

Disorder characterized by abnormal rarefaction of bone, occurring most frequently in postmenopausal women, sedentary or immobilized individuals, and patients on long-term steroid therapy. A. Nystagmus B. Olfaction C. Orthopnea D. Osteoporosis E. Ototoxic

answer

D

question

Having a harmful effect on the eighth cranial (auditory) nerve or the organs of hearing and balance. A. Nystagmus B. Olfaction C. Orthopnea D. Osteoporosis E. Ototoxic

answer

E

question

Method of physical examination whereby the fingers or hands of the examiner are applied to the patient's body to feel body parts underlying the skin. A. Palpation B. Percussion C. Peristalsis D. Petechiae E. Pigmentation

answer

A

question

Method of physical examination whereby the location, size, and density of a body part is determined by the tone obtained from the striking of short, sharp taps of the fingers. A. Palpation B. Percussion C. Peristalsis D. Petechiae E. Pigmentation

answer

B

question

Rhythmical contractions of the intestine that propel gastric contents through the length of the gastrointestinal tract. A. Palpation B. Percussion C. Peristalsis D. Petechiae E. Pigmentation

answer

C

question

Tiny purple or red spots that appear on skin as minute hemorrhages within dermal layers. A. Palpation B. Percussion C. Peristalsis D. Petechiae E. Pigmentation

answer

D

question

The coloring of the skin, hair, mucous membranes, and retina of the eye due to deposition of the pigment melanin. A. Palpation B. Percussion C. Peristalsis D. Petechiae E. Pigmentation

answer

E

question

What does PERRLA stand for? (Select all that apply) A. Physical B. Pupils equal C. Redness D. Round E. Residual tearing F. Reactive to light G. Accommodation H. Acclimated to light

answer

B, D, F, G

question

Tumorlike growths. A. Polyps B. Ptosis C. Hemorrhoids D. Vesicles

answer

A

question

Abnormal condition of one or both upper eyelids in which the eyelid droops; caused by weakness of the levator muscle or paralysis of the third cranial nerve. A. Olfaction B. Ptosis C. Ectropion D. Entropion

answer

B

question

Lateral spinal curvature. A. Scoliosis B. Stenosis C. Striae D. Lordosis

answer

A

question

Abnormal condition characterized by the constriction or narrowing of an opening or passageway in a body structure. A. Scoliosis B. Stenosis C. Striae D. Lordosis

answer

B

question

Streaks or linear scars that result from rapid development of tension in the skin. A. Scoliosis B. Stenosis C. Striae D. Lordosis

answer

C

question

Brief lapse in consciousness caused by transient cerebral hypoxia. A. Syncope B. Thrill C. Turgor D. Ventricular Gallop

answer

A

question

Continuous palpable sensation like the purring of a cat.

answer

B

question

Normal resiliency of the skin caused by the outward pressure of the cells and interstitial fluid. A. Syncope B. Thrill C. Turgor D. Ventricular Gallop

answer

C

question

S3 sound, caused by a premature rush of blood into a ventricle that is stiff or dilated as a result of heart failure and hypertension, which occurs after S2. A. Syncope B. Thrill C. Turgor D. Ventricular Gallop

answer

D

question

Externally palpable vibrations caused by sound waves created by the vocal cords and transmitted through the lung to the chest wall. Can be blocked by mucus accumulation, the collapse of lung tissue, or the presence of one or more lung lesions. A. Tactile fremitus B. Thrill C. Turgor D. Ventricular Gallop

answer

A

question

The nurse prepares to conduct a general survey on an adult patient. Which assessment is performed first while the nurse initiates the nurse-patient relationship? A. Appearance and behavior B. Measurement of vital signs C. Observing specific body systems D. Conducting a detailed health history

answer

A

question

The nurse is teaching a young mother to palpate her 8-year-old child to quickly evaluate if the child has a fever. Which information is important for the nurse to include? A. Place the palm of the hand on the child's back. B. Lightly touch the child's forehead with the fingertips. C. Place the back of your hand against the child's forehead and then on the back of the neck. D. Use the pads of your fingers and press against the child's neck and over the thorax.

answer

C

question

While assessing the adult patient's lungs, the nurse identifies the following assessment findings. Which finding should be reported to the health care provider? A. Respiratory rate: 14 B. Pain reported when palpating posterior lower thorax C. Thorax rising and falling symmetrically for right and left lungs D. Vesicular breath sounds heard with auscultation of peripheral lung fields

answer

B

question

The nurse is teaching a young female patient to practice good skin health. Which information is important for the nurse to include? A. Avoid sunbathing between 3 PM and 7 PM. B. Oral contraceptives and anti-inflammatories make the skin more sensitive to the sun. C. Call the health care provider for the presence of a mole on an arm or leg that appears uniformly brown. D. Wear sunscreen with an SPF of 30 or greater if using a sunlamp or tanning parlor.

answer

B

question

As a nurse prepares to provide morning care and treatments, it is important to question a patient about a latex allergy before which intervention? (Select all that apply.) A. Applying adhesive tape to anchor a nasogastric tube B. Inserting a rubber Foley catheter into the patient's bladder C. Providing oral hygiene using a standard toothbrush and toothpaste D. Giving an injection using plastic syringes with rubber-coated plungers E. Applying a transparent wound dressing

answer

A, B, D

question

The nurse is assessing a patient who returned 3 hours ago from a cardiac catheterization, during which the large catheter was inserted into the patient's femoral artery in the right groin. Which assessment finding would require immediate follow-up? A. Palpation of a femoral pulse with a heart rate of 76 B. Auscultation of a heart murmur over the left thorax C. Identification of mild bruising at the catheter insertion site D. Palpation of a right dorsalis pedis pulse with strength of +1

answer

D

question

The patient reports having a sore throat, coughing, and sneezing. While performing a focused assessment, which finding supports the patient's reported symptoms related to upper respiratory infection? A. Buccal mucosa is moist and dark pink. B. Respiratory rate is 18, rhythm is even. C. Retropharyngeal lymph nodes are enlarged and firm. D. Inspection with a tongue depressor on the posterior tongue causes gagging.

answer

C

question

The nurse is teaching a patient with poor arterial circulation about checking blood flow in the legs. Which information should the nurse include? (Select all that apply.) A. A normal pulse on the top of the foot indicates adequate blood flow to the foot. B. To locate the dorsalis pedis pulse, take the fingers and palpate behind the knee C. When there is poor arterial blood flow, the leg is generally warm to the touch. D. Loss of hair on the lower leg indicates a long-term problem with arterial blood flow.

answer

A, D

question

How should the patient be positioned to best palpate for lumps or tumors during an examination of the right breast? A. Supine with both arms overhead with palms upward B. Sitting with hands clasped just above the umbilicus C. Supine with the right arm abducted and hand under the head and neck D. Lying on the right side, adducting the right arm on the side of the body

answer

C

question

The nurse is planning a staff education conference about abdominal assessment. Which point is important for the nurse to include? A. The aorta can be felt using deep palpation in the upper abdomen near the midline. B. The patient should be sitting to best determine the contour and shape of the abdomen. C. Always wear gloves when palpating the skin on the patient's abdomen. D. Avoid palpating the abdomen if the patient reports any discomfort or feelings of fullness.

answer

A

question

The nurse is teaching a patient how to perform a testicular self-examination. Which statement by the nurse is correct? A. "The testes are normally round and feel smooth and rubbery." B. "The best time to do a testicular self-examination is before your bath or shower." C. "Perform a testicular self-examination weekly to detect signs of testicular cancer." D. "Since you are over 40 years old, you are in the highest risk group for testicular cancer."

answer

A

question

The patient is assessed for range of joint movement. He or she is unable to move the right arm above the shoulder. How should the nurse document this finding? A. Patient was not able to flex arm at shoulder. B. Extension of right arm is limited. C. Patient's abduction of right arm was limited to 100 degrees. D. Internal rotation of right arm is limited to less than 90 degrees.

answer

C

question

The nurse plans to assess the patient's abstract reasoning. Which task should the nurse ask the patient to perform? A. "Tell me where you are." B. "What can you tell me about your illness?" C. "Repeat these numbers back to me: 7...5...8." D. "What does this mean: 'A stitch in time saves nine? ' "

answer

D

question

The nurse teaches a patient about cranial nerves to help explain why the patient's right side of the mouth droops instead of moving up into a smile. What nerve does the nurse explain to the patient? A. VII — Facial B. V — Trigeminal C. XII — Hypoglossal D. XI— Spinal accessory

answer

A

question

The nurse is planning to teach the student nurse how to assess the hydration status of an older adult. Which techniques are appropriate for this situation? (Select all that apply.) A. Inspect the lips and mucous membranes to determine if they are moist. B. Pinch the skin on the back of the hand to see if the skin tents. C. Check the patient's pulse and blood pressure. D. Weigh the patient daily.

answer

A, C, D

question

The component that should receive the highest priority before a physical examination is: A. Preparation of the equipment B. Preparation of the environment C. Physical preparation of the patient D. Psychological preparation of the patient

answer

D

question

The nurse assesses the skin turgor of the patient by: A. Inspecting the buccal mucosa with a penlight B. Palpating the skin with the dorsum of the hand C. Grasping a fold of skin on the back of the forearm and releasing D. Pressing the skin for 5 seconds, releasing, and noting each centimeter of depth

answer

C

question

While examining Mr. Parker, the nurse notes a circumscribed elevation of skin filled with serous fluid on his upper lip. The lesion is 0.4mc in diameter. This type of lesion is called a: A. Macule B. Nodule C. Vesicle D. Pustule

answer

C

question

When assessing the patient's thorax, the nurse should: A. Complete the left side and then the right side B. Compare symmetrical areas from side to side C. Begin with the posterior lobes on the right side D. Change the position of the stethoscope between inspiration and expiration.

answer

B

question

In a patient with pneumonia, the nurse hears high-pitched, continuous musical sounds over the bronchi on expiration. These sounds are called: A. Rhonchi B. Crackles C. Wheezes D. Friction rubs

answer

C

question

The second heart sound (S2) occurs when: A. Systole begins B. There is rapid ventricular filling C. The mitral and tricuspid valves close D. The aortic and pulmonic valves close

answer

D

question

Which of the following is not a characteristic of Delirium? A. Fever B. Confusion C. Disorientation D. Restlessness

answer

A

question

Foot / toes downward: A. Plantar Flexion B. Dorsiflexion C. Inversion D. Eversion

answer

A

question

Foot / toes upward: A. Plantar Flexion B. Dorsiflexion C. Inversion D. Eversion

answer

B

question

Turning away from midline: A. Plantar Flexion B. Dorsiflexion C. Inversion D. Eversion

answer

D

question

Turning toward midline: A. Plantar Flexion B. Dorsiflexion C. Inversion D. Eversion

answer

C

question

Moving away from midline: A. Abduction B. Adduction C. Eversion D. Inversion

answer

A

question

Moving toward midline: A. Abduction B. Adduction C. Eversion D. Inversion

answer

B

question

Frontal or ventral surface face down: A. Pronation B. Supination C. Flexion D. Extension E. Hyperextension

answer

A

question

Frontal or ventral surface face up: A. Pronation B. Supination C. Flexion D. Extension E. Hyperextension

answer

B

question

Beyond the normal resting extended position of a limb: A. Pronation B. Supination C. Flexion D. Extension E. Hyperextension

answer

E

question

Increasing angle between two bones: A. Pronation B. Supination C. Flexion D. Extension E. Hyperextension

answer

D

question

Decreasing angle between two bones: A. Pronation B. Supination C. Flexion D. Extension E. Hyperextension

answer

C

question

A blowing sound caused by turbulence in a narrowed section of a blood vessel: A. Bruit B. Atherosclerosis C. Occlusion D. Syncope

answer

A

question

Indicated by a diminished or unequal carotid pulsation: A. Bruit B. Atherosclerosis C. Occlusion D. Syncope

answer

B

question

A blockage of a vessel: A. Bruit B. Atherosclerosis C. Occlusion D. Syncope

answer

C

question

Which of the following is not one of the 12 specific observations of the patient's general appearance and behavior that should be reviewed in a health assessment? A. Gender & Race B. Age C. Culture D. Signs of Distress E. Body Type F. Posture G. Gait H. Body Measurements I. Hygiene & Grooming J. Dress K. Body Odor L. Affect (Feelings) & Mood M. Speech

answer

C

question

Which development stage is particularly crucial for identity development? A. Infancy B. Young Adult C. Adolescence D. Preschool Age

answer

C

question

Which of the following statements about body image is correct? A. Body image refers only to the external appearance of a person's body. B. Physical changes are quickly incorporated into a person's body image. C. Perceptions by other persons have no influence on a person's body image. D. Body image is a combination of a person's actual and perceived (ideal) body.

answer

D

question

Robert, who is 2 years old, is praised for using his potty instead of wetting his pants. This is an example of learning a behavior by: A. Imitation B. Substitution C. Identification D. Reinforcement-extinction

answer

D

question

Following a bilateral mastectomy, a 50-year-old patient refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which of the following is the best response from the nurse? A. "What's the special occasion?" B. "You must be feeling better today." C. "This is the first time I have seen you look this good." D. "I see that you've combed your hair and put on makeup."

answer

D

question

A patient diagnosed with major depressive disorder has a nursing diagnosis of chronic low self-esteem related to negative view of self. Which of the following would be the most appropriate cognitive intervention by the nurse? A. Promote active socialization with other patients B. Role play to increase assertiveness skills C. Focus on identifying strengths and accomplishments D. Encourage journaling of underlying feelings

answer

C

question

Several staff members complain about a patient's constant questions such as "Should I have a cup of coffee or a cup of tea?" and "Should I take a shower now or wait until later?" Which interpretation of the patient's behavior helps the nurses provide optimal care? A. Asking questions is attention-seeking behavior. B. Inability to make decisions reflects a self-concept issue. C. Dependence on staff must be stopped immediately. D. Indecisiveness is aimed at testing how the staff reacts.

answer

B

question

A depressed patient is crying and verbalizes feelings of low self-esteem and self-worth such as "I'm such a failure...I can't do anything right." The best nursing response would be to: A. Remain with the patient until he or she stops crying. B. Tell the patient that is not true and that every person has a purpose in life. C. Review recent behaviors or accomplishments that demonstrate skill ability. D. Reassure the patient that you know how he is feeling and that things will get better.

answer

A

question

An adult woman is recovering from a mastectomy for breast cancer and is frequently tearful when left alone. The nurse's approach should be based on an understanding of which of the following: A. Patients need support in dealing with the loss of a body part. B. The patient's family should take the lead role in providing support. C. The nurse should explain that breast tissue is not essential to life. D. The patient should focus on the cure of the cancer rather than loss of the breast.

answer

A

question

When caring for an 87-year-old patient, the nurse needs to understand that which of the following most directly influences the patient's current self-concept: A. Attitude and behaviors of relatives providing care B. Caring behaviors of the nurse and health care team C. Level of education, economic status, and living conditions D. Adjustment to role change, loss of loved ones, and physical energy

answer

D

question

A 20-year-old patient diagnosed with an eating disorder has a nursing diagnosis of situational low self-esteem. Which of the following nursing interventions would be best to address self-esteem? A. Offer independent decision-making opportunities B. Review previously successful coping strategies C. Provide a quiet environment with minimal stimuli D. Support a dependent role throughout treatment

answer

A

question

The nurse asks the patient, "How do you feel about yourself?" The nurse is assessing the patient's: A. Identity. B. Self-esteem. C. Body image. D. Role performance.

answer

B

question

The nurse can increase a patient's self-awareness through which of the following actions? (Select all that apply.) A. Helping the patient define her problems clearly B. Allowing the patient to openly explore thoughts and feelings C. Reframing the patient's thoughts and feelings in a more positive way D. Have family members assume more responsibility during times of stress

answer

A, B, C

question

When developing an appropriate outcome for a 15-year-old girl, the nurse considers that a primary developmental task of adolescence is to: A. Form a sense of identity. B. Create intimate relationships. C. Separate from parents and live independently. D. Achieve positive self-esteem through experimentation.

answer

A

question

An appropriate nursing diagnosis for an individual who experiences confusion in the mental picture of his physical appearance is: A. Acute confusion. B. Disturbed body image. C. Chronic low self-esteem. D. Situational low self-esteem.

answer

B

question

In planning nursing care for an 85-year-old male, the most important basic need that must be met is: A. Assurance of sexual intimacy. B. Preservation of self-esteem. C. Expanded socialization. D. Increase in monthly income.

answer

B

question

Based on knowledge of Erikson's stages of growth and development, the nurse plans her nursing care with the knowledge that old age is primarily focused on: A. Intimacy versus Isolation. B. Autonomy versus Shame and Doubt. C. Generativity versus Self-Absorption. D. Ego Integrity versus Despair.

answer

D

question

The home health nurse is visiting a 90-year-old man who lives with his 89-year-old wife. He is legally blind and is 3 weeks' post right hip replacement. He ambulates with difficulty with a walker. He comments that he is saddened now that his wife has to do more for him and he is doing less for her. Which of the following is the priority nursing diagnosis? A. Self-care deficit, toileting B. Deficient knowledge regarding resources for the visually impaired C. Disturbed body image D. Risk for situational low self-esteem

answer

D

question

Based on knowledge of the developmental tasks of Erikson's Industry versus Inferiority, the nurse emphasizes proper technique for use of an inhaler with a 10-year-old boy so he will: A. Increase his self-esteem with mastery of a new skill. B. Accept changes in his appearance and physical endurance. C. Experience success in role transitions and increased responsibilities. D. Appreciate his body appearance and function.

answer

A

question

Example: perceived inability to meet parental expectations, harsh criticism, and inconsistent discipline: A. Identity B. Self-esteem stressors C. Role performance D. Role overload

answer

B

question

An adolescent attempting to adjust to the physical, emotional, and mental changes of increasing maturity. Internal sense of individuality, wholeness, and consistency of a person over time and in different situations. A. Identity B. Self-esteem stressors C. Role performance D. Role overload

answer

A

question

Situational transitions; The way in which individuals perceive their ability to carry out significant roles: A. Identity B. Self-esteem stressors C. Role performance D. Role overload

answer

C

question

Unsuccessfully attempting to meet the demands of work and family while carving out some personal time: A. Identity B. Self-esteem stressors C. Role performance D. Role overload

answer

D

question

Includes physical appearance, structure, and function of the body. Examples: Amputation, facial disfigurement, or scars from burns: A. Body image B. Role conflict C. Role ambiguity D. Role strain

answer

A

question

Example: a middle-aged woman with teenage children assuming responsibility for the care of her older parents: A. Body image B. Role conflict C. Role ambiguity D. Role strain

answer

B

question

Common in adolescents and employment situations: A. Body image B. Role conflict C. Role ambiguity D. Role strain

answer

C

question

Example: providing care to a family member with Alzheimer disease: A. Body image B. Role conflict C. Role ambiguity D. Role strain

answer

D

question

The nurse is providing education on sexually transmitted infections (STIs) to a group of adolescents. The nurse knows that further teaching is needed when one of the adolescents states: A. "A vaccine is available to reduce infection from certain types of human papillomavirus." B. "I should be screened for an STI after I am with a new partner." C. "I know I' m not infected if I don't have any symptoms such as discharge or sores." D. "A viral infection such as herpes or human papillomavirus cannot be treated with antibiotics."

answer

C

question

A 25-year-old patient is in the emergency department and states that she has had a cough and fever for the past 3 days. While performing a physical assessment, the nurse finds several bruises that are in various stages of healing and suspects that the patient possibly is a victim of sexual abuse. Which of the following is the nurse's first action? A. Refer the patient to a sexual counselor B. Tell the patient about the safe house for women C. Ask the patient to describe how she got the bruises D. Report the abuse immediately to the proper authorities

answer

B

question

A 26-year-old married woman recently discovered that she is pregnant and is at her first prenatal visit. While assessing the patient, the woman's health nurse practitioner discovers that she has purulent vaginal discharge. The patient states, "It burns when I urinate, and I seem to have to go to the bathroom frequently." Based on these symptoms, the nurse practitioner determines that further follow-up is needed because the patient: A. Should be tested for human immunodeficiency virus (HIV). B. May have a sexually transmitted infection (STI) such as chlamydia. C. Is experiencing normal signs of pregnancy. D. Needs education on proper perineal hygiene.

answer

B

question

A new graduate nurse is working in a rehabilitation center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common among patients with SCIs. Which of the following actions enhances the nurse's comfort in discussing sexual issues with the patients? (Select all that apply.) A. Clarifying personal values related to sexuality B. Role playing discussion of sexual concerns with another nurse C. Attending a conference to enhance knowledge about sexuality D. Avoiding a discussion of sexual concerns until after completing new nurse orientation

answer

A, B, C

question

The nurse is gathering a sexual history from a 68-year-old man in a nursing home. It is important for the nurse to keep in mind that: A. Older adults are usually not part of a sexual minority group. B. Older adults sometimes do not reveal intimate details. C. Older men and women lose their interest in sex. D. Older adults in nursing homes do not usually participate in sexual activity.

answer

B

question

Certain cultural groups in the United States are disproportionately affected by diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The nurse understands that this is most likely caused by: (Select all that apply.) A. Expectations about behavior by men or women in the culture. B. Higher percentages of lesbian, gay, bisexual, or transgender individuals in the culture. C. Genetic predisposition to the disease in the culture D. Communication patterns and language practiced by the culture.

answer

A, D

question

Since the majority of sexually transmitted infections (STIs) have few if any symptoms, it is important for the nurse to: A. Encourage regular screenings in all sexually active individuals. B. Provide information about contraception options. C. Administer prescribed antibiotics for human papillomavirus (HPV) or genital herpes outbreaks. D. Ask all patients if they are experiencing any symptoms.

answer

A

question

Establishing trust and encouraging disclosure about sexuality are often facilitated if the nurse begins by asking the patient: A. How often he or she has sexual intercourse. B. To disrobe in preparation for the physical assessment. C. For permission to discuss sexual issues. D. For specific examples of sexual practices and problems.

answer

C

question

A 15-year-old girl states that she is having unprotected intercourse with her boyfriend. She asks for more information about birth control methods. The nurse informs the patient that: (Select all that apply.) A. Condoms or diaphragms must be used with each sexual encounter. B. Hormonal methods offer little protection against sexually transmitted infections (STIs). C. Barrier methods offer some protection against STIs. D. Sterilization is an effective option that she should consider.

answer

B, C

question

The nurse reviews the health history of a 24-year-old woman who indicates that she has had three new sexual partners since her previous examination 2 years ago. The nurse discusses the need for sexually transmitted infection (STI) screening with the patient even though she denies symptoms or discomfort. The nurse realizes that the most serious complication from untreated STIs in females is: A. Genital discharge and dyspareunia. B. Painful menstrual cycles. C. Infertility and pelvic inflammatory disease. D. Genital warts.

answer

C

question

The nurse is providing education about condom use at a community clinic for older adults. Which of following statements demonstrates that the adults understand correct use of condoms? (Select all that apply.) A. "I can use any kind of lubricant such as lotions or baby oil." B. "Before using the condom, I should check the package for damage or expiration." C. "I need to use a condom to help reduce the risk of sexually transmitted infections." D. "A good place to store condoms is in the bathroom so they don't dry out."

answer

B, C

question

Which of the following represents a nonjudgmental approach when gathering a sexual health history? A. How do you and your wife/husband feel about intimacy? B. Do you have sex with men, women, or both? C. Are you heterosexual or homosexual? D. What is your sexual orientation?

answer

B

question

A 54-year-old male patient who is being seen for an annual physical tells the nurse that he is having difficulty sustaining an erection. The nurse reviews his health history and notes no current health problems except medical treatment for depression. The nurse understands that: A. A personal issue such as this is best addressed by the male physician during the examination. B. Erectile dysfunction affects most men over the age of 50. C. The patient needs to be screened for sexually transmitted infections (STIs). D. Antidepressant medication may be affecting his sexual functioning.

answer

D

question

The nurse at a community health center is teaching a group of menopausal women about normal changes in the female sexual response that occur with aging. The nurse knows that the information is understood when one of the women states that: A. It's normal for me to take longer to reach an orgasm. B. I might experience chest pain or shortness of breath during intercourse. C. It's normal for me to lose interest in sexual relationships. D. I won't need to be concerned about contraception or sexually transmitted infections because of my age.

answer

A

question

A school nurse is completing a health history on an adolescent female and notices several body piercings and tattoos. The student tells the nurse that she is planning to get more tattoos and piercings over the summer break. The nurse tells the student piercing and tattoos can: A. Prevent you from being involved in contact sports. B. Only create health problems if they are located in the nipples or genital area. C. Increase your risk for infection at the site and in the body. D. Be a safe and important way of establishing your personality.

answer

C

question

At what developmental stage is it particularly important for children reared in single-parent families to be exposed to same-sex adults? A. Infancy B. School Age C. Adolescence D. Toddlerhood and preschool years

answer

D

question

Which statement about sexual response in older adults is correct? A. The resolution phase is slower. B. The orgasm phase is prolonged. C. The refractory phase is more rapid. D. Both genders experience a reduced availability of sex hormones.

answer

D

question

The only 100% effective method to avoid contracting a disease through sex is: A. Abstinence B. Using condoms C. Avoiding sex with partners at risk D. Knowing the sexual partner's health history

answer

A

question

Pill, intrauterine device, condoms, diaphragm, tubal ligation, vasectomy: A. Contraceptive options B. Middle adulthood C. Older adulthood D. Adolescents E. School-age children F. Sexuality

answer

A

question

Changes in physical appearance lead to concerns about sexual attractiveness: A. Contraceptive options B. Middle adulthood C. Older adulthood D. Adolescents E. School-age children F. Sexuality

answer

B

question

Factors that determine sexual activity include present health status, past and present life satisfaction, status of intimate relationships: A. Contraceptive options B. Middle adulthood C. Older adulthood D. Adolescents E. School-age children F. Sexuality

answer

C

question

Need accurate information on sexually transmitted infections, contraception, and pregnancy: A. Contraceptive options B. Middle adulthood C. Older adulthood D. Adolescents E. School-age children F. Sexuality

answer

D

question

Have general questions regarding the physical and emotional aspects of sex: A. Contraceptive options B. Middle adulthood C. Older adulthood D. Adolescents E. School-age children F. Sexuality

answer

E

question

Part of a person's personality and important for overall health: A. Contraceptive options B. Middle adulthood C. Older adulthood D. Adolescents E. School-age children F. Sexuality

answer

F

question

Influenced by culture: A. Gender roles B. Sexual health C. Gender identity D. Sexual minority group E. Dyspareunia F. Young Adulthood

answer

A

question

State of physical, emotional, mental and social well-being in relation to sexuality: A. Gender roles B. Sexual health C. Gender identity D. Sexual minority group E. Dyspareunia F. Young Adulthood

answer

B

question

The first 3 years are crucial for its development: A. Gender roles B. Sexual health C. Gender identity D. Sexual minority group E. Dyspareunia F. Young Adulthood

answer

C

question

Lesbian, gay, bisexual, or transgender: A. Gender roles B. Sexual health C. Gender identity D. Sexual minority group E. Dyspareunia F. Young Adulthood

answer

D

question

Painful intercourse: A. Gender roles B. Sexual health C. Gender identity D. Sexual minority group E. Dyspareunia F. Young Adulthood

answer

E

question

Intimacy and sexuality are issues for this group: A. Gender roles B. Sexual health C. Gender identity D. Sexual minority group E. Dyspareunia F. Young Adulthood

answer

F

question

Which is not a primary route for human immunodeficiency virus (HIV) transmission? A. Contaminated IV needles B. Urinary Tract infections C. Anal intercourse D. Vaginal intercourse E. Oral-genital sex F. Blood transfusions

answer

B

question

Which is not a commonly diagnosed STI? A. Syphilis B. Gonorrhea C. Chlamydia D. Osteoporosis E. Trichomoniasis F. HPV G. Herpes Simplex

answer

D

question

When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response? A. Results in neurophysiological response. B. Reduces body temperature C. Causes a person to be hypervigilant D. Reduces level of consciousness to conserve energy.

answer

A

question

A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following while assessing the patient? A. Posttraumatic stress disorder B. Rising hormone levels C. Chronic illness D. Return of vital signs to normal

answer

C

question

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." The patient is using the defense mechanism: A. Denial. B. Conversion. C. Dissociation. D. Displacement.

answer

A

question

When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as: A. Conversion. B. Post Traumatic Stress Disorder (PTSD). C. Dissociation. D. Displacement.

answer

B

question

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: A. A situational crisis. B. A maturational crisis. C. An adventitious crisis. D. A developmental crisis.

answer

C

question

During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions? A. How is this flood affecting your life? B. Since your husband has died, what have you been doing in the evening when you feel lonely? C. How is having diabetes affecting your life? D. I know this must be hard for you. Let me tell you what might help.

answer

B

question

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? A. Loss of autonomy caused by health problems B. Physical appearance, family, friends, and school C. Self-esteem issues, changing family structure D. Search for identity with peer groups and separating from family

answer

D

question

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress the nurse says: A. "Tell me who I can call to help you." B. "Tell me what bothers you the most about this experience." C. "I'll contact someone who can help get you temporary housing." D. "I'll sit with you until other family members can come help you get settled."

answer

B

question

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following? A. The amount of family support B. A 3-day diet recall C. A thorough physical assessment D. Threats to safety in her home

answer

C

question

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse's first response is which of the following? A. "Don't be sad. People live with cancer every day." B. "Have you thought about how you are going to tell your family?" C. "Would you like for me to sit down with you for a few minutes so you can talk about this?" D. "I know another patient whose colon cancer was cured by surgery."

answer

C

question

A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. Your best response would be which of the following? A. "Are you thinking of suicide?" B. "You've been doing a good job raising your children. You can do it!" C. "Is there someone who can help you?" D. "You have so much to live for."

answer

A

question

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says: A. "I'm going to learn to drive a car so I can be more independent." B. "My sister says she feels better when she goes shopping, so I'll go shopping." C. "I've always felt better when I go for a long walk. I'll do that when I get home." D. "I' m going to attend a support group to learn more about multiple sclerosis."

answer

D

question

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds: A. "Let's talk about something cheerful." B. "Do other members of your family have diabetes?" C. "I can tell that you feel stressed to learn that you have diabetes." D. With silence.

answer

D

question

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that: A. Nurses who feel stress usually pass the stress along to their patients. B. A nurse who feels stress is ineffective as a nurse and should not be working. C. Nurses who talk about feeling stress are unprofessional and should calm down. D. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

answer

D

question

A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain stability after how long? A. After 2 weeks when the child's pneumonia begins to improve B. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks C. After 1 month when the child goes home and the mother gets help from a food pantry D. After 6 months when the child is back in school

answer

B

question

Which definition does not characterize stress? A. Efforts to maintain relative constancy within the internal environment. B. A condition eliciting an intellectual, behavioral, or metabolic response. C. Any situation in which a nonspecific demand requires an individual to respond or take action. D. A phenomenon affecting social, psychological, developmental, spiritual, and physiological dimensions.

answer

A

question

Major homeostatic mechanisms are controlled by all of the following except: A. Thymus gland B. Pituitary gland C. Medulla Oblongata D. Reticular Formation

answer

A

question

Which of the following is an example of the general adaptation syndrome? A. Alarm reaction B. Inflammatory response C. Fight-or-flight response D. Ego-defense mechanisms

answer

A

question

Crisis intervention is a specific measure used for helping a patient resolve a particular, immediate stress problem. This approach is based on: A. An in-depth analysis of a patient's situation B. The ability of the nurse to solve the patient's problems C. Effective communication between the nurse and patient D. Teaching the patient how to use ego-defense mechanisms.

answer

C

question

An experience a person is exposed to through a stimulus or stressor: A. Stress B. Allostatic load C. Appraisal D. Stressors

answer

A

question

Chronic arousal that causes excessive wear and tear on the person: A. Stress B. Allostatic load C. Appraisal D. Stressors

answer

B

question

How people interpret the impact of the stressor on themselves: A. Stress B. Allostatic load C. Appraisal D. Stressors

answer

C

question

Are tension-producing stimuli operating within or on any system: A. Stress B. Allostatic load C. Appraisal D. Stressors

answer

D

question

Arousal of the sympathetic nervous system: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

answer

A

question

A three-stage reaction to stress: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

answer

B

question

Symptoms of stress persist beyond the duration of a stressor: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

answer

C

question

Rising hormone levels result in increased blood volume: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

answer

D

question

Body stabilizes and responds in the opposite manner to the alarm reaction: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

answer

A

question

Occurs when the body is no longer able to resist the effects of the stressor: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

answer

B

question

Controls heart rate, blood pressure and respirations: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

answer

C

question

Produces hormones necessary for adaptation to stress: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

answer

D

question

Person's effort to manage psychological stress: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

answer

A

question

Allows a person to cope with stress indirectly: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

answer

B

question

Monitors the physiological status of the body through connections with sensory and motor tracts: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

answer

C

question

Identifying the event or circumstance as a threat: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

answer

D

question

A trauma occurs, and its effects sometimes last well after the event ends: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

answer

A

question

Occurs in stable conditions and from stressful roles: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

answer

B

question

Recurrent or intrusive recollections of the event: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

answer

C

question

Occurs as the person moves through life's stages: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

answer

D

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