Basics of Nursing Practice – Flashcards

A nurse is caring for a newly admitted client in a long-term care facility. The nurse notes that the client has a decreased attention span and cannot concentrate. The nurse suspects which effects of sensory deprivation? 1.Cognitive response 2.Emotional response 3.Perceptual response 4.Physical response

The nurse is providing information about blood pressure to Unlicensed Assistive Personnel (UAP) and recalls that the factor that has the greatest influence on diastolic blood pressure is: 1.Renal function 2.Cardiac output 3.Oxygen saturation 4.Peripheral vascular resistance

Nurses are held responsible for the commission of a tort. The nurse understands that a tort is: 1.The application of force to the body of another by a reasonable individual. 2.An illegality committed by one person against the property or person of another. 3.Doing something that a reasonable person under ordinary circumstances would not do. 4.An illegality committed against the public and punishable by the law through the courts.

Health promotion efforts within the health care system should include efforts related to secondary prevention. Which activities reflect secondary prevention interventions in relation to health promotion? (Select all that apply.) 1.Encouraging regular dental checkups 2.Facilitating smoking cessation programs 3.Administering influenza vaccines to older adults 4.Teaching the procedure for breast self-examination 5.Referring clients with a chronic illness to a support group

What is the priority nursing intervention for a client during the immediate postoperative period? 1.Monitoring vital signs 2.Observing for hemorrhage 3.Maintaining a patent airway 4.Recording the intake and output

As a nurse prepares an older adult client for sleep, actions are taken to help reduce the likelihood of a fall during the night. What nursing action is most appropriate when targeting older adults' most frequent cause of falls? 1.Moving the client's bedside table closer to the bed. 2.Encouraging the client to take an available sedative. 3.Instructing the client to call the nurse before going to the bathroom. 4.Assisting the client to telephone home to say goodnight to the spouse.

When providing care for a client with a nasogastric (NG) tube, the nurse should take measures to prevent what serious complication? 1.Skin breakdown 2.Aspiration pneumonia 3.Retention ileus 4.Profuse diarrhea

Which nursing behavior is an intentional tort? 1.Miscounting gauze pads during a client's surgery. 2.Causing a burn when applying a wet dressing to a client's extremity. 3.Divulging private information about a client's health status to the media. 4.Failing to monitor a client's blood pressure before administering an antihypertensive.

What is the most important factor relative to a therapeutic nurse-client relationship when a nurse is caring for a client who is terminally ill? 1.Knowledge of the grieving process 2.Personal feelings about terminal illness 3.Recognition of the family's ability to cope 4.Previous experience with terminally ill clients

A nurse applies an ice pack to a client's leg for 20 minutes. The cold application will cause what physiological effect? 1.Local anesthesia 2.Peripheral vasodilation 3.Depression of vital signs 4.Decreased viscosity of blood

A nurse provides discharge teaching related to intermittent urinary self-catheterization to a client with a new spinal cord injury. Which instruction is most important for the nurse to include? 1."Wear sterile gloves when doing the procedure." 2."Wash your hands before performing the procedure." 3."Perform the self-catheterization every 12 hours." 4."Dispose of the catheter after you have catheterized yourself."

While undergoing a soapsuds enema, the client reports abdominal cramping. What action should the nurse take? 1.Immediately stop the infusion. 2.Lower the height of the enema bag. 3.Advance the enema tubing 2 to 3 inches. 4.Clamp the tube for 2 minutes, then restart the infusion.

On the third postoperative day following a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. What is the best initial approach that the nurse should take when interacting with this client? 1.Explain why there is a need to increase activity. 2.Emphasize that with a prosthesis, there will be a return to the previous lifestyle. 3.Appear cheerful and non-critical regardless of the client's response to attempts at intervention. 4.Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving

A nurse instructs a client to breathe deeply to open collapsed alveoli. What should the nurse include in the explanation of the relationship between alveoli and improved oxygenation? 1."The alveoli need oxygen to live." 2."The alveoli have no direct effect on oxygenation." 3."Collapsed alveoli increase oxygen demands." 4."Oxygen is exchanged for carbon dioxide in the alveolar membrane."

Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? 1.Chlorothiazide (Diuril) 2.AcetaZOLAMIDE (Diamox) 3.Bendroflumethiazide (Naturetin) 4.Demecarium bromide (Humorsol)

When caring for a client who is receiving enteral feedings, the nurse should take which measure to prevent aspiration? 1.Elevate HOB 30-45 degrees. 2.Decrease flow rate at night. 3.Check for residual daily. 4.Irrigate regularly with warm tap water.

Place each step of the nursing process in the order that it should be used. 1.Develop a plan of care. 2.State client's nursing needs. 3.Implement nursing interventions 4.Obtain client's nursing history. 5.Identify goals for care.

The nurse is discussing discharge plans with a client who had a myocardial infarction. The client states, "I'm worried about going home." The nurse responds, "Tell me more about this." What interviewing technique did the nurse use? 1.Exploring 2.Reflecting 3.Refocusing 4.Acknowledging

The client asks the nurse to recommend foods that might be included in a diet for diverticular disease. Which foods would be appropriate to include in the teaching plan? (Select all that apply.) 1.Whole grains 2.Cooked fruit and vegetables 3.Nuts and seeds 4.Lean red meats 5.Milk and eggs

A nurse is teaching members of a health care team how to help disabled clients stand and transfer from the bed to a chair. To protect the caregivers from injury, the nurse teaches them to lift the client by first placing their arms under the client's axillae and next: 1.Bending and then straightening their knees 2.Bending at the waist and then straightening the back 3.Placing one foot in front of the other and then leaning back 4.Placing pressure against the client's axillae and then raising their arms

A female client explains to the nurse that she sleeps until noon every day and takes frequent naps during the rest of the day. What should the nurse do initially? 1.Encourage her to exercise during the day 2.Arrange a referral for a thorough medical evaluation 3.Explain that this behavior is an attempt to avoid facing daily responsibilities 4.Identify that the client is describing clinical findings associated with narcolepsy

When meeting the unique preoperative teaching needs of an older adult, the nurse plans a teaching program based on the principle that learning: 1.Reduces general anxiety 2.Is negatively affected by aging 3.Requires continued reinforcement 4.Necessitates readiness of the learner

A client who is dying appears happy and tells a nurse a joke about the situation despite becoming sicker and weaker. What is the nurse's most therapeutic response? 1."Why are you always telling jokes?" 2."Your laughter is a cover for your fear." 3."Does it help to joke about your illness?" 4."The one who laughs on the outside cries on the inside."

Nursing actions for the older adult should include health education and promotion of self-care. Which is most important when working with the older adult client? 1.Encouraging frequent naps 2.Strengthening the concept of ageism 3.Reinforcing the client's strengths and promoting reminiscing 4.Teaching the client to increase calories and focusing on a high carbohydrate diet

Alternative therapy measures have become increasingly accepted within the past decade, especially in the relief of pain. Which methods qualify as alternative therapies for pain? (Select all that apply.) 1.Prayer 2.Hypnosis 3.Medication 4.Aromatherapy 5.Guided imagery

The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)? 1.Pregnancy 2.Inactivity 3.Aerobic exercise 4.Tight clothing

A nurse takes into consideration that the key factor in accurately assessing how a client will cope with body image changes is the: 1.Suddenness of the change 2.Obviousness of the change 3.Extent of the body changes 4.Perception of the body changes

A nurse is discussing Alcoholics Anonymous (AA) with a client. What behavior expected of members of AA should the nurse include in the discussion? 1.Speaking aloud at weekly meetings 2.Promising to attend at least 12 meetings yearly 3.Maintaining controlled drinking after six months 4.Acknowledging an inability to control the problem

A graduate nurse is preparing to apply to the State Board of Nursing for licensure to practice as a licensed practical nurse. What group primarily is protected under the regulations of the practice of nursing? 1.The public 2.Practicing nurses 3.The employing agency 4.People with health problems

The nurse providing care for a client with a diagnosis of neutropenia reviews isolation procedures with the client's spouse. The nurse determines that the teaching was effective when the spouse states that protective environment isolation helps prevent the spread of infection: 1.To the client from outside sources. 2.From the client to others. 3.From the client by using special techniques to destroy infectious fluids and secretions. 4.To the client by using special sterilization techniques for linens and personal items