nur-2356-nur2356-multidimensional-care-i-mdc-1-exam-1-latest, Exams of Health sciences

Download nur-2356-nur2356-multidimensional-care-i-mdc-1-exam-1-latest and more Exams Health sciences in PDF only on Docsity! nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Multidimensional Care I Exam 1 MDC 1 Exam 1 1. A nurse is preparing to initiate a bladder-retraining program for a client who has incontinence. Which of the following actions should the nurse take? (Select all that apply.) A. Restrict the client's intake of fluids during the daytime. B. Have the client record urination times. C. Gradually increase the urination intervals. D. Remind the client to hold urine until the next scheduled urination time. E. Provide a sterile container for urine. 2. A nurse is reviewing factors that increase the risk of urinary tract infections (UTIs) with a client who has recurrent UTIs. Which of the following factors should the nurse include? (Select all that apply.) A. Frequent sexual intercourse B. Lowering of testosterone levels C. Wiping from front to back to clean the perineum D. Location of the urethra closer to the anus E. Frequent catheterization 3. A nurse is teaching a client who reports stress urinary incontinence. Which of the following instructions should the nurse include? (Select all that apply.) A. Limit total daily fluid intake. B. Decrease or avoid caffeine. nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest C. Take calcium supplements. D. Avoid drinking alcohol. E. Use the Credé maneuver 4. A nurse is teaching a group of newly licensed nurses on complementary and alternative therapies they can incorporate into their practice without the need for specialized licensing or certification. Which of the following should the nurse encourage them to use? (Select all that apply.) A. Guided imagery B. Massage therapy C. Meditation D. Music therapy E. Therapeutic touch 5. A nurse is reviewing complementary and alternative therapies with a group of newly licensed nurses. Which of the following interventions are mind-body therapies? (Select all that apply.) A. Art therapy B. Acupressure C. Yoga D. Therapeutic touch E. Biofeedback 6. A nurse is caring for a client who fell at a nursing home. The client is oriented to person, place, and time and can follow directions. Which of the following actions should the nurse take to decrease the risk of another fall? (Select all that apply.) nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 12. use gait belts and other assistive equipment when moving patients 13. keep floor clean (no clutter, cords, scatter rugs, etc.) nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 14. electronic safety monitors (chair or bed sensors) 13. What is a nurse's concern with patients using their call lights? That nurses respond in a timely manner...otherwise the patient may become impatient and attempt to move themselves 14. What must be completed before performing first aid? primary survey 15. Name the nursing interventions for BLEEDING - apply pressure to wound site (home) - DO NOT remove impaling objects, stabilize the object (home) - IV volume replacement with blood or volume replacement (hospital) 16. The acronym RICE is used to manage sprains, what do the letters stand for? R - refrain from weight bearing (also known as "rest") I - apply ice to decrease inflammation C - apply a compression dressing to minimalize swelling E - elevate the affected limb 17. Name the nursing interventions for BURNS - remove the agent - smooth any flames present - cover the client and maintain NPO status - elevate the extremities - Stop, Drop, and Roll (home) - call 911 (home) - perform H to T assessment (hospital) - administer fluids and tetanus toxoid (hospital) nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 18. A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The client who has heat stroke will have which of the following? A. Hypotension B. Bradycardia C. Clammy skin D. Bradypnea A. Hypotension 19. Name the nursing interventions of INFANT SUFFOCATION - place infants on back to rest - never leave alone in bathtub - do not place anything in the crib; remove mobiles when baby can sit up - keep latex balloons away - toilet lids down, bathroom doors closed - make sure slats on crib are a safe distance 20. Name the nursing interventions of INFANT BURNS - test the temperature of formula and bath water - place pots on back burner and turn handle away from the front of the stove - supervise the use of faucets - cover electrical outlets - apply sunblock SPF 30 or higher 21. Name the nursing interventions of INFANT MOTOR VEHICLE INJURY - rear-facing car seat - car seat with 5-point harness - forward facing seat after the age of 2 or when they meet the height/weight requirements nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest - Clients often use alternative or complementary practices 28. What are the dietary considerations for Hinduism? - vegetarians - they have an adherence to nonviolence 29. What are the bathing considerations for Hinduism? - free-flowing shower - disrespectful to touch their feet or head - do not like to remove jewelry 30. What are the dietary considerations for Islam/Muslim? - avoid alcohol and pork - may fast for Ramadan 31. What are the dietary considerations for Mormons? - avoid tobacco, alcohol, caffeine 32. Name the nursing interventions for CULTURALLY RESPONSIVE CARE - provide language assistance - informing clients of language services verbally and in writing - providing competent, trained interpreters - giving the client learning materials 33. A nurse is using an interpreter to communicate with a client. Which of the following actions should the nurse use when communicating with a client and family members? (Select all that apply.) nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest A. Talk to the interpreter about the family while the family is in the room. B. Determine client understanding several times during the conversation. C. Look at the interpreter when asking the family questions. D. Use lay terms if possible. E. Do not interrupt the interpreter and the family as they talk. B. Determine client understanding several times during the conversation D. Use lay terms if possible E. Do not interrupt the interpreter and the family as they talk 34. A nurse is caring for two clients who report following the same religion. Which of the following information should the nurse consider when planning care for these clients? A. Members of the same religion share similar feelings about their religion. B. A shared religious background generates mutual regard for one another. C. The same religious beliefs can influence individuals differently. D. The nurse and client should discuss the differences and commonalities in their beliefs. C. The same religious beliefs can influence individuals differently. 35. A nurse enters the room of a client who is crying while reading from a religious book and asks to be left alone. Which of the following actions should the nurse take? A. Contact the hospital's spiritual services. B. Ask what is making the client cry. C. Ensure no visitors or staff enter the room for a short time period. D. Turn on the television for a distraction. C. Ensure no visitors or staff enter the room for a short time period nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 36. A nurse is discussing the plan of care for a client who reports following Islamic practices. Which of the following statements by the nurse indicates culturally responsive care to the client? A. "I will make sure the menu includes kosher options." B. "I will ask the client if they want to schedule some times to pray during the day." C. "I will avoid discussing care when the client's family is around." D. "I will make sure daily communion is available for this client." B. "I will ask the client if they want to schedule some times to pray during the day" 37. A nurse is caring for a client who tells the nurse that based on religious values and mandates, a blood transfusion is not an acceptable treatment option. Which of the following responses should the nurse make? A. "I believe in this case you should really make an exception and accept the blood transfusion." B. "I know your family would approve of your decision to have a blood transfusion." C. "Why does your religion mandate that you cannot receive any blood transfusions?" D. "Let's discuss the necessity for a blood transfusion with your religious and spiritual leaders and come to a reasonable solution." D. "Let's discuss the necessity for a blood transfusion with your religious and spiritual leaders and come to a reasonable solution." 38. A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The client who has heat stroke will have which of the following? A. Hypotension B. Bradycardia C. Clammy skin nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest - allow them to wash their faces or perineal area if they are able to - give them all the materials and let them do what they can control 44. Name some benefits of perineal care - maintain skin integrity - relieve discomfort - prevent transmission of micro organisms (catheter care) 45. Name some patient education for foot care - inspect daily - use lukewarm water, and dry feet thoroughly - apply moisturizer - avoid over-the-counter meds with alcohol or other strong chemicals - clean socks - check shoes for objects, rough seams, or edges - cut nails straight across - avoid self-treating corns or calluses - do not apply heat 46. Sudden attacks of sleep that are often uncontrollable often happens at inappropriate times and increases the risk of injury narcolepsy 47. Patient education for Narcolepsy - exercise regularly - eat small meals that are high in protein - avoid activities that increase sleepiness (sitting too long, warm environments, drinking alcohol) - avoid activities that could cause injury to the client should they fall asleep (heights, driving) - take naps nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest - take prescribed simulants nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 48. Factors that interfere with sleep - Physiologic disorders: can require more sleep or disrupt sleep (sleep apnea, nocturia) - Current life events: traveling more, change in work hours - Emotional stress or Mental illness: anxiety, fear, grief - Diet: caffeine, heavy meals before bedtime - Exercise: promotes sleep if at least 2 hour before bedtime, otherwise can disrupt sleep - Fatigue: exhausting or stressful work makes falling asleep difficult - Sleep environment: too light, the wrong temperature, or too noisy - Medications: some can induce sleep but interfere with restorative sleep. Others cause insomnia (bronchodilators, antihypertensives) - Substance use: nicotine and caffeine are simulants, caffeine and alcohol tend to cause night awakenings 49. A nurse is performing mouth care for a client who is unconscious. Which of the following actions should the nurse take? A. Turn the client's head to the side. B. Place two fingers in the client's mouth to open it. C. Brush the client's teeth once per day. D. Inject a mouth rinse into the center of the client's mouth. A. Turn the client's head to the side 50. A nurse is instructing a client who has diabetes mellitus about foot care. Which of the following guidelines should the nurse include? (Select all that apply.) A. Inspect the feet daily. B. Use moisturizing lotion on the feet. C. Wash the feet with warm water and let them air dry. D. Use over-the-counter products to treat abrasions. E. Wear cotton socks nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest B. "Do you feel confused in the late afternoon?" nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest C. "Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day?" D. "Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep?" E. "Tell me about any personal stress you are experiencing." A. "Have your working hours changed recently?" C. "Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day?" D. "Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep?" E. "Tell me about any personal stress you are experiencing." 54. A nurse is talking with a client about ways to help sleep and rest. Which of the following recommendations should the nurse give to the client to promote sleep and rest? (Select all that apply.) A. Practice muscle relaxation techniques. B. Exercise each morning. C. Take an afternoon nap. D. Alter the sleep environment for comfort. E. Limit fluid intake at least 2 hr before bedtime. A. Practice muscle relaxation techniques B. Exercise each morning D. Alter the sleep environment for comfort E. Limit fluid intake at least 2 hr before bedtime. 55. A nurse is caring for a client who has been following the facility's routine and bathing in the morning. However, at home, the client always takes a warm bath just before bedtime. Now the client is having difficulty sleeping at night. Which of the following actions should the nurse take first? nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest A. Rub the client's back for 15 min before bedtime. B. Offer the client warm milk and crackers at 2100. C. Allow the client to take a bath in the evening. D. Ask the provider for a sleeping medication. C. Allow the client to take a bath in the evening 56. A nurse is instructing a client who has narcolepsy about measures that might help with self-management. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I'll add plenty of carbohydrates to my meals." B. "I'll take a short nap whenever I feel a little sleepy." C. "I'll make sure I stay warm when I am at my desk at work." D. "It's okay to drink alcohol as long as I limit it to one drink per day." B. "I'll take a short nap whenever I feel a little sleepy." 57. Name some nursing actions for immobility - turn patient every 2 hours - ROM exercises - check for sores (redness) - pad bony prominences 58. A nurse is caring for a client who has been sitting in a chair for 1 hr. Which of the following complications is the greatest risk to the client? A. Decreased subcutaneous fat B. Muscle atrophy C. Pressure injury nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 63. What do vital signs look like during acute pain? - BP increased - Pulse increased - RR increased 64. Before nurses give a pain medication, what should they assess? - drug interactions - allergies - vital signs - side effects *need to find this in ATI 65. What are common side effects to pain medications? - low BP - low HR - sedation - respiratory depression - orthostatic hypotension - urinary retention - nausea/vomiting - constipation 66. After administering pain medication, what is the follow up? - reevaluate pain level - if given orally, follow up q 1 hour - if given IV, follow up q 15 min - check vital signs! *need to find this in ATI nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 67. What are the complications related to pain management? nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest - anxiety - fear -depression - slower healing - slower recovery *need to find this in ATI 68. Superficial pain usually involving the skin or subcutaneous tissue cutaneous pain 69. Pain in internal organs (the stomach or intestines). It can cause referred pain in other body locations separate from the stimulus visceral pain 70. Sensation of pain without demonstrable physiologic or pathologic substance; commonly observed after the amputation of a limb phantom pain* a type of neuropathic pain 71. Arises from abnormal or damaged pain nerves. It includes phantom limb pain, pain below the level of a spinal cord injury, and diabetic neuropathy "pins and needles" neuropathic pain 72. What's the difference between acute and chronic pain? - new pain vs. old pain (> 6 months) - chronic pain effects ADLs nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 80. What does ginko biloba promote? improves memory 81. What does ginseng promote? increases physical endurance 82. What does valerian promote? Promotes sleep, reduces anxiety 83. A variety of therapeutic or preventive health care practices, such as homeopathy, naturopathy, chiropractic, and herbal medicine, that do not follow generally accepted medical methods and may not have a scientific explanation for their effectiveness. used in addition to or to enhance conventional medical care complementary therapy 84. Includes herbs and other "natural" products as often found in ancient records; these products are not controlled or tested by the U.S. Food and Drug Administration and are considered to be dietary supplements; however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication treatment approaches that are used in addition to or to enhance conventional medical care alternative therapy 85. A nurse is assessing a client as part of an admission history. The client reports drinking an herbal tea every afternoon at work to relieve stress. Tea includes which of the following ingredients? nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest A. Chamomile B. Ginseng C. Ginger D. Echinacea A. Chamomile 86. A nurse is caring for a client scheduled for abdominal surgery. The client reports being worried. Which of the following actions should the nurse take? A. Offer information on a relaxation technique and ask the client if they are interested in trying it. B. Request a social worker see the client to discuss meditation. C. Attempt to use biofeedback techniques with the client. D. Tell the client many people feel the same way before surgery and to think of something else. A. Offer information on a relaxation technique and ask the client if they are interested in trying it. 87. Complications of urinary elimination UTIs 88. UTI patient education - wipe front to back - pee before and after sex - cleanse beneath foreskin - provide catheter care regularly (nurses) 89. A client who has an indwelling catheter reports a need to urinate. Which of the following actions should the nurse take? nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest A. Check to see whether the catheter is patent. B. Reassure the client that it is not possible for them to urinate. C. Recatheterize the bladder with a larger-gauge catheter. D. Collect a urine specimen for analysis. A. Check to see whether the catheter is patent. 90. The totality of socially trans-mitted behavior patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of a population of people that guides their worldview and decision making **can be taught** culture 91. Groups whose members share a common social and cultural heritage that is passed down from generation to generation. It is also similar to subculture in that the members of an ethnic group have some characteristics in common (e.g., race, ancestry, physical characteristics, geographic region, lifestyle, religion) that are not shared or understood by outsiders. Ethnicity 92. Is a widely held but oversimplified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. stereotype 93. Not only language itself, but different definitions for the same thing healthcare jargon street talk, slang, jargon nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Individuality nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Wealth Comfort Cleanliness Achievement Youth and beauty 100. What are some Dominant Values among Hispanic or Latino? Extended family Group emphasis Fatalistic Faith and spirituality 101. What are some Dominant Values among Native Americans? Bonding to family or group Acceptance of nature (Mother Earth) Tradition Sharing Belief in a spiritual power Respect of elders 102. What are some Dominant Values among Asian and Pacific Islander? Extended family Respect for elders Group orientation Subordination to authority Conformity Self-respect and self-control Love of the land 103. What are some Dominant values among Black and African Americans? Family bonding Matrifocal Spiritual orientation nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Present-oriented nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Exploring issues nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Using silence Summarizing the conversation Process recordings 112. Name some barriers to therapeutic communication Asking too many questions Asking why Fire-hosing information Changing the subject inappropriately Failing to probe Expressing approval or disapproval Offering advice Providing false reassurance Stereotyping Using patronizing language 113. Name some non-verbal communication Facial expression Posture and gait Personal appearance Gestures Touch 114. What are the 4 types of personal space? intimate distance (patients) personal distance (with patients and healthcare team members) social distance (with a group) public distance (with a group or community) 115. What factors are a part of verbal communication? vocabulary nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest denotative and connotative meaning pacing nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest 126. What happens during the Planning phase of the Nursing Process? nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest - the nurse sets measurable and achievable short- and long-range goals for this patient. - Assessment data, diagnosis, and goals are written in the patient's care plan so that nurses as well as other health professionals caring for the patient have access to it. 127. What happens during the Intervention phase of the Nursing Process? - activities or actions that a nurse performs to achieve client goals. - Interventions chosen should focus on eliminating or reducing the etiology of the nursing diagnosis. 128. What happens during the Evaluation phase of the Nursing Process? - to determine whether, after application of the nursing process, the client's condition or well-being improves. - The nurse conducts evaluation measures to determine if expected outcomes are met, not the nursing interventions. 129. Normal respiratory rate 12-20 breaths per minute 130. Normal range for BP 120/80... Systolic: 90-120 Diastolic: 60-80 131. Normal range for temperature 96.4 -99.5 degrees Fahrenheit Oral: 98.6 nur-2356-nur2356-multidimensional-care-i- mdc-1-exam-1-latest Tympanic: 99.6 Rectal: 99.6