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Which nursing interventions are examples of the nurse as a caregiver? Select all that apply. - answer Encouraging the client to exercise daily Setting goals for the client to reduce weight Arranging for the client to meet a spiritual advisor A nurse is evaluating situations based on the responses of several clients. Which client's statement confirms that he or she has reached the Integrity versus Despair stage according to Erikson's theory of psychosocial development? Select all that apply. - answer "Looking back at my entire life, I find that I have actually achieved nothing." "In the twilight of my life, I regret not fulfilling the promises I made to my wife." "Now that I am at the end of the road, I think I am the luckiest person on the earth because God has given me everything that I had asked for." Which intervention by the home health care nurse conforms to the use of safety competency while providing health care? - answer The nurse ensures the furniture does not obstruct the client's movement. A middle-aged client says, "I have been unsuccessful in raising my kids." Which stage should the nurse expect the client to have reached, according to Erikson's theory of psychosocial development? - answer The client has reached the Generativity versus Self-Absorption and Stagnation stage. A nurse is recalling Piaget's theory of cognitive development. What is the characteristic of the preoperational stage? - answer "An infant may learn to think with the use of symbols and mental images." A nurse is heading a performance improvement team. The nurse collects records of needlestick injuries due to improper needle recapping techniques used during medicine administration. What is the next step to
be followed by the nurse, if he or she is using the "plan, do, study, act model - answer Facilitate a training program for all nurses to teach the proper technique of recapping needles While teaching a nursing student, a registered nurse says "This is a study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable." Which type of research is the above statement? - answer Experimental research What makes a crisis access hospital (CAH) different from an intensive care unit (ICU)? - answer It provides temporary care for 96 hours or less. A nursing student is taking down notes about paradigm. Which point noted down by the nursing student needs correction? - answer A paradigm is the perspective of a profession. According to Watson's theory, in which practice is the nurse least likely to engage? - answer Curing the disease before engaging in care of the client A nursing student is listing the goals of theoretical nursing models. Which goal listed by the nursing student needs correction? - answer Provide knowledge to validate nursing interventions A registered nurse is teaching a student nurse about Gesell's theory of biophysical development. Which statement by the student nurse indicates the need for further teaching? Select all that apply. - answer "Proximodistal growth describes the sequence in which growth is fastest from the head down." "In the cephalocaudal pattern, growth starts at the center of the body and moves toward the extremities." What kind of health service does the nurse offer in a health promotion or primary care program? - answer Nutrition counseling A nurse is examining different situations that represent the superego component of human personality, as per Sigmund Freud. Which situations accurately represent superego? Select all that apply. - answer A client controls the urge to eat candy because he or she knows that it will affect the blood sugar levels.
A nursing student is listing various stages of Lawrence Kohlberg's Theory of Moral Development. Which situation indicates that the individual has reached the Instrumental Relativist Orientation stage? - answer "An individual identifies that there is more than one right view." How is public health nursing different from community health nursing? - answer Public health nursing focuses on population. A pregnant woman complains, "I have had morning sickness for one week, which caused me to eat less. I am experiencing irritability because of weakness." The nurse taught the client relaxation and distraction techniques to overcome this problem. During a follow-up visit, the nurse evaluates the client's response and determines if the condition is resolved. Which model is the nurse using in this situation? - answer Neuman systems model A nursing student is listing the steps that need to be followed for applying developmental theory when caring for chronically ill older adults with depression. Which step listed by the nursing student needs correction? - answer "The nurse should recognize the need to identify depression so that heart failure can be prevented." A nurse is evaluating different situations related to Maslow's hierarchy of needs. Which situations come under the second level of needs? Select all that apply. - answer A client tells the nurse that he or she is taunted by his or her boss every day. A client tells the nurse that his or her spouse belongs to a criminal gang. A client tells the nurse that he or she lives beside a factory that manufactures harmful chemicals. A nurse is recollecting Sigmund Freud's psychoanalytical model of personality development. What are the characteristics of the phallic stage, as per this model? Select all that apply. - answer "In this stage, a child may develop an oedipal complex." "In this stage, a girl may experience 'penis envy' feelings." "In this stage, the genital organs are the focus of pleasure. Which program is an example of a continuing education program? - answer A program on caring for the elderly with dementia offered by a university
A healthcare facility is using the "plan, do, study, act (PDSA)" cycle model for performing a quality improvement. Arrange the order in which quality improvement takes place based on this model. - answer 1. Review available data.
Choose the appropriate intervention.
Evaluate the outcomes.
Incorporate new practices in daily performance Which age is considered the phallic stage according to Sigmund Freud's developmental theory? - answer 3 to 6 years old A registered nurse is teaching a student nurse about a rapid-improvement event (RIE), a quality improvement model. Which statement by the student nurse indicates effective learning? - answer "It is a very intense, usually week-long, event." A hospital organization plans to conduct a study on the effect of dried plums for lowering the risk of colon cancer. After selecting the subjects, a nurse researcher provides adequate information about the research and then inquires about the preference of the subjects to associate with the research. What does this procedure indicate? - answer Informed consent Evidence-informed nursing uses a variety of sources to support nursing practice. Which are sources of evidence-informed practice? Select all that apply. - answer Theory Research Clinical expertise Which group benefits from Medicare? - answer People who are 65 years or older Which internal variable influences health beliefs and practices? - answer Intellectual background Which steps are taken by a nurse during the implementation phase of drug research? Select all that apply. - answer Obtaining necessary approvals
to provide patient-centered care? - answer Share decision-making and management. The school nurse conducts a class in nutrition planning for parents. What is the goal of school health nursing programs? - answer Health promotion Which theory describes the phenomenon of grief or caring? - answer Descriptive theories A nursing instructor asks a student to describe Betty Neuman's theory. Which statement by the student indicates the need for further education? - answer "Betty Neuman's theory outlines that the external environmental factors act as stressor." How does a nurse prepare a "factual" record when performing a client documentation? - answer By recording descriptive and objective information of what the nurse sees, hears, feels, and smells Which degree does The American Association of Colleges of Nursing (AACN) recommend as terminal practice degree for all advanced practice registered nurses (APRNs)? - answer Doctor of Nursing Practice (DNP) What information should the nurse provide for a client who is discharged from the health care facility with a surgical wound? Select all that apply. - answer Skill to care for the surgical wound Safe and effective use of medications List of appropriate community resources How does a nurse incorporate the quality of accuracy into client documentation? - answer By using exact measurements for each client's activity A nurse conducting a research study is obtaining informed consent from a research subject. Which statement made by the nurse to the client needs correction? - answer "Let me explain all the details about the research and why it is the best available method of treatment." A hospital needs to hire a nursing staff for the intensive care of cancer clients. Which of these positions is most likely to be filled by the nurse? - answer Clinical nurse specialist
The nurse uses evidence-based practice while providing nursing care to clients. What distinguishes research-based practice different from evidence-based practice? - answer It uses knowledge based only on research studies. A nurse finds that there is an inaccurate match between clinical cues and the nursing diagnosis. What is the category of the diagnostic error? - answer Interpreting While caring for a group of clients from different ethnicities, the nurse observes that a client from Ireland is stoic and not complaining about pain. Which theory should the nurse follow in this situation? - answer Leininger's Theory The nurse finds that a client with bilateral oral swelling, pain, and trismus had undergone a surgical extraction of an impacted tooth five days ago. What type of nursing diagnosis does the documentation of acute pain refer to? - answer Actual nursing diagnosis How many levels of critical thinking exist for nursing judgment? - answer 3 A registered nurse is teaching a nursing student about Nightingale's theory of nursing. Which statements have been correctly stated by the nursing student as a result of the teaching? Select all that apply. - answer Nightingale's theory states that the focus of nursing is caring through the environment. Nightingale's theory is oriented towards providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. Nightingale's theory focuses on helping the client deal with the symptoms and changes in function related to an illness. A new toy is shown to a baby, and after his or her attention is drawn, the parent hides the toy under the bed. Then the baby tries to find the toy, which is hidden. Which stage of cognitive development does the child belong, according to Jean Piaget? - answer Sensorimotor How is a SOAP progress note different from a PIE progress note? Select all that apply. - answer In a SOAP progress note, the P stands for plan; in a PIE progress note, the P stands for problem.
Validation therapy - answer Validation therapy is a communication technique that can help the client in a confused state. At which site would the nurse obtain a sterile urinalysis from a client with an indwelling catheter? - answer Tubing injection port Which assessment finding is associated with depression? - answer The client has islands of intact memory. Which assessment finding is associated with depression? - answer The client has islands of intact memory. Which assessment finding is associated with dementia? - answer The client has impaired recent and remote memory. Delirium - answer The onset of delirium may be abrupt, causing impaired recent and immediate memory. A client with delirium is forgetful and requires step-by-step instructions to complete simple tasks. Which fine motor skills may be observed in an 8- to 10-month-old infant? Select all that apply. One, some, or all responses may be correct. - answer Using pincer grasp well Picking up small objects Showing hand preference Gross motor skills in an 8-10 month old infant - answer Crawling Pulling up to standing or sitting Arrange the stages of Freud's psychoanalytical model of personality development in the correct order. - answer Oral Anal Phallic Latency Genital Oral Stage - answer birth to 18 months Anal Stage - answer second stage, from 12 to 18 months to 3 years of age.
Phallic or Oedipal stage - answer Children between the ages of 3 and 6 years are considered to be in the phallic or oedipal stage. Latency stage - answer 6-12 years Genital stage - answer 12-adulthood. he genital stage is the sixth stage; it starts in puberty and continues to adulthood. The nursing student is learning about the realms of family life. Which component would be included while learning about integrity processes? - answer Family rituals The family health system - answer includes five realms, or processes, of family life. These realms are interactive, developmental, coping, integrity, and health. This approach is a method for family assessment used to determine areas of concern and strengths and to help develop an effective care plan. The component of integrity includes family rituals. Family relationships are a part of interactive processes. Family life stressors and daily hassles are considered components of coping processes. Health processes include family care takings and responsibilities. Integrity process - answer Family rituals Coping process - answer Family life stressors and daily hassles Interactive process - answer Family relationship Do alcohol based hand scrubs kill C.Diff? - answer No. Alcohol does not kill C. difficile spores. Use of soap and water is more efficacious than alcohol-based hand rubs. Which concept refers to respecting the rights of others? - answer Open- mindedness Maturity - answer reflecting on one's own judgments and having cognitive maturity Systematicity - answer Organized and focused Inquisitiveness - answer acquiring knowledge.
Evaluation - answer Reflecting on the nurse's own behavior Explanation - answer Supportive findings and conclusions Interpretation - answer Interpretation involves clarifying any data about which the nurse is uncertain. alternative family - answer grandparents caring for grandchildren The nurse should take which infection control measures when caring for a client admitted with a tentative diagnosis of infectious pulmonary tuberculosis (TB)? Don an N95 respirator mask before entering the room. Put on a permeable gown each time before entering the room. Implement contact precautions and post appropriate signage. After finishing with client care, remove the gown first and then remove the gloves - answer Don an N95 respirator mask before entering the room. An N95 respirator mask is unique to airborne precautions and for clients with a diagnosis such as tuberculosis, varicella, or measles. The gown needs to be nonpermeable to be protective. Airborne precautions, not contact precautions, are required. When finished with care, gloves would be removed first because they are the most contaminated. To ensure the safety of a client who is receiving a continuous intravenous normal saline infusion, the nurse would change the administration set how often? - answer every 72 to 96 hours Best practice guidelines recommend replacing administration sets no more frequently than 72 to 96 hours after initiation of use in clients not receiving blood, blood products, or fat emulsions. This evidence-based practice is safe and cost effective. Changing the administration set every 4 to 48 hours is not a cost-effective practice. Factors that can lead to nurses making medication errors - answer stress, overwork, and fatigue
Which developmental changes require the nurse's assessment in a 12- year-old female? - answer Skeletal think scoliosis When ammonia is excreted by healthy kidneys, which mechanism usually is maintained? - answer acid-base balance Which activity demonstrates fine motor skills in infants aged 2 to 4 months?
- answer Bringing objects from hand to mouth Responsibility - answer Responsibility refers to all duties and activities the nurse is employed to perform. Authority - answer Authority refers to the legitimate power to give commands and make final decisions specific to a given position. A client is to receive a transfusion of packed red blood cells (PRBCs). Which solution would the nurse use to prime the blood intravenous (IV) tubing? - answer 0.9% normal saline Blood and blood products for transfusion should be infused/diluted only with 0.9% normal saline solution. Solutions other than normal saline are incompatible and may cause RBC destruction by hemolysis. Arrange in order the items of personal protection equipment (PPE) removed after seeing a client in droplet precautions. - answer 1. Gloves
- Face Shield
- gown
- Mask RACE - answer RESCUE, ALARM, CONFINE, EXTINGUISH/EVACUATE. The acronym RACE stands for Remove all clients from immediate danger, Activate the alarm, Confine the fire by closing doors and windows, and Extinguish the fire with an appropriate fire extinguisher. The acronym does not include alerting the local fire department or releasing the pin from the fire extinguisher.
When meeting the preoperative teaching needs of an older adult, the nurse plans a teaching program based on which principle about learning? - answer It requires continued reinforcement. Neurological aging causes forgetfulness and slower response time; repetition increases learning. Which is an example of independent thinking in nursing practice? - answer Talking with other nurses to share ideas about nursing interventions Which is the first sign that would assist the nurse in suspecting malignant hyperthermia in a client? - answer Increased expired carbon dioxide increased expired carbon dioxide, caused by an abnormal and continuous contraction of the skeletal muscles. Which behavior by the client exhibits denial after a recent diagnosis? - answer attempts to minimize the illness A client is transferred to an acute care nursing unit after surgery. Which action of the nurse is most important and would be performed first? - answer Assess the patency of airway. Which nursing intervention fosters the infant's development of trust? - answer Follow the parents' directions while providing care. Parents would provide the majority of the care when an infant is hospitalized. If the parents are away, the nurse would follow the parents' directions. This helps foster the infant's continuing development of trust. When a client's total parenteral nutrition (TPN) bag is empty, which action is appropriate for the nurse to take? - answer Hang a bag of 10% dextrose at the ordered TPN rate and place an urgent request for the next TPN bag. Which complication would the nurse monitor for in a client on strict bed rest for 3 days? - answer Atelectasis Hypotension Constipation Pressure injuries Urinary tract infection
The client has a closed chest tube drainage system connected to suction. Which assessment finding requires additional evaluation by the nurse? - answer Constant bubbling in the water-seal chamber is indicative of an air leak. The nurse would assess the entire length of the system from the container to the client's chest wall tube insertion site to find the source of the air leak. If the source of the air leak is not found in the system and bubbling continues, the leak is most likely within the client's chest or at the insertion site. This could cause the lung to collapse because of a buildup of air pressure within the plural cavity, and the health care provider should be notified. I Elbow restraints have been prescribed for a confused client to keep the client from pulling out a nasogastric tube and indwelling urinary retention catheter. Which nursing intervention is correct regarding restraints? - answer Assess the clients condition per hospital protocol A restraint impedes the movement of a client; therefore a client's condition needs to be assessed every hour. All restraints are required to be represcribed every 24 hours. Restraints should be removed and activity and skin care provided at least every 2 hours to prevent contractures and skin breakdown. Which questions would the nurse ask when gathering a client's physical and developmental health history? - answer "Do you have any marital problems?" "Are you able to complete your activities of daily living?" The nurse is caring for a client whose mobility is restricted to a wheelchair after a motor vehicle accident. The client has been prescribed physiotherapy as a part of rehabilitation care. Which interventions would the nurse consider when the client is discharged from the health care facility? - answer Assist the family in identifying community support systems. Encourage the primary caregiver to set a routine time for respite. Consider the primary caregiver's experience in the discharge plan Which action is appropriate when caring for an elderly client admitted to a health care facility? - answer Invite a family member to join the conversation
