Potter Perry Fundamentals of Nursing I CH 15,16,17,18,19,20 2024-2025 Edition. Graded A+, Exams of Nursing

Download Potter Perry Fundamentals of Nursing I CH 15,16,17,18,19,20 2024-2025 Edition. Graded A+ and more Exams Nursing in PDF only on Docsity! Potter Perry Fundamentals of Nursing I CH 15,16,17,18,19,20 2024-2025 Edition. Distinction Guaranteed -address the client with the appropriate title and her last name -use a mix of open-ended and close-ended questions -perform the general survey before the examination - ANSA nurse is introducing herself to a client as the first step of a comprehensive physical examination. Which of the following strategies should the nurse use with this client? -plan to allow plenty of time for position changes -make sure the client has any essential sensory aids in place -tell the client to take her time answering questions -invite the client to use the bathroom before beginning the examination - ANSA nurse is performing a comprehensive physical examination of an older adult client. Which of the following interventions should the nurse use in consideration of the client's age? -posture -skin lesions -speech - ANSA nurse in a provider's office is documenting his findings following an examination he performed for a client new to the practice. Which of the following parameters should he include as part of the general survey? -respiratory rate is 22/min with even, unlabored respirations -skin is pink, warm, and dry -the assistive personnel reports the client walked with a limp - ANSA charge nurse is reviewing the steps of the nursing process with a group of nurses. Which of the following data should the charge nurse identify as objective data? -showing a client how to use progressive muscle relaxation -performing a daily bath after the evening meal -repositioning a client every 2 hr to reduce pressure ulcer risk - ANSA charge nurse is talking with a newly licensed nurse and is reviewing nursing interventions that do not require a provider's prescription. Which of the following interventions should the nurse include? -the client is nonadherent with coughing, deep breathing, and dangling -the client may have pain medication every 4 to 6 hr but accepts it every 6 to 7 hr -the client's vital sings are heart rate 110/min, respiratory rate 20/min, temperature 98.6 F, and blood pressure 136/80 mm Hg - ANSA nurse is caring for a client who is 24 hr postoperative following abdominal surgery. The nurse suspects the client's pan management is inadequate. Which of the following data reinforce this suspicion? "I will determine the most important client problems that we should address." - ANSA nurse is discussing the nursing process with a newly hired nurse. Which of the following statements by the newly hired nurse should the nurse identify as appropriate for the planning step of the nursing process? "My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history." "Tell me what brought you to the hospital." "You say you've lost weight. Tell me how much weight you've lost in the last month." "So, to summarize, you've lost about 6 lbs in the last month, and your appetite has been poor—correct?" "I have no further questions. Thank you for your patience." - ANSA nurse is conducting a patient-centered interview. Place the statements from the interview in the correct order, beginning with the first statement a nurse would ask. "You have four children; do you have any concerns about going home and caring for them?" - ANSA nurse is assigned to a 42-year-old mother of 4 who weighs 136.2 kg (300 lbs), has diabetes, and works part time in the kitchen of a restaurant. The patient is facing surgery for gallbladder disease. Which of the following approaches demonstrates the nurse's cultural competence in assessing the patient's health care problems? A problem-oriented approach - ANSA 72-year-old male patient comes to the health clinic for an annual follow-up. The nurse enters the patient's room and notices him to be diaphoretic, holding his chest and breathing with difficulty. The nurse immediately checks the patient's heart rate and blood pressure and asks him, "Tell me where your pain is." Which of the following assessment approaches does this scenario describe? An observation of how a patient turns and moves in bed The care recommendations of a physical therapist The results of a diagnostic x-ray film - ANSWhen a nurse conducts an assessment, data about a patient often comes from which of the following sources? analyticity - ANSAnticipate how a patient might respond to a treatment. Applying ethical criteria. - ANSA nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of: assessment - ANSA newly licensed nurse is reporting to the charge nurse about the are she gave to a client. She states, "The client said his leg pain was back, so I checked his medical record, and he last received his pain medication 6 hr ago. The prescription reads every 4 hrs PRN for pain, so I decided he needs it. I asked the unit nurse to observe me preparing and administering it. I checked with the client 40 minutes later, and he said his pain is going away." The charge nurse should inform the newly licensed nurse that she left out which of the following steps of the nursing process? Listen attentively to the patient's story. Use gestures that reinforce your questions or comments. Maintain direct eye contact. Ask questions quickly to reduce the patient's fatigue. - ANSThe nurse enters the room of an 82-year-old patient for whom she has not cared previously. The nurse notices that the patient wears a hearing aid. The patient looks up as the nurse approaches the bedside. Which of the following approaches are likely to be effective with an older adult? Open-ended - ANSWhich type of interview question does the nurse first use when assessing the reason for a patient seeking health care? open-mindedness - ANSBe tolerant of the patient's views and beliefs Participate in a unit meeting to discuss feelings about the patient deaths - ANSTwo patient deaths have occurred on a medical unit in the last month. The staff notices that everyone feels pressured and team members are getting into more arguments. As a nurse on the unit, what will best help you manage this stress? Patient's level of function. - ANSA nurse is checking a patient's intravenous line and, while doing so, notices how the patient bathes himself and then sits on the side of the bed independently to put on a new gown. This observation is an example of assessing: reassess the client to determine the reasons for inadequate pain relief - ANSBy the second postoperative day, a client has not achieved satisfactory pain relief. Based on this evaluation, which of the following actions should the nurse take, according to the nursing practice? reflection - ANSA nurse just started working at a well-baby clinic. One of her recent experiences was to help a mother learn the steps of breastfeeding. During the first clinic visit the mother had difficulty positioning the baby during feeding. After the visit the nurse considers what affected the inability of the mother to breastfeed, including the mother's obesity and inexperience. The nurse's review of the situation is called: responsibility - ANSA nurse receives a prescription for an antibiotic for a client who has cellulitis. The nurse checks the client's medical record, discovers that she is allergic to the antibiotic, and call the provider to request a prescription for a different antibiotic. Which of the following critical thinking attitudes did the nurse demonstrate? responsible - ANSA nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the doctor's order. At the bedside the nurse checks the patient's name against the medication order as well. The nurse is following which critical thinking attitude: Self-perception-self-concept pattern - ANSA patient who visits the surgery clinic 4 weeks after a traumatic amputation of his right leg tells the nurse practitioner that he is worried about his ability to continue to support his family. He tells the nurse he feels that he has let his family down after having an auto accident that led to the loss of his left leg. The nurse listens and then asks the patient, "How do you see yourself now?" On the basis of Gordon's functional health patterns, which pattern does the nurse assess? Spending time establishing relationships with patients - ANSAn aspect of clinical decision making is knowing the patient. Which of the following is the most critical aspect of developing the ability to know the patient? Systematicity - ANSOrganize assessment on the basis of patient priorities. Tell me what makes your headaches begin. - ANSDuring a visit to the clinic, a patient tells the nurse that he has been having headaches on and off for a week. The headaches sometimes make him feel nauseated. Which of the following responses by the nurse is an example of probing? The nurse asks the patient to rate his pain on a scale of 0 to 10. The nurse assesses the patient's lower-limb strength. - ANSA nurse makes the following statement during a change-of-shift report to another nurse. "I assessed Mr. Diaz, my 61-year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, and he moves slowly as he transfers to a chair." What can the nurse who is beginning a shift do to validate the previous nurse's assessment findings when she rounds on the patient? The nurse thinks back about a personal experience before administering a medication subcutaneously. The nurse uses a pain-rating scale to measure a patient's pain. The nurse gathers data on a patient with a mobility limitation to identify a nursing diagnosis. - ANSIn which of the following examples is a nurse applying critical thinking skills in practice? The skin around the wound is tender to touch Patient has drainage from surgical wound. Body temperature is 38.3° C (101° F). - ANSA nurse gathers the following assessment data. Which of the following cues together form(s) a pattern suggesting a problem? truth seeking - ANSBe objective in asking questions of a patient. Working phase - ANSThe nurse asks a patient, "Describe for me a typical night's sleep. What do you do to fall asleep? Do you have difficulty falling or staying asleep? This series of questions would likely occur during which phase of a patient-centered interview?