Course Introduction
Nursing Process Exam
Solutions
The Nursing Process course introduces students to the foundational framework for delivering effective and patient-centered care in various healthcare settings. Emphasizing a systematic approach, the course covers the five essential steps: assessment, diagnosis, planning, implementation, and evaluation. Students learn to gather and analyze patient data, develop individualized care plans, and apply critical thinking for clinical decision-making. Emphasis is placed on communication, documentation, and ethical considerations, preparing students to collaborate with interdisciplinary teams and advocate for optimal patient outcomes throughout the continuum of care.
Recommended Textbook
Fundamentals of Nursing 8th Edition by
Patricia A. Potter
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50 Chapters
1445 Verified Questions
1445 Flashcards
Source URL: https://quizplus.com/study-set/1297
Page 2
Chapter 1: Nursing Today
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21 Verified Questions
21 Flashcards
Source URL: https://quizplus.com/quiz/25750
Sample Questions
Q1) Nurses working in the Henry Street Settlement in 1893 were among the first nurses to demonstrate autonomy in practice.This was because those nurses
A) Had no ability to work in the hospital setting.
B) Were required to use critical thinking skills.
C) Focused solely on healing the very ill.
D) Planned their care around research findings.
Answer: B
Q2) A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1.The nurse realizes that
A) Legislation is politics beyond the nurse's control.
B) National programs have no bearing on state politics.
C) The individual nurse can influence legislative decisions.
D) Focusing on nursing care provides the best patient benefit.
Answer: C
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3
Chapter 2: The Health Care Delivery System
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) The nurse is evaluating the Falls Program instituted on the medical unit to decrease the number of falls.The number of falls has decreased in the last month.The nurse realizes that
A) The program has been successful and can be terminated.
B) Policies for the program need to be developed or evaluated further.
C) The program evaluation is a nursing-sensitive outcome that can enhance safety.
D) The program results need to be reported to the QI Committee only.
Answer: B,C
Q2) The nurse is caring for a patient who is on Medicare.Because the patient is on Medicare,the nurse is aware that
A) The hospital will be paid for the full cost of the patient's hospitalization.
B) Capitation provides the hospital with a means of recovering variable charges.
C) Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost.
D) Medicare will pay the national average for the patient's condition.
Answer: C
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Chapter 3: Community-Based Nursing Practice
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) The community has three components: structure or locale,the people,and the social systems.While doing a community assessment,the nurse seeks data on the average household income and the number of residents on public assistance.In doing so,the nurse is evaluating which of the following?
A) Structure
B) Population
C) Welfare system
D) Social system
Answer: A
Q2) The patient is in the hospital with the diagnosis of early-onset Alzheimer's disease.Before the patient is discharged,the community-based nurse is making a visit to the patient's home,where he lives with his daughter and her family.A major focus of this visit will be to
A) Demonstrate caregiver techniques for providing care.
B) Stress to the family how difficult it will be to provide care at home.
C) Encourage the family to send the patient to an extended care facility.
D) Teach the family how to have the patient declared incompetent.
Answer: A
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Chapter 4: Theoretical Foundations of Nursing Practice
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20 Flashcards
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Sample Questions
Q1) Nursing has its own body of knowledge that is both theoretical and practical.Which of the following is an example of theoretical knowledge?
A) Reflection on care experiences
B) Synthesis and integration of the art and science of nursing
C) Reflection on basic values and principles
D) Creating a narrow understanding of nursing practice
Q2) The nurse is visiting a patient at home after he was discharged from the hospital following a heart attack.She listens to the patient's concerns about being an invalid for the rest of his life because of his bad heart,but he is afraid of having "open heart" surgery.The nurse explains the different surgical procedures that are available to the patient,as well as other options such as cardiac rehabilitation.After several such visits,the patient states that he believes that cardiac rehabilitation therapy would be best for him,and asks the nurse how he can get in.The nurse calls the patient's physician and sets up a referral for cardiac rehabilitation.This action most closely fits which of the following theories?
A) Peplau's theory
B) Henderson's theory
C) Nightingale's theory
D) Orem's self-care deficit theory
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Chapter 5: Evidence-Based Practice
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22 Verified Questions
22 Flashcards
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Sample Questions
Q1) The hospital quality improvement committee has noted that the incidence of needlestick injuries on a particular unit has increased.When faced with issues,the committee applies the PDSA model,a formal model for exploring and resolving quality concerns.Because the committee is multidisciplinary in nature,and few members are nurses,it is imperative that the committee first A) Plan.
B) Do.
C) Study.
D) Act.
Q2) The nurse is writing a research article on a patient care topic.The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the
A) Abstract.
B) Introduction.
C) Literature review or background.
D) Results.
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Chapter 6: Health and Wellness
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21 Verified Questions
21 Flashcards
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Sample Questions
Q1) The patient is describing moderate incisional pain that was not relieved by the last dose of hydromorphone (Dilaudid)given 90 minutes earlier.The patient is not due for another dose of medication for another 2 1/2 hours.The nurse repositions the patient,asks what type of music she likes,and puts on the music channel on the television,setting it to play that type of music.The nurse is attempting to utilize which health care model?
A) Health Belief Model
B) Health Promotion Model
C) Basic Human Needs Model
D) Holistic Health Model
Q2) The health care model that utilizes Maslow's hierarchy as its base is the _____ Model.
A) Health Belief
B) Health Promotion
C) Basic Human Needs
D) Holistic Health
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Chapter 7: Caring in Nursing Practice
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16 Verified Questions
16 Flashcards
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Sample Questions
Q1) The nurse has cared for a patient for several days.The patient is terminal and is very near death.The nurse notices the heart rate on the monitor decreasing and then the absence of a pattern.The family is standing at the patient's bed,and when the nurse checks the patient and finds no pulse or blood pressure,the family begins sobbing and hugging each other.Some hold the patient's hand.The nurse is overwhelmed by the presence of grief and leaves the room to cry in the nurses' lounge.What is the nurse demonstrating?
A) Task-oriented touch
B) Caring touch
C) Protective touch
D) None of the above
Q2) Caring is a universal phenomenon that influences the ways in which people
A) Learn.
B) Think.
C) Believe.
D) Feel.
E) Behave.
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Page 9
Chapter 8: Caring for the Cancer Survivor
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15 Verified Questions
15 Flashcards
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Sample Questions
Q1) The nurse is caring for a patient who is undergoing chemotherapy and radiation for cancer.The patient says that he can't wait until the therapy is done so that he can feel stronger,and asks the nurse about the value of cancer screening when his course of therapy is over.The nurse should inform the patient that cancer screening
A) Should be done on an ongoing schedule.
B) Probably will not be needed because the patient has been cured.
C) Usually is not done even if recommended by the health care provider.
D) Is not something that the health care provider should recommend.
Q2) The nurse is caring for a patient diagnosed with cancer.The family of the patient asks the nurse for information.What should the nurse do?
A) Refer family members to the physician because it is his/her role to prescribe.
B) Inform them that few options are available.
C) Tell them to take their family member to an NCI cancer center.
D) Offer information about the different resources available.
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Chapter 9: Culture and Ethnicity
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Sample Questions
Q1) Foster (1976)identified two distinct categories of healers cross-culturally.Of the following characteristics,which are congruent with the healing practices of naturalistic practitioners?
A) Illness is impersonal and is due to biological forces.
B) Illness is caused by alterations in the body equilibrium.
C) Sorcerers can cause health and illness.
D) Human relationships should be emphasized.
E) Healing modalities include herbs, massage, and surgery.
Q2) Providing culturally congruent care means providing care that
A) Fits the patient's valued life patterns and set of meanings.
B) Is based on meanings generated by predetermined criteria.
C) Is the same as the values of the professional health care system.
D) Holds one's own way of life as superior to those of others.
Q3) Which statement is true relative to caring for a Hindu patient who is dying?
A) The family will turn his head eastward or to the right.
B) A close kin will stay with the patient to hear his last wishes.
C) Anointing of the sick is a common right of the dying.
D) The family will place a drop of water on the patient's lips.
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11
Chapter 10: Caring for Families
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16 Flashcards
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Sample Questions
Q1) When initiating the care of families,one factor that helps organize the family approach to the nursing process is that the nurse
A) Views all patients as unique individuals.
B) Realizes that families have little impact on individuals.
C) Understands that individuals have little impact on families.
D) Realizes that individuals have an impact on families.
Q2) The nurse is interviewing a patient who is being admitted to the hospital.The patient's family went home before the nurse's interview.The nurse asks the patient,"Who decides where to go on vacation?" In asking this,what is the nurse trying to do?
A) Assess the family structure.
B) Assess the family form.
C) Assess the family function.
D) Make a categorical generalization.
Q3) When focusing on older adults,the nurse must be aware that
A) Elder abuse happens in lower socioeconomic classes only.
B) Elders have the same social networks as younger people.
C) Caregivers may be spouses or middle-age children.
D) Caregiver stress is minimal when caring for a parent.
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Page 12
Chapter 11: Developmental Theories
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20 Flashcards
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Sample Questions
Q1) Jean Piaget's cognitive developmental theory focuses on four stages of development,including
A) Formal operations.
B) Intimacy versus isolation.
C) Latency.
D) The postconventional level.
Q2) Which of these statements would be most appropriate for a nurse to state when assessing an adult patient for growth and developmental delays?
A) "How many times per week do you exercise?"
B) "Are you able to stand on one foot for 5 seconds?"
C) "Would you please describe your usual activities during the day?"
D) "How many hours a day do you spend watching television or sitting in front of a computer?"
Q3) According to Piaget's theory of cognitive development,the nurse should allow a hospitalized 4-year-old patient to safely play with
A) The pump administering intravenous fluids.
B) The blood pressure cuff.
C) A baseball bat.
D) A book to read alone in a quiet place.
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Page 13
Chapter 12: Conception Through Adolescence
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25 Verified Questions
25 Flashcards
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Sample Questions
Q1) During hospitalization,the nurse should encourage the parents of an 8-month-old infant to
A) Provide as much care as possible.
B) Not worry about attachments because the infant is too young to develop them.
C) Remember that infants cannot differentiate a stranger from a familiar person.
D) Relax and allow nursing staff to care for the child at all times.
Q2) The nurse is observing his 2-year-old hospitalized patient in the playroom.The nurse is most likely to observe the child
A) Participating as the leader of a small group activity.
B) Sitting beside another child while playing with blocks.
C) Separating building blocks into groups by size and color.
D) Seeking out same sex children to play with.
Q3) The nursing instructor will need to provide further instruction to the student who states,"Development proceeds
A) In a proximal-distal pattern."
B) In a cephalocaudal pattern."
C) At a slower rate during the embryonic stage."
D) At a predictive rate from the moment of conception."
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Chapter 13: Young and Middle Adults
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) When choosing an appropriate topic for a young adult health fair,the nurse ranks which topic as least relevant?
A) Unplanned pregnancies
B) Menopause and climacteric factors
C) Smoking cessation
D) Alcohol and drug use
Q2) During a routine physical assessment,the nurse obtaining a health history notes that a 50-year-old female patient reports pain and redness in the right breast.What is the nurse's best action in response to this finding?
A) Explain to the patient that breast tenderness is normal at her age.
B) Tell the patient that redness is not a cause for concern and is quite common.
C) Assess the patient as thoroughly as possible.
D) Inform her that redness is the precursor to normal unilateral breast enlargement.
Q3) What do changing norms and values about family life in the United States reveal?
A) Basic shifts in attitudes in our society
B) Greater resistance to cohabitation without marriage
C) Decreased numbers of infants born to unmarried women
D) Greater support and acceptance from the health care system
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Chapter 14: Older Adults
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26 Verified Questions
26 Flashcards
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Sample Questions
Q1) Which of these assessments of an older adult,who has a urinary tract infection,requires an immediate nursing intervention?
A) Presbycusis
B) Confusion
C) Death of a spouse 3 months ago
D) Temperature of 97.6° F
Q2) What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing center?
A) Suggest choosing a nursing center that is as sanitary as possible. The closer the center is to hospital standards, the better.
B) Have family members evaluate nursing home staff according to their ability to get tasks done efficiently.
C) Make sure that nursing home staff members get patients out of bed every day for the entire day.
D) Explain that it is probably best for the family to visit the center and inspect it personally.
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16
Chapter 15: Critical Thinking in Nursing Practice
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20 Flashcards
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Sample Questions
Q1) While caring for a hospitalized older adult female post hip surgery,the new graduate nurse is faced with the task of inserting an indwelling urinary catheter,which involves rotating the hip into a contraindicated position.The nurse exhibits critical thinking to perform this task by
A) Following textbook procedure.
B) Notifying the physician of the need for a urologist consult.
C) Adapting the positioning technique to the situation.
D) Postponing catheter insertion until the next shift.
Q2) A new nurse is pulled from the surgical unit to work on the oncology unit.The nurse displays the critical thinking attitudes of humility and responsibility by
A) Refusing the assignment.
B) Asking for an orientation to the unit.
C) Assuming that patient care will be the same as on the other units.
D) Admitting lack of knowledge and going home.
Q3) Critical thinking characteristics include
A) Considering what is important in a given situation.
B) Accepting one, established way to provide patient care.
C) Making decisions based on intuition.
D) Being able to read and follow physician's orders.
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Page 17
Chapter 16: Nursing Assessment
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20 Flashcards
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Sample Questions
Q1) Which of the following are examples of subjective data?
A) Patient describing excitement about discharge
B) Patient's wound appearance
C) Patient's expression of fear regarding upcoming surgery
D) Patient pacing the floor while awaiting test results
E) Patient's temperature
Q2) A nurse using the problem-oriented approach to data collection will first
A) Complete an observational overview.
B) Disregard cues and complete the database questions in chronological order.
C) Focus on the patient's presenting situation.
D) Make accurate interpretations of the data.
Q3) While interviewing an older female patient of Asian descent,the nurse notices that the patient looks at the ground when answering questions.This nurse should
A) Notify the physician to recommend a psychological evaluation.
B) Consider cultural differences during this assessment.
C) Ask the patient to make eye contact to determine her affect.
D) Continue with the interview and document that the patient is depressed.
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Chapter 17: Nursing Diagnosis
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19 Verified Questions
19 Flashcards
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Sample Questions
Q1) One purpose of using standard formal nursing diagnoses in practice is to
A) Form a language that can be encoded only by nurses.
B) Distinguish the nurse's role from the physician's role.
C) Allow for the communication of patient needs to assistive personnel.
D) Help nurses focus on the scope of medical practice.
Q2) A nurse administers an antihypertensive medication to a patient at the scheduled time of 0900.The nursing assistant then reports to the nurse that the patient's blood pressure was low when it was taken at 0830.The nursing assistant states she was busy and had not had a chance to tell the nurse yet.The patient begins to complain of feeling dizzy and light-headed.The blood pressure is re-checked and it has dropped even lower.The nurse first made an error in what phase of the nursing process?
A) Assessment
B) Diagnosis
C) Planning
D) Evaluation
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19
Chapter 18: Planning Nursing Care
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Sample Questions
Q1) A patient has reduced muscle strength following a left-sided stroke and is at risk for falling.Which intervention is most appropriate for the nursing diagnostic statement,Risk for falls?
A) Encourage patient to remain in bed most of the shift.
B) Keep all side rails down at all times.
C) Place patient in room away from the nurses' station if possible.
D) Assist patient into and out of bed every 6 hours or as tolerated.
Q2) The nurse recognizes that another term for a collaborative nursing intervention is _____ intervention.
A) Dependent
B) Independent
C) Interdependent
D) Physician-initiated
Q3) A registered nurse administers pain medication to a patient suffering from fractured ribs.What type of nursing intervention is this nurse implementing?
A) Collaborative
B) Independent
C) Interdependent
D) Dependent
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Page 20
Chapter 19: Implementing Nursing Care
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23 Verified Questions
23 Flashcards
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Sample Questions
Q1) The nurse defines a clinical guideline or protocol as a
A) Guideline to follow that replaces the nursing care plan.
B) Document that assists the clinician in making decisions and choosing interventions for specific health care problems or conditions.
C) Hospital policy designating each nurse's duty according to standards of care and a code of ethics.
D) Prescriptive order form that individualizes the plan of care.
Q2) A patient visiting with family members in the waiting area tells the nurse that his stomach is not feeling good.Before intervening,what should the nurse do?
A) Ask the patient to return to his room so the nurse can inspect his abdomen.
B) Request that the family leave, so the patient can rest.
C) Ask the patient when his last bowel movement was and to lie down on the sofa.
D) Tell the patient that his dinner tray will be ready in 15 minutes.
Q3) Which intervention is most appropriate for a patient who has a new onset of chest pain?
A) Administer a prn medication for pain.
B) Reassess the patient because of the change in condition.
C) Notify the health care provider.
D) Call radiology for a portable chest x-ray.
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Page 21
Chapter 20: Evaluation
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Sample Questions
Q1) A nurse administrator is at a meeting with nurses on the quality council.Several new members are sitting on the council.They ask the nurse administrator to clarify what a nursing-sensitive outcome is.Which response by the nurse administrator best defines nursing-sensitive outcomes?
A) "Nursing-sensitive outcomes determine the patient's progress as a result of prescribed treatments, such as medications."
B) "Patient falls is an example of a nursing-sensitive outcome because they are directly affected by nursing interventions."
C) "Nursing-sensitive outcomes promote universal health care."
D) "We use nursing-sensitive outcomes at this hospital to evaluate nursing tasks and to determine safe staffing ratios."
Q2) Which of these options is a patient outcome indicating positive progress toward resolving the nursing diagnosis of Acute confusion?
A) Side rails are up with bed alarm activated.
B) Patient denies pain while ambulating with assistance.
C) Patient wanders halls at night.
D) Patient correctly states names of family members in the room.
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Page 22
Chapter 21: Managing Patient Care
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Sample Questions
Q1) A nurse manager conducts rounds on the unit and discovers that expired stock medicine is still in the cabinet despite the e-mail she sent stating that it had to be discarded.The staff nurse dress code is not being adhered to,and the staff lounge is not kept neat and tidy as she requested in the same e-mail.Several staff nurses deny having received the e-mail.After evaluating this situation,one way the nurse manager could resolve the issue is to
A) Include the findings on each staff member's annual evaluation.
B) Close the staff lounge.
C) Enforce a stricter dress code.
D) Place a hard copy of announcements and unit policies in each staff member's mailbox.
Q2) Which of these approaches would be most appropriate for a nurse to take when faced with the challenge of performing many tasks in one shift?
A) Evaluate the effectiveness of all tasks when all tasks are completed.
B) Delegate tasks the nurse does not like doing.
C) Do as much as possible by oneself before seeking assistance from others.
D) Complete one task before starting another task.
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Chapter 22: Ethics and Values
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Sample Questions
Q1) Ethical dilemmas are common occurrences when caring for patients.The nurse understands that dilemmas are a result of
A) Presence of conflicting values.
B) Hierarchical systems.
C) Judgmental perceptions of patients.
D) Poor communication with the patient.
Q2) The nurse has become aware of missing narcotics in the patient care area.Which ethical principle obligates the nurse to report the missing medications?
A) Advocacy
B) Responsibility
C) Confidentiality
D) Accountability
Q3) The patient's son requests to view the documentation in his mother's medical record.What is the nurse's best response to this request?
A) "I'll be happy to get that for you."
B) "You will have to talk to the physician about that."
C) "You will need your mother's permission."
D) "You are not allowed to see it."
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24
Chapter 23: Legal Implications in Nursing Practice
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Sample Questions
Q1) A 17-year-old patient,dying of heart failure,wants to have his organs removed for transplantation after his death.What action by the nurse is correct?
A) Prepare the organ donation form for the patient to sign while he is still oriented.
B) Instruct the patient to talk with his parents about his desire to donate his organs.
C) Notify the physician about the patient's desire to donate his organs.
D) Contact the United Network for Organ Sharing after talking with the patient.
Q2) A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier.The nursing student says,"I don't understand what the big deal is.As my instructor,you are there to protect me and make sure I don't make mistakes." What is the best response from the nursing instructor?
A) "You are expected to perform at the level of a professional nurse."
B) "You are expected to perform at the level of a nursing student."
C) "You are practicing under the license of the nurse assigned to the patient."
D) "You are expected to perform at the level of a skilled nursing assistant."
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25
Chapter 24: Communication
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Sample Questions
Q1) A patient was admitted 2 days ago with pneumonia and a history of angina.The patient is now having chest pain with a pulse rate of 108.Using the SBAR,which piece of data will the nurse use for B?
A) Having chest pain
B) Pulse rate of 108
C) History of angina
D) Oxygen is needed.
Q2) During the initial home visit,a home health nurse lets the patient know that the visits are expected to end in about a month.The nurse is in which phase of the helping relationship?
A) Pre-interaction
B) Orientation
C) Working
D) Termination
Q3) A nurse uses SBAR during hand-offs.The purpose of SBAR is to
A) Use common courtesy.
B) Establish trustworthiness.
C) Promote autonomy.
D) Standardize communication.
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Page 26
Chapter 25: Patient Education
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Sample Questions
Q1) After a teaching session on taking blood pressures,the nurse tells the patient,"You took that blood pressure like an experienced nurse." What type of reinforcement did the nurse use?
A) Material
B) Activity
C) Social
D) Entrusting
Q2) A patient has been taught how to change a colostomy bag but is having trouble measuring and manipulating the equipment and has many questions.What is the nurse's next action?
A) Refer to a mental health specialist.
B) Refer to an ostomy specialist.
C) Refer to a dietitian.
D) Refer to a wound care specialist.
Q3) When the nurse describes a patient's perceived ability to successfully complete a task,which term should the nurse use?
A) Self-efficacy
B) Motivation
C) Attentional set
D) Active participation
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Chapter 26: Documentation and Informatics
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Sample Questions
Q1) A nurse prepared an audiotaped exchange with another nurse of information about a patient.Which action did the nurse complete? The nurse completed a A) Report.
B) Record.
C) Consultation.
D) Referral.
Q2) A nurse needs to begin discharge planning for a patient admitted with pneumonia and a congested cough.When is the best time the nurse should start discharge planning for this patient?
A) Upon admission
B) Right before discharge
C) After the congestion is treated
D) When the primary care provider writes the order
Q3) A patient is being discharged home.Which information should the nurse include?
A) Acuity level
B) Community resources
C) Standardized care plan
D) Kardex
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28
Chapter 27: Patient Safety
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Sample Questions
Q1) The nurse enters the patient's room and notices a small fire in the headlight above the patient's bed.Immediately,the nurse assigns a nursing diagnosis of risk for injury with a goal for the patient to be safe.Which of the following actions should the nurse take first?
A) Activate the alarm.
B) Extinguish the fire.
C) Remove the patient.
D) Confine the fire.
Q2) A nurse is teaching a community group of school-aged parents about safety.The most important item to prioritize and explain is how to check the proper fit of A) a bicycle helmet.
B) swimming goggles.
C) soccer shin guards.
D) baseball sliding shorts.
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Chapter 28: Infection Prevention and Control
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46 Verified Questions
46 Flashcards
Source URL: https://quizplus.com/quiz/25777
Sample Questions
Q1) The nurse is caring for an adult patient in the clinic who has been evacuated and is a victim of flooding.The patient presents with signs and symptoms of a urinary tract infection.Along with needed education surrounding this diagnosis,the nurse teaches the patient about rest,exercise,eating properly,and how to utilize deep breathing and visualization.Which of these explanations would best support these nursing interventions?
A) Urinary tract infections are painful, and these techniques would help with managing the pain.
B) Interventions listed are standard topics taught during health care visits.
C) Stress for long periods of time can lead to exhaustion and decreased resistance to infection.
D) The patient requested this information to teach to extended family at home.
Q2) The nurse is providing an education session to an adult community group about the effects of smoking.Which of the following is the most important point to be included in the educational session?
A) Smoke from tobacco products clings to your clothing and hair.
B) Smoking affects the cilia lining the upper airways in the lungs.
C) Smoking tobacco products can be very expensive.
D) Smoking can affect the color of the patient's fingernails.
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Page 30
Chapter 29: Vital Signs
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46 Verified Questions
46 Flashcards
Source URL: https://quizplus.com/quiz/25778
Sample Questions
Q1) The patient is found to be unresponsive and not breathing.To determine the presence of central blood circulation and circulation of blood to the brain,the nurse checks the patient's _____ pulse.
A) Radial
B) Brachial
C) Posterior tibial
D) Carotid
Q2) The patient requires temperatures to be taken every two hours.Which of the following cannot be delegated to nursing assistive personnel?
A) Selecting appropriate route and device
B) Obtaining temperature measurement at ordered frequency
C) Being aware of the usual values for the patient
D) Assessing changes in body temperature
Q3) The posterior hypothalamus helps control temperature by
A) Causing vasoconstriction.
B) Shunting blood to the skin and extremities.
C) Increasing sweat production.
D) Causing vasodilation.
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Chapter 30: Health Assessment and Physical Examination
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40 Verified Questions
40 Flashcards
Source URL: https://quizplus.com/quiz/25779
Sample Questions
Q1) An advanced practice nurse is preparing to assess the external genitalia of a 25-year-old American woman of Chinese descent.Which of the following nursing actions does the nurse do first?
A) Place the patient in the lithotomy position.
B) Drape the patient to enhance patient comfort.
C) Assess the patient's feelings and explain the purpose of the examination.
D) Ask the patient if she would like her mother to be present in the room during the examination.
Q2) A nurse is assessing a patient's hearing.Which of the following items does the nurse gather before conducting the assessment?
A) Tuning fork
B) Ophthalmoscope
C) Cotton-tipped applicator
D) Current list of medications
E) Snellen chart
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Chapter 31: Medication Administration
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50 Flashcards
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Sample Questions
Q1) A patient needs assistance excreting a gaseous medication.What is the correct nursing action?
A) Encourage the patient to cough and deep-breathe.
B) Suction the patient's respiratory secretions.
C) Administer the antidote via inhalation.
D) Administer 100% FiO<sub>2</sub> via simple face mask.
Q2) A patient is in need of immediate pain relief for a severe headache.The nurse knows that which medication will be absorbed the quickest?
A) Tylenol 650 mg PO
B) Morphine 4 mg SQ
C) Ketorolac (Toradol) 8 mg IM
D) Hydromorphone (Dilaudid) 4 mg IV
Q3) A drug requires a low pH to be metabolized.Knowing this,the nurse anticipates that the medication will be administered by which route?
A) Oral
B) Parenteral
C) Buccal
D) Inhalation
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Chapter 32: Complementary and Alternative Therapies
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20 Verified Questions
20 Flashcards
Source URL: https://quizplus.com/quiz/25781
Sample Questions
Q1) Drawbacks of complementary and alternative therapies would be all of the following except
A) Lack of evidence-based guidelines.
B) Minimal supportive research studies.
C) Strong support by allopathic medical providers.
D) Lack of a long tradition of therapies taught in health care education.
Q2) The therapy that is more effective in treating physical ailments than in preventing disease or managing chronic illness is _____ medicine.
A) Allopathic
B) Complementary
C) Alternative
D) Mind-body
Q3) A patient asks about the new clinic in town that is staffed by allopathic and complementary practitioners.The nurse recognizes that the patient is most likely asking about which clinic?
A) Integrative medical clinic
B) Ayurvedic clinic
C) Naturopathic medical clinic
D) Healing intention clinic
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Page 34
Chapter 33: Self-Concept
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20 Flashcards
Source URL: https://quizplus.com/quiz/25782
Sample Questions
Q1) A nurse who grimaces when seeing a patient's colostomy opening while changing the colostomy bag is most likely to have what effect on the patient?
A) Assist recovery by using honest communication.
B) Motivate the patient to increase physical activity.
C) Promote development of a negative body image.
D) Develop a kind nickname for the colostomy opening.
Q2) A 9-year-old is proudly telling everyone about mastering the yellow belt in her martial arts class.Identify the appropriate developmental task.
A) Initiative versus guilt
B) Industry versus inferiority
C) Identity versus role confusion
D) Autonomy versus shame and doubt
Q3) Based on current evidence,the nurse who plans smoking cessation interventions for adolescent girls should focus on interventions directed toward
A) Obeying parents and reducing television viewing.
B) Fostering generativity over self-absorption.
C) Role overload, addiction counseling, and depression.
D) Weight management, self-esteem, and stress management.
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Chapter 34: Sexuality
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23 Verified Questions
23 Flashcards
Source URL: https://quizplus.com/quiz/25783
Sample Questions
Q1) A patient has been hospitalized from a motor vehicle accident for the past month.The nurse notices that the patient has been becoming withdrawn and asks the patient if something is upsetting him.The patient confides to the nurse that he wants to have sex with his spouse but is afraid to in a hospital.How should the nurse proceed?
A) Arrange a schedule with the patient to allow for intimacy at a time when the patient is well rested and able to participate in activity.
B) Educate the patient about the dangers of strenuous activity in his condition.
C) Ask the patient if it would be okay to have a monitor on in the room for his safety.
D) Stress the importance of using barrier contraceptives to prevent infection because he is already susceptible.
Q2) A patient admits that he knew for several months that he had an STI but did not report it.The nurse knows that this is because many people with STIs
A) Do not acknowledge the importance of STI testing and treatment.
B) Are hesitant to admit they contracted an STI.
C) Have lifestyles that subject them to repeated exposure.
D) Are uncomfortable discussing sexual health issues with a same-sex provider.
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Chapter 35: Spiritual Health
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20 Verified Questions
20 Flashcards
Source URL: https://quizplus.com/quiz/25784
Sample Questions
Q1) The patient is admitted with chronic back pain.The nurse who is caring for this patient should
A) Focus on finding quick remedies for the back pain.
B) Look at how pain influences the patient's ability to function.
C) Realize that the patient's only goal is relief of the back pain.
D) Help the patient realize that there is little hope of relief from chronic pain.
Q2) In discussing spiritual well-being,the nurse identifies that the vertical dimension involves
A) The positive relationships and connections people have with others.
B) The transcendent relationship between a person and God.
C) Confidence in something for which there is no proof.
D) Providing an attitude of something to live for and look forward to.
Q3) The nurse creates a referral to pastoral care when he/she realizes that the patient is in need of
A) Psychiatric care.
B) Return to religious affiliation.
C) Spiritual care.
D) Transfer to the psychiatric unit.
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Chapter 36: The Experience of Loss, death, and Grief
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Sample Questions
Q1) The nurse has had three patients die during the past 2 days.Which approach is most appropriate to manage the nurse's sadness?
A) Telling the next patients why the nurse is sad
B) Talking with a colleague or writing in a journal
C) Exercising vigorously rather than sleeping
D) Avoiding friends until the nurse feels better
Q2) An Orthodox Jewish Rabbi has been pronounced dead.The nursing assistant respectfully asks family members to leave the room and go home as postmortem care is provided.Which of the following statements from the supervising nurse reflects correct knowledge of Jewish culture?
A) "I wish they would go home because we have work to do here."
B) "Family members stay with the body until burial the next day."
C) "I should have called a male colleague to handle the body."
D) "I thought they would quietly leave after praying and touching the Rabbi's head."
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Chapter 37: Stress and Coping
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20 Verified Questions
20 Flashcards
Source URL: https://quizplus.com/quiz/25786
Sample Questions
Q1) The purpose of unconscious ego defense mechanisms is to do which of the following for the individual?
A) Protect against feelings of worthlessness and anxiety.
B) Facilitate the use of problem-focused coping.
C) Evaluate an event for its personal meaning.
D) Trigger the stress control functions of the medulla oblongata.
Q2) A person states that he was not shoplifting from the store despite very clear evidence on the store surveillance tape.This person is demonstrating which ego defense mechanism?
A) Dissociation
B) Conversion
C) Denial
D) Compensation
Q3) Identify a sociocultural factor that can lead to developmental problems.
A) Family relocation
B) Childhood obesity
C) Prolonged poverty
D) Loss of stamina
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Chapter 38: Activity and Exercise
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) Isotonic,isometric,and resistive isometric are three categories of exercise.They are classified according to the type of muscle contraction involved.Of the following exercises,which are considered isotonic?
A) Bicycling, swimming, walking, jogging, dancing
B) Tightening or tensing of muscles without moving body parts
C) Push-ups, hip lifting, pushing feet against a footboard on the bed
D) Quadriceps set exercises and contraction of the gluteal muscles
Q2) The patient is eager to begin his exercise program with a 2-mile jog.The nurse instructs the patient to warm up with stretching exercises.The patient states that he is ready and does not want to waste time with a "warm-up." The nurse explains that the warm-up
A) Allows the body to readjust gradually to baseline functioning.
B) Prepares the body and decreases the potential for injury.
C) Should not involve stretching exercises because they can lead to injury.
D) Should be performed with high intensity to prepare for the coming challenge.
Q3) In assisting the patient to exercise,the nurse should
A) Expect that pain will occur with exercise of unused muscle groups.
B) Set the pace for the exercise class.
C) Force muscles or joints to go just beyond resistance.
D) Stop the exercise if pain is experienced.
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Chapter 39: Hygiene
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50 Verified Questions
50 Flashcards
Source URL: https://quizplus.com/quiz/25788
Sample Questions
Q1) The nurse is caring for an unresponsive patient who has a nasogastric tube in place for continuous tube feedings.The nurse assesses the patient's oral hygiene because good oral hygiene
A) Helps prevent gingivitis.
B) May cause glossitis.
C) May lead to halitosis.
D) Causes tongue coating.
Q2) The unconscious patient is resisting attempts by the nurse to provide oral hygiene.To provide the needed care,the nurse may
A) Insert an oral airway upside down.
B) Hold the patient's mouth open with her fingers.
C) Position the patient on his back.
D) Use undiluted hydrogen peroxide as a cleaner.
Q3) The nurse is caring for a patient who is immobile.The nurse is aware that the patient is at risk for Impaired skin integrity because
A) Pressure reduces circulation to affected tissue.
B) Patients with limited caloric intake develop thicker skin.
C) Inadequate blood flow leads to decreased tissue ischemia.
D) Local nerve damage leads to pain sensation.
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Page 41
Chapter 40: Oxygenation
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48 Verified Questions
48 Flashcards
Source URL: https://quizplus.com/quiz/25789
Sample Questions
Q1) Which nursing diagnosis is the priority when caring for a patient with a traumatic brain injury who had a tracheostomy placed?
A) Risk for skin breakdown
B) Impaired gas exchange
C) Ineffective airway clearance
D) Risk for infection
Q2) The nurse determines that an elderly patient is at risk for infection due to decreased immunity.Which plan of care best addresses the prevention of infection for the patient?
A) Encourage the patient to stay up to date on all vaccinations.
B) Inform the patient of the importance of finishing the entire dose of antibiotics.
C) Schedule patient to get annual tuberculosis skin testing.
D) Create an exercise routine to run 30 minutes every day.
Q3) The nurse would expect a patient with right-sided heart failure to have which of the following?
A) Peripheral edema
B) Basilar crackles
C) Chest pain
D) Cyanosis
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Chapter 41: Fluid, electrolyte, and Acid-Base Balance
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45 Verified Questions
45 Flashcards
Source URL: https://quizplus.com/quiz/25790
Sample Questions
Q1) A patient informs the nurse that he has the type of diabetes that does not require insulin.The nurse advises the patient to make which dietary change?
A) Drink plenty of fluids throughout the day to stay hydrated.
B) Avoid food high in acid to avoid metabolic acidosis.
C) Reduce the quantity of carbohydrates ingested to lower blood sugar.
D) Include a serving of dairy in each meal to elevate calcium levels.
Q2) The nurse is caring for a diabetic patient in renal failure.Which laboratory findings would the nurse expect?
A) pH 7.3, PaCO<sub>2</sub> 36 mm Hg, HCO<sub>3</sub><sup>- </sup>19 mEq/L
B) pH 7.5, PaCO<sub>2</sub> 35 mm Hg, HCO<sub>3</sub><sup>- </sup>35 mEq/L
C) pH 7.3, PaCO<sub>2</sub> 47 mm Hg, HCO<sub>3</sub><sup>- </sup>23 mEq/L
D) pH 7.35, PaCO<sub>2</sub> 40 mm Hg, HCO<sub>3</sub><sup>- </sup>25 mEq/L
Q3) The nurse would expect a patient with respiratory acidosis to have an excessive amount of
A) Carbon dioxide.
B) Bicarbonate.
C) Oxygen.
D) Phosphate.
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43
Chapter 42: Sleep
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30 Flashcards
Source URL: https://quizplus.com/quiz/25791
Sample Questions
Q1) A patient has received a nursing diagnosis of sleep deprivation.Which of the following statements by the patient would indicate that outcomes are being met?
A) "I wake up only once a night to go the bathroom."
B) "I feel rested when I wake up in the morning."
C) "I go to sleep within 30 minutes of lying down."
D) "I only take a 20-minute nap during the day."
Q2) The patient and the nurse discuss the need for sleep.After the discussion,the patient is able to state factors that hinder sleep.Which statements indicate that the patient has a good understanding of sleep?
A) "Drinking coffee at 7 PM could interrupt my sleep."
B) "Worry about work can disrupt my sleep."
C) "Exercising 2 hours before bedtime can decrease relaxation."
D) "Changing the time of day that I eat dinner can disrupt sleep."
E) "Taking an antacid can decrease sleep."
F) "Staying up late for a party can interrupt sleep patterns."
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44
Chapter 43: Pain Management
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) The nurse is administering pain medication for several patients.Which patient does the nurse administer medication to first?
A) The patient who needs to take a scheduled dose of maintenance pain medication
B) The patient who needs to be premedicated before walking
C) The patient with a PCA running who needs to have the syringe replaced
D) The patient who is experiencing 8/10 pain and has a STAT order for pain medication
Q2) The nurse recognizes that which of the following is a modifiable contributor to a patient's perception of pain?
A) Age and gender
B) Anxiety and fear
C) Culture
D) Previous pain experience
Q3) Which of the following is the best way for the nurse to manage pain for a patient with chronic pain from arthritis?
A) Administer pain medication before any activity.
B) Provide intravascular bolus as needed for breakthrough pain.
C) Give medications around-the-clock.
D) Administer pain medication only when nonpharmacological measures have failed.
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Chapter 44: Nutrition
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45 Flashcards
Source URL: https://quizplus.com/quiz/25793
Sample Questions
Q1) The patient has been diagnosed with cardiovascular disease and placed on a low-fat diet.The patient asks the nurse,"How much fat should I have? I guess the less fat,the better." The nurse needs to explain that
A) Fats have no significance in health and the incidence of disease.
B) All fats come from external sources so can be easily controlled.
C) Deficiencies occur when fat intake falls below 10% of daily nutrition.
D) Vegetable fats are the major source of saturated fats and should be avoided.
Q2) The patient has a calculated body mass index (BMI)of 34.This would classify the patient as
A) Unclassifiable.
B) Normal weight.
C) Overweight.
D) Obese.
Q3) The patient has just started on enteral feedings but is complaining of abdominal cramping.The nurse should
A) Slow the rate of tube feeding.
B) Instill cold formula to "numb" the stomach.
C) Place the patient in a supine position.
D) Change the tube feeding to a high-fat formula.
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Page 46
Chapter 45: Urinary Elimination
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44 Flashcards
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Sample Questions
Q1) A patient is having difficulty voiding in a bedpan but states that she feels her bladder is full.To stimulation micturition,which nursing intervention should the nurse try first?
A) Exiting the room and informing the patient that the nurse will return in 30 minutes to check on the patient's progress
B) Utilizing the power of suggestion by turning on the faucet and letting the water run
C) Obtaining an order for a Foley catheter
D) Administering diuretic medication
Q2) A patient is experiencing oliguria.Which action should the nurse perform first?
A) Increase the patient's intravenous fluid rate.
B) Encourage the patient to drink caffeinated beverages.
C) Assess for bladder distention.
D) Request an order for diuretics.
Q3) When establishing a diagnosis of altered urinary elimination,the nurse should first
A) Establish normal voiding patterns for the patient.
B) Encourage the patient to flush kidneys by drinking excessive fluids.
C) Monitor patients' voiding attempts by assisting them with every attempt.
D) Discuss causes and solutions to problems related to micturition.
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Page 47
Chapter 46: Bowel Elimination
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40 Verified Questions
40 Flashcards
Source URL: https://quizplus.com/quiz/25795
Sample Questions
Q1) While a cleansing enema is administered to an 80-year-old patient,the patient expresses the urge to defecate.What is the next priority nursing action?
A) Positioning the patient in the dorsal recumbent position with a bed pan
B) Assisting the patient to the bedside commode
C) Stopping the enema cleansing and rolling the patient into right-lying Sims' position
D) Inserting a rectal plug to contain the enema solution
Q2) The nurse would expect the least formed stool to be present in which portion of the digestive tract?
A) Ascending
B) Descending
C) Transverse
D) Sigmoid
Q3) The nurse is emptying an ileostomy pouch for a patient.Which assessment finding would the nurse report immediately?
A) Liquid consistency of stool
B) Presence of blood in the stool
C) Noxious odor from the stool
D) Continuous output from the stoma
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Chapter 47: Mobility and Immobility
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48 Flashcards
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Sample Questions
Q1) The nurse is assessing body alignment for a patient who is immobilized.To do this,the nurse must
A) Place the patient in the supine position.
B) Remove the pillow from under the patient's head.
C) Insert positioning supports to help the patient.
D) Place the patient in a lateral position.
Q2) The nurse is caring for a patient who has had a stroke causing total paralysis of the right side.To help maintain joint function and to prevent contractures,passive ROM will be initiated.When should therapy begin?
A) After the acute phase of the disease has passed
B) As soon as the ability to move is lost
C) Once the patient enters the rehab unit
D) No ROM is needed.
Q3) The patient is being admitted to the neurological unit with the diagnosis of stroke.The nurse should begin discharge planning
A) At the time of admission.
B) The day before the patient is to be discharged.
C) As soon as the patient's discharge destination is known.
D) When outpatient therapy will no longer be needed.
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Page 49
Chapter 48: Skin Integrity and Wound Care
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50 Verified Questions
50 Flashcards
Source URL: https://quizplus.com/quiz/25797
Sample Questions
Q1) The nurse is caring for a patient with a stage III pressure ulcer.The nurse has assigned a nursing diagnosis of Risk for infection.Which intervention would be most important for this patient?
A) Teach the family how to manage the odor associated with the wound.
B) Discuss with the family how to prepare for care of the patient in the home.
C) Encourage thorough handwashing of all individuals caring for the patient.
D) Encourage increased quantities of carbohydrates and fats.
Q2) The nurse is caring for a medical-surgical patient.To decrease the risk of pressure ulcers and encourage the patient's willingness and ability to increase mobility,which intervention is most important for the nurse to complete?
A) Encourage the patient to sit up in the chair.
B) Provide analgesic medication as ordered.
C) Explain the risks of immobility to the patient.
D) Turn the patient every 3 hours while in bed.
Q3) The nurse is completing an assessment of the skin's integrity,which includes
A) Pressure points.
B) All pulses.
C) Breath sounds.
D) Bowel sounds.
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Page 50
Chapter 49: Sensory Alterations
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29 Verified Questions
29 Flashcards
Source URL: https://quizplus.com/quiz/25798
Sample Questions
Q1) Which of the following sensory changes are normal with aging?
A) Impaired night vision
B) Difficulty hearing low pitch
C) Increase in taste discrimination
D) Heightened sense of smell
Q2) Which nursing diagnosis addresses psychological concerns for a patient with both hearing and visual sensory impairment?
A) Self-care deficit
B) Risk for falls
C) Social isolation
D) Impaired physical mobility
Q3) The nurse is caring for a patient with expressive aphasia from a traumatic brain injury.Which desired outcome should be included in the plan of care?
A) Patient will recover full use of speech vocabulary in 1 week.
B) Patient will carry a pen and a pad of paper around for communication.
C) Patient will thicken drinks to prevent aspiration.
D) Patient will communicate nonverbally.
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Chapter 50: Care of Surgical Patients
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45 Flashcards
Source URL: https://quizplus.com/quiz/25799
Sample Questions
Q1) During preoperative assessment for a 7:30 case,the patient indicates to the nurse that he had a cup of coffee this morning.The nurse reports this information to the anesthesia provider anticipating
A) A delay in or cancellation of surgery.
B) Questions regarding components of the coffee.
C) Additional questions about why the patient had coffee.
D) Instructions to determine what education was provided in the preoperative visit.
Q2) The nurse and the nursing assistant are caring for a group of postoperative patients who need turning,coughing,deep breathing,incentive spirometer,and leg exercises.The nurse directs the nursing assistant to
A) Teach and demonstrate postoperative exercises.
B) Inform the nurse if the patient is unwilling to perform exercises.
C) Document in the medical record when exercises are completed.
D) Do nothing associated with postoperative exercises.
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