Chapter 1--The Health Care System and Contemporary Nursing MULTIPLE CHOICE 1. The nurse ensures that a client’s bedspace is neat and clean with the call light within easy reach. The nurse is focusing on which nursing theorist who realized the importance of the environment for care? 1. Florence Nightingale 2. Sister Callista Roy 3. Dorothea Orem 4. Martha Rogers ANS: 1 Florence Nightingale’s theory focused on the environment for care. Sister Callista Roy’s model is based in systems theory and an individual’s ability to adapt. Dorothea Orem’s model is the self-care deficit theory. Martha Roger’s model is the science of unitary human beings. PTS: 1 DIF: Apply REF: Emergence of Contemporary Nursing in the United States 2. The nurse is instructing a client on self-administration of insulin so that the client will not need a health care provider to do this activity. The nurse is implementing which of the following aspects of Virginia Henderson’s theory of nursing? 1. A caring relationship 2. Helping the client achieve independence from the nurse’s assistance as quickly as possible 3. Integration of objective and subjective data 4. Application of critical thinking ANS: 2 Virginia Henderson’s theory of nursing is to help people achieve health or a peaceful death so that they can be independent from the nurse’s assistance as quickly as possible. A caring relationship, integration of objective and subjective data, and application of critical thinking are included in the American Nurses Association’s essential features of professional nursing. PTS: 1 DIF: Analyze REF: Emergence of Contemporary Nursing in the United States 3. A client tells the nurse that he has an HMO for his health insurance. The nurse understands that the purpose of this type of health plan is to: 1. ensure payment is made to Medicare for services rendered. 2. maximize the utilization of health care resources. 3. efficiently manage costs while providing quality care. 4. focus on the illness when providing care. ANS: 3 Health maintenance organizations (HMOs) were created to efficiently manage health care costs while providing quality care. An HMO is a type of managed care plan with the goal of providing wellness care and not focusing on the illness during the provision of care. HMOs do not ensure payment is made to Medicare for services rendered. HMOs also do not maximize the utilization of health care resources but rather uses financial incentives to decrease care costs. PTS: 1
DIF: Understand
REF: Cost of Care
4. A client tells the nurse that he does not have a primary care physician but rather makes an appointment with a doctor who specializes in the area in which he is experiencing a problem. The nurse realizes this client is at risk for which of the following? 1. Fragmented care 2. Overpayment of services 3. Inability to sustain health 4. Finding an appropriate general practitioner ANS: 1 In the 1980s, the close and trusting relationship between an individual and the individual’s physician waned and was replaced by acquaintances with specialists based upon particular health care problems. These episodes of care cause fragmentation of care. The client who utilizes specialists is not at risk for overpayment of services, the inability to sustain health, or finding an appropriate general practitioner. PTS: 1
DIF: Analyze
REF: Providers of Care
5. The nurse is attending a master’s degree program in efforts to be educationally prepared to serve as a hospital leader. The nurse realizes that this educational preparation will: 1. hinder the nurse’s ability to work with physicians. 2. be viewed as not supporting the profession of nursing by other nurses. 3. ensure the nurse is biased towards clinicians’ interests. 4. prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. ANS: 4 The nurse is attending an educational program to serve as a hospital leader. This education will prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. This education will not hinder the nurse’s ability to work with physicians. This education will not be viewed as unsupportive to the profession of nursing. The education will ensure that the nurse is not biased towards clinicians’ interests. PTS: 1
DIF: Analyze
REF: Clinical Systems Leadership
6. A client tells the nurse that all hospitals care about is doing the minimum for a client regardless of the outcome. Which of the following should the nurse respond to this client? 1. “It does feel like that sometimes.” 2. “Health insurance companies have caused this problem.” 3. “The doctors will get paid regardless of the clients’ outcomes.” 4. “There are quality programs in place to make sure clients receive the best quality of care regardless of the cost.” ANS: 4 In response to concerns about safety and quality of care voiced by clients and providers, total quality management and continuous quality improvement programs were initiated. These programs ensure society that cost management is not compromising safety or quality. This is what the nurse should respond to the client. The other choices do not address the client’s concerns nor do they explain quality management programs. PTS: 1
DIF: Apply
REF: Quality Measure Shift
7. The nurse is providing care at a time that is the most beneficial to the client. The nurse is implementing which of the following Joint Commission Dimensions of Quality Performance? 1. Safety 2. Timeliness 3. Efficiency
4. Availability ANS: 2 The dimension of timeliness means the degree in which interventions are provided at the most beneficial time to the client. Safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. Efficiency means the degree in which care has the desired effect with a minimum of effort, waste, or expense. Availability means the degree in which appropriate interventions are available to meet the client’s needs. PTS: 1 DIF: Analyze REF: Box 1-1 Joint Commission Dimensions of Quality Performance 8. The nurse is providing care while adhering to safety as a Joint Commission Dimension of Quality Performance. Which of the following did the nurse provide to the client? 1. Using a needleless device when providing intravenous medications 2. Keeping the siderails of the bed in the down position after providing a pain medication to a client 3. Having the client sit in a wheelchair with the wheels in the unlocked position 4. Placing cloth towels over a spill in the room of an ambulatory client ANS: 1 The dimension of safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. The nurse who uses a needleless device when providing intravenous medications is adhering to this dimension. Keeping the siderails in the down position is not a safe practice. Having a client sit in a wheelchair with the wheels unlocked is not a safe practice. Placing cloth towels over a spill in the room of an ambulatory client is not a safe practice. PTS: 1 DIF: Analyze REF: Box 1-1 Joint Commission Dimensions of Quality Performance 9. The nurse is planning and providing care while adhering to the American Nurses Association definition of professional nursing. Which of the following does the nurse include when implementing client care? 1. Follows the NANDA nursing diagnoses process 2. Integrates objective and subjective data 3. Respects cultural diversity of peers 4. Acknowledges the experience and training of physicians ANS: 2 The American Nurses Association acknowledges six essential features of professional nursing. These include: 1) a caring relationship, 2) attention to the full range of human health and illness experiences, 3) integrates objective and subjective data, 4) applies scientific knowledge and critical thinking, 5) advances nursing knowledge through scholarly inquiry, and 6) promotes social justice. The nurse integrating objective and subjective data is implementing one of the six essential features of professional nursing. The other choices are not essential features of professional nursing. PTS: 1 DIF: Analyze REF: Emergence of Contemporary Nursing in the United States 10. The nurse has shifted her practice from an illness focus to a health focus. Which of the following has this nurse implemented? 1. Standardized care plans 2. Critical pathways 3. Instructing a client on relaxation techniques to aid with sleep
4. Holding around-the-clock medication when a client is asleep ANS: 3 The use of client education as a strategy to attain and maintain the potential for health is an example of the shift of care from an illness focus to a health focus. The nurse instructing a client on relaxation techniques to aid with sleep is implementing a health focus of care. The other choices do not support the shift from an illness focus to a health focus. PTS: 1
DIF: Analyze
REF: Leadership
11. A client is admitted with a highly communicable disease. The nurses do not want to participate in the care of this client. Which of the following should be done to ensure the client receives the highest quality of care? 1. Adhere to strict standard precautions. 2. Plan to have the client transferred to another health care organization. 3. Ask the physician if the client can be cared for in the home. 4. Suspend the nurses without pay who refuse to care for the client. ANS: 1 When providing care in a highly global environment, the risks of communicable diseases increases. In the event that a client is admitted with a highly communicable disease and the nurses are fearing for their own health and safety, the only safe approach is to ensure all staff adhere to strict standard precautions. The other choices do not ensure that the client will receive the highest quality of care. The nurses must learn emotional intelligence and resolve issues under fire. PTS: 1
DIF: Analyze
REF: Globalization
12. The nurse has been an employee of an organization for 2 years and is considering a job change. Which of the following does this nurse’s plan suggest to any future employers? 1. The nurse moves to other jobs too frequently. 2. The nurse is inflexible. 3. The nurse is searching for a more challenging environment with career opportunities. 4. The nurse is willing to sacrifice home and personal life for a job. ANS: 3 At one point in time, job changes every 2 or 3 years was considered a red flag for employers. This does not hold true today. The nurse who changes jobs every 2 or 3 years is interested in career advancement and success. Creativity is valued and opportunities are desired. Moving to another job in 2 to 3 years does not mean the nurse is inflexible. The new generation of nurses does not want to sacrifice home and personal life for a job. PTS: 1
DIF: Analyze
REF: Care Delivery Models
13. The nurse is experiencing pain and fatigue in both arms when using the computer to document client care. Which of the following can the nurse do to reduce these symptoms? 1. Refuse to use the computer and document using a pen and paper. 2. Stand up when using the computer. 3. Adjust the keyboard and chair to reduce the pressure on the wrists and arms. 4. Ask another nurse to input the information for client care activities. ANS: 3
Ergonomic hazards are increasing with health care providers and nurses in particular. Many of these hazards are because of the implementation of computers for documentation. The nurse should adjust the keyboard and chair to reduce the pressure on the wrists and arms when documenting with the computer. The nurse cannot refuse to use the computer. Standing up may not reduce the nurse’s symptoms. The nurse cannot legally ask another nurse to document client care. PTS: 1
DIF: Apply
REF: Ergonomic Hazards
MULTIPLE RESPONSE 1. The nurse is planning care for a client and reviewing appropriate educational materials to use for discharge instructions. Which domains of nursing is this nurse implementing? (Select all that apply.) 1. Nursing process 2. Clinical practice 3. Education 4. Literature 5. Administration 6. Research ANS: 2, 3 The four domains of nursing are: 1) clinical practice, 2) education, 3) administration, and 4) research. When the nurse plans care for a client, the domain being implemented is clinical practice. When reviewing appropriate educational materials to use for discharge instructions, the domain being implemented is education. The nurse is not utilizing the domains of research or administration. Nursing process and literature are not domains of nursing. PTS: 1 DIF: Apply REF: Emergence of Contemporary Nursing in the United States 2. The nurse suspects that another health care colleague may be chemically dependent when which of the following is assessed? (Select all that apply.) 1. Prolonged work “breaks” 2. Clinical care omissions 3. Mood stability 4. Extraordinary accomplishments 5. Heavy use of fragrances 6. Inability to recall recent events ANS: 1, 2, 4, 5, 6 Clues of possible chemical dependency include tardiness, late sick calls, frequent or prolonged work “breaks,” inability to recall recent events, heavy use of fragrances, clinical care omissions or errors, patient complaints or requests for a change in care provider, mood instability, and extraordinary accomplishments. Mood stability is not a characteristic of a colleague who is experiencing chemical dependency. PTS: 1 DIF: Apply REF: Box 1-6 Clues to the Possibility of Chemical Dependence 3. The nurse is a member of a health care team that includes a physician and other health care providers. These providers work together to ensure the client is relieved of suffering, has diseases cured, and experiences enhanced health and performance. Which of the following are the levels of care represented by this team of health care providers? (Select all that apply.) 1. Sustain life 2. Maintain health
3. 4. 5. 6.
Regain health Minimize injury Maximize cost Attain enhanced health
ANS: 1, 2, 3, 6 The medical team’s mission is to relieve suffering and cure disease. This involved the three levels of care: 1) sustain life, 2) regain health, and 3) maintain health. Once the shift toward health care occurred, the fourth level of attaining enhanced health was added. Minimize injury and maximize cost is not a level of care. PTS: 1
DIF: Analyze
REF: Providers of Care
4. A client tells the nurse that she is disappointed that her employer is offering a health maintenance organization for a health care benefit. Which of the following can the nurse use as responses to the client as advantages of this type of health plan? (Select all that apply.) 1. “Since there is a nursing shortage, clients need to stay out of the hospital.” 2. “This type of plan provides wellness care at a minimal cost to keep people healthy.” 3. “This type of plan helps clients avoid illnesses with high costs.” 4. “An HMO standardizes diagnostic and treatment decisions across the nation.” 5. “This type of plan ensures coordinated services from wellness to death.” 6. “This type of plan costs as much as the traditional plans, but the insurance companies get the extra money from premiums.” ANS: 2, 3, 4, 5 There are several missions and visions of managed care. The first is to provide wellness care at a minimal cost to keep people healthy and avoid providing illness care at a higher cost. Another mission is to standardize diagnostic and treatment decisions across the nation. Managed care emphasizes the delivery of coordinated services across the care spectrum from wellness to death and uses financial incentives to decrease length of stay and achieve cost efficiency. Managed care was not implemented to address the nursing shortage. This type of plan does not cost as much as a traditional health plan nor do the insurance companies receive the extra money from premiums. PTS: 1
DIF: Apply
REF: Cost of Care
5. The nurse has incorporated several criteria that are essential for being a member of a profession. Which of the following has this nurse done? (Select all that apply.) 1. Has passed the licensure examination 2. Works regularly scheduled shifts 3. Completed a bachelor’s degree in nursing 4. Limits absences from work 5. Joined the American Nurses Association 6. Reads evidenced-based information to incorporate into planning client care ANS: 1, 3, 5, 6 There are seven essential criteria for a profession. The nurse has incorporated four of these criteria by passing the licensure examination, the nurse has implemented a code of ethics; by completing a bachelor’s degree in nursing, the nurse has been educated in an institution of higher education; by joining the American Nurses Association and reading evidenced-based information, the nurse is affiliated with a professional association that promotes and ensures quality practice. Working regularly scheduled shifts and limiting absences from work are not essential criteria for a profession. PTS: 1
DIF: Analyze
REF: Box 1-3 Essential Criteria for a Profession
Chapter 2--Clinical Decision Making and Evidence-Based Practice MULTIPLE CHOICE 1. The nurse is implementing evidence-based practice. Which of the following is not a component of this process? 1. Patient preference 2. Clinical expertise 3. Research evidence 4. Leader practice ANS: 4 Evidence-based practice is the combination of applying research findings, creating clinical guidelines, and the individualization of the plan of care to meet the patient’s needs and desired. Leader practice is not a component of the evidence-based process. PTS: 1
DIF: Analyze
REF: The Process of EBP
2. The nurse is planning the care for a client using an unstructured approach. Which of the following approaches did the nurse most likely use? 1. Research 2. Trial and error 3. Nursing theory 4. Validated order ANS: 2 Examples of unstructured approaches to plan client care include trial and error, tradition, and authority. The approaches of research, nursing theory, and validated order all represent a structured approach to planning client care. PTS: 1
DIF: Analyze
REF: Knowledge Bases for Clinical Decisions
3. The nurse is participating in an activity that is the first step of the ACE Star Model of Knowledge Transformation. Which of the following is the nurse doing? 1. Creating evidence summaries 2. Evaluating outcomes 3. Integrating findings into practice 4. Participating in research ANS: 4 The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge according to five sequential steps. The first step is primary research. Subsequent steps are: 2) evidence summary, 3) translation, 4) integration, and 5) evaluation. PTS: 1
DIF: Analyze
REF: EBP in Nursing
4. A committee has been developed to implement knowledge transformation when providing client care. The members realize that the purpose of knowledge transformation is to: 1. reduce length of stay. 2. convert research findings to impact health outcomes. 3. reduce the cost of care. 4. increase the number of patients with health insurance. ANS: 2
The core concept of the ACE Star Model is knowledge transformation. Knowledge transformation is the conversion of research findings to have an impact on health outcomes by way of evidence-based care. Knowledge transformation is not a method to reduce length of stay, reduce the cost of care, or increase the number of patients with health insurance. PTS: 1
DIF: Analyze
REF: Definition of Knowledge Transformation
5. An advance practice nurse is being consulted to participate during the translation phase of the ACE Star Model of Knowledge Transformation. During this phase, which of the following will the nurse create? 1. Standardized care plans 2. Critical pathways 3. Clinical practice guidelines 4. Checklists to streamline documentation ANS: 3 In the third step of the ACE Star Model of Knowledge Transformation, experts are consulted to consider the evidence summaries, fill in gaps, and merge research knowledge with expertise to produce clinical practice guidelines. The nurse is not creating standardized care plans, critical pathways, or checklists to streamline documentation since these items are not a part of the ACE Star Model of Knowledge Transformation. PTS: 1
DIF: Apply
REF: Star Point 3: Translation
6. The nurse leaders of a health care organization are creating plans to change clinical and organizational practices to support evidence-based practice. Which phase of the ACE Star Model of Knowledge Transformation are the leaders implementing? 1. Integration 2. Evaluation 3. Translation 4. Evidence summaries ANS: 1 During the Integration phase of the ACE Star Model of Knowledge Transformation, implementation plans are put into action to change the individual clinician practices, organizational practices, and environmental policies. Implementation plans are not a part of the evidence summaries, translation, or evaluation of the ACE Star Model of Knowledge Transformation. PTS: 1
DIF: Apply
REF: Star Point 4: Integration
7. The advance practice nurse is writing clinical practice guidelines. Prior to writing these guidelines which of the following will the nurse need? 1. Current client census 2. Evidence summaries 3. Nursing department budget 4. Staffing ratios ANS: 2 The ideal base for writing clinical guidelines are evidence summaries because they increase the power and validity of the cause-and-effect relationship between interventions and outcomes. Current client census, nursing department budgets, and staffing ratios are not used to write clinical practice guidelines. PTS: 1
DIF: Apply
REF: Evidence Summaries
8. The nurse is writing a systematic review. After the nurse formulates questions and locates relevant studies, the nurse thing the nurse will do is: 1. update the reviews. 2. interpret the findings. 3. summarize and synthesize results. 4. select and appraise the studies. ANS: 4 The next step in the systematic review writing process is selecting and appraising the studies. Afterwards, the nurse will complete, in order, summarize and synthesize results, interpret the findings, and regularly update the reviews. PTS: 1
DIF: Apply
REF: Method for Producing Systematic Reviews
9. The nurse is using the scale for rating the strength of research evidence for one research article for potential inclusion in a clinical practice guideline. Which of the following is considered the strongest evidence? 1. Individual cohort study 2. Meta-analysis of randomized clinical trials 3. Expert opinion 4. Case studies ANS: 2 When utilizing the Scale for Rating the Strength of Research Evidence, the level with the strongest evidence is level I, meta-analysis of randomized clinical trials. Level III is individual cohort studies. Expert opinion is Level VII or the weakest evidence. Case studies are Level VI. PTS: 1 DIF: Analyze REF: Table 2-1 Scale for Rating the Strength of Research Evidence 10. The nurse is considering a research study for inclusion in a clinical practice guideline that has been identified as being sufficient to determine effects on health outcomes. This research study would be considered as being: 1. fair. 2. passable. 3. poor. 4. good. ANS: 1 Research studies are rated according to the Scale for Rating the Quality of Research Evidence. According to this scale, a research study that is sufficient to determine the effects on health outcomes is considered fair. A good study has consistent results for well-designed, well-conducted studies that directly assess effects on health outcomes. A poor study has insufficient results to assess the affects on health outcomes. Passable is not a category of this rating scale. PTS: 1 DIF: Analyze REF: Table 2-2 Scale for Rating the Quality of Research Evidence 11. The nurse is reviewing evidence-based clinical practice guidelines to use when planning care for a client. One guideline has been graded by the U.S. Preventive Services Task Force as being an A. According to this grade, the nurse should do which of the following? 1. Do not use this guideline because the harm outweighs the benefits. 2. Do not use this guideline because the benefits and harms cannot be determined. 3. Use this guideline because the benefit is substantial. 4. Use this guideline but understand that the net benefit to the client is small.
ANS: 3 The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D plus I. A grade A guideline is recommended for care since there is high certainty that the benefit to the client is substantial. A grade C guideline has a small net benefit to the client. A grade D guideline has harms that outweigh the benefits. A grade I guideline has benefits and harms that cannot be determined. PTS: 1 DIF: Apply REF: Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force 12. The nurse identifies errors and hazards in a care environment and implements basic safety to reduce the likelihood of an adverse event. Which of the following core competencies is this nurse implementing? 1. Provide patient-centered care 2. Apply quality improvement 3. Employ evidence-based practice 4. Utilize informatics ANS: 2 Of the five Core Competencies for Health Professions, the competency that focuses on the identification of errors and hazards with implementation of basic safety is apply quality improvement. Provide patient-centered care focuses on direct care activities. Employ evidence-based practice focuses on the integration of research with clinical expertise. Utilize informatics to focus on communication and the use of information technology to support decision making. PTS: 1 DIF: Apply REF: Box 2-1 Core Competencies for Health Professions 13. The nurse is participating on a committee to select evidence-based practice guidelines.Which of the following statements by the nurse indicate a clear understanding of the purpose of these guidelines? 1. “They provide the best evidence to make decisions about the care of individual clients.” 2. “They promote changes in client care according to a research study. 3. “They ensure cost-effective care to the client.” 4. “They identify safe staffing ratios for client care.” ANS: 1 Evidence-based practice guidelines provide the best evidence to make decisions about the care of individual clients. The use of a single research study to make changes in client care is a concept within research utilization and not evidence-based practice. Evidence-based practice does impact the costs of client care but their intent is not to ensure cost-effective care but rather to improve the overall quality of care. Evidence-based guidelines do not provide staffing ratios for client care. PTS: 1
DIF: Analyze
REF: The Process of EBP
MULTIPLE RESPONSE 1. The nurse is determining the best way to ensure adherence to the core competencies for health professions. Which of the following competencies will the nurse implement when providing client care? (Select all that apply.) 1. Work in interdisciplinary teams 2. Utilize informatics 3. Implement basic safety principles 4. Employ evidence-based practice 5. Apply quality improvement
6. Provide patient-centered care ANS: 1, 2, 4, 5, 6 Core competencies for health professions include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Implementing basic safety principles is only one part of a quality improvement program. PTS: 1 DIF: Apply REF: Box 2-1 Core Competencies for Health Professions. 2. There are impediments that make the practice of evidence-based practice difficult. Which of the following are impediments to evidence-based practice? (Select all that apply.) 1. Complexity of science and technology 2. Difficulty of nowledge transformation 3. Variety of knowledge forms 4. Number of patient diagnoses 5. Evidence summary 6. Application of quality improvement ANS: 1, 3 Hurdles to evidence-based practice are the increasing complexity of science and technology and the variety of knowledge forms, many of which are not suitable for direct practice. Knowledge transformation, number of patient diagnoses, evidence summary, application of quality improvement are not considered impediments to the implementation of evidence-based practice. PTS: 1
DIF: Apply
REF: Applying Evidence-Based Concept
3. The nurse identifyies evidence summaries for evidence-based practice. Which of the following are references to types of evidence summaries? (Select all that apply.) 1. Review of literature 2. Evidence synthesis 3. Authentication review 4. Systematic reviews 5. Integrative reviews 6. Substantiation evidence ANS: 1, 2, 4, 5 Evidence summaries are also referred to as being review of literature, evidence synthesis, systematic reviews, and integrative reviews. These summaries are not referred to as being authentication review or substantiation evidence. PTS: 1
DIF: Apply
REF: Star Point 2: Evidence Summary
4. A health care organization is determining which clinical practice guidelines to adopt when providing client care. The organization is using the AGREE Instrument for Assessing Guidelines because this checklist helps the organization determine which of the following? (Select all that apply.) 1. Scope and purpose 2. Stakeholder involvement 3. Rigor of development 4. Clarity and presentation 5. Author credentials 6. Application ANS: 1, 2, 3, 4, 6
The AGREE Instrument for Assessing Guidelines outlines the primary facets of the clinical practice guideline being appraised for adoption. It includes the following criteria: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application, and editorial independence. Author credentials is not a criteria of this checklist. PTS: 1
DIF: Analyze
REF: Clinical Practice Guidelines
5. The nurse is participating in a committee to address the Institute of Medicine’s priority areas for quality improvement. Which of the following are considered priority areas? (Select all that apply.) 1. Diabetes 2. End-of-life organ failures 3. Motor vehicle accidents 4. Scoliosis 5. Tobacco dependence 6. Major depression ANS: 1, 2, 5, 6 The Institute of Medicine has identified 20 priority areas for quality improvement which include diabetes, end-of-life organ failures, tobacco dependence, and major depression. Motor vehicle accidents and scoliosis are not priority areas identified by the Institute of Medicine. PTS: 1
DIF: Analyze
REF: Box 2-7 IOM-Priority Areas for National Action
Chapter 3--Health Education and Promotion MULTIPLE CHOICE 1. A client is reviewing a videotape without the assistance of the nurse for instruction. The type of teaching strategy this client is using is considered: 1. demonstration. 2. slides. 3. programmed instruction. 4. discussion. ANS: 3 Programmed instruction is often referred to as “canned” presentation and is intended for use without the nurse. Demonstration, slides, and discussion require a nurse to be present. PTS: 1
DIF: Analyze
REF: Teaching Strategies: Programmed Instruction
2. The nurse is instructing a client regarding food safety, injury prevention, and occupational health. Which of the following Healthy People 2010 objectives is the nurse instructing the client? 1. Promote healthy behaviors 2. Promote healthy and safe communities 3. Improve systems for personal health and public health 4. Prevent and reduce diseases and disorders ANS: 2 This objective addresses instruction that focuses on the health and safety of communities such as food safety, prevention of injury, and occupational health. Promoting healthy behaviors would include weight reduction and smoking cessation. Improve systems for personal health and public health would include immunization programs. Prevent and reduce diseases and disorders would include instruction on screening programs, physician visits, and routine health maintenance care. PTS: 1
DIF: Analyze
REF: Health Promotion on a Global Level
3. A client has inadequate resources and impairment of personal support systems. Which nursing diagnosis would apply to this patient? 1. Noncompliance 2. Deficient knowledge 3. Ineffective health maintenance 4. Health-seeking behavior ANS: 3 Defining characteristics for ineffective health maintenance includes impairment of personal support systems, observed inability to take responsibility for meeting basic health practices, demonstrated lack of knowledge, failure to recognize important symptoms reflective to altered health status, lack of health-seeking behaviors, and inadequate resources. Inadequate resources and impairment of personal support systems would not support the nursing diagnoses of Noncompliance, Deficient Knowledge, or Health-Seeking Behavior. PTS: 1 DIF: Apply REF: Box 3-3 Defining Characteristics for Ineffective Health Maintenance 4. While planning care for a client, the nurse identifies content that would address the client’s diagnosis of Deficient Knowledge. The nurse will ensure time is allocated for client instruction because:
1. 2. 3. 4.
the client cannot be discharged without it. it is a legal component of the nursing process. it is a nice thing to do for a client. the physician has written an order for instruction.
ANS: 2 Patient education is a legal component of the nursing process that was identified in the Patient’s Bill of Rights. Patient education is a necessary function of nursing care. The client could be discharged without receiving instructions. Education is not done because it is a nice thing to do for a client. Client education does not necessitate a physician’s order. PTS: 1
DIF: Apply
REF: Patient Education
5. The nurse is engaged in an information teaching session with a client. Which of the following would be appropriate to instruct during an informal teaching session? 1. Expected effects of a new medication 2. Instruction on leg exercises to be used after surgery 3. How to use an incentive spirometer 4. Diet and medications to manage a new diagnosis of diabetes mellitus ANS: 1 Instruction can be either informal or formal. Informal instruction occurs intermittently and frequently during the course of client care. These instructions are simple, relate to the disease process, and answer client questions. Providing the expected effects of a new medication is a type of information instruction. Formal instructions are deliberate with specific goals and an evaluation process. Instructing on postoperative leg exercises, the use of an incentive spirometer, and diet and medications to manage a new health diagnosis are all examples of formal instruction. PTS: 1
DIF: Apply
REF: Formal and Informal Patient Education
6. The nurse is planning a presentation to a group of senior citizens as part of a wellness program. Which of the following topics would be appropriate for the nurse to instruct this client population? 1. Importance of taking medications as prescribed 2. Ways to follow a physician’s treatment plan 3. Ease of changing an abdominal dressing 4. Strategies to reduce salt in the diet and increase activity ANS: 4 Some educational topics can be instructed in a group setting. Strategies to reduce salt intake and increase activity are two topics that would be appropriate for a group instruction. The other choices are appropriate for individual instruction. PTS: 1
DIF: Apply
REF: Individual and Group Patient Education
7. A client is considering several changes in personal habits to improve his health. Which of the following critical thinking strategies can the nurse use to help this client? 1. Ask the client to identify his goals to improve his health. 2. Remind the client that the physician has to approve all changes in his health improvement plan. 3. Suggest the client wait until he is discharged before planning to make personal habit changes. 4. Recommend that immediate changes are made to confuse the body’s responses. ANS: 1
Critical thinking is a self-directed, deliberate, self-corrected, results-oriented reasoning process that strives to problem-solve client care issues by combining logic, intuition, and creativity. The goal of critical thinking is to assist clients to use what they already know and work with the client to make changes that they identify through self-discovery. Asking the client to identify goals to improve health is one strategy that the nurse can use when implementing critical thinking with client education. The other choices do not support critical thinking with client education. PTS: 1
DIF: Apply
REF: Critical Thinking and Patient Education
8. A client has several identified learning needs. Which of the following should the nurse assess prior to planning instruction for this client? 1. Home address 2. Client’s learning style 3. Living arrangements 4. Financial resources ANS: 2 Areas to include in the assessment of a client’s learning needs include the client’s ability to learn, style of learning, information about a health condition, cultural background, and other information as required. The client’s home address, living arrangements, and financial resources are not a part of a client’s assessment of learning needs. PTS: 1
DIF: Apply
REF: Patient Education and the Nursing Process
9. Which of the following teaching strategy would best support a client who needs to learn how to selfadminister insulin injections? 1. Discussion 2. Role-playing 3. Demonstration 4. Programmed instruction ANS: 3 Demonstration is a practical strategy used when teaching a new skill such as self-injection of insulin. Discussion is an exchange of information and does not provide an opportunity for the client to learn a new skill. Role playing allows the client to apply knowledge in a simulated environment. This strategy does not support learning a new skill. Programmed instruction is intended for use without the nurse. This strategy does not support learning a new skill. PTS: 1
DIF: Apply
REF: Teaching Strategies
10. A client tells the nurse that she uses audio CDs in her vehicle when driving to and from work to keep current with educational requirements for her job. The nurse would assess this client as preferring which type of learning style? 1. Auditory 2. Visual 3. Kinesthetic 4. Anesthetic ANS: 1 The client who learns by hearing prefers an auditory learning style. The client who learns by reading uses a visual learning style. The client who learns by doing or touching is using a kinesthetic learning style. Anesthetic is not a type of learning style but rather a medication used for surgery. PTS: 1
DIF: Analyze
REF: Teaching Strategies
11. The nurse is attempting to instruct a client on ways to eliminate smoking. The client tells the nurse that he has no health problems because of smoking and does not understand why he needs to quit. Which of the following is interfering with the nurse’s ability to instruct the client in health promotion behaviors? 1. Motivation 2. Perception 3. Self-image 4. Maintenance ANS: 2 Perception is a client’s sense and understanding of his current health status. If the client does not perceive a problem with current health maintenance activities, the nurse should not intervene at this time. Motivation is the internal drive or external stimulus to perform an action or thought. Maintenance is practicing a new behavior for an extended period of time. The client’s self-image is not interfering with the nurse’s ability to instruct the client in health promotion behaviors. PTS: 1
DIF: Analyze
REF: Characteristics of Health Maintenance
12. The nurse is planning instruction to support health promotion behaviors. Which of the following clients would benefit the most from these instructions? 1. 60-year-old client diagnosed with type 2 diabetes mellitus 2. 83-year-old client with hypertension 3. 75-year-old client recovering from a total hip replacement 4. 35-year-old client desiring to begin an exercise program ANS: 4 Health promotion interventions are for healthy individuals and are intended to maximize their health status. The 35-year-old client who wants to begin an exercise program would benefit from health promotion instruction. The other clients are considered to be ill and would not benefit from instruction in health promotion behaviors. PTS: 1
DIF: Analyze
REF: Health Promotion
13. The nurse and client have determined that goals established for health maintenance behaviors have not been achieved. In which step of the nursing process are the nurse and client working at this time? 1. Evaluation 2. Assessment 3. Planning 4. Implementation ANS: 1 The nurse and client together measure how well the client has achieved the goals for health maintenance in the plan of care. Goals that have not been achieved are evaluated and adjusted. This is an activity done during the evaluation step of the nursing process. Evaluation of goals is not done during the assessment, planning, or implementation steps of the nursing process. PTS: 1
DIF: Analyze
REF: Evaluation of Outcomes
MULTIPLE RESPONSE 1. A client is demonstrating behaviors consistent with normal health maintenance. Which of the following has this client demonstrated? (Select all that apply.) 1. Motivation 2. Health encouragement
Chapter 28--Hypertension: Nursing Management MULTIPLE CHOICE 1. Which of the following should the nurse instruct a client who is newly diagnosed with hypertension? 1. It is a lifelong process. 2. It can be managed easily. 3. It is a short-term problem. 4. It happens only in the very poor and treatment is expensive. ANS: 1 Treatment of hypertension is a lifelong process. It requires lifestyle modification and occurs in all racial and economical groups. Hypertension can either be easy or difficult to manage. PTS: 1
DIF: Apply
REF: Introduction
2. A client is diagnosed with isolated systolic hypertension. The nurse realizes that this diagnosis means the client is experiencing a systolic pressure: 1. greater than 140 mmHg and a diastolic pressure greater than 90 mmHg. 2. greater than 90 mmHg and a diastolic pressure greater than 60 mmHg. 3. greater than 140 mmHg and a diastolic pressure lower than 90 mmHg. 4. lower than 140 mmHg and a diastolic pressure greater than 90 mmHg. ANS: 3 The likelihood of developing isolated systolic hypertension is greater with age and is confirmed with a systolic pressure greater than 140 mmHg while the diastolic pressure remains less than 90 mmHg. PTS: 1
DIF: Analyze
REF: Hypertension: Nonmodifiable Risk Factors
3. The nurse is instructing a client on the impact of cigarette smoking and the development of hypertension. Which of the following would not be appropriate for the nurse to include in these instructions? 1. Tobacco damages the lining of the artery walls. 2. Tobacco temporarily constricts blood vessels, increasing pulse and blood pressure. 3. Tobacco thins the blood and makes the person at risk for bleeding. 4. Carbon monoxide in tobacco smoke replaces the oxygen in the blood, forcing the heart to work harder to supply oxygen. ANS: 3 Tobacco and smoking have been shown to increase heart rate and blood pressure because of vasoconstriction and the accumulation of plaque on the artery walls. Because of the replacement of oxygen with carbon monoxide from tobacco smoke, the heart has to work harder to supply oxygen to the organs. There is no evidence that smoking thins the blood and causes bleeding. PTS: 1
DIF: Apply
REF: Hypertension: Modifiable Risk Factors
4. The nurse is assessing a client’s pulse pressure. His blood pressure reading is 130/82 mmHg. Which of the following is the correct pulse pressure? 1. 40 2. 48 3. 130 4. 82 ANS: 2
The pulse pressure is the difference between the systolic and diastolic pressure: 130 82 = 48. The other choices represent miscalculations or not understanding the correct way to calculate pulse pressure. PTS: 1
DIF: Apply
REF: Hypertension: Pathophysiology
5. A client is surprised to learn that she has high blood pressure. Which of the following should the nurse assess in this client? The presence or occurrence of: 1. nausea. 2. pain. 3. headache. 4. fear. ANS: 3 With very elevated blood pressure, headache is the most commonly reported symptom. Although pain and nausea may be reported, they are not the most common. Fear is not commonly associated with hypertension though it may occur with an onset of pain or nausea. PTS: 1 DIF: Apply REF: Hypertension: Assessment with Clinical Manifestations 6. A client’s blood pressure has been measured at 130/86 mmHg on two separate occasions. The nurse realizes this client’s blood pressure reading would be categorized as being: 1. normal. 2. prehypertension. 3. stage 1 hypertension. 4. stage 2 hypertension. ANS: 2 Prehypertension is a new designation used to identify individuals at high risk for the development of hypertension. Systolic blood pressure of 120 to 139 and diastolic blood pressure of 80 to 90 are values for prehypertension. A normal blood pressure is less than or equal to 120 mmHg systolic and less than or equal to 80 mmHg diastolic. Stage 1 hypertension is a systolic blood pressure between 140 to 159 and a diastolic pressure between 90 to 99. Stage 2 hypertension is a systolic reading greater than or equal to 160 and a diastolic pressure of greater than or equal to 100 mmHg. PTS: 1 DIF: Analyze REF: Table 28-6 JNC VII Classification of Blood Pressure in Adults 7. The nurse uses a blood pressure cuff that is too small for the circumference of the client’s arm. How will this size of blood pressure cuff affect the client’s blood pressure measurement? 1. Falsely low 2. Falsely high 3. Not clearly heard 4. More time consuming ANS: 2 The blood pressure cuff must be the appropriate size to get an accurate reading. A cuff that is too small could result in a falsely high reading. A blood pressure cuff that is too large could result in a falsely low reading. The cuff size may not affect the nurse’s ability to hear the blood pressure sounds. An incorrect blood pressure cuff size will not be more time consuming to use. PTS: 1 DIF: Analyze REF: Table 28-2 Factors Causing False Blood Pressure Readings
8. A client diagnosed with hypertension should be instructed by the nurse to avoid which of the following foods? 1. Cold cuts 2. Bananas 3. Milk 4. Oatmeal ANS: 1 Cold cuts are processed meats that are usually high in sodium and may cause water retention and an increase in blood pressure. The rest of the foods really have no effect on blood pressure. PTS: 1 DIF: Apply REF: Hypertension: Planning and Implementation: Evidence-Based Care 9. A client is instructed to reduce his intake of daily sodium intake so that the total amount is what his body needs. The nurse should instruct the client to reduce sodium intake to: 1. 500 mg a day. 2. 1000 mg a day. 3. 2500 mg a day. 4. 4500 mg a day. ANS: 1 A human body needs about 500 mg of sodium each day. The average intake of sodium for individuals in the United States is between 4000 to 6000 mg a day. PTS: 1 DIF: Apply REF: Hypertension: Planning and Implementation: Evidence-Based Care 10. A client asks the nurse why she should be concerned about the amount of sodium in ice cream. Which of the following should the nurse respond to this client? 1. Sodium is used to enhance the flavor. 2. Sodium is used to emulsify the ice cream. 3. Sodium is used to prevent mold. 4. Sodium is used as a preservative. ANS: 2 Sodium is used in ice cream as an emulsifier. Sodium in canned or processed foods is used to enhance flavor. Sodium is used to prevent mold in cheese, breads, and cakes. Sodium is used as a preservative in cured meats and sausages. PTS: 1
DIF: Apply
REF: Table 28-6 Sodium-Based Food Additives
11. Which of the following should the nurse instruct a client who desires to reduce his blood pressure through increasing physical activity? 1. Regular exercise can lower the blood pressure by 5 to 10 mmHg. 2. Regular exercise must be done 7 days a week. 3. Regular exercise has to be done for at least 2 hours each day. 4. Regular exercise is the participation in aerobic activities. ANS: 1 Regular exercise can lower blood pressure by 5 to 10 mmHg. Regular exercise should be done 5 days a week for 60 minutes or 20 minutes of vigorous exercise at least 3 times a week to be effective. Regular exercise includes aerobic activity, flexibility, and strengthening exercises. PTS: 1
DIF: Apply
REF: Hypertension: Planning and Implementation: Evidence-Based Care 12. A client is prescribed Spironolactone (Aldactone) for blood pressure control. Which of the following should the nurse assess in this client as a potential side effect? 1. Hypokalemia 2. Hyperkalemia 3. Hyponatremia 4. Hypernatremia ANS: 2 Spironolactone (Aldactone) is a potassium-sparing diuretic. Side effects include hyperkalemia. Hypokalemia and hyponatremia are side effects of the thiazide diuretics. Hypernatremia is not a known side effect of any antihypertensive medication. PTS: 1 DIF: Apply REF: Table 28-9 Pharmacologic Management of Hypertension 13. A client is prescribed an ACE inhibitor for management of hypertension. Which of the following side effects should the nurse instruct the client as being expected with this medication? 1. Tachycardia 2. Constipation 3. Bizarre dreams 4. Persistent dry cough ANS: 4 One side effect of ACE inhibitors that is expected with this medication is a persistent dry cough. Tachycardia, constipation, and bizarre dreams are not side effects associated with ACE inhibitors. PTS: 1 DIF: Apply REF: Table 28-9 Pharmacologic Management of Hypertension MULTIPLE RESPONSE 1. The nurse is considering the risk factors for a client’s development of primary hypertension. Which of the following would be considered nonmodifiable risk factors for the client? (Select all that apply.) 1. Age 2. Stress 3. Gender 4. Ethnicity 5. Regular exercise 6. Limits fat and salt in diet ANS: 1, 3, 4 Nonmodifiable risk factors are those thing we cannot change or control, such as age, gender, and ethnicity. Stress, exercise, and diet are considered modifiable risk factors or those the client can control. PTS: 1
DIF: Analyze
REF: Hypertension: Risk Factors
2. Which of the following should the nurse tell a client when instructing on ways to reduce the risk factors for hypertension? (Select all that apply.) 1. Smoking 2. Diet 3. Exercise
4. Family history 5. Race 6. Stress ANS: 1, 2, 3, 6 Modifiable risk factors can be changed or modified to help control hypertension. Smoking, diet, stress, and exercise can be changed to affect blood pressure. Persons with more risk factors have a greater chance of having hypertension during their lives. Family history and race cannot be modified. PTS: 1
DIF: Apply
REF: Hypertension: Risk Factors
3. Which of the following assessment questions would be appropriate for the nurse to use when assessing a client for hypertension? (Select all that apply.) 1. Do you consume alcohol products? How much? How long? 2. Do you use nicotine products? How much? How long? 3. Do you experience nosebleeds? 4. Do you get hungry at night? 5. Do you experience cold sweats? 6. Do you experience headaches? ANS: 1, 2, 3, 6 The nurse will often ask the client questions about risks of hypertension. Asking about alcohol and nicotine product use will tell you about increased risk factors. Nosebleeds and headaches are often associated with hypertension. Although cold sweats and hunger are symptoms a patient may report, they are not indicative of hypertension. PTS: 1
DIF: Apply
REF: Box 28-2 Hypertension Assessment
4. The blood pressure measurement for a client is very different from the one that was assessed a few hours previously. The nurse should suspect that the blood pressure measurement is false when which of the following is assessed in the client? 1. Client needs to void. 2. Client smoked a cigarette 10 minutes prior to the measurement. 3. The examination room is very warm. 4. Doors are slamming and children are crying in the environment. 5. Client just had lunch. 6. Client slept for 8 hours the previous night. ANS: 1, 2, 3, 4 Factors that cause false blood pressure readings include anxiety, full urinary bladder, excessively warm room, recent tobacco use, and loud or repetitive noises. Eating a meal or having 8 hours of sleep are not known to cause a false blood pressure reading. PTS: 1 DIF: Analyze REF: Table 28-2 Factors Causing False Blood Pressure Readings 5. A client is planning to use nicotine gum to aid with cigarette cessation. Which of the following should the nurse instruct the client as adverse effects of using nicotine gum? (Select all that apply.) 1. Rapid heart rate may result. 2. Mild headaches can occur. 3. A sore mouth and throat are possible. 4. Abnormal dreams are common. 5. Pruritis is possible. 6. Nausea can occur.
ANS: 1, 2, 3, 6 Adverse effects associated with the use of nicotine chewing gum include tachycardia, mild headache, sore mouth and throat, and nausea. Abnormal dreams and pruritis are adverse effects of nicotine patches, nicotine nasal spray, and nicotine inhalers. PTS: 1
DIF: Apply
REF: Table 28-7 Medications for Smoking Cessation
Chapter 29--Hematological Dysfunction: Nursing Management MULTIPLE CHOICE 1. A client is diagnosed with anemia. The nurse realizes that which of the following could be the treatment for this client’s disorder? 1. Erythropoietin therapy 2. Leukemia 3. Poor nutrition 4. Trauma ANS: 1 Anemia is caused for a variety of reasons such as nutrition, chronic illness, trauma, medication therapy, immune suppression, and alterations of erythropoiesis. Erythropoietin therapy stimulates red blood cell production in the bone marrow as a treatment for anemia. PTS: 1
DIF: Analyze
REF: Anemias: Epidemiology
2. A client is diagnosed with alpha- and beta- defect thalassemia. The nurse realizes that this disease is common within which of the following cultural groups? 1. Persons from China 2. People of Mediterranean ancestry 3. African Americans 4. Persons from the Philippines ANS: 3 African Americans and Africans are more likely to have both alpha- and beta-defect thalassemia. Populations of Asian descent such as those from China or the Philippines more often have alpha-defect thalassemia. Populations of Mediterranean ancestry are more susceptible to beta-defect thalassemia. PTS: 1
DIF: Analyze
REF: Thalassemia: Epidemiology
3. The mother of a newborn is concerned since the baby is jaundiced. The nurse realizes that the infant should be assessed for which of the following anemias? 1. Glucose-6-phosphate dehydrogenase (G6PD) 2. Hereditary spherocytosis 3. Sickle-cell anemia 4. Thalassemia ANS: 2 Hereditary spherocytosis is also known as congenital hemolytic anemia. This anemia begins in utero and manifests as anemia and hyperbilirubinemia. A client with Glucose-6-phosphate dehydrogenase may develop jaundice later in life but not upon birth. Thalassemia and sickle-cell anemia do not present with hyperbilirubinemia upon birth. PTS: 1 DIF: Analyze REF: Glucose-6-Phosphate Dehydrogenase Anemia: Assessment with Clinical Manifestations 4. During the health history portion of the assessment, the client states, “I have sickle-cell trait.” The nurse realizes that: 1. precautions should be taken to prevent the cell from sickling. 2. the client is a carrier. 3. the client will show signs of the disease as she grows older.
4. the client will transmit the disease to any offspring. ANS: 2 Sickle-cell anemia is an autosomal recessive disorder passed from parent to offspring in this pattern. An individual with one HbS has the sickle-cell trait and has a 50% chance of transmitting the gene to each child. There are no precautions to take to prevent the cell from sickling. The client will not demonstrate signs of the disease as she grows older. It will depend upon the other parent having the trait if any offspring will be affected with the disorder. PTS: 1
DIF: Analyze
REF: Sickle-Cell Anemia: Etiology
5. A client diagnosed with acute myeloid leukemia is recovering from a bone marrow transplant. Which of the following nursing interventions would not be appropriate for this client? 1. Assess for reactions to anesthesia. 2. Assess vital signs. 3. Maintain isolation precautions. 4. Obtain a low-pressure mattress to prevent skin breakdown. ANS: 1 The client having a bone marrow transplant does not receive anesthesia. Maintaining skin integrity, implementing isolation precautions, and monitoring vital signs are appropriate nursing measures for the client recovering from a bone marrow transplant. PTS: 1
DIF: Apply
REF: Leukemia: Planning and Implementation
6. A client diagnosed with chronic disseminated intravascular coagulation is prescribed heparin. The nurse realizes that this medication is used to: 1. increase blood flow to the circulation. 2. increase blood clot formation. 3. decrease blood flow in the circulation. 4. decrease blood clot formation. ANS: 4 Heparin is given for its interference with the clotting processes and the chance of preventing further overuse of clotting factors. Heparin is usually only used when other methods of management are failing. Heparin does not increase or decrease blood flow in the circulation. Heparin does not increase blood clot formation. PTS: 1 DIF: Analyze REF: Disseminated Intravascular Coagulation: Pharmacology 7. The nurse should assess a client diagnosed with multiple myeloma for which of the following electrolyte imbalances? 1. Hypercalcemia 2. Hyperkalemia 3. Hypermagnesemia 4. Hypernatremia ANS: 1 Destruction of the bone leads to elevated calcium levels. The other electrolyte imbalances are not characteristic of multiple myeloma. PTS: 1 DIF: Apply REF: Multiple Myeloma: Assessment with Clinical Manifestations
8. A client is receiving treatment for the diagnosis of hemophilia. Which of the following should the nurse assess in this client? 1. Appetite 2. Urine output 3. Muscle and joint pain 4. Respiratory rate ANS: 3 The clinical features of hemophilia include joint and muscle hemorrhages. The weight-bearing joints are most frequently affected. The nurse should assess the client for muscle and joint pain, which occurs with bleeding. Appetite, urine output, and respiratory rate are not specifically affected by hemophilia. PTS: 1 DIF: Apply REF: Hemophilia: Assessment with Clinical Manifestations 9. A client is diagnosed with emphysema. For which of the following hematologic disorders should the nurse include in the assessment of this client? 1. Hemolytic anemia 2. Disseminated intravascular coagulation 3. Polycythemia 4. Hemophilia ANS: 3 One type of polycythemia is caused by an increase in the number of red blood cells in response to a reduced amount of oxygen in the body. The client with emphysema could develop this type of polycythemia. Hemolytic anemia, disseminated intravascular coagulation, and hemophilia are not associated with emphysema. PTS: 1
DIF: Apply
REF: Polycythemia: Secondary Polycythemia
10. A client, diagnosed with acute lymphoblastic leukemia, is receiving the first phase of chemotherapy. The nurse realizes this client is in which phase of treatment for the disorder? 1. Induction 2. Consolidation 3. Maintenance 4. Central nervous system prophylaxis ANS: 1 The primary goal of therapy for this type of leukemia is complete remission with restoration of normal hematopoiesis. Induction chemotherapy is administered first. Consolidation occurs afterwards. Maintenance therapy then occurs followed by central nervous system prophylaxis. PTS: 1 DIF: Analyze REF: Acute Lymphoblastic Leukemia: Pharmacology 11. The nurse is encouraging a client diagnosed with chronic leukemia to join a support group. Which of the following would a support group address? 1. Fatigue 2. Infection 3. Anxiety 4. Social isolation ANS: 4 Social isolation is a common concern for clients with this diagnosis. The client should be encouraged to join a support group. A support group will not help with fatigue, infection, or anxiety.
PTS: 1 DIF: Apply REF: Box 29-6 Common Problems of Patients with Chronic Lymphocytic Leukemia 12. A client is diagnosed with stage II Hodgkin’s lymphoma. The nurse realizes that this diagnosis means the disease is: 1. terminal. 2. limited to lymph nodes on the same side of the diaphragm. 3. in the bone marrow. 4. easily treated. ANS: 2 Stage II Hodgkin’s lymphoma means that the disease is located in two or more lymph node regions on the same side of the diaphragm. This diagnosis does not mean the client is terminal or easily treated. Stage IV of the disease would mean the disease is in the bone marrow. PTS: 1
DIF: Analyze
REF: Box 29-8 Staging Hodgkin's and NHL
13. A client is diagnosed with disseminated low-grade non-Hodgkin’s lymphoma. Which of the following treatments would be indicated for this client? 1. Administration of CHOP 2. Radiation therapy 3. Bone marrow transplant 4. Watch and wait ANS: 4 In disseminated low-grade non-Hodgkin’s lymphoma, early intervention does not prolong survival, so watch and wait is an acceptable approach. The reason to delay is that the client may remain stable for years without treatments that could cause adverse reactions and decrease quality of life. CHOP is standard treatment for intermediate-grade non-Hodgkin’s lymphoma. Radiation therapy is appropriate for both intermediate-grade and high-grade non-Hodgkin’s lymphoma. Bone marrow transplant is used for a client with a recurrence of the disease. PTS: 1 DIF: Analyze REF: Non-Hodgkin's Lymphoma: Planning and Implementation MULTIPLE RESPONSE 1. A client is diagnosed with G6PD anemia. Which of the following medications should the nurse instruct the client to avoid? (Select all that apply.) 1. Acetaminophen 2. Aspirin 3. Chloroquine 4. Nitrofurantoin 5. Sulfonamides 6. Vitamin K ANS: 2, 3, 4, 5, 6 Medications that heighten the hemolytic affects of G6PD are antimalarial drugs (e.g., chloroquine), common coal tar analgesics (including aspirin), nitrofurantoin, oral hypoglycemics, sulfonamides, thiazides, diuretics, and vitamin K. Acetaminophen has only analgesic and antipyretic properties. PTS: 1 DIF: Apply REF: Box 29-1 Medications that Heighten the Hemolytic Affects of G6PD
2. A client diagnosed with sickle-cell anemia is experiencing vaso-occlusive crisis. Which of the following interventions would be appropriate for this client? (Select all that apply.) 1. Administering oxygen 2. Decreasing hydration 3. Managing pain 4. Promoting activity 5. Encouraging rest 6. Restricting calories ANS: 1, 3, 5 The nursing management of sickle-cell anemia is to manage pain and prevent sickling. This type of management is accomplished by adequate hydration, oxygenation, adequate nutrition, rest, medications, management of fever and complications, and use of transfusions. Restricting fluids and calories could be detrimental to the client’s recovery. The client should be encouraged to rest and not engage in activity. PTS: 1 DIF: Apply REF: Sickle-Cell Anemia: Planning and Implementation 3. A client is having diagnostic tests to determine the cause of anemia. The nurse realizes that these tests will focus on which of the following? (Select all that apply.) 1. Presence of bleeding 2. Fluid balance 3. Disorders that cause red blood cell destruction 4. Cardiac functioning 5. Disorders that reduce the production of red blood cells 6. Digestion ANS: 1, 3, 5 Anemias have three causes: 1) bleeding that results in red blood cell loss, 2) conditions that cause red blood cell destruction, and 3) conditions that cause a reduction in the number of red blood cells made by the body. Diagnostic tests will focus on these three causes. Testing for anemia will not focus on fluid balance, cardiac functioning, or digestion. PTS: 1
DIF: Analyze
REF: Anemias: Pathophysiology
4. A client tells the nurse that he is anemic because of a “poor diet.” Which deficiencies cause nutritional anemias? (Select all that apply.) 1. Iron deficiency 2. Folic acid deficiency 3. Vitamin C deficiency 4. Vitamin D deficiency 5. Vitamin A deficiency 6. Vitamin B-12 deficiency ANS: 1, 2, 6 Nutritional anemias can be caused by deficiencies in iron, folic acid, or vitamin B-12. A vitamin D deficiency can cause osteomalacia or rickets. Vitamin C or vitamin A deficiencies do not cause anemia. PTS: 1
DIF: Analyze
REF: Nutritional Anemias
5. Which of the following should the nurse instruct a client who is receiving treatment for the diagnosis of leukemia? (Select all that apply.) 1. See a dentist regularly.
2. 3. 4. 5. 6.
Increase fluids. Report any fatigue to the physician. Expect to have frequent coughs and colds. Use a sunblock when outdoors. Report gastrointestinal distress to the physician.
ANS: 1, 2, 5, 6 Nursing care for a client diagnosed with leukemia should include regular dental care, increasing fluids, using a sunblock when outdoors, and reporting gastrointestinal distress to the physician. Fatigue is common with this illness and does not need to be reported to the physician. Frequent coughs and colds could be signs of a severe infection and should be reported to the physician. PTS: 1 DIF: Apply REF: Box 29-5 General Nursing Care for Patients with Leukemia