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Nurse 1611-70

Nurse 1611-70. Nurse 1611-70………………………….
 
Womens Health Test for RN student

 
Multiple Choice
Identify the choice that best completes the statement or answers the question.
 
   1. The nurse is aware that the risk for a woman being involved in intimate partner violence in this country is:

a. 1 in 2.
b. 1 in 4.
c. 1 in 6.
d. 1 in 8.

 

   2. When presenting a talk to high school students on intimate partner violence, the nurse explains that:

a. proportionately, more men become homicide victims than do women.
b. violence often begins early in a relationship and gets progressively worse.
c. intimate partner abuse is generally confined to the lower socioeconomic strata.
d. violence occurs randomly without any association with family violence during childhood.

 

   3. A nurse works with a diverse clientele. When discussing intimate partner violence (IPV) with women from differing cultural backgrounds, the nurse should emphasize that:

a. rates of IPV are roughly the same among different cultural/ethnic groups.
b. women should take advantage of the resources available to victims of IPV.
c. although cultural perceptions of abuse may differ, harming others is illegal.
d. interventions in IPV situations should not take immigration status into account.

 

   4. A clinic nurse is taking a history from a woman who has vague complaints she can’t describe well. The nurse is frustrated and consults a more experienced nurse who advises checking the chart for:

a. chronic illnesses.
b. psychiatric problems.
c. missed appointments.
d. drug or alcohol abuse.

 

   5. A woman seen in the emergency department has facial injuries she states were the result of being hit during an attempted purse-snatching. Which diagnostic finding would lead the nurse to believe the patient’s account is accurate? The patient has:

a. a mandibular fracture.
b. loose and missing teeth.
c. a zygomatic arch fracture.
d. an orbital blow out fracture.

 

   6. A woman is complaining of a sore throat and difficulty swallowing over the last several weeks. Her complete blood count (CBC) and rapid strep swab are normal. The nurse should next assess for:

a. an intact gag reflex.
b. a history of smoking.
c. signs of strangulation.
d. intimate partner violence.

 

   7. The nurse is counseling a pregnant woman who is in a violent relationship about some of the consequences of intimate partner violence (IPV) during pregnancy. Which statement by the nurse is inconsistent with current knowledge about this situation?

a. Violence tends to decrease when a woman is pregnant.
b. Babies born to women experiencing violence often are premature.
c. Approximately one-third of homicides of pregnant women are related to IPV.
d. Kidney infections occur more often in pregnant women experiencing IPV.

 

   8. A woman is experiencing intimate partner violence (IPV) and the nurse is trying to assist her to identify resources. The woman states she has no real friends anymore and her family won’t help her. The nurse can most likely conclude that:

a. no one believes the woman is being harmed.
b. the violence is not as bad as the woman says it is.
c. the family and friends are tired of trying to help her.
d. the abuser has isolated her and intimidated her support system.

 

   9. The manager of a busy clinic initiates a policy for screening for intimate partner violence (IPV) in accordance with the American Nurses Association (ANA) 2000 position statement. The manager explains to the staff that this means:

a. assessing all patients for the presence of IPV at every visit.
b. asking women who have injuries if they have been harmed.
c. only asking women who share a residence with someone about IPV.
d. performing an IPV assessment if the patient shares a concern about it.

 

   10. A nurse is counseling a woman in a violent relationship about ways to keep herself safe. Which recommendation by the nurse is inconsistent with this goal? The nurse tells the patient to:

a. change the locks on the doors and install window locks.
b. try to leave the house when it appears violence is imminent.
c. pre-pack a bag with important items in case she needs to flee.
d. hide in a closet or small room when her partner is becoming violent.

 

   11. A woman wonders if she has premenstrual syndrome. The nurse explains that the most important criteria for this diagnosis is:

a. psychological symptoms that disrupt her life.
b. the timing of the symptoms in the menstrual cycle.
c. the presence of at least five major and three minor symptoms.
d. a constellation of symptoms that occur during her cycle.

 

   12. The nurse understands that the “luteal phase” of the menstrual cycle is the:

a. onset and duration of the monthly menstrual cycle.
b. period of time that begins with ovulation and ends with the beginning of menstruation.
c. first half of the cycle when the ovarian graafian follicle is growing.
d. time when the corpus luteum produces 80% of the circulating estrogen.

 

   13. A nurse is providing community education on premenstrual syndrome (PMS). Which statement by the nurse is inconsistent with current knowledge about this condition?

a. “Indirect costs are higher than direct medical costs for PMS.”
b. “The direct economic costs associated with PMS are substantial.”
c. “Symptoms must occur for at least six cycles for a diagnosis of PMS to be made.”
d. “There are at least 100 distinct signs and symptoms related to PMS.”

 

   14. The nurse explains to a patient that the main difference between premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is:

a. the symptoms are more severe and disabling in PMDD.
b. psychiatric symptoms are present exclusively in PMDD.
c. the absence of gastrointestinal symptoms in PMDD.
d. that no effective treatment exists for PMDD.

 

   15. A patient is in the clinic with symptoms of premenstrual syndrome (PMS). She reports extreme fatigue, depression, and a feeling of worthlessness. Which action by the nurse takes priority? The nurse should:

a. prepare the patient for a pelvic exam.
b. order blood work for hormone levels.
c. assess the patient for suicidal thoughts.
d. take a thorough history of the patient’s complaints.

 

   16. A woman with symptoms of premenstrual syndrome (PMS) asks whether or not she should have serum hormone testing. The best response by the nurse is:

a. “Yes, hormone levels are important in establishing a diagnosis of PMS.”
b. “Yes, we can draw serial hormone levels throughout your menstrual cycle.”
c. “No, actually hormone levels are similar in women with and without PMS.”
d. “Not right now, unless you are in the follicular stage of your menstrual cycle.”

 

   17. A patient has symptoms she thinks are related to premenstrual syndrome (PMS). A strategy the nurse can teach the patient that would help with confirming the diagnosis is to:

a. monitor how long each menstrual cycle lasts.
b. keep a symptom diary for two to three menstrual cycles.
c. avoid caffeine and other stimulants while menstruating.
d. investigate the relationship between symptoms and exercise.

 

   18. A nurse is teaching a woman with premenstrual syndrome (PMS) about exercise as a treatment modality. Which instruction by the nurse is most accurate?

a. “Avoid low-intensity exercise like yoga and stretching.”
b. “Vigorous exercise is better than moderate exercise for PMS.”
c. “You need to exercise moderately at least 75 minutes a week.”
d. “Exercising moderately for about 150 minutes a week can help with PMS symptoms.”

 

   19. A woman with premenstrual syndrome asks about alternative and complementary medicine practices that might be helpful for her. The nurse explains that:

a. evening primrose (Oenothera biennis) has been proven beneficial in relieving PMS symptoms.
b. chasteberry has not been approved for use for PMS symptoms in any country.
c. good randomized trials of relaxation therapy demonstrate a clear benefit in PMS symptom relief.
d. there are some herbal remedies that may help to reduce PMS symptoms, but claims about the benefits associated with other herbal products are unsubstantiated.

 

   20. A woman who has premenstrual syndrome (PMS) has been prescribed spironolactone (Aldactone) for her symptoms. The nurse would evaluate that treatment with this medication has been effective when the patient says:

a. “I am so glad I don’t get my period anymore because of this medication.”
b. “I have really noticed a decrease in my bloating while on this medication.”
c. “My anxiety and depression have slowly gotten better with this medicine.”
d. “My partner and I like that this medication decreases my PMS symptoms and provides contraception.”

 

   21. A patient asks how obesity is related to the development of breast cancer. The best response by the nurse is that:

a. adipose tissue can hide the developing tumors easily.
b. limited exercise contributes to several types of cancer.
c. estrogen is produced in adipose tissue after menopause.
d. larger breasts in heavy women are more prone to cancer.

 

   22. A nurse wishes to plan a breast health educational activity. In order to have the greatest potential impact, in which location should the nurse conduct the activity? The nurse should plan to conduct this activity in:

a. a busy shopping mall.
b. several local fitness centers.
c. high school and college health centers.
d. a predominantly African-American church.

 

   23. To increase comfort, the nurse advises women to perform breast self-examination (BSE)

a. one week after their menstrual cycle.
b. one week before their menstrual cycle.
c. without regard to their menstrual cycle.
d. whenever it is most comfortable for them.

 

   24. The nurse knows the best position for the patient to assume when performing self breast palpation is:

a. sitting upright with one arm above the head.
b. lying flat on the back on a supportive mattress.
c. standing in front of a mirror in order to see well.
d. reclining in bed with a pillow under the shoulder.

 

   25. The nurse working with a patient in her 40s would advise her to have a clinical breast examination every:

a. one year.
b. two years.
c. three years.
d. five years.

 

   26. A patient is complaining of tender masses in her breasts that tend to change in size related to her menstrual cycle. The nurse can counsel this patient to try:

a. drinking several cups of green tea each day.
b. reducing her intake of caffeine and other stimulants.
c. sleeping on her side with pillows supporting the breasts.
d. using ice packs on the tender areas for 20 minutes at a time.

 

   27. A patient is complaining of tender, warm lumps in her breast and tender, swollen ipsilateral lymph nodes. Which question by the nurse would elicit the most useful information? The nurse asks:

a. “Are you currently breastfeeding?”
b. “Where in your menstrual cycle are you?”
c. “Have you had any recent breast trauma?”
d. “Do you have a family history of breast cancer?”

 

   28. A patient has a breast lump discovered during a clinical breast examination. The provider directs the patient to return after her next menstrual period for another examination. The nurse can most likely conclude that the patient:

a. has had a screening mammogram within the last year.
b. does not have significant risk factors for breast cancer.
c. frequently has lumps detected on her clinical breast exam.
d. has fibrocystic breast disease, making clinical judgment difficult.

 

   29. A woman has been diagnosed with breast cancer in situ and questions the nurse as to what that means. The best explanation by the nurse is that this type of cancer:

a. is only found in one area of the breast that was biopsied.
b. is confined to its original location and has not spread.
c. can be treated with locally administered chemotherapy.
d. only occurs in one breast or the other; it is not bilateral.

 

   30. A woman has unilateral breast swelling and complains that the affected breast is itching and has peeling skin. The nurse anticipates the physician will order:

a. a mammogram.
b. a dermatology consultation.
c. magnetic resonance imaging (MRI).
d. a positron emission tomography (PET scan).

 

   31. The nurse reviewing a patient’s chart sees the term “metrorrhagia” and knows that this woman is experiencing:

a. excess bleeding in either the amount or in the length of time.
b. bleeding that occurs at abnormal times during an ovulatory cycle; more often than every 21 days.
c. variable bleeding that occurs between the regular menses.
d. bleeding at abnormal times during an anovulatory cycle.

 

   32. A patient with painful menstrual periods (dysmenorrhea) is advised to take a nonsteroidal anti-inflammatory drug such as ibuprofen (Motrin) for her discomfort. When she asks why ibuprofen is better than acetaminophen (Tylenol), the nurse explains that ibuprofen works better because:

a. acetaminophen tends to cause more side effects when taken for cramps.
b. ibuprofen tends to work more quickly than either acetaminophen or aspirin.
c. menstrual cramps are related to an inflammation of the cervical tissue and ibuprofen decreases the inflammation.
d. the pain is related to an excessive production of prostaglandins, and ibuprofen inhibits the synthesis of prostaglandins.

 

   33. A physician tells the nurse that a patient has a positive “whiff test.” The nurse anticipates that the physician will write the patient a prescription for:

a. metronidazole (Flagyl).
b. miconazole (Monistat).
c. boric acid gelatin capsules.
d. clotrimazole (Gyne-Lotrimin).

 

   34. A patient has come to the clinic for a physical exam and complains of having her fourth vaginal yeast infection in 6 months. The diagnostic test results that the nurse would be most interested in is the:

a. Pap test.
b. blood glucose.
c. complete blood count.
d. absolute neutrophil count.

 

   35. The nurse evaluates that teaching related to toxic shock syndrome (TSS) has been effective when the patient states:

a. “I should change my tampons frequently.”
b. “I can use super absorbent tampons any time.”
c. “I should not use tampons at all during my period.”
d. “I can take ibuprofen for fever if I think I have TSS.”

 

   36. A woman is being prescribed leuprolide (Lupron) for endometriosis. The nurse determines that patient teaching has been effective when the patient states:

a. “Side effects will be similar to menopause.”
b. “A serious side effect is permanent bone loss.”
c. “I can take this medication for years if needed.”
d. “If I get ankle swelling, I should call my doctor.”

 

   37. The nurse understands that “dysfunctional uterine bleeding” is diagnosed:

a. most often in women who experience normal monthly menstrual periods.
b. more often than any other cause of abnormal vaginal bleeding.
c. after all pathologic causes of bleeding have been excluded.
d. when menstrual bleeding is either abnormally heavy or lengthy.

 

   38. A woman with heavy vaginal bleeding who does not wish to have more children is discussing endometrial ablation with the nurse. Which statement by the nurse is inconsistent with knowledge about this procedure? The nurse tells the patient:

a. “Since the endometrium scars after this procedure, the bleeding is halted.”
b. “Following this procedure, you will not need to use any contraception when you resume sexual activity.”
c. “There are several methods that have been approved for endometrial ablation.”
d. “Endometrial ablation is usually reserved for patients who have not responded to other treatments.”

 

   39. A patient undergoing a workup for infertility also complains of hirsutism and acne. The nurse anticipates diagnostic testing for:

a. uterine fibroids.
b. benign leiomyomata.
c. follicular ovarian cysts.
d. polycystic ovary syndrome.

 

   40. A nurse counseling a patient about infection with the Human Immunodeficiency Virus (HIV) explains that the virus is detectable in plasma within:

a. 3 days.
b. 5 days.
c. 1 week.
d. 1 month.

 

   41. A nurse in a women’s health clinic explains to a new graduate nurse that they follow current recommendations for opt-out Human Immunodeficiency Virus (HIV) testing. The nurse explains this means that patients:

a. are told about the testing but need to give specific consent for it.
b. are informed about testing but consent is assumed unless they decline.
c. can choose not to be informed of the test results when they are available.
d. can specify that they want results sent directly to them, not to the provider.

 

   42. A woman just diagnosed with chlamydia tells the nurse she is relieved that it’s “just chlamydia” and not something “serious.” The best response by the nurse is to say:

a. “You’re right; chlamydia is easily cured with common antibiotics.”
b. “Yes, chlamydia is not as serious as other STDs since it isn’t associated with any long-term effects.”
c. “Chlamydia can increase the risk of contracting ‘serious’ infections like HIV.”
d. “All STDs are equally serious because they show that you engage in unsafe behavior.”

 

   43. The nurse caring for a woman with a chlamydial infection anticipates an order for which medication?

a. metronidazole (Flagyl) 2 grams orally administered one time
b. ceftriaxone (Rocephin) 250 mg IM administered once
c. doxycycline (Vibramycin) 100 mg orally bid for 7 days
d. acyclovir (Zovirax) 800 mg every 4 hours orally for 7 days

 

   44. A patient diagnosed with gonorrhea was treated in the clinic with a single dose of cefixime (Suprax), 400 mg orally. Two weeks later she returns stating her symptoms are back. The nurse would most likely conclude that:

a. the woman’s sex partner(s) had not been treated.
b. cefixime is not the best drug to use in this patient.
c. the patient’s particular strain of gonorrhea is resistant to this medication.
d. the prescribed dose was too low to be effective against N. gonorrhoeae.

 

   45. A patient is being treated for trichomoniasis with metronidazole (Flagyl). Which instruction specific to this medication should the nurse give the patient?

a. “Don’t drink alcohol until 24 hours after you have finished this medication.”
b. “Avoid getting any direct sunlight for 1 week after you finish the Flagyl.”
c. “Make sure you take all the medication that has been prescribed for you.”
d. “Since only one dose is needed, we will watch you take it before you leave.”

 

   46. A nurse is assisting with a pelvic examination and the provider comments that the patient has “cervical motion tenderness.” With which condition does the nurse associate this finding?

a. gonorrhea
b. chlamydia
c. trichomoniasis
d. pelvic inflammatory disease

 

   47. A patient in the clinic has what appears to be a chancre. The nurse anticipates ordering tests to confirm which disease?

a. syphilis
b. chlamydia
c. gonorrhea
d. trichomoniasis

 

   48. A nurse is counseling a patient who engages in risky sexual behavior about getting tested for sexually transmitted diseases (STDs). The patient is hesitant to get tested, stating she is too embarrassed to do so. Which action by the nurse would most likely result in the patient’s agreeing to undergo STD screening? The nurse should advise the patient that:

a. records are kept confidential and not shared with outsiders.
b. home screening for some common diseases is now available.
c. there are serious consequences of having undiagnosed STDs.
d. health-care providers have seen many patients with STDs before.

 

   49. The nurse knows that the transformation zone is the area where the:

a. darker pink columnar cells line the vagina.
b. cervix communicates with the uterine body.
c. process of squamous metaplasia does not occur.
d. squamous cells constantly replace columnar cells.

 

   50. A nurse is assisting with a pelvic examination and traditional Pap testing. Which action by the nurse is most important for the accuracy of the test results? The nurse should:

a. suspend the sample in a special liquid preservative.
b. preserve the specimen on a special agar-coated slide.
c. preserve the specimen within 5 seconds of collection.
d. allow the sample to air dry on the slide before analysis.

 

   51. A nurse is explaining recommended guidelines for cervical cancer screening to a community group. Which statement by the nurse is most accurate? The nurse explains that women:

a. aged 21 to 29 should be screened every 2 years.
b. over age 60 do not need regular cervical screening.
c. 30 years of age and older need to continue annual screening.
d. need their first screen when they become sexually active.

 

   52. A nurse explains to a patient that a colposcopy is:

a. vaporization of abnormal cells using a laser beam.
b. a treatment that involves freezing of precancerous cells.
c. a specialized examination for the early detection and treatment of cancer.
d. a sampling method that uses a curette to obtain specimens.

 

   53. A patient had an endocervical sampling procedure 2 days ago and calls the clinic complaining of a thin vaginal discharge that looks like it contains “coffee grounds.” The best response by the nurse is to say:

a. “This may indicate an infection; call us if you develop a fever over 101.5°F.”
b. “This is an abnormal reaction to the drugs used during the procedure.”
c. “This is a normal result of the material used to stop cervical bleeding.”
d. “This might indicate an allergy to the solution used in the procedure.”

 

   54. A nurse is giving a patient post-procedure education after cryosurgery. The nurse determines that additional teaching is needed when the patient states: “I should:

a. continue to obtain repeat Pap testing as directed.”
b. avoid inserting anything into my vagina for 2 to 3 weeks.”
c. call the office if I develop a foul-smelling watery vaginal discharge.”
d. contact my health-care provider if I develop increasing pelvic pain.”

 

   55. The nurse providing education to a group of adolescents on the human papilloma virus (HPV) explains that:

a. newer HPV vaccines require only one injection.
b. only latex condoms prevent the spread of HPV.
c. most people infected with HPV have visible warts.
d. condoms may not totally prevent the spread of HPV.

 

   56. A nurse is counseling a woman ready to initiate a new sexual relationship about testing for sexually transmitted infections (STIs). Which information about human papilloma virus (HPV) should the nurse provide to the patient?

a. “Owing to the link between HPV and cervical cancer, testing for HPV is crucial.”
b. “HPV screening is not recommended since it is common and difficult to diagnose.”
c. “Since there are no treatments for HPV, there isn’t a real reason to screen for it.”
d. “You should be screened for all STIs, including HPV, with all new relationships.”

 

   57. A clinic nurse wants to develop a program that will impact the prevalence of cervical cancer in the community. To design a program that has maximum effects, the nurse should plan to:

a. incorporate routine screening for human papilloma virus into clinic policy.
b. create a pamphlet for patients that discusses how to avoid the known risk factors.
c. provide culturally relevant education on regular Pap testing and needed follow up.
d. lobby elected representatives for federal funds to pay for cervical cancer screening.

 

   58. A nurse is counseling a 52-year-old woman who relates that her periods have become very heavy over the last year and wonders if she is entering menopause. The best action by the nurse would be to:

a. assure the patient that at her age, she is most likely entering into menopause.
b. discuss ways to manage irregular and heavy perimenopausal menstrual cycles.
c. provide education on medical and nonpharmacological methods to treat menopause.
d. explain that heavy bleeding needs investigation even if the patient is perimenopausal.

 

   59. The nurse caring for perimenopausal women understands that urogenital problems associated with menopause:

a. are unusual and do not often pose much difficulty.
b. are common and often worsen with advancing age.
c. usually can’t be effectively treated once they manifest.
d. often are worse at the start of menopause, then improve.

 

   60. The nurse has instructed a patient on performing Kegel exercises. The nurse determines that further instruction is needed when the patient says, “I will:

a. hold each contraction for 6 seconds.”
b. do these exercises 5 to 10 times each day.”
c. perform 10 repetitions as quickly as I can.”
d. contract the muscles like trying to stop my urine flow.”

 

   61. A post-menopausal woman is complaining about vaginal dryness that interferes with sexual intimacy and causes discomfort. Which statement would be inconsistent with a nurse’s knowledge about sexuality in post-menopausal women?

a. “Frequent sexual activity actually helps with vaginal lubrication.”
b. “Vegetable oil may feel better than lubricants that contain alcohol.”
c. “If intercourse causes discomfort, you should refrain from having it.”
d. “If you don’t have high blood pressure, you can try vitamin E supplements.”

 

   62. A nurse providing education to a community group on symptoms of menopause relates that the most common symptom reported by perimenopausal women is:

a. hot flashes.
b. hot flushes.
c. night sweats.
d. mood swings.

 

   63. A woman reports to the nurse that she uses a traditional healing approach to manage menopausal symptoms that includes qi gong to unblock the flow of vital energy and blood through her meridians. The nurse realizes the woman is seeing a practitioner of :

a. homeopathy.
b. ayurvedic medicine.
c. naturopathic medicine.
d. traditional Chinese medicine.

 

   64. A woman asks the nurse about using soy products to reduce her menopausal symptoms. Which information should the nurse provide?

a. “Soy can be found in many products, including ginseng tea.”
b. “Soy is a dietary supplement and there is no proof as to its effectiveness.”
c. “These products are good for long-term management of vasomotor symptoms.”
d. “Like all the other isoflavones, soy products are monitored for safety and purity.”

 

   65. A nurse is counseling a patient about hormone therapy (HT) for symptoms of menopause. The most appropriate information the nurse can share would be:

a. “If you want an estrogen-progestogen product, they only come in pill form.”
b. “Hormone therapy was found to cause breast cancer in recent research trials.”
c. “The benefits of short-term HT may outweigh the risks if used for a short time.”
d. “Women with cardiovascular risks should use HT just to help decrease that risk.”

 

   66. A woman wants to have her physician write a prescription for compounded, bio-identical hormone therapy (HT). Which information from the nurse is most appropriate?

a. “Compounded hormones are not yet regulated by the FDA.”
b. “Compounding produces bio-identical hormones that are highly effective.”
c. “Individualized bio-identical, compounded hormones are more natural than standard prescriptions.”
d. “There is research that shows compounded hormones are safe and effective.”
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
 
 67. The nurse instructing the patient about self care after a myomectomy includes directions to: (Select all answers that apply.)

  a. take stool softeners as needed.
  b. take all medications as directed.
  c. resume intercourse in 2 days.
  d. eat high protein, high iron foods.

 

 68. Which of the following instructions would be useful for the patient with a herpes outbreak? (Select all answers that apply.)

  a. Keep lesions dry with a blow dryer set on hot.
  b. Take a warm bath with baking soda added to the water.
  c. Kelp powder and sunflower seed oil may help the discomfort.
  d. Try placing compresses containing peppermint oil on the lesions for comfort.

 

 69. The nurse knows that signs and symptoms of early cervical cancer may include: (Select all answers that apply.)

  a. pelvic pain.
  b. weight loss.
  c. abnormal vaginal bleeding.
  d. continuous vaginal discharge.
  e. menstrual periods that become heavier.

 

 70. The nurse is counseling a woman with incontinence who is unable to perform Kegel exercises. The nurse explains that alternatives the woman could consider are: (Select all answers that apply.)

  a. biofeedback.
  b. vaginal cones.
  c. incontinent pads.
  d. electric stimulation.

WomansHealthCompanionRN

 
Multiple Choice
Identify the choice that best completes the statement or answers the question.
 
   1. The nurse is aware that the risk for a woman being involved in intimate partner violence in this country is:

a. 1 in 2.
b. 1 in 4.
c. 1 in 6.
d. 1 in 8.

 

   2. When presenting a talk to high school students on intimate partner violence, the nurse explains that:

a. proportionately, more men become homicide victims than do women.
b. violence often begins early in a relationship and gets progressively worse.
c. intimate partner abuse is generally confined to the lower socioeconomic strata.
d. violence occurs randomly without any association with family violence during childhood.

 

   3. A nurse works with a diverse clientele. When discussing intimate partner violence (IPV) with women from differing cultural backgrounds, the nurse should emphasize that:

a. rates of IPV are roughly the same among different cultural/ethnic groups.
b. women should take advantage of the resources available to victims of IPV.
c. although cultural perceptions of abuse may differ, harming others is illegal.
d. interventions in IPV situations should not take immigration status into account.

 

   4. A clinic nurse is taking a history from a woman who has vague complaints she can’t describe well. The nurse is frustrated and consults a more experienced nurse who advises checking the chart for:

a. chronic illnesses.
b. psychiatric problems.
c. missed appointments.
d. drug or alcohol abuse.

 

   5. A woman seen in the emergency department has facial injuries she states were the result of being hit during an attempted purse-snatching. Which diagnostic finding would lead the nurse to believe the patient’s account is accurate? The patient has:

a. a mandibular fracture.
b. loose and missing teeth.
c. a zygomatic arch fracture.
d. an orbital blow out fracture.

 

   6. A woman is complaining of a sore throat and difficulty swallowing over the last several weeks. Her complete blood count (CBC) and rapid strep swab are normal. The nurse should next assess for:

a. an intact gag reflex.
b. a history of smoking.
c. signs of strangulation.
d. intimate partner violence.

 

   7. The nurse is counseling a pregnant woman who is in a violent relationship about some of the consequences of intimate partner violence (IPV) during pregnancy. Which statement by the nurse is inconsistent with current knowledge about this situation?

a. Violence tends to decrease when a woman is pregnant.
b. Babies born to women experiencing violence often are premature.
c. Approximately one-third of homicides of pregnant women are related to IPV.
d. Kidney infections occur more often in pregnant women experiencing IPV.

 

   8. A woman is experiencing intimate partner violence (IPV) and the nurse is trying to assist her to identify resources. The woman states she has no real friends anymore and her family won’t help her. The nurse can most likely conclude that:

a. no one believes the woman is being harmed.
b. the violence is not as bad as the woman says it is.
c. the family and friends are tired of trying to help her.
d. the abuser has isolated her and intimidated her support system.

 

   9. The manager of a busy clinic initiates a policy for screening for intimate partner violence (IPV) in accordance with the American Nurses Association (ANA) 2000 position statement. The manager explains to the staff that this means:

a. assessing all patients for the presence of IPV at every visit.
b. asking women who have injuries if they have been harmed.
c. only asking women who share a residence with someone about IPV.
d. performing an IPV assessment if the patient shares a concern about it.

 

   10. A nurse is counseling a woman in a violent relationship about ways to keep herself safe. Which recommendation by the nurse is inconsistent with this goal? The nurse tells the patient to:

a. change the locks on the doors and install window locks.
b. try to leave the house when it appears violence is imminent.
c. pre-pack a bag with important items in case she needs to flee.
d. hide in a closet or small room when her partner is becoming violent.

 

   11. A woman wonders if she has premenstrual syndrome. The nurse explains that the most important criteria for this diagnosis is:

a. psychological symptoms that disrupt her life.
b. the timing of the symptoms in the menstrual cycle.
c. the presence of at least five major and three minor symptoms.
d. a constellation of symptoms that occur during her cycle.

 

   12. The nurse understands that the “luteal phase” of the menstrual cycle is the:

a. onset and duration of the monthly menstrual cycle.
b. period of time that begins with ovulation and ends with the beginning of menstruation.
c. first half of the cycle when the ovarian graafian follicle is growing.
d. time when the corpus luteum produces 80% of the circulating estrogen.

 

   13. A nurse is providing community education on premenstrual syndrome (PMS). Which statement by the nurse is inconsistent with current knowledge about this condition?

a. “Indirect costs are higher than direct medical costs for PMS.”
b. “The direct economic costs associated with PMS are substantial.”
c. “Symptoms must occur for at least six cycles for a diagnosis of PMS to be made.”
d. “There are at least 100 distinct signs and symptoms related to PMS.”

 

   14. The nurse explains to a patient that the main difference between premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is:

a. the symptoms are more severe and disabling in PMDD.
b. psychiatric symptoms are present exclusively in PMDD.
c. the absence of gastrointestinal symptoms in PMDD.
d. that no effective treatment exists for PMDD.

 

   15. A patient is in the clinic with symptoms of premenstrual syndrome (PMS). She reports extreme fatigue, depression, and a feeling of worthlessness. Which action by the nurse takes priority? The nurse should:

a. prepare the patient for a pelvic exam.
b. order blood work for hormone levels.
c. assess the patient for suicidal thoughts.
d. take a thorough history of the patient’s complaints.

 

   16. A woman with symptoms of premenstrual syndrome (PMS) asks whether or not she should have serum hormone testing. The best response by the nurse is:

a. “Yes, hormone levels are important in establishing a diagnosis of PMS.”
b. “Yes, we can draw serial hormone levels throughout your menstrual cycle.”
c. “No, actually hormone levels are similar in women with and without PMS.”
d. “Not right now, unless you are in the follicular stage of your menstrual cycle.”

 

   17. A patient has symptoms she thinks are related to premenstrual syndrome (PMS). A strategy the nurse can teach the patient that would help with confirming the diagnosis is to:

a. monitor how long each menstrual cycle lasts.
b. keep a symptom diary for two to three menstrual cycles.
c. avoid caffeine and other stimulants while menstruating.
d. investigate the relationship between symptoms and exercise.

 

   18. A nurse is teaching a woman with premenstrual syndrome (PMS) about exercise as a treatment modality. Which instruction by the nurse is most accurate?

a. “Avoid low-intensity exercise like yoga and stretching.”
b. “Vigorous exercise is better than moderate exercise for PMS.”
c. “You need to exercise moderately at least 75 minutes a week.”
d. “Exercising moderately for about 150 minutes a week can help with PMS symptoms.”

 

   19. A woman with premenstrual syndrome asks about alternative and complementary medicine practices that might be helpful for her. The nurse explains that:

a. evening primrose (Oenothera biennis) has been proven beneficial in relieving PMS symptoms.
b. chasteberry has not been approved for use for PMS symptoms in any country.
c. good randomized trials of relaxation therapy demonstrate a clear benefit in PMS symptom relief.
d. there are some herbal remedies that may help to reduce PMS symptoms, but claims about the benefits associated with other herbal products are unsubstantiated.

 

   20. A woman who has premenstrual syndrome (PMS) has been prescribed spironolactone (Aldactone) for her symptoms. The nurse would evaluate that treatment with this medication has been effective when the patient says:

a. “I am so glad I don’t get my period anymore because of this medication.”
b. “I have really noticed a decrease in my bloating while on this medication.”
c. “My anxiety and depression have slowly gotten better with this medicine.”
d. “My partner and I like that this medication decreases my PMS symptoms and provides contraception.”

 

   21. A patient asks how obesity is related to the development of breast cancer. The best response by the nurse is that:

a. adipose tissue can hide the developing tumors easily.
b. limited exercise contributes to several types of cancer.
c. estrogen is produced in adipose tissue after menopause.
d. larger breasts in heavy women are more prone to cancer.

 

   22. A nurse wishes to plan a breast health educational activity. In order to have the greatest potential impact, in which location should the nurse conduct the activity? The nurse should plan to conduct this activity in:

a. a busy shopping mall.
b. several local fitness centers.
c. high school and college health centers.
d. a predominantly African-American church.

 

   23. To increase comfort, the nurse advises women to perform breast self-examination (BSE)

a. one week after their menstrual cycle.
b. one week before their menstrual cycle.
c. without regard to their menstrual cycle.
d. whenever it is most comfortable for them.

 

   24. The nurse knows the best position for the patient to assume when performing self breast palpation is:

a. sitting upright with one arm above the head.
b. lying flat on the back on a supportive mattress.
c. standing in front of a mirror in order to see well.
d. reclining in bed with a pillow under the shoulder.

 

   25. The nurse working with a patient in her 40s would advise her to have a clinical breast examination every:

a. one year.
b. two years.
c. three years.
d. five years.

 

   26. A patient is complaining of tender masses in her breasts that tend to change in size related to her menstrual cycle. The nurse can counsel this patient to try:

a. drinking several cups of green tea each day.
b. reducing her intake of caffeine and other stimulants.
c. sleeping on her side with pillows supporting the breasts.
d. using ice packs on the tender areas for 20 minutes at a time.

 

   27. A patient is complaining of tender, warm lumps in her breast and tender, swollen ipsilateral lymph nodes. Which question by the nurse would elicit the most useful information? The nurse asks:

a. “Are you currently breastfeeding?”
b. “Where in your menstrual cycle are you?”
c. “Have you had any recent breast trauma?”
d. “Do you have a family history of breast cancer?”

 

   28. A patient has a breast lump discovered during a clinical breast examination. The provider directs the patient to return after her next menstrual period for another examination. The nurse can most likely conclude that the patient:

a. has had a screening mammogram within the last year.
b. does not have significant risk factors for breast cancer.
c. frequently has lumps detected on her clinical breast exam.
d. has fibrocystic breast disease, making clinical judgment difficult.

 

   29. A woman has been diagnosed with breast cancer in situ and questions the nurse as to what that means. The best explanation by the nurse is that this type of cancer:

a. is only found in one area of the breast that was biopsied.
b. is confined to its original location and has not spread.
c. can be treated with locally administered chemotherapy.
d. only occurs in one breast or the other; it is not bilateral.

 

   30. A woman has unilateral breast swelling and complains that the affected breast is itching and has peeling skin. The nurse anticipates the physician will order:

a. a mammogram.
b. a dermatology consultation.
c. magnetic resonance imaging (MRI).
d. a positron emission tomography (PET scan).

 

   31. The nurse reviewing a patient’s chart sees the term “metrorrhagia” and knows that this woman is experiencing:

a. excess bleeding in either the amount or in the length of time.
b. bleeding that occurs at abnormal times during an ovulatory cycle; more often than every 21 days.
c. variable bleeding that occurs between the regular menses.
d. bleeding at abnormal times during an anovulatory cycle.

 

   32. A patient with painful menstrual periods (dysmenorrhea) is advised to take a nonsteroidal anti-inflammatory drug such as ibuprofen (Motrin) for her discomfort. When she asks why ibuprofen is better than acetaminophen (Tylenol), the nurse explains that ibuprofen works better because:

a. acetaminophen tends to cause more side effects when taken for cramps.
b. ibuprofen tends to work more quickly than either acetaminophen or aspirin.
c. menstrual cramps are related to an inflammation of the cervical tissue and ibuprofen decreases the inflammation.
d. the pain is related to an excessive production of prostaglandins, and ibuprofen inhibits the synthesis of prostaglandins.

 

   33. A physician tells the nurse that a patient has a positive “whiff test.” The nurse anticipates that the physician will write the patient a prescription for:

a. metronidazole (Flagyl).
b. miconazole (Monistat).
c. boric acid gelatin capsules.
d. clotrimazole (Gyne-Lotrimin).

 

   34. A patient has come to the clinic for a physical exam and complains of having her fourth vaginal yeast infection in 6 months. The diagnostic test results that the nurse would be most interested in is the:

a. Pap test.
b. blood glucose.
c. complete blood count.
d. absolute neutrophil count.

 

   35. The nurse evaluates that teaching related to toxic shock syndrome (TSS) has been effective when the patient states:

a. “I should change my tampons frequently.”
b. “I can use super absorbent tampons any time.”
c. “I should not use tampons at all during my period.”
d. “I can take ibuprofen for fever if I think I have TSS.”

 

   36. A woman is being prescribed leuprolide (Lupron) for endometriosis. The nurse determines that patient teaching has been effective when the patient states:

a. “Side effects will be similar to menopause.”
b. “A serious side effect is permanent bone loss.”
c. “I can take this medication for years if needed.”
d. “If I get ankle swelling, I should call my doctor.”

 

   37. The nurse understands that “dysfunctional uterine bleeding” is diagnosed:

a. most often in women who experience normal monthly menstrual periods.
b. more often than any other cause of abnormal vaginal bleeding.
c. after all pathologic causes of bleeding have been excluded.
d. when menstrual bleeding is either abnormally heavy or lengthy.

 

   38. A woman with heavy vaginal bleeding who does not wish to have more children is discussing endometrial ablation with the nurse. Which statement by the nurse is inconsistent with knowledge about this procedure? The nurse tells the patient:

a. “Since the endometrium scars after this procedure, the bleeding is halted.”
b. “Following this procedure, you will not need to use any contraception when you resume sexual activity.”
c. “There are several methods that have been approved for endometrial ablation.”
d. “Endometrial ablation is usually reserved for patients who have not responded to other treatments.”

 

   39. A patient undergoing a workup for infertility also complains of hirsutism and acne. The nurse anticipates diagnostic testing for:

a. uterine fibroids.
b. benign leiomyomata.
c. follicular ovarian cysts.
d. polycystic ovary syndrome.

 

   40. A nurse counseling a patient about infection with the Human Immunodeficiency Virus (HIV) explains that the virus is detectable in plasma within:

a. 3 days.
b. 5 days.
c. 1 week.
d. 1 month.

 

   41. A nurse in a women’s health clinic explains to a new graduate nurse that they follow current recommendations for opt-out Human Immunodeficiency Virus (HIV) testing. The nurse explains this means that patients:

a. are told about the testing but need to give specific consent for it.
b. are informed about testing but consent is assumed unless they decline.
c. can choose not to be informed of the test results when they are available.
d. can specify that they want results sent directly to them, not to the provider.

 

   42. A woman just diagnosed with chlamydia tells the nurse she is relieved that it’s “just chlamydia” and not something “serious.” The best response by the nurse is to say:

a. “You’re right; chlamydia is easily cured with common antibiotics.”
b. “Yes, chlamydia is not as serious as other STDs since it isn’t associated with any long-term effects.”
c. “Chlamydia can increase the risk of contracting ‘serious’ infections like HIV.”
d. “All STDs are equally serious because they show that you engage in unsafe behavior.”

 

   43. The nurse caring for a woman with a chlamydial infection anticipates an order for which medication?

a. metronidazole (Flagyl) 2 grams orally administered one time
b. ceftriaxone (Rocephin) 250 mg IM administered once
c. doxycycline (Vibramycin) 100 mg orally bid for 7 days
d. acyclovir (Zovirax) 800 mg every 4 hours orally for 7 days

 

   44. A patient diagnosed with gonorrhea was treated in the clinic with a single dose of cefixime (Suprax), 400 mg orally. Two weeks later she returns stating her symptoms are back. The nurse would most likely conclude that:

a. the woman’s sex partner(s) had not been treated.
b. cefixime is not the best drug to use in this patient.
c. the patient’s particular strain of gonorrhea is resistant to this medication.
d. the prescribed dose was too low to be effective against N. gonorrhoeae.

 

   45. A patient is being treated for trichomoniasis with metronidazole (Flagyl). Which instruction specific to this medication should the nurse give the patient?

a. “Don’t drink alcohol until 24 hours after you have finished this medication.”
b. “Avoid getting any direct sunlight for 1 week after you finish the Flagyl.”
c. “Make sure you take all the medication that has been prescribed for you.”
d. “Since only one dose is needed, we will watch you take it before you leave.”

 

   46. A nurse is assisting with a pelvic examination and the provider comments that the patient has “cervical motion tenderness.” With which condition does the nurse associate this finding?

a. gonorrhea
b. chlamydia
c. trichomoniasis
d. pelvic inflammatory disease

 

   47. A patient in the clinic has what appears to be a chancre. The nurse anticipates ordering tests to confirm which disease?

a. syphilis
b. chlamydia
c. gonorrhea
d. trichomoniasis

 

   48. A nurse is counseling a patient who engages in risky sexual behavior about getting tested for sexually transmitted diseases (STDs). The patient is hesitant to get tested, stating she is too embarrassed to do so. Which action by the nurse would most likely result in the patient’s agreeing to undergo STD screening? The nurse should advise the patient that:

a. records are kept confidential and not shared with outsiders.
b. home screening for some common diseases is now available.
c. there are serious consequences of having undiagnosed STDs.
d. health-care providers have seen many patients with STDs before.

 

   49. The nurse knows that the transformation zone is the area where the:

a. darker pink columnar cells line the vagina.
b. cervix communicates with the uterine body.
c. process of squamous metaplasia does not occur.
d. squamous cells constantly replace columnar cells.

 

   50. A nurse is assisting with a pelvic examination and traditional Pap testing. Which action by the nurse is most important for the accuracy of the test results? The nurse should:

a. suspend the sample in a special liquid preservative.
b. preserve the specimen on a special agar-coated slide.
c. preserve the specimen within 5 seconds of collection.
d. allow the sample to air dry on the slide before analysis.

 

   51. A nurse is explaining recommended guidelines for cervical cancer screening to a community group. Which statement by the nurse is most accurate? The nurse explains that women:

a. aged 21 to 29 should be screened every 2 years.
b. over age 60 do not need regular cervical screening.
c. 30 years of age and older need to continue annual screening.
d. need their first screen when they become sexually active.

 

   52. A nurse explains to a patient that a colposcopy is:

a. vaporization of abnormal cells using a laser beam.
b. a treatment that involves freezing of precancerous cells.
c. a specialized examination for the early detection and treatment of cancer.
d. a sampling method that uses a curette to obtain specimens.

 

   53. A patient had an endocervical sampling procedure 2 days ago and calls the clinic complaining of a thin vaginal discharge that looks like it contains “coffee grounds.” The best response by the nurse is to say:

a. “This may indicate an infection; call us if you develop a fever over 101.5°F.”
b. “This is an abnormal reaction to the drugs used during the procedure.”
c. “This is a normal result of the material used to stop cervical bleeding.”
d. “This might indicate an allergy to the solution used in the procedure.”

 

   54. A nurse is giving a patient post-procedure education after cryosurgery. The nurse determines that additional teaching is needed when the patient states: “I should:

a. continue to obtain repeat Pap testing as directed.”
b. avoid inserting anything into my vagina for 2 to 3 weeks.”
c. call the office if I develop a foul-smelling watery vaginal discharge.”
d. contact my health-care provider if I develop increasing pelvic pain.”

 

   55. The nurse providing education to a group of adolescents on the human papilloma virus (HPV) explains that:

a. newer HPV vaccines require only one injection.
b. only latex condoms prevent the spread of HPV.
c. most people infected with HPV have visible warts.
d. condoms may not totally prevent the spread of HPV.

 

   56. A nurse is counseling a woman ready to initiate a new sexual relationship about testing for sexually transmitted infections (STIs). Which information about human papilloma virus (HPV) should the nurse provide to the patient?

a. “Owing to the link between HPV and cervical cancer, testing for HPV is crucial.”
b. “HPV screening is not recommended since it is common and difficult to diagnose.”
c. “Since there are no treatments for HPV, there isn’t a real reason to screen for it.”
d. “You should be screened for all STIs, including HPV, with all new relationships.”

 

   57. A clinic nurse wants to develop a program that will impact the prevalence of cervical cancer in the community. To design a program that has maximum effects, the nurse should plan to:

a. incorporate routine screening for human papilloma virus into clinic policy.
b. create a pamphlet for patients that discusses how to avoid the known risk factors.
c. provide culturally relevant education on regular Pap testing and needed follow up.
d. lobby elected representatives for federal funds to pay for cervical cancer screening.

 

   58. A nurse is counseling a 52-year-old woman who relates that her periods have become very heavy over the last year and wonders if she is entering menopause. The best action by the nurse would be to:

a. assure the patient that at her age, she is most likely entering into menopause.
b. discuss ways to manage irregular and heavy perimenopausal menstrual cycles.
c. provide education on medical and nonpharmacological methods to treat menopause.
d. explain that heavy bleeding needs investigation even if the patient is perimenopausal.

 

   59. The nurse caring for perimenopausal women understands that urogenital problems associated with menopause:

a. are unusual and do not often pose much difficulty.
b. are common and often worsen with advancing age.
c. usually can’t be effectively treated once they manifest.
d. often are worse at the start of menopause, then improve.

 

   60. The nurse has instructed a patient on performing Kegel exercises. The nurse determines that further instruction is needed when the patient says, “I will:

a. hold each contraction for 6 seconds.”
b. do these exercises 5 to 10 times each day.”
c. perform 10 repetitions as quickly as I can.”
d. contract the muscles like trying to stop my urine flow.”

 

   61. A post-menopausal woman is complaining about vaginal dryness that interferes with sexual intimacy and causes discomfort. Which statement would be inconsistent with a nurse’s knowledge about sexuality in post-menopausal women?

a. “Frequent sexual activity actually helps with vaginal lubrication.”
b. “Vegetable oil may feel better than lubricants that contain alcohol.”
c. “If intercourse causes discomfort, you should refrain from having it.”
d. “If you don’t have high blood pressure, you can try vitamin E supplements.”

 

   62. A nurse providing education to a community group on symptoms of menopause relates that the most common symptom reported by perimenopausal women is:

a. hot flashes.
b. hot flushes.
c. night sweats.
d. mood swings.

 

   63. A woman reports to the nurse that she uses a traditional healing approach to manage menopausal symptoms that includes qi gong to unblock the flow of vital energy and blood through her meridians. The nurse realizes the woman is seeing a practitioner of :

a. homeopathy.
b. ayurvedic medicine.
c. naturopathic medicine.
d. traditional Chinese medicine.

 

   64. A woman asks the nurse about using soy products to reduce her menopausal symptoms. Which information should the nurse provide?

a. “Soy can be found in many products, including ginseng tea.”
b. “Soy is a dietary supplement and there is no proof as to its effectiveness.”
c. “These products are good for long-term management of vasomotor symptoms.”
d. “Like all the other isoflavones, soy products are monitored for safety and purity.”

 

   65. A nurse is counseling a patient about hormone therapy (HT) for symptoms of menopause. The most appropriate information the nurse can share would be:

a. “If you want an estrogen-progestogen product, they only come in pill form.”
b. “Hormone therapy was found to cause breast cancer in recent research trials.”
c. “The benefits of short-term HT may outweigh the risks if used for a short time.”
d. “Women with cardiovascular risks should use HT just to help decrease that risk.”

 

   66. A woman wants to have her physician write a prescription for compounded, bio-identical hormone therapy (HT). Which information from the nurse is most appropriate?

a. “Compounded hormones are not yet regulated by the FDA.”
b. “Compounding produces bio-identical hormones that are highly effective.”
c. “Individualized bio-identical, compounded hormones are more natural than standard prescriptions.”
d. “There is research that shows compounded hormones are safe and effective.”

 

Multiple Choice
Identify the choice that best completes the statement or answers the question.
 
   1. The nurse has a prescription to give ear drops to a 2-year-old child. The nurse positions the child’s ear properly by pulling the pinna of the ear:

a. Upward and outward
b. Downward and outward
c. Downward and backward
d. Upward and backward

 

   2. A client who was receiving enteral feedings in the hospital has been started on a regular diet and is almost ready for discharge. The client will be self-administering supplemental tube feedings between meals for a short time after discharge. When the client expresses concern about his or her ability to perform this procedure at home, the nurse would best respond with which of the following?

a. “Tell me more about your concerns about going home.”
b. “Do you want to stay in the hospital a few more days?”
c. “Maybe a friend will do the feeding for you.”
d. “Have you discussed your feelings with your family and doctor?”

 

   3. The nurse is administering enteral feedings via a nasogastric (NG) tube. The nurse should do which of the following when caring for this client to maintain client safety?

a. Keep the client in a supine position.
b. Change the NG tube with every other feeding.
c. Check for tube placement and residual amount at least every 4 hours.
d. Increase the rate of the feeding if the infusion falls behind schedule.

 

   4. The client with pancreatitis is being weaned from parenteral nutrition (PN). The client asks the nurse why the PN cannot just be stopped. The nurse includes in a response to the client that which of the following complications could occur with sudden termination of PN formula?

a. Dehydration
b. Hypokalemia
c. Hypernatremia
d. Rebound hypoglycemia

 

   5. The nurse hears in intershift report that a client receiving parenteral nutrition (PN) at 100 mL/hr has bilateral crackles and 1+ pedal edema. When the nurse obtains a daily weight, the nurse notes that the client has gained 4 lb in 2 days. Which of the following nursing actions should the nurse take first?

a. Encourage the client to cough and deep-breathe.
b. Compare the intake and output records of the last 2 days.
c. Slow the PN infusion rate to 50 mL/hr per infusion pump.
d. Administer the prescribed daily diuretic, and check the client in 2 hours.

 

   6. The nurse is caring for a client receiving parenteral nutrition (PN) via a central line. The nurse should monitor which of the following to detect the development of the mostcommon complication of PN?

a. Temperature
b. Daily weight
c. Intake and output (I&O)
d. Serum blood urea nitrogen (BUN) level

 

   7. The nurse is providing care to a client with continuous tube feedings through a nasogastric (NG) tube. The nurse should avoid doing which of the following, which is not part of the standard care for a client receiving enteral nutrition?

a. Check the residual every 4 hours.
b. Check for placement every 4 hours.
c. Hang a new feeding bag every 72 hours.
d. Check for placement prior to administering medications through the tube.

 

   8. The nurse is monitoring the nutritional status of the client receiving enteral nutrition. The nurse monitors which of the following to determine the effectiveness of the tube feedings for this client?

a. Daily weight
b. Calorie count
c. Serum protein level
d. Daily intake and output

 

   9. A client is scheduled for insertion of a peripherally inserted central catheter (PICC) and the nurse explains the advantages of this catheter. The nurse determines that the client needs additional information about the catheter if the client makes which statement?

a. “It is reasonable in cost.”
b. “There is less pain and discomfort than other types of catheters.”
c. “This type of catheter is very reliable.”
d. “It is specifically designed for short-term use.”

 

   10. A nurse is making initial rounds on the nursing unit to check the condition of assigned clients. The nurse notes that a client’s intravenous (IV) site is cool, pale, and swollen, and the solution is not infusing. The nurse interprets that which of the following complications has been experienced by the client?

a. Phlebitis
b. Infection
c. Infiltration
d. Thrombosis

 

   11. The nurse has been assigned to the care of four adult clients who are receiving continuous intravenous (IV) infusions. The nurse planning the work assignment for the shift makes a notation to check the IV sites of these clients at which of the following frequencies?

a. Every hour
b. Every 2 hours
c. Every 3 hours
d. Every 4 hours

 

   12. The client had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 15:00. The nurse, making rounds at 15:45, finds the client is complaining of a pounding headache, is dyspneic with chills, is apprehensive, and has an increased pulse rate. The intravenous (IV) bag has 400 mL remaining. The nurse should take which of the following actions first?

a. Shut off the infusion.
b. Sit the client up in bed.
c. Remove the angiocatheter and IV.
d. Place the client in Trendelenburg’s position.

 

   13. The nurse notes that the site of a client’s peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. After taking appropriate steps to care for the client, the nurse documents in the medical record that the client has experienced:

a. Phlebitis of the vein
b. Infiltration of the IV line
c. Hypersensitivity to the IV solution
d. Allergic reaction to the IV catheter material

 

   14. The nurse has a written prescription to discontinue an intravenous (IV) line. The nurse obtains which of the following supplies from the unit supply area for use in applying pressure to the site after removing the IV catheter?

a. Band-Aid
b. Alcohol swab
c. Betadine swab
d. Sterile 2  2 gauze

 

   15. The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse prepares to attach the distal end of the IV tubing to a needleless device, the tubing drops and hits the top of the medication cart. Which of the following is the appropriate action by the nurse?

a. Change the IV tubing.
b. Attach a new needleless device.
c. Wipe the tubing port with Betadine.
d. Scrub the needleless device with an alcohol swab.

 

   16. The nurse is collecting data from an African-American client scheduled for surgery. Which of the following questions would be of least priority for the nurse to ask on initial assessment?

a. “Do you ever experience chest pain?”
b. “Do you have any difficulty breathing?”
c. “Do you have a close family relationship?”
d. “Do you frequently have episodes of headache?”

 

   17. The nurse is providing discharge instructions to an Asian-American client regarding prescribed dietary modifications. During the teaching session, the client continuously turns away from the nurse. Which of the following nursing actions is most appropriate?

a. Continue with the instructions verifying client understanding.
b. Walk around to the client so that you continuously face the client.
c. Identify the importance of the instructions for the maintenance of health care.
d. Give the client a dietary booklet, and return later to continue with the instructions.

 

   18. The nurse is planning to instruct the Hispanic-American client about nutrition and dietary restrictions. When developing the plan for the instructions, the nurse is aware that this ethnic group:

a. Primarily eats raw fish
b. Enjoys eating red meat
c. Views food as a primary form of socialization
d. Eats bland food and food that lacks color, flavor, and texture

 

   19. The nurse is preparing to assist a Jewish-American client with eating lunch. A kosher meal is delivered to the client. Which of the following nursing actions is most appropriate in assisting the client with the meal?

a. Unwrap the eating utensils for the client.
b. Replace the plastic utensils with metal eating utensils.
c. Carefully place the food from the paper plates to glass plates.
d. Ask the client to unwrap the eating utensils, and allow the client to prepare the meal for eating.

 

   20. The nurse is assigned to collect data from a Hispanic-American client during the hospital admission. When meeting the client, the nurse should plan to do which of the following?

a. Avoid touching the client.
b. Greet the client with a handshake.
c. Smile and use humor throughout the entire admission process.
d. Avoid any affirmative nods during the conversations with the client.

 

   21. The nurse is assisting in developing a postoperative plan of care for a 40-year-old male Filipino-American client scheduled for an appendectomy. The nurse includes which of the following in the plan of care?

a. Offer pain medication on a regular basis as prescribed.
b. Offer pain medication when nonverbal signs of discomfort are identified.
c. Inform the client that he will need to ask for pain medication when needed.
d. Allow the client to maintain control and request pain medication on his own.

 

   22. The nurse is planning the menu for a Chinese-American client with the hospital dietitian. On collaboration with the dietitian, the meal plan is designed to include which of the following foods generally included in the diet of this cultural group?

a. Milk
b. Vegetables
c. Rice pudding
d. Fruit and yogurt

 

   23. The nurse is preparing to assist in examining a Hispanic-American child who was brought to the clinic by the mother. During assessment of the child, the nurse would avoid which of the following?

a. Admiring the child
b. Taking the child’s temperature
c. Obtaining an interpreter if necessary
d. Asking the mother questions about the child

 

   24. The nurse plans to do dietary teaching with an African-American client. The nurse understands that foods preferred by individuals of this culture are which of the following?

a. Rice
b. Fruits
c. Red meat
d. Fried foods

 

   25. The registered nurse (RN) gives an inaccurate dose of a medication to a client. Following an assessment of the client, the nurse completes an incident report. The RN notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication dose understands that the:

a. Error will result in suspension.
b. Incident will be reported to the board of nursing.
c. Incident will be documented in the personnel file.
d. Incident report is a method of promoting quality care and risk management.

 

   26. The registered nurse (RN) has been caring for a terminally ill client. The RN has developed a close relationship with the family of the client. Which of the following nursing interventions will the RN avoid in dealing with the family during this difficult time?

a. Making decisions for the family
b. Encouraging family discussion of feelings
c. Accepting the family’s expressions of anger
d. Facilitating the use of spiritual practices identified by the family

 

   27. A registered nurse (RN) who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. The most appropriate initial action by the RN is which of the following?

a. Call security.
b. Call the police.
c. Call the nursing supervisor.
d. Lock the co-worker in the medication room until help is obtained.

 

   28. A hospitalized client tells the registered nurse (RN) that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the RN for assistance in obtaining a witness to the will. The most appropriate response to the client is which of the following?

a. “I will sign as a witness to your signature.”
b. “You will need to find a witness on your own.”
c. “Whoever is available at the time will sign as a witness for you.”
d. “I will call the nursing supervisor to seek assistance regarding your request.”

 

   29. The nurse caring for a newly admitted client is reviewing the medication prescription sheet in preparation for administering medications to the client. The nurse notes that the physician has prescribed a medication dose that is twice the amount that the client has reported taking prior to admission. The most appropriate nursing action is to:

a. Contact the physician directly.
b. Administer the medication as prescribed.
c. Question the client regarding the accuracy of the reported dosage.
d. Ask the physician about the prescription the next time the physician makes rounds.

 

   30. The registered nurse (RN) is caring for a client with severe cardiac disease. While caring for the client, the client states, “If anything should happen to me, please make sure that the doctors do not try to push on my chest and revive me.” The most appropriate nursing action is to:

a. Tell the client that the family must agree with the request.
b. Plan a client conference with the nursing staff to share the client’s request.
c. Tell the client that it is necessary to notify the physician of the client’s request.
d. Tell the client that this procedure cannot legally be refused by a client if the physician believes that it is necessary to save the client’s life.

 

   31. The registered nurse (RN) has made an error in documenting an assessment finding on a client in the client’s record and obtains the record to correct the error. The RN corrects the error by:

a. Documenting a late entry into the client’s record
b. Trying to erase the error to make space for writing in the correct data
c. Using white correction fluid to delete the error and writing in the correct data
d. Drawing one line through the error, initialing and dating the line, and then providing the correct information

 

   32. The registered nurse (RN) hears a client calling out for help. The RN hurries down the hallway to the client’s room and finds the client lying on the floor. The RN performs a thorough assessment and assists the client back to bed. The physician is notified of the incident, and the nurse completes an incident report. Which of the following would the RN document on the incident report?

a. The client fell out of bed.
b. The client climbed over the side rails.
c. The client was found lying on the floor.
d. The client became restless and tried to get out of bed.

 

   33. An adult client is brought to the emergency department by emergency medical services after being hit by a car. The name of the client is not known. The client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. In regard to informed consent for the surgical procedure, which of the following is the best initial action?

a. Obtain a court order for the surgical procedure.
b. Transport the victim to the operating room for surgery.
c. Call the police to identify the client and locate the family.
d. Ask the emergency medical services team to sign the informed consent.

 

   34. A client brought to the emergency department is dead on arrival (DOA). The family of the client tells the physician that the client had terminal cancer. The emergency department physician examines the client and asks the registered nurse (RN) to contact the medical examiner regarding an autopsy. The family of the client tells the RN that they do not want an autopsy performed. Which of the following responses to the family is most appropriate?

a. “An autopsy is mandatory for any client who is DOA.”
b. “The decision is made by the medical examiner.”
c. “I will contact the medical examiner regarding your request.”
d. “It is required by federal law. Why don’t we talk about it, and why don’t you tell me how you feel?”

 

   35. The nurse is caring for a client whose physician prescribes airborne precautions. The nurse notes that the client is scheduled for magnetic resonance imaging (MRI). Which of the following nursing actions is most appropriate in preparing the client for the test?

a. Place the client in gown, gloves, and mask.
b. Request that the MRI technicians wear masks.
c. Delay the test until airborne precautions are discontinued.
d. Place a surgical mask on the client for transport and for contact with other individuals.

 

   36. The nurse employed in the ambulatory care department hears a client in the waiting room call out, “Help, fire!” The nurse rushes to the waiting room and finds the wastebasket on fire. Which action should the nurse take first?

a. Confine the fire.
b. Extinguish the fire.
c. Activate the fire alarm.
d. Remove the clients from the waiting room.

 

   37. The physician writes a prescription to apply a heating pad to a client’s back. The nurse implements the prescription and avoids which of the following?

a. Setting the heating pad on a low setting
b. Placing the heating pad under the client
c. Assessing the heating pad periodically for proper electrical function
d. Assessing the skin integrity frequently for signs of burns

 

   38. The nurse is providing instructions to a client regarding the use of ice packs to treat an eye injury. The nurse instructs the client to:

a. Place the ice pack directly on the eye.
b. Avoid the use of commercially prepared ice bags.
c. Keep the ice pack on the eye continuously for 24 hours.
d. Wrap a plastic bag filled with ice with a pillowcase, and place it on the eye.

 

   39. A filled blood specimen tube was dropped and broken in the client’s room. Which of the following actions by the nursing assistant is incorrect?

a. Uses tongs to collect any broken glass
b. Wears gloves for the cleaning procedure
c. Blots up the spill with a face cloth or cloth towel
d. Disinfects the area of the blood spill with a dilute bleach solution

 

   40. The nurse is assigned to care for a chemically dependent client who has the potential for violent episodes. In planning to care for the client, which of the following actions is the priority? The nurse:

a. Speaks slowly to the client
b. Moves slowly when approaching the client
c. Bargains with the client to prevent the violent episodes
d. Projects an attitude of calmness when caring for the client

 

   41. A community health nurse is providing an educational session on childhood poisoning at a local school. The topic of the discussion is preventive measures to avoid accidental poisoning. The nurse includes instructions that if an accidental poisoning occurs to immediately:

a. Call an ambulance.
b. Call the poison control center.
c. Induce vomiting.
d. Bring the child to the emergency department.

 

   42. A nurse is conducting a basic life support (BLS) recertification class and is discussing automated external defibrillation (AED) when a member of the class asks the nurse to identify the correct location for the placement of conductive gel pads to treat ventricular fibrillation. The nurse correctly responds with:

a. Bilaterally, under the right-sided and left-sided clavicles
b. Parallel, between the umbilicus and the left-sided nipple
c. Centered on the upper and lower halves of the sternum
d. Under the right-sided clavicle and to the left of the nipple in the midaxillary line

 

   43. The nurse is initiating one-rescuer cardiopulmonary resuscitation (CPR) on an adult client. After ventilating the client, the nurse places the hands in which of the following positions to begin chest compressions?

a. On the lower half of the sternum
b. On the lower third of the sternum
c. On the upper third of the sternum
d. On the upper half of the sternum

 

   44. A nurse walking in a downtown business area witnesses a worker fall from a ladder. The nurse rushes to the victim, who is unresponsive. The nurse then opens the victim’s airway by using the:

a. Head tilt–chin lift
b. Head tilt–jaw thrust
c. Jaw thrust maneuver
d. Chin lift position

 

   45. The nurse notes that a 5-year-old child is choking but is awake and alert at this time. As the nurse rushes to aid the child, the nurse plans to place the hands between which of the following landmarks to do the abdominal thrust maneuver?

a. The umbilicus and the groin
b. The lower abdomen and chest
c. The umbilicus and xiphoid process
d. The groin and the xiphoid process

 

   46. The nurse employed in the pediatric unit working on the 11 PM to 7 AM shift finds an infant unresponsive and without respirations or a pulse. After opening the airway and initiating ventilation, the nurse delivers chest compressions at a minimum rate of:

a. 140 times/min
b. 100 times/min
c. 80 times/min
d. 60 times/min

 

   47. A nurse is undergoing annual recertification in basic life support (BLS). The BLS instructor asks the nurse to identify the most appropriate pulse point to use when determining pulselessness on an infant. The nurse undergoing recertification replies that the correct pulse point is:

a. Radial
b. Carotid
c. Brachial
d. Popliteal

 

   48. An automatic external defibrillator (AED) interprets that the rhythm of a pulseless client is ventricular fibrillation. The nurse takes which of the following actions next?

a. Performs cardiopulmonary resuscitation (CPR) for 1 minute before defibrillating
b. Administers rescue breathing during the defibrillation
c. Charges the machine and immediately pushes the discharge buttons on the console
d. Orders personnel away from the client, charges the machine, and depresses the discharge buttons

 

   49. The client has been defibrillated unsuccessfully three times using an automatic external defibrillator (AED). The nurse determines that which of the following actions should be taken next?

a. Defibrillate one more time, and then terminate the resuscitation effort.
b. Perform cardiopulmonary resuscitation (CPR) for 5 minutes, and then defibrillate three more times.
c. Administer sodium bicarbonate intravenously, and resume defibrillation attempts.
d. Perform cardiopulmonary resuscitation (CPR) for 1 minute, assess, and then defibrillate up to three more times.

 

   50. The nurse has completed four cycles of compressions after beginning cardiopulmonary resuscitation (CPR) on a hospitalized adult client. At this time, the nurse should:

a. Stop CPR.
b. Continue CPR.
c. Prepare for defibrillation.
d. Prepare for the administration of bicarbonate.

 

   51. The nurse is teaching cardiopulmonary resuscitation (CPR) to a group of lay persons. Which of the following behaviors by one of the participants would indicate the need for further review?

a. Letting the fingers rest on the chest
b. Keeping the shoulders directly over the hands
c. Straightening the arms and locking the elbows
d. Placing the heel of the hand over the lower half of the sternum

 

   52. The client with a perforated gastric ulcer who is scheduled for emergency surgery cannot sign the operative consent form because of sedation with opioid analgesics. The nurse takes which priority action?

a. Obtains a court order for the surgery
b. Sends the client to surgery without the consent form being signed
c. Has the hospital chaplain sign the informed consent immediately
d. Obtains a telephone consent from the family member witnessed by two persons

 

   53. The preoperative client expresses anxiety to the nurse about the upcoming surgery. Which of the following statements by the nurse is most likely to stimulate further discussion between the client and the nurse?

a. “If it’s any help, everyone is nervous before surgery.”
b. “I will be happy to explain the entire surgical procedure to you.”
c. “Can you share with me what you’ve been told about your surgery?”
d. “Let me tell you about the care you’ll receive after surgery and the amount of pain you can anticipate.”

 

   54. The nurse is preparing the client for transfer to the operating room (OR). The nurse should take which of the following actions first?

a. Ensure that the client has voided.
b. Administer all the daily medications.
c. Practice postoperative breathing exercises.
d. Verify that the client has not eaten for the last 24 hours.

 

   55. The nurse is assigned to assist in caring for a client who recently returned from the operating room (OR). On data collection, the nurse notes that the client’s vital signs are blood pressure (BP), 118/70 mm Hg; pulse, 91 beats/min; and respirations, 16 breaths/min. Preoperative vital signs were BP, 132/88 mm Hg; pulse, 74 beats/min; and respirations, 20 breaths/min. Which of the following actions should the nurse plan to take first?

a. Shake the client gently to arouse.
b. Call the surgeon immediately.
c. Cover the client with a warm blanket.
d. Recheck the vital signs in 15 minutes.

 

   56. The nurse has just reassessed the condition of the postoperative client who was admitted 1 hour ago to the surgical unit. The nurse monitors which of the following parameters during the next hour most carefully?

a. Urinary output of 20 mL/hr
b. Temperature of 37.6° C (99.6° F)
c. Blood pressure of 116/78 mm Hg
d. Serous drainage on the surgical dressing

 

   57. The client is admitted to the surgical unit postoperatively with a wound drain (Jackson-Pratt) in place. Which of the following correctly describes the primary purpose of a Jackson-Pratt?

a. It decreases the risk of infection.
b. It decreases the risk of evisceration and dehiscence.
c. It provides an accurate measurement of wound drainage.
d. It assists in the evacuation of fluid and blood from the surgical wound.

 

   58. When performing a surgical dressing change of a client’s abdominal dressing, the nurse notes an increase in the amount of drainage and separation of the incision line. The underlying tissue is visible to the nurse. The priority nursing action at this time is to:

a. Apply a povidone-iodine (Betadine)–soaked sterile dressing.
b. Leave the incision exposed to the air to dry the area.
c. Apply a sterile dressing soaked with normal saline.
d. Irrigate the wound, and apply a dry sterile dressing.

 

   59. The nurse is reviewing the physician’s prescription sheet for the preoperative client, which states that the client must be NPO after midnight. The nurse should clarify which of the following medications should be given to the client and not withheld?

a. Ferrous sulfate
b. Atenolol (Tenormin)
c. Cyclobenzaprine (Flexeril)
d. Conjugated estrogen (Premarin)

 

   60. The client who underwent preadmission testing prior to a surgical procedure had serum laboratory studies drawn, including complete blood count, electrolytes, coagulation studies, and creatinine. Which of the following laboratory results should be reported to the surgeon immediately?

a. Platelet count, 210,000/mm3
b. Serum sodium (Na) level, 141 mEq/L
c. Hemoglobin (Hgb) level, 8.9 g/dL
d. Serum creatinine level, 0.8 mg/dL

 

   61. The client has just returned from the cardiac catheterization laboratory. The left-sided femoral vessel was used as the access site. The nurse should position the client:

a. In a semi-Fowler’s position
b. With the head of the bed elevated 45 degrees
c. With the head of the bed elevated no more than 15 degrees
d. With the foot of the bed elevated as much as tolerated by the client

 

   62. The nurse is assisting the physician with a bedside liver biopsy. When the procedure is complete, the nurse assists the client into which of the following positions?

a. Left side-lying, with the right-sided arm elevated above the head
b. Right side-lying, with the left-sided arm elevated above the head
c. Left side-lying, with a small pillow or towel under the puncture site
d. Right side-lying, with a small pillow or towel under the puncture site

 

   63. The client has a prescription for administering an enema. After preparing the equipment and solution, the nurse assists the client into which of the following positions?

a. Left-sided lateral Sims position
b. Right-sided lateral Sims position
c. Left side-lying, with the head of the bed elevated 45 degrees
d. Right side-lying, with the head of the bed elevated 45 degrees

 

   64. The client with right-sided pleural effusion by chest x-ray is being prepared for a thoracentesis. The nurse assists the client to which of the following positions for the procedure?

a. Sims position, with the head of the bed flat
b. Left side-lying position, with the head of the bed elevated 45 degrees
c. Prone, with the head turned to the side supported by a pillow
d. Right side-lying position, with the head of the bed elevated 45 degrees

 

   65. The client is about to undergo a lumbar puncture (LP). The nurse tells the client that which of the following positions will be used during the procedure?

a. Side-lying position, with a pillow under the hip
b. Prone, with a pillow under the abdomen
c. Prone, in a slight Trendelenburg’s position
d. Side-lying position, with legs pulled up and head bent down onto chest

 

   66. The client has had surgery to repair a fractured left-sided hip. The nurse will use which of the following important items when repositioning the client from side to side in bed?

a. Bed pillow
b. Abductor splint
c. Adductor splint
d. Overhead trapeze

 

   67. The nurse has admitted a client to the clinical nursing unit following right-sided mastectomy. The nurse plans to place the right-sided arm in which of the following positions?

a. Level with the right-sided atrium
b. Elevated above shoulder level
c. Elevated on one or two pillows
d. Dependent to the right-sided atrium

 

   68. The nurse is inserting an indwelling urinary catheter into a male client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. The nurse notes the urine beginning to flow and next:

a. Immediately inflates the balloon
b. Inserts the catheter 2.5 to 5 cm farther, then inflates the balloon
c. Inserts the catheter until resistance is met, then inflates the balloon
d. Withdraws the catheter approximately 1 inch, then inflates the balloon

 

   69. The nurse is caring for a client with a chest tube who accidentally disconnects the tube from the drainage system when trying to get out of bed. The nurse takes which immediate action?

a. Has the client hold a breath
b. Places the client in a prone position
c. Immerses the end of the tube in sterile saline
d. Places a sterile dressing over the end of the chest tube

 

   70. The nurse caring for a client who has a pneumothorax notes continuous bubbling in the water seal chamber of the client’s closed-chest drainage system. The nurse determines that which of the following is occurring?

a. The pneumothorax is resolving.
b. The drainage chamber is full.
c. The suction to the system is shut off.
d. There is an air leak somewhere in the system.

 

   71. A nurse is inserting a nasogastric (NG) tube for an adult client. During the procedure, the client begins to cough and have difficulty breathing. The priority action at this time is which of the following?

a. Quickly insert the NG tube.
b. Remove the tube, and notify the physician.
c. Remove the tube, and reinsert when the client fully recovers.
d. Pull back on the tube, and wait until the client is breathing easily.

 

   72. The nurse has a prescription to give 30 mL of an antacid to a client through a feeding tube. Which of the following is a priority nursing action?

a. Assess tube placement.
b. Administer the antacid by gravity flow.
c. Aspirate to determine residual volume.
d. Follow medication administration with 30 mL of sterile saline.

 

   73. Treatment for a client with bleeding esophageal varices has been unsuccessful and the physician decides to insert a Sengstaken-Blakemore tube. The nurse brings which of the following items to the bedside so that it is available at all times?

a. An obturator
b. A Kelly clamp
c. An irrigation set
d. A pair of scissors

 

   74. The male client complains of pain as the nurse is inflating the balloon following insertion of a Foley catheter. The nurse takes which of the following actions immediately?

a. Aspirate the fluid, withdraw the catheter slightly, and reinflate the balloon.
b. Remove the catheter, and reinsert a new one that is one size smaller.
c. Finish inflating the balloon; the discomfort is normal and temporary.
d. Aspirate the fluid, advance the catheter farther, and reinflate the balloon.

 

   75. The unit manager is reviewing documentation describing a client’s progress in terms of a critical path (Care Map) for postoperative colon resection recovery. The manager notes that, although the documentation is complete, the client has made minimal progress in the areas of mobility and pain control for the prior 48 hours. The manager’s first activity after making the observation of deviation from the path is to contact the client’s:

a. Family to determine what is wrong
b. Assigned nurse to increase client care interventions
c. Physician to determine measures to discharge the client
d. Case manager to determine whether the predicted variance has been negotiated with the health insurer

 

   76. The newly appointed vice president for nursing operations has announced that the authority for decision making will be decentralized and distributed throughout the organization. The nurse managers anticipate that the channel of communication and authority will be characterized by an organizational chart that is:

a. Flat
b. Vertical
c. Circular
d. Horizontal

 

   77. Which client would the emergency department triage nurse classify as emergent?

a. A client with a displaced fracture
b. A client with a temperature of 101° F
c. A client with a simple laceration and soft tissue injury
d. A client with crushing substernal pain who is short of breath

 

   78. The graduate nurse is interviewed by the manager of a unit that has three vacancies and is told that the manager’s leadership style is one of letting the staff nurses make the decisions about the unit’s operations. When the interviewee meets with the day nursing staff, the graduate nurse hears examples of unit issues indicating that the manager’s approach is laissez-faire. Which of the following questions should the graduate nurse ask to confirm her suspicions?

a. “Does the manager facilitate decision making by the group?”
b. “Does the manager maintain control and make all decisions?”
c. “Does the manager assume a passive, nondirective approach?”
d. “Does the manager change style according to the needs of the group?”

 

   79. The nurse manager meets with the staff nurses and announces that management has developed a new policy and procedure that is significantly different from old practices. Which of the following statements, if made by the nurse manager, would reflect the manager’s use of legitimate power?

a. “The health care system services a client population that presents particular challenges. The changes made will enhance client safety and reduce errors.”
b. “If you don’t follow the new policy and procedure, I’ll have no choice but to give you a notice about poor performance—which could lead to termination of your employment.”
c. “Every manager has the responsibility to see that these new policies and procedures are followed 100% of the time. Please join me in this organization’s effort to continue to improve quality care.”
d. “You’re just going to have to trust me on this one. I was a member of the committee that wrote the policy and procedure, and there are good reasons why the specific nursing actions need to be done this new way.”

 

   80. For which of the following client situations would a consultation with a rapid response team (RRT) be most appropriate?

a. 45-year-old, 2 years after kidney transplant, second hospital day for treatment of pneumonia, no urine output for 6 hours, temperature 101.4° F, heart rate 98 beats/min, respirations 20 breaths/min, blood pressure 168/94 mm Hg
b. 72-year-old, 24 hours after removal of a chest tube that was used to drain pleural fluid (effusion), temperature 97.8° F, heart rate 92 beats/min, respirations 28 breaths/min, blood pressure 136/86 mm Hg, anxious about going home
c. 56-year-old, fourth hospital day after coronary artery bypass procedure, sore chest, pain with walking, temperature 97° F, heart rate 84 beats/min, respirations 22 breaths/min, blood pressure 122/78 mm Hg, bored with hospitalization
d. 86-year-old, 48 hours after operative repair of fractured hip (nail inserted), alert, oriented, using patient-controlled analgesia (PCA) pump, temperature 96.8° F, heart rate 60 beats/min, respirations 16 breaths/min, blood pressure 120/82 mm Hg, talking with daughter

 

   81. The nurse assigned to four clients reviews client data at the beginning of the shift. Which information is assessed as the highest priority?

a. Hemoglobin, 12.2 g/dL
b. Potassium level, 3.6 mEq/L
c. Pulse oximetry reading, 89%
d. Urine output, 240 mL/8 hr

 

 
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
 
 1. The nurse is providing preoperative teaching with the client about the use of an incentive spirometer in the postoperative period. The nurse should include which of the following pieces of information in discussions with the client? Select all that apply.

  a. Sit leaning forward.
  b. Inhale deeply and quickly.
  c. Sit upright or lean slightly back.
  d. Hold the mouthpiece tightly with the teeth.
  e. Keep a tight seal between the lips and the mouthpiece.
  f. After maximum inspiration, hold the breath for 2 to 3 seconds and exhale.

 

 2. From the following list of nursing activities, select those that the registered nurse (RN) can delegate to the licensed practical nurse or licensed vocational nurse (LPN/LVN).Select all that apply.

  a. Assessment
  b. Urinary catheterization
  c. Endotracheal suctioning
  d. Intravenous push medication administration
  e. Intramuscular medication administration
  f. Subcutaneous medication administration

 

 3. Of the following list of responsibilities for disaster preparedness in the United States, identify those that are functions of the American Red Cross (ARC) as opposed to the Federal Emergency Management Agency (FEMA). Select all that apply.

  a. Provide monetary relief.
  b. Provide crisis counseling.
  c. Identify and train personnel.
  d. Deploy National Guard troops.
  e. Handle inquiries from families.
  f. Issue presidential declarations.

 

 4. The community health nurse is preparing to teach “personal and family preparedness for disasters” to a group of parents of school-age children. From the following list of items to be kept ready, identify the appropriate items that should be identified by the nurse. Select all that apply.

  a. Flashlight
  b. Supply of batteries
  c. Battery-operated radio
  d. Extra pair of eyeglasses
  e. Three-week supply of nonperishable food
  f. Three-week supply of water (1 gallon per person per day)

 

 5. The nurse is providing instructions to the client being discharged to home with a peripherally inserted central catheter (PICC). The nurse provides which instructions to the client? Select all that apply.

  a. Wear a Medic-Alert tag or bracelet.
  b. Report redness or swelling at the catheter insertion site.
  c. Have a repair kit available in the home for use if needed.
  d. Keep activity level to a minimum while this catheter is in place.
  e. Cover the PICC dressing with plastic when in the shower or bath.

 

 

 

 

Nurse 1611-70

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