The nurse independently plans and implements client care based on:

A. the physician's orders.

B. the findings of other members of the health care team.

C. nursing knowledge and skills.

D. the wishes of the family.

C. nursing knowledge and skills.

The nurse independently plans and implements client care based on nursing knowledge and skills.

The role of the nurse that is most evident when the nurse is protecting the client's rights is:

A. caregiver.

B. advocate.

C. educator.

D. manager.

B. advocate.

The nurse as client advocate actively promotes the client's rights to autonomy and free choice. The nurse may speak for the client, mediate between the client and other persons, and protect the client's right to self-determination. 

The nurse is responsible for the quality of client care through a process called:

A. quality assurance.

B. delgation.

C. nursing diagnosis.

D. implementation

A. quality assurance.

The nurse is responsible for the quality of client care through a process called quality assurance. Quality control activities include evaluating, monitoring, or regulating the standard of services provided to the client.

The step of the nursing process in which the nurse collects data from clients is called:

A. evaluation.

B. diagnosis.

C. implementation.

D. assessment.

D. assessment.

Nurses assess clients in two ways: an initial assessment, and ongoing, focused assessments.

The step of nursing process that is complex, involves uncertainty, and requires the nurse to use reasoning and critical thinking is:

A. diagnosis.

B. evaluation.

C. assessment.

D. planning.

A. diagnosis.

Making a diagnosis is a complex process and always involves uncertainty. Critical thinking and reasoning are used to choose nursing diagnosis that best define the individual client's health problems.

Planned nursing interventions must be:

A. determined by the nurse alone.

B. specific and individualized.

C. initiated by the physician.

D. based on medical problems.

B. specific and individualized.

Nursing interventions must be specific and individualized. The nurse identifies client problems and needed interventions, then works with the client to determine those that are needed and preferred by the individual client.

The nurse's role during the implementation phase of the nursing process is to:

A. carry out planned activities.

B. establish outcome criteria.

C. identify client problems.

D. evaluate the care given.

A. carry out planned activities.

Implementation is the action or "doing" phase of the nursing process, when nurses carry out planned activities.

The final component of implementation that the nurse is legally required to complete is:

A. setting priorities.

B. assessing the client's condition.

C. documenting interventions.

D. teaching the client.

C. documenting interventions.

Documenting interventions is the final component of implementation, and it is a legal requirement. "If it isn't documented, it isn't done."

The public is protected and nursing practice is guided by:

A. the nursing process.

B. physicians' oversight.

C. standardized procedures.

D. standards and codes of ethics.

D. standards and codes of ethics.

Nursing practice is structured by standards and codes of ethics that quide nursing practice and protect the public.

According to the ANA, the nurse has a moral obligation to provide care for the client with AIDS:

A. when the client agrees to HIV testing.

B. unless the risk exceeds the responsibility.

C. only if a release of information is obtained.

D. in all situations.

The young adult is at risk for alterations in health from:

A. accidents, STIs, and substance abuse.

B. obesity, cardiovascular disease, and cancer.

C. chronic illness, stroke and substance abuse.

D. injuries, pharmacologic therapy, and obesity.

 A. accidents, STIs, and substance abuse.

Accidents are the leading cause of injury and death in people between ages 15 and 24. Unprotected sex with a variety of people and substance abuse are also major causes of concern for this age group.

What factor often causes the middle adult to gain weight?

A. maintaining calorie intake without increased physical activity

B. physical and psychosocial stressors

C. chronic illness such as arthritis and hypertenstion

D. normal physiologic changes of aging

 A. maintaining calorie intake without increased physical activity

Middle adults often have problems maintaining a healthy weight because they consume the same number of calories as when they were young, while decreasing physical activity.

In comparison to young adults, health promotion behaviors in middle adults include:

A. men no longer needing to do a testicular self-exam.

B. women having a mammogram at age 40.

C. having a vision examination every 4 years.

D. carrying out regular exercise that is strenous.

B. women having a mammogram at age 40.

Women should have an annual mammogram, beginning at age 40. Men should continue to do testicular self-examination. Vision examinations should be done each year. Rgular amounts of exercise are recommended for this age group.

Significant others related or bonded to the client by birth, adoption, marriage, or friendship are the client's family, and the nurse should:

A. ask them to step out when giving nursing care.

B. expect them to assist with care of the client.

C. speak with them regarding confidential client matters.

D. include them as an integral component of health care.

D. include them as an integral component of health care.

Although not always meeting traditional definitions, people (or even pets) who are significant to the client are the client's family. They should be an integral component of care in all health care settings.

An active process that maximizes the potential capability of a person within the environment where he or she is functioning is known as:

A. health.

B. wellness.

C. continuum.

D. integration.

B. wellness.

Wellness is an integrated method of functioning, oriented toward maximizing the individual's potential. Good health can exist as a relatively passive state of freedom from illness.

What factors affect a client's ability to understand health teaching?

A. race and ethnicity

B. cognitive abilities and educational level

C. lifestyle and environment

D. socioeconomic background and geographic area

B. cognitive abilities and educational level

Cognitive development affects whether people view themselves as healthy or ill and may affect health practices. Educational level affects the ability to understand and follow guidelines for health.

The nurse, by following healthy practices, serves as a role model, which is one way to:

A. provide continuity of care.

B. provide acute care.

C. promote health.

D. identify risk factors.

C. promote health.

The nurse promotes health by teaching activities that maintain wellness, providing information about diseases, and following healthy practices that serve as a model.

The response a person has to disease is called:

A. illness.

B. biologic.

C. normative.

D. developmental.

 A. illness.

Illness is the highly individualized response a person has to disease.

What category of illness occurs rapicly, lasts for a short period, and is self-limiting?

A. remission

B. chronic

C. exacerbation

D. acute

D. acute

An acute illness occurs rapidly, lasts for a relatively short period of time, and is self-limiting. It usually responds to self-treatment or to medical-surgical intervention.

Nearly all people with a chronic illness need:

A. to live as normally as possible.

B. to live in a health care facility.

C. to be assisted with activities of daily living.

D. large doses of pain relief medicaiton.

A. to live as normally as possible.

Almost all people with a chronic illness need to live as normally as possible, despite their symptoms and treatment. Chronic illness can make a person feel alienated, lonely, and different from others.

What is the major factor in the projected increase in the number of older adults during the next 30 years?

A. a significant decrease in chronic illness in older adults

B. decreased physical effects of longevity

C. increased number of people know as "baby boomers"

D. increased efforts to provde effective home care

C. increased number of people know as "baby boomers"

The rapid increase projected in the aging population by 2030s is largely the result of the "baby boom," which refers to the increased number of people born in the post-World War II period from 1946 to 1964.

The immunity theory of aging supports the idea of immunosenescence, meaning people have fewer defenses against foreign orgamisms with aging. What results from this?

A. increased risk of chronic illnesses

B. people living a predetermined life span

C. decreased tolerance of environmental pollutants

D. an imbalance in cell regeneration and cell death

A. increased risk of chronic illnesses

Immunity theories are based on the knowledge that the immune system is affected by aging, with decreased defenses against foreign organisms and an increase in chronic illness.

A member of your health team says, "Oh, that old lady in Room 232 won't be able to learn how to take her own pulse." What is this an example of?

A. reality

B. ageism

C. critical thinking

D. nursing process

B. ageism

Ageism is a form of prejudice in which older adults are stereotyped by characteristics of only a small number of their age group, a common myth is that older adults cannot learn new knowledge and skills.

Which of the following statements is true of cognitive function in the older adult?

A. "The ability to learn new skills ends at about age 45."

B. "Dementia is inevitable as one reaches the 70s."

C. "Long-term memory loss interferes with learning."

D. "Cognitive function normally does not change."

D. "Cognitive function normally does not change."

Cognition means the ability to perceive and understand one's world; cognitive function does not normally change with aging.

You are caring for an older woman in a long-term care facility. She says, "When I was ten years old, my parents took me to the circus and I had such a good time." What does this statement facilitate?

A. problems with short-tem memory

B. achievment of ego integrity

C. inability to cope with change

D. increasingly living in the past

B. achievment of ego integrity

Older adults like to tell stories about their past during reminiscence, allowing them to relive and restructure life experiences and facilitate achieving ego integrity.

What two terms might best describe the time following widowhood?

A. loss, loneliness

B. bitterness, sadness

C. peace, strength

D. friends, family

A. loss, loneliness

When faced with widowhood, the remaining spouse is faced with not only adjusting to the loss of the loved person, but also to living alone.

You are caring for an older man who has been hospitalized for treatment of pneumonia. He says, "I want to be able to live in my own home, but I don't know if I can." What topic would you discuss with him?

A. need for nursing home care

B. services of the local community center

C. educational opportunities at a local college

D. assistance from home health services

D. assistance from home health services

The ability to function safely and independently at home alone depends on a variety of factors, but many older adults can continue living at home with the assistance of home health services, home-delivered meals, and senior transportation.

Which of the following chronic diseases is a leading cause of death in older adults?

A. pneumonia

B. influenza

C. stroke

D. arthritis

C. stroke

The leading causes of death in older adults are cardiovascular disease, cancer, and stroke.

You are caring for an older adult who is caring for herself at home alone. What would you assess on a regular basis to facilitate safety?

A. her temperature, pulse and respirations

B. prescribed and over-the-counter medications

C. amount of food in her refrigerator

D. condition of the windows in her house

B. prescribed and over-the-counter medications

Although medications do make life more comfortable for older adults, they carry a risk of adverse drug reactions and interactions that can cause adverse effects such as dizziness and numbness. These effects in turn may increase the risk for falling.

Which of the following nursing actions will facilitate cognitive function in an older adult?

A. Give a complete bed bath.

B. Ensure the television is on.

C. Monitor ability to use walker or cane.

D. Ensure hearing aid battery strength.

D. Ensure hearing aid battery strength.

Nursing care to promote cognition in older adults includes ensuring that eyeglasses and hearing devices are used and that they have clean lenses and good batteries, respectively.

Nursing care provided directly to clients wherever they are, including where they live, work, play, worship, and go to school, is know as:

A. home health nursing.

B. community health nursing.

C. community-based nursing.

D. parish nursing.

C. community-based nursing.

Community-based nursing focuses on individual and family health care needs where they live, work, play, worship, and go to school. Community health nursing focuses on the health of a community.

Community-based health care services may include.

A. obstetrical serivces.

B. day care centers.

C. emergency departments.

D. surgery units.

B. day care centers.

Some of the most common community-based health care services include community centers, clinics, day care centers, block nursing and parish nursing.

When the family's desires differ from those of the client, the home care nurse must?

A. remain the primary client's advocate.

 B. try to please everyone.

C. avoid negative responses from the family.

D. call the physician to resolve the conflict.

A. remain the primary client's advocate.

If a conflict arises, the nurses must remain the primary client's advocate, regardless of any negative response from the family.

In order for home care to receive Medicare reimbursement, cetain criteria must be met. Which of the following are necessary? (Choose all that apply.)

A. The client must need help with cooking and cleaning.

B. The client must have a "skilled need."

C. The client must have an income below poverty level.

D. The client must be essentially homebound.

E. The client must have a plan of care.

B. The client must have a "skilled need."

D. The client must be essentially homebound.

E. The client must have a plan of care.

Specific criteria that the client must meet in order to secure Medicare reimbursement are to have a need for skilled care, be essentially homebound, and have a plan of care. 

Clients cannot realistically be taught everything they need to know during today's shortened hospital stays. Therefore, a client needing follow-up teaching should:

A. have a home health referral.

B. have more frequent physician appointments.

C. Have the option to increase his or her hospital stay.

D. rely on family for continued care.

A. have a home health referral.

With shorter hospital stays, all clients should be evaluated for their ability to manage at home. The nurse should make a referral to a home health agency if the client has need for follow-up beyond the present clinical setting.

In the home, one nursing responsibilty and legal requirement is:

A. identifying caregiver burden.

B. respecting client boundaries.

C. completeing a safety assessment.

D. honoring family customs.

C. completeing a safety assessment.

Nurses cannot close their eyes to an unsafe environment. Safety assessment in the home is both a nursing responsibility and a legal requirement.

Nursing interventions for unsafe and hazardous conditions in the home would include:

A. changing the unsafe home environment regardless of client wishes.

B. ignoring the unsafe environment, allowing the client freedom to choose his or her own lifestyle.

C. threatening to discontinue home care if the environment is not made safe.

D. alerting the client/family, suggesting remedies, and documenting the response.

D. alerting the client/family, suggesting remedies, and documenting the response.

The nurse cannot go into homes and change the family's living space and lifestyle. However, the nurse must alert the family to unsafe and hazardous conditions, suggest remedies, and document the family's response in the record.

The process of learning to live to one's maximum potential with a chronic impairment/functional disability is:

A. long-term care.

B. rehabilitation.

C. reintegration.

D. short-term care.

B. rehabilitation.

 Rehabilitation is the process of learning to live to one's maximum potential with a chronic impairment and of enabling a person to live with diginity, self-worth, and independence.

Rehabilitation includes many different aspects of the client's life such as physical, mental, social, and vocational status. This comprehensive consideration of the client requires:

A. an interdisciplinary approach to care.

B. primarily nursing care.

C. focusing on the physical disability.

D. short-term care.

 A. an interdisciplinary approach to care.

Rehabilitation promotes reintegration into the client's family and community through an interdisciplinary approach that includes in the plan of care physical funciton, mental health, interpersonal relationships, social interactions, and vocational status. It requires the expertise of a team of health care providers.

Before establishing any plan of care in rehabilitation, it is important to:

A. guarantee the client independence in all areas of functioning.

B. determine the priorities of needs from the client's and family's perspective.

C. establish a rapport with the family.

D. complete all physical exercises.

B. determine the priorities of needs from the client's and family's perspective.

The plan of care developed for each client is individualized, based on the priority of needs from the client's and family's perspective.

When the nurse collects a urine speciment and notes the color of the urine, this assessment data is referred to as:

A. comprehensive.

B. objective.

C. subjective.

D. secondary.

B. objective.

Objective data are observable or measurable pieces of information (such as the color of urine). Objective data can be seen, heard, touched, or smelled.

A focused assessment for a client complaining of abdominal pain would include assessing the client's:

A. legs.

B. vision.

C. bowel movements.

D. blood pressure.

C. bowel movements.

A focused assessment addresses a specific client problem. Assessing a client with abdominal pain includes assessing bowel movements, temperature, trauma, location, duration, and type of pain.

It is preferable to collect assessment data from secondary sources instead of directly from the client when the:

A. client is irritable or agitated.

B. client is very young, unconscious, or confused.

C. client's family prefers to speak for him or her.

D. client's medical records are available.

B. client is very young, unconscious, or confused.

If the client is very young, very ill, unconscious, or confused, data may be collected from secondary sources, such as family and friends.

The health history data are collected through an interview with the client. Questions that give the client a chance to provide more information are called:

A. yes or no.

B. why.

C. closed ended.

D. open ended.

D. open ended.

Open-ended questions give the client the chance to provide more information than do closed-ended questions. "Why" questions often make the client feel threatened or foolish.

A basic method of physical examination that uses the hands to touch and feel is called:

A. inspection.

B. auscultation.

C. palpation.

D. percussion.

C. palpation.

Palpation is use of the hands to touch and feel. Light palpation is used for determining pulses, tenderness, skin texture, skin temperature, and skin moisture.

The first thing that the nurse should do in preparing for a physical examination is:

A. wash his or her hands.

B. don gloves and mask.

C. set up the equipment.

D. position the client.

A. wash his or her hands.

The nurse should was his or her hands before and after the assessment, even if gloves need to be worn.

Mrs. Haynes developed a bowel obstruction following abdominal surgery 3 days ago. To monitor paristalsis, the nurse would:

A. inspect the abdomen.

B. auscultate the abdomen.

C. percuss the abdomen.

D. palpate the abdomen.

B. auscultate the abdomen.

Bowel sounds are clicks or gurgles made as intestinal contents move through the bowel; they should always be present.

Mr. Scott has a history of alcohol abuse and has developed cirrhosis of the liver. The nurse might expect to observe what change in skin color?

A. mottling

B. erythema

C. jaundice

D. cyanosis

C. jaundice

Jaundice is a yellow color of the skin and mucous membranes. It is caused by liver or gallbladder disease, or by an excessive breakdown of red blood cells. Jaundice is usually first seen in the eyes and then in the skin and mucous membranes.

Documenting the client assessment is as important as the actual assessment. Identify the documentation that is most correctly stated.

A. Breath sounds normal.

B. The client had bowel sounds in the right upper and lower quadrants and left upper and lower quadrants.

C. BP 120/70

D. Client obese, indicating lack of knowledge about nutrition.

C. BP 120/70

When recording blood pressure, the nurse should write "BP 120/70," not give a detailed description of the assessment method. Data should be organized in a logical way, and inferences of judgements should be avoided. The word normal should not be used; instead, write the specific assessment finding.

Decreased serum albumin levels in the older adult would affect which part of the pharmacokinetic process?

A. excretion

B. metabolism

C. distribution

D. absorption

C. distribution

Decreased serum albumin levles in older adults affect drug distribution. There is no effect on absorption, metabolism, or excretion.

The nurse receives the following order: Lasix 40 PO BID. Dr. Lowe. What action should the nurse take?

A. Call the physician for a complete dosage.

B. Give the medicaiton as ordered.

C. Wait until the physician calls the unit.

D. Call the physician for a time to start the drug.

A. Call the physician for a complete dosage.

This order is missing the number of milligrams. The nurse must call the physician for a complete order. Because the nurse is unsure when the physician will return to the health care facility, the nurse must call the physician.

Which of the following drug examples indicates a synergistic drug response?

A. aspirin and an anticoagulant drug

B. two different antihypertensive drugs

C. nicotine and an anticonvulsant drug

D. alcohol and a sedative drug

B. two different antihypertensive drugs

Synergism is giving two drugs to cause a greater effect than each drug given separately. Aspirin and an anticoagulant potentiate each other, causing increased risk for bleeding. Nicotine increases the metabolism of anticonvulsants. Alcohol and a sedative drug have an additive effect, increasing sedative effects.

To prevent a medication error, the nurse should:

A. check illegible handwriting with another nurse.

B. accept atypical drug names as a new medication.

C. use the dropper of one medication to administer another.

D. question the use of multiple tablets to provide a single dose.

D. question the use of multiple tablets to provide a single dose.

The nurse should question when mutiple tablets are prescribed for a single dose. Illegible handwriting should be clarified with the physician who wrote the order. Atypical drug names should always be investigated further. Never use a medication dropper from one medication for another medication.

In which of the following clients is an adverse drug reaction most likely to occur?

A. a four-year-old with croup

B. a 35-year-old with pneumonia

C. a 50-year-old with kidney disease

D. a 60-year-old with osteoarthritis

C. a 50-year-old with kidney disease

Because drugs are excreted by the kidneys, anyone with kidney disease is at an increased risk for adverse drug reactions. The other ages and conditions do not increase the risk for ADRs like liver or kidney disease.

List the order of drug absorption from the most rapic route to the least rapid route.

A. subcutaneous (SC)

B. oral (PO)

C. transdermal

D. intravenous (IV)

E. sublingual  

F. Intramuscular (IM)

D. intravenous (IV)

E. sublingual

F. Intramuscular (IM)

A. subcutaneous (SC)

B. oral (PO)

C. transdermal

The IV route has the fastest absorption followed by sublingual, IM, subcutaneous, oral, and transdermal.

The physician prescribes Vicodin for a patient experiencing pain. Under what category of controlled substances is this drug found?

A. Schedule V

B. Schedule IV

C. Schedule III

D. Schedule II

C. Schedule III

Vicodin is a Schedule III controlled substance.

What is the most important factor in administering medications to a 1-year-old infant?

A. weight of the child

B. age of the child

C. ethnicity of the child

D. sex of the child

A. weight of the child

Pediatric medication doses are calculated according to the child's body weight. Age, ethnicity, and sex do not effect dose calculation.

When digoxin (Lanoxin) is started, a larger than normal dose may be given. This is called a:

A. scheduled dose.

B. maintenance dose.

C. therapeutic dose.

D. loading dose.

D. loading dose.

A loading dose (giving a larger than normal dose) is administered in clinical situations when it is necessary to reach therapeutic drug levels rapidly.

The nurse is reviewing information on a medication in a drug handbook and notices that the drug is teratogenic. Which of the following clients should not receive this medication?

A. cleints with renal failure

B. pregnant clients

C. children under 10 years old

D. clients older than 65 years

B. pregnant clients

Teratogenic drugs must be avoided in women who are pregnant because they may cause harm to the fetus.

Which of thse clients would most likely develope dehydration after surgery?

A. 24-year-old male diagnosed with an inguinal hernia

B. 70-year-old female with ovarian cancer

C. 65-year-old male with prostate cancer

D. 19-year-old female with a badly fractured leg

B. 70-year-old female with ovarian cancer

Females, in general, have more body fat and less body water than males. There is less water available in clients with a higher percentage of body fat. Individuals over the age of 65 also have decreased body water due to higher body fat content.

A client has been diagnosed with deficiant antidiuretic hormone (ADH). Which assessment finding should the nurse anticipate?

A. increased serum osmolality

B. dilute urine

C. decreased thirst

D. normal blood pressure

B. dilute urine

ADH regulates water excretion in the kidneys. The kidneys are less permable to water. Copious amounts of dilute urine are produced. Serum osmolality decrease, blood pressure falls slightly, and the thirst mechanism in the brain is activated.

The nurse assessing a client in the emergency department notes dry, sticky mucous membranes; weak peripheral pulses; and tachycardia. The primary nursing diagnosis should be:

A. Deficient Fluid Volume.

B. Impaired Skin Integrity.

C. Risk for Injury.

D. Decreased Cardiac Output.

A. Deficient Fluid Volume.

These signs and symptoms indicate a decrease in fluid volume, such as dehydration. Although the client is at risk for the other problems listed here, the assessment data directly relates to fluid volume status

A client admitted to the medical floor has muscle spasms and a positive Chvostek's sign. In obtaining the history, the nurse notes that the client had a thyroidectomy 6 weeks ago. Based on this finding, the nurse anticipates tht the physician will order a lab test for:

A. sodium.

B. potassium.

C. magnesium.

D. calcium.

D. calcium.

Decreased calcium level is manifested by increased muscle excitability. The parathyroid glands, involved in regulation of calcium in the body, may be inadvertently removed or damaged during a thyroidectomy.

A client presents with muscle weakness, tremors, and confusion. Laboratory testing reveals a serum magnesium level of 0.9 mg/dL. The nurse recalls that a common cause of hypomagnesemia is

A. kidney failure.

B. excessie antacid use.

C. chronic alcoholism.

D. lack of sun exposure.

C. chronic alcoholism.

Chronic alcoholism is a principal cause of hypomagnesemia, Excessive antacid use, in contrast, may cause hypermagnesemia.

A client is hyperventilating due to anxiety. Which of the following lab values indicates an altered acid-base balance?

A. pH 7.51

B. Paco2 38 mm Hg

C. HCO3 22 mEq/L

D. Pao2 95 mm Hg

A. pH 7.51

The normal pH is 7.35 to 7.45. Respiratory alkalosis (pH > 7.45) occurs during hyperventilation. Other values listed are within the normal ranges.

The nurse knows that a client's low bicarbonate level may be caused by:

A. gastrointestinal suction.

B. constipation.

C. use of baking soda for indigestion.

D. alcohol abuse.

A. gastrointestinal suction.

The pancreas secretes bicarbonate into the small intestine. Vomiting, suctioning, and diarrhea contribute to the loss of bicarbonate. Overuse of baking soda increases the bicarbonate levels.

A client with hyperkalemia is admitted to the medical floor. Which of the following complications of this electrolyte imbalance does the nurse monitor most closely for?

A. paralytic ileus

B. cardiac dysrhythmias

C. fluid retention and edema

D. kidney stones

B. cardiac dysrhythmias

The client with a potassium imbalance is at risk for cardiac dysrhythmias.

The nurse administered the prescribed dose of furosemide (Lasix). To evaluate the effectiveness of the drug, the nurse should assess:

A. weight.

B. apical pulse.

C. breath sounds.

D. fluid intake PO.

A. weight.

Lasix is a loop diuretic that promotes water loss. Daily weights should be obtained; they are the most accurate measurement for water loss. Intake and output are also measured and compared.

The nurse is caring for a client being treated for diabetic ketoacidosis (metabolic acidosis). Which laboratory value should the nurse monitor closely as the acidosis is corrected?

A. hemoglobin and hematocrit

B. serum potassium

C. urine specific gravity

D. serum magnesium

B. serum potassium

As the acidosis is corrected, potassium tends to shift fromextracellular fluid into the cells. As a result, hypokalemia may develop.

Client reports a history of constant low back pain for the past 7 months. In planning care for client, the nurse recognizes this type of pain as:

A. acute pain.

B. chronic pain.

C. cutaneous pain.

D. neuropathic pain.

B. chronic pain.

Chronic pain is prolonged pain that lasts more than 6 months. It is usually nonresponsive to treatment. Acute pain is sudden, temporary, has an identified cause, and lasts less than 6 months.

A client complains of pain in her abdomen radiating to the left shoulder. The nurse explains this type of pain is:

A. visceral.

B. deep somatic.

C. referred.

D. cutaneous

C. referred

Referred pain starts in one site but is perceived in another part of the body. It frequently occurs with visceral pain (pain from body organs lined with viscera), because the pain impulses travel along the same nerve paths.

Client has pain related to a brain tumor that required multiple pharmacologic approaches. This pain is classified as:

A. acute pain.

B. neuropathic pain.

C. referred pain.

D. chronic malignant pain.

D. chronic malignant pain.

Progression of cancer frequently produces pain that requires multiple therapies and is often unresponsive to treatment. Pain is caused by pressure on body organs, nerves and metastasis to bone.

Client has a below-the-knee amputation of her right leg. She reports pain in her right foot and requests pain medication. The appropriate nursing intervention is to:

A. report the symptoms to the charge nurse.

B. remind the client that her foot has been amputated.

C. administer pain medication.

D. offer a back rub.

C. administer pain medication.

Phantom limb pain occurs in some individuals following the removal of an extremity. The client is aware that the part is missing, but the pain can be intense and difficult to treat. Medication should be administered to attempt relief. Nonpharmacologic approaches are ineffective.

Client has a history of gastric ulcer. The nurse recognizes this client should avoid which of the following analgesics?

A. ibuprofen (Motrin)

B. acetaminophen (Tylenol)

C. meperidine (Demerol)

D. codeine sulfate (Codeine)

A. ibuprofen (Motrin)

Ibuprofen is an irritant to the gastric mucosa. Clients with gastric ulcer disease shoud use alternate medications for pain relief.

Client complains of pain in his surgical incision. To assess the severity of his pain, which of the following would be most effective?

A. Observe his facial expressions.

B. Assess his vital signs.

C. Ask if the pain is mild, moderate, or severe.

D. Ask the client to describe the pain using a sclae of 0-10.

D. Ask the client to describe the pain using a sclae of 0-10.

Allowing the client to describe his pain based on a pain scale provides an objective, individualized description of the pain. The nurse can make decisions for intervention based on this assessment.

Client, age 75, complains of arthritic pain in her left hip. Which of the following analgesics will provide the least risk of accumulation and toxicity of this client?

A. meperidine (Demerol)

B. ibuprofen (Motrin)

C. acetaminophen (Tylenol)

D. propoxyphene (Darvon)

B. ibuprofen (Motrin)

This drug has a short half-life and will not accumulate and cause toxicity. Elderly patients may have impairment of liver and renal function that leads to increased risk for toxicity. Drugs such a meperidine and propoxyphene cause sedation and respiratory depression. Long-term use of ecetaminophen may lead to liver damage.

Client receives morphine sulfate 10 mg intravenously for severe abdominal pain. Thirty minutes later client is unresponsive to physical stimulation. His breathing is shallow with respiratory rate of 8. Which of the following medications should the nurse expect to be administered?

A. lorazepam (Ativan)

B. diazepam (Valium)

C. naloxone (Narcan)

D. ketorolac (Toradol)

C. naloxone (Narcan)

Nalozone blocks the effects of opioid drugs and reverses sedation and respiratory depression that may result from excessive dosages.

A client is prescribed naproxen (Naprosyn) 500 mg for treatment of osteoarthritis. Teaching for home care should include:

A. discontinuing the medication when the pain is relieved.

B. limiting alcohol intake to three servings/day.

C. taking with meals to decrease gastric irritation.

D. combining with aspirin to enhance analgesic effect.

C. taking with meals to decrease gastric irritation.

Osteoarthritis requires long-term therapy with NSAIDs. A common side effect is gastric bleeding. Taking the drug with foods helps to reduce this risk. The physician should be consulted before medicaiton is discontinued. Alcohol and aspirin should be avoided because they increase the risk of gastric irritation and bleeding.

Client, age 67, is receiving codeine 60 mg PO every 3 to 4 hours prn for pain. A priority nursing implication is to:

A. assess bowel sounds every 4 hours.

B. limit fluids to 1,000 mL/day

C. assess respiratory rate every 4 hours.

D. monitor for evidence of gastrointestinal bleeding.

 A. assess bowel sounds every 4 hours.

Decreased peristalsis and constipation are common side effects of codeine. Assessment of bowel sounds is essential, expecially int he elderly. Fluids should be increased to at least 3,000 mL/day if not contraindicated.

A client is scheduled for a thyroidectomy. Which of the following would be an appropriate preoperative nursing diagnosis?

A. Infection, Risk for (surgical would)

B. Aspiration, Risk for

C. Deficient Knowledge (surgical procedure)

D. Urinary Retention

C. Deficient Knowledge (surgical procedure)

A and D are postoperative nursing diagnoses. B is an intraoperative nursing diagnosis.

A man is admitted to the abulatory surgery unit in preparation for a hernia repair. Which of the following lab results noted by the nurse may require medical intervention?

A. hemoglobin 13.4, hematocrit 44

B. potassium 2.8

C.  platelets 280,000

D. blood urea nitrogen (BUN) 10

B. potassium 2.8

Potassium level of 2.8 is below normal and places the client at risk for cardiac arrhythmias.

A client asks the nurse to explain possible complications she might experience as a result of her total abdominal hysterectomy. The most appropriate response by the nurse would be:

A. "I will contact your physicain to discuss this with you."

B. "Let's not worry about complications. You will be just fine."

C. "Why are you worried about comolications?"

D. "There are many potential complications. Let's discuss them."

A. "I will contact your physicain to discuss this with you."

  Discussion of risk factors is included in informed consent. Informed consent is the responsibility of the physician.

A client is 5 hours postoperative. He has an IV infusing at 125 mL/hr. He has not voided and complains of pain in his lower abdomen. All of the following are appropriate nursing actions. Place them in the order in which the nurse would perform them.

A. Assist Mr. Harris to stand to void.

B. Assess the bladder for distention.

C. Notify the physician of inablilty to void.

D. Prepare to perform a straight catheterization.

E. Run water in the sink.

B. Assess the bladder for distention.

 A. Assist Mr. Harris to stand to void.

E. Run water in the sink.

C. Notify the physician of inablilty to void.

D. Prepare to perform a straight catheterization.

Assessment is needed before nursing intervention can be determined. Nursing measures to promote urination are appropriate before notifying the physician or preparing for straight catheterization.

A client has been taught coughing exercises prior to surgery. Which one of the following actions indicates a need for further teaching?

A. He splints his incision wiht a pillow.

B. He takes a deep breath through his nose prior to coughing.

C. He positions himself supine and flat in bed.

D. He coughs forcefully after the deep breath.

C. He positions himself supine and flat in bed.

The client should be in simi-Fowler's or Fowler's position for effective coughing and deep-breathing exercises.

The client's surgical incision is healing by primary intention. Which assessment finding should the nurse expect?

A. Wound edges are approximated.

B. Wound exudate is present.

C. The wound is large, gaping, and irregular.

D. Granulation tissue is evident.

 A. Wound edges are approximated.

Primary intention is normal wound healing. The wound edges are approximated and closed by staples or sutures.

A teenage girl, age 16, and her husband, age 23, present to the outpatient center to complete her preoperative procedures. The appropriate procedure for completion of the surgical consent would be to:

A. have the husband sign the consent for the wife.

B. have the girl sign the consent.

C. have the husband co-sign the consent.

D. contact the girl's parents to sign the consent.

B. have the girl sign the consent.

The client is a married minor and can sign her own consent.

The nurse assesses a postoperative client on return to the nursing unit. The following data are collected:

1:15 p.m: T 99F, P 92, R 20, BP 120/80, alert, oriented

1:30 p.m.: T 98F, P 100, R 24, BP 116/68, sleeping

1:45 p.m.: T 98F, P 116, R 28, BP 100/54, restless

2:00 p.m.: T 97F, P 130, R 32, BP 90/50

The appropriate INITIAL nursing action would be to:

A. assess the surgical dressing.

B. notify the physician.

C. Position the client flat with the feet elevated 8 to 12 inches.

D. increase the IV infusion rate. 

C. Position the client flat with the feet elevated 8 to 12 inches.

Assessment suggests impending shock. The client should be placed in the shock position to facilitate blood supply to vital organs.

A client had a right total hip replacement 3 days ago. The LPN/LVN assesses a positive Homan's sign in the left leg. The MOST important action by the nurse at this time would be to:

A. document the findings.

B. notify the physician.

C. place the client on complete bed rest.

D. assess the extremity for signs of thrombus formation.

D. assess the extremity for signs of thrombus formation.

A positive Homan's sign is suggestive of thrombophlebitis. Further assessment of the leg is indicated to support this finding.

A client asks if she should take her medications for hypertension and diabetes the morning of surgery. The MOST appropriate response by the nurse would be:

A. "No, the anesthesiologist will monitor your blood pressure and blood glucose."
B. "NPO means nothing by mouth."

C. "Yes, take them with no more than a glass of water."

D. "I will clarify this with your physician."

D. "I will clarify this with your physician."

The nurse must clarify this action with the physician. Alteration of physician orders is not an independent nursing action.

A client, age 82, has been admitted to your sigucal unit after 3 days in the intensive care unit following a colon resection. His vital signs are stable and his urinary bag contains 300 mL of clear yellow urine. Which of the following information is most important to determine if the client is at risk for developing a nosocomial infection?

A. Foley catheter insertion during surgery

B. use of an antibiotic for 1 week prior to surgery

C. weight of 150 lbs

 D. poor venous circulation in the left leg

A. Foley catheter insertion during surgery

Urinary tract infections are the leading cause of nosocomial infections. The client has a Foley catheter that was inserted 4 days ago. The 1-week use of the antibiotic is significant but not as important as the invasive insertion of the Foley catheter. Peripheral vascular disease increases the susceptibility for a nosocomial infection, but is not a major factor in the hospital stay.

Your client is scheduled for a left knee replacement. Which of the following lab values must you report to the physician immediately?

A. WBC count of 7,000

B. WBC count of 3,500

C. WBC count of 15,000

D. WBC count of 4,500  

C. WBC count of 15,000

The normal WBC count is 4,500 to 10,000. An increased levle indicates acute infection.

Prior to the administration of aspirin to your client with rheumatoid arthritis, it is most important to assess:

A. the age of the client

B. the client's use of alcohol.

C. the expiration date of the medication.

D. the client's allergy history.

D. the client's allergy history.

Allergy histories must always be discussed before giving any medication. The age and mental status are important factors. Old medications should be destroyed. Clients should be taught not to mix any drugs with alcohol.

A client has been taking penicillin G for a staph infection. Three days after beginning the drug, she returns to your clinic. She complains of vaginal itchiness and redness. You suspect that the client has developed vaginitis. Your response to the client should be:

A. "Oh, don't worry about that. It will go away after you finish the medication."

B. "I will let the doctor know right away."

C. "Its just vaginitis. We'll give you something for it."

B. "Okay. Are you having any other problems?"

B. "I will let the doctor know right away."

The infection is an overgrowth of bacteria due to the side effects of the antibiotic. Nurses cannot diagnose medical conditions. You should address the problem and reassure the client. Never tell the client not to worry. "D" is incorrect, because it acknowledges the complaint but doesn't adequatley address the client's concern.

You are planning discharge care for your client who has suffered numerous abrasions sustained in a motor vehicle accident. Which of the following should be included in the discharge instructions?

A. Discontinue the antibiotics once the redness has subsided.

B. A slight fever is common and should not be reported.

C. Drink at least 2 quarts of water per day.

D. Wash your hands carefully before changing the wound dressings.

D. Wash your hands carefully before changing the wound dressings.

Handwashing is extremely important in preventing infection. Antibiotic treatments should be completed as prescribed. Any fever should be reported because it may indicate an infection. Water intake should be at least 2 1/2 quarts per day to maintain body temperature and metabolism.

Which medication treatment would the nurse anticipate for the client with a diagnosis of MRSA?

A. vancomycin (Vancocin)

B. erythromycin (E-Mycin)

C. fluconazole (Diflucan)

D. acyclovir (Zovirax)

A. vancomycin (Vancocin)

Although there is an increase in the growth of vancomycin-resistant organisms, vancomycin is still the drug of choice.

A 70-year-old male client was admitted to the medical floor with a diagnosis of left periorbital cellulitis. Based on this diagnosis, which of the following interventions should the nurse include in the client's care plan in order to promote the healing process?

A. Administer IV antibiotics as ordered.

B. Maintain bed rest.

C. Medicate the client around the clock with IM morphine.

D. Monitor the WBC count.

A. Administer IV antibiotics as ordered.

Cellulitis is a subcutaneous/connective tissue infection. Antibiotics must be given at the appropriate times to decrease the potential damage to the eye. Bed rest is unlikely order for this client. Morphine in frequent doses is contraindicated in older clients and may lead to respiratory depression. Lab values are important but may be checked at a later time.

Which of the following conditions indicate that an infection has become systemic?

A. A fistula forms.

B. Lymphadenitis is observed.

C. Abscesses form int he area of infection.

D. Cellulitis begins to develop.

B. Lymphadenitis is observed.

Systemic infection produces the enlargement of lymph nodes throughout the body. Cellulitis, fistulas, and abscesses are all manifestations of local infection.

Your AIDS client has been diagnosed with Pneumocystis carinii pneumonia. Your client asks you what type of "bug" causes this illness. You state that Pneumocystis carinii is a:

A. virus

B. fungus

C. bacteria

D. protozoan

B. fungus

The Pneumocystis carinii organism is a fungus. It is considered to be an opportunisitic disease in clients who are immunocompromised.

An elderly woman was admitted on your shift with varicella. What type of isolation precautions should be used for this client?

A. Droplet Precautions

B. Contact Precautions

C. Airborne Precautions

D. Standard Precautions

C. Airborne Precautions

The chicken-pox virus is spread through the air. Examples of droplet transmission include pneumonia and meningitis. Clients with acute diarrhea are placed on contact precautions. Standard precautions (universal precautions) include the use of gloves and handwashing.

A client was given an immunization for influenza 10 minutes ago. Which of these statements, if made by the client, would indicate that the client has a correct understanding of the discharge instructions?

A. "I must be having a sever reaction; my arm is red."

B. "My ride is here. I have to leave now."

C. "I'll put a heating pad on my arm when I get home."

D. "I'll be back in two weks to get my second shot."

A nursing assistant tells you that she is allergic to pineapples. Your best response should be:

A. "Make sure you don't eat foods with pinapples as an ingredient."

B. "I'm allergic to peanuts. What symptoms do you get?"

C. "You must have a type I hypersensitivity reaction."

D. "I will order you some latex-free gloves for your client care."

A client arrives in the clinic complaining of a swollen lip after being stung by a bee. The nurse's first priority would be to:

A. assess the respiratory status.

B. ask the client about prior episodes with insect bites.

C. administor epinephrine.

D. explain the allergic reaction pathophysiology.

The physician has ordered azathioprine (Imuran) for a post-kidney transplant recipient. Which of the following teaching instructions must be emphasized to the client?

A. Increase PO fluids to 2,000 mL/day.

B. Avoid large crowds.

C. Limit activity to walking.

D. Expect urine output to be normal.

When a client diagnosed with HIV says to the nurse, "I guess hugging my little girl is out of the question now," the best response by the nurse would be:

A. "HIV is not transmitted by casual kissing or hugging."

B. "I'm sorry, but you don't wnat to infect your child."

C. "Perhaps you can show your affection in other ways."

D. "You're right; you must not share your utensils either."

When assessing a client who has recently been diagnosed with HIV, the nurse should expect the client to have which of these symptoms?

A. diarrhea

B. Pneumocystis carinii pneumonia

C. sore throat

D. night sweats

Which of these safe sex guidelines should be included in teaching a client who is HIV positive?

A. Use oil-based lubricants.

B. Oral contraceptives are effective in preventing transmission.

C. Anal sex is acceptable if a condom is used.

D. Do not reuse condoms.

A client reports a persistent cough, night sweats, fever, fatigue, and weight loss. The Mantoux test is assessed at 10 mm. The most likely condition that the nurse expects is:

A. Mycobacterium avium complex.

B. tuberculosis.

C. candidiasis.

D. cryptosporidiosis.

When caring for a client with HIV encephalopathy, which of these nursing interventions should be given priority?

A. Obtain vital signs every 4 hours.

B. Assess the client's support system.

C. Serve small portions of soft foods.

D. Remove excess furniture from the room.

A client who is undergoing chemotherapy for Kaposi's sarcoma states, "I'm just too sick to eat." Which of these actions should the nurse take?

A. Remove the tray of food.

B. Administer nausea medication prior to meals.

C. Encourage fluids with meals.

D. Give appetite stimulants as ordered.