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Chapter 24
1.As a nursing student, you give yourself positive messages regarding your ability to do well on a test. This is an example of what level of communication?
1. Public
2. Intrapersonal
3. Interpersonal
4. Transpersonal

2 Intrapersonal

2.The nurse demonstrates active listening by:
1.Agreeing with the client
2.Repeating everything the client says to clarify
3.Assuming a relaxed posture and leaning toward the client
4.Smiling and nodding continuously throughout the interview

3. Assuming a relaxed posture and leaning toward the client

3.During the orientation phase of the helping relationship, the nurse might do which of the following?
1.Discuss the cards and flowers in the room
2.Work together with the client to establish goals
3.Review the client's history to identify possible health concerns
4.Use therapeutic communication to manage the client's confusion

1.Discuss the cards and flowers in the room

4.If the nurse is working with a client who has expressive aphasia, it would be most helpful for the nurse to:
1.Ask open-ended questions
2.Speak loudly and use simple sentences
3.Allow extra time for the client to respond
4.Encourage a family member to answer for the client

3.Allow extra time for the client to respond

5.The statement that best explains the role of collaboration with others for the client's plan of care is which of the following?
1.The professional nurse consults the physician for direction in establishing goals for clients.
2.The professional nurse depends on the latest literature to complete an excellent plan of care for clients.
3.The professional nurse works independently to plan and deliver care and does not depend on other staff for assistance.
4.The professional nurse collaborates with colleagues and the client's family to provide combined expertise in planning care.

4.The professional nurse collaborates with colleagues and the client's family to provide combined expertise in planning care.

6."I'm not sure I understand what you mean by 'sicker than usual.' What is different now?" The nurse is using the therapeutic technique:
1.Focusing
2.Clarifying
3.Paraphrasing
4.Providing information

2.Clarifying

7."We've talked a lot about your medications, but let's look more closely at the trouble you're having in taking them on time." The nurse is using the therapeutic technique:
1.Focusing
2.Clarifying
3.Paraphrasing
4.Providing information

1.Focusing

8.When working with an older adult, the nurse should remember to avoid:
1.Touching the client
2.Allowing the client to reminisce
3.Shifting from subject to subject
4.Asking the client how he or she feels

3.Shifting from subject to subject

9.Which of the following nurse statements would be nontherapeutic and tend to block communication? (Choose all that apply.)
1."You look sad today."
2."Why are you so nervous?"
3."If I were you, I'd have the surgery."
4."I'm sure the test will come out fine."
5."Tell me what it's like to live with dizziness."

2."Why are you so nervous?"
3."If I were you, I'd have the surgery."
4."I'm sure the test will come out fine."

10.A nurse should consider zones of personal space and touch when caring for clients. If the nurse is taking the client's nursing history, she should:
1.Sit next to the client
2.Be 4 to 12 feet from the client
3.Be 18 inches to 4 feet from the client
4.Be 12 inches to 3 feet from the client

3.Be 18 inches to 4 feet from the client

Chapter 25
1.A client needs to learn to use a walker. Acquisition of this skill will require learning in the:
1.Affective domain
2.Cognitive domain
3.Attentional domain
4.Psychomotor domain

4.Psychomotor domain

2.The nurse plans to teach a client about the importance of exercise:
1.When there are visitors in the room
2.When the client's pain medications are working
3.Just before lunch, when the client is most awake and alert
4.When the client is talking about current stressors in his or her life

2.When the client's pain medications are working

3.A client newly diagnosed with cervical cancer is going home. The client is avoiding discussion of her illness and postoperative orders. In teaching the client about discharge instructions, the nurse:
1.Teaches the client's spouse
2.Provides only the information the client needs to go home
3.Focuses on knowledge the client will need in a few weeks
4.Convinces the client that learning about her health is necessary

2.Provides only the information the client needs to go home

4.The school nurse is about to teach a freshman-level health class about nutrition. To achieve the best learning outcomes, the nurse:
1.Provides information using a lecture
2.Uses simple words to promote understanding
3.Develops topics for discussion that require problem solving
4.Completes an extensive literature search focusing on eating disorders

3.Develops topics for discussion that require problem solving

5.A nurse is going to teach a client how to perform a breast self-examination. The behavioral objective that best measures the client's ability to perform the examination is:
1.The client will verbalize the steps involved in breast self-examination within 1 week
2.The nurse will explain the importance of performing breast self-examination once a month
3.The client will perform breast self-examination correctly on herself before the end of the teaching session
4.The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society

3.The client will perform breast self-examination correctly on herself before the end of the teaching session

6.A client who is having chest pain is going for an emergency cardiac catheterization. The most appropriate teaching approach in this situation is the:
1.Telling approach
2.Selling approach
3.Entrusting approach
4.Participating approach

1.Telling approach

7.The nurse is teaching a parenting class to a group of pregnant adolescents and has given the adolescents baby dolls to bathe and talk to. This is an example of:
1.Role play
2.Discovery
3.An analogy
4.A demonstration

1.Role play

8.An older adult is being started on a new antihypertensive medication. In teaching the client about the medication, the nurse:
1.Speaks loudly
2.Presents the information once
3.Expects the client to understand the information quickly
4.Allows the client time to express himself or herself and ask questions

4.Allows the client time to express himself or herself and ask questions

9.A client needs to learn how to administer a subcutaneous injection. The nurse knows the client is ready to learn when the client:
1.Has walked 400 feet
2.Expresses the importance of learning the skill
3.Can see and understand the markings on the syringe
4.Has the dexterity needed to prepare and inject the medication

2.Expresses the importance of learning the skill

10.A client who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. The best teaching method would be:
1.Simulation
2.Demonstration
3.Group instruction
4.One-on-one discussion

2.Demonstration

Chapter 26
1.A manager is reviewing the nurses' notes in a client's medical record. She finds the following entry, "Client is difficult to care for, refuses suggestion for improving appetite." Which of the following directions should the manager give to the staff nurse who entered the note?
1.Avoid rushing when charting an entry
2.Use correction fluid to remove the entry.
3.Draw a single line through the statement and initial it.
4.Enter only objective and factual information about the client.

4.Enter only objective and factual information about the client.

2.A client tells the nurse, "I have stomach cramps and feel nauseous." This is an example of what type of data?
1.Objective
2.Historical
3.Subjective
4.Assessment

3.Subjective

3.As you enter the client's room, you notice he is anxious to say something. He quickly states, "I do not know what is going on; I cannot get an explanation from my doctor about the results of my test. I want something done about this." Which of the following is most appropriate documentation of the client's emotional status?
1.The client has a defiant attitude.
2.The client appears to be upset with his physician.
3.The client is demanding and complains frequently.
4.The client stated that he felt frustrated by the lack of information he received regarding his diagnostic tests.

4.The client stated that he felt frustrated by the lack of information he received regarding his diagnostic tests.

4.A primary benefit of HIPAA regulations is to:
1.Allow access of the medical record to all hospital staff
2.Limit what information must be documented in the client's record
3.Provide clients with greater control over personal health care information
4.Enable health care institutions to release any client-related information with a general client authorization

3.Provide clients with greater control over personal health care information

5.Clients frequently request copies of their medical records. The nurse understands:
1.Only the families may read the records
2.They have the right to read those records
3.They are not allowed to read those records
4.Only the health care workers have access to the records

2.They have the right to read those records

6.Accurate entries are an important characteristic of good documentation. Which of the following charting entries is most accurate in the way it is written?
1.Client up, out of bed, walked down hallway with assistance, tolerated well.
2.Client up, out of bed, walked 50 feet and back down hallway, tolerated well.
3.Client up, out of bed, walked 50 feet and back down hallway with assistance from nurse.
4.Client up, out of bed, walked 50 feet and back down hallway with assistance from nurse, HR 88 and regular before exercise, 94 and regular following exercise.

4.Client up, out of bed, walked 50 feet and back down hallway with assistance from nurse, HR 88 and regular before exercise, 94 and regular following exercise.

7.Match the correct entry with the appropriate SOAP category.
S
O
A
P
Repositioned client on right side. Encouraged client to use PCA device.
The pain increases every time I try to turn on my left side.
Acute pain related to tissue injury from surgical incision.
Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation.

S-The pain increases every time I try to turn on my left side.
O-Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation.
A-Acute pain related to tissue injury from surgical incision.
P-Repositioned client on right side. Encouraged client to use PCA device.

8.On the nursing unit at Stevens Health Center a nurse is able to access a client's medical record and review the education that nurses provided the client during an initial hospitalization and three subsequent clinic visits. This type of record system is an example of:
1.Information technology
2.Electronic health record
3.Personal health information
4.Administrative information system

2.Electronic health record

Chapter 21
1.After 0700 shift report the registered nurse (RN), Joan, delegates three tasks to Susan, the nursing assistant. At 1300, Joan tells Susan she would like to talk to her about the first task that was delegated, which was walking Mrs. Taylor in the morning. Joan said to Susan, "You did a good job walking Mrs. Taylor by 0930. I saw that you recorded her pulse before and after the walk. I saw that Mrs. Taylor walked in the hallway barefoot. For safety, the next time you walk a client you need to make sure that the client wears slippers or shoes. Please walk Mrs. Taylor again by 1500." What are the characteristics of good feedback that Joan used when talking to Susan? (Choose all that apply.)
1.Feedback is given immediately.
2.Feedback focuses on one issue.
3.Feedback offers concrete details.
4.Feedback identifies ways to improve.
5.Feedback focuses on changeable things.
6.Feedback is specific about what is incorrectly done only.

2.Feedback focuses on one issue.
3.Feedback offers concrete details.
4.Feedback identifies ways to improve.
5.Feedback focuses on changeable things.

2.As the nurse, you need to complete all of the following. Which task do you complete first?
1.Cough and deep breathe the client who had surgery yesterday.
2.Make a referral to the home care nurse for a client who is being discharged in 2 days.
3.Do the teaching on wound care for a client with a wound drain who is being discharged later today.
4.Notify the health care provider of the decreased level of consciousness in the client who had a stroke yesterday.

4.Notify the health care provider of the decreased level of consciousness in the client who had a stroke yesterday.

3.You are the charge nurse on a surgical unit. You are doing staff assignments for the 3 to 11 shift. Which client do you assign to the licensed practical nurse (LPN)?
1.Mr. Lilly, who had a total laryngectomy yesterday
2.Mrs. Amber, who had a mastectomy this morning
3.Mrs. Ellis, who had a vaginal hysterectomy 2 days ago
4.Mr. Thielan, who is being discharged this evening following total colectomy

3.Mrs. Ellis, who had a vaginal hysterectomy 2 days ago

4.The type of care management approach that coordinates and links health care services to clients and their families while streamlining costs and maintaining quality is:
1.Primary nursing
2.Total patient care
3.Functional nursing
4.Case management

4.Case management

5.While administering medications, the nurse realizes she has given the wrong dose of medication to a client. The nurse acts by completing an incident report and notifying the client's physician. The nurse is exercising:
1.Authority
2.Responsibility
3.Accountability
4.Decision making

3.Accountability

6.Many managers distribute biweekly newsletters of ongoing unit or health care agency activities and post minutes of committee meetings in an accessible location for all staff to read. This is an example of:
1.Staff communication
2.Problem-solving committees
3.Interdisciplinary collaboration
4.Nurse-physician collaborative practice

1.Staff communication

7.During the morning rounds a nurse assesses the client's condition. He had major heart surgery 2 days ago. His vital signs are stable, and his incision is clean and healing well. He complains of pain in his lower leg where the vein graft was removed. The nurse finds that the intravenous (IV) infusion is running on time, but only 100 ml remains before the infusion runs out. An order exists for the IV infusion to continue. A second order of priority is:
1.The need to replace the IV bag with a new one
2.The need to instruct the client on complications of wound healing
3.The need to have an analgesic administered to the client for his leg pain
4.The need for the nurse to determine if the pharmacy has delivered IV solutions ordered for the day

3.The need to have an analgesic administered to the client for his leg pain

8.A client is experiencing an anxiety attack. This is which priority nursing need for this client?
1.Low priority
2.High priority
3.Intermediate priority
4.Nonemergency priority

2.High priority

9.The nurse checks on her client who was admitted to the hospital with pneumonia. He has been coughing profusely and has required nasotracheal suctioning. He has an IV infusion of antibiotics. He is febrile. The client asks the nurse if he can have a bath because he has been perspiring profusely. The nurse delegates to the nursing assistant working with her today the task of:
1.Assessing vital signs
2.Changing IV dressing
3.Nasotracheal suctioning
4.Administering a bed bath

4.Administering a bed bath

10.Which task is appropriate for an RN to delegate to the nursing assistant?
1.Explaining to the client about the preparation for an abdominal CT scan
2.Administering the contrast medium to the client for an abdominal CT scan
3.Obtaining the intravenous solution that is to be started before the client's CT scan
4.Assessing vital signs on a client who is having an abdominal computed tomography (CT) scan later in the morning

4.Assessing vital signs on a client who is having an abdominal computed tomography (CT) scan later in the morning

Chapter 5
1.A nurse researcher interviews senior oncology nurses, asking them to describe how they deal with the loss of a client. The analysis of the interviews yields common themes describing the nurses' grief. This is an example of a(n):
1.Historical study
2.Qualitative study
3.Correlational study
4.Experimental study

2.Qualitative study

2.An operating room nurse is talking with colleagues during a meeting and asks, "I wonder if we would see fewer wound infections if we used chlorhexidine instead of povidone-iodine to clean the skin of our surgical clients?" In this example of a PICO question, the P is:
1.Betadine use
2.Surgical clients
3.Chlorhexidine use
4.Operating room nurse

2.Surgical clients

3.A nurse researcher is designing an exercise study that involves 100 clients who attend a wellness clinic. As the clients come to the clinic, they have a choice as to whether they want to be in the new exercise program or remain in the traditional program. The nurse plans to measure the clients' self-report of exercise before and 6 months after the program begins. What factor might influence the results of this study in an unfavorable way?
1.Bias
2.Anonymity
3.Sample size
4.Sampling method

1.Bias

4.The foundation of research is based on which of the following:
1.Evidence
2.Experience
3.Critical thinking
4.Scientific method

4.Scientific method

5.Number the following steps of evidence-based practice in the appropriate order:
___ Integrate the evidence.
___ Ask the burning clinical question.
___ Evaluate the practice decision or change.
___ Critically appraise the evidence you gather.
___ Collect the most relevant and best evidence.

Ask the burning clinical question
Collect the most relevant and best evidence
Critically appraise the evidence you gather.
Integrate the evidence.
Evaluate the practice decision or change.

6.When a researcher gives a subject full and complete information about the purpose of a study, this is an example of:
1.Bias
2.Anonymity
3.Confidentiality
4.Informed consent

4.Informed consent

7.A new nurse on an orthopedic unit is assigned to a client on skeletal traction. The nurse asks a colleague, "What is the best practice for cleaning pin sites in skeletal traction?" This question is an example of a:
1.Hypothesis
2.PICO question
3.Problem-focused trigger
4.Knowledge-focused trigger

3.Problem-focused trigger

8.The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their clients. The nurses decide to initiate a quality improvement project using the PDSA model. Which of the following is an example of "Do" from that model?
1.Implement the new skin care protocol on all medicine units.
2.Review the data collected on clients cared for using the protocol.
3.Review the QI reports on the six clients who developed ulcers over the last 3 months.
4.Based on findings from clients who developed ulcers, implement an evidence-based skin care protocol.

1.Implement the new skin care protocol on all medicine units.

Chapter 22
1.In the United States, access to health care usually depends on a client's ability to pay for health care, either through insurance or by paying cash. The client the nurse is caring for needs a liver transplant to survive. This client has been out of work for several months and does not have insurance or enough cash. A discussion about the ethics of this situation would involve predominately the principle of:
1.Accountability, because you as the nurse are accountable for the well-being of this client
2.Respect for autonomy, because this client's autonomy will be violated if he does not receive the liver transplant
3.Ethic of care, because the caring thing that a nurse could provide this client is resources for a liver transplant
4.Justice, because the first and greatest question in this situation is how to determine the just distribution of resources

4.Justice, because the first and greatest question in this situation is how to determine the just distribution of resources

2.It may seem redundant that health care providers, including professional nurses, agree to "do no harm" to their clients. The point of this agreement is to reassure the public that in all ways the health care team will not only work to heal clients, they agree to do this in the least painful and harmful way possible. The principle that describes this agreement is called:
1.Beneficence
2.Accountability
3.Nonmaleficence
4.Respect for autonomy

3.Nonmaleficence

3.A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and for society, outweigh the temporary discomforts. This involves the principle of:
1.Fidelity
2.Beneficence
3.Nonmaleficence
4.Respect for autonomy

2.Beneficence

4.If a nurse assesses a client for pain and then offers a plan to manage the pain, the principle that encourages the nurse to monitor the client's response to the plan is:
1.Fidelity
2.Beneficence
3.Nonmaleficence
4.Respect for autonomy

1.Fidelity

5.Nurses agree to be advocates for their clients. Practice of advocacy calls for the nurse to:
1.Seek out the nursing supervisor in conflicting situations
2.Document all clinical changes in the medical record in a timely manner
3.Work to understand the law as it applies to the client's clinical condition
4.Assess the client's point of view and prepare to articulate this point of view

4.Assess the client's point of view and prepare to articulate this point of view

6.Successful ethical discussion depends on people who have a clear sense of personal values. When many people share the same values, it may be possible to identify a philosophy of utilitarianism, which proposes that:
1.The value of something is determined by its usefulness to society
2.The value of people is determined solely by leaders in the Unitarian Church
3.The decision to perform a liver transplant depends on a measure of the moral life that the client has led so far
4.The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider

1.The value of something is determined by its usefulness to society

7.The philosophy sometimes called the ethic of care suggests that ethical dilemmas can best be solved by attention to:
1.Clients
2.Relationships
3.Ethical principles
4.Code of ethics for nurses

2.Relationships

8.In most ethical dilemmas the solution to the dilemma requires negotiation among members of the health care team. The nurse's point of view is valuable because:
1.The principle of autonomy guides all participants to respect their own self-worth
2.Nurses have a legal license that encourages their presence during ethical discussions
3.Nurses develop a relationship to the client that is unique among all professional health care providers
4.The nurse's code of ethics recommends that a nurse be present at any ethical discussion about client care

3.Nurses develop a relationship to the client that is unique among all professional health care providers

9.Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined that the dilemma is ethical, a critical first step in negotiating the difference of opinion would be to:
1.Consult a professional ethicist to ensure that the steps of the process occur in full
2.Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma
3.Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process
4.List the ethical principles that inform the dilemma so that negotiations agree on the language of the discussion

2.Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma

Chapter 23
1.A nurse works on a cardiac unit. She is taking care of a client who recently had coronary bypass surgery. Which of the following represent legal sources of standards of care nurses use to deliver safe health care? (Choose all that apply.)
1.Information provided by the head nurse
2.Policies and procedures of the employing hospital
3.Nurse Practice Act of the state the nurse is working in
4.Regulations identified in The Joint Commission's manual
5.The American Nurses Association standards of nursing practice

2.Policies and procedures of the employing hospital
3.Nurse Practice Act of the state the nurse is working in
4.Regulations identified in The Joint Commission's manual
5.The American Nurses Association standards of nursing practice

2.A nurse is sued for failure to monitor a client appropriately. Which statements are correct about professional negligence lawsuits? (Choose all that apply.)
1.The nurse represents the plaintiff.
2.The defendant must prove injury, damage, or loss.
3.The person filing the lawsuit has the burden of proof.
4.The plaintiff must prove that a breach in the prevailing standard of care caused an injury.

3.The person filing the lawsuit has the burden of proof.
4.The plaintiff must prove that a breach in the prevailing standard of care caused an injury.

3.When the nurse stops to help in an emergency at the scene of an accident, if the injured party files suit and the nurse's employing institution's insurance does not cover the nurse, the nurse would probably be covered by:
1.The nurse's automobile insurance
2.The nurse's homeowner's insurance
3.The Good Samaritan laws, which grant immunity from suit if there is no gross negligence
4.The Patient Care Partnership, which may grant immunity from suit if the injured party consents

3.The Good Samaritan laws, which grant immunity from suit if there is no gross negligence

4.Even though the nurse may obtain the client's signature on a form, obtaining informed consent is the responsibility of the:
1.Client
2.Physician
3.Nursing student
4.Supervising nurse

2.Physician

5.The legal definition of death that facilitates organ donation is cessation of:
1.Pulse
2.Respirations
3.Functions of entire brain
4.Circulatory and respiratory functions

3.Functions of entire brain

6.The nurse notes that an advance directive is on the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow?
1.A living will allows an appointed person to make health care decisions when the client is in an incapacitated state.
2.A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state.
3.The client cannot make changes in the advance directive once admitted to the hospital.
4.A Durable Power of Attorney for Health Care is invoked only when the client has a terminal condition or is in a persistent vegetative state.

2.A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state.

7.A nurse notes that the health care unit keeps a listing of the client names at the front desk in easy view for health care providers to more efficiently locate the client. The nurse knows that this action would be a violation of:
1.Mental Health Parity Act
2.Patient Self-Determination Act
3.Health Insurance Portability and Accountability Act
4.Emergency Medical Treatment and Active Labor Act

3.Health Insurance Portability and Accountability Act

8.Which of the following statements represent actions that may result in a registered nurse's receiving either disciplinary action by the nurse's State Board of Nursing or revocation of the nurse's professional license? (Choose all that apply.)
1.Taking or selling controlled substances
2.Assisting with physician-assisted suicide
3.Reporting suspected abuse and neglect of children
4.Applying physical restraints without a written physician's order

1.Taking or selling controlled substances
4.Applying physical restraints without a written physician's order

9.The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides clients basic rights pertaining to their medical records. Which statement reflects a violation of HIPAA?
1.Discussing client conditions in the nursing report room at the change of shift
2.Allowing nursing students to review client charts before caring for clients to whom they are assigned
3.Posting daily nursing care information along with the medical condition of the client on a message board in the client's room
4.Releasing client information regarding terminal illness to family when the client has given permission for information to be shared

3.Posting daily nursing care information along with the medical condition of the client on a message board in the client's room

10.The nurse must follow standards of care to avoid potential litigation and suits of negligence. Which of the following statements represents a potential nursing malpractice situation? (Choose all that apply.)
1.Failure to make a nursing diagnosis
2.Failure to provide discharge instructions
3.Failure to follow the six rights of medication administration
4. Failure to use proper medical equipment ordered for client monitoring
5.Failure to question a health care provider about appropriateness of a client order

1.Failure to make a nursing diagnosis
2.Failure to provide discharge instructions
3.Failure to follow the six rights of medication administration
4. Failure to use proper medical equipment ordered for client monitoring
5.Failure to question a health care provider about appropriateness of a client order

1.Following a bilateral mastectomy, a 50-year-old client refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the client with her hair combed and makeup applied. Which of the following is the best response from the nurse?
1."What's the special occasion?"
2."You must be feeling better today."
3."This is the first time I have seen you look this good."
4 "I see you have combed your hair and put on makeup."

4 "I see you have combed your hair and put on makeup."

2.When developing an appropriate outcome for a 15-year-old girl, the nurse considers that a primary developmental task of adolescence is to:
1.Form a sense of identity
2.Create intimate relationships
3.Separate from parents and live independently
4.Achieve positive self-esteem through experimentation

1.Form a sense of identity

3.Several staff members complain about a client's constant questions, such as "Should I have a cup of coffee or a cup of tea?" and "Should I take a shower now or wait until later?" Which interpretation of the client's behavior will help the nurses provide optimal care?
1.Asking questions is attention-seeking behavior.
2.Inability to make decisions reflects a self-concept issue.
3.Dependence on staff needs to be stopped immediately.
4.Indecisiveness is aimed at testing how the staff reacts.

2.Inability to make decisions reflects a self-concept issue.

4.A depressed client is crying and verbalizes feelings of low self-esteem and self-worth such as "I'm such a failure ... I can't do anything right." The best nursing response would be to:
1.Remain with the client until the client stops crying
2.Tell the client that is not true and that every person has a purpose in life
3.Review recent behaviors or accomplishments that demonstrate skill ability
4.Reassure the client you know how he is feeling and that things will get better

3.Review recent behaviors or accomplishments that demonstrate skill ability

5.When an individual internalizes the beliefs, behavior, and values of role models into a personal, unique expression of self, the nurse would document this as:
1.Inhibition
2.Substitution
3.Identification
4.Reinforcement-extinction

3.Identification

6.When caring for an 87-year-old client, the nurse needs to understand which of the following most directly influences the client's self-concept:
1.Attitude and behaviors of relatives providing care
2.Caring behaviors of the nurse and health care team
3.Level of education, economic status, and living conditions
4.Adjustment to role change, loss of loved ones, and physical energy

4.Adjustment to role change, loss of loved ones, and physical energy

7.An appropriate nursing diagnosis for an individual who experiences confusion in the mental picture of his physical self is:
1.Acute confusion
2.Disturbed body image
3.Chronic low self-esteem
4.Situational low self-esteem

2.Disturbed body image

8.The nurse asks the client, "How do you feel about yourself?" The nurse is assessing the client's:
1.Identify
2.Self-esteem
3.Body image
4.Role performance

2.Self-esteem

9.The nurse can increase a client's self-awareness by which of the following? (Choose all that apply.)
1.Helping the client to define her problems clearly
2.Allowing the client to openly explore thoughts and feelings
3.Reframing the client's thoughts and feelings in a more positive way
4.Having the client identify her positive and negative coping mechanisms

1.Helping the client to define her problems clearly
2.Allowing the client to openly explore thoughts and feelings
3.Reframing the client's thoughts and feelings in a more positive way
4.Having the client identify her positive and negative coping mechanisms

Chapter 31
1.The vital functions necessary for survival, which include heart rate, blood pressure, and respiration, are controlled by the:
1.Adrenal gland
2.Pituitary gland
3.Medulla oblongata
4 Reticular formation

3.Medulla oblongata

2.While assessing a person for effects of the general adaptation syndrome, the nurse should be aware that:
1.Heart rate increases in the resistance state
2.Blood volume increases in the exhaustion stage
3.Vital signs return to normal in the exhaustion stage
4.Blood glucose level increases during the alarm reaction stage

4.Blood glucose level increases during the alarm reaction stage

3.A client avoids emotional conflict by refusing to consciously acknowledge anything that might cause intolerable emotional pain. The client is using the defense mechanism:
1.Denial
2.Conversion
3.Dissociation
4.Displacement

1.Denial

4.When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as:
1.Acute anxiety
2.Social phobia
3.Posttraumatic stress disorder
4.Borderline personality disorder

3.Posttraumatic stress disorder

5.A man is adjusting to chronic illness; this is an example of:
1.A situational factor
2.A maturational factor
3.A sociocultural factor
4.A developmental factor

1.A situational factor

6.A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress she should say:
1."Tell me whom I can call to help you."
2."Tell me what bothers you the most about thisexperience."
3."I will contact someone who can help get you temporary housing."
4."I will sit with you until other family members can come help you get settled."

2."Tell me what bothers you the most about thisexperience."

7.The nurse is evaluating the coping success of a client experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the client is coping successfully when the client says:
1."I am going to learn to drive a car so I can be more independent."
2."My sister says she feels better when she goes shopping, so I will go shopping."
3."I have always felt better when I go for a long walk. I will do that when I get home."
4."I am going to attend a support group to learn more about multiple sclerosis and what I will be able to do."

4."I am going to attend a support group to learn more about multiple sclerosis and what I will be able to do."

8.A client newly diagnosed with type 2 diabetes exhibits denial when she says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds:
1."Let's talk about something cheerful."
2."Do other members of your family have diabetes?"
3."I can tell that you feel stressed to learn that you have diabetes."
4.With silence; the nurse understands the denial is a defense mechanism that assists in coping with a shock.

4.With silence; the nurse understands the denial is a defense mechanism that assists in coping with a shock.

9.A staff nurse is talking with her nursing supervisor about the stress she feels on the job. The supervising nurse recognizes that:
1.Nurses who feel stress usually pass the stress along to their clients
2.A nurse who feels stress is ineffective as a nurse and should not be working
3.Nurses who talk about feeling stress are unprofessional and should calm down
4.Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring

4.Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring

10.Generally a person's crisis is resolved in some way within approximately:
1.2 weeks
2.6 weeks
3.1 month
4.6 months

2.6 weeks

NCLEX practice book
Chapter 6
1.An ambulatory care nurse is discussing preoperative procedures with a Japanese American client who is scheduled for surgery the following week. During the discussion, the client continually smiles and nods the head. The nurse interprets this nonverbal behavior as:
1.Reflecting a cultural value
2.An acceptance of the treatment
3.The client is agreeable to the required procedures.
4.The client understands the preoperative procedures.

1.Reflecting a cultural value

2.When communicating with a client who speaks a different language, the best practice for a nurse is to:
1.Speak loudly and slowly.
2.Stand close to the client and speak loudly.
3.Arrange for an interpreter when communicating with the client.
4.Speak to the client and family together to increase the chances that the topic will be understood.

3.Arrange for an interpreter when communicating with the client.

3.A nurse educator is providing in-service education to the nursing staff regarding transcultural nursing care; a staff member asks the nurse educator to describe the concept of acculturation. Which of the following is the appropriate response?
1."It is a subjective perspective of the person's heritage and a sense of belonging to a group."
2."It is a process of learning a different culture to adapt to a new or changing environment."
3."It is a group of individuals in a society who are culturally distinct and have a unique identity."
4."It is a group that shares some of the characteristics of the larger population group of which it is a part."

2."It is a process of learning a different culture to adapt to a new or changing environment."

4.A nurse is providing discharge instructions to a Chinese-American client regarding prescribed dietary modifications. During the teaching session, the client continuously turns away from the nurse. The nurse should implement which appropriate action?
1.Continue with the instructions, verifying client understanding.
2.Walk around the client so that the nurse constantly faces the client.
3.Give the client a dietary booklet and return later to continue with the instructions.
4.Tell the client about the importance of the instructions for the maintenance of health care.

1.Continue with the instructions, verifying client understanding.

5.A nurse educator asks a student to list the five categories of complementary and alternative medicine (CAM), developed by the National Center for Complementary and Alternative Medicine (NCCAM). Which of the following, if stated by the nursing student, would indicate an understanding of the five categories of CAM?
1.Herbology, hydrotherapy, acupuncture, nutrition, and chiropractic care
2.Mind-body medicine, traditional Chinese medicine, homeopathy, naturopathy, and healing touch
3.Biologically based practices, body-based practices, magnetic therapy, massage therapy, and aromatherapy
4.Whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine

4.Whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine

6.Which of the following clients has the lowest risk of obesity and diabetes mellitus?
1.A 45-year-old Native-American man
2.A 23-year-old Asian-American woman
3.A 35-year-old Hispanic-American man
4.A 40-year-old African-American woman

2.A 23-year-old Asian-American woman

7.A nurse is preparing a plan of care for a client who is a Jehovah's Witness. The client has been told that surgery is necessary. The nurse considers the client's religious preferences in developing the plan of care and documents that:
1.Religious sacraments are important.
2.Medication administration is not allowed.
3.Surgery is prohibited in this religious group.
4.The administration of blood and blood products is forbidden.

4.The administration of blood and blood products is forbidden.

8.Which of the following meal trays would be appropriate for a nurse to deliver to a client of Orthodox Judaism faith who follows a kosher diet?
1.Pork roast, rice, vegetables, mixed fruit, milk
2.Crab salad on a croissant, vegetables with dip, potato salad, milk
3.Sweet and sour chicken with rice and vegetables, mixed fruit, juice
4.Fettuccini Alfredo with shrimp and vegetables, salad, mixed fruit, iced tea

3.Sweet and sour chicken with rice and vegetables, mixed fruit, juice

10.The role of a nurse regarding complementary and alternative medicine (CAM) should include:
1.Advising the client about "good" versus "bad" therapies
2.Recommending herbal remedies that the client should use
3.Discouraging the client from using any alternative therapies
4.Educating the client about therapies that he or she is using or is interested in using

4.Educating the client about therapies that he or she is using or is interested in using

11.An antihypertensive medication has been prescribed for a client with hypertension. The client tells a clinic nurse that she would like to take an herbal substance to help lower her blood pressure. The nurse should take which appropriate action?
1.Tell the client that herbal substances are not safe and should never be used.
2.Encourage the client to discuss the use of an herbal substance with the physician.
3.Teach the client how to take her blood pressure so that it can be monitored closely.
4.Tell the client that if she takes the herbal substance she will need to have her blood pressure checked frequently.

2.Encourage the client to discuss the use of an herbal substance with the physician.

12.A nurse describes low-risk therapies to a client and includes which of the following in the discussion? Select all that apply.
1.Herbs
2.Prayer
3.Touch
4.Massage
5.Relaxation
6.Acupuncture

2.Prayer
3.Touch
4.Massage
5.Relaxation

9.An Asian-American client is experiencing a fever. A nurse recognizes that the client is likely to self-treat the disorder with:
1.Magnetic therapy
2.Intercessory prayer
3.Foods considered to be yin
4.Foods considered to be yang

3.Foods considered to be yin

Chapter 7
13.A nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs a thorough assessment, assists the client back to bed, notifies the physician of the incident, and completes an incident report. Which of the following should the nurse document on the incident report?
1.The client fell out of bed.
2.The client climbed over the side rails.
3.The client was found lying on the floor.
4.The client became restless and tried to get out of bed.

3.The client was found lying on the floor.

14.A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which of the following is the best action?
1.Obtain a court order for the surgical procedure.
2.Ask the EMS team to sign the informed consent.
3.Transport the victim to the operating room for surgery.
4.Call the police to identify the client and locate the family.

3.Transport the victim to the operating room for surgery.

15.A nurse has just assisted a client back to bed after a fall. The nurse and physician have assessed the client and have determined that the client is not injured. After completing the incident report, the nurse implements which action next?
1.Reassess the client.
2.Conduct a staff meeting to describe the fall.
3.Document in the nurse's notes that an incident report was completed.
4.Contact the nursing supervisor to update information regarding the fall.

1.Reassess the client.

16.A registered nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first?
1.Call the hospital lawyer.
2.Refuse to float to the ICU.
3.Call the nursing supervisor.
4.Report to the ICU and identify tasks that can be performed safely.

4.Report to the ICU and identify tasks that can be performed safely.

17.A nurse 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 appropriate initial action by the nurse is which of the following?
1.Call security.
2.Call the police.
3 Call the nursing supervisor.
4.Lock the co-worker in the medication room until help is obtained.

3 Call the nursing supervisor.

18.A hospitalized client tells the nurse 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 nurse for assistance in obtaining a witness to the will. The appropriate response to the client is which of the following?
1."I will sign as a witness to your signature."
2."You will need to find a witness on your own."
3."Whoever is available at the time will sign as a witness for you."
4."I will call the nursing supervisor to seek assistance regarding your request."

4."I will call the nursing supervisor to seek assistance regarding your request."

19.A nurse has made an error in a narrative documentation of an assessment finding on a client and obtains the client's record to correct the error. The nurse corrects the error by:
1.Documenting a late entry into the client's record
2.Trying to erase the error for space to write in the correct data
3.Using whiteout to delete the error to write in the correct data
4.Drawing one line through the error, initialing and dating the line, and then documenting the correct information

4.Drawing one line through the error, initialing and dating the line, and then documenting the correct information

20.A nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. The appropriate initial nursing action is to:
1.Call the police.
2.Cut up the photograph and throw it away.
3.Call the nursing supervisor and report the incident.
4.Call the laboratory and ask for the individual's name who sent the photograph.

3.Call the nursing supervisor and report the incident.

21.A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which of the following, if identified by the student, indicates an understanding of a violation of this client right?
1.Performing a procedure without consent
2.Threatening to give a client a medication
3.Telling the client that he or she cannot leave the hospital
4.Observing care provided to the client without the client's permission

4.Observing care provided to the client without the client's permission

22.Nursing staff members are sitting in the lounge taking their morning break. A nursing assistant tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. Which legal tort has the nursing assistant violated?
1.Libel
2.Slander
3.Assault
4.Negligence

2.Slander

23.An 87-year-old woman is brought to the emergency department for treatment of a fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. Which of the following is the appropriate nursing response?
1."Oh, really. I will discuss this situation with your son."
2."This is a legal issue, and I must tell you that I will need to report it."
3."Let's talk about the ways you can manage your time to prevent this from happening."
4."Do you have any friends that can help you out until you resolve these important issues with your son?"

2."This is a legal issue, and I must tell you that I will need to report it."

24.A nurse calls the physician regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the physician, and the medication is due to be administered. Which action should the nurse implement?
1.Contact the nursing supervisor.
2Administer the dose prescribed.
3.Hold the medication until the physician can be contacted.
4.Administer the recommended dose until the physician can be located.

1.Contact the nursing supervisor

25.A client involved in a head-on automobile crash has awakened from a coma and asks for her husband, who was killed in the same accident. The family does not want the client to know at this time that her husband has died. The family wants all nursing staff to tell the client that the husband was taken by helicopter to another hospital, has a head injury, and is in the intensive care unit (ICU). Because the American Nurses Association Code of Ethics requires the nurse to preserve integrity, but the nurse wants to follow the family's instruction, the nurse faces an ethical dilemma. Number in order the steps for systematic processing of the ethical dilemma. (Number 1 is the first step, and number 6 is the last step.)
___ Evaluate the action.
___ Verbalize the problem.
___ Negotiate the outcome.
___ Consider possible courses of action.
___ Gather all of the information relevant to the case.
___ Examine and determine one's own values on the issues.

Gather all of the information relevant to the case.
Examine and determine one's own values on the issues
Verbalize the problem.
Consider possible courses of action.
Negotiate the outcome
Evaluate the action.

Chapter 8
26.A nurse is assigned to care for four clients. In planning client rounds, which client should the nurse assess first?
1.A client scheduled for a chest x-ray
2.A client requiring daily dressing changes
3.A postoperative client preparing for discharge
4.A client receiving nasal oxygen who had difficulty breathing during the previous shift

4.A client receiving nasal oxygen who had difficulty breathing during the previous shift

27.A nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse should assign highest priority to which of the following clients?
1.A client complaining of muscle aches, a headache, and malaise
2.A client who twisted her ankle when she fell while rollerblading
3.A client with a minor laceration on the index finger sustained while cutting an eggplant
4.A client with chest pain who states that he just ate pizza that was made with a very spicy sauce

4.A client with chest pain who states that he just ate pizza that was made with a very spicy sauce

28.A new nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice?
1.A task approach method is used to provide care to clients.
2.Managed care concepts and tools are used in providing client care.
3.A single registered nurse is responsible for providing care to a group of clients.
4.A registered nurse leads nursing personnel in providing care to a group of clients.

4.A registered nurse leads nursing personnel in providing care to a group of clients.

29.A registered nurse has received the assignment for the day shift. After making initial rounds and checking all of the assigned clients, which client will the registered nurse plan to care for first?
1.A client who is ambulatory
2.A client scheduled for physical therapy at 1 PM
3.A client with a fever who is diaphoretic and restless
4.A postoperative client who has just received pain medication

3.A client with a fever who is diaphoretic and restless

30.A nurse is giving a bed bath to an assigned client when a nursing assistant enters the client's room and tells the nurse that another assigned client is in pain and needs pain medication. The appropriate nursing action is which of the following?
1.Finish the bed bath and then administer the pain medication to the other client.
2.Ask the nursing assistant to find out when the last pain medication was given to the client.
3.Ask the nursing assistant to tell the client in pain that medication will be administered as soon as the bed bath is complete.
4.Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client.

4.Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client

31.A nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing assistant is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following is the best approach in dealing with the nursing assistant?
1.Ignore the resistance.
2.Exert coercion with the nursing assistant.
3.Provide a positive reward system for the nursing assistant.
4.Confront the nursing assistant to encourage verbalization of feelings regarding the change.

4.Confront the nursing assistant to encourage verbalization of feelings regarding the change.

32.A registered nurse is planning the client assignments for the day. Which of the following is the most appropriate assignment for a nursing assistant?
1.A client requiring a colostomy irrigation
2.A client receiving continuous tube feedings
3.A client who requires urine specimen collections
4.A client with difficulty swallowing food and fluids

3.A client who requires urine specimen collections

33.A new unit nurse manager is holding her first staff meeting. The manager greets the staff and comments that she has been employed to bring about quality improvement. The manager provides a plan that she developed and a list of tasks and activities for which each staff member must volunteer to perform. In addition, she instructs staff members to report any problems directly to her. What type of leadership style do the new manager's characteristics suggest?
1.Autocratic
2.Situational
3.Democratic
4.Laissez-faire

1.Autocratic

34.A registered nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The registered nurse needs to assign four clients and has a licensed practical (vocational) nurse and three nursing assistants on a nursing team. Which of the following clients would the registered nurse most appropriately assign to the licensed practical (vocational) nurse?
1.A client who requires a bed bath
2.An older client requiring frequent ambulation
3.A client who requires a 24-hour urine collection
4.A client requiring abdominal wound irrigations and dressing changes every 3 hours

4.A client requiring abdominal wound irrigations and dressing changes every 3 hours

Chapter 16
131.A nurse is preparing to initiate an intravenous line containing a high dose of potassium chloride and plans to use an intravenous infusion pump. The nurse brings the pump to the bedside, prepares to plug the pump cord into the wall, and notes that no receptacle is available in the wall socket. Which of the following is the appropriate nursing action?
1.Initiate the intravenous line without the use of a pump.
2.Contact the electrical maintenance department for assistance.
3.Plug in the pump cord in the available plug above the room sink.
4.Use an extension cord from the nurses' lounge for the pump plug.

2.Contact the electrical maintenance department for assistance.

132.A nurse obtains a prescription from a physician to restrain a client by using a jacket safety device and instructs a nursing assistant to apply the safety device to the client. Which observation by the nurse indicates unsafe application of the safety device by the nursing assistant?
1.A safety knot in the safety device straps
2.Safety device straps that are safely secured to the side rails
3.Safety device straps that do not tighten when force is applied against them
4.Safety device secured so that two fingers can slide easily between the safety device and the client's skin

2.Safety device straps that are safely secured to the side rails

133.The nurse is caring for a client with meningitis and implements which transmission-based precautions for this client?
1.Private room or cohort client
2.Personal respiratory protection device
3. Private room with negative airflow pressure
4.Mask worn by staff when the client needs to leave the room

1.Private room or cohort client

134.A nurse is giving a report to a nursing assistant who will be caring for a client who has hand restraints (safety devices). The nurse instructs the nursing assistant to check the skin integrity of the restrained hands:
1.Every 2 hours
2.Every 3 hours
3.Every 4 hours
4.Every 30 minutes

4.Every 30 minutes

135. A nurse is planning care for a client with an internal radiation implant. Which of the following is an incorrect component to include in the plan of care?
1.Wearing gloves when emptying the client's bedpan
2. Keeping all linens in the room until the implant is removed
3.Wearing a lead apron when providing direct care to the client
4.Placing the client in a semiprivate room at the end of the hallway

4.Placing the client in a semiprivate room at the end of the hallway

136.Contact precautions are initiated for a client with a health care-associated (nosocomial) infection caused by methicillin-resistant Staphylococcus aureus. The nurse prepares to provide colostomy care and obtains which of the following protective items needed to perform this procedure?
1.Gloves and gown
2.Gloves and goggles
3.Gloves, gown, and shoe protectors
4.Gloves, gown, goggles, and face shield

4.Gloves, gown, goggles, and face shield

137.A nurse enters a client's room and finds that the wastebasket is on fire. The nurse immediately assists the client out of the room. What is the next nursing action?
1.Call for help.
2.Extinguish the fire.
3.Activate the fire alarm.
4.Confine the fire by closing the room door

3.Activate the fire alarm.

138.A mother calls a neighbor who is a nurse and tells the nurse that her 3-year-old child has just ingested liquid furniture polish. The nurse would direct the mother immediately to:
1.Induce vomiting.
2.Call an ambulance.
3.Call the Poison Control Center.
4.Bring the child to the emergency department.

3.Call the Poison Control Center.

139.An emergency department nurse receives a telephone call and is informed that a tornado has hit a local residential area and that numerous casualties have occurred. The victims will be brought to the emergency department. The initial nursing action is which of the following?
1.Prepare the triage rooms.
2.Activate the emergency response plan.
3.Obtain additional supplies from the central supply department.
4.Obtain additional nursing staff to assist in treating the casualties.

2.Activate the emergency response plan

140.A community health nurse is providing a teaching session about terrorism to members of the community and is discussing information regarding anthrax. The nurse tells those attending that anthrax can be transmitted by which route(s)? Select all that apply.
1. Bites from ticks or deer flies
2. Inhalation of bacterial spores
3. Through a cut or abrasion in the skin
4. Direct contact with an infected individual
5. Sexual contact with an infected individual
6. Ingestion of contaminated undercooked meat

2. Inhalation of bacterial spores
3. Through a cut or abrasion in the skin
6. Ingestion of contaminated undercooked meat

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