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NEW QUESTION 337
The orientation nurse educator reviewing the biohazard legend with a class of new employees states that the emblem is affixed to containers whenever:
- A. there is the need for droplet precaution.
- B. there is the potential for airborne transmission.
- C. there is presence of blood and body fluids.
- D. there is contact isolation.
Answer: C
Explanation:
When body substances are handled, the potential for transmission is increased; therefore, federal regulations require warning labels to communicate with other employees and/or waste collectors. The biohazard alert is a three-ring symbol overlaying a central concentric ring. Blood, drainagefrom wounds, feces, and urine are all body fluids that can transfer infection and disease to others.Safety and Infection Control
NEW QUESTION 338
A nurse taking a patient's history realizes the patient is complaining of SOB and weakness in the lower extremities. The patient has a history of hyperlipidemia, and hypertension. Which of the following may be occurring?
- A. The patient may be developing COPD
- B. The patient is developing CHF
- C. The patient may be having a MI
- D. The patient may be having an onset of PVD
Answer: C
Explanation:
Explanation/Reference:
Explanation:
Myocardial infarction may be associated with SOB and muscle weakness.
NEW QUESTION 339
Which of the following should be included in a diet rich in iron?
- A. peaches, eggs, beef
- B. cereals, kale, cheese
- C. red beans, enriched breads, squash
- D. legumes, green beans, eggs
Answer: A
Explanation:
Home sources of iron that can be absorbed in the body include meat, poultry, and fish. In addition, these sources contain a factor that helps to enhance iron absorption of nonheme sources. Eating Vitamin C at the same time as iron sources also helps to promote iron absorption.High calcium intake in the diet promotes the absorption of iron because it helps to bind to phytates and thereby limits their effect.Physiological Adaptation
NEW QUESTION 340
Client self-determination is the primary focus of:
- A. confidentiality.
- B. health care.
- C. malpractice insurance.
- D. nursing's advocacy for clients.
Answer: D
Explanation:
Advocacy for clients by nurses is the primary focus of the client's right to autonomy and self-determination. Confidentiality involves the maintenance of the privacy of the client and information regarding him or her. Malpractice insurance is a type of insurance for professionals.Coordinated Care
NEW QUESTION 341
A nursing care plan for a client with sleep problems has been implemented. All of the following should be expected outcomes except:
- A. the client reports satisfaction with his amount of sleep.
- B. the client rates sleep as an 8 or more on the visual analog scale.
- C. the client falls asleep within 1 hour of going to bed.
- D. the client reports no episodes of awakening during the night.
Answer: C
Explanation:
Explanation/Reference:
Explanation:
An expected outcome is that the client falls asleep shortly after going to bed. The stages of sleep are defined by 4 stages. By stage 3 or 4 (within a short period of time - usually 1 hour) the client is considered to be in the deep part of sleep. Basic Care and Comfort
NEW QUESTION 342
Appropriate nursing strategies to assist a client in maintaining a sense of self include:
- A. discouraging the use of personal items.
- B. explaining procedures only if the client is attentive.
- C. using the client's first name when addressing the client.
- D. treating the client with dignity.
Answer: D
Explanation:
Explanation/Reference:
Explanation:
All clients must be treated with dignity. Rather than a strategy, treating clients with dignity is a basic core value universal to nursing. Psychosocial Integrity
NEW QUESTION 343
A gastroenterologist should be consulted for clients suffering from:
- A. digestive system diseases.
- B. female reproductive system diseases.
- C. nervous system diseases.
- D. urinary system diseases.
Answer: A
Explanation:
A gastroenterologist cares for clients with digestive system diseases.
A urologist cares for clients with urinary system diseases.
A gynecologist cares for clients with female reproductive system diseases.
A neurologist cares for clients with nervous system diseases.
Coordinated Care
NEW QUESTION 344
The nurse is caring for a 4-year-old patient.
What is the most appropriate pain scale for the nurse to use during the assessment?
- A. FLACC Pain Scale
- B. McGill Pain Scale
- C. CRIES Pain Scale
- D. Wong-Baker Pain Scale
Answer: D
Explanation:
Section: Health Promotion and Maintenance
NEW QUESTION 345
In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations.
The next step is to elicit the client's __________.
- A. intent in sharing the description
- B. feelings about what has been described
- C. possible solutions to the problem
- D. thoughts about what has been described
Answer: D
Explanation:
Section: Psychosocial Integrity
Explanation:
Questions should be asked in a precise order (specifically, from the most-simple description to the more difficult disclosure of feelings).
When the problems have been described, eliciting the client's thoughts about the dilemmas provides further assessment data as well as the client's interpretation of what has happened.
Feelings, solutions and articulating intent are more complex processes.
NEW QUESTION 346
The most common cause of injury from a house fire is:
- A. explosion.
- B. thermal damage to skin and body surfaces.
- C. inhalation injury.
- D. falls from second-story windows.
Answer: C
Explanation:
Explanation/Reference:
Explanation:
Inhalation is the most common cause of injury from a house fire. Accident Prevention
NEW QUESTION 347
A client was involved in a motor vehicle accident in which the seat belt was not worn. The client is exhibiting crepitus, decreased breath sounds on the left, complains of shortness of breath, and has a respiratory rate of 34/min. Which of the following assessment findings should concern the nurse the most?
- A. temperature of 102 F and a productive cough
- B. trachea deviating to the right
- C. arterial blood gases (ABGs) with a PaO2 of 92 and PaCO2 of 40 mmHg
- D. barrel-chested appearance
Answer: B
Explanation:
A mediastinal shift is indicative of a tension pneumothorax along with theother symptoms in the question.Because the individual was involved in an MVA, assessment is targeted at acute traumatic injuries to the lungs, heart, or chest wall rather than other conditions indicated in the other choices. Choice 1 is common with pneumonia. Values in Choice 2 are not alarming. Choice 4 is typical of someone with chronic obstructive pulmonary disease (COPD). A tensionpneumothorax is a dangerous complication and a medical emergency where entering air cannot escape by the same route and pressure within the pleural cavity increases, resulting in complete collapse of the lung. A mediastinal shift to the unaffected side and a downward displacement of the diaphragm can be observed.
Physiological Adaptation
NEW QUESTION 348
A 27 year-old woman has delivered twins in the OB unit. The patient develops a condition of 5 centimeter diastasis recti abdominis. Which of the following statements is the most accurate when instructing the patient?
- A. Sit-ups are o.k. to do as long as you don't strain
- B. This condition leads to surgery in 80% of cases.
- C. Antibiotics are required for this condition in 70% of patients.
- D. Guarding the abdominal region is important at this time.
Answer: D
Explanation:
Explanation/Reference:
Explanation:
Protection of the abdominal wall is critical at this point in time.
NEW QUESTION 349
An LPN student nurse is assigned to shadow you for the day. When she learns one of the patients you are caring for has Hepatitis C, she states, "I might find another nurse to shadow. I really don't feel comfortable caring for anyone with Hepatitis C." What is your best response?
- A. "What do you know about Hepatitis C?"
- B. "Don't worry. I've taken care of this guy many times. He's super nice and pretty independent, so you won't have any physical contact with him."
- C. "As a nurse, you will take care of patients with many types of illnesses. I think it's best you stay with me."
- D. "Why are you so afraid of Hepatitis C? If you take proper precautions, you will not get it."
Answer: A
Explanation:
Section: Psychosocial Integrity
NEW QUESTION 350
Which of the following statements indicates adequate dietary understanding in a client with constipation?
- A. "I should increase my intake of milk."
- B. "I should increase my intake of apples."
- C. "I should decrease my level of activity."
- D. "I should decrease my intake of fluids."
Answer: B
Explanation:
Section: Physiological Integrity
Explanation:
Apples are a source of high fiber, which decreases constipation. A constipated client needs to increase fluids and activity level.
Milk is not a high-fiber food.
NEW QUESTION 351
Which isolation procedure will be followed for secretions and blood?
- A. Respiratory
- B. Standard Precautions
- C. Contact Isolation
- D. Droplet
Answer: B
Explanation:
Explanation/Reference:
Explanation:
Standard precautions are taken in all situations for all clients and involve all body secretions except sweat and are designed to reduce the rate of transmission of microbes from one host to another or one source (environment such as the client's bedside table) to another. Safety and Infection Control
NEW QUESTION 352
An assessment of the skull of a normal 10-monthold baby should identify which of the following?
- A. Overlap of cranial bones.
- B. Ossification of the sutures.
- C. Closure of the anterior fontanel.
- D. Closure of the posterior fontanel.
Answer: D
Explanation:
Section: Health Promotion and Maintenance
Explanation:
The posterior fontanel should close by the age of 2 months.
NEW QUESTION 353
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