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Exam 3 review nu 1 3 6 Flashcards | StudBud
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Exam 3 review nu 1 3 6
Exam 3 review nu 1 3 6
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1
Why must a nurse be cautious when using humor as a complementary treatment?
it may be considered disrespectful by some
Nureses are not funny people
It doesn't work at all
Laughing can be loud and disturbing to other patients
2
Define charting by exception
organizes patient illness on a time frame
focus on deviations from norms
centers on patient from a positive prespective
narrative or story driven charting
3
When prioritizing nursing diagnosis, according to Maslow's which of the following would the nurse address first?
fall/injury risk
Imbalanced nutrition less than body requirement
disturbed sleep pattern
Risk for social isolation
4
A patient with B12 deficiency should increase their intake of
Kiwi and broccoli
Rice and wheat
Lentils and sweet potato
Sardines and clams
5
A client came to the ER with paleness and extreme fatigue what should the nurse assess next
the client bowels habit needs to be observed
Meds they took during their last visit to the hospital
The nurse should ask about their daily diet
whether their spouse or S.O. will stay the night with them
6
the client asks the nurse about alternative therapies that may help lower their BP and HR. the nurse correctly states
help from a doctor that tells them to use medication
Biofeedback, relaxation, and meditation therapies
alternative therapies do not work
over-the-counter medication
7
A client who practices christian science is refusing to take their scheduled meds. the nurse understands that
They will have to ask again at a time more convenient for the patient
The physician needs to be notified stat
The patient is wanting to save on the visitation cost
Christian science do not normally seek traditional health care
8
This type of charting allows for documentation at the point of care but it is costly and time consuming to implement
focus charting
problem oriented
computer charting
case management charting
9
The nurse properly documents the nursing diagnosis for a client with a BMI of 50 when they document
imbalanced nutrition: more than body requirements
imbalanced nutrition; less than body requirements
risk for imbalanced nutrition: more than they body requirements
obesity related to increase consumption of fatty foods
10
What are goals for patients
what to be achieved, short term, long term, has numbers
date and signs
..
Bedside care and assistance
11
When charting is organized in chronological order it is..
problem oriented
case management charting
source-oriented (narrative)
focus charting
12
Documentation that only requires abnormal assessment findings to be recorded is known as which type of charting
Narrative charting
PIE charting
charting by exception
problem oriented charting
13
When a client speaks a language that is different from the nurse's language, what should the nurse do?
Ask Jose the CNA to help with translation
use a certified medical interpreter
ask siri for help
Use the patient's family as translators
14
The nursing student is trying to determine if a task can be delegated to a CNA. The SN chooses correctly if they choose.
Placing a sublingual tablet under the client's tongue
Checking the client's wounds for formation of granulation tissue
Ensuring the client understands proper hygiene care after being taught
Assisting the client with obtaining a lunch menu
15
the client at high risk for hypertension should be taught which of the following
Decreases their intake of unsaturated fats
Lower LDL levels will be good for your heart
keep their recommended fibers intake to only every other day
increasing saturated fats in the diet will help lower LDL levels
16
The new nurse calls the MD and states, " good morning Dr., I am nurse Ratchet.." which part of ISBARR is this?
recommendation
introduction
situation
read back
17
Which of the following demonstrates accuracy in documentation?
client ambulated 100 feet while using walker at 1030
physician called for medications
Patient previous nurse refused to document vitals last shift
patient did not sleep too well last night
18
After getting a telephone order from the physician the nurse should
read the back of order
Initiate the 5 rights of medication administration
call the pharmacy to confirm the order
administer the medication
19
what fat-soluble vitamins the nurse understands that
Those are the most important of all the vitamins
they are easily absorbed into the bloodstream
they have high caloric value
consumption of too much fat-soluble vitamins can lead to toxicity
20
When prioritizing nursing diagnoses according to Maslow's which of the following would the nurse address first
Deficient knowledge r/t unfamiliarity w/ conduction aeb misconception of fx
impaired physical mobility r/t fatigue aeb frequent daytime naps
Acute pain r/t injury of soft tissue aeb guarding, protective behavior
Risk for infection aeb tissue injury
21
Which of the following is an example of a sign?
Coarse crackles are heard upon auscultation over lower lung lobes
The nurse made a conclusion bases on observed data
The patient states that they are afraid of falling if they try to walk
Jesus took the wheel
22
Which of the following is an example of stereotyping another person?
A person from Alabama says certain English phrases with a variation
The nursing student believes that all Japanese people watch anime
A patient form Canada feels helpless and disoriented
The husband dominates all decision making and family choices
23
The nurse states, "Everything will work out eventually" is an example of
giving advice
looking at alternatives
using cliches
clarifying
24
which of the following is an example of adequate documentation ?
Reports of dyspnea, 02 sat 88%, HR 120, PRN inhaler given, 02 sats now 95%
Pt states aching pain in right leg, morphine given
patient ambulated with little difficulty, will continue to monitor
The patient's blood pressure is 145/90, physician notified
25
Which of the following is an example of properly written goals?
the physician will order x-ray by tomorrow
client will state a pain of 2/10 by the end of the day
all morning medication will be administered by 1015
client will have no wounds
26
Determining if progress is made when comparing actual nursing outcomes allow the to expected nurse to
discharge the client quicker
determine if revisions are needed
Help the doctor determine the next steps medication
save the facility money and cut down on waste
27
Which of the following is an advantage of narrative (source) charting?
Abnormal findings are the only assessments that will be documented
Physicians prefer long and detailed nursing chating
It saves time during the charting process
it includes all aspects of the nursing process
28
When helping the visually impaired client with their meal the nurse should
Be aware that this condition affects mainly men
never track the patient weight in order to maintain their self esteem
teach them the types of foods they're eating bases on the food texture
tell them where their food is using a clock as a reference
29
What is objective data
information obtained from the patient and/or family members
Information obtained through the senses and hands on physical examination
feelings, experiences, opinions, and thoughts
Data obtained from pt verbally that only the pt can describe or verify
30
A Jewish client may ask for which type of diet during their stay in the hospital
Kosher
vegetarian
medium steaks
Halal
31
along with protein, what also helps with healing?
potassium
vitamin C
calcium
phosphorus
32
Which of the following best demonstrated the nurse giving clear and concise orders to the CNA
Make sure to teach room 103 how to take their inhaler before leaving today
Ask the physician to clarify the medication order for Mr. R
Assist Mr.s Z in room 112 to ambulate from their room to the nurse station
I need you to take vital signs on the first 10 rooms
33
This complementarity treatment is directed at disease prevention, lifestyle management and a diet of natural foods
ayurveda
homeopathy
aromatherapy
naturopathic medicine
34
Which of the following should the nurse not include in the end of shift report
The patient stated that the morphine IV relieves their pain
The patient's. family is at the bedside
the patient physician is John Doe M.D.
The patient is scheduled for an MRI in at 1100
35
Telling a client "when you are stressed just find ways to relax" is which communication block?
inattentive listening
using cliches
giving false reassurance
giving advice
36
what is subjective data
Data obtained from pt verbally that only the pt can describe or verify
obtained during the physical examination
information on the client's status at discharge
Data that you can measure. such as bp
37
Which of the following is included in the nursing assessment?
the nurse assists the client with ambulation
Subjective and objective data
a client-centered goal that is realistic and attainable
The nurse identified the reasons for an interventions to be carried out?
38
saying "i'll just sit with you for a while" is an example of..
offering of self
seeking clarification
reflection
using general leads
39
which commonly used herb is thought to decrease migraines and hay fever symptoms
ginger
ginkgo biloba
butterbur
cranberry
40
Which of the following tasks can be delegated to a CNA?
reading the EKG stripes after obtaining an EKG on an MI patient
Preparing discharge teaching papers
assisting the client with repositioning every 2 hours
cleaning the pins on a patient's fixator
41
Which of the following problems will have the highest priority?
a client oozing blood from a laceration on the left forearm
A client complaining of pain of 7/10
a client being admitted with audible wheezing in bilateral up per lobes
A patient admitted with type 2 DM has glucose level of 263
42
What does confidentiality with a patient's medical records mean?
As long as the person is a family member they can view the medical records
All healthcare personnel can view any medical records at anytime
Access to medical records are given only to other medical institutions
Only those caring for the patent can view the medical record
43
Which of the following is an example of a symptom?
There is purplish black ecchymosis on the patient's arm
The patients blood pressure is 165/100
The patient states that they have a throbbing headache
By the end of the shift the patient has had 2500 mL's of urine output
44
The client with PEG tube feeding complains of nausea and fullness.. the most appropriate action by the nurse is to?
lay the patient flat
call the physician and stop the feeding
slow the feeding to 20 mLs/hr
Change the feeding to a low calorie formula
45
When caring for Muslim women, what must the nurse understand about their beliefs and values?
Prayer is not considered an integral part of Islam
Her grandmother wishes is the final authority
The nurse must respect her modesty
The women is the head of the household
46
A Native American pt asks the nurse if his shaman can perform traditional healing rituals, and the proper response is
it is against hospital policy to allow healing methods that are untested
I do not believe in those rituals therefore they can not be preformed here
I will inform the physician and allow him to confer with your shaman
I cannot allow you to do that. it may be more harmful to you if he does
47
the nurse states "I think breathing treatment would help with pt's SOB" is which part of SBAR?
assessment
background
situation
recommendation
48
The nurse properly teaches a PEG tube patient on self administrating feedings at home when the nurse states
residual is checked every 6 hours
Flushing with water before and after feeds is not required
a feeding pump is not required for continuous feedings
do not push the feeding in with the syringe
49
what does the use of encouraging elaboration accomplish?
it shows the readiness to help
allows the client to gather thoughts
helps the client fully describe concern or problem
sums up important parts of the conversation
50
The nurse with client on a PCA reckeacks their pain at regular intervals. This is which phase of the nursing process?
assess
implementation
evaluation
planning
51
A client is diagnosed with potassium deficiency, which foods should the client increase in their diet?
Green beans
Figs
Beef liver
Nuts
