NURS 3000 Exam 4 Study Guide Fall 2023.pdf

NURS 3000 Exam 4 Study Guide EXAM 4 STUDY GUIDE NURS 3000 Review assigned readings, active learning guides, and other assigned resources related to this content. Review the concepts and terms on this study guide from the perspective of being able to apply this information, not simply regurgitate it....

NURS 3000 Exam 4 Study Guide EXAM 4 STUDY GUIDE NURS 3000 Review assigned readings, active learning guides, and other assigned resources related to this content. Review the concepts and terms on this study guide from the perspective of being able to apply this information, not simply regurgitate it. Clarify any questions with the course coordinator. OXYGENATION (49/50) Nursing interventions (independent) for client receiving O₂ via nasal cannula; treating supplemental O₂ as a medication Nursing interventions (independent) to promote circulation in hospitalized clients Nursing interventions (independent) to promote oxygenation in hospitalized clients Priority nursing actions for a client exhibiting s/s of impaired oxygenation Independent nursing interventions to maintain a patent airway in client with Ineffective Airway Clearance Therapeutic communication with a client who doesn’t use CPAP as ordered Actions for client experiencing sudden onset chest pain while ambulating in hall Atelectasis – What is it? How would it affect lung sounds? O₂ administration in client with COPD; What’s important to remember? Incentive Spirometry – What is it? Purpose of it; Client teaching needs Medications that can increase risk of impaired oxygenation A client with chronic pulmonary disease has a bluish tinge around the lips. The nurse charts which term to most accurately describe the client’s condition? a. b. c. d. Hypoxia Hypoxemia Dyspnea Cyanosis To prevent postoperative complications, the nurse assists the client with coughing and deep-breathing exercises. This is best accomplished by implementing which of the following? a. b. c. d. Coughing exercises 1 hour before meals and deep breathing 1 hour after meals Forceful coughing as many times as tolerated Huff coughing every 2 hours or as needed Diaphragmatic and pursed-lip breathing 5 to 10 times, 4 times a day The nurse is preparing to perform tracheostomy care. Prior to beginning the procedure the nurse performs which action? a. b. c. d. Tells the client to raise two fingers to indicate pain or distress. Changes the twill tape holding the tracheostomy in place. Cleans the incision site. Checks the tightness of the ties and knot. NURS 3000 Exam 4 Study Guide Which action by the nurse represents proper nasopharyngeal and nasotracheal suction technique? a. b. c. d. Lubricate the suction catheter with petroleum jelly before and between insertions. Apply suction intermittently while inserting the suction catheter. Rotate the catheter while applying suction. Hyperoxygenate with 100% oxygen for 30 minutes before and after suctioning. Which of the following client conditions can alter respiratory function? Select all that apply. a. b. c. d. e. A client who has increasing thick secretions. A client with eupnea. A client with GI bleeding resulting in a large blood loss. A client with heart failure. A client with a temperature of 103.6°F (39.7°C) and experiencing severe pain. While a client with chest tubes is ambulating, the connection between the tube and the water seal dislodges. Which action by the nurse is most appropriate? a. b. c. d. Assist the client to ambulate back to bed. Reconnect the tube to the water seal. Assess the client’s lung sounds with a stethoscope. Have the client cough forcibly several times. The nurse makes the assessment that which client has the greatest risk for a problem with the transport of oxygen from the lungs to the tissues? A client who has a. b. c. d. Anemia. An infection. A fractured rib. A tumor of the medulla. Which term does the nurse document to best describe a client experiencing shortness of breath when lying down who must assume an upright or sitting position to breathe more comfortably and effectively? a. b. c. d. Dyspnea Hyperpnea Orthopnea Acapnea A client with emphysema is prescribed corticosteroid therapy on a short-term basis for acute bronchitis. The client asks the nurse how the steroids will help him. The nurse responds by saying that the corticosteroids will do which of the following? a. b. c. d. Promote bronchodilation. Help the client to cough. Prevent respiratory infection. Decrease inflammation in the airways. NURS 3000 Exam 4 Study Guide The nurse is planning to perform percussion and postural drainage. Which is an important aspect of planning the client’s care? a. Percussion and postural drainage should be done before lunch. b. The order should be coughing, percussion, positioning, and then suctioning. c. A good time to perform percussion and postural drainage is in the morning after breakfast when the client is well rested. d. Percussion and postural drainage should always be preceded by 3 minutes of 100% oxygen. The home health nurse has developed a teaching guide for a client with cardiovascular risk factors that focuses on the importance of regular physical activity with gradually increasing activity levels. This teaching guide specifically promotes which topic? a. b. c. d. Cardiac output and tissue perfusion Renal perfusion and formation of urine Oxygen-carrying capacity of white blood cells Effective breathing and airway clearance The client’s electrocardiogram (ECG) monitor reflects normal electrical activity through the heart’s conduction system. The nurse knows that the electrical impulse travels in which sequence? a. b. c. d. e. Atrioventricular node Bundle branches Sinoatrial node Bundle of His Purkinje fibers Place the letters in the correct sequence: _________________________ Which would most likely be included in the evaluation of the client goal of “Demonstrate adequate tissue perfusion”? a. b. c. d. Symmetrical chest expansion Use of pursed-lip breathing Brisk capillary refill Activity intolerance A client is admitted with acute crushing chest pain that radiates down his left arm. The nurse expects which blood tests to be ordered for this client? Select all that apply. a. b. c. d. e. Blood urea nitrogen (BUN) Hemoglobin and hematocrit Creatine kinase (CK) Homocysteine level Troponin Which client is most likely to experience poor cardiac output? a. b. c. d. A client who has recently completed exercising and is talking easily with an exercise partner A client who has a stroke volume of 70 mL per beat and a heart rate of 70 beats/min A client with a sustained heart rate of 150 beats/min A client who receives a positive inotropic medication NURS 3000 Exam 4 Study Guide The nurse is assigned to three clients with the following diagnoses: myocardial infarction (MI), heart failure (HF), and anemia. In planning for their nursing care, the nurse knows that all three clients will have which sign or symptom? a. b. c. d. Pain Distended neck veins Shortness of breath Nausea Which set of assessment data best validates that the nurse should initiate cardiopulmonary resuscitation on a comatose client? a. b. c. d. Cool, pale skin; unconsciousness; absence of radial pulse Cyanosis, slow pulse, dilated pupils Absent pulses, flushed skin, pinpoint pupils Apnea, absence of carotid or femoral pulses, dilated pupils Which diagnoses would be most appropriate for clients with cardiovascular disease? Select all that apply. a. b. c. d. e. Impaired tissue perfusion Confusion Inadequate cardiac output Impaired sleep Inadequate physical energy for activities The surgeon ordered sequential compression devices (SCDs) to be applied postoperatively. The client asks why the SCDs are needed. Which is the best response by the nurse when teaching the client about the purpose of SCDs? a. b. c. d. They promote arterial circulation. They promote venous return from the legs. They decrease afterload. They decrease postoperative pain. A client with severe mitral stenosis is having surgery tomorrow. While teaching the client, the nurse shows the client a diagram of the heart. Identify with an “X” which valve the client will have replaced. NURS 3000 Exam 4 Study Guide FLUID AND ELECTROLYTES (51) Application of clinical reasoning/judgment process in care of client with fluid imbalance Main organs/body systems involved in fluid/electrolyte balance Why are the elderly at increased risk of fluid imbalances? What other factors place a client at risk of fluid imbalance? Hyperkalemia—priority nursing assessments Excess/Deficient Fluid Volume — s/s; priority nursing interventions; actions for client with severe edema Hyper/Hypo calcemia, natremia, kalemia; Hyper/Hypoglycemia—normal ranges, s/s of imbalances, nursing actions Best indicator of a client’s fluid balance; Example: When receiving an antihypertensive/diuretic Bounding pulse – What does it mean? Nursing actions if client assessment reveals a bounding pulse Effects of diuretics—risk of potassium loss; food sources of potassium An older nursing home resident has refused to eat or drink for several days and is admitted to the hospital. The nurse should expect which assessment finding? a. b. c. d. Elevated blood pressure Weak, rapid pulse Moist mucous membranes Jugular vein distention A man brings his elderly wife to the emergency department. He states that she has been vomiting and has had diarrhea for the past 2 days. She appears lethargic and is complaining of leg cramps. What should the nurse do first? a. b. c. d. Start an IV. Review the results of serum electrolytes. Offer the woman foods that are high in sodium and potassium content. Administer an antiemetic. The nurse administers an IV solution of D5 1/2NS to a postoperative client. This is classified as what type of intravenous solution? __________________________________________ An older client comes to the emergency department experiencing chest pain and shortness of breath. An arterial blood gas is ordered. Which ABG results indicate respiratory acidosis? a. b. c. d. pH 7.54; PaCO2 28 mmHg; HCO3 22 mEq/L pH 7.32; PaCO2 46 mmHg; HCO3 24 mEq/L pH 7.31; PaCO2 35 mmHg; HCO3 20 mEq/L pH 7.50; PaCO2 37 mmHg; HCO3 28 mEq/L NURS 3000 Exam 4 Study Guide The intake and output (I&O) record of a client with a nasogastric tube who has been attached to suction for 2 days shows greater output than input. Which nursing diagnoses are most applicable? Select all that apply. a. b. c. d. e. Decreased fluid volume Potential for decreased fluid volume Dry oral mucous membranes Altered gas exchange Inadequate cardiac output Which client statement indicates a need for further teaching regarding treatment for hypokalemia? a. b. c. d. “I will use avocado in my salads.” “I will be sure to check my heart rate before I take my digoxin.” “I will take my potassium in the morning after eating breakfast.” “I will stop using my salt substitute.” An older man is admitted to the medical unit with a diagnosis of dehydration. Which sign or symptom is most indicative of a sodium imbalance? a. b. c. d. Hyperreflexia Mental confusion Irregular pulse Muscle weakness The client’s arterial blood gas results are pH 7.32; PaCO2 58; HCO3 32. The nurse knows that the client is experiencing which acid–base imbalance? a. b. c. d. Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis A client is admitted to the hospital for hypocalcemia. Nursing interventions relating to which system would have the highest priority? a. b. c. d. Renal Cardiac Gastrointestinal Neuromuscular The nurse would assess for signs of hypomagnesemia in which of the following clients? Select all that apply. a. b. c. d. e. A client with renal failure A client with pancreatitis A client taking magnesium-containing antacids A client with excessive nasogastric drainage A client with chronic alcoholism NURS 3000 Exam 4 Study Guide NUTRITION (46) Therapeutic diets--Clear Liq, Full Liq, Sodium restricted, Calorie restricted—foods allowed, reasons client might be placed on the diet Nursing actions to stimulate a client’s appetite Priority actions if client does not comply with their ordered therapeutic diet Factors affecting a client’s nutritional status; considerations with alcohol misuse Physical signs of poor nutritional status Basic lab tests done r/t assessment of a client’s nutritional status Which nursing diagnosis is most appropriate for a client with a body mass index (BMI) of 35? a. b. c. d. Inadequate dietary intake Obesity Overweight Undernutrition An adult reports usually eating 3 cups dairy, 2 cups fruit, 2 cups vegetables, 5 ounces grains, and 5 ounces meat each day. The nurse would counsel the client to: a. b. c. d. Maintain the diet; the servings are adequate. Increase the number of servings of dairy. Decrease the number of servings of vegetables. Increase the number of servings of grains. Which items are allowed on a full liquid diet? Select all that apply. a. b. c. d. e. f. g. h. Scrambled eggs Chocolate pudding Tomato juice Hard candy Mashed potatoes Cream of Wheat cereal Oatmeal cereal Fruit “smoothies” What is the best indication of proper placement of a nasogastric tube in the stomach? a. b. c. d. Client is unable to speak. Client gags during insertion. pH of the aspirate is less than 5. Fluid is easily instilled into the tube. What is the proper technique with gravity tube feeding? a. Hang the feeding bag 1 foot higher than the tube’s insertion point into the client b. Administer the next feeding only if there is less than 25 mL of residual volume from the previous feeding c. Place client in the left lateral position. d. Administer feeding directly from the refrigerator. NURS 3000 Exam 4 Study Guide A 55-year-old female is about 9 kg (20 lb) over her desired weight. She has been on a “low-calorie” diet with no improvement. Which statement reflects a healthy approach to the desired weight loss? “I need to: a. b. c. d. Increase my exercise to at least 30 minutes every day.” Switch to a low-carbohydrate diet. Keep a list of my forbidden foods on hand at all times.” Buy more organic and less processed foods.” An older Asian client has mild dysphagia from a recent stroke. The nurse plans the client’s meals based on the need to: a. b. c. d. Have at least one serving of thick dairy (e.g., pudding, ice cream) per meal. Eliminate the beer usually ingested every evening. Include as many of the client’s favorite foods as possible. Increase the calories from lipids to 40%. Two months ago a client weighed 195 pounds. The current weight is 182 pounds. Calculate the client’s percentage of weight loss and determine its significance. _______ % weight loss a. b. c. d. Not significant Significant weight loss Severe weight loss Unable to determine significance Which of the sites on the diagram below indicates the correct location for the tip of a small-bore nasally placed feeding tube? Which meal would the nurse recommend to the client as highest in calcium, iron, and fiber a. b. c. d. 3 ounces cottage cheese with 1/3 cup raisins and 1 banana 1/2 cup broccoli with 3 ounces chicken and 1/2 cup peanuts 1/2 cup spaghetti with 2 ounces ground beef and 1/2 cup lima beans plus 1/2 cup ice cream 3 ounces tuna plus 1 ounce cheese sandwich on whole-wheat bread plus a pear NURS 3000 Exam 4 Study Guide LOSS, GRIEF, AND DEATH (43) Types of loss/grief: anticipatory, abbreviated, delayed, chronic, inhibited, and disenfranchised Nursing actions if client refuses treatment for terminal illness Nursing actions for elderly client reminiscing about past losses Specific nursing actions to maintain dignity/self-worth for dying client Essential nursing actions in post-mortem care Livor mortis, Algor mortis, Rigor mortis Therapeutic communication with family members of dying client Therapeutic communication with dying client who is questioning life after death Clinical Signs of Impending Death Stages of the Grief Process—common behaviors of clients/family members in those stages Which of the following may be considered normal or “healthy” types of grief? Select all that apply. a. Abbreviated grief b. Anticipatory grief c. Disenfranchised grief d. Complicated grief e. Unresolved grief f. Inhibited grief A client’s family tells the nurse that their culture does not permit a dead individual to be left alone before burial. Hospital policy states that after 6:00 p.m. when mortuaries are closed, bodies are to be stored in the hospital morgue refrigerator until the next day. How would the nurse best manage this situation? a. Gently explain the policy to the family and then implement it. b. Inquire of the nursing supervisor how an exception to the policy could be made. c. Call the client’s primary care provider for advice. d. Move the deceased to an empty room and assign an aide to stay with the body. The shift changed while the nursing staff was waiting for the adult children of a deceased client to arrive. The oncoming nurse has never met the family. Which initial greeting is most appropriate? a. “I’m very sorry for your loss.” b. “I’ll take you in to view the body.” c. “I didn’t know your father but I am sure he was a wonderful person.” d. “How long will you want to stay with your father?” At which age does a child begin to accept that he or she will someday die? a. Less than 5 years old b. 5–9 years old c. 9–12 years old d. 12–18 years old NURS 3000 Exam 4 Study Guide An 82-year-old man has been told by his primary care provider that it is no longer safe for him to drive a car. Which statement by the client would indicate beginning positive adaptation to this loss? a. “I told the doctor I would stop driving, but I am not going to yet.” b. “I always knew this day would come, but I hoped it wouldn’t be now.” c. “What does he know? I’m a better driver than he will ever be.” d. “Well, at least I have friends and family who can take me places.” When asked to sign the permission form for surgical removal of a large but noncancerous lesion on her face, the client begins to cry. Which is the most appropriate response? a. “Tell me what it means to you to have this surgery.” b. “You must be very glad to be having this lesion removed.” c. “I cry when I am happy or relieved sometimes, too.” d. “Isn’t it wonderful that the lesion is not cancer?” A nursing care plan includes the desired outcome of “quality of life” for a client with a chronic degenerative illness who is likely to live for many more years. Which example would indicate the outcome has been met? a. The client demonstrates having adequate financial resources to pay for healthcare for many more years. b. The client spends the majority of his or her time in spiritual reflection. c. The client has no signs or symptoms of preventive complications of the illness. d. The client verbalizes satisfaction with current relationships with other people. The nurse is caring for a family in a shelter 2 days after the loss of their home due to a fire. The fire caused minor burns to several members of the family but no life-threatening conditions. Which is the most important assessment data for the nurse to gather at this time? a. Availability of insurance coverage for rebuilding the house b. Family members’ understanding of the extent of their physical injuries c. Psychological support resources available from friends or other sources d. Family members’ grief responses and coping behaviors The client has been close to death for some time and the family asks how the nurse will know when the client has actually died. What would be the most accurate response from the nurse? a. When the blood pressure can no longer be measured b. When the gag reflex is no longer present c. When there is no apical pulse d. When the extremities are cool and dark in color In working with a dying client, the nurse demonstrates assisting the client to die with dignity when performing which action? a. Allows the client to make as many decisions about care as is possible b. Shares with the client the nurse’s own views about life after death c. Avoids talking about dying and focuses on the present d. Relieves the client of as much responsibility for self-care as is possible NURS 3000 Exam 4 Study Guide SPIRITUALITY (41) Components of an individual’s spiritual dimension; cues indicating unmet spiritual needs Behaviors/assessment findings in a client experiencing a loss of meaning, love, forgiveness, etc. Potential Practices r/t death when client professes to practice the Roman Catholic faith Culturally sensitive care for a client of the Jewish faith Therapeutic communication with elderly client experiencing various losses Therapeutic communication with client regarding beliefs about prayer When planning care for an older client residing in a skilled nursing facility who is searching to make life meaningful, which nursing action would be most beneficial? a. Assess for depression. b. Diagnose and document that the client has “spiritual disruption.” c. Keep the client busy with social activities. d. Explore with the client desired legacy. A client’s wife asks the nurse to pray for her. What would be the best initial response for a nurse who believes in prayer? a. “May I call the chaplain to come and pray with you?” b. “I know your faith is important to you. It is to me, too. Let’s pray.” c. “I’m happy to do that. For what would you like me to pray?” d. “Isn’t it wonderful that we have a God with whom we can share our concerns?” A client is experiencing severe pain that cannot be controlled by analgesics. An appropriate intervention is full presencing, which involves which of the following? a. Physical presence b. Physical presence with mental awareness of the client c. Physical, mental, and emotional presence d. Physical, mental, emotional, and spiritual presence A client reports, “Cancer was the best thing that happened to me! It is making me appreciate life so much more.” This statement fits best with which nursing diagnosis? a. Spiritual disruption b. Potential for spiritual disruption c. Spiritual health enhancement d. Cognitive denial A dying client states, “Part of what makes dying hard is that I don’t know for sure where I’m going. Nurse, what do you believe happens in the hereafter?” Which ethical guideline should guide your response? a. Never share personal spiritual beliefs. b. Share all spiritual beliefs, favoring none. c. Share only your beliefs. d. First assess for what prompts the client’s question. Research evidence that supports providing spiritual care to older adults suggests that… NURS 3000 Exam 4 Study Guide a. Older adults are not very religious, but are very spiritual. b. Older adults who are more religious have more illness. c. Spiritual health and mental health are correlated. d. Increased spiritual well-being is found among older adults with depression. A client in the emergency department needs a transfusion of red blood cells. The client tells the nurse that, as a Jehovah’s Witness, blood transfusions are not permitted. Which statement would most likely lead to a resolution for this conflict? a. You must accept the transfusion or else leave. b. Don’t worry, you will be forgiven. c. May I please call a representative of your religion so that I can understand your position better? d. I understand your position; I’ll be here with you as you die. An 88-year-old woman has just been admitted to a skilled nursing facility. She tells the nurse that she has been a Sunday school teacher and volunteers for many of her church’s projects. Which of the following nursing diagnoses is most appropriate? a. Potential for spiritual disruption b. Potential for religious struggle c. Spiritual health enhancement d. Religious struggle Which of the following thoughts made by a nurse illustrate a “wounded healer”? a. “I didn’t need that much analgesic when I had abdominal surgery.” b. “No pain, no gain!” c. “If clients would choose a more positive attitude, they’d feel better.” d. “I felt scared when I had surgery; maybe this client feels similarly.” The mother of a pediatric client states, “I can’t understand why God would allow this to happen to my innocent child!” Which nursing diagnosis is most accurate? a. Spiritual disruption related to search for meaning of child’s illness b. Religious struggle related to anger at God c. Impaired coping related to anger d. Potential for spiritual disruption related to threatened sense of hope WELLNESS-ILLNESS (17/20) Therapeutic communication/client teaching with client asking about risk factors for a disease NURS 3000 Exam 4 Study Guide Maslow’s Hierarchy of Basic Human Needs—examples of basic nursing actions to assist clients in meeting physiological, safety/security, and self-esteem needs Which learning activity reflects Bloom’s affective domain? a. Administering an injection b. Accepting the loss of a limb c. Inserting a catheter d. Learning how to read Which is the best method of helping a client newly diagnosed with diabetes to learn the dietary requirements associated with the disease? a. Provide a videotape that addresses the dietary requirements associated with the disease. b. Ask a nutritionist to visit the client to present information and handouts about the diabetic diet. c. Ask the client to make a list of her favorite foods and how to work them into her diet. d. Have the client attend a group meeting for clients with diabetes to discuss their adaptation to this chronic health condition. A nurse is scheduling a teaching situation. Which client is most ready to learn? a. A 45-year-old man whose healthcare provider has just informed him that he has cancer b. A 3-year-old child whose parents are reading a storybook about going to the hospital c. A 60-year-old female who received medication 5 minutes ago for the relief of abdominal pain d. A 70-year-old man, recovering from a stroke, who has returned from physical therapy How can the nurse best assess a client’s style of learning? a. Ask the client how he or she learns best. b. Use a variety of teaching strategies. c. Observe the client’s interactions with others. d. Ask family members. A 74-year-old client who takes multiple medications tells the nurse, “I have no idea what that little yellow pill is for.” What is the best nursing diagnosis for this client? a. Lack of knowledge b. Willingness for knowledge enhancement c. Lack of knowledge (medication information) d. Potential for lack of knowledge A client is scheduled to have a diagnostic procedure. Which questions by the nurse will most likely produce a “teachable moment”? Select all that apply. a. “Have you ever had this procedure before?” b. “What are your concerns about this procedure?” c. “What would you like to know about the procedure?” d. “Are you prepared for this procedure?” e. “What have you heard or read about the procedure?” A client needs to learn to self-administer insulin injections. Which statements reflect possible low literacy skills? Select all that apply. a. “I will read the information later—I’m too tired right now.” b. “I’ve watched my brother give his own shots. I know how to do it.” NURS 3000 Exam 4 Study Guide c. “Just show my wife.” d. “Do you have a video showing how I should give myself the shot?” e. “I don’t understand this one section in the handout.” A primary care provider admitted a client experiencing hypertensive crisis because of the failure to take his prescribed medications. To determine learning needs, which client assessment by the nurse would have the highest priority? a. Age b. Perception of the effects of hypertension c. Ability to purchase needed medications d. Support system A client has a learning outcome of “Select foods that are low in fat content.” Which statement reflects that the client has met this learning outcome? a. “I understand the importance of maintaining a low-fat diet.” b. “I feel better about myself now.” c. “I revised my favorite recipe to be lower in fat.” d. “Since changing my diet, my husband is also losing weight.” A client’s learning outcome is “Client will verbalize medication name, purpose, and appropriate precautions.” Which documented statement reflects evidence of learning? a. Taught name, purpose, and precautions for the new cardiac medication; seemed to understand. b. Provided and reviewed written information about the medication; correct responses were given to follow-up questions. c. Written information read to client; client stated he would read it when he got home. d. Asked questions about the new cardiac medication; satisfied with the information. Which one of the following is an example of the emotional component of wellness? a. The client chooses healthy foods. b. A new father decides to take parenting classes. c. A client expresses frustration with her partner’s substance abuse. d. A widow with no family decides to join a bowling league. Which individual appears to have “taken on” the sick role? a. A client who is obese states, “I deserve to have a heart attack.” b. A mother is ill and says, “I won’t be able to make your lunch today.” c. A man with low back pain misses several physical therapy appointments. d. An older adult states, “My horoscope says I will be well again.” Because a client recently diagnosed with diabetes mellitus is confident that blood sugar control can be improved with diet and exercise alone and recently checked out a video on the management of diabetes at the clinic education center, the client’s actions are most representative of which model? a. Health belief model b. Clinical model c. Role performance model d. Agent–host–environment model NURS 3000 Exam 4 Study Guide Because a client with an infection is scheduled to begin several medications, the nurse will need to provide client education. Which client characteristics are most likely to predict adherence to the treatment program? Select all that apply. a. Educational level b. A trusting relationship with the healthcare provider c. An expectation that the medications will be helpful d. Being able to take the medications twice daily instead of 4 times daily e. Sex Which one of the following might be the best way to measure adherence to a prescribed medication regime? a. Direct observation of medication administration b. Evidence of illness complications or exacerbations c. Monitoring laboratory values of elements influenced by the medication d. Questioning the client about his or her medication routine Which of the following is least likely to influence a client’s personal definition of health and wellness? a. The client’s ability to perform his or her usual activities b. The cultural traditions the client uses in everyday life c. The availability and accessibility of healthcare services appropriate for the client’s health condition d. The medical diagnostic terminology used to describe the client’s signs and symptoms Which of the following is an internal variable affecting health status, beliefs, or practices? a. Living situation b. Socioeconomic status c. Family structure d. Genetics A client recently diagnosed with a chronic illness asks for help in understanding the term chronic. It would be correct for the nurse to say which of the following? a. Symptoms are always less severe than with an acute illness. b. Chronic illnesses are considered incurable. c. Signs and symptoms of chronic illnesses tend to be stable for many years. d. Chronic illnesses have no effective treatments. Although not every client progresses in order through each stage, what is the usual sequence in Suchman’s stages of illness? a. The client makes contact with medical care. b. The client goes into rehabilitation and recovery. c. Signs and symptoms appear. d. The client takes on the dependent role. e. The client takes on the sick role. NURS 3000 Exam 4 Study Guide A married mother of three small children has frequent immobilizing headaches of unknown cause. The nurse anticipates that the woman may have which of the following possible reactions? Select all that apply. a. She feels guilty when unable to perform her usual activities. b. She is angry and acting out. c. She shifts some responsibilities to the spouse. d. She takes on a job to help pay for the medical expenses. e. She has fewer social interactions with her friends. NURS 3000 Exam 4 Study Guide GROWTH AND DEVELOPMENT (23) Developmental Tasks of young adults, older adults; nursing actions appropriate to clients based on their developmental stage Physiological/Psychological changes commonly experienced by middle age adults The parents of a 5-month-old infant and a 3-year-old child ask the nurse about the sequence and timing of developmental milestones for the infant. Which is the most appropriate response? a. “This infant should reach the milestones at the same time as your older child.” b. “The infant may reach the milestones in a different order than your older child.” c. “The sequence of reaching each milestone should follow the same pattern but may be at a different rate.” d. “There are no predictable patterns. Try to enjoy the uniqueness of each child.” The nurse knows that the study of growth and development is an exploration of which of the following? a. Physical changes of the growing child b. Increasing complexity of function and skill progression of the growing child c. Environmental factors such as family, religion, and culture of the growing child d. Physical development and the increasing level and progression of function and skill of the growing child The nurse examines a 2-year-old child recently hospitalized with pneumonia. Which pattern of behavior is most likely to be exhibited by the child? a. Lies quietly while the nurse listens to the lungs b. Asks many questions about what the nurse is doing and hearing c. Fusses, cries, and pushes the nurse away during assessment of the breath sounds d. Enjoys playing “nurse” with the stethoscope and listens to self and others’ breath sounds A 14-year-old is scheduled to have surgical repair of a spinal curvature (scoliosis). The adolescent will be hospitalized for about 2 weeks. Which nursing intervention will be most helpful during the hospital stay? a. Have peers visit frequently during the day. b. Instruct parents to room-in with her. c. Encourage her to go to the recreation room. d. Encourage her to arrange for her teachers to provide her with homework. A 65-year-old man who recently retired from 40 years of work as an independent contractor is scheduled for a physical examination. The nurse should be concerned about which comment? a. “My wife and I are planning to drive to Nebraska in June to visit our grandkids.” b. “Every day, when I wake up, it’s hard to find a reason to get out of bed.” c. “I often take ibuprofen for the pain in my knees.” d. “People still call me for advice on building projects. I may never get to retire!” NURS 3000 Exam 4 Study Guide An 11-year-old child is scheduled for a yearly physical examination. The accompanying parent expresses concern because the girl “seems all wrapped up in soccer teammates and other peers, leaving very little time for the family.” Using Havighurst’s developmental tasks, what would be the nurse’s best response? a. “This is somewhat unusual. Are there problems that we need to discuss?” b. “Although this is normal for 11-year-olds, this transition can be difficult for families.” c. “Become involved in her life and insist that she set aside time for the family.” d. “This is normal development. You need to let her grow up.” A nurse decides that a review of which theorist would be helpful before teaching 4- and 5-year-olds in a preschool class how to brush their teeth? a. Fowler b. Erikson c. Gould d. Peck A 5-year-old boy arrives for the preadmission workup for a surgical procedure. When the nurse brings in the intravenous (IV) control pump the child states: “It’s going to bite me because I have been bad.” Using knowledge of Piaget, Erikson, and Fowler, which is the best nursing action? a. Reassure him by providing opportunities to touch and explore the machine, as well as explaining how it works. b. Understand that his imagination is out of control. Tell him that his fears are unfounded and that he needs to be a “big boy.” c. Recognize that he is too young to understand and that he needs to be quickly distracted. d. Acknowledge his need for fantasy by reassuring him that if he is a “good boy,” the bad machine will not bite him. A 15-month-old is admitted to the hospital for hernia surgery. When his mother leaves him, he cries inconsolably. Using knowledge of attachment theory and cognitive theory, which is the best nursing action? a. Encourage his mother to stay with him as much as possible. b. Put a picture of his mother in his crib to remind him that she will return soon. c. Hold and cuddle him as much as possible. d. Distract him with toys and music. Which behavior is of most concern to the nurse caring for a 25-year-old client after surgery for an appendectomy? a. The client states: “It will be good to get back on my bike. I miss the exercise.” b. The client states: “I have no problem living at my parents’ house. They have lots of room and money, and it’s a very comfortable and easy lifestyle for me.” c. The client gets out of bed and walks to the bathroom with assistance. d. Several age-mate friends visit while the client is hospitalized.