Nursing Interventions/Mgmt/Math/Informatics/Assessment Flashcards by Mary Anne Saldaen

The nurse attempts to determine whether learning outcomes were met after teaching a family about the importance of proper medication administration and by the practice of using weekly medication boxes with each day’s medications. Which learning outcome dimension is the nurse evaluating?

Knowledge.
Skills.
Attitudes/Values.
Behaviors.

The four learning outcome dimension include knowledge, skills, attitudes/values, and behaviors. The nurse is evaluating the skills of the family members by determining whether cognitive knowledge can be applied to healthy behaviors. The family members will still have to practice this skill to routinely implement the behavior, so the proper administration of prescribed medications is done.

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What is the most important action for the nurse who is implementing a standing order?

Compare the order with the client’s current status.
Confirm the order with the healthcare provider.
Transcribe the order into the record.
Verify the order with another nurse.

The implementation of standing orders requires the nurse to use clinical judgment. Comparing the client’s current status with the order is one way to apply clinical judgment.

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The nurse is reviewing the medication calcium acetate (Phoslo) with a client who receives dialysis three times per week. Which statement by the client indicates a need for additional client teaching?

My dose of medication is based on my calcium levels.
I should try to avoid dark green leafy vegetable such as spinach.
My phosphate levels indicate the effectiveness of the medication.
I should take this medication one hour before eating my meals or snacks.

For phosphate binding purposes, calcium acetate (Phoslo) should be taken one hour after each meal and snack and again at bedtime.

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A client diagnosed with active pulmonary tuberculosis has been taking prescribed rifampin and isoniazid for the past two weeks. The client reports feeling tired all the time, loss of appetite and urine having a dark appearance. The nurse notices icterus in the client’s sclera and gums. Which lab test should the nurse request the healthcare provider to prescribe?

Purified protein derivative skin test.
Complete blood cell count with differential.
Liver function test to include ALT, AST and bilirubin.
Serum folate and vitamin B12.

A liver function test to include ALT, AST and bilirubin should be prescribed. Clients who are older than 35 years old and female should be monitored periodically because they are at increased risk of developing fatal hepatitis as a result of the treatment with rifampin and isoniazid, both used to manage tuberculosis.

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The nurse assesses a pregnant client who has received oxytocin. Upon assessment, the nurse finds uterine tachysystole with nonreassuring fetal heart rhythm. Which action should the nurse take first?

Stop the oxytocin.
Administer 1000ml IV bolus of NS.
Reposition the client in semi-fowler’s position.
Prepare the client to deliver.

Uterine tachysystole is a condition of excessive uterine contractions and is considered an emergency causing potential to the fetus and an increase risk of uterine rupture. The first priority for the nurse is to reduce uterine contractions by stopping the oxytocin infusion.

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A client is admitted for a thyroid scan to rule out Graves Disease. The nurse has delegated care of this client to an unlicensed assistive personnel (UAP). Which is the most important data that the UAP should report to the nurse immediately?

Apical pulse of 110 beats per minute.
Blood glucose reading of 150mg/dl.
Presence of tremors and blurred vision.
Temperature change from 99.1 to 100.1°F (37.3-37.8°C).

For the client with Graves disease (hyperthyroidism), an increase in temperature may indicate worsening of the condition and the onset of a thyroid storm. An increase of 1° F should be reported immediately.

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The nurse is educating a pregnant client about breastfeeding. Which information should the nurse provide regarding effective breastfeeding of a healthy neonate?

Breastfeeding should begin within the first hour of life.
Breast milk should be supplemented with formula.
Newborns should nurse every 2 to 3 hours.
Pacifier should be used between feedings.

The nurse should educate clients on the benefits and best practices of establishing breastfeeding during the neonatal period. Exclusive breastfeeding provides adequate nutrition to a healthy neonate and should be encouraged within the first hour of life.

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The nurse is tasked to develop a nursing employment outlook report. Which health care sector is expected to have the largest increase of open nursing positions?

Acute care facilities.
Outpatient centers.
Long-term care facilities.
Home health agencies.

The nurse leader must possess a thorough knowledge of recruitment in order to forecast needs and prevent shortages. Home health agencies are predicted to have the largest increase in open positions and needs due to the aging population and the shift in focus from institutionalization to home healthcare.

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A client with asthma reports a pain level of 7 out of 10. The health care provider orders morphine 2 mg IV for pain. Which action should the nurse implement?

Question the health care provider’s order.
Administer the medication.
Reassess the pain level.
Measure the client’s respirations.

Morphine can exacerbate the symptoms of asthma, so this medication should be used with caution in clients with asthma. The nurse should question the health care provider’s order.

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The nurse is teaching a group of adolescents about dealing with bullying. Which is the best strategy for teaching interpersonal skills?

Worksheets.
Discussion.
Role-playing.
Demonstration.

Role-playing can be effective in teaching parenting, relationship, and other interpersonal skills.

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A nurse is educating a client about nutrition and celiac disease. Which should the nurse tell the client to avoid?

Fruit.
Cheese.
Bread.
Wine.

A client with celiac disease should maintain a gluten-free diet. Foods such as bread, cookies, cereal, and other products made with wheat, barley, or rye should be avoided.

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The nurse is assessing a 4-year old child. Which best descirbe this chiild’s concept of illness?

Possesses magical thoughts of how and why illness occurs.
Demonstrates deep understanding of the cause of illness.
Has a very concrete and rigid idea, but no abstract understanding.
Little comprehension due to lack of life experiences, but can list the symptoms.

Possesses magical thoughts of how and why illness occurs.

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A client with a body mass index (BMI) of 27 asks the nurse how much weight she should gain during her pregnancy with a single fetus. Which range should the nurse recommend?

a) 28-to-40 lbs (12.7 to 18.1 kg).
b) 25-to-35 lbs (11.3 to 15.9 kg).
c) 15-to-25 lbs (6.8 to 11.3 kg).
d) 11-to-20 lbs (4.9 to 9.1 kg).

With a body mass index (BMI) of 27, the client is considered overweight. A woman who is overweight should aim to gain 15 to 25 lbs (6.8 to 11.3 kg) during a single-fetus pregnancy.

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The nurse is reviewing basic dietary guidelines with a client who is newly diagnosed with diabetes. Which statement by the client regarding macronutrients indicates a need for further education?

“I should limit my carbohydrate intake to 80 grams a day.”
“I should try to eat salmon or tuna a few times a week.”
“Eating enough protein is important for improving my insulin response.”
“My total fat intake should be limited to about 50 or 60 grams a day.”

Individuals with diabetes should be advised to consume at least 45% of their total calories from carbohydrates, with a minimum of 130 g per day. The nurse should explain to the client that consuming 80 grams of carbohydrates per day is not sufficient.

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Cataracts Nursing Outcomes

Outcomes

The patient will verbalize questions and concerns regarding cataracts and the recommended surgical treatment.
The patient will have cataract surgery, when appropriate.
The patient will not fall.
The patient will assist with self-care to the fullest extent possible, as evidenced by fulfilling needs for cleanliness, grooming, and toileting.
The patient will report reduced anxiety, as evidenced by a relaxed state and learning about cataract surgery.

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The nurse is interviewing for an open position at one of the city’s older hospital . Which factor should make the nurse most suspicious that retention efforts may be lacking at this facility?

There are many open positions.
The equipment is outdated.
There are minimal educational opportunities.
The pay scale is comparatively low.

Evidence indicates that nursing shortages and low staff satisfaction is directly related to a facility’s inability or unwillingness to retain existing staff. Therefore, a large number of open positions in an established facility is the best evidence that reflects of poor retention efforts on the part of the facility.

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Which is true about the nurse delegating a task to an unlicensed assistive personnel (UAP)?

The nurse retains accountability for client care.
Clinical judgment is transferred to the UAP.
Responsibility for the task is retained by the nurse.
Clinical assessment is shared between the nurse and the UAP.

When delegating a task to a UAP, the nurse will always maintain accountability for client care.

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The home health nurse completes documentation during a home client visit. Which is critical documentation to ensure continuity of care and continued reimbursement?

Assessment completed.
Education presented.
Homebound status.
Skilled care performed.

Home health documentation requires notation of assessment, services, and skilled care, education, observations, and evaluation requirements for reimbursement. Critical documentation for services is notation of homebound status at each visit or the client is ineligible for benefits.

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The home health nurse completes documentation during a home client visit. Which is critical documentation to ensure continuity of care and continued reimbursement?

Assessment completed.
Education presented.
Homebound status.
Skilled care performed.

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An older client reports to the nurse that she “leaks a little bit of urine” whenever she lifts a heavy object, laughs, or coughs. What type of urinary incontinence best describes this client’s symptoms?

Urge.
Functional.
Stress.
Overflow.

Stress incontinence is leakage of urine during circumstances such as exercise, lifting heavy objects, laughing, coughing, or sneezing. This problem is most commonly observed in women. The amount of urine lost is generally small.

The nurse notices a 34-year-old client with a suspected hearing loss is very soft spoken, and their tympanic membrane appears to have scarred tissue present when examined with the otoscope. The client stated experiencing difficulty hearing in quiet and noisy environments and that they occasionally experience dizziness and constantly hear a slight humming in their ears. These findings would indicate of what type of hearing?

Mixed hearing loss.
Conductive hearing loss.
Normal auditory sensory.
Sensorineural hearing loss.

Assessment findings of the client indicate a mixed hearing loss. This evident by the findings. Conductive hearing loss is the result of obstructed sound wave transmission caused by foreign body in the ear canal and/or abnormal tympanic membrane or fused bony/diseased ossicles. The anticipated presenting assessment findings could be evidence of an obstruction, abnormality present in the tympanic membrane, speaking softly, and hearing best in a noisy environment.Sensorineural hearing loss is the result of a defect in the cochlea, the eighth cranial nerve or the brain. Loud music or noise can cause damage to the cochlear hairs. The anticipated presenting assessment findings could be evidence of normal appearance of the external canal and tympanic membrane, presence of tinnitus and occasional dizziness, speaking loudly and hearing poorly in loud environments.

A client presents to the emergency department with generalized muscle weakness, fatigue, and palpitations. Lab results indicate a serum potassium level of 2.4 mEq/L. Which body system should be assessed first?

Cardiovascular.
Respiratory.
Renal.
Gastrointestinal.

A serum potassium level below 3.5 mEq/L indicates hypokalemia. Signs and symptoms of hypokalemia include muscle weakness, fatigue, and palpitations. A potassium level below 3.5 mEq/L can cause ECG changes such as ST-segment depression , T waves that are inverted or flat and increased U waves. The dysrhythmias brought on by the hypokalemia can be lethal and the first thing the nurse should do is connect the client to an ECG monitor.

While assessing a client’s health history, the nurse notes that the client has been prescribed timolol (Timoptic) for open-angle glaucoma. Which health outcome would indicate this medication is effective?

Slowing of the loss of peripheral vision.
Increase in intraocular pressure readings.
Improvement in the line of sight of all vision fields.
Decreased formation of abnormal blood vessels in the eye.

The glaucoma medication will not reverse or cure the disease, but it will slow any further loss of peripheral vision if administered properly by decreasing the intraocular pressure that was causing loss of peripheral vision.

A toddler presents to the clinic with cellutlitis on the sole of the right foot with a history of a laceration from stepping on a broken shell while walking on the beach. Which describes the appearance of cellulitis?

Flesh-colored papules with a central caseous plug.
Rose-colored rash with firm elevated papules.
Intense red rash with swelling and poorly defined borders.
Reddish vesicles with sharply defines borders.

Cellulitis is inflammation of the skin and subcutaneous tissues, usually caused by streptococcal and staphylococcal infections. It often presents as a poorly defined area of intense redness and swelling.

In assessing a client's chest expansion, the nurse's hands are positioned on the client's posterior thorax. As the client takes a deep breath, the nurse should observe which movement? 1. Client's ribs. 2. Client's shoulders. 3. Nurse's palms. 4. Nurse's thumbs.

4 The nurse's hands are positioned so that the thumbs are located bilaterally at the level of T9 or T10. During the client's inhalation, the nurse should observe for symmetric movement of the thumbs and note any asymmetric movement, indicating a problem with lung expansion.

An older client reports to the nurse about having constipation. Which response should the nurse use to clarify the client's report of constipation? 1. "Describe your daily activity." 2. "Describe what you normally eat daily." 3. "Describe the frequency of your bowel movements." 4. "Describe the characteristics of your stools."

3 Bowel elimination patterns can differ widely from person to person. To clarify symptoms of constipation, the nurse should determine if stools are hard, dry, and difficult to pass or if the client has to strain to defecate.

The nurse is assessing a newborn. The newborn appears pink with blue extremities, with arms and legs flexed. The nurse also notes that the child has a heart rate greater than 100 and is crying during the assessment. What APGAR score should the nurse assign? a) 4. b) 6. c) 7. d) 9.

4 The APGAR score is completed immediately (1) minute after birth to determine the initial health of the newborn and then again (5) minutes after birth. Based on the information provided, the correct APGAR score for this newborn is 9. APGAR scoring consists of: Heart rate- 0= absent; 1= less than 100; 2= over 100; Respiratory effort- 0= absent; 1= slow irregular; 2= good cry; Muscle tone- 0= limp; 1= some flexion; 2= active motion; Reflex irritability- 0= no response; 1= grimace; 2= cry; Color- 0= pale; 1= body pink, extremities blue; 2= all pink.

The nurse is assessing a client with complaints of abdominal discomfort, rusty colored urine and increase frequency of urination. Upon inspection some bladder distention is present and abdominal tenderness noted with light palpation. Client's social history includes smoking 1.5- 2 packs of cigarettes per day for 35 years and 20 year employment history as a hair dresser/beautician. Based on these findings which medical diagnosis would the nurse suspect? 1. Urolithiasis. 2. Urothelial cancer. 3. Urinary incontinence. 4. Urinary tract infection.

2 Urothelial cancer is suspected on based on the client's presenting findings. Urothelial cancer is a malignant tumor of the urothelium that can occur anywhere in the renal/urinary tract. These tumors occur more often in the bladder. Risks factors for the development of this cancer include active and/or passive exposure to cigarette smoke; occupation exposures to toxic chemicals such as hair dyes. Assessment findings of description of change in color, frequency and amount of urine, presence of abdominal discomfort and bladder distention. The presence of blood in the urine is the first sign of bladder cancer.

The nurse witnesses an older client having a seizure with rigid extension of the arms and legs, sudden jerking movements, loss of consciousness, and urinary incontinence. Which term describes this type of seizure? 1. Focal seizure. 2. Tonic-clonic. 3. Myoclonic. 4. Complex partial.

2 A tonic-clonic (grand mal) seizure is best described as rigid extension of arms and legs followed by sudden jerking movement with loss of consciousness. Bowel and bladder incontinence is also common.

The nurse is leading a team which will be developing policies and procedures for a new nursing unit. Which is the best resource to support evidence-based care? 1. Nursing curriculum. 2. State legislative mandates. 3. Clinical practice guidelines. 4. Healthcare providers' prescriptions.

3 Evidence-based practice is based in the summaries of research evidence found in clinical practice guidelines.

Which type of therapy is most helpful for a teen with depression in an outpatient setting? 1. Group. 2. Individual. 3. Family. 4. Relationship.

1 Treatment for a teen with depression is multidimensional. Group therapy is especially helpful for adolescents in the outpatient setting because it is in a structured environment and the adolescent can be comfortable when relating to their peers in a positive way.

(healthinformatics) What actions should the nurse implement when taking a telephone order (TO)? 1. Sign, date and time the order and document that it was a phone order. 2. Repeat back to the healthcare provider the order as it was recorded. 3. Include the healthcare provider's telephone number on the order. 4. Verify the identity of the person calling in the order. 5. Remind the prescribing healthcare provider to sign the order within a week.

1, 2, 4 The telephone order may be necessary if there is not a healthcare provider on site, or in an emergency situation, and is only used when absolutely necessary. The nurse must document all pertinent information and read back the order to the prescriber. Most facilities require the prescriber to sign the order within a day.

(health informatics) A client has recently been admitted for evaluation of sudden onset psychosis. In addition to a medical assessment and serum drug screen, which other tests should the nurse expect the client will undergo to find a cause for this change in mental status? 1. Brain MRI, PET scan. 2. Skull radiographs, free thyroxin. 3. CT angiography, electromyogram. 4. Carotid Doppler, electrocardiogram.

1 Magnetic resonance imaging (MRI) of the brain can detect structural abnormalities or changes. A PET scan can measure blood flow and glucose utilization in regions of the brain.

(health informatics) How is the client's confidentiality maintained when a nurse inputs client data into the electronic medical record? 1. The client must give consent each time before the nurse inputs or retrieves any data. 2. The nurse must log into the electronic medical record using a secured password prior to data entry. 3. Because the client is admitted to the hospital, it is assumed consent is given to any employee of the hospital. 4. The nurse must print a copy of the client data, date and sign the printed copy, and place it in client's chart.

2 To protect the client's rights and keep the client's record confidential, anyone who enters data into or consults a computerized record must log into the system using a secure password.

(health promotion) The nurse working at a community blood pressure screening health fair suggests that all the screenings should be performed by calibrated automated blood pressure cuff machines. Which screening test selection criterion concerns the nurse? 1. Sensitivity. 2. Specificity. 3. Validity. 4. Reliability.

4 Criteria for screening test selectivity and implementation include sensitivity, specificity, validity, and reliability. If the criterias are not met, the screening may do more harm than good. By using calibrated automated blood pressure cuff machines, it helps ensure the reliability and consistency of the blood pressure readings.

The nurse is conducting client education. Which statement lets the nurse know that the client understands the education regarding vitamin C? 1. Foods high in vitamin C should be avoided. 2. Smoking decreases vitamin C levels in the body. 3. Large doses of vitamin C can cause a decrease urine output. 4. Omit a missed dose of vitamin C and take the next dose the following day.

2 When providing education about vitamin C, the nurse should encourage clients to consume foods rich in vitamin C such as citrus fruits, cantaloupes, and tomatoes. Smoking decreases vitamin C levels, and it is recommended that clients not exceed the recommended daily allowance (RDA) of vitamin C because it can cause urinary stones.

(health promotion) Which is the best method a nurse can teach a mother of an infant to minimize the occurrence of a diaper rash? 1. To place talcum powder in the diaper. 2. To dry the infant's buttocks with a hair dryer. 3. To change the diaper as soon as it is soiled. 4. To place petrolatum on the infant's buttocks.

3 Changing a soiled diaper as soon as soiling is detected is the best way to decrease the occurrence of a diaper rash.

(math) A client with hypertension has a prescription for 8 mg of candesartan cilexetil PO daily. The medication is available as a 16 mg tablet. How many tablets should the nurse administer? (Enter numeric value only, rounded to the tenth.)

0.5 Rationale 8 mg: X tablets :: 16 mg: 1 tablet8 :: 16XX = 8/16 = 1/2 or 0.5 tablets

A child needs to receive a continuous intravenous infusion of furosemide (Lasix) at a dosage of 0.05 mg/kg/hr. The child weighs 22 pounds. How many mg/hour should the child receive? (Enter the numerical value only. If rounding is required, round to the nearest tenth.)

0.5 Rationale First, calculate the child's weight in kg by dividing 22 by 2.2 (1 kg = 2.2 pounds) = 10 kgThen determine the dose per hour:0.05 mg X 10 kg = 0.5 mg/hour

The nurse offers a client a 16-ounce soft drink. The client drinks half. How many mL should the nurse document on the fluid intake record? (Enter numeric value only)

240 Rationale One ounce = 30 mL.30 mL x 16 ounces = 480 mL x 1/2 = 240 mL

The nurse is preparing to administer a dose of nafcillin 200 mg IM. The available medication vial is labeled, "Add 3.4 mL diluent for a concentration of 250 mg/mL." How many mL should the nurse administer? (Enter the numeric value only. If rounding is required, round to the nearest tenth.)

0.8 Rationale After mixing, the medication is available in a concentration of 250 mg/mL.Using Desired/Have X Volume:200 mg/250 mg X 1 mL = 0.8 mL

(math ) The nurse learns in report that a client is receiving an IV infusion of magnesium sulfate diluted in 500 mL of 0.9% NaCl. The infusion is to be administered over 4 hours. The nurse checks the infusion pump and notes that the magnesium is infusing at a rate of 125 mL/hour. What action should the nurse take? 1. Stop the infusion immediately. 2. Increase the rate of infusion. 3. Decrease the rate of infusion. 4. Continue the current infusion rate.

4 Using Volume/Time:500 mL/4 hrs = 125 mL/hour.The infusion is being administered at the correct rate and the nurse should continue the infusion at that rate.

(mgmt) The nurse pilots a discharge program to investigate trends in readmission rates for the unit. Results indicate that clients who receive follow-up discharge contact had a significantly lower rates of readmission. Which statement justifies the practice of the additional nursing hours required to follow up with discharge instructions? 1. Available funding to increase nursing staff. 2. Improve nursing staff efficiency. 3. Demonstrate nursing-led research outcomes. 4. Earn administrative promotions.

1 Affordable Care Organizations receive reimbursement based on client outcomes and readmission rates; an organization that can find innovative ways to significantly improve these indicators will significantly improve cost effectiveness. The cost of a nurse to follow up with discharge instructions is far less than the penalties of non-reimbursements for client stays or readmissions. The increased revenue can be used to obtain funding for more nursing staff.

(mgmt) A client enters the emergency department for back pain. The health care provider orders oxycodone HCl IR 10mg PO, in addition to diagnostic labs and an MRI. The nurse reviews the electronic medical record and notes a history of past emergency department visits, particularly an admission two years prior for narcotic overdose. Which action should the nurse take? 1. Administer the medication and evaluate for signs of drug-seeking behavior. 2. Document administration of the medication with a note about prior overdose. 3. Administer the medication and inquire therapeutically about the overdose incident. 4. Notify the interprofessional team of drug-seeking behavior.

3 Client information is private and may be shared with health care providers on condition of confidentiality. Past information that is obtained out of context may create bias, which can compromise care. A therapeutic relationship should be used to obtain and document information that is accurate and relevant. The client's pain should be addressed first and then an inquiry in a non-threatening manner should be conducted in reference to the narcotic overdose.

(mgmt) The nurse is applying for open positions on general medical-surgical units. Which client care delivery model should the nurse expect to be implemented on these units? 1. Functional nursing. 2. Primary care. 3. Team nursing. 4. Total patient care.

3 Client care delivery models are implemented to maximize safety, efficiency, and effectiveness of client care. The type of care delivery model used varies according to setting. Team nursing is most frequently used in an acute-care general medical-surgical setting, as it is cost-effective (using a higher proportion of unlicensed personnel) and efficient (using skill sets to the highest degree).

(mgmt) The lead nurse is concerned that current staffing methods may no longer be effective. This concern is based on clinical and human resource staffing effectiveness indicators. Which indicators are directly related to staffing effectiveness? 1. Increased interventions, complex treatments, physician orders, and readmissions. 2. Increased adverse drug events, client complaints, physician orders, and client acuity. 3. Increased call-outs, client complaints, length of stay, and postoperative infections. 4. Increased upper gastrointestinal bleeds, family complaints, readmissions, and complex treatments.

3 Staffing effectiveness can be measured directly with clinical indicators (including family and client complaints) and human resource indicators (including staff vacancy and turnover rates). Interventions, treatments, orders, and readmissions may affect staffing but are not a direct indicator of staffing effectiveness.

(mgmt) The nurse writes the following goal for the unit: "Within 3 hours of the start of shift, the temperature, pulse, respirations, and blood pressure for all 15 clients will be documented, reviewed, and signed in the electronic medical record." Which category of SMART goals is missing from this statement? 1. Specific. 2. Measurable. 3. Time-bound. 4. Realistic.

3 SMART goals are specific, measurable, achievable, realistic, and time-bound. To make this statement a SMART goal, the nurse should note that the temperatures, pulses, respirations, and blood pressures (specific vital signs) should be documented (achievable) and reviewed between 7 a.m. and 10 a.m. (time-bound) for 15 clients (realistic). The nurse is delegated a task and specifying what is to be done and the time frame it should be completed.

(mgmt) The lead nurse is creating a nurse internship program. The nurse is exploring various tools to help the mentor to facilitate the learning for the novice nurse. Which tool best incorporates key elements of professional education and mentoring? 1. A novice nurse values inventory for personal awareness throughout the internship. 2. An internet professional development scavenger hunt journal activity with mentor feedback. 3. A list of professional organizations for inclusion in the orientation packet. 4. A chart of self-directed learning tips for inclusion in the orientation packet.

2 Key elements of mentoring in professional education should include facilitation of self-directed learning, using the novice nurse's values for engagement, and generating awareness of self-discovery and development opportunities. The internet professional development scavenger hunt promotes interactivity between the novice nurse and the mentor; it also and encourages self-learning, professional development and self-awareness.