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Medical Surgical Nursing 2nd Edition, Kathleen Test Bank

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Test Bank For Medical Surgical Nursing 2nd Edition, Kathleen. Note: This is not a text book. Description: ISBN-13: 978-0132706698, ISBN-10: 0132706695.

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Test Bank Medical Surgical Nursing 2nd Edition, Kathleen

Chapter 01
Question 1
Type: MCSA
The nurse plans and implements care for a patient based on nursing knowledge and skills. The nurse is functioning within which role?
1. Caregiver
2. Advocate
3. Educator
4. Leader
Question 2
Type: MCSA
A patient tells the nurse that he does not understand the surgical procedure the physician told him he needed. What should the nurse do to advocate for this patient?
1. Contact the physician and ask that the procedure be explained to the patient.
2. Explain the procedure to the patient.
3. Document that the patient does not understand the proposed surgical procedure.
4. Instruct the patient about alternatives to the surgical procedure.
Question 3
Type: MCSA
The nurse, instructing a patient newly diagnosed with type 2 diabetes, reminds the patient about the need for an annual dilated retinal eye examination and annual urine tests to measure protein levels. The nurse is functioning within which role with this patient?
1. Educator
2. Researcher
3. Advocate
4. Leader
Question 4
Type: MCSA
The nurse manager of a care area asks that a new intravenous-therapy monitoring device not be used for any patients until the entire staff has received appropriate instruction on its use. The nurse manager is demonstrating which component of caring?
1. Comportment
2. Confidence
3. Conscience
4. Commitment
Question 5
Type: MCMA
The nurse is concerned about new scheduling changes and their impact on staffing levels. If applying the component of professional comportment, in which ways should the nurse respond?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Call a friend in another care area and discuss the changes in the unit station.
2. Request a private discussion of the proposed changes with the nurse manager.
3. Shake her head and laugh while saying, “Here we go again.”
4. Discuss the changes with other staff members in the unit hallway.
5. Ask to serve on the committee that will evaluate the changes over the next 6 months.
Question 6
Type: MCSA
A staffing issue and lack of patient care supplies cause a nurse to cancel planned evening activities and stay on the care area until all issues are resolved. The nurse’s actions are most typical of which role?
1. Administrator
2. Educator
3. Manager
4. Researcher
Question 7
Type: MCSA
A nurse with community-health nursing experience provides monthly blood pressure checks for fellow members of a religious congregation. The nurse is functioning within which role?
1. Parish nurse
2. Clinic nurse
3. Gerontologic nurse
4. Occupational health nurse
Question 8
Type: MCSA
A patient is admitted to a patient care area. The nurse has never provided care to a patient from this patient’s culture before and is concerned. How should the nurse proceed?
1. Briefly review the patient’s culture and its expectations of health care providers.
2. Have another nurse provide care to this patient.
3. Approach the care of this patient as with any other patient admitted to the care area.
4. Locate an interpreter to assist with communication.
Question 9
Type: MCSA
A nurse of Hispanic descent is assigned to provide care to a patient of the same culture. How would the assignment benefit the patient?
1. The nurse will not make any cultural errors.
2. The nurse will provide expert care.
3. The nurse will make sure the patient has a timely discharge.
4. The nurse is culturally competent.
Question 10
Type: MCMA
A nurse of German descent is providing care to a patient of Asian descent. Which assets should this nurse possess to work effectively in this cross-cultural situation?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Understanding of the health care system
2. Motivation to engage in the care of this patient
3. Ability to self-examine
4. Patience
5. Skill in assessment based on culture
Chapter 02
Question 1
Type: MCSA
The nurse is a member of a committee that is studying the frequency of medication errors. Other committee members include a health care provider, pharmacist, pharmacy technician, and nurse manager. The nurse is most likely participating in which specific type of quality process?
1. Total quality management
2. Continuous quality improvement
3. Quality improvement
4. Quality assurance
Question 2
Type: MCSA
At the end of a scheduled work shift, the nurse asks each of his patients if there was anything he could have done to make their day more comfortable. The nurse is most likely participating in which process?
1. Quality improvement
2. Self-assessment
3. Continuous quality improvement study
4. Departmental assessment
Question 3
Type: MCSA
The hospital benefits manager describes a health care program in which the nurse employee will pay a certain amount of money each month for comprehensive health services. The nurse will have a primary physician who will direct care within a specific network of providers. The nurse’s heath care must be provided by these in-network physicians. The nurse will have which type of health care?
1. Health maintenance organization (HMO)
2. Traditional insurance service plan
3. Independent practice association (IPA) coverage
4. Preferred provider organization (PPO)
Question 4
Type: MCSA
A patient tells the nurse that her primary care provider wants her to see a specialist, but the specialist is out of the network and her deductible will be higher. The nurse realizes the patient is a member of which type of health care organization?
1. Medicare
2. Health maintenance organization (HMO)
3. Independent practice association (IPA)
4. Preferred provider organization (PPO)
Question 5
Type: MCSA
A 46-year-old patient, unemployed and diagnosed with kidney disease, tells the nurse that he is having difficulty with his medical bills. What should the nurse do to help this patient?
1. Work with the pharmacist to determine which medications the patient can discontinue and still maintain an acceptable level of health.
2. Suggest the patient take prescribed medications every other day to make the prescription last longer.
3. Ask social services to discuss Medicare as a health care coverage option.
4. Assure the patient that the nurse will ask the health care provider if the patient can be quickly discharged to home.
Question 6
Type: MCMA
A patient brought into the emergency department tells the nurse that she does not need anything because she cannot pay for any health services. The nurse’s assessment is that the patient is very ill and needs care. What nursing actions are indicated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Provide paperwork for the patient to sign out of the hospital against medical advice.
2. Explain that all care will be covered by the Emergency Medical Treatment and Labor Act (EMTALA).
3. Ask the health care provider for medication because the patient is confused.
4. Encourage the patient to stay until care is provided.
5. Agree that services cannot be delivered without pay and refer the patient to the local free clinic.
Question 7
Type: MCSA
The state board of nursing has notified a hospital about the changes in mandatory continuing education requirements for the nurses. The administration realizes these changes would impact which activity?
1. Regulations
2. Accreditation
3. Licensure
4. Life safety
Question 8
Type: MCSA
A patient tells the nurse that he had made some decisions about his care when he thought he was going to die, but now that he knows he isn’t, he wants all possible medical treatment. Which nursing action is indicated?
1. Tell the patient that he cannot change is mind or treatment plan.
2. Change the patient’s classification in the medical record.
3. Contact social services to discuss the change in plans.
4. Contact the health care provider for the patient to discuss the patient’s decision.
Question 9
Type: MCSA
A patient tells the nurse that if he does not wake up after surgery, his friend should be contacted because the friend knows what should be done concerning his health care needs. After referring to the patient’s medical record, the nurse realizes that the friend has which relationship with the patient?
1. The patient’s best friend
2. The patient’s health care power of attorney
3. The patient’s next-door neighbor
4. The patient’s brother
Question 10
Type: MCSA
A patient cries quietly while undergoing a painful treatment. The nurse realizes that although the treatment is painful, it is necessary for the patient’s healing and recovery. Which ethical principle does this situation exemplify?
1. Paternalism
2. Nonmaleficence
3. Veracity
4. Respect for others
Chapter 03
Question 1
Type: MCSA
A nurse notices a particular nursing intervention is not successful in helping patients achieve their health care goals and decides to study the issue. What should the nurse do first?
1. Identify the problem.
2. Design the sampling plan.
3. Conduct a literature review.
4. Conduct a pilot study.
Question 2
Type: MCSA
A qualitative research study has concluded and the nurse researcher is currently watching the study participants to make sure that the research findings can be observed in their routine lives. The nurse is conducting which type of basic research?
1. Ethnography
2. Experimental research
3. Phenomenology
4. Grounded theory
Question 3
Type: MCSA
The nurse asks a patient if he has used a newly developed exercise to relieve the arthritis pain in his shoulders. The nurse is most likely employing which concept?
1. Applied research
2. Basic research
3. Critical thinking
4. Discharge planning
Question 4
Type: MCMA
The nurse is analyzing a phenomenological research study. Which data would the nurse evaluate as matching this study design?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Waiting to have a procedure done is more stressful than the actual procedure.
2. A patient’s blood pressure is 150/90 after ambulating 10 feet.
3. A patient’s urine output after ingesting 240 mL of water is 100 mL.
4. Ten mothers in the same housing community desire a centrally located day care facility.
5. Breast cancer survivors are more likely than others to participate in efforts to raise money for breast cancer research.
Question 5
Type: MCSA
The nurse, working with patients in an orthopedic surgical unit, wants to study the impact of assistive devices on progressive
ambulation. What would be an example of a research problem for this study?
1. Do post–hip replacement patients ambulate faster with one crutch or two?
2. How does learning postsurgical exercises before the hip replacement impact the patient’s use of assistive devices?
3. Will post–hip replacement patients recover from surgery faster if ambulated the day after surgery?
4. Will post–hip replacement surgery patients be discharged using a cane for ambulation?
Question 6
Type: MCSA
Even though the nurses in a patient care area have been asked to collect data while conducting patient care, several nurses do the data collection only if time is available. Which research problem criteria does the inconsistent collection of data exemplify?
1. Feasible to address
2. Researchable
3. Of interest to the researcher
4. Significant to nursing
Question 7
Type: MCSA
A nurse is going to determine the best design to use for a research project. Which action would the nurse perform to guide this choice?
1. Collect data.
2. Do a review of the literature.
3. Write an overview of the conceptual framework.
4. Identify themes and categories.
Question 8
Type: MCSA
A patient has not responded to an intervention with the desired outcome. Which nursing action is the best example of using evidence-based practice to solve this problem?
1. Apply the intervention again.
2. Find a research study about the intervention and apply the study’s finding.
3. Evaluate what went wrong with the intervention.
4. Find research, quality improvement study outcomes, and information from experts to change the intervention.
Question 9
Type: MCSA
The nurses have been instructed on the use of an evidence-based practice (EBP) method to monitor patients; however, several nurses continue to conduct patient monitoring using the previous method. What can the nurse manager do to increase the use of the evidence-based practice method?
1. Assign the nurses not using the new method to participate in gathering data for a research study.
2. Review the evidence-based material again with those nurses who are not using the new method.
3. Remind the nurses that performance evaluations are tied to the use of evidence-based practice.
4. Determine that either method would be appropriate for the nurses to use.
Question 10
Type: MCSA
A patient refuses to participate in a research study for an experimental medication. By accepting the patient’s decision, the nurse is exercising which ethical principle?
1. Respect for persons
2. Justice
3. Informed consent
4. Beneficence
Chapter 04
Question 1
Type: MCSA
The nurse is providing care to patients for whom she has 24-hour accountability and responsibility. How would the nurse describe this care delivery system?
1. Team nursing
2. Functional nursing
3. Case method
4. Primary nursing
Question 2
Type: MCMA
The nurse works in a hospital that practices functional care delivery. Which statements represent common perceptions about this system?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. “My job is so boring.”
2. “My job is very satisfying.”
3. “Knowing that I am instrumental in my patient’s return to health is very joyful.”
4. “It is hard for me to see the impact of my work in helping patients get better.”
5. “As long as I do my job correctly, I am not responsible for when or how the patient gets better.”
Question 3
Type: MCMA
A hospital utilizes the functional nursing care delivery system, and patient satisfaction scores have been falling in each quarter of the past year. What is a likely reason for this decrease?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Utilization of advanced practice nurses on the unit
2. Efficient nursing staff
3. Lack of confidence in the caregivers
4. Lower health care costs
5. Fragmentation of the nursing care
Question 4
Type: MCSA
A registered nurse is seeking employment at a hospital with magnet status after hearing about the high nurse satisfaction at this hospital. High nursing satisfaction in a hospital with magnet status rating is a result of which commonality?
1. Unlicensed assistive personnel are used to perform direct patient care such as hygiene.
2. Charge nurses direct all care by tight control of nursing services.
3. Responsibility for care of the patient rests with the primary health care provider rather than the nurse.
4. Nurses have a great deal of professional autonomy.
Question 5
Type: MCSA
A registered nurse (RN) wants to delegate the insertion of an intravenous catheter (IV) to a licensed practical nurse (LPN/LVN). The RN bases the decision to delegate on which factor?
1. The RN does not have time to start the IV.
2. Inserting an IV catheter is within the scope of the LPN/LVN role according to the state’s nurse practice act.
3. The RN has not started an IV since nursing school.
4. The RN does not have time to evaluate the outcome of the procedure.
Question 6
Type: MCMA
A registered nurse desires to work at a hospital close to her home. A nurse who works at the hospital tells her that he spends much of his day delegating to unlicensed assistive personnel (UAPs). The nurse realizes that the hospital practices one of which types of care delivery?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Functional nursing
2. Primary nursing
3. Team nursing
4. Case method
5. Relationship-based care
Question 7
Type: MCSA
The nurse manager has been charged with evaluating whether the current system of team nursing is efficient and cost-effective for the unit. Which statement supports the cost-effectiveness of team nursing on this unit?
1. Team nursing is cost-effective because it allows for the use of unlicensed assistive personnel to provide care delegated by the registered nurse.
2. Research concludes that team nursing is the most cost-effective care delivery system.
3. Managed care organizations provide financial incentives to institutions that use team nursing as a means to decrease the high cost of registered nurse salaries.
4. The Institute of Medicine’s 2004 report Keeping Patients Safe identified team nursing as the most cost-effective care delivery system.
Question 8
Type: MCSA
A state has experienced an economic downturn and a shortage of registered nurses. Which nursing care delivery model would hospital administrators be likely to avoid?
1. Case method
2. Team nursing
3. Primary care nursing
4. Functional nursing
Question 9
Type: MCSA
The nurse administrator is considering employing an advanced practice nurse. The administrator would refer to which documents to determine this nurse’s role in the hospital’s nursing care delivery model?
1. The State Board of Nursing scope of practice information
2. The job description for the advanced practice nurse
3. The Joint Commission standards for nursing practice
4. The curriculum of the advanced practice nurse’s educational program
Question 10
Type: MCSA
The nurse’s chief function is to collaboratively plan, coordinate, and evaluate services in a cost-effective manner. The nurse fulfills which role within the care delivery system?
1. Nurse practitioner
2. Clinical nurse specialist
3. Clinical nurse leader
4. Case manager
Chapter 05
Question 1
Type: MCMA
The nurse is providing care for a patient who is unhappy with the health care provider’s care. The patient signs the Against Medical Advice (AMA) form and leaves the hospital against medical advice. What should the nurse include in the documentation of this event in the patient’s medical record or on the AMA form?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Documentation that the patient was informed that he or she cannot come back to the hospital
2. Documentation that the patient was informed that he or she was leaving against medical advice
3. Documentation that the risks of leaving against medical advice were explained to the patient
4. Documentation of any discharge instructions given to the patient
5. Documentation indicating an incident report has been completed
Question 2
Type: MCMA
A nurse documents this statement in a patient’s medical record: “2/25/–, 2235. At 2015 patient awoke suddenly and complained of shortness of air. Pulse oximetry reading was 82% on room air and audible wheezes could be heard.” This documentation meets which documentation guidelines?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Documentation is timely
2. Documentation is concise
3. Documentation is objective
4. Documentation includes date and time of entry
5. Documentation is complete and accurate
Question 3
Type: MCSA
A nurse documents the following in a patient’s medical record: “2/1/__, 1500. Patient appears weak and faint. Patient’s skin is moist and cool, vomited bright red blood with clots. Health care provider notified and order received to give 2 u of packed red blood cells if stat Hgb is < 8.0. Pain medication will be given.” This documentation meets which documentation principle?
1. Document objectively.
2. Do not document procedures in advance.
3. Use approved abbreviations.
4. Document changes in patient condition.
Question 4
Type: MCSA
A nursing unit has changed its documentation system to documenting by exception. How will this system save time?
1. It eliminates lengthy or repetitive documentation.
2. It allows flexibility and description in the documentation.
3. It allows the reader to easily locate information about a specific problem.
4. It allows for quick and easy retrieval of information.
Question 5
Type: MCSA
A hospital is considering changing its documentation system to reduce the number of medication errors. Which system should the hospital investigate?
1. Problem, intervention, evaluation (PIE) system
2. Electronic medical record
3. Problem-oriented medical record
4. Narrative system
Question 6
Type: MCMA
Which nursing activities are examples of independent functions of the nursing role?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Teaching a soon-to-be-discharged patient about the medication regimen that the health care provider has prescribed
2. Talking with the patient about his or her abilities to manage personal hygiene activities while in the usual state of health at home
3. Incorporating adaptive techniques into nursing care as recommended by occupational therapy
4. Administering analgesic medication ordered by the health care provider
5. Introducing oneself to, and interviewing, the patient to collect data about physical health status
Question 7
Type: MCSA
The nurse is caring for a 70-year-old patient who was just admitted to an inpatient rehabilitation center. The patient had required total parenteral nutrition for several days, but recently resumed and is tolerating a regular diet. She has another 4 days left in a course of intravenous antibiotics to complete treatment of a positive central line culture. Which nursing action, required in the care of this patient, is considered a dependent role function?
1. Requesting that the health care provider order a consult because the patient states that her dentures no longer fit properly and she has trouble chewing
2. Asking the nursing assistant to demonstrate to the patient how to operate the call system
3. Interviewing the patient to assess whether she needs assistance with getting out of bed
4. Administering the antibiotics prescribed by the health care provider
Question 8
Type: MCSA
When asking a patient if a pain medication provided a few hours ago has been effective, the nurse is performing which step of the nursing process?
1. Planning
2. Implementation
3. Evaluation
4. Assessment
Question 9
Type: MCSA
The nursing instructor knows that further education is needed when a student makes which statement?
1. “Assessment precedes nursing diagnosis and outcome identification.”
2. “Planning follows nursing diagnosis and outcome identification and precedes implementation.”
3. “Evaluation follows implementation and precedes planning.”
4. “Planning follows assessment and precedes evaluation.”
Question 10
Type: MCSA
A 16-year-old patient has been admitted for treatment of presumptive pelvic inflammatory disease. The patient’s hygiene is poor and she reports living “on the street” for a year. She is febrile and tachycardic and reports pain as 10 on the 1-to-10 scale. The nurse identifies Acute Pain as the priority nursing diagnosis. Which outcome statement is appropriate?
1. The patient’s comfort will be achieved and maintained.
2. The patient will be discharged to a safe living environment.
3. The patient will be reunited with her parents.
4. The patient’s infection will be eradicated.

Chapter 06
Question 1
Type: MCSA
While conducting a health assessment, the nurse documents a patient’s response under the heading “chief complaint.” Which part of the assessment is the nurse conducting?
1. History of present illness
2. Family history
3. Psychosocial history
4. Past medical history
Question 2
Type: MCSA
A patient comes to the emergency department and states, “I am having chest pain and I feel short of breath.” How is the data the patient has just given the nurse classified?
1. Nonspecific
2. Objective
3. Factual
4. Subjective
Question 3
Type: MCSA
The nurse has completed the collection and analysis of data from a patient assessment. What is the nurse’s next action?
1. Evaluate outcomes from care.
2. Plan care.
3. Determine patient care goals.
4. Formulate nursing diagnoses.
Question 4
Type: MCSA
The nurse asks the patient, “What brings you to the hospital today?” What is the nurse’s rationale for using this type of question?
1. It acknowledges agreement between the patient and the nurse.
2. It elicits specific information.
3. It is useful for introducing a subject in general terms.
4. It helps to clarify information.
Question 5
Type: MCSA
While conducting a health history, the nurse nods her head as the patient is talking. What is the nurse’s primary rationale for this action?
1. It conveys acknowledgment of the patient’s feelings.
2. It helps to reduce the patient’s anxiety level.
3. It encourages the patient to continue talking.
4. It allows the nurse time to observe the patient’s nonverbal cues.
Question 6
Type: MCSA
A patient tells the nurse that he has a history of back pain that is controlled with yoga and herbal supplements. How would the nurse document this information?
1. The patient does not believe in Western medicine.
2. The patient has strong spiritual beliefs.
3. The patient uses some alternative forms of medicine to treat illness.
4. The patient uses stress reduction techniques to control back pain.
Question 7
Type: MCSA
The nurse introduces herself and shakes the patient’s hand, then sits so as to maintain eye contact during the health interview. What do the nurse’s actions demonstrate?
1. Facilitation
2. Negative nonverbal messages
3. Positive nonverbal messages
4. Empathy
Question 8
Type: MCSA
During the health history, a patient tells the nurse that she is in an abusive relationship and is fearful of getting hurt if her husband finds out that she told the nurse. Which response by the nurse is most appropriate for this patient?
1. “Don’t worry. They only strike back when they are angry.”
2. “Are you saying that you are in danger?”
3. “I would get an attorney if I were you.”
4. “Remember, what goes around comes around.”
Question 9
Type: MCSA
During an assessment, the patient describes shoulder pain. The nurse responds, “So, you have this shoulder pain when you eat fried foods or ice cream, is that correct?” The nurse is using which interview technique?
1. Facilitation
2. Empathy
3. Interpretation
4. Summary
Question 10
Type: MCSA
The nurse notices a patient has a strong, foul body odor. The patient tells the nurse he has trouble getting in and out of the bathtub. Which areas of the physical assessment does this information address?
1. Behavior and pain
2. Nutritional assessment, mental status, and behavior
3. Physical appearance, height, and weight
4. Functional assessment, physical appearance, and mobility
Chapter 07
Question 1
Type: MCSA
A patient tells the nurse that she does not want to pass on a genetic disorder to any future children. What is the nurse’s most accurate response?
1. “A complete genetic study could help guide you in your decision making.”
2. “I suppose, then, that you are not going to have any children.”
3. “Adoption is always a possibility.”
4. “Just because the disease is genetic doesn’t mean your children will inherit it.”
Question 2
Type: MCSA
A patient tells the nurse that she is genetically predisposed to type 2 diabetes. The patient is hypertensive and smokes a pack of cigarettes daily. What information should the nurse provide for this patient?
1. “Maintaining a healthy weight and activity level will help you avoid type 2 diabetes.”
2. “Unfortunately, you are probably predestined to develop type 2 diabetes.”
3. “You probably need to begin monitoring your blood glucose levels daily.”
4. “The risk of developing diabetes is several years away, and you have other health problems to consider now.”
Question 3
Type: MCSA
The nurse is conducting a class for expectant parents who need genetic counseling. Which statement by a parent would indicate the need for further education?
1. “The reason men and women are so different from one another is that none of their chromosomes are alike.”
2. “Half of the sets of chromosomes come from the mother and the other half come from the father.”
3. “The 23rd pair of chromosomes will determine if our child will be male or female.”
4. “One Y chromosome and one X chromosome will produce a male child.”
Question 4
Type: MCSA
At the conclusion of genetic testing, a patient learns that he has a predisposition for developing cardiovascular disease at a young age. Which instruction should the nurse provide this patient?
1. “This information can help guide you to make lifestyle changes to reduce your chances of developing cardiovascular disease.”
2. “At least you know now that you will need cardiac bypass surgery.”
3. “As you are likely to develop the disease early in life, enjoy your life as much as possible now.”
4. “I would not place too much emphasis on these test results, as most of the time they are inconclusive.”
Question 5
Type: MCSA
A patient is concerned about transmitting genetic illnesses to any future children. What can the nurse do initially to help the patient determine which diseases might be transmitted?
1. Work with the patient to complete a pedigree.
2. Conduct a health promotion assessment.
3. Schedule a complete genetic analysis.
4. Refer the patient to a geneticist for diagnosis.
Question 6
Type: MCSA
A patient has been told that her unborn child has Down syndrome. Which information will the nurse include when teaching the patient about the etiology of this disorder?
1. “Down syndrome is the most common type of trisomy, which occurs when there is an extra chromosome.”
2. “Most Down syndrome is caused by monosomy.”
3. “Down syndrome occurs as a result of breaks in chromosomes called translocations.”
4. “Deletions or loss of part of a chromosome is a common cause of Down syndrome.”
Question 7
Type: MCSA
The mother of a child with cystic fibrosis says, “No one in our family has ever had cystic fibrosis. Why did it suddenly appear in my child?” What information should the nurse offer this mother?
1. “While all people carry the gene for cystic fibrosis, those who develop the disease have a mutation in that gene.”
2. “A small percentage of the general population carries the gene for cystic fibrosis. If two carriers have children, 25% of those children will develop the disease.”
3. “One in four people carries the gene for cystic fibrosis. If two carriers have children, 25% of those children will develop the disease.”
4. “Some people carry the gene for cystic fibrosis. Of those carriers, one in four will develop the disease.”
Question 8
Type: MCSA
At the completion of genetic testing, it has been determined that a patient’s baby will have Down syndrome. What should the nurse say to the patient after learning this information?
1. “I realize that this news is difficult for you. Is there anything I can do to help you at this time?”
2. “It’s not too late to consider ending the pregnancy.”
3. “You are young enough to be able to handle the baby’s challenges.”
4. “It does not matter if the baby has problems; all life is precious.”
Question 9
Type: MCSA
A patient planning to be married tells the nurse that she has a strong family history of Huntington’s chorea but does not plan to let her fiancé know. How should the nurse respond?
1. “Is there any reason you do not want your fiancé to know about your genetic illness?”
2. “It is probably best that he is not aware of the disease.”
3. “Are you afraid he will not want to marry you if he knows?”
4. “There are worse disease processes than Huntington’s chorea.”
Question 10
Type: MCSA
A patient planning to have genetic testing prior to having children tells the nurse that she is fearful that people will learn about the testing and the results. How should the nurse respond to this concern?
1. “The results of the tests are confidential, and no one can see them without your permission.”
2. “Most insurance companies will want the results before paying for the tests.”
3. “The results will be available to anyone who reviews your medical record.”
4. “The doctor will most likely use the results when planning care and treatment for other patients with the same genetic disorder.”
Chapter 08
Question 1
Type: MCSA
During a nutritional assessment, a patient asks why the waist circumference measurement is needed. What is the nurse’s best response?
1. “It helps determine if the BMI is accurate.”
2. “It is more reliable than skinfold measurements.”
3. “It is the only tool that can reliably provide information on nutritional status.”
4. “It helps in determining your risk for cardiovascular disease.”
Question 2
Type: MCSA
The nurse is conducting a nutrition assessment on a patient who has been admitted for hip replacement surgery. The patient reports that he is Jewish and follows the kosher dietary tradition. Which statement by the nurse will have the greatest impact on the patient’s nutritional health during his hospitalization?
1. “I’ll arrange for a dietitian to come and discuss your food requirements with you.”
2. “Would you be more comfortable with having your family bring you food from home?”
3. “Remember that you will need to increase your protein input postsurgery.”
4. “Please tell me more about your preferred eating habits.”
Question 3
Type: MCSA
The nurse is advising a patient who is concerned about the need to lose weight. When discussing daily nutritional requirements, the patient reports hating vegetables. Which statement best reflects the current recommendations appropriate for this patient?
1. “Would you consider drinking a vegetable juice in place of whole vegetables?”
2. “If you want to maintain a healthy weight, eating vegetables will help tremendously.”
3. “Vegetables are generally low in calories and should be incorporated in the daily diet.”
4. “Can you try eating a daily serving of carrots or spinach, either cooked or in a salad?”
Question 4
Type: MCSA
The nurse is reviewing written material on nutrition that is being distributed at a senior citizens center. The nurse recognizes that which statement does not accurately reflect the Dietary Guidelines for Americans, 2010 Edition and should be revised?
1. Half of all grains should be consumed as whole grains.
2. Sodium intake should be less than 1,500 mg daily.
3. Use oils to replace solid fats where possible.
4. Saturated fats should account for no more than 30% of daily calories.
Question 5
Type: MCSA
The nurse is planning care for a postoperative patient who has just resumed a regular diet. What should the nurse include when planning for this patient’s nutritional needs?
1. Protein intake should be restricted.
2. Calories should be limited because of reduced activity.
3. Carbohydrate intake should be restricted.
4. Daily caloric intake should be increased.
Question 6
Type: MCSA
The nurse is caring for a patient receiving an extensive regimen of chemotherapy. The nurse recognizes that the patient’s ability to avoid muscle wasting during this treatment is most affected by which factor?
1. Pretreatment nutritional status
2. Management of nausea and vomiting
3. General attitude related to food
4. Nutritional value of the foods the patient is likely to eat
Question 7
Type: MCMA
The nurse is providing care to a patient in the burn unit. What should the nurse do to ensure an adequate nutritional status for this patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Plan for a parenteral nutrition access site.
2. Ensure that 5 g/kg of protein are provided daily.
3. Keep the patient NPO.
4. Report daily weights to avoid a weight loss of >10%.
5. Ensure the patient receives a minimum of 35 to 40 calories/kg of body weight each day.
Question 8
Type: MCSA
The nurse is caring for a patient recovering from a total hip replacement. Which nutritional intervention is indicated?
1. Assess for tolerance to diet and progress from clear liquid to another level as tolerated.
2. Maintain a clear liquid diet with intravenous fluid supplementation.
3. Plan to support nutritional status with parenteral supplements.
4. Plan to support nutritional status with enteral feedings.
Question 9
Type: MCMA
A patient is postoperative from kidney transplant. What nutritional care is appropriate for this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Begin the introduction of previously restricted foods.
2. Meet the demands of any existing hypermetabolic process.
3. Correct any preexisting deficiencies.
4. Provide necessary support to promote wound healing.
5. Restrict calories to prevent the postoperative weight gain common with this procedure.
Question 10
Type: MCSA
The nurse is planning care for a patient with liver cirrhosis and resultant ascites. What intervention should be included to ensure an adequate nutritional status for this patient?
1. Ensure caloric intake of 10 to 15 calories per kg of body weight.
2. Provide small, more frequent, high-protein meals.
3. Encourage foods higher in sodium.
4. Implement a very low-fat diet.

Chapter 09
Question 1
Type: MCSA
A patient is admitted after being bitten by a dog and tells the nurse he feels fine except for the bite. The nurse assesses that this patient is functioning within which phase of the general adaptation syndrome?
1. Transaction
2. Resistance
3. Alarm
4. Exhaustion
Question 2
Type: MCSA
While being assessed, a patient tells the nurse that she has many stresses in her life. Which statement would the nurse evaluate as indicating external stress?
1. “I am a workaholic.”
2. “My job has many rigid rules.”
3. “I feel like I have to please everyone.”
4. ”I drink several cups of coffee in the morning and then switch to cola drinks in the afternoon.”
Question 3
Type: MCSA
The nurse is caring for a burn patient. Because of the amount of stress the patient is experiencing, the nurse realizes that the patient would benefit from which intervention?
1. An increase in activity
2. An increased supply of protein
3. Fluid restriction
4. Antinausea medication
Question 4
Type: MCSA
The nurse is reviewing the serum laboratory values of a patient just admitted with traumatic injuries. Which laboratory value might be abnormally elevated because of the trauma?
1. Potassium
2. Hemoglobin
3. Glucose
4. Sodium
Question 5
Type: MCSA
A patient asks the nurse about free radicals and how they contribute to illness. How should the nurse respond?
1. “Free radicals are cells also known as natural killer cells.”
2. “Free radicals are bad substances that clog the liver so it cannot get rid of body toxins.”
3. “Free radicals are substances that develop when we don’t breathe deeply enough.”
4. “Free radicals are produced naturally in cells but can be harmful if their balance in the body is not maintained.”
Question 6
Type: MCSA
A patient tells the nurse that she never had “bowel problems” until she started a new job that is highly demanding. What is the nurse’s best response to this patient?
1. “You might have had the bowel problems all along but didn’t realize it until recently.”
2. “There is no connection between the new bowel problems and your new job.”
3. “The new job might be a trigger for a stress reaction in your body, causing the new bowel problems.”
4. “Because of your new job you may be eating in different places. That can upset your stomach.”
Question 7
Type: MCMA
At the completion of a patient assessment, the nurse reviews a list of the patient’s stated and observed behaviors. Which behaviors would indicate to the nurse that the patient is experiencing stress?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. The patient stated an inability to sleep more than 2 hours per night.
2. The patient asked for water for a dry throat.
3. The patient commented on recent pleasant weather.
4. The patient sat quietly in the chair, hands resting in the lap.
5. The patient’s rate and depth of respirations are increased.
Question 8
Type: MCSA
A student nurse is having difficulty establishing relationships with patients. What should this student be counseled to do?
1. Focus on the purpose of a therapeutic alliance.
2. Study cognitive theory.
3. Review the concepts of caring.
4. Develop self-awareness to focus on being helpful to patients.
Question 9
Type: MCSA
While changing a patient’s abdominal dressing, the nurse talks about aspects of wound care such as the need to check the skin and protect the wound from infection or injury. The nurse and patient are in which phase of the nurse-patient relationship?
1. Orientation
2. Working
3. Caring
4. Termination
Question 10
Type: MCSA
While conducting an assessment, the nurse asks the patient to rate her pain, with 1 being no pain and 10 being the worst pain she ever experienced. The nurse is utilizing which therapeutic communication technique?
1. Focusing
2. Encouraging comparison
3. Offering self
4. Accepting
Chapter 10
Question 1
Type: MCSA
An elderly patient leaves the home for several hours most days of the week and attends a facility where care is provided specific to the needs of the elderly. The patient is attending which type of community-based nursing care program?
1. Adult day care
2. Health care clinic
3. Residential care facility
4. Outpatient center
Question 2
Type: MCSA
Upon discharge from the hospital, a patient is going home and will need medication injected weekly, assistance with meal preparation, and minor assistance with activities of daily living. The nurse would identify which community-based care service as appropriate for this patient?
1. Home care
2. Hospice care
3. Ambulatory surgical care
4. Long-term care
Question 3
Type: MCSA
A 78-year-old patient’s respiratory vital capacity measurement is decreased. How would the nurse evaluate this information?
1. The patient will likely also have cardiac insufficiency.
2. This finding can be normal in older patients.
3. This finding indicates neurological deterioration.
4. This patient has had undiagnosed chronic respiratory disease.
Question 4
Type: MCSA
An elderly female patient tells the nurse that she is having trouble “holding her water” and doesn’t want to drink fluids anymore. How should the nurse interpret this statement?
1. The patient has a urinary tract infection.
2. The patient needs estrogen cream.
3. The patient has a reduced thirst reflex.
4. The patient is experiencing incontinence.
Question 5
Type: MCSA
An elderly female patient has a sudden onset of delirium during the first night of hospitalization. What does this episode suggest to the nurse?
1. The patient has an infection.
2. The patient is dehydrated.
3. The cause must be determined immediately because it can signal another health problem.
4. The patient has Alzheimer’s disease.
Question 6
Type: MCSA
The nurse is planning care for a 70-year-old patient. Which screening should the nurse include in this patient’s care plan?
1. Biannual eye examinations
2. Hearing test every 5 years
3. Testing for fecal occult blood every 5 years
4. Annual PSA test and digital rectal exam
Question 7
Type: MCSA
A 68-year-old female patient has had a complete hysterectomy, including the removal of the cervix. Which information would the nurse provide regarding long-term screening?
1. “Once you have a negative Pap smear, you can reduce the frequency to one every 3 years.”
2. “You should continue to have annual Pap smears.”
3. “You should have a Pap smear every 3 years.”
4. “You no longer need to have Pap smears.”
Question 8
Type: MCSA
An 85-year-old male patient is aware of the need for a colonoscopy; however, he has a history of severe electrolyte imbalances associated with bowel preps for diagnostic tests. Which intervention should the nurse plan?
1. Discuss the option of having a flexible sigmoidoscopy instead.
2. Investigate medications the patient can take after the colonoscopy to correct the electrolyte imbalances.
3. Discuss the option of not having the colonoscopy.
4. Consider the option of delaying the colonoscopy for a year.
Question 9
Type: MCSA
A hospitalized 72-year-old patient wants to know where her digoxin pill is because she always takes it for her heart. How should the nurse respond?
1. “Digoxin is a bad medication to take.”
2. “The health care provider will likely order a different heart medication.”
3. “Digoxin doesn’t work as well as it used to.”
4. “Digoxin is no longer manufactured.”
Question 10
Type: MCSA
A 75-year-old female has been brought to the emergency department. She tells the nurse that her son, who has taken care of her, said he would “be right back,” but she has not seen him for weeks. The nurse is concerned that the patient is describing which possible situation?
1. Neglect
2. Physical abuse
3. Abandonment
4. Self-neglect
Chapter 11
Question 1
Type: MCSA
A terminally ill patient is experiencing dyspnea. What should the nurse do to help the patient feel more comfortable?
1. Raise the head of the bed.
2. Gently massage the patient.
3. Replace the oxygen cannula with a face mask.
4. Provide oral care.
Question 2
Type: MCSA
A competent elderly patient has a living will that specifies avoiding resuscitation and heroic life support measures. The family members are not supportive of this directive. Which action by the nurse is most appropriate?
1. Consider the document valid and document its existence in the medical record.
2. Contact the Social Services department.
3. Notify the hospital attorney.
4. Explain to the patient that the conflict could invalidate the document.
Question 3
Type: MCSA
While preparing for the discharge of an elderly, terminally ill patient, the family asks for information concerning the most appropriate time to become involved with a hospice agency. Which action by the nurse is most appropriate?
1. Assist the family in making contact with a hospice agency at this time.
2. Estimate the patient’s life expectancy to gauge when contact with hospice should be made.
3. Encourage the family to “hold off” making the contact until death is very close.
4. Determine what expectations the family has of the hospice agency.
Question 4
Type: MCSA
A terminally ill patient is receiving palliative care. How would the nurse explain the purpose of this type of care to the family?
1. “Palliative care is designed to alleviate suffering and promote quality of life.”
2. “Palliative care reduces pain and prevents medical complications.”
3. “Palliative care’s purpose is to control the side effects of illness while postponing death.”
4. “Palliative care involves withdrawing all medical care to allow natural death.”
Question 5
Type: MCSA
A patient asks the nurse what it means to have hospice care at home. What is the most accurate response to this patient?
1. “Hospice makes sure that you are comfortable at home.”
2. “Hospice care helps cure your illness.”
3. “Hospice care is for patients who will be sick for longer than a year.”
4. “Hospice care means all your needs will be met.”
Question 6
Type: MCSA
A patient with a chronic illness who is receiving palliative care asks the nurse if a newly prescribed medication will cure the disease. What is the nurse’s best response?
1. “It will help you be more comfortable. I don’t think it’s going to cure the disease.”
2. “Of course it’s going to cure the disease.”
3. “If you believe it will cure the disease, then it will.”
4. “I don’t think it’s going to help or hurt at this time.”
Question 7
Type: MCSA
Several visitors are in the room of a terminally ill patient. The nurse enters the room to discuss the plan of care for the patient. Which actions should be taken?
1. Stand at the foot of the patient’s bed and tell all present the best course of action.
2. Ask the patient which individuals he or she would like to have stay in the room.
3. Ask the other patient in the room to raise the volume of the television.
4. Sit down next to the patient and discuss the plan.
Question 8
Type: MCSA
A terminal patient with a fulminating leg wound needs surgery, yet it is unlikely the patient will survive the procedure. The nurse could ethically support which action by the health care team?
1. Explaining that the surgery is needed and every effort will be done to keep the patient alive
2. Deciding not to conduct the surgery and determining if there are other treatment approaches
3. Telling the patient that offering surgery was an error and that treatment will be done with medications and therapy
4. Conducting the surgery without telling the patient that survival is unlikely.
Question 9
Type: MCSA
The family of an incapacitated patient desires one course of treatment that contradicts the decisions of the person with durable power of attorney. The disagreement is affecting the patient’s nursing care. What should the nurse do?
1. Tell the person with durable power of attorney that he has to get the family’s consent.
2. Follow the family’s desires.
3. Provide care according to the decisions of the person with durable power of attorney.
4. Ask the physician to talk with the family and the person with durable power of attorney.
Question 10
Type: MCSA
The nurse is preparing an analgesic infusion for a cancer patient who is in pain and is nearing the end of life. What should the nurse do to ensure this patient’s comfort?
1. Titrate the medication to help with pain relief and not hasten the dying process.
2. Use meperidine in the infusion.
3. Limit the amount of medication infused.
4. Contact the pharmacy for the correct dose to provide the patient.
Chapter 12
Question 1
Type: MCSA
Which statement explains why the nurse should assess each patient’s pain response individually in every situation?
1. Everyone has a unique tolerance to pain.
2. Everyone has the same pain threshold.
3. Everyone perceives painful stimuli at the same intensity.
4. Most people have the same pain response to surgery.
Question 2
Type: MCSA
A patient is being treated for chronic pain. The nurse realizes that which characteristic is typical of chronic pain?
1. The pain rating may be inconsistent with the underlying pathology.
2. Chronic pain usually has a clear, physiologic cause.
3. Chronic pain typically lasts 2 months or less.
4. The pain reported is usually less severe than acute pain.
Question 3
Type: MCMA
The nurse is managing care for a group of patients with pain. The nurse plans care for acute pain for which patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. A patient who had a cholecystectomy this morning
2. A patient with phantom limb pain
3. A patient with a compound femur fracture that occurred 5 days ago
4. A patient with degenerative joint disease
5. A patient being treated for a burn that occurred 8 months ago
Question 4
Type: MCSA
The nurse is planning care for a patient with chronic pain. What would be the most appropriate pain control goal for this patient?
1. The patient will reduce the focus on pain.
2. The patient will require minimal analgesic medications.
3. The patient will be completely pain free.
4. The patient will report that the pain is bearable.
Question 5
Type: MCSA
The nurse, caring for a patient recovering from surgery, knows that which intervention will provide the most pain relief for the patient?
1. Offer pain relief before the patient complains of pain.
2. Wait until the patient can describe the pain specifically.
3. Assess the pain level every 4 hours around the clock.
4. Allow the patient to “sleep off” the anesthesia, and then offer pain medication.
Question 6
Type: MCMA
A patient is receiving an opioid for severe acute pain. What information should the nurse provide regarding this medication?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Increase fluid intake.
2. Take a vitamin D supplement.
3. Eat more protein.
4. Increase intake of complex carbohydrates.
5. Take a stool softener daily.
Question 7
Type: MCSA
The nurse is planning to administer a pain medication to a patient who has just returned to the unit following bowel resection surgery. The patient has four standing orders for pain medication. Which order should the nurse select?
1. The one to be administered intravenously by patient demand and under patient control
2. The one to be given intramuscularly to work quickly
3. The one ordered on a prn basis
4. The one to be administered orally
Question 8
Type: MCMA
A patient recovering from abdominal surgery is refusing hydromorphone (Dilaudid) because she has heard that people may become addicted. She is crying and rates her pain 10 of 10. Which information should the nurse include as part of the patient’s education?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Because the patient will take the medication on a prn basis, addiction cannot occur.
2. Untreated pain can result in poor wound healing.
3. Patients with uncontrolled pain have a higher risk of blood clots.
4. Dehydration can result from poorly managed pain.
5. Family members do not want to visit patients with visible signs of pain.
Question 9
Type: MCSA
A patient with a history of chronic pain tells the nurse, “I do a variety of things to make my body produce its own pain reliever.” How should the nurse evaluate this statement?
1. This is a common denial technique.
2. The patient is trying to appear to be a pain expert.
3. This statement offers the nurse a reason to reduce the amount of pain medication prescribed.
4. The patient is taking advantage of the body’s ability to make endorphins.
Question 10
Type: MCSA
A patient has periodic severe nerve pain that is not well controlled with the current pain medication regimen. The nurse anticipates adding a medication from which category?
1. Nonsteroidal anti-inflammatory drugs (NSAID)
2. Opioids
3. Antidepressants
4. Local anesthetics
Chapter 13
Question 1
Type: MCSA
A patient tells the nurse that both his parents are alcoholics, and he wonders about the likelihood of becoming an alcoholic as well. How should the nurse respond?
1. “There are studies that support a genetic link for developing alcoholism.”
2. “Why are you concerned about becoming an alcoholic?”
3. “You will likely become an alcoholic.”
4. “Don’t worry about that.”
Question 2
Type: MCSA
The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not consumed at home and the patient is adopted. How would the nurse evaluate this information?
1. The patient’s biological parents might have abused alcohol.
2. The patient spends time drinking with friends.
3. Consuming alcohol is a symptom of stress.
4. Alcoholism is a learned behavior.
Question 3
Type: MCSA
A patient tells the nurse that she started to have a glass of wine every evening at home after work to “unwind” and then realized that she cannot continue with her day unless she has the wine. The nurse realizes that this patient uses wine for which reason?
1. To cope with day-to-day problems
2. To deal with difficulty expressing emotions
3. To suppress a genetic need for alcohol
4. To socialize with others
Question 4
Type: MCSA
The nurse is concerned about possible substance abuse by a coworker. Which behavior warrants further investigation?
1. The coworker frequently wastes medications.
2. The coworker frequently requests the largest patient care assignment for the shift.
3. The coworker prefers not to be the “medication nurse” on the shift.
4. The coworker declines to take scheduled breaks.
Question 5
Type: MCSA
A nurse frequently cannot be found on the unit when patients call for assistance. When colleagues mention these absences, the nurse becomes defensive and withdraws from the others. What does the nurse’s behavior suggest?
1. Substance abuse
2. A long-standing illness
3. Introverted behavior
4. Low self-esteem
Question 6
Type: MCMA
The nurse manager is concerned that a staff nurse is demonstrating signs of substance abuse. Which behaviors did the manager observe in the staff nurse?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Calling for days off or illness before scheduled days off
2. Using the bathroom frequently
3. Offering to give medication to patients not assigned to the nurse
4. Volunteering to transfer a patient to the intensive care unit
5. Following up with nursing assistants on patient care needs
Question 7
Type: MCSA
A community pharmacist calls the clinic and reports that a patient has asked for pain medication refills early for the last 2 months. What action should be taken by the nurse?
1. Notify the health care provider that the patient has lost control of his or her consumption of medication.
2. Tell the pharmacist to refill the prescriptions early.
3. Ask the pharmacist if the patient has received medications early from any other provider.
4. Notify the health care provider of the patient’s request.
Question 8
Type: MCSA
A patient is brought to the emergency department with a gunshot wound inflicted while attempting to steal beer from a convenience store. Which statement by the patient would reflect a sociocultural influence on the patient’s behavior?
1. “My dad was killed while driving drunk before I was even born.”
2. “I didn’t take anything out of that store. The manager is just trying to pin something on me.”
3. “There was lots of beer in that store. I didn’t see how taking one six-pack would hurt anything.”
4. “I can’t have fun at a party without beer.”
Question 9
Type: MCSA
A patient tells the nurse that he becomes very angry and abusive to his friends and family when he is unable to obtain an illegal substance. How should the nurse respond?
1. “Have you considered seeking treatment for this behavior?”
2. “You must not have many friends left.”
3. “Have your actions caused problems for you at work?”
4. “I don’t see how that kind of behavior helps get you what you want.”
Question 10
Type: MCSA
A patient who is a recovering alcoholic says, “I haven’t had a drink in 10 days. I think I am over the hardest part and will be okay now.” The nurse formulates a response based on which information?
1. Symptoms of postacute withdrawal syndrome begin about a month after the last drink.
2. Symptoms of postacute withdrawal syndrome peak from 3 to 6 months after the last drink.
3. The recovering alcoholic is never “okay” again.
4. It is easier to recover from cocaine abuse than from alcohol abuse.
Chapter 14
Question 1
Type: MCSA
While reviewing the white blood cell count differential for a patient, the nurse notes that the basophil count is elevated. What does this laboratory value indicate to the nurse?
1. The patient may be experiencing an acute hypersensitivity reaction.
2. The patient has a viral gastrointestinal infection.
3. The patient is fighting a bacterial skin infection.
4. The patient is not responding to a parasitic infection.
Question 2
Type: MCMA
The nurse would be concerned that a patient is exhibiting signs and symptoms of inflammation after assessing which findings in a leg wound?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Edema
2. Pain
3. Erythema
4. Coolness of tissues
5. Decreased distal pulses
Question 3
Type: MCSA
Which finding would indicate that a patient is experiencing a systemic reaction associated with an inflammatory response?
1. Fever
2. Erythema
3. Edema
4. Pain
Question 4
Type: MCSA
The nurse is planning care for a patient at risk for developing an infection. Which intervention is the most important for the nurse to include in this patient’s plan of care?
1. Wash hands prior to providing care to the patient.
2. Provide prophylactic antibiotic therapy as prescribed.
3. Wear a mask when caring for the patient.
4. Wear a gown and gloves when changing the patient’s linen.
Question 5
Type: MCSA
A patient is diagnosed with an antibiotic-resistant infection. What can the nurse do to reduce the spread of this infection?
1. Isolate the supplies used when caring for this patient.
2. Transfer the patient to a semiprivate room.
3. Limit exposure to this patient.
4. Restrict visitors and plan activities to coincide with meal delivery times.
Question 6
Type: MCSA
The nurse is instructing a patient on ways to prevent the onset of infection. What should be included in these instructions?
1. Wash hands after using disposable tissues for nasal secretions.
2. Reduce animal protein in the diet.
3. Take prescribed antibiotics until symptoms subside.
4. There is no need to limit interactions with people or crowds.
Question 7
Type: MCSA
A patient diagnosed with active tuberculosis is being admitted to the hospital. The nurse should prepare for this patient to be placed in which type of isolation?
1. Airborne precautions
2. Standard precautions
3. Droplet precautions
4. Contact precautions
Question 8
Type: MCSA
The nurse needs to obtain a sputum specimen for culture and sensitivity from a patient. When should the nurse obtain this specimen?
1. Before the first dose of antibiotics is administered
2. Immediately after the first dose of antibiotic is administered
3. 30 minutes after the first dose of antibiotics is administered
4. As the first dose of antibiotics is administered
Question 9
Type: MCSA
The nurse needs to change a patient’s abdominal wound dressing. Which precautions should be implemented?
1. Standard precautions
2. Contact precautions
3. Droplet precautions
4. Airborne precautions
Question 10
Type: MCSA
The nurse has completed caring for a patient’s indwelling urinary catheter. What should the nurse do after clearing used supplies and removing the gloves?
1. Wash the hands with soap.
2. Document the care provided.
3. Prepare medications for the patient.
4. Discuss with the nursing assistant additional care needs for the patient.
Chapter 15
Question 1
Type: MCSA
When caring for an elderly patient who is intermittently confused, what is the nurse’s primary concern regarding fluid and electrolytes?
1. Risk of dehydration
2. Risk of kidney damage
3. Risk of stroke
4. Risk of bleeding
Question 2
Type: MCSA
A patient experiencing multisystem fluid volume deficit has tachycardia and decreased urine output. The nurse realizes these findings are most likely a direct result of which factor?
1. The body’s natural compensatory mechanisms
2. Pharmacologic effects of a diuretic
3. Effects of rapidly infused intravenous fluids
4. Cardiac failure
Question 3
Type: MCSA
A pregnant patient is admitted with excessive thirst, increased urination, and a medical diagnosis of diabetes insipidus. The nurse chooses which nursing diagnosis as most appropriate?
1. Risk for Imbalanced Fluid Volume
2. Excess Fluid Volume
3. Imbalanced Nutrition
4. Ineffective Tissue Perfusion
Question 4
Type: MCSA
An adult patient recovering from surgery has an indwelling urinary catheter. The nurse would contact the patient’s primary health care provider with which 24-hour urine output volume?
1. 600 milliliters
2. 750 milliliters
3. 1,000 milliliters
4. 1,200 milliliters
Question 5
Type: MCSA
A patient is diagnosed with severe hyponatremia. The nurse realizes this patient will mostly likely need which precautions implemented?
1. Seizure precautions
2. Infection precautions
3. Neutropenic precautions
4. High-risk fall precautions
Question 6
Type: MCSA
A patient prescribed spironolactone is demonstrating ECG changes and complaining of muscle weakness. The nurse realizes this patient is exhibiting signs of which imbalance?
1. Hyperkalemia
2. Hypokalemia
3. Hypercalcemia
4. Hypocalcemia
Question 7
Type: MCSA
The nurse is planning care for a patient with fluid volume overload and hyponatremia. Which intervention should be included in this patient’s plan of care?
1. Restrict fluids.
2. Administer intravenous fluids.
3. Provide Kayexalate.
4. Administer intravenous normal saline with furosemide.
Question 8
Type: MCSA
When caring for a patient diagnosed with hypocalcemia, the nurse would also assess for which other finding?
1. Other electrolyte disturbances
2. Hypertension
3. Visual disturbances
4. Drug toxicity
Question 9
Type: MCSA
A patient with a history of stomach ulcers is diagnosed with hypophosphatemia. Which intervention should the nurse include in this patient’s plan of care?
1. Request a dietitian consult to select foods high in phosphorous.
2. Provide aluminum hydroxide antacids as prescribed.
3. Instruct the patient to avoid poultry, peanuts, and seeds.
4. Instruct the patient to avoid the intake of sodium phosphate.
Question 10
Type: MCSA
When analyzing an arterial blood gas report of a patient with COPD and respiratory acidosis, the nurse anticipates that compensation will develop through which mechanism?
1. The kidneys retain bicarbonate.
2. The kidneys excrete bicarbonate.
3. The lungs will retain carbon dioxide.
4. The lungs will excrete carbon dioxide.
Chapter 16
Question 1
Type: MCMA
A patient’s peripheral intravenous catheter has infiltrated several times during an 8-hour shift. The nurse realizes that the patient needs a central venous access device. Which intravascular devices could a properly trained nurse insert under the guidelines of the infusion nursing standards of practice?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. A triple-lumen catheter
2. A peripherally inserted central catheter
3. A tunneled noncuffed catheter
4. An implanted port
5. A midline catheter
Question 2
Type: MCSA
Which nursing diagnosis would explain the purpose of using a self-sheathing stylet catheter?
1. Risk for Fluid Volume Deficit
2. Risk for Injury
3. Risk for Altered Nutrition
4. Risk for Infection
Question 3
Type: MCSA
The nurse is preparing to discharge a patient after infusing chemotherapy through an implanted port. What instructions for port care would the nurse provide?
1. Apply a nonadhering dressing weekly.
2. Apply a sterile dressing every 2 days.
3. Place a clean bandage daily.
4. No dressings are necessary.
Question 4
Type: MCSA
A patient receiving peripheral intravenous therapy is mobile but having difficulty maneuvering the intravenous infusion pump. The nurse would choose which add-on device to allow greater mobility for the patient?
1. A multiflow adapter
2. An extension set
3. A stopcock
4. A filter device
Question 5
Type: MCMA
The alarm of a patient’s infusion delivery system is sounding. The nurse should assess for which conditions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Air in the line
2. Occlusion of the tubing
3. Infusion complete
4. Wrong fluid being infused
5. Free flow
Question 6
Type: MCMA
Prior to initiating infusion therapy, which nursing diagnosis is the nurse most likely to incorporate into the patient’s plan of care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Risk for Infection
2. Alteration in Comfort
3. Impaired Gas Exchange
4. Fluid Volume Deficit
5. Ineffective Individual Coping
Question 7
Type: MCSA
The nurse would initiate which method to facilitate drying of the antiseptic solution applied to the intravenous site?
1. Fan the area
2. Blot the area
3. Blow on the area
4. Allow the area to dry itself
Question 8
Type: MCMA
The nurse has successfully completed insertion of a peripheral venous catheter. Documentation following the procedure includes which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Method of securing the catheter
2. Size, length, and type of catheter
3. Patient complaints of pain during the procedure
4. Patient participation in the procedure
5. Complications of the procedure
Question 9
Type: MCMA
The nurse inspects the intravenous catheter after removal. Documentation would include which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Length of catheter
2. Condition of access caps
3. Type of catheter
4. Condition of catheter
5. Size of catheter
Question 10
Type: MCSA
A patient complains of heaviness and swelling in the extremity of the intravenous infusion. The nurse assesses that the skin around the site is stretched, firm, and cool. What primary nursing intervention is indicated?
1. Flush the catheter.
2. Document the finding.
3. Notify the physician.
4. Discontinue the catheter.
Chapter 17
Question 1
Type: MCSA
During preoperative assessment, the patient says, “My surgery must be minor because it’s being done on an outpatient basis.” How should the nurse respond?
1. “Every surgical procedure is serious, and I will make sure you have the information you need for a successful recovery.”
2. “You are right.”
3. “If it were more serious, you would be admitted to the hospital.”
4. “Your insurance plan does not cover inpatient surgical procedures. That’s why your surgery is being done on an outpatient basis.”
Question 2
Type: MCSA
Prior to surgery, the nurse instructed the patient on exercises that should be done prior to and after surgery. The patient is currently recovering from surgery and is experiencing a deep vein thrombosis. Which preoperative exercise instruction was not adequate for this patient?
1. Leg exercises
2. Deep breathing and coughing
3. Use of incentive spirometry
4. Splinting when coughing
Question 3
Type: MCSA
After administering a preoperative sedative, the nurse notes that the surgical consent form has not been signed by the patient. What is the nurse’s priority intervention?
1. Contact the surgeon.
2. Ask the patient to sign the consent form.
3. Send the patient for surgery with an unsigned consent form.
4. Phone the operating room suite to notify the nurse that the patient has not signed the consent form.
Question 4
Type: MCSA
A chart review reveals that a patient being prepared for surgery has been diagnosed with dehydration. Which laboratory results would the nurse review to evaluate the effect of treatment of this condition?
1. Hemoglobin and hematocrit
2. Glucose
3. White blood cell count
4. Platelet count
Question 5
Type: MCSA
An elderly patient is being prepared for orthopedic surgery. The nurse realizes this patient is at risk for which complication?
1. Decreased tolerance of general anesthesia
2. Prolonged effects of anesthesia because of herbal supplements
3. Wound dehiscence
4. Increased hypotensive effects of anesthesia
Question 6
Type: MCSA
A patient who is being admitted for surgery asks the nurse why information is being collected about the patient’s use of herbal and natural supplements. Which statement is an appropriate nursing response?
1. “Herbal supplements may interact with medications given during or after surgery.”
2. “We would like to continue these medications postoperatively.”
3. “The physician is in charge of medications.”
4. “There is no need to take these preparations.”
Question 7
Type: MCSA
The patient who is preparing for surgery asks the nurse to keep his glasses in place until he is under anesthesia. Which statement by the nurse demonstrates accurate, therapeutic communication?
1. “I will contact the surgery department to discuss your requests.”
2. “You cannot keep your glasses on.”
3. “The policies in the surgery unit will not allow it.”
4. “Certainly, you can keep them for that time.”
Question 8
Type: MCSA
The nurse takes an informed consent document to the patient’s room in preparation for an emergency surgical procedure. The patient states, “Doc said he would tell me all about the surgery when he gets here. Do you know what they are going to do?” What is the nurse’s best response?
1. “Let’s wait on signing this until your physician has talked to you.”
2. “Let me go get a medical surgical textbook so I can use the pictures to explain the procedure.”
3. “I am not certain; let me call the nursing supervisor to explain it to you.”
4. “Go ahead and sign this so we will have that part done when the physician gets here.”
Question 9
Type: MCSA
While completing item 4 in the preoperative preparation section of the depicted checklist, the nurse notes that the patient depends on a hearing aid. What action should the nurse take?
1. Leave the device in the patient’s ear and notify the OR nurse of its presence.
2. Remove the device and place it in a denture cup in the patient’s room.
3. Remove the device and give it to the patient’s family member.
4. Place a piece of tape across the patient’s ear and the device.
Question 10
Type: SEQ
Place the steps of deep breathing in the order the nurse should teach the elderly preoperative patient.
Standard Text: Click and drag the options below to move them up or down.
Choice 1. Breathe out normally.
Choice 2. Breathe in deeply through your nose.
Choice 3. Hold your breath to a count of three.
Choice 4. Slowly exhale.
Choice 5. Take five to ten deep breaths every hour.
Chapter 18
Question 1
Type: MCSA
An omission of information occurred when the nurse anesthetist informed the nurse in the postanesthesia care unit about a patient’s surgical procedure. The risk management nurse would review the standards of which process?
1. Handoff communication
2. Discharge summary
3. End-of-shift report
4. Surgical time-out
Question 2
Type: MCSA
During a surgical procedure, the nurse assesses the patient’s response to anesthesia and determines the amount of pain medication to provide. Which role is this nurse fulfilling?
1. Scrub nurse
2. Certified registered nurse anesthetist
3. Registered nurse first assistant
4. Circulating nurse
Question 3
Type: MCSA
A registered nurse is assisting the surgeon in conducting an exploratory laparoscopy. The nurse holds the tissue retractors, biopsies tissue, and sutures the patient at the conclusion of the case. Which role is this nurse fulfilling?
1. Circulating nurse
2. Scrub nurse
3. Certified registered nurse anesthetist
4. Registered nurse first assistant
Question 4
Type: MCSA
The surgical team is assembled and is preparing to conduct a procedure on a patient. Which health care professional is responsible for the overall functioning of the surgical team?
1. Surgeon
2. Circulating nurse
3. Scrub nurse
4. Registered nurse first assistant
Question 5
Type: MCSA
A patient has just had surgery and is being transported to the postanesthesia care unit. Which team member will accompany the nurse
when transporting the patient?
1. The scrub nurse
2. The surgeon
3. The circulating nurse
4. The nurse anesthetist
Question 6
Type: MCMA
The surgical team is participating in a surgical time-out. What activities are part of this procedure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Verification that the correct patient is prepared for surgery
2. Announcement of the name of the surgical procedure planned
3. A pause to allow last-minute preparation of the surgical suite
4. Determination of the body side on which the surgery will occur
5. Final surgical hand scrub
Question 7
Type: MCSA
Prior to bringing a patient into the operating room, the nurse examines an instrument that will be used for the surgical procedure. What is the rationale for this action?
1. To ensure the correct instrument is reflected in the charges to be made to the patient’s insurance for the surgical procedure
2. To allow the nurse to efficiently use the instrument as required
3. To ensure the patient’s safety when the instrument is used for the procedure
4. To determine if the instrument should be replaced with one that is disposable after use
Question 8
Type: MCSA
After the anesthesiologist inserts the anesthetic agent into the patient’s spinal column, the nurse assists the patient into a supine position with the neck flexed. What is the rationale for the nurse’s action?
1. This position allows for better monitoring of the patient’s blood pressure and pulse.
2. Positioning can help the anesthetic agent reach the appropriate level in the spinal column.
3. This position helps to ensure the patient’s cardiac function will not be affected by the anesthesia.
4. The patient will be able to breathe more easily in this position.
Question 9
Type: MCSA
The scrub nurse is preparing to access a sterilized item; however, the item is missing the appropriate sterilization tag. What action should the nurse take?
1. Substitute the item with another similar item that has been properly sterilized.
2. Use the item.
3. Request another item be brought that has the appropriate sterilization tag.
4. Inform the physician that the item does not have the sterilization tag and use the item.
Question 10
Type: MCSA
A patient tells the nurse that her brother had surgery done on the wrong hand, and she wants to make sure the surgeon knows she is having surgery on her left shoulder. What should the nurse do to address the patient’s concerns?
1. Tell the patient that she should write the words “Left Shoulder” on a piece of paper and take it to the operating room with her.
2. Explain that the surgeon will mark the site of surgery directly on the patient during a preoperative visit.
3. Assure the patient that someone will tell the circulating nurse that the surgery is to be done on the left shoulder.
4. Show the patient where the site of the surgery has been documented on the medical record.
Chapter 19
Question 1
Type: MCSA
The nurse has just received a patient from the surgical area. After 30 minutes in the recovery area, the patient’s vital signs are: pulse 92; blood pressure 110/50; respirations 12; and pulse oximeter 86%. What should be the initial nursing response?
1. Call the physician.
2. Ask another nurse for his or her opinion.
3. Stimulate the patient.
4. Place an oral airway in the patient.
Question 2
Type: MCSA
The recovery room nurse has just received a patient whose abdominal drain has an excessive amount of sanguineous drainage. The nurse contacts the physician without delay, recognizing that the drainage could indicate which critical situation?
1. A major wound infection
2. Need for further assessment
3. A potential respiratory crisis
4. Need to return immediately to surgery
Question 3
Type: MCSA
A patient is just arriving in the postanesthesia care unit following general anesthesia. What is the nurse’s priority intervention?
1. Assess the patient’s respiratory status.
2. Assess the patient’s IV.
3. Ask the patient about pain.
4. Assess the patient’s cardiac status.
Question 4
Type: MCSA
A patient has just arrived in the recovery room. As part of the evaluation for determining discharge from the postanesthesia recovery unit, what will be the nurse’s next action?
1. Assess the patient’s respirations, oxygen saturation, consciousness, circulation, and activity.
2. Assess whether the patient wants the family in the recovery room.
3. Assess the patient for pain.
4. Take the patient’s temperature.
Question 5
Type: MCSA
Progression through the various phases in the postanesthesia recovery unit (PACU) depends on which factor?
1. The severity of the procedure the patient underwent
2. The attentiveness and caring of the nursing staff
3. The temperature and environment of the unit
4. The patient’s progress toward physiological homeostasis
Question 6
Type: MCSA
A patient is being evaluated for discharge from the postanesthesia care unit. The patient had a preoperative baseline blood pressure of 124/80. Currently, the patient is moving all four extremities voluntarily, has a respiratory rate of 11, and rouses when her name is called. Which other assessment would mandate that the patient stay in postanesthesia care until more stable?
1. The patient has vomited once since admission.
2. The patient’s blood pressure is 120/76.
3. The patient has had no pain since admission to the unit.
4. The patient’s pulse oximeter measures 92% on oxygen.
Question 7
Type: MCSA
A 75-year-old patient is received into the postanesthesia recovery room (PACU) following a 6-hour abdominal surgery. The patient’s hemodynamic status is stable. Based on knowledge of the patient’s surgery and the common postoperative complications the patient might be at risk for, the recovery room nurse would perform which interventions?
1. Keep the room temperature at 70 degrees, consider supplemental oxygen, and provide warm blankets.
2. Consider increasing the IV fluids, assess for urine output, and monitor the oxygen saturation.
3. Assess the patient’s blood pressure more frequently than for younger clients and provide oxygen.
4. Provide postoperative instructions to avoid straining and eat a low-fiber diet.
Question 8
Type: MCSA
The nurse assesses a patient in the postanesthesia recovery unit and finds a BP of 88/50, pulse 116, and respirations of 20. What assessment data will the nurse collect next?
1. Pain assessment
2. Urine output
3. Pulse oximeter reading
4. Whether the patient is nauseated
Question 9
Type: MCSA
What is the purpose of a call by the ambulatory care unit nurse to the patient on the day after discharge?
1. To minimize patient complications and ensure patient safety
2. To let the patient know the nurse cares about him or her
3. To assist in collecting discharge data for the health care provider
4. To meet federal and regulatory requirements
Question 10
Type: MCSA
The recovery room nurse is preparing to discharge a 24-year-old patient to home following ambulatory surgery. Which discharge instructions provided by the nurse would be the most comprehensive?
1. Verbal and written instructions to the patient and family regarding the wound, activity and diet restrictions, new medications, pain management, potential complications, and process for reaching the health care provider if needed
2. Written instructions to manage the wound, instructions to resume activities slowly, methods for pain control, and information on whom to contact in 2 days
3. Verbal and written instructions to the family regarding the patient’s activity levels, diet, potential problems, and medications
4. Verbal instructions to restrict all activities, diet restrictions, pain management, and circumstances that require contacting the health care provider
Chapter 20
Question 1
Type: MCSA
When assessing the patient’s cognitive function, the nurse would evaluate which parameter?
1. Ability to smell items placed under the nose while eyes are closed
2. Orientation to time, place, and person, and ability to recall recent and past events
3. Ability to walk with a smooth, steady gait
4. Level of consciousness
Question 2
Type: MCSA
When testing cranial nerve XI (spinal accessory), the nurse should ask the patient to perform which activity?
1. Shrug the shoulders and turn the head against resistance.
2. Stick out the tongue and move it from side to side.
3. Taste foods and distinguish sweet from sour.
4. Identify smells correctly with one side of the nares blocked.
Question 3
Type: MCSA
The nurse observes a patient who has a lack of coordination, clumsy movements, and an unbalanced gait. How would the nurse document this observation?
1. As flaccidity
2. As paralysis
3. As hemiparesis
4. As ataxia
Question 4
Type: MCSA
What precaution must the nurse take when performing the Romberg test?
1. Have the patient remain seated.
2. Stand close to the patient.
3. Have the patient keep the eyes open.
4. Warn the patient that a sharp object is being used for the test.
Question 5
Type: MCSA
What should the nurse include in the assessment of muscle strength and movement?
1. Grade the posterior tibial pulses.
2. Grade flaccidity.
3. Observe to see whether strength and movement are bilaterally equal and strong.
4. Percuss the muscle for dullness.
Question 6
Type: MCSA
The patient has upper motor neuron injuries. The nurse anticipates that what type of reflex is present?
1. Pathologic
2. Increased
3. Normal
4. Exaggerated
Question 7
Type: MCMA
Which terms would a nurse use to document abnormal posturing in an adult with a neurological deficit?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Decorticate posturing
2. Decerebrate posturing
3. Circumduction
4. Steppage
5. Nystagmus
Question 8
Type: MCMA
The nurse observes signs that a patient may be experiencing dysfunction related to the acoustic nerve (CN VIII). Which action by the nurse is most appropriate for minimizing the patient’s risk for injury?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Identify the patient’s fall risk category.
2. Assess the patient’s gag reflex prior to offering food or liquids.
3. Assist the patient with bedside sitting or toileting.
4. Assess the patient’s vision using a Snellen chart.
5. Place a red “falls risk” bracelet on the patient’s arm.
Question 9
Type: MCSA
During an assessment of a patient’s cranial nerves, the nurse asks the patient to stick out the tongue. The nurse observes that the tongue deviates markedly to the right side. Which condition is the patient most likely exhibiting?
1. Abnormal hypoglossal nerve response
2. First cranial nerve (CN I) damage
3. Sluggish oculomotor response
4. Absence of Homans’ sign
Question 10
Type: MCSA
An emergency department (ED) nurse receives a report that an incoming patient has a Glasgow Coma Scale (GCS) score of 8. Which is the
most appropriate action by the nurse?
1. Treat the patient’s pain.
2. Assess the patient’s airway, breathing, and circulation.
3. Obtain a complete history from the patient.
4. Triage the patient with the other ED patients.

 

AND MUCH MORE