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NURSING PRACTICE III Care of Clients with Physiologic and Psychosocial Alterations (Part A) Situation 1 Spinal Cord Injury

ry (SCI) requires the nurse to give serious consideration to primary prevention of accidents in the population, including continued teaching to the public about the use of seatbelts, and regarding the prevention of falls, especially in the elderly. Mang Juan met a vehicular accident and was diagnosed to of spinal cord injury. 1. Nurse Marikit is caring for Mang Juan who has a C6 SCI. She anticipates that the Mang Juan understands the teaching about the long-term effects of the injury when he says: A. I will be able to transfer myself to the wheelchair and bed. B. I will be able to feed myself. C. I will be on a ventilator to support my breathing for the rest of my life. D. I will not need urinary catheterization after I am discharged from the hospital. 2. What response would be the best response for Mang Juan with a new SCI who asks if his current paralysis will be permanent? A. If there is a loss of function at the accident, it is not possible to regain motor functioning. B. There is often a period of spinal shock when it is difficult to determine if the paralysis will be permanent, and when it resolves there can be some regaining of abilities. C. You're experiencing spinal shock now; in three weeks you will regain your functioning when the spinal shock resolves. D. It's best to start trying to accept your limitations; it's unlikely that any improvement can occur. 3. Positive Phalen's sign for carpal tunnel syndrome is indicated by which of the following? A. Relief of pain on flexion of the wrist at a right angle for one minute B. Pain and tingling experienced on tapping over the median nerve at the wrist C. Relief of pain experienced upon tapping over the median nerve at the wrist D. Pain and tingling experienced on flexion of the wrist at a right angle for one minute 4. Emergency treatment with methylprednisolone for a patient with an SCI must be instituted in what time period? A. Within the first 8 hours after injury B. Within the first 24 hours after injury C. Within the first hour after injury D. Within 72 hours after injury 5. The priority nursing action for a patient with an SCI experiencing a pounding headache and blood pressure of 220/120 indicating autonomic dysreflexia is to: A. Call the physician for order for antihypertensive medication B. Check for distended bladder or kinked catheter tubing C. Assess heart rate and skin temperature

D. Check for fecal impaction Situation 2 The health of the mother and child are inextricably linked. 6. A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which of the following would be the priority for this woman on admission? A. Performing a vaginal examination to assess the extent of bleeding. B. Helping the woman remain ambulatory to reduce bleeding. C. Assessing fetal heart tones by use of an external monitor. D. Assessing uterine contractions by an internal pressure gauge. 7. A woman who is Rh negative asks you how many children she will be able to have before Rh incompatibility causes them to die in utero. Your best response would be that A. no more than three children are recommended. B. as long as she receives RHIG, there is no limit. C. only her next child will be affected. D. she will have to ask her physician. 8. Phenylketonuria testing is done by a blood sample from the newborn. This blood specimen is most accurate when taken A. within 1 hour after birth. B. at 24 hours after birth. C. 2 to 3 days after birth. D. 4 weeks after solid food is first eaten. 9. An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately following the procedure, which nursing action would best prevent decompression from excessive CSF flow? A. Elevating the infant's head 60 degrees. B. Avoiding exercising the upper extremities during bathing. C. Positioning the infant with the head dependent to the body. D. Keeping the head of the infant level with the body. 10. A child with allergic rhinitis is prescribed a nasal antihistamine spray. When advising parents about the use of such sprays, you would tell them about a rebound phenomenon. This phenomenon results in A. a permanent increase in nasal secretions. B. a decrease in histamine release after an initial increase. C. an increase in nasal secretions after an initial decrease. D. reflux of gastric contents into the esophagus. Situation 3 Immune responses are triggered when foreign substances called antigens, substances capable of stimulating an immune response, are identified by the immune system. 11. Patient Lara has a history of abdominal bloating, cramping, and loose stools and thinks that she has a food allergy. As a nurse, you know: A. Elimination and challenge diets form the basis for the diagnosis of food allergy. B. An SPT will help locate the problem. C. Blood testing will identify the food allergy. D. Hair sample testing will identify the food allergy.

12. Another patient Lino with a newly diagnosed


latex allergy is being discharged from the hospital today. As part of your discharged teaching plan, you inform Lino that he needs to seek immediate medical mention if the following occurs: A. His medical alert bracelet falls off. B. He accidentally ingests sunflower seeds. C. He experiences swelling around the lips or eyes. D. He feels his heart pounding after strenuous exercise. 13. A woman is pregnant and has asthma. Her physician has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this? A. Prednisone is considered safe in the doses prescribed by her physician. B. She should half her dose during the first 3 months of pregnancy. C. You would recommend she omit the drug during pregnancy. D. Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms. 14. A woman at 32 weeks' gestation is admitted in preterm labor. On your admission assessment, which of following findings would cause you to question the administration of a tocolytic agent? A. Cervical dilation of 5 cm. B. Strong, regular contractions. C. Fetus in a breech presentation. D. A spontaneous abortion in an earlier pregnancy. 15. A pregnant woman who has suffered contusions on her lower abdomen from a fall is prescribed acetaminophen and codeine for pain, She telephones after she returns home to tell you that she is voiding "red-stained" urine. Your best response to her would be that A. "codeine salts" are causing this reaction. B. this may be rectal bleeding that she is mistaking as urine. C. she will need to return to the emergency room for evaluation of urinary tract bleeding, D. as long as she feels the fetus move, this finding is insignificant. 16. A woman who is 36 weeks pregnant is brought to the emergency room because she was trapped in her upstairs apartment by a fire downstairs. Her breathing stops as she is moved to the examining table. Which of the following would you do next? A. Assess fetal heart tones to see that they remain above 100 beats/minute. B. Avoid exerting pressure on her sternum to prevent uterine rupture. C. Administer two quick breaths of air to her by resuscitation bag, D. Press her uterine fundus to the side to allow diaphragmatic descent. 17. A woman with premature rupture of the membranes tells you she is worried that her birth will be extremely painful because it is "dry." Which of the following would be your best response? A. "This is true, but you can receive pain medication to help relieve this."

B. "No birth is ever really dry because amniotic fluid continues to be manufactured." C. "Don't think so far ahead; concentrate on the problem at hand." D. "Although the birth will be dry, it won't be painful." 18. During pregnancy, women should drink at least eight glasses of fluid daily. For a woman on bed rest at home, which of the following would be the best method to encourage her to drink this amount? A. She drinks the eight glasses before her husband leaves for work in the morning. B. She gets up every hour, stretches, and gets a drink from the refrigerator. C. She keeps a pitcher of fluid readily available beside her on a table. D. She drinks primarily cool liquids and avoids hot liquids, because they increase thirst. 19. An indwelling urinary catheter is inserted for a woman with a high spinal cord injury who has had a cesarean birth. As you walk into her room, you notice her face is reddened, and she says she has a sharp headache. You take her blood pressure and discover it is 160/120 mm Hg. Which of the following would you do first? A. Lower her head and ask her to breathe slowly in and out. B. Raise her head and assess the catheter for blockage. C. Immediately cut and remove the indwelling catheter. D. Sit her up abruptly and massage her lower back. 20. You care for a female infant born with a congenital anomaly. Which of the following factors is likely to have the most influence on her mother's ability to cope with the infant's handicap? A. The parent's perception of the handicap. B. The fact that this is a mental, not a physical, challenge. C. The mother's age. D. The fact that the infant is female. 21. A female client is eclamptic and has been receiving magnesium sulfate IV. The nurse evaluating her condition knows that the symptom indicating it is unsafe to continue the drug is A. Presence of deep tendon reflexes. B. Respiratory rate of 10 per minute. C. Urine output of 150 mL over the last 4 hours. D. Complaints of back pain. Situation 4 The degree of symptomatology associated with GI problems is not always explained by the diagnostic findings of endoscopy, manometry, or radiography. Emotional distress can influence individuals who have no history of GI dysfunction. As with care for all patients, individuals with GI disorders should be listened to with empathy and be given reassurance and education. 22. Mr. Jones has symptoms related to erosion of the esophagus. Which of the following is the correct label for his painful swallowing? A. Pyrosis

B. C. D. 23. A PEG A.

24.

25.

26.

Dysphagia Odynophagia Esophagitis tube is: Synonymous with a nasogastric feeding tube B. Usually not used in the elderlv population C. Typically inserted by a nurse in the patient's acute care room D. Sutured in place and has complications such as bleeding, infection, or peritonitis Mr. Barok has pain in the esophagus from esophagitis. This pain can be confused as: A. Dental disorders of the teeth B. Cardiac pain C. Appendicitis D. Acute bronchitis Mrs. Kikay has been experiencing heartburn after meals and some regurgitation of fluids that taste foul when she is full, and she is often is not able to lie down comfortably just after eating. This is most likely: A. GERD B. Stomach cancer C. Achalasia D. Peptic ulceration Mrs. Candelaria is pregnant and experiencing pyrosis and regurgitation after eating her meals. This is most likely: A. Esophagitis B. Gastritis C. Hiatal hernia D. Aphagia

C. Intermittent claudication and hyper tension. D. Increased peripheral pulses and jugu lar vein distention. Situation 6 A properly functioning urinary system is essential to the bodys physical wellbeing, to life itself, and to a persons general sense of well-being. Elimination from the urinary tract helps to rid the body of waste products and materials that exceed bodily needs. Nurses assisting a patient with urinary elimination problems or intervening to resolve health problems related to urination need many specialized skills. 30. Which of the following is a definitive method to monitor for bleeding into the urinary system post renal biopsy? A. Ask the patient if he or she has noticed blood in his or her urine B. Check the urine with a dipstick before discarding it C. Collect a small sample of each voiding and place in a rack for comparison over time D. Use a Foley catheter to collect a urine specimen 31. You must collect a 24-hour creatinine clearance on Mr. Jones. What will you do to begin the urine Collection? A. Have the patient void and place the sample in the collection container B. Have the patient void and discard urine, noting this as the beginning of the 24-hour urine collection C. Wait until the patient voids to start the 24-hour urine collection D. All of the above are appropriate options 32. A 21-year-old woman is admitted to the hospital with a diagnosis of acute renal failure. She is oliguric and has proteinuria. She asks the nurse, "How long will it be before I start to make urine again?" Which of the following would be the correct response? A. This phase of renal failure will last for one to two days. B. This phase of renal failure will last for three to seven days. C. This phase of renal failure will last for one to two weeks. D. This phase of renal failure will last for three to four weeks. 33. You are caring for a patient who is admitted to the hospital in acute renal failure. The appearance of a U wave on the electrocardiogram (EGG) should alert you to check for which of the following laboratory values? A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hyponatremia 34. You are caring for a patient receiving Perionteal dialysis. You are completing the exchange by draining the dialysate. You notice it is cloudy. How do you interpret this finding? A. It is the normal appearance of draining dialysate. B. It is a sign of infection. C. It is an indication of an impending lower back problem.

Situation 5 The hepatic, biliary, and pancreas are organ systems that have tremendous implications on the body. Each of these different organs has physiological functions that are vital to the bodys health. If any of these structures is compromised, there are many consequences to the health of the individual. 27. The liver has many complicated functions. Which the following is the definition of gluconeogenesis? A. It is the conversion of glucose to glycogen, Which can be stored in preparation of times of fasting. B. It is the conversion of stored glycogen into usable glucose to meet the immediate energy needs of the body. C. It is the synthesis of glucose from amino acids during times of fasting. D. It is the production of amino acids and bile. 28. Mr. Abernathv has a hereditary disease of the liver which is an autosomal recessive disorder related to copper metabolism. Which of the following disorders is this? A. Wilson's disease B. Crigler-Najjar disease C. Alpha-antitrypsin deficiency D. Hemochromatosis 29. A 54-year-old male client with a 15 year history of cirrhosis from alcohol abuse has had several hospital admissions for bleed ing esophageal varices. He has just been readmitted. Assessing his condition, the nurse will observe for A. Varicose veins and stasis ulcers. B. Ascites and hemorrhoids.

D. It is a sign of a vascular access occlusion. 35. Your patient is admitted for an appendectomy and states he has been suffering with Reiter's syndrome. You remember that patient's with Reiter's syndrome can present with all of the following symptoms except: A. The patient's eyes may be red and irritated. B. One of your patient's toes may be swollen and red. C. Your patient will complain of headaches. D. Your patient will complain of low back pain. 36. Your 55-year-old female patient with ankylosing spondylitis has been taking NSAIDs for years and finds these are no longer effective. A disease-modifying antirheumatic drug (DMARD) is now being prescribed. You tell you patient the following about DMARDs: A. They will help to increase the lubrication in the joint. B. They are analgesics. C. They assist with reducing inflammation. D. They should be taken with milk. Situation 7 The years 2000 to 2010 have been declared the Bone and Joint Decade with a goal of improving the health-related quality of life for people with musculoskeletal disorders throughout the world. By becoming familiar with the basic anatomy and physiology and assessment of the musculoskeletal system, nurses will be able to assist in keeping musculoskeletal diseases in the forefront. Nurses will also be able to speak with confidence regarding issues that may arise during discussions with patients and family members. 37. Mrs. Johana is newly diagnosed with osteoarthritis of her knees. She told you the health care provider prescribed acetaminophen or ibuprofen for pain. She asks you how she can afford this medication. Your best response would be: A. "Dr. Mo thinks your pain is only minimal, and the cheap drugs are a good way to keep you out of the office." B. "Dr. Mo knows that these medications will help your pain and are relatively inexpensive and available over the-counter at your local grocery or pharmacy." C. "I'll call the social worker." D. "Dr. Mo knows that these medications are covered by insurance and you shouldn't worry." 38. A 15 year old has been admitted to the ado lescent unit with scoliosis and will be hav ing surgery for insertion of a Harrington rod. Considering the course of therapy with a Harrington rod insertion, the prob lem that she is most likely to exhibit is A. Identity crisis. B. Body image changes. C. Feelings of displacement. D. Loss of privacy. 39. A patient enters the emergency department for a lower leg injury. There is a visible

deformity to the lower aspect of the leg, and it appears shorter than the other leg. The area is painful, swollen, and beginning to show signs of bruising. The nurse understands that the patient has experienced a: A. Contusion B. Sprain C. Fracture D. Strain 40. The nurse witnesses a patient fall in the bathroom, and the patient is now lying on the floor. The nurse suspects that the hip may be fractured. Which of the following interventions is of the highest priority of the nurse? A. Immobilize the leg before moving the patient B. Notify the patient's family of the fall C. Call the radiology department for an Xray D. Reassure the patient that everything will be alright 41. A 50-year-old man has suffered from low back pain and sciatica for over two years. He is admitted to the hospital for evaluation and treatment of this problem. A thorough assessment of his level of discomfort from low back pain is important primarily because: A. This will provide a baseline for later comparison. B. This is a method for identifying patients with low back neurosis. C. Patients who have pain localized to the back radiating to one extremity are probably not candidates for surgery. D. Surgery is contraindicated for patients who had pain for less than two years. 42. A 16-year-old male client was struck by a car. When the paramedics arrived at the scene, they found him in a prone position. When an initial assessment was made, he stated that he did not have feeling or sen sation in his lower extremities. Before transporting the client to the emergency room, the paramedics would most probably A. Place him on a spinal board in prone position. B. Place a neck collar on the client. C. Log-roll him to a supine position and place him on a spinal board. D. Place the client in a MAST suit. 43. While reading the physician's progress notes on a client admitted following a bad fall, the nurse finds that he is a quadri plegic. Quadriplegia indicates there is spinal cord damage A. Above C8. B. Below T1. C. At C3. D. At T10. 44. Mr. Cooper, a 65 year-old white male, has just been diagnosed with gout. Your teaching would include instructions to: A. Check his feet everyday for ulcers B. Avoid alcohol and turkey C. Avoid fats and milk products D. Take his antigout medications only when his toe hurts

Situation 8 The respiratory and cardiovascular systems are closely linked and depend on each other to deliver oxygen to the tissues 45. Ramon, age 60, has been admitted to the hospital with a diagnosis of right ventricu lar failure. With a central venous line in place, the nurse would expect that the CVP reading would be

A. 0 to 2 mmHg. 5 to 10 cm H20. C. 8 to 10 mmHg. D. 15 to 20 cm H20. 46. Patient Cita has been hospitalized for 2 days with chronic congestive heart failure. Her physician has written orders that in clude Lasix IV and oxygen. The client sud denly complains of breathing difficulty. The immediate assessment indicates that she has bi-basilar rales, increased pulse and blood pressure, and a frequent moist cough. The first nursing intervention is to A. Give Lasix IV push according to stand ing orders. B. Apply rotating tourniquets according to standing orders. C. Place the client in highFowler's position . D. Call the physician and inform him of the change in her condition. 47. When caring for Susy with pul monary edema who is receiving oxygen, you have observed that she frequently removes her oxygen mask even though she is dyspne ic. The appropriate nursing intervention is to A. Change from O2 mask to 02 cannula. B. Increase the liter flow of 02 to 10 Umin. C. Tighten the strap on the 02 mask. D. Change O2 administration to a Venturi mask. 48. A client sustained burns of her right arm, right chest, face, and neck. She has just been admitted to the burn unit. Her weight on admission is 50 kg. Using the Rule of Nines, the estimate of the extent of burns is A. 27 percent. B. 31.5 percent. C. 36 percent. D. 15 percent. 49. After the first week of hospitalization for a burn client, the diet should be A. High protein, low sodium, low carbohydrate. B. Low fat, low sodium, high calorie. C. High protein, high carbohydrate. D. High protein, high vitamin B complex, low sodium.

B.

Situation 9 The recent trends of shortened hospital stays, increased use of outpatient care and ambulatory surgery, and managed care have had a direct impact on the practice of pediatric nursing. Many aspects of psychosocial care were developed during an era of extended patient stays, however, many of the principles and issues remain relevant in todays changing health environment. The challenge for nurses is to adapt practices by supporting the physical, emotional, and developmental needs of the child and family while reducing costs without negatively influencing the quality of life provided. 50. Nurse Karia in the newborn observation nursery is unable to pass a nasogastric tube into a baby's stomach; she has met resistance with each attempt. Tracheoesophageal fistula with atresia is suspected. Other observations that validate this condition and are important for Nurse Karia to chart during an assessment include A. Excessive mucus, coughing and gagging, frequent crying. B. Gradual onset of projectile vomiting, cyanosis, irritability. C. Excessive drooling, choking and coughing during feeding. D. Abdominal distention, visible peristaltic waves. 51. The best nursing response to parents who are concerned that their baby may have a congenital defect is to say, A. "You should express your concern to the physician." B. "Don't be concerned about your baby. He's going to be fine." C. "Tell me how you are feeling concerned." D. "There seems to be little permanently wrong with your child." 52. The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the childs head (opisthotonos) with pain on flexion. Which of the following is the most appropriate action? A. Refer for immediate medical evaluation. B.Continue assessment to determine cause of neck pain. C.Ask parent when neck was injured. D. Record head lag on assessment record, and continue assessment of child. 53. If a child has impetigo contagiosa, to pre vent further spread of the disease the nurse should instruct the mother to A. Strictly isolate this child from others in his family. B. Wash toys and other objects the child uses with soap and very hot water. C. Take all other children in the family to the physician to be vaccinated for this disease. D. Not take any special precautions. 54. Which of the following is descriptive of attention deficit-hyperactivity disorder (ADHD)? A. Manifestations exhibited are so bizarre that the diagnosis is fairly easy.

B. Manifestations affect every aspect of the childs life but are most obvious in the classroom. C. Learning disabilities associated with ADHD eventually disappear when adulthood is reached. D. Diagnosis of ADHD requires that all manifestations of the disorder be present. Situation 10 Knowledge is the awareness of the reality one acquires through learning or investigation. Every individual collects, organizes, and arranges facts to build a knowledge base relevant to his or her personal reality. 55. The criterion used by quantitative researchers involving the soundness of the findings is: A. Reliability B. Validity C. Credibility D. Dependability 56. When an observer is not concealed, the findings may be biased because of: A. Reactivity B. Ethical problems C. Lack of mobility D. Acquiescence response set 57. In a qualitative research report, the thematic analysis of the data would be presented in the: A. Introduction B. Method section C. Results section D. Discussion section 58. In which section of a research report would the following sentence most likely appear: "Patients who coughed were significantly more likely to have spontaneous dislodgement of small-bore nasogastric tubes than patients who did not"? A. Introduction B. Method section C. Results section D. Discussion 59. Which of the following is not a purpose of a research literature review for a consumer? A. To identify nursing interventions that have potential for use in evidence-based practice B. To identify a suitable research design C. To acquire knowledge about a specific topic D. To facilitate the development of research-based protocols 60. Which of the following limits the power of the scientific method to answer questions about human experience? A. The necessity of departing from traditional beliefs B. The difficulty of accurately measuring complex human traits C. The difficulty of gaining the cooperation of humans as study participants D. The shortage of theories about human behavior 61. To those espousing a positivist paradigm, a fundamental belief is that: A. The researcher is objective and independent of those being studied B. The researcher cannot interact with those being studied

C. The researcher instructs those being studied to be objective in providing information D. The distance between the researcher and those being researched is minimized to enhance the interactive process 62. The use of inferential statistics permits the researcher to: A. Draw conclusions about a population based on information gathered from a sample B. Describe information obtained from empirical observation C. Interpret descriptive statistics D. None of the above 63. Which of the following a datum from a quantitative study of the labor and delivery experiences of women over age 40? A. Length of time in labor B. 107 oz C. "I practically slept through the whole thing!" D. Vaginal versus cesarean delivery 64. The nurse is seeing a patient with Meniere's disease in the clinic for the first time; which of the following would the nurse do first: A. Assess for a history of taking thyroid supplements B. Teach about safety to prevent falls in patients experiencing vertigo C. Refer to a health care provider for treatment of tinnitus D. Instruct the patient about the need for bed rest 65. A patient has been diagnosed with trigeminal neuralgia. Which medication is likely to be prescribed as a first choice for treatment? A. Phenytoin (Dilantin) B. Gabapentin C. Baclofen D. Carbamazepine (Tegretol) Situation 11 A fundamental concern of nurses is prevention of harm. This includes harm by accidents and injury, as well as harm by the spread of infection. This concern extends from the bedside to the home and to the community. 66. "You are asked to teach a parenting class on safety at a community center. One of the parents asks why young children are so prone to accidents. Of the following, which is the best answer? A. Young children are uncoordinated, so they are more likely to fall. B. Misbehavior results in many injuries to children. C. Young children's curiosity exceeds their judgment. D. Parental neglect results in many accidents. 67. Restraining a client without a physician's order stating type of restraint and how long it will be used is considered to be: A. false imprisonment. B. allowed for short time periods. C. allowed if family members agree. D. allowed by facility policy. 68. A young child is restrained following surgery to the face. The child is in a crib and is attempting to climb out. Which of the following would be the most appropriate type of restraint? A. wrist restraint. B. belt restraint. C. mitten restraints.

D. vest restraint. 69. A man has a history of a draining wound infection in his lower right leg. He was admitted with a wet soiled dressing and the following vital signs: BP 136/70, P 90, R 20,T 100.6F. A nursing priority would be: A. elevation of the right leg. B. placing the person in isolation. C. medicating the client for an elevated temperature. D. changing the wound dressing. 70. A client with infectious tuberculosis needed to go to the radiology department for a chest xray. The nurse was aware that appropriate nursing care included: A. calling the radiology department and telling them the client was still in isolation. B. covering the client with a blanket and providing tissues. C. telling the transport person to wear a mask for protection. D. putting a mask and gloves on the client to prevent the spread of organisms. 71. You are assigned to care for a client in isolation. After you have changed the bed, you need to remove the soiled linen from the room. What is the procedure for dealing with soiled linen? A. Keep the linen in the room until the client is discharged. B. Carry the rolled-up linen to the facility laundry without letting it touch your uniform. C. Bag the soiled linen and send it to the facility laundry. D. Dispose of the linen in the refuse container. Situation 12 Client education is a major responsibility both legally and professionally. 72. The health educator asks you to use behavioral theory to teach an exercise class for morbidly obese teenagers. Which of the following methods would apply this theory the best? A. lecture, video, and handouts B. rewarding the participants for a good job C. sessions where participants talk about achieving their full potential D. reading material and paper-and-pencil tests 73. Your teenage client is newly diagnosed with diabetes. He has just been visited by the nutritionist, who gave him a long list of foods he should avoid. What domain of learning might be most appropriate to explore first? A. health domain B. cognitive domain C. affective domain D. psychomotor domain 74. Your client is scheduled to meet the physical therapist for mobility training following TKR (total knee replacement). When you administer pain medication prior to the session, the client's family asks why. Your best response is: A. "The next dose is due during the time physical therapy is scheduled. I don't want to interrupt them." B. "The medication will take effect, so she will be able to rest following therapy." C. "Your mother wants medication, so I need to give it to her."

D. "Pain decreases ability to concentrate, so the pain needs to be controlled before teaching begins." 75. You have just told your outpatient surgical client not to get the incision wet until after his follow-up visit. Which statement demonstrates a need for more instruction? A. "I will not take a shower until I see the doctor." B. "I will only wipe the area with a damp washcloth daily." C. "I will be careful not to get the area wet while washing." D. "The dressing should be kept clean and dry until I see the doctor." 76. When instructing a patient who is to have a transsphenoidal hypophysectomy. What information should the nurse include? A. Nasal passage will be packed with gauze for 24 to 48 hours. B. A soft bulky head dressing will be present. C. A pureed diet will be provided immediately after surgery. D. Teeth will need brushing four to six times daily after surgery. 77. Manang Santa, age 56, is admitted to the oncology unit for implantation of a radium nee dle after diagnosis of a cervical tumor. The client asks if she can get out of bed to go to the bathroom. The appropriate reply is to say, A. ''Yes, but I will help you go to the bath room." B. "No, you must have a catheter inserted instead." C. "No, you must remain on bedrest, so I will bring you a bedpan." D. ''Yes, but after you go to the bathroom, please stay in bed. Situation 13 Nursing research is integral with meeting the challenge of achieving the goal of providing quality biopsychosocial outcomes in partnership with clients, their families/significant others, and the communities in which they live. 78. Ruth, a pediatric nurse, undertakes a study of the effect of low birth weight on infants' cognitive development. Lauren, a developmental psychologist, works with her on the study. Alaine is asked to give statistical advice in analyzing the data. Norah, a pediatrician, helps by recruiting families into the study. The study is an example of: A. Multisite research B. Qualitative research C. Funded research D. Collaborative research 79. A researcher gets on an elevator and, instead of facing forward, faces backward toward other elevator passengers. This would be an example of: A. An ethnographer's attempt to gain an emic perspective B. A phenomenologist's effort to appreciate the essence of what the passengers are experiencing C. An ethnomethodologist's attempt to understand the social expectations regarding behavior in an elevator

D. A discourse analyst's attempt to listen to people's conversation on an elevator 80. The purpose of an operational definition in a quantitative study is to: A. Assign numeric values to variables B. Specify how a variable will be defined and measured C. State the expected relationship between the variables under investigation D. Designate the conceptual underpinnings of a variable 81. For which of the following pairs of variables is there most likely to be a relationship that could be described as causal? A. Degree of physical activity and heart rate B. Stress and coping style C. Age and health beliefs D. Gender and depression 82. The mode is an index of: A. Bivariate relationships B. Central tendency C. Skewness D. Variability Situation 14 The growing number of adults has important implications for nurses. 83. Mrs. Sandras daughter asks you the term for her mother's condition. Her mother has a shrinkage of the thoracic intervertebral disks, causing her to assume a stooped-over position which is called: A. disk shrinkage disease. B. kyphosis. C. rheumatoid arthritis. D. osteoarthritis. 84. You have been assigned to care for a 58-yearold female with a diagnosis of transient ischemic attack (TIA). You know from your knowledge of TIAs that they are an interruption in the blood supply of the: a. digestive system. b. heart. c. brain. d. respiratory system 85. Mrs. Singson has been diagnosed with COPD. You realize Mrs. Singson needs more teaching about her disease when she says: A. "I realize I am at an increased risk for respiratory infections so I have to be careful and stay healthy." B. "I realize I have a productive cough because of my COPD." C. "I can keep on smoking as long as I smoke outside." D. "I realize that my shortness of breath is due to my condition." 86. This disorder is a progressive, chronic disease in which there are decreased levels of acetylcholine, norepinephrine, and dopamine in the brain. A. Alzheimer's disease B. Meniere's disease C. Tourette's syndrome D. Parkinson's disease 87. Your client with bursitis is complaining because of the pain from his condition. You realize that bursitis is an autoimmune, painful disease characterized by inflammation of the: A. lining of the joint. B. myocardium. C. epidermis. D. stapes.

88. Mr. Kokey has been diagnosed with


congestive heart failure (CHF). He has developed cardiomegaly, which is often associated with CHF and is caused by an enlargement of the: A. joints in the feet. B. pancreas. C. heart. D. lungs. 89. Diabetes mellitus (DM) has many side effects. A condition frequently associated with DM that causes foot ulcers is referred to as: A. retinal neuropathy. B. peripheral neuropathy. C. autonomic neuropathy. D. nephropathy. 90. Mrs.Valeria, aa 5'5", 250 lb woman has been diagnosed with a varicose veins in both lower extremities. You realize after talking with her that she needs education about her condition when she states: A. "I know that I might not have had this condition if I were not so heavy." B. "I realize that it is important for me to walk to circulate my blood." C. "My shopping days are over!" D. "I shouldn't sit so long with my legs not elevated. 91. Mr. Nonoy has come into your facility for his vitamin B12 injection. You suspect he has a condition commonly found in colder adults caused by a decrease in or inadequate absorption of vitamin B12 in the body. This condition is called: A. gout. B. wasting syndrome. C. pernicious anemia. D. chronic lymphocytic leukemia. 92. Mrs. Adelina asks you the medical name for the brown spots on her hands and arms. You tell her the name of this condition is: A. arcus senilis. B. lentigo senilis. C. osteosenilis. D. rosacea. Situation 15 Surgery is a unique experience of a planned physical alteration encompassing three phases: preoperative, intraoperative, and postoperative. 93. Preoperative teaching is a vital part of nursing care. Good pre-operative teaching: A. shortens the length of hospitalization. B. facilitates the client's return to work and other activities of daily living. C. reduces postoperative pain. D. increases anxiety in the client. 94. You are preparing clients for surgery. Several clients request that they be allowed to wear their wedding rings. Of the following, which client must remove the ring, rather than having it secured with tape? A. a 65-year-old male scheduled for a TURP (transurethral prostatectomy) B. a 31-year-old female having a repeat csection C. a 72-year-old female having a total hip replacement D. a 49-year-old female scheduled for a left modified radical mastectomy 95. Postoperative assessments are usually made every 15 minutes until vital signs stabilize. Of

the following, which client would require qh vital signs? A. stable vital signs on the day of discharge B. stable vital signs 3 hours postop C. client with hypotension and depressed respirations 2 hours postop D. temperature of 99.8F second day postop 96. A client returns to the unit following surgery in which spinal anesthesia was administered. You need to give instructions to the nursing assistant about positioning the client. Of the following positions, which is the most appropriate for this client? A. Reverse Trendelenburg B. on his or her left side with head slightly elevated C. flat for 8 to 12 hours D. semi-Fowler's 97. You are teaching deep breathing and coughing to your client who is having surgery later today. Which of the following statements indicates the need for further teaching? A. "I will lie prone and flat .while coughing to control pain." B. "I will hold a pillow against my abdomen during coughing." C. "After taking a deep breath, I will cough forcefully." D. "I will take a deep breath through my nose prior to coughing." 98. One day following surgery your client is to begin to ambulate. He asks, "Why can't I just stay in bed until I feel better?" Of the following, which would be the best response? A. "Your doctor has written an order for you to walk and must follow the doctor's orders." B. "If you walk to the chair, it will be easier to change the bed while you are up." C. "Walking is one of the best ways to prevent respirator and circulatory complications." D. "You will never feel better if you just lie in bed." 99. You are preparing your client for surgery. Of the following assessment information, what needs to be reported to the physician immediately? A. Vital signs 98.8-84-20, BP 132/80 B. The client reports he took his pills with sips of water before coming to the hospital. C. The client tells you he doesn't understand what they a-e going to do, and he is not sure he wants to go through with the surgery. D. The client is allergic to morphine sulfate. 100. Reflux of gastric contents into the vent lumen may occur when stomach pressure exceeds atmospheric pressure. To prevent this, you would: A. clamp the vent tube and turn up the suction. B. place the vent tubing higher than the client's stomach. C. place the vent tube lower than the stomach. D. irrigate the tube via the vent.