chronic exam 2

50問 • 2年前

問題一覧

1. You’re teaching a patient about antipsychotic neuroleptics what should you include in the teaching?

You’re more susceptible to heart issues and stroke while taking a medication (Follow up constantly with their provider when they’re on neuroleptics)

2. You’re teaching an older adult client about a new medication, which of the following nursing action enhances the client’s ability to learn most?

Keep it simple (K.I.S.S), and relevant to the subject (Don’t use medical speak)

3. You’re evaluating the active involvement of a client who’s having difficulty keeping medications organized demonstrates a correct understanding of active involvement if the client

Explains to you the purpose of the medication as the pill is placed into the medication organizer

4. The home health Nurse arrives at the home the client finds the inside temperature 82 degrees the windows and doors are closed the client is covered with a heavy winter blanket the Nurse initially recognizes that this behavior maybe related to

Normal age-related changes that impairs the client’s ability to thermoregulate (remember layers and layers)

5. You’re caring for a frail older adult in a acute care facility and is concerned about preventing hypothermia which of the following interventions should the Nurse implement?

use warm humidified air by mask (Moisture)

6. The community nurse is preparing a course addressing key components in determining when a client is no longer safe to drive use the pneumonic S.A.F.E.D.R.I.V.E. (items of box below) SATA

Safety record, family report, attention skills. Family reports executive function, attention skills (are they able to connect when you’re talking about something)

7. The nurse caring for a client who due to increasing age switching from the tricyclic antidepressant (TCA) amitriptyline to the SSRI Fluoxetine the nurse should monitor the client for which of the following side effects

Sexual dysfunction

8. The Nurse is caring for a client who’s been receiving Haloperidol which of the following is the most serious side effect that you should watch for?

Neuroleptic Malignant Syndrome (NMS)

9. The Nurse is speaking with a family member of a client who have early-stage Dementia. The family member is concerned that the client should no longer be driving which of the following statements by the nurse is appropriate?

You should begin having discussion now and then evaluate the client’s driving every 6 months.

10. The Nurse has taught a client who have a new prescription for metered dose inhaler about how to use the inhaler which of the following is the best way for the nurse to evaluate learning?

Observe the client using the inhaler to administer a dose of medication

11. Follow up Nurse working in rural community has started seeing clients via telehealth, the nurse understands that some of the benefits important to the clients using telehealth includes

self-management of illness and ability to have diagnosis, monitored, and treatment remotely from the primary care health provider

12. A home health nurse is caring for an older client who asks the nurse why they are always cold, the correct response by the nurse is

you have a decreased stability to shiver which prevent you from producing enough heat (Thermoregulation)

13. Home health nurse is counseling the family of an 85-year-old about establishing rules for their family member to promote safe driving it requires follow up by the nurse if the family identifies which of the following rules?

drive below speed limit to maintain control of the car

14. Nurse has attended an education session regarding complication of frequent medications used by older adults that are affected by food interactions, which of the following combinations should alert the nurse to possible interactions?

antibiotics and any foods

15. The nurse finds a client with Alzheimer’s wandering the halls trying to water the flowers and leaving puddles of water on the floor, which of the following statements is the appropriate response by the nurse?

Thank you for helping to care for the flowers it looks like some of the water has spilled on the floor can I help you clean it up so your friends don’t slip and fall

16. Nurse working in the ED is discharging an older adult client who was admitted with hyperthermia which of the following should the nurse include in discharge teaching to the client?

place your hands and feet in cool water if you get too warm

17. You’re creating a teaching plan for a client who’s taking lithium the nurse should include which of the following in the plan of care?

maintain normal salt & fluid intake in your diet

18. The nurse is teaching a client who has orders for pt eval about ways to remain safe which of the following statement is correct for the nurse to make?

you will need an activity assessment prior to beginning daily physical activities

19. Nurse is caring for a newly admitted client who have a hearing deficit which of the following actions should the nurse performs as part of the care?

Directly face the client when speaking in good lighting if possible

20. The is preparing to conduct an interview to determine a client’s cognitive status which of the following question should the nurse ask to elicit the information needed?

Are you able to drive and run errands without difficulty

21. The nurse is preparing to teach an older adult client when teaching this population of clients, the nurse remembers that

sensory alteration occurs with age

22. Nurse is caring for the following assigned clients which finding should the nurse correlate to having dementia?

A 65-year-old client who have trouble remembering recent events and loses their train of thought.

23. You’re working at a long-term care facility reviewing meal consumption documented by the UAP, which of the following entries in the medical record indicates correct documentation by the UAP?

client refused breakfast, ate 0% but drank 240ml of juice

24. Nurse is provided care to an older client with major depression and experience feelings of worthlessness the client states “life just isn’t worth living”, which of the following is an appropriate nursing intervention?

Monitor the client frequently and provide 1:1 care if possible

25. Caring for a client who appears to have decreased cognitive functioning which of the following action should the nurse take next?

Administer a mini-mental state exam for proper screening

26. Nurse documenting on a newly admitted older client following a full assessment which of the following is the appropriate statement to include in your documentation?

Client does not wish to be resuscitate (DNR) signed, bracelet placed on client

27. Nurse is performing initial assessment on an 85-year-old client which of the following should the nurse use to obtain relevant information?

Establish rapport and report by proxy

28. You’re assessing the learning needs of a client prior to teaching them which factors should be the focus of the nurse on this assessment?

The client’s ability to read and write, age of client, client’s understanding of the health problem and client’s sensory acuity

29. The nurse is caring for an older adult client and plans to do a quick overall assessment focusing on any potential geriatric syndromes. The nurse knows which of the following tools is the best option to accomplish this task?

Former’s SPICES

30. Nurse planning a conference on depression for the general public, which of the following common risk factors for depression should the nurse include in the conference?

Chronic medical conditions

31. You’re caring for an older client who drops a tray while setting the table, another client makes a rude comment about the accident. Which of the following is an appropriate question by the nurse to determine that the client is depressed?

It’s ok it’s just an accident how does this whole incident makes you feels

32. The nurse is providing discharge teaching to a client who has visual alterations, which of the following client statements indicated a need for further teaching:

I will fill my pill organizer to help keep me on track

33. Nurse manger for a long-term care facility is auditing and monitoring documentations in client health record, which of the following actions is the nurse taking?

Determining the degree which standards of care are met by reviewing client health record for reimbursement purposes

34. The nurse caring for a resident in the nursing home who’s diagnosed with under nutrition and unable to take inadequate food despise efforts by the team and family members, prior to insertion of a permanent feeding tube, which of the following issues needs to be consider?

The client’s advance directive and evaluation of risks, benefits and ethical considerations

35. You’re caring for an older adult client who reports toothbrushing is seldom done, which of the following should the nurse assess as the reason why the client has stopped performing oral hygiene?

Relies on the care-giver for assistance Loss of manual dexterity

36. Nurse caring for a client who has Alzheimer’s late stage has apraxia and poor oral hygiene, which of the following nursing interventions is appropriate for the nurse to complete?

Get at eye level with the client and explain each step one at a time while brushing the teeth

37. You’re caring for a 70 year old client who’s beginning to notice mild memory impairment related to a recent dementia diagnosis, the family is concerned that the client has increasing episodes of urinary incontinence, which of the following prescriptions ordered by the primary health provider should the nurse question for this client?

Place an indwelling urethral catheter with a leg bag collector

38. Nurse is caring for a client who has the nursing diagnosis of urge urinary incontinence related to UTI, which of the following statements is appropriate for the as evidence by portion of the client’s nursing diagnosis?

As evidence by sub leakage of urine when client’s unable to get to the toilet in time

39. Nurse caring for an older adult client suspects they maybe experiencing dysphagia and/or aspiration, which of the following observations leads the nurse to this conclusion?

Drooling, excessive throat clearing and hiccups

40. Nurse is caring for a client who have urinary incontinence, which of the following client’s statements most concerns the nurse?

I never had urinary incontinence before this week (sudden onset)

41. Nurse is instructing an older adult client on the use of my plate to ensure adequate nutritional intake, which of the following client meal choices requires further teaching?

A peanut butter & jelly sandwich, a cup of yogurt and orange juice

42. A nurse working in a long-term care facility observing an UAP perform denture care for a client, it requires follow up by the nurse if the UAP being observed doing which of the following?

Brushing the dentures over a sink filled with warm water (must be cold water)

43. A Nurse is reviewing an older adult client’s medical record, which of the following medications in the medical record places the client at greatest risk for development of xerostomia? (Dry mouth)

Furosemide Fluoxetine (SSRI)

44. Nurse is instructing an older adult client for the importance of maintaining adequate hydration, which of the following statements by the client most indicates that additional teaching is needed?

I’ll drink water, tea, soda or juice whenever I feel thirsty

45. A Nurse caring for a client that haven’t had a bowel movement for two days, which of the following nursing interventions is the priority for this client?

Assess their usual bowel movements patterns (this may be normal for the client)

46. You’re caring for an older adult client suspects the client is suffering from undernutrition, the nurse identifies as a possible cause of the undernutrition?

recovering from recent hip replacement surgery

47. Nurse caring for a client who has a history of dementia is incontinent of stool, because they cannot communicate the need to defecate, which of the following is the priority action by the nurse?

Begin a prompted toileting program to facilitate bowel incontinence

48. Nurse is caring for an older adult client who has abdominal pain, urinary retention, and frequent small liquid stools; which of the following actions by the nurse is the highest priority?

Assess the client for fecal impaction

49. The nurse is assessing a client who’s a risk for dehydration, which of the following statements by the client indicates that further education by the nurse is required?

I stop drinking fluids in the afternoon to avoid bathroom trips at night.

50. Nurse is caring for a client who’s becoming malnourished, because nothing taste good, which of the following should the nurse recommend?

Take sips of water between different foods (cleaning the palate)

NUR 170 exam 4

V Farris · 50問 · 2年前

NUR 170 exam 4