Fundamentals Of Nursing: Trivia Quiz!

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Fundamentals Of Nursing: Trivia Quiz! - Quiz

Nursing is a career that is designed for the most patient and caring people there is, the main objective of a nurse is to guide someone through their healing up until they get back to health. In the fundamentals of nursing, you get to understand what is required of a nurse and how to ensure you meet your patient’s expectations. Take this test and review what you learned.


Questions and Answers
  • 1. 

    The nurse sees the nursing assistant personnel (NAP) perform the following for a patient receiving continuous enteral feedings.  What intervention does the nurse need to address immediately with the NAP? The NAP:

    • A.

      Fastens the tube to the gown with tape.

    • B.

      Places the patient supine while giving a bath.

    • C.

      Performs oral care for the patient.

    • D.

      Elevates the head of the bed 45 degrees.

    Correct Answer
    B. Places the patient supine while giving a bath.
    Explanation
    Placing the patient supine while giving a bath is the intervention that the nurse needs to address immediately with the NAP. Enteral feedings should be administered with the patient in an upright or semi-upright position to prevent aspiration. Placing the patient supine increases the risk of aspiration and can be dangerous for a patient receiving continuous enteral feedings. The nurse should educate the NAP about the importance of maintaining an upright position during enteral feedings to ensure patient safety.

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  • 2. 

    After the 0700 shift report the registered nurse (RN) delegates three tasks to the nursing assistant.  At 1300 the RN tells the nursing assistant that he would like to talk to her about the first task that was delegated, which was walking the patient, Mrs. Taylor, earlier this morning.  The RN says, "You did a good job walking Mrs. Taylor today by 0930.  I saw that you recorded her pulse before and after the walk.  I saw that Mrs. Taylor walked in the hallway barefoot.  For safety, the next time you walk a patient, you need to make sure that the patient wears slippers or shoes.  Please walk Mrs. Taylor again by 1500." Which characteristics of good feedback did the RN use when talking to the nursing assistant?  (Select all that apply.)

    • A.

      Feedback is given immediately

    • B.

      Feedback focused on one issue

    • C.

      Feedback offers concrete details

    • D.

      Feedback identifies ways to improve

    • E.

      Feedback focuses on changeable things

    • F.

      Feedback is specific about what is done incorrectly only.

    Correct Answer(s)
    B. Feedback focused on one issue
    C. Feedback offers concrete details
    D. Feedback identifies ways to improve
    E. Feedback focuses on changeable things
    Explanation
    The RN used the following characteristics of good feedback when talking to the nursing assistant: feedback focused on one issue, feedback offers concrete details, feedback identifies ways to improve, and feedback focuses on changeable things. The RN specifically addressed the issue of Mrs. Taylor walking barefoot and provided concrete details about the situation, such as recording her pulse before and after the walk. The RN also identified a way to improve by instructing the nursing assistant to ensure that the patient wears slippers or shoes for safety. By focusing on one issue and providing specific details and suggestions for improvement, the RN effectively delivered constructive feedback to the nursing assistant.

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  • 3. 

    As a nurse you need to complete all of the following. Which task do you complete first?

    • A.

      Administer oral pain medication to the patient who had surgery 3 days ago

    • B.

      Make a referral to the homecare nurse for a patient who is being discharged in 2 days.

    • C.

      Complete wound care for a patient with a wound drain that has an increased amount of drainage since last shift

    • D.

      Notify the health care provider of the decreased level of consiousness in the patient who had surgery 2 days ago

    Correct Answer
    D. Notify the health care provider of the decreased level of consiousness in the patient who had surgery 2 days ago
    Explanation
    The correct answer is to notify the health care provider of the decreased level of consciousness in the patient who had surgery 2 days ago. This is the highest priority because a decreased level of consciousness may indicate a serious complication or deterioration in the patient's condition that requires immediate medical attention. Administering oral pain medication, making a referral to a homecare nurse, and completing wound care are important tasks, but they can be prioritized after ensuring the patient's safety and addressing any urgent medical concerns.

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  • 4. 

    You are the charge nurse on a surgical unit.  You are doing staff assignments for the 3-to-11 shift.  Which patient do you assign to the licensed practical nurse (LPN)?

    • A.

      The patient who transferred out of intensive care an hour ago

    • B.

      The patient who requires teaching on new medications before discharge

    • C.

      The patient who had a vaginal hysterectomy 2 days ago and is being discharged tomorrow

    • D.

      The patient who is experiencing some bleeding problems following surgery earlier today

    Correct Answer
    C. The patient who had a vaginal hysterectomy 2 days ago and is being discharged tomorrow
    Explanation
    The patient who had a vaginal hysterectomy 2 days ago and is being discharged tomorrow can be assigned to the licensed practical nurse (LPN) because this patient is stable and requires routine care and monitoring. The LPN can assist with activities of daily living, medication administration, and provide education on post-operative care and discharge instructions. This assignment does not require advanced nursing skills or critical thinking, making it suitable for an LPN.

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  • 5. 

    The type of care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality is:

    • A.

      Primary nursing

    • B.

      Total patient care

    • C.

      Functional nursing

    • D.

      Case management

    Correct Answer
    D. Case management
    Explanation
    Case management is the correct answer because it involves coordinating and linking health care services to patients and their families. This approach aims to streamline costs and maintain quality by ensuring that all aspects of a patient's care are properly managed and coordinated. Case managers work closely with healthcare providers, patients, and their families to develop and implement a comprehensive care plan. They also monitor the patient's progress and make any necessary adjustments to ensure that the patient receives the appropriate care and support.

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  • 6. 

    While administering meds, the nurse realizes that she has given the wrong dose of med to a patient.  She acts by completing an incident report and notifying the patient's health care provider.  The nurse is exercising:

    • A.

      Authority

    • B.

      Responsibility

    • C.

      Accountability

    • D.

      Decision making

    Correct Answer
    C. Accountability
    Explanation
    The nurse is exercising accountability in this situation. Accountability refers to taking responsibility for one's actions and being answerable for the outcomes. By completing an incident report and notifying the patient's health care provider, the nurse is acknowledging the mistake and taking the necessary steps to ensure that the incident is documented and appropriate actions are taken to address the error. This demonstrates the nurse's accountability for their actions and their commitment to patient safety and quality care.

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  • 7. 

    Your nusing manager distributes biweekly newsletters of ongoing unit or health care agency activities and posts minutes of committee meetings on a bulletin board on the staff break room.  This is an example of:

    • A.

      Staff communication

    • B.

      Problem-solving committees

    • C.

      Interdisciplinary collaboration

    • D.

      Nurse-physician collaborative practice

    Correct Answer
    A. Staff communication
    Explanation
    The given scenario describes the nursing manager distributing biweekly newsletters and posting committee meeting minutes on a bulletin board in the staff break room. This demonstrates staff communication, as the manager is effectively sharing information and updates with the staff members. It is important for effective communication to take place within a healthcare team to ensure everyone is informed and on the same page. This helps to promote a cohesive and collaborative work environment.

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  • 8. 

    The nurse asks the nursing assistant to hold the legs of a female patient during a foley catheter insertion.  This is an example of:

    • A.

      Organizational skills

    • B.

      Use of resources

    • C.

      Time management

    • D.

      Evaluation

    Correct Answer
    B. Use of resources
    Explanation
    The nurse asking the nursing assistant to hold the legs of a female patient during a foley catheter insertion demonstrates the use of resources. In this situation, the nurse is utilizing the skills and assistance of the nursing assistant to ensure that the procedure is carried out safely and effectively. By delegating this task to the nursing assistant, the nurse is making efficient use of the available resources in order to provide optimal patient care.

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  • 9. 

    The nurse is assisting a patient with coughing and deep-breathing exercises following abdominal surgery.  This is which priority nursing need for this patient?

    • A.

      Low priority

    • B.

      High priority

    • C.

      Intermediate priority

    • D.

      Nonemergency priority

    Correct Answer
    C. Intermediate priority
    Explanation
    The patient's need for coughing and deep-breathing exercises following abdominal surgery is considered an intermediate priority. These exercises are important to prevent complications such as pneumonia and atelectasis. While they are not as urgent as immediate life-threatening situations, they should still be prioritized to ensure the patient's recovery and well-being.

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  • 10. 

    The registered nurse (RN) checks on a patient who was admitted to the hospital with pneumonia.  The patient is coughing profusely and requires nasotracheal suctioning.  Orders include an intravenous (IV) infusion of antibiotics.  The patient is febrile and asks the RN if he can have a bath because he has been prespiring profusely.  Which task is appropriate to delegate to a nursing assistant?

    • A.

      Assessing vital signs

    • B.

      Changing IV dressing

    • C.

      Nasotracheal suctioning

    • D.

      Administering a bed bath

    Correct Answer
    D. Administering a bed bath
    Explanation
    Administering a bed bath is an appropriate task to delegate to a nursing assistant. This task does not require specialized medical knowledge or skills and can be safely performed by a nursing assistant under the supervision of a registered nurse. Assessing vital signs, changing IV dressing, and nasotracheal suctioning require medical expertise and should be performed by a registered nurse.

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  • 11. 

    Which task is appropriate for a RN to delegate to the nursing assistant?

    • A.

      Explaining to the patient the preoperative preparation before the surgery in the morning

    • B.

      Administering the ordered antibiotic to the patient before surgery.

    • C.

      Obtaining the patient's signature on the surgical informed consent

    • D.

      Assisting the patient to the bathroom before leaving for the operating room

    Correct Answer
    D. Assisting the patient to the bathroom before leaving for the operating room
    Explanation
    Assisting the patient to the bathroom before leaving for the operating room is an appropriate task for a nursing assistant to perform. This task does not require the specialized knowledge and skills of a registered nurse and can be safely delegated to a nursing assistant. The nursing assistant can provide support and assistance to the patient in a non-medical capacity, ensuring their comfort and safety before they are taken to the operating room.

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  • 12. 

    Which of the following strategies focus on improving nurse-physician collaborative practice?   (Select all that apply.)

    • A.

      Inviting the physician to attend the practice council meeting

    • B.

      Participating in physician morning rounds

    • C.

      Placing physician photos and names in unit newsletter

    • D.

      Contacting physician promptly to discuss patient problems

    • E.

      Providing a list of physician contact numbers to all staff nurses

    Correct Answer(s)
    A. Inviting the physician to attend the practice council meeting
    B. Participating in physician morning rounds
    D. Contacting physician promptly to discuss patient problems
    Explanation
    The strategies that focus on improving nurse-physician collaborative practice are inviting the physician to attend the practice council meeting, participating in physician morning rounds, and contacting the physician promptly to discuss patient problems. These strategies promote communication and collaboration between nurses and physicians, allowing for better coordination of patient care and improved teamwork. By involving physicians in meetings and rounds, as well as ensuring prompt communication, nurses can work more effectively with physicians to address patient needs and make informed decisions together.

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  • 13. 

    The nurses on unit developed a system for self-scheduling of work shifts.  This is an example of:

    • A.

      Responsibility

    • B.

      Autonomy

    • C.

      Accountability

    • D.

      Authority

    Correct Answer
    B. Autonomy
    Explanation
    The nurses developing a system for self-scheduling work shifts demonstrates autonomy. Autonomy refers to the ability to make independent decisions and take responsibility for one's actions. In this case, the nurses are given the freedom to organize their work schedules according to their preferences and needs, showing a level of self-governance and independence in their professional roles.

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  • 14. 

    Which example demonstrates the nurse performing the skill of evaluation?

    • A.

      The nurse explains the side effects of the new blood pressure med ordered for the patient

    • B.

      The nurse asks the patient to rate pain on a scale of 0 to 10 before administering pain meds

    • C.

      After completing the teaching, the nurse observes the patient draw up and administer and insulin injection

    • D.

      The nurse changes the patient's leg ulcer dressing using aseptic technique

    Correct Answer
    C. After completing the teaching, the nurse observes the patient draw up and administer and insulin injection
    Explanation
    The example of the nurse observing the patient draw up and administer an insulin injection demonstrates the skill of evaluation because the nurse is assessing the patient's ability to correctly perform the task after teaching them. This allows the nurse to determine if the patient has understood and can independently carry out the skill, and if any additional teaching or support is needed.

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  • 15. 

    The nurse is explaining the case management model to a group of nursing students.  Which characteristics best describe the model? (Select all that apply.)

    • A.

      Case managers provide all patient care

    • B.

      Multidisciplinary care plans are used

    • C.

      Case managers coordinate discharge planning

    • D.

      Staffing is expensive and may not decrease care costs

    • E.

      Communication with health care team members is important

    • F.

      Model helps to improve patient safety and quality

    Correct Answer(s)
    B. Multidisciplinary care plans are used
    C. Case managers coordinate discharge planning
    E. Communication with health care team members is important
    F. Model helps to improve patient safety and quality
    Explanation
    The case management model involves the use of multidisciplinary care plans, where healthcare professionals from different disciplines collaborate to create a comprehensive plan for patient care. Case managers also play a crucial role in coordinating discharge planning, ensuring a smooth transition for patients from the hospital to their home or another care facility. Communication with healthcare team members is important in this model to ensure effective coordination and continuity of care. Additionally, the model aims to improve patient safety and quality by implementing strategies and protocols to enhance patient outcomes.

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  • 16. 

    The nurse collects the supplies for the dressing change for the patient in bed 1 and signs out the capillary blood glucose monitoring equipment to test the glucose of the patient in bed 2 before walking down the hall to the room.  The nurse is displaying:

    • A.

      Organizational skills

    • B.

      Use of resources

    • C.

      Priority setting

    • D.

      Clinical decision making

    Correct Answer
    A. Organizational skills
    Explanation
    The nurse is displaying organizational skills by efficiently collecting the supplies for the dressing change for the patient in bed 1 and signing out the capillary blood glucose monitoring equipment for the patient in bed 2 before heading down the hall to the room. This shows that the nurse is able to prioritize tasks, manage time effectively, and coordinate multiple responsibilities in a structured manner.

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  • 17. 

    A student nurse practicing primary leadership skills would demonstrate all of the following except:

    • A.

      Being sensitive to the group's feelings

    • B.

      Recognizing others for their contributions

    • C.

      Developing listening skills and being aware of personal motivation

    • D.

      Assuming primary responsibility for planning, implementation, follow-up, and evaluation.

    Correct Answer
    D. Assuming primary responsibility for planning, implementation, follow-up, and evaluation.
    Explanation
    A student nurse practicing primary leadership skills would demonstrate sensitivity towards the group's feelings, recognizing others for their contributions, and developing listening skills and being aware of personal motivation. However, assuming primary responsibility for planning, implementation, follow-up, and evaluation is not a skill that a student nurse would typically demonstrate as it falls more under the role of a nurse manager or a higher-level leadership position.

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  • 18. 

    Which statement made by an adult patient demonstrates understanding of healthy nutrition teaching?

    • A.

      I need to stop eating red meat.

    • B.

      I will increase the servings of fruit juice to four a day.

    • C.

      I will make sure that I eat a balanced diet and exercise regularly.

    • D.

      I will not eat so many dark green vegetables and eat more yellow vegetables.

    Correct Answer
    C. I will make sure that I eat a balanced diet and exercise regularly.
    Explanation
    This statement demonstrates understanding of healthy nutrition teaching because it mentions the importance of eating a balanced diet and exercising regularly. A balanced diet includes a variety of foods from different food groups, ensuring that the body receives all the necessary nutrients. Regular exercise is also crucial for maintaining good health. This response shows an understanding of the importance of both diet and exercise in maintaining a healthy lifestyle.

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  • 19. 

    The nurse teaches a patient who has had surgery to increase which nutrient to help with tissue repair?

    • A.

      Fat

    • B.

      Protein

    • C.

      Vitamin

    • D.

      Carbohydrate

    Correct Answer
    B. Protein
    Explanation
    Protein is the correct answer because it is essential for tissue repair. After surgery, the body needs an increased amount of protein to heal and regenerate damaged tissues. Protein provides the building blocks for new cells and tissues, promoting the repair process. It also helps to strengthen the immune system and prevent infections. Therefore, increasing protein intake is crucial for optimal tissue repair and recovery after surgery.

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  • 20. 

    The nurse is caring for a patient with dysphagia.  Which interventions help decrease the risk of aspiration during feeding?

    • A.

      Sit the patient upright in a chair

    • B.

      Give liquids at the end of the meal

    • C.

      Place food in the strong side of the mouth

    • D.

      Provide thin foods to make it easier to swallow

    • E.

      Feed the patient slowly, allowing time to chew and swallow

    • F.

      Encourage patient to lie down and rest for 30 minutes after eating.

    Correct Answer(s)
    A. Sit the patient upright in a chair
    C. Place food in the strong side of the mouth
    E. Feed the patient slowly, allowing time to chew and swallow
    Explanation
    To decrease the risk of aspiration during feeding for a patient with dysphagia, it is important to sit the patient upright in a chair. This position helps to ensure proper swallowing and prevents food or liquid from entering the airway. Additionally, placing food in the strong side of the mouth helps to improve control and coordination during swallowing. Feeding the patient slowly and allowing them enough time to chew and swallow also reduces the risk of aspiration. These interventions promote safe and effective feeding for patients with dysphagia.

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  • 21. 

    The nurse suspects that the patient receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus.  What action does the nurse need to take first?

    • A.

      Raise head of the bed to 90 degrees

    • B.

      Turn patient to left lateral decubitus position

    • C.

      Notify health care provider immediately

    • D.

      Have patient perform valsava maneuver

    Correct Answer
    B. Turn patient to left lateral decubitus position
    Explanation
    The nurse needs to turn the patient to the left lateral decubitus position first. This position helps to trap the air in the right atrium, preventing it from traveling to the heart and lungs. It is an immediate action that can help to minimize the risk of further complications from the air embolus.

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  • 22. 

    Which action is initially taken by the nurse to verify correct position of a newly placed small-bore feeding tube?

    • A.

      Placing an order for an x-ray film exam to check position

    • B.

      Confirming the distal mark on the feeding tube after taping

    • C.

      Testing the pH of the gastric contents and observing the color

    • D.

      Auscultating over the gastric area as air is injected into the tube

    Correct Answer
    A. Placing an order for an x-ray film exam to check position
    Explanation
    The nurse initially takes the action of placing an order for an x-ray film exam to check the position of the newly placed small-bore feeding tube. This is because an x-ray is the most reliable method to confirm the correct placement of the feeding tube. It allows the healthcare provider to visualize the exact location of the tube within the gastrointestinal tract, ensuring that it is in the correct position and not at risk of causing harm to the patient. Other methods such as confirming the distal mark, testing the pH of gastric contents, or auscultating over the gastric area may provide some indication of correct placement, but they are not as accurate or definitive as an x-ray.

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  • 23. 

    Based on knowledge of peptic ulcer disease (PUD), the nurse anticipates the presence of which bacteria when reviewing the lab data for a patient suspected of having PUD?

    • A.

      Micrococcus

    • B.

      Staphylococcus

    • C.

      Corynebacterium

    • D.

      Helicobacter pylori

    Correct Answer
    D. Helicobacter pylori
    Explanation
    Helicobacter pylori is the correct answer because it is a bacteria commonly associated with peptic ulcer disease. It is known to colonize the stomach and duodenum, causing inflammation and damage to the lining of these organs, leading to the development of ulcers. This bacterium is able to survive in the acidic environment of the stomach and can be identified through lab tests such as urea breath tests or stool antigen tests. Treatment for PUD often includes antibiotics to eradicate Helicobacter pylori infection.

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  • 24. 

    The nurse is assessing a patient receiving enteral feedings via a small-bore nasogastric tube.  Which assessment findings need further intervention?

    • A.

      Gastric pH of 4.0 during placement check

    • B.

      Weight gain of 1 pound over the course of a week

    • C.

      Active bowel sounds in the 4 abdominal quadrants

    • D.

      Gastric residual aspirate of 350 mL for the second consecutive time

    Correct Answer
    D. Gastric residual aspirate of 350 mL for the second consecutive time
  • 25. 

    The home care nurse os seeing the following patients.  Which patient is at greatest risk for experiencing inadequate nutrition?

    • A.

      A 55 year old obese man recently diagnosed with diabetes mellitus

    • B.

      A recently widowed 76 year old woman recovering from a mild stroke

    • C.

      A 22 year old mother with a 3 year old toddler who had tonsillectomy surgery

    • D.

      A 46 year old man recovering at home following coronary artery bypass surgery

    Correct Answer
    B. A recently widowed 76 year old woman recovering from a mild stroke
    Explanation
    The recently widowed 76 year old woman recovering from a mild stroke is at the greatest risk for experiencing inadequate nutrition. This is because she is likely going through a period of emotional distress and grief, which can lead to a loss of appetite and difficulty in maintaining a healthy diet. Additionally, recovering from a stroke may result in swallowing difficulties or limited mobility, making it challenging for her to prepare or consume nutritious meals.

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  • 26. 

    Which statement made by a patient of a 2 month old infant requires further education?

    • A.

      I'll continue to use formula for the baby until he is at least a year old

    • B.

      I'll make sure I purchase iron-fortified formula

    • C.

      I'll start feeding the baby cereal at 4 months

    • D.

      I'm going to alternate formula with whole milk starting next month

    Correct Answer
    D. I'm going to alternate formula with whole milk starting next month
    Explanation
    The correct answer is "I'm going to alternate formula with whole milk starting next month." This statement requires further education because it is not recommended to introduce whole milk to infants until they are at least one year old. Infants should continue to be fed formula or breast milk exclusively until they reach this age, as their digestive systems are not yet ready to process whole milk. Introducing whole milk too early can lead to digestive issues and nutrient deficiencies.

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  • 27. 

    The nurse is teaching a program on healthy nutrition at the senior community center.  Which points should be included in the program for older adults? (Select all that apply)

    • A.

      Avoid grapefruit and grapefruit juice, which would impair drug absorption

    • B.

      Increase the amount of carbohydrates for energy

    • C.

      Take a multivitamin that includes vitamin D for bone health

    • D.

      Cheese and eggs are good sources of protein

    • E.

      Limit fluids to decrease the risk of edema

    Correct Answer(s)
    A. Avoid grapefruit and grapefruit juice, which would impair drug absorption
    C. Take a multivitamin that includes vitamin D for bone health
    D. Cheese and eggs are good sources of protein
    Explanation
    The program for older adults should include the points of avoiding grapefruit and grapefruit juice, as they can impair drug absorption. It is also important for them to take a multivitamin that includes vitamin D for bone health. Additionally, cheese and eggs are good sources of protein and should be included in their nutrition plan.

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  • 28. 

    The patient receiving TPN asks the nurse why his blood glucose is being checked since he does not have diabetes.  WHat is the best response by the nurse?

    • A.

      TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range

    • B.

      The high concentration of dextrose in the TPN can give you diabetes; thus you need to be monitored closely

    • C.

      Monitoring your blood glucose level helps to determine the dose of insulin that you need to absorb the TPN

    • D.

      Checking your blood glucose regularly helps to determine if the TPN is effective as a nutrition intervention

    Correct Answer
    A. TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range
    Explanation
    TPN (total parenteral nutrition) is a method of providing nutrition directly into the bloodstream. It contains a high concentration of dextrose, which can cause an increase in blood glucose levels, leading to hyperglycemia. Monitoring blood glucose levels is important to ensure that the patient's blood glucose remains within an acceptable range. By checking blood glucose regularly, healthcare providers can make adjustments to the TPN dosage or provide insulin if necessary to maintain a stable blood glucose level.

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  • 29. 

    Which nutrient is the body's most preferred energy source?

    • A.

      Fat

    • B.

      Protein

    • C.

      Vitamin

    • D.

      Carbohydrate

    Correct Answer
    D. Carbohydrate
    Explanation
    Carbohydrate is the body's most preferred energy source because it is easily broken down into glucose, which is then used by cells for energy production. Carbohydrates provide a quick and efficient source of energy compared to fats and proteins. Additionally, carbohydrates are stored in the body as glycogen, which can be readily accessed when energy demands increase. Vitamins are essential for various bodily functions but do not serve as a primary energy source.

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  • 30. 

    Positive nitrogen balance would occur in which condition?

    • A.

      Infection

    • B.

      Starvation

    • C.

      Pregnancy

    • D.

      Burn injury

    Correct Answer
    C. Pregnancy
    Explanation
    During pregnancy, the body's demand for nutrients increases to support the growth and development of the fetus. This increased demand leads to an increased intake of protein, which is necessary for the synthesis of new tissues. As a result, the body retains more nitrogen than it excretes, leading to a positive nitrogen balance. In contrast, infection, starvation, and burn injury can cause a negative nitrogen balance due to increased protein breakdown and decreased protein intake.

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  • 31. 

    Mrs. Nelson is talking with the nurse about the dietary needs of her 23 month old daughter, Laura.  Which of the following responses by the nurse would be appropriate?

    • A.

      Use skim milk to cut down on the fat in Laura's diet

    • B.

      Laura should be drinking at least 1 quart of milk per day

    • C.

      Laura needs less protein in her diet now because she isnt growing as fast

    • D.

      Laura needs fewer calories in relation to her body weight now than she did as an infant

    Correct Answer
    D. Laura needs fewer calories in relation to her body weight now than she did as an infant
    Explanation
    As children grow older, their growth rate slows down, resulting in a decreased need for calories. Therefore, it would be appropriate for the nurse to suggest that Laura needs fewer calories in relation to her body weight now than she did as an infant. This response acknowledges the developmental changes that occur as children transition from infancy to toddlerhood.

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  • 32. 

    All of the following patients are at risk for alteration in nutrition except:

    • A.

      Patient L, whose weight is 10% above his ideal body weight

    • B.

      Patient J, who is 86 years old, lives alone, and has poorly fitting dentures

    • C.

      Patient M, a 17 year old girl who weighs 90 pounds and frequently complains about her body fat

    • D.

      Patient K, who has been allowed NPO for 7 days after bowel surgery and is receiving 3000 mL of 10% dextrose per day

    Correct Answer
    A. Patient L, whose weight is 10% above his ideal body weight
    Explanation
    Patient L, whose weight is 10% above his ideal body weight, is not at risk for alteration in nutrition because being slightly overweight does not necessarily indicate poor nutrition. The other patients in the options have factors that put them at risk for alteration in nutrition. Patient J is at risk due to poor fitting dentures, which can make it difficult for them to eat and chew properly. Patient M is at risk due to their low body weight and body fat concerns, which may indicate an unhealthy relationship with food. Patient K is at risk due to being on NPO (nothing by mouth) status for 7 days after surgery, which can lead to inadequate nutrient intake.

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  • 33. 

    Which of the following is the most accurate method of bedside confirmation of placement of a small-bore nasogastric tube?

    • A.

      Assess the patient's ability to speak

    • B.

      Test the pH of withdrawn gastric contents

    • C.

      Auscultate the epigastrium for gurgling or bubbling

    • D.

      Assess the length of the tube that is outside the patient's nose.

    Correct Answer
    B. Test the pH of withdrawn gastric contents
    Explanation
    Testing the pH of withdrawn gastric contents is the most accurate method of bedside confirmation of placement of a small-bore nasogastric tube. This is because the pH of gastric contents is typically acidic, ranging from 1 to 5, indicating that the tube is correctly positioned in the stomach. Assessing the patient's ability to speak or auscultating the epigastrium for gurgling or bubbling may not provide definitive confirmation of tube placement. Assessing the length of the tube that is outside the patient's nose can give an indication of correct placement, but it is not as accurate as testing the pH of gastric contents.

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  • 34. 

    A patient who has been hospitalized after experiencing a heart attack will most likely receive a diet consisting of:

    • A.

      Low fat, Low sodium, and low carbs

    • B.

      Low fat, low sodium, and high carbs

    • C.

      Low fat, high protein, and high carbs

    • D.

      Liquids for several days, progressing to a soft and the regular diet

    Correct Answer
    B. Low fat, low sodium, and high carbs
    Explanation
    A patient who has been hospitalized after experiencing a heart attack will most likely receive a diet consisting of low fat, low sodium, and high carbs. This is because a low-fat diet helps to reduce the risk of further heart complications by preventing the build-up of cholesterol in the arteries. A low-sodium diet is important to control blood pressure, as high sodium intake can lead to fluid retention and strain on the heart. High carbohydrate intake is recommended to provide energy for the body, as the heart needs a constant supply of fuel to function properly.

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  • 35. 

    A nurse hears a colleague tell a nursing student that she never touches a patient unless she is performing a procedure or doing an assessment.  The nurse tells the student that from a caring perspective:

    • A.

      She does not touch the patients either

    • B.

      Touch is a type of verbal communication

    • C.

      There is never a problem with using touch

    • D.

      Touch forms a connection between nurse and patient

    Correct Answer
    D. Touch forms a connection between nurse and patient
    Explanation
    Touch forms a connection between a nurse and a patient. Touch is a nonverbal form of communication that can convey empathy, comfort, and support. By physically touching a patient, a nurse can establish a sense of trust and build a therapeutic relationship. Touch can also provide reassurance and promote healing. It is an important aspect of patient-centered care and can enhance the overall well-being of the patient.

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  • 36. 

    Of the 5 caring processes described by Swanson, which describes "Knowing the patient?"

    • A.

      Anticipating the patient's cultural preferences

    • B.

      Determining the patient's physician preference

    • C.

      Establishing an understanding of a specific patient

    • D.

      Gathering task oriented info during assessment

    Correct Answer
    C. Establishing an understanding of a specific patient
    Explanation
    The caring process of "Knowing the patient" refers to establishing an understanding of a specific patient. This involves developing a relationship with the patient, gaining knowledge about their unique characteristics, needs, and preferences, and using this information to provide individualized care. It goes beyond the surface level and aims to understand the patient holistically, including their physical, emotional, social, and spiritual dimensions. By knowing the patient, healthcare providers can tailor their care to meet the patient's specific needs and enhance their overall well-being.

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  • 37. 

    A Muslim woman enters the clinic to have a woman's health exam for the first time.  Which nursing behavior applies Swanson's caring process of "Knowing th patient?"

    • A.

      Sharing feelings about the importance of having regular woman's health exams.

    • B.

      Gaining and understanding of what a woman's health exam means to the patient

    • C.

      Recognizing that the patient is modest; obtaining gender-congruent caregiver

    • D.

      Explaining the risk factors for cervical cancer

    Correct Answer
    B. Gaining and understanding of what a woman's health exam means to the patient
    Explanation
    The nursing behavior that applies Swanson's caring process of "Knowing the patient" is gaining an understanding of what a woman's health exam means to the patient. This involves taking the time to listen to and understand the patient's thoughts, feelings, and concerns about the exam. By doing so, the nurse can provide personalized and patient-centered care, addressing any fears or misconceptions the patient may have and ensuring that their individual needs and preferences are met.

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  • 38. 

    Helping a new mother through the birthing experience demonstrates which of Swanson's 5 caring processes?

    • A.

      Knowing

    • B.

      Enabling

    • C.

      Doing for

    • D.

      Being with

    Correct Answer
    B. Enabling
    Explanation
    Enabling is the correct answer because helping a new mother through the birthing experience involves providing support, resources, and information that empower her to make informed decisions and take an active role in her own care. By enabling her, the caregiver helps the mother gain confidence and autonomy during this transformative experience.

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  • 39. 

    A patient is fearful of upcoming surgery and a possible cancer diagnosis.  He discusses his love for the bible with his nurse, who recommends a favorite bible verse.  Another nurse tells the patient's nurse that there is no place in nursing for spiritual caring.  The patient's nurse replies:

    • A.

      Spiritual care should be left to a professional

    • B.

      You are correct, religion is a personal decision

    • C.

      Nurses should not force their religious beliefs on patients

    • D.

      Spiritual, mind, and body connections can affect health

    Correct Answer
    D. Spiritual, mind, and body connections can affect health
    Explanation
    The patient's nurse replies that spiritual, mind, and body connections can affect health. This response acknowledges the importance of spirituality in healthcare and recognizes that it can have an impact on a patient's well-being. It suggests that addressing the patient's spiritual needs can contribute to their overall health and healing process.

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  • 40. 

    Which of the following is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors?

    • A.

      Increasing the working hours of the staff

    • B.

      Increasing salary benefits of the staff

    • C.

      Creating a setting that allows flexibility and autonomy for staff

    • D.

      Encouraging increased input concerning nursing functions from physicians.

    Correct Answer
    C. Creating a setting that allows flexibility and autonomy for staff
    Explanation
    Creating a setting that allows flexibility and autonomy for staff is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors. By providing flexibility, nurses are able to customize their approach to patient care and adapt to individual needs. Autonomy allows nurses to make decisions and take ownership of their work, which can lead to increased job satisfaction and a greater sense of fulfillment in their role. This can ultimately result in more caring behaviors towards patients as nurses feel empowered and valued in their work environment.

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  • 41. 

    When a nurse helps a patient find the meaning of cancer by supporting beliefs about life, this is an example of:

    • A.

      Instilling hope and faith

    • B.

      Forming a human-altruistic value system

    • C.

      Cultural caring

    • D.

      Being with

    Correct Answer
    A. Instilling hope and faith
    Explanation
    When a nurse helps a patient find the meaning of cancer by supporting their beliefs about life, it is an example of instilling hope and faith. By providing emotional support and fostering a positive mindset, the nurse helps the patient maintain a sense of hope and belief in their ability to overcome the challenges posed by cancer. This can have a significant impact on the patient's well-being and their ability to cope with the disease.

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  • 42. 

    An example of a nurse caring behavior that families of acutely ill patients percieve as important to patients' well-being is:

    • A.

      Making health care decisions for patients

    • B.

      Having family members provide a patient's total personal hygiene

    • C.

      Injecting the nurse's perceptions about the level of care provided

    • D.

      Asking permission before performing a procedure on a patient

    Correct Answer
    D. Asking permission before performing a procedure on a patient
    Explanation
    Asking permission before performing a procedure on a patient is an example of a nurse caring behavior that families of acutely ill patients perceive as important to patients' well-being. This behavior shows respect for the patient's autonomy and allows them to be involved in their own care. It also promotes trust and open communication between the nurse, patient, and family members. By seeking permission, the nurse acknowledges the patient's right to make decisions about their own body and treatment, fostering a sense of dignity and empowerment.

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  • 43. 

    A nurse demonstrates caring by helping family members:

    • A.

      Become active participants in care

    • B.

      Provide activities of daily living

    • C.

      Remove themselves from personal care

    • D.

      Make health care decisions for the patient

    Correct Answer
    A. Become active participants in care
    Explanation
    A nurse demonstrates caring by helping family members become active participants in care. This means that the nurse supports and encourages family members to be involved in the care of their loved ones. By doing so, the nurse recognizes the importance of the family's role in the patient's well-being and promotes collaboration between the healthcare team and the family. This can include educating the family about the patient's condition, involving them in care planning and decision-making, and providing support and resources to help them actively participate in the patient's care.

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  • 44. 

    Listening is not only "taking in" what the patient says, it also includes:

    • A.

      Incorporating the views of the physician

    • B.

      Correcting any errors in the patient's understanding

    • C.

      Injecting the nurse's personal views and statements

    • D.

      Interpreting and understanding what the patient means

    Correct Answer
    D. Interpreting and understanding what the patient means
    Explanation
    Listening in healthcare involves more than just passively hearing what the patient says. It also involves actively interpreting and understanding what the patient means. This goes beyond the literal words spoken and requires the healthcare professional to consider the patient's emotions, non-verbal cues, and context to fully grasp their intentions and needs. By doing so, healthcare providers can better address the patient's concerns, provide appropriate care, and establish effective communication and rapport. Incorporating the views of the physician, correcting errors in the patient's understanding, and injecting personal views and statements are not part of active listening and can hinder effective communication.

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  • 45. 

    A nurse is caring for an older adult who needs to enter an assisted living facility following discharge from the hospital.  Which of the following is an example of listening that displays caring?

    • A.

      The nurse encourages the patient to talk about his concerns while reviewing the computer screen in the room

    • B.

      The nurse sits at the patient's bedside, listens as he relays his fear of never seeing his home again, and then asks if he wants anything to eat

    • C.

      The nurse listens to the patient's story while sitting on the side of the bedand then summarizes the story

    • D.

      The nurse listens the the patient talk about his fears of not returning home and then tells him to think positively

    Correct Answer
    C. The nurse listens to the patient's story while sitting on the side of the bedand then summarizes the story
    Explanation
    The answer is the nurse listens to the patient's story while sitting on the side of the bed and then summarizes the story. This example demonstrates active listening and empathy. By sitting at the patient's bedside and summarizing the story, the nurse shows that they are fully engaged and interested in understanding the patient's concerns. This type of listening displays caring because it shows the nurse's willingness to listen, validate the patient's feelings, and provide support.

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  • 46. 

    Presence involves a person-to-person encounter that:

    • A.

      Enables patients to care for self

    • B.

      Provides personal care to a patient

    • C.

      Conveys a closeness and a sense of caring

    • D.

      Describes being in close contact with a patient

    Correct Answer
    C. Conveys a closeness and a sense of caring
    Explanation
    The correct answer conveys a closeness and a sense of caring. This means that presence involves creating an atmosphere of intimacy and compassion towards the patient. It goes beyond just providing personal care or enabling the patient to care for themselves. Presence is about establishing a connection with the patient, making them feel supported and understood. It is about being emotionally present and demonstrating empathy towards the patient's needs and concerns.

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  • 47. 

    A nurse enters a pateint's room and arranges the supplies for a foley catheterinsertion, and explains the procedure to the patient.  She tells the patient what to expect; just before inserting the catheter, she tells the patient to relax and that once the catheter is in place, she will not feel the bladder pressure.  The nurse then proceeds to skillfully insert the foley catheter.  This is an example of what type of touch?

    • A.

      Caring touch

    • B.

      Protective touch

    • C.

      Task oriented touch

    • D.

      Interpersonal touch

    Correct Answer
    C. Task oriented touch
    Explanation
    The nurse's action of arranging the supplies, explaining the procedure, and skillfully inserting the catheter demonstrates a task-oriented touch. This type of touch is focused on efficiently and effectively completing a specific task or procedure, in this case, inserting the foley catheter. The nurse's primary goal is to provide the necessary care and ensure the procedure is carried out successfully. The touch is not primarily driven by a caring or protective intention, but rather by the task at hand.

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  • 48. 

    A hospice nurse sits at the bedside of a male patient in the final stages of cancer.  He and his parents made the decision that he would move home and they would help him in the final stages of his disease.  The pamily participates in his care, but lately the nurse has increased the amount of time she spends with the family.  Whenever she enters the room or approaches the patient to give care, she touches his shoulder and tells him she is present.  This is an example of what type of touch?

    • A.

      Caring touch

    • B.

      Protective touch

    • C.

      Task-oriented touch

    • D.

      Interpersonal touch

    Correct Answer
    A. Caring touch
    Explanation
    The nurse's action of touching the patient's shoulder and reassuring him that she is present demonstrates a caring touch. This type of touch is meant to provide comfort, support, and emotional connection to the patient and their family during the final stages of the disease. It helps to establish trust, show empathy, and convey a sense of compassion and care.

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  • 49. 

    Leinunger's care theory states that the patient's caring values and behaviors are derived largely from:

    • A.

      Gender

    • B.

      Culture

    • C.

      Experience

    • D.

      Religious beliefs

    Correct Answer
    B. Culture
    Explanation
    Leinunger's care theory suggests that a patient's caring values and behaviors are primarily influenced by their culture. This means that the customs, traditions, and beliefs of their specific cultural background play a significant role in shaping their approach to care. This can include factors such as language, social norms, and societal expectations. By understanding a patient's cultural background, healthcare providers can better tailor their care to meet their specific needs and preferences.

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  • 50. 

    The central common theme of caring theories is:

    • A.

      Maintenance of patient homeostasis

    • B.

      Compensation for patient disabilities

    • C.

      Pathophysiology and self-care abilities

    • D.

      The nurse-patient relationship and psychosocial aspects of care

    Correct Answer
    D. The nurse-patient relationship and psychosocial aspects of care
    Explanation
    The central common theme of caring theories is the nurse-patient relationship and psychosocial aspects of care. Caring theories emphasize the importance of establishing a therapeutic relationship between the nurse and the patient, where the nurse provides emotional support, empathy, and respect to promote the patient's well-being. These theories also highlight the significance of considering the psychosocial aspects of care, such as the patient's cultural background, values, beliefs, and social support system, in order to provide holistic and patient-centered care.

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