N10 EXAM 3 QUESTIONS AND ANSWERS | 2022 LATEST UPDATE

N10 EXAM 3 Fundamental book - Chapters 8, 23, 32, 35, 36, 37, 38, 41, 42, 43 ATI Chapters 25, 30, 32-36, 39, 40, 43-45 Aging Chapters 11, 12, 13, 14, 15, 16, 27 CH 8 - communication 1. During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. Upon entering the room, what is the nurse’s BEST response? a. “You need to speak to the patient quietly so you don’t disturb the other patients.” b. “Let me help you with your transfer technique.” c. “When you are finished, be sure to apologize for your rough demeanor.” d. “When your patient is safe and comfortable, meet me at the desk.” 2. A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, “How is she doing, since the baby’s father is no help?” What is the nurse’s BEST response to the neighbor? a. “New mothers need support.” b. “The lack of a father is difficult.” c. “How are you today?” d. “It is a very sad situation.” 3. A 3-year-old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents? a. The use of reflective questions b. The use of closed questions c. The use of assertive questions d. The use of clarifying questions 4. A nurse enters a patient’s room and examines the patient’s IV fluids and cardiac monitor. The patient states, “Well, I haven’t seen you before. Who are you?” What is the nurse’s BEST response? a. “I’m just the IV therapist checking your IV.” b. “I’ve been transferred to this division and will be caring for you.” c. “I’m sorry, my name is John Smith and I am your nurse.” d. “My name is John Smith, I am your nurse and I’ll be caring for you until 11 PM.” 5. A nurse enters the room of a patient with cancer. The patient is crying and states, “I feel so alone.” Which response by the nurse is the most therapeutic action? a. The nurse stands at the patient’s bedside and states, “I understand how you feel. My mother said the same thing when she was ill.” b. The nurse places a hand on the patient’s arm and states, “You feel so alone.” c. The nurse stands in the patient’s room and asks, “Why do you feel so alone? Your wife has been here every day.” d. The nurse holds the patient’s hand and asks, “What makes you feel so alone?” 6. A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of the helping relationship? a. Determining the progress made in achieving established goals b. Clarifying when the patient should take medications c. Reporting the progress made in teaching to the staff d. Including all family members in the teaching session 7. A nursing student is nervous and concerned about working at a clinical facility. Which action would BEST decrease anxiety and ensure success in the student’s provision of patient care? a. Determining the established goals of the institution b. Ensuring that verbal and nonverbal communication is congruent c. Engaging in self-talk to plan the day and decrease fear d. Speaking with fellow colleagues about how they feel 8. A nurse in the rehabilitation division states to the head nurse: “I need the day off and you didn’t give it to me!” The head nurse replies, “Well, I wasn’t aware you needed the day off, and it isn’t possible since staffing is so inadequate.” Instead of this exchange, what communication by the nurse would have been more effective? a. “I placed a request to have 8th of August off, but I’m working and I have a doctor’s appointment.” b. “I would like to discuss my schedule with you. I requested the 8th of August off for a doctor’s appointment. Could I make an appointment?” c. “I will need to call in on the 8th of August because I have a doctor’s appointment.” d. “Since you didn’t give me the 8th of August off, will I need to find someone to work for me?” 9. During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply. a. Group decision making b. Group leadership c. Group power d. Group identity e. Group patterns of interaction f. Group cohesiveness 10. A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. Based on these nonverbal clues, for which condition would the nurse assess? a. Pain b. Anxiety c. Depression d. Fluid volume deficit 11. A nursing student is preparing to administer morning care to a patient. What is the MOST important question that the nursing student should ask the patient about personal hygiene? a. “Would you prefer a bath or a shower?” b. “May I help you with a bed bath now or later this morning?” c. “I will be giving you your bath. Do you use soap or shower gel?” d. “I prefer a shower in the evening. When would you like your bath?” 12. A nurse is providing instruction to a patient regarding the procedure to change a colostomy bag. During the teaching session, the patient asks, “What type of foods should I avoid to prevent gas?” The patient’s question allows for what type of communication on the nurse’s part? a. A closed-ended answer b. Information clarification c. The nurse to give advice d. Assertive behavior 13. When interacting with a patient, the nurse answers, “I am sure everything will be fine. You have nothing to worry about.” This is an example of what type of inappropriate communication technique? a. Cliché b. Giving advice c. Being judgmental d. Changing the subject 14. A patient states, “I have been experiencing complications of diabetes.” The nurse needs to direct the patient to gain more information. What is the MOST appropriate comment or question to elicit additional information? a. “Do you take two injections of insulin to decrease the complications?” b. “Most health care providers recommend diet and exercise to regulate blood sugar.” c. “Most complications of diabetes are related to neuropathy.” d. “What specific complications have you experienced?” 15. During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after communicating the nursing care plan. What would be appropriate nurse responses in this situation? Select all that apply. a. Fill the silence with lighter conversation directed at the patient. b. Use the time to perform the care that is needed uninterrupted. c. Discuss the silence with the patient to ascertain its meaning. d. Allow the patient time to think and explore inner thoughts. e. Determine if the patient’s culture requires pauses between conversation. f. Arrange for a counselor to help the patient cope with emotional issues. CH 23 - the aging adult 1. A nurse caring for adults in a provider’s office researches aging theories to understand why some patients age more rapidly than others. Which statements describe the immunity theory of the aging process? Select all that apply. a. Chemical reactions in the body produce damage to the DNA. b. Free radicals have adverse effects on adjacent molecules. c. Decrease in size and function of the thymus results in more infections. d. There is much interest in the role of vitamin supplementation. e. Lifespan depends on a great extent to genetic factors. f. Organisms wear out from increased metabolic functioning. 2. A nurse caring for older adults in a skilled nursing home observes physical changes in patients that are part of the normal aging process. Which changes reflect this process? Select all that apply. a. Fatty tissue is redistributed. b. The skin is drier and wrinkles appear. c. Cardiac output increases. d. Muscle mass increases. e. Hormone production increases. f. Visual and hearing acuity diminishes. 3. A nurse caring for patients in a primary care setting refers to Erikson’s theory that middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which patient statement is an example of this finding? a. “I am helping my parents move into an assisted-living facility.” b. “I spend all of my time going to the doctor to be sure I am not sick.” c. “I have enough money to help my son and his wife when they need it.” d. “I earned this gray hair and I like it!” 4. A nurse providing health services for a 55 plus community setting formulates diagnoses for patients. Which of the following nursing diagnoses would be most appropriate for many middle adults? a. Risk for Imbalanced Nutrition: Less Than Body Requirements b. Delayed Growth and Development c. Self-Care Deficit d. Caregiver Role Strain 5. An experienced nurse tells a less-experienced nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have “outlived their usefulness.” What is the term for this type of prejudice? a. Harassment b. Whistle blowing c. EA d. Ageism 6. A nurse is caring for older adults in a senior adult day services (ADS) center. Which findings related to the normal aging process would the nurse be likely to observe? Select all that apply. a. Patients with wrinkles on the face and arms due to increased skin elasticity b. A patient with skin pigmentation caused by exposure to sun over the years c. A patient with thinner toenails with a bluish tint to the nail beds d. A patient healing from a hip fracture that occurred due to porous and brittle bones e. Bruising on a patient’s forearms due to fragile blood vessels in the dermis f. Decreased patient voiding due to increased bladder capacity 7. A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? a. Most older adults live in their own homes. b. Healthy older adults enjoy sexual activity. c. Old age means mental deterioration. d. Older adults want to be attractive to others. 8. A nurse is helping to prepare a calendar for an older adult patient with cognitive impairment. What is the leading cause of cognitive impairment in old age? a. Stroke b. Malnutrition c. AD d. Loss of cardiac reserve 9. A nurse is caring for an 80-year-old patient who is living in a long-term care facility. To help this patient adapt to the present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? a. “Tell me about how you celebrated Christmas when you were young.” b. “Tell me how you plan to spend your time this weekend.” c. “Did you enjoy the choral group that performed here yesterday? d. “Why don’t you want to talk about your feelings?” 10. Following a fall that left an older adult temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply. a. S—Senility b. P—Problems with feeding c. I—Irritability d. C—Confusion e. E—Edema of the legs f. S—Skin breakdown CH 32 - skin integrity and wound care 1. Thirty-six hours after having surgery, a patient has a slightly elevated body temperature and generalized malaise, as well as pain and redness at the surgical site. Which intervention is most important to include in this patient’s nursing care plan? a. Document the findings and continue to monitor the patient. b. Administer antipyretics, as prescribed. c. Increase the frequency of assessment to every hour and notify the patient’s primary care provider. d. Increase the frequency of wound care and contact the primary care provider for an antibiotic prescription. 2. A nurse caring for patients in the PACU teaches a novice nurse how to assess and document wound drainage. Which statements accurately describe a characteristic of wound drainage? Select all that apply. a. Serous drainage is composed of the clear portion of the blood and serous membranes. b. Sanguineous drainage is composed of a large number of red blood cells and looks like blood. c. Bright-red sanguineous drainage indicates fresh bleeding and darker drainage indicates older bleeding. d. Purulent drainage is composed of white blood cells, dead tissue, and bacteria. e. Purulent drainage is thin, cloudy, and watery and may have a musty or foul odor. f. Serosanguineous drainage can be dark yellow or green depending on the causative organism. 3. A patient who has a large abdominal wound suddenly calls out for help because the patient feels as though something is falling out of her incision. Inspection reveals a gaping open wound with tissue bulging outward. In which order should the nurse perform the following interventions? Arrange from first to last. a. Notify the health care provider of the situation. b. Cover the exposed tissue with sterile towels moistened with sterile 0.9% sodium chloride solution. c. Place the patient in the low Fowler’s position. i. CORRECT ORDER C - B - A 4. A patient was in an automobile accident and received a wound across the nose and cheek. After surgery to repair the wound, the patient says, “I am so ugly now.” Based on this statement, what nursing diagnosis would be most appropriate? a. Pain b. Impaired Skin Integrity c. Disturbed Body Image d. Disturbed Thought Processes 5. A patient is admitted with a nonhealing surgical wound. Which nursing action is most effective in preventing a wound infection? a. Using sterile dressing supplies b. Suggesting dietary supplements c. Applying antibiotic ointment d. Performing careful hand hygiene 6. A nurse who is changing dressings of postoperative patients in the hospital documents various phases of wound healing on the patient charts. Which statements accurately describe these stages? Select all that apply. a. Hemostasis occurs immediately after the initial injury. b. A liquid called exudate is formed during the proliferation phase. c. White blood cells move to the wound in the inflammatory phase. d. Granulation tissue forms in the inflammatory phase. e. During the inflammatory phase, the patient has generalized body response. f. A scar forms during the proliferation phase. 7. The nurse assesses the wound of a patient who was cut on the upper thigh with a chain saw. The nurse documents the presence of biofilms in the wound. What is the effect of this condition on the wound? Select all that apply. a. Enhanced healing due to the presence of sugars and proteins b. Delayed healing due to dead tissue present in the wound c. Decreased effectiveness of antibiotics against the bacteria d. Impaired skin integrity due to overhydration of the cells of the wound e. Delayed healing due to cells dehydrating and dying f. Decreased effectiveness of the patient’s normal immune process 8. The nurse is cleaning an open abdominal wound that has unapproximated edges. What are accurate steps in this procedure? Select all that apply. a. Use standard precautions or transmission-based precautions when indicated. b. Moisten a sterile gauze pad or swab with the prescribed cleansing agent and squeeze out excess solution. c. Clean the wound in full or half circles beginning on the outside and working toward the center. d. Work outward from the incision in lines that are parallel to it from the dirty area to the clean area. e. Clean to at least 1 in beyond the end of the new dressing if one is being applied. f. Clean to at least 3 in beyond the wound if a new dressing is not being applied. 9. A nurse is developing a care plan for an 86-year-old patient who has been admitted for right hip arthroplasty (hip replacement). Which assessment finding(s) indicate a high risk for pressure injury development for this patient? Select all that apply. a. The patient takes time to think about responses to questions. b. The patient is 86 years old. c. The patient reports inability to control urine. d. The patient is scheduled for a hip arthroplasty. e. Lab findings include BUN 12 (older adult normal 8 to 23 mg/dL) and creatinine 0.9 (adult female normal 0.61 to 1 mg/dL). f. The patient reports increased pain in right hip when repositioning in bed or chair. 10. A nurse is explaining to a patient the anticipated effect of the application of cold to an injured area. What response indicates that the patient understands the explanation? a. “I can expect to have more discomfort in the area where the cold is applied.” b. “I should expect more drainage from the incision after the ice has been in place.” c. “I should see less swelling and redness with the cold treatment.” d. “My incision may bleed more when the ice is first applied.” 11. A nurse is providing patient teaching regarding the use of negative pressure wound therapy. Which explanation provides the most accurate information to the patient? a. The therapy is used to collect excess blood loss and prevent the formation of a scab. b. The therapy will prevent infection, ensuring that the wound heals with less scar tissue. c. The therapy provides a moist environment and stimulates blood flow to the wound. d. The therapy irrigates the wound to keep it free from debris and excess wound fluid. 12. After an initial skin assessment, the nurse documents the presence of a reddened area that has blistered. According to recognized staging systems, this pressure injury would be classified as: a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 13. The nurse uses the RYB wound classification system to assess the wound of a patient whose arm was cut on a factory machine. The nurse documents the wound as “red.” What would be the priority nursing intervention for this type of wound? a. Irrigate the wound. b. Provide gentle cleansing of the wound. c. Debride the wound. d. Change the dressing frequently. 14. A nurse is developing a care plan related to prevention of pressure injuries for residents in a long-term care facility. Which action accurately describes a priority intervention in preventing a patient from developing a pressure injury? a. Keeping the head of the bed elevated as often as possible b. Massaging over bony prominences c. Repositioning bed-bound patients every 4 hours d. Using a mild cleansing agent when cleansing the skin 15. A nurse is measuring the depth of a patient’s puncture wound. Which technique is recommended? a. Moisten a sterile, flexible applicator with saline and insert it gently into the wound at a 90-degree angle with the tip down. b. Draw the shape of the wound and describe how deep it appears in centimeters. c. Gently insert a sterile applicator into the wound and move it in a clockwise direction. d. Insert a calibrated probe gently into the wound and mark the point that is even with the surrounding skin surface with a marker. CH 35 - COMFORT AND PAIN MANAGEMENT 1. A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon? Select all that apply. a. Pain is whatever the health care provider treating the pain says it is b. Pain exists whenever the person experiencing it says it exists c. Pain is an emotional and sensory reaction to tissue damage d. Pain is a simple, universal, and easy-to-describe phenomenon e. Pain that occurs without a known cause is psychological in nature f. Pain is classified by duration, location, source, transmission, and etiology 2. A nurse is monitoring patients in a hospital setting for acute and chronic pain. Which patients would most likely receive analgesics for chronic pain from the nurse? Select all that apply. a. A patient is receiving chemotherapy for bladder cancer b. An adolescent is admitted to the hospital for an appendectomy c. A patient is experiencing a ruptured aneurysm d. A patient who has fibromyalgia requests pain medication e. A patient has back pain related to an accident that occurred last year f. A patient is experiencing pain from second-degree burns 3. A patient reports abdominal pain that is difficult to localize. The nurse documents this as which type of pain? a. Cutaneous b. Visceral c. Superficial d. Somatic 4. A patient who is having a myocardial infarction reports pain that is situated in the neck. The nurse documents this as what type of pain? a. Transient pain b. Superficial pain c. Phantom pain d. Referred pain 5. The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply. a. A patient cradles a wrist that was injured in a car accident b. A child is moaning and crying due to a stomachache c. A patient’s pulse is increased following a myocardial infarction d. A patient in pain strikes out at a nurse who attempts to provide a bath e. A patient who has chronic cancer pain is depressed and withdrawn f. A child pulls away from a nurse trying to give an injection 6. A nurse is caring for patients in a hospital setting. Which patient would the nurse place at risk for pain related to the mechanical activation of pain receptors? a. An older adult on bedrest following cervical spine surgery b. A patient with a severe sunburn being treated for dehydration c. An industrial worker who has burns caused by a caustic acid d. A patient experiencing cardiac disturbances from an electrical shock 7. A nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in the patient’s legs. What is a potent pain-blocking neuromodulator, released through relaxation techniques? a. Prostaglandins b. Substance P c. Endorphins d. Serotonin 8. A patient is postoperative following an emergency cesarean section birth. The patient asks the nurse about the use of pain medications following surgery. What would be a correct response by the nurse? a. “It’s not a good idea to ask for pain medication regularly as it can be addictive.” b. “It is better to wait until the pain is severe before asking for pain medication.” c. “It’s natural to have to put up with pain after surgery and it will lessen in intensity in a few days.” d. “Your doctor has prescribed pain medications for you, which you should request when you have pain.” 9. Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? a. Encouraging regular use of analgesics b. Applying a moist heating pad to the area at prescribed intervals c. Reviewing the pain experience with the patient d. Ambulating the patient after administering medication 10. The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient? a. CRIES scale b. COMFORT scale c. FLACC scale d. FACES scale 11. When the nurse assists a patient recovering from abdominal surgery to walk, the nurse observes that the patient grimaces, moves stiffly, and becomes pale. The nurse is aware that the patient has consistently refused pain medication. What would be a priority nursing diagnosis for this patient? a. Acute Pain related to fear of taking prescribed postoperative medications b. Impaired Physical Mobility related to surgical procedure c. Anxiety related to outcome of surgery d. Risk for Infection related to surgical incision 12. When developing the care plan for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain not related to cancer or palliative/end-of-life care is most effectively relieved through which method? a. Using the highest effective dose of an opioid on a PRN (as needed) basis b. Using nonopioid drugs conservatively c. Using consistent nonpharmacologic and nonopioid pharmacologic therapies d. Administering a continuous intravenous infusion on a regular basis 13. When assessing pain in a child, the nurse needs to be aware of what considerations? a. Immature neurologic development results in reduced sensation of pain b. Inadequate or inconsistent relief of pain is widespread c. Reliable assessment tools are currently unavailable d. Narcotic analgesic use should be avoided 14. A pregnant woman is receiving an epidural analgesic prior to delivery. The nurse provides vigilant monitoring of this patient to prevent the occurrence of what side effect? a. Pruritus b. Urinary retention c. Vomiting d. Respiratory depression 15. A nurse is assessing a patient receiving a continuous opioid infusion. For which related condition would the nurse immediately notify the primary care provider? a. A respiratory rate of 10/min with normal depth b. A sedation level of 4 c. Mild confusion d. Reported constipation CH 36 - nutrition 1. A nurse is calculating the body mass index (BMI) of a 35-year-old male patient who is extremely obese. The patient’s height is 5′6″ and his current weight is 325 lb. What would the nurse document as his BMI? a. 50.5 b. 52.4 c. 54.5 d. 55.2 2. A nurse is evaluating a patient following the administration of an enteral feeding. Which findings are normal and are criteria that indicate patient tolerance to the feeding? Select all that apply. a. Absence of nausea, vomiting b. Weight gain c. Bowel sounds within normal range d. Large amount of gastric residue e. Absence of diarrhea and constipation f. Slight abdominal pain and distention 3. A nurse is feeding an older adult patient who has dementia. Which intervention should the nurse perform to facilitate this process? a. Stroke the underside of the patient’s chin to promote swallowing. b. Serve meals in different places and at different times. c. Offer a whole tray of various foods to choose from. d. Avoid between-meal snacks to ensure hunger at mealtime. 4. A patient who has COPD is refusing to eat. Which intervention would be most helpful in stimulating appetite in this patient? a. Administering pain medication after meals. b. Encouraging food from home when possible. c. Scheduling his respiratory therapy before each meal. d. Reinforcing the importance of his eating exactly what is delivered to him. 5. A nurse is feeding a patient who is experiencing dysphagia. Which nursing intervention would the nurse initiate for this patient? a. Feed the patient solids first and then liquids last. b. Place the head of the bed at a 30-degree angle during feeding. c. Puree all foods to a liquid consistency. d. Provide a 30-minute rest period prior to mealtime. 6. A nurse is evaluating patients to determine their need for parenteral nutrition (PN). Which patients would be the best candidates for this type of nutritional support? Select all that apply. a. A patient with irritable bowel syndrome who has intractable diarrhea b. A patient with celiac disease not absorbing nutrients from the GI tract c. A patient who is underweight and needs short-term nutritional support d. A patient who is comatose and needs long-term nutritional support e. A patient who has anorexia and refuses to take foods via the oral route f. A patient with burns who has not been able to eat adequately for 5 days 7. A nurse is feeding a patient who states that she is feeling nauseated and can’t eat what is being offered. What would be the most appropriate initial action of the nurse in this situation? a. Remove the tray from the room. b. Administer an antiemetic and encourage the patient to take small amounts. c. Explore with the patient why she does not want to eat her food. d. Offer high-calorie snacks such as pudding and ice cream. 8. A patient has been admitted to the alcoholic referral unit in the local hospital. Based on an understanding of the effects of alcohol on the GI tract, which is a priority concern related to nutrition? a. Vitamin B malnutrition b. Obesity c. Dehydration d. Vitamin C deficiency 9. A nurse is caring for a newly placed gastrostomy tube of a postoperative patient. Which nursing action is performed correctly? a. The nurse dips a cotton-tipped applicator into sterile saline solution and gently cleans around the insertion site. b. The nurse wets a washcloth and washes the area around the tube with soap and water. c. The nurse adjusts the external disk every 3 hours to avoid crusting around the tube. d. The nurse tapes a gauze dressing over the site after cleansing it. 10. A nurse is assessing a patient who has been NPO (nothing by mouth) prior to abdominal surgery. The patient is ordered a clear liquid diet for breakfast, to advance to a house diet as tolerated. Which assessments would indicate to the nurse that the patient’s diet should not be advanced? a. The patient consumed 75% of the liquids on her breakfast tray. b. The patient tells you she is hungry. c. The patient’s abdomen is soft, nondistended, with bowel sounds. d. The patient reports fullness and diarrhea after breakfast. 11. A patient who is moved to a hospital bed following throat surgery is ordered to receive continuous tube feedings through a small-bore nasogastric tube. Following placement of the tube, which nursing action would the nurse initiate to ensure correct placement of the tube? a. Auscultate the bowel sounds. b. Measure the gastric aspirate pH. c. Measure the amount of residual in the tube. d. Obtain an order for a radiographic examination of the tube. 12. Which nursing diagnosis would be most appropriate for a patient with a body mass index (BMI) of 18? a. Risk for Imbalanced Nutrition: More Than Body Requirements b. Imbalanced Nutrition: More Than Body Requirements c. Readiness for Enhanced Nutrition d. Imbalanced Nutrition: Less Than Body Requirements 13. A nurse nutritionist is collecting assessment data for a patient who complains of “tiredness” and appears malnourished. The nurse orders tests for hemoglobin and hematocrit. What condition might these tests confirm? a. Malabsorption b. Anemia c. Protein depletion d. Reduction in total muscle mass 14. A nurse is administering a tube feeding for a patient who is post bowel surgery. When attempting to aspirate the contents, the nurse notes that the tube is clogged. What would be the nurse’s next action following this assessment? a. Use warm water or air and gentle pressure to remove the clog. b. Use a stylet to unclog the tubes. c. Administer cola to remove the clog. d. Replace the tube with a new one. 15. A nurse performs presurgical assessments of patients in an ambulatory care center. Which patient would the nurse report to the surgeon as possibly needing surgery to be postponed? a. A 19-year-old patient who is a vegan b. An older adult patient who takes daily nutritional drinks c. A 43-year-old patient who takes ginkgo biloba and an aspirin daily d. An infant who is breastfeeding CH 37 - urinary elimination 1. A nurse caring for patients in a long-term care facility is often required to collect urine specimens from patients for laboratory testing. Which techniques for urine collection are performed correctly? Select all that apply. a. The nurse catheterizes a patient to collect a sterile urine sample for routine urinalysis. b. The nurse collects a clean-catch urine specimen in the morning from a patient and stores it at room temperature until an afternoon pick-up. c. The nurse collects a sterile urine specimen from the collection receptacle of a patient’s indwelling catheter. d. The nurse collects about 3 mL of urine from a patient’s indwelling catheter to send for a urine culture. e. The nurse collects a urine specimen from a patient with a urinary diversion by catheterizing the stoma. f. The nurse discards the first urine of the day when performing a 24-hour urine specimen collection on a patient. 2. A nurse caring for patients in an extended-care facility performs regular assessments of the patients’ urinary functioning. Which patients would the nurse screen for urinary retention? Select all that apply. a. A 78-year-old male patient diagnosed with an enlarged prostate b. An 83-year-old female patient who is on bedrest c. A 75-year-old female patient who is diagnosed with vaginal prolapse d. An 89-year-old male patient who has dementia e. A 73-year-old female patient who is taking antihistamines to treat allergies f. A 90-year-old male patient who has difficulty walking to the bathroom 3. A nurse is preparing a brochure to teach patients how to prevent UTIs. Which teaching points would the nurse include? Select all that apply. a. Wear underwear with a synthetic crotch b. Take baths rather than showers c. Drink 8 to 10 8-oz glasses of water per day d. Drink a glass of water before and after intercourse and void afterward e. Dry the perineal area after urination or defecation from the front to the back f. Observe the urine for color, amount, odor, and frequency 4. A patient who has pneumonia has had a fever for 3 days. What characteristics would the nurse anticipate related to the patient’s urine output? a. Decreased and highly concentrated b. Decreased and highly dilute c. Increased and concentrated d. Increased and dilute 5. The health care provider has ordered an indwelling catheter inserted in a hospitalized male patient. What consideration would the nurse keep in mind when performing this procedure? a. The male urethra is more vulnerable to injury during insertion. b. In the hospital, a clean technique is used for catheter insertion. c. The catheter is inserted 2 to 3 in into the meatus. d. Since it uses a closed system, the risk for UTI is absent. 6. A nurse is ordered to perform continuous irrigation for a patient with a long-term urinary catheter. What rationale would the nurse expect for this order? a. Irrigation of long-term urinary catheters is a routine order. b. Irrigation is recommended to prevent the introduction of pathogens into the bladder. c. A blood clot threatens to block the catheter. d. It is preferred to irrigate the catheter rather than increase fluid intake by the patient. 7. A nurse is caring for a patient diagnosed with bladder cancer who has a urinary diversion. Which actions would the nurse take when caring for this patient? Select all that apply. a. Measure the patient’s fluid intake and output. b. Keep the skin around the stoma moist. c. Empty the appliance frequently. d. Report any mucus in the urine to the primary care provider. e. Encourage the patient to look away when changing the appliance. f. Monitor the return of intestinal function and peristalsis. 8. A nurse is changing the stoma appliance on a patient’s ileal conduit. Which characteristic of the stoma would alert the nurse that the patient is experiencing ischemia? a. The stoma is hard and dry. b. The stoma is a pale pink color. c. The stoma is swollen. d. The stoma is a purple-blue color. 9. After surgery, a patient is having difficulty voiding. Which nursing action would most likely lead to an increased difficulty with voiding? a. Pouring warm water over the patient’s fingers. b. Having the patient ignore the urge to void until her bladder is full. c. Using a warm bedpan when the patient feels the urge to void. d. Stroking the patient’s leg or thigh. 10. A nurse caring for a patient’s hemodialysis access documents the following: “5/10/20 0930 AV fistula patent in right upper arm. Area is warm to touch and edematous. Patient denies pain and tenderness. Positive bruit and thrill noted.” Which documented finding would the nurse report to the primary care provider? a. Positive bruit noted. b. Area is warm to touch and edematous. c. Patient denies pain and tenderness. d. Positive thrill noted. 11. A nurse is caring for an alert, ambulatory, older resident in a long-term care facility who voids frequently and has difficulty making it to the bathroom in time. Which nursing intervention would be most helpful for this patient? a. Teach the patient that incontinence is a normal occurrence with aging. b. Ask the patient’s family to purchase incontinence pads for the patient. c. Teach the patient to perform PFMT exercises at regular intervals daily. d. Insert an indwelling catheter to prevent skin breakdown. 12. A nurse is caring for a patient who is taking phenazopyridine (a urinary tract analgesic). The patient questions the nurse: “My urine was bright orangish red today; is there something wrong with me?” What would be the nurse’s best response? a. “This is a normal finding when taking phenazopyridine.” b. “This may be a sign of blood in the urine.” c. “This may be the result of an injury to your bladder.” d. “This is a sign that you are allergic to the medication and must stop it.” 13. A nurse is caring for a male patient who had a urinary sheath applied following hip surgery. What action would be a priority when caring for this patient? a. Preventing the tubing from kinking to maintain free urinary drainage b. Not removing the sheath for any reason c. Fastening the sheath tightly to prevent the possibility of leakage d. Maintaining bedrest at all times to prevent the sheath from slipping off 14. A nurse is ordered to catheterize a patient following surgery. Which nursing guideline would the nurse follow? a. The nurse would use different equipment for catheterization of male versus female patients. b. The nurse should use the smallest appropriate indwelling urinary catheter. c. The nurse should always sterilize the equipment prior to insertion. d. The nurse should choose a 12F, 5-mL or 10-mL balloon, unless ordered otherwise. 15. Data must be collected to evaluate the effectiveness of a plan to reduce urinary incontinence in an older adult. Which information is least important for the evaluation process? a. The incontinence pattern b. State of physical mobility c. Medications being taken d. Age of the patient CH 38 - bowel elimination 1. A nurse is assessing the abdomen of a patient who is experiencing frequent bouts of diarrhea. The nurse first observes the contour of the abdomen, noting any masses, scars, or areas of distention. What action would the nurse perform next?Auscultate the abdomen using an orderly clockwise approach in all abdominal quadrants. a. Percuss all quadrants of the abdomen in a systematic clockwise manner to identify masses, fluid, or air in the abdomen. b. Lightly palpate over the abdominal quadrants; first checking for any areas of pain or discomfort. c. Deeply palpate over the abdominal quadrants, noting muscular resistance, tenderness, organ enlargement, or masses. d. Deeply palpate over the abdominal quadrants, noting muscular resistance, tenderness, organ enlargement, or masses. 2. A nurse is administering a large-volume cleansing enema to a patient prior to surgery. Once the enema solution is introduced, the patient reports severe cramping. What nursing intervention would the nurse perform next based on this patient reaction? a. Elevate the head of the bed 30 degrees and reposition the rectal tube. b. Place the patient in a supine position and modify the amount of solution. c. Lower the solution container and check the temperature and flow rate. d. Remove the rectal tube and notify the primary care provider. 3. A nurse working in a hospital includes abdominal assessment as part of patient assessment. In which patients would a nurse expect to find decreased or absent bowel sounds after listening for 5 minutes? Select all that apply. a. A patient diagnosed with peritonitis b. A patient who is on prolonged bedrest c. A patient who has diarrhea d. A patient who has gastroenteritis e. A patient who has an early bowel obstruction f. A patient who has paralytic ileus caused by surgery 4. A nurse assesses the stool of patients who are experiencing gastrointestinal problems. In which patients would diarrhea be a possible finding? Select all that apply. a. A patient who is taking narcotics for pain b. A patient who is taking metformin for type 2 diabetes mellitus c. A patient who is taking diuretics d. A patient who is dehydrated e. A patient who is taking amoxicillin for an infection f. A patient taking over-the-counter antacids 5. A patient has a fecal impaction. Which nursing action is correctly performed when administering an oil-retention enema for this patient? a. The nurse administers a large volume of solution (500 to 1,000 mL) b. The nurse mixes milk and molasses in equal parts for an enema c. The nurse instructs the patient to retain the enema for at least 30 minutes d. The nurse administers the enema while the patient is sitting on the toilet 6. A nurse prepares to assist a patient with a newly created ileostomy. Which recommended patient teaching points would the nurse stress? Select all that apply. a. “When you inspect the stoma, it should be dark purple-blue.” b. “The size of the stoma will stabilize within 2 weeks.” c. “Keep the skin around the stoma site clean and moist.” d. “The stool from an ileostomy is normally liquid.” e. “You should eat dark-green vegetables to control the odor of the stool.” f. “You may have a tendency to develop food blockages.” 7. A nurse is preparing a hospitalized patient for a colonoscopy. Which nursing action is the recommended preparation for this test? a. Have the patient follow a low-fiber diet several days before the test. b. Have the patient take bisacodyl and ingest a gallon of bowel cleaner on day 1. c. Prepare the patient for the use of general anesthesia during the test. d. Explain that barium contrast mixture will be given to drink before the test. 8. A nurse is performing digital removal of stool on a patient with a fecal impaction. During the procedure the patient tells the nurse she is feeling dizzy and nauseated, and then vomits. What should be the nurse’s next action? a. Reassure the patient that this is a normal reaction to the procedure. b. Stop the procedure, prepare to administer CPR, and notify the primary care provider. c. Stop the procedure, assess vital signs, and notify the primary care provider. d. Stop the procedure, wait 5 minutes, and then resume the procedure. 9. A nurse is scheduling tests for a patient who has been experiencing epigastric pain. The health care provider ordered the following tests: (a) barium enema, (b) fecal occult blood test, (c) endoscopic studies, and (d) upper gastrointestinal series. Which is the correct order in which the tests would normally be performed? a. c, b, d, a b. d, c, a, b c. a, b, d, c d. b, a, d, c 10. A nurse is caring for a patient who has an NG tube in place for gastric decompression. Which nursing actions are appropriate when irrigating an NG tube connected to suction? Select all that apply. a. Draw up 30 mL of saline solution into the syringe. b. Unclamp the suction tubing near the connection site to instill solution. c. Place the tip of the syringe in the tube to gently insert saline solution. d. Place the syringe in the blue air vent of a Salem sump or double-lumen tube. e. After instilling irrigant, hold the end of the NG tube over an irrigation tray. f. Observe for return flow of NG drainage into an available container. 11. A nurse is planning a bowel-training program for a patient with frequent constipation. What is a recommended intervention? a. Using a diet that is low in bulk b. Decreasing fluid intake to 1,000 mL c. Administering an enema once a day to stimulate peristalsis d. Monitoring bowel movements 12. A nurse is caring for a patient who is post-surgical following an IPAA. For which adverse effect would the nurse monitor in this patient? a. Incontinence b. Constipation c. Electrolyte imbalances d. Infection 13. For which patient would a nurse expect the primary care provider to order colostomy irrigation? a. A patient with IBS b. A patient with a left-sided end colostomy in the sigmoid colon c. A patient with post-radiation damage to the bowel d. A patient with Crohn’s disease 14. A nurse is assisting a patient to empty and change an ostomy appliance. When the procedure is finished, the nurse notes that the stoma is protruding into the bag. What would be the nurse’s first action in this situation? a. Reassure the patient that this is a normal finding with a new ostomy. b. Notify the primary care provider that the stoma is prolapsed. c. Have the patient rest for 30 minutes to see if the prolapse resolves. d. Remove the appliance and redo the procedure using a larger appliance. 15. A nurse is caring for an older adult who has constipation. Which laxative would be contraindicated for this patient? a. A saline osmotic laxative b. A bulk-forming laxative c. Methylcellulose d. A stool softener CH 41 - self concept 1. A nurse is performing a psychological assessment of a 19-year-old patient who has Down’s syndrome. The patient is mildly developmentally disabled with an intelligence quotient of 82. He told his nurse, “I’m a good helper. You see I can carry these trays because I’m so strong. But I’m not very smart, so I have just learned to help with the things I know how to do.” What findings for self-concept and self-esteem would the nurse document for this patient? a. Negative self-concept and low self-esteem b. Negative self-concept and high self-esteem c. Positive self-concept and fairly high self-esteem d. Positive self-concept and low self-esteem 2. A nurse asks a 25-year-old patient to describe himself with a list of 20 words. After 15 minutes, the patient listed “25 years old, male, named Joe,” then declared he couldn’t think of anything else. What should the nurse document regarding this patient? a. Lack of self-esteem b. Deficient self-knowledge c. Unrealistic self-expectation d. Inability to evaluate himself 3. A nurse asks a patient who has few descriptors of his self to list facts, traits, or qualities that he would like to be descriptive of himself. The patient quickly lists 25 traits, all of which are characteristic of a successful man. When asked if he knows anyone like this, he replies, “My father; I wish I was like him.” What does the discrepancy between the patient’s description of himself as he is and as he would like to be indicate? a. Negative self-concept b. Modesty (lack of conceit) c. Body image disturbance d. Low self-esteem 4. A nurse is counseling a husband and wife who have decided that the wife will get a job so that the husband can go to pharmacy school. Their three teenagers, who were involved in the decision, are also getting jobs to buy their own clothes. The husband, who plans to work 12 to 16 hours weekly, while attending school, states, “I was always an A student, but I may have to settle for Bs now because I don’t want to neglect my family.” How would the nurse document the husband’s self-expectations? a. Realistic and positively motivating his development b. Unrealistic and negatively motivating his development c. Unrealistic but positively motivating his development d. Realistic but negatively motivating his development 5. A school nurse is teaching parents how to foster a healthy development of self in their children. Which statement made by one of the parents needs to be followed up with further teaching? a. “I love my child so much I ‘hug him to death’ every day.” b. “I think children need challenges, don’t you?” c. “My husband and I both grew up in very restrictive families. We want our children to be free to do whatever they want.” d. “My husband and I have different ideas about discipline, but we’re talking this out because we know it’s important for Johnny that we be consistent.” 6. A mother of a 10-year-old daughter tells the nurse: “I feel incompetent as a parent and don’t know how to discipline my daughter.” What should be the nurse’s first intervention when counseling this patient? a. Recommend that she discipline her daughter more strictly and consistently. b. Make a list of things her husband can do to give her more time and help her improve her parenting skills. c. Assist the mother to identify both what she believes is preventing her success and what she can do to improve. d. Explore with the mother what the daughter can do to improve her behavior and make the mother’s role as a parent easier. 7. A nurse is counseling parents attending a parent workshop on how to build self-esteem in their children. Which teaching points would the nurse include to help parents achieve this goal? Select all that apply. a. Teach the parents to reinforce their child’s positive qualities. b. Teach the parents to overlook occasional negative behavior. c. Teach parents to ignore neutral behavior that is a matter of personal preference. d. Teach parents to listen and “fix things” for their children. e. Teach parents to describe the child’s behavior and judge it. f. Teach parents to let their children practice skills and make it safe to fail. 8. A nurse practicing in a health care provider’s office assesses self-concept in patients during the patient interview. Which patient is least likely to develop problems related to self-concept? a. A 55-year-old television news reporter undergoing a hysterectomy (removal of uterus) b. A young clergyperson whose vocal cords are paralyzed after a motorbike accident c. A 32-year-old accountant who survives a massive heart attack d. A 23-year-old model who just learned that she has breast cancer 9. A patient who has been in the United States only 3 months has recently suffered the loss of her husband and job. She states that nothing feels familiar—“I don’t know who I am supposed to be here”—and says that she “misses home terribly.” For what alteration in self-concept is this patient most at risk? a. Personal Identity Disturbance b. Body Image Disturbance c. Self-Esteem Disturbance d. Altered Role Performance 10. A sophomore in high school has missed a lot of school this year because of leukemia. He said he feels like he is falling behind in everything, and misses “hanging out at the mall” with his friends most of all. For what disturbance in self-concept is this patient at risk? a. Personal Identity Disturbance b. Body Image Disturbance c. Self-Esteem Disturbance d. Altered Role Performance 11. A college freshman away from home for the first time says to a counselor, “Why did I have to be born into a family of big bottoms and short fat legs! No one will ever ask me out for a date. Oh, why can’t I have long thin legs like everyone else in my class? What a frump I am.” What type of disturbance in self-concept is this patient experiencing? a. Personal Identity Disturbance b. Body Image Disturbance c. Self-Esteem Disturbance d. Altered Role Performance 12. A 33-year-old businessperson is in counseling, attempting to deal with a long-repressed history of sexual abuse by her father. “I guess I should feel satisfied with what I’ve achieved in life, but I’m never content, and nothing I achieve makes me feel good about myself…. I hate my father for making me feel like I’m no good. This is an awful way to live.” What self-concept disturbance is this person experiencing? a. Personal Identity Disturbance b. Body Image Disturbance c. Self-Esteem Disturbance d. Altered Role Performance 13. A 36-year-old woman enters the emergency department with severe burns and cuts on her face after an auto accident in a car driven by her fiancé of 3 months. Three weeks later, her fiancé has not yet contacted her. The patient states that she is very busy and she is too tired to have visitors anyway. The patient frequently lies with her eyes closed and head turned away. What do these data suggest? a. There is no disturbance in self-concept. b. This patient has ego strength and high self-esteem but may have a disturbance of body image. c. The area of self-esteem has very low priority at this time and should be ignored until much later. d. It is probable that there are disturbances in self-esteem and body image. 14. A nurse is performing patient care for a severely ill patient who has cancer. Which nursing interventions are likely to assist this patient to maintain a positive sense of self? Select all that apply. a. The nurse makes a point to address the patient by name upon entering the room. b. The nurse avoids fatiguing the patient by performing all procedures in silence. c. The nurse performs care in a manner that respects the patient’s privacy and sensibilities. d. The nurse offers the patient a simple explanation before moving her in any way. e. The nurse ignores negative feelings from the patient since they are part of the grieving process. f. The nurse avoids conversing with the patient about her life, family, and occupation. 15. A 16-year-old patient has been diagnosed with Body Image Disturbance related to severe acne. In planning nursing care, what is an appropriate goal for this patient? a. The patient will make above-B grades in all tests at school. b. The patient will demonstrate, by diet control and skin care, increased interest in control of acne. c. The patient reports that she feels more self-confident in her music and art, which she enjoys. d. The patient expresses that she is very smart in school. CH 42 - stress & adaptation 1. A nurse is assessing a patient who complains of migraines that have become “unbearable.” The patient tells the nurse, “I just got laid off from my job last week and I have two kids in college. I don’t know how I’m going to pay for it all.” Which physiologic effects of stress would be expected findings in this patient? Select all that apply. a. Changes in appetite b. Changes in elimination patterns c. Decreased pulse and respirations d. Use of ineffective coping mechanisms e. Withdrawal f. Attention-seeking behaviors 2. A nurse caring for patients in a hospital setting uses anticipatory guidance to prepare them for painful procedures. Which nursing intervention is an example of this type of stress management? a. The nurse teaches a patient rhythmic breathing to perform prior to the procedure. b. The nurse tells a patient to focus on a pleasant place, mentally place himself in it, and breathe slowly in and out. c. The nurse teaches a patient about the pain involved in the procedure and describes methods to cope with it. d. The nurse teaches a patient to create and focus on a mental image during the procedure in order to be less responsive to the pain. 3. A nurse witnesses a street robbery and is assessing a patient who is the victim. The patient has minor scrapes and bruises, and tells the nurse, “I’ve never been so scared in my life!” What other symptoms would the nurse expect to find related to the fight-or-flight response to stress? Select all that apply. a. Increased heart rate b. Decreased muscle strength c. Increased mental alertness d. Increased blood glucose levels e. Decreased cardiac output f. Decreased peristalsis 4. A nurse is assessing the developmental levels of patients in a pediatric office. Which person would a nurse document as experiencing developmental stress? a. An infant who learns to turn over b. A school-aged child who learns how to add and subtract c. An adolescent who is a “loner” d. A young adult who has a variety of friends 5. A nurse is caring for an older adult in a long-term care facility who has a spinal cord injury affecting his neurologic reflex arc. Based on the patient’s condition, what would be a priority intervention for this patient? a. Monitoring food and drink temperatures to prevent burns b. Providing adequate pain relief measures to reduce stress c. Monitoring for depression related to social isolation d. Providing meals high in carbohydrates to promote healing 6. A nurse is caring for a patient in the shock or alarm reaction phase of the GAS. Which response by the patient would be expected? a. Decreasing pulse b. Increasing sleepiness c. Increasing energy levels d. Decreasing respirations 7. A nurse interviews a patient who was abused by her partner and is staying at a shelter with her three children. She tells the nurse, “I’m so worried that my husband will find me and try to make me go back home.” Which data would the nurse most appropriately document? a. “Patient displays moderate anxiety related to her situation.” b. “Patient manifests panic related to feelings of impending doom.” c. “Patient describes severe anxiety related to her situation.” d. “Patient expresses fear of her husband.” 8. A college student visits the school’s health center with vague complaints of anxiety and fatigue. The student tells the nurse, “Exams are right around the corner and all I feel like doing is sleeping.” The student’s vital signs are within normal parameters. What would be an appropriate question to ask in response to the student’s verbalizations? a. “Are you worried about failing your exams?” b. “Have you been staying up late studying?” c. “Are you using any recreational drugs?” d. “Do you have trouble managing your time?” 9. A nurse is interviewing a patient who just received a diagnosis of pancreatic cancer. The patient tells the nurse “I would never be the type to get cancer; this must be a mistake.” Which defense mechanism is this patient demonstrating? a. Projection b. Denial c. Displacement d. Repression 10. A visiting nurse is performing a family assessment of a young couple caring for their newborn who was diagnosed with cerebral palsy. The nurse notes that the mother’s hair and clothing are unkempt and the house is untidy, and the mother states that she is “so busy with the baby that I don’t have time to do anything else.” What would be the priority intervention for this family? a. Arrange to have the infant removed from the home. b. Inform other members of the family of the situation. c. Increase the number of visits by the visiting nurse. d. Notify the care provider and recommend respite care for the mother. 11. A nurse is teaching a patient a relaxation technique. Which statement demonstrates the need for additional teaching? a. “I must breathe in and out in rhythm.” b. “I should take my pulse and expect it to be faster.” c. “I can expect my muscles to feel less tense.” d. “I will be more relaxed and less aware.” 12. A certified nurse midwife is teaching a pregnant woman techniques to reduce the pain of childbirth. Which stress reduction activities would be most effective? Select all that apply. a. Progressive muscle relaxation b. Meditation c. Anticipatory socialization d. Biofeedback e. Rhythmic breathing f. Guided imagery 13. A nurse teaches problem solving to a college student who is in a crisis situation. What statement best illustrates the student’s understanding of the process? a. “I need to identify the problem first.” b. “Listing alternatives is the initial step.” c. “I will list alternatives after I develop the plan.” d. “I do not need to evaluate the outcome of my plan.” 14. A nurse is performing an assessment of a woman who is 8 months pregnant. The woman states, “I worry all the time about being able to handle becoming a mother.” Which nursing diagnosis would be most appropriate for this patient? a. Ineffective Coping related to the new parenting role b. Ineffective Denial related to ability to care for a newborn c. Anxiety related to change in role status d. Situational Low Self-Esteem related to fear of parenting 15. A nurse is responsible for preparing patients for surgery in an ambulatory care center. Which technique for reducing anxiety would be most appropriate for these patients? a. Discouraging oververbalization of fears and anxieties b. Focusing on the outcome as opposed to the details of the surgery c. Providing time alone for reflection on personal strengths and weaknesses d. Mutually determining expected outcomes of the care plan CH 43 - loss, grief and dying 1. A nurse midwife is assisting a patient who is firmly committed to natural childbirth to deliver a full-term baby. A cesarean delivery becomes necessary when the fetus displays signs of distress. Inconsolable, the patient cries and calls herself a failure as a mother. The nurse notes that the patient is experiencing what type of loss? Select all that apply. a. Actual b. Perceived c. Psychological d. Anticipatory e. Physical f. Maturational 2. A nurse who cared for a dying patient and his family documents that the family is experiencing a period of mourning. Which behaviors would the nurse expect to see at this stage? Select all that apply. a. The family arranges for a funeral for their loved one. b. The family arranges for a memorial scholarship for their loved one. c. The coroner pronounces the patient’s death. d. The family arranges for hospice for their loved one. e. The patient is diagnosed with terminal cancer. f. The patient’s daughter writes a poem expressing her sorrow. 3. A nurse interviews an 82-year-old resident of a long-term care facility who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing? a. Somatic grief b. Anticipatory grief c. Unresolved grief d. Inhibited grief 4. A home health care nurse has been visiting a patient with AIDS who says, “I’m no longer afraid of dying. I think I’ve made my peace with everyone, and I’m actually ready to move on.” This reflects the patient’s progress to which stage of death and dying? a. Acceptance b. Anger c. Bargaining d. Denial 5. A nurse is visiting a patient with pancreatic cancer who is dying at home. During the visit, he breaks down and cries, and tells the nurse that it is unfair that he should have to die now when he’s finally made peace with his family. Which response by the nurse would be most appropriate? a. “You can’t be feeling this way. You know you are going to die.” b. “It does seem unfair. Tell me more about how you are feeling.” c. “You’ll be all right; who knows how much time any of us has.” d. “Tell me about your pain. Did it keep you awake last night?” 6. A nurse is caring for a terminally ill patient during the 11 PM to 7 AM shift. The patient says, “I just can’t sleep. I keep thinking about what my family will do when I am gone.” What response by the nurse would be most appropriate? a. “Oh, don’t worry about that now. You need to sleep.” b. “What seems to be concerning you the most?” c. “I have talked to your wife and she told me she will be fine.” d. “I’m not qualified to advise you, I suggest you discuss this with your wife.” 7. A patient tells a nurse that he would like to appoint his daughter to make decisions for him should he become incapacitated. What should the nurse suggest he prepare? a. POLST form b. Durable power of attorney for health care c. Living will d. Allow Natural Death (AND) form 8. A hospice nurse is caring for a patient who is terminally ill and who is on a ventilator. After a restless night, the patient hands the nurse a note with the request: “Please help me end my suffering.” Which response by a nurse would bestreflect adherence to the position of the American Nurses Association (ANA) regarding assisted suicide? a. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient’s death. b. The nurse tells the patient that under no condition can he be removed from the ventilator because this is active euthanasia and is expressly forbidden by the Code for Nurses. c. After exhausting every intervention to keep a dying patient comfortable, the nurse says, “I think you are now at a point where I’m prepared to do what you’ve been asking me. Let’s talk about when and how you want to die.” d. The nurse responds: “I’m personally opposed to assisted suicide, but I’ll find you a colleague who can help you.” 9. A patient diagnosed with breast cancer who is in the end stages of her illness has been in the medical intensive care unit for 3 weeks. Her husband tells the nur