RN Question Trainer 7 Answers.
The father of a 1-day-old son works the evening shift (3 PM to 11
PM) at another hospital. Which of the following plans is a priority
to meet the needs of this father?
1. Encourage the father to call his wife after work.
2. Instruct the father about visiting policy and suggest AM
visitation.
3. Adjust visiting hours to meet the new parents' needs.
4. Present a change of visiting hours to the appropriate hospital
committee.
Strategy: Answers are implementation. Determine the outcome of
each answer. Is it desired?
(1) inflexible
(2) inflexible
(3) correct—role of nurse is to be a family and client advocate; this
provides individualized care
(4) not a priority, although it may be an appropriate long-range goal
The nurse believes a coworker is diverting narcotics for personal
consumption. The nurse approaches the nurse manager to report
the suspicions. Which of the following statements by the nurse is
BEST?
1. "After my coworker has been on duty, the patients often need
repeated doses of pain medication. I have seen her/him sleeping
on duty three times."
2. "I saw my coworker downtown after work. She/he was acting
really strange, like she/he didn't even recognize me."
3. "I think my coworker is stealing narcotics because she/he is
always acting euphoric and seems high."
4. "My coworker is hanging around with drug dealers, and I think
I saw tracks on her/his arms."
Strategy: All answers are assessment. Determine how each relates
to the situation.
(1) correct—report objective information that can be verified; clues
to possible substance abuse by staff include memory lapses,
frequent absences from the floor, increased number of clients
reporting unrelieved pain or insomnia
(2) subjective observation
(3) subjective observation
,(4) "hanging around with drug dealers" is subjective
,A client diagnosed with chronic obstructive pulmonary disease
(COPD) is admitted with an acute exacerbation. The client's vital
signs are B/P 162/100, pulse 78, respirations 30 and labored with
wheezing. The nurse should question which of the following
orders?
1. Theophylline (Somophyllin) 0.7 mg/kg/h IV.
2. Tetracycline hydrochloride (Sumycin) 250 mg IM qd.
3. Ipratropium bromide (Atrovent) inhaler 2 inhalations qid.
4. Propranolol hydrochloride (Inderal) 40 mg PO bid.
Strategy: Select the incorrect medication. Think about the action of
each drug.
(1) drug of choice for acute asthma
(2) broad spectrum antibiotic, not contraindicated
(3) blocks parasympathetic stimulation and decreases mucus; used
with asthma
(4) correct—beta-blocker that blocks beta adrenergic impulses to
the bronchial tree that cause bronchodilation resulting in increased
bronchoconstriction
A husband and wife meet at the mental health clinic to make an
appointment for family therapy. Suddenly, the wife begins to sob
loudly. As the nurse approaches, the husband says, "I guess we
just don't get along." Which of the following responses by the
nurse is MOST appropriate?
1. "Your wife seems to be upset by the situation."
2. "Perhaps you should both go home now."
3. "Try to think about what precipitated her crying."
4. "The situation is difficult for both of you."
Strategy: Remember therapeutic communication.
(1) nontherapeutic; emphasis is placed on wife, not the situation
(2) nontherapeutic; closes off communication
(3) nontherapeutic; appears to blame the husband for precipitating
the wife's behavior, would cause him to react defensively
(4) correct—therapeutic; avoids blaming, focuses on feelings of both
husband and wife
The nurse cares for a client receiving chemotherapy. The client
has a WBC count of 1,200/mm3. Which of the following nursing
actions should the nurse take FIRST?
, 1. Check temperature q4h.
2. Monitor urine output.
3. Assess for bleeding gums.
4. Obtain an order for blood cultures.
Strategy: Determine how each assessment relates to a low white
count.
(1) correct—important to monitor for infection, which would be
evidenced by an elevated temperature in a client with a low WBC
(2) important because of problems of increased uric acid excretion
from chemotherapeutic drugs but should not be done first
(3) would be associated with a low platelet count
(4) would be done if the temperature were elevated to determine
the type of organism involved
A woman is in active labor with her first child when her
membranes rupture. She voices a concern to the nurse that she is
afraid of having a "dry labor." Which of the following responses by
the nurse is MOST appropriate?
1. "The amniotic fluid provides only minimal lubrication for
the labor process."
2. "The amniotic sac may impede the progress of labor and is
often ruptured artificially."
3. "Labor is only slightly more difficult with early rupture of the
amniotic sac."
4. "Because there is limited amniotic fluid, additional fluids will be
supplied."
Strategy: "MOST" indicates there may be more than one attractive
answer.
(1) amniotic fluid cushions fetus, allows freedom of movement for
musculoskeletal development, facilitates symmetrical growth,
maintains constant body temperature, is a source of oral fluids, and
collects wastes
(2) correct—sometimes done to assist or induce labor
(3) does not make labor more difficult
(4) no additional fluids will be supplied
The nurse performs an ice massage for a client in chronic pain.
The nurse is MOST concerned if which of the following is
observed?
1. Redness or inflammation of the tissue.
The father of a 1-day-old son works the evening shift (3 PM to 11
PM) at another hospital. Which of the following plans is a priority
to meet the needs of this father?
1. Encourage the father to call his wife after work.
2. Instruct the father about visiting policy and suggest AM
visitation.
3. Adjust visiting hours to meet the new parents' needs.
4. Present a change of visiting hours to the appropriate hospital
committee.
Strategy: Answers are implementation. Determine the outcome of
each answer. Is it desired?
(1) inflexible
(2) inflexible
(3) correct—role of nurse is to be a family and client advocate; this
provides individualized care
(4) not a priority, although it may be an appropriate long-range goal
The nurse believes a coworker is diverting narcotics for personal
consumption. The nurse approaches the nurse manager to report
the suspicions. Which of the following statements by the nurse is
BEST?
1. "After my coworker has been on duty, the patients often need
repeated doses of pain medication. I have seen her/him sleeping
on duty three times."
2. "I saw my coworker downtown after work. She/he was acting
really strange, like she/he didn't even recognize me."
3. "I think my coworker is stealing narcotics because she/he is
always acting euphoric and seems high."
4. "My coworker is hanging around with drug dealers, and I think
I saw tracks on her/his arms."
Strategy: All answers are assessment. Determine how each relates
to the situation.
(1) correct—report objective information that can be verified; clues
to possible substance abuse by staff include memory lapses,
frequent absences from the floor, increased number of clients
reporting unrelieved pain or insomnia
(2) subjective observation
(3) subjective observation
,(4) "hanging around with drug dealers" is subjective
,A client diagnosed with chronic obstructive pulmonary disease
(COPD) is admitted with an acute exacerbation. The client's vital
signs are B/P 162/100, pulse 78, respirations 30 and labored with
wheezing. The nurse should question which of the following
orders?
1. Theophylline (Somophyllin) 0.7 mg/kg/h IV.
2. Tetracycline hydrochloride (Sumycin) 250 mg IM qd.
3. Ipratropium bromide (Atrovent) inhaler 2 inhalations qid.
4. Propranolol hydrochloride (Inderal) 40 mg PO bid.
Strategy: Select the incorrect medication. Think about the action of
each drug.
(1) drug of choice for acute asthma
(2) broad spectrum antibiotic, not contraindicated
(3) blocks parasympathetic stimulation and decreases mucus; used
with asthma
(4) correct—beta-blocker that blocks beta adrenergic impulses to
the bronchial tree that cause bronchodilation resulting in increased
bronchoconstriction
A husband and wife meet at the mental health clinic to make an
appointment for family therapy. Suddenly, the wife begins to sob
loudly. As the nurse approaches, the husband says, "I guess we
just don't get along." Which of the following responses by the
nurse is MOST appropriate?
1. "Your wife seems to be upset by the situation."
2. "Perhaps you should both go home now."
3. "Try to think about what precipitated her crying."
4. "The situation is difficult for both of you."
Strategy: Remember therapeutic communication.
(1) nontherapeutic; emphasis is placed on wife, not the situation
(2) nontherapeutic; closes off communication
(3) nontherapeutic; appears to blame the husband for precipitating
the wife's behavior, would cause him to react defensively
(4) correct—therapeutic; avoids blaming, focuses on feelings of both
husband and wife
The nurse cares for a client receiving chemotherapy. The client
has a WBC count of 1,200/mm3. Which of the following nursing
actions should the nurse take FIRST?
, 1. Check temperature q4h.
2. Monitor urine output.
3. Assess for bleeding gums.
4. Obtain an order for blood cultures.
Strategy: Determine how each assessment relates to a low white
count.
(1) correct—important to monitor for infection, which would be
evidenced by an elevated temperature in a client with a low WBC
(2) important because of problems of increased uric acid excretion
from chemotherapeutic drugs but should not be done first
(3) would be associated with a low platelet count
(4) would be done if the temperature were elevated to determine
the type of organism involved
A woman is in active labor with her first child when her
membranes rupture. She voices a concern to the nurse that she is
afraid of having a "dry labor." Which of the following responses by
the nurse is MOST appropriate?
1. "The amniotic fluid provides only minimal lubrication for
the labor process."
2. "The amniotic sac may impede the progress of labor and is
often ruptured artificially."
3. "Labor is only slightly more difficult with early rupture of the
amniotic sac."
4. "Because there is limited amniotic fluid, additional fluids will be
supplied."
Strategy: "MOST" indicates there may be more than one attractive
answer.
(1) amniotic fluid cushions fetus, allows freedom of movement for
musculoskeletal development, facilitates symmetrical growth,
maintains constant body temperature, is a source of oral fluids, and
collects wastes
(2) correct—sometimes done to assist or induce labor
(3) does not make labor more difficult
(4) no additional fluids will be supplied
The nurse performs an ice massage for a client in chronic pain.
The nurse is MOST concerned if which of the following is
observed?
1. Redness or inflammation of the tissue.
