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NEW QUESTION # 74
When a client has a chest drainage system in place, where should the system be placed?

• A. at the client's shoulders
• B. below the level of the chest
• C. at the level of the chest
• D. above the client's head

Answer: B

Explanation:
Section: Physiological Integrity
Explanation:
A chest drainage system should be placed below the level of the client's chest so that the drainage flows out of the chest into the system.
The remaining choices are too high and do not allow fluid to drain out of the chest.

NEW QUESTION # 75
Attaching a restraint to a side rail or other movable part of the bed can __________.

• A. help the client stay in the bed without falling out
• B. do nothing to the client
• C. injure the client if the rail or bed is moved
• D. help the client with better posture

Answer: C

Explanation:
Section: Safe and Effective Care Environment
Explanation:
Attaching a restraint to a movable part of the bed can cause client injury if that part of the bed is moved before releasing restraints.

NEW QUESTION # 76
Major competencies for the nurse giving end-oflife care include:

• A. setting goals, expectations, and dynamic changes to care for the client.
• B. keeping all sad news away from the family and client.
• C. demonstrating respect and compassion, and applying knowledge and skills in care of the family and the client.
• D. assessing and intervening to support total management of the family and client.

Answer: C

Explanation:
There are many competencies that the nurse must have to care for families and clients at the end of life. Demonstration of respect and compassion as well as using knowledge and skills in the care of the client and family are major competencies.Basic Care and Comfort

NEW QUESTION # 77
There are many types of torts that can be committed against clients. They include all of the following except:

• A. negligence.
• B. battery.
• C. felony.
• D. assault.

Answer: C

Explanation:
Felonies are serious crimes punishable by time in prison. Types of torts are assault, battery, and negligence in addition to slander, invasion of privacy, false imprisonment, and fraud.Coordinated Care

NEW QUESTION # 78
A diet high in fiber content can help an individual to __________.

• A. reduce the need for folate
• B. reduce diabetic ketoacidosis
• C. lose body weight fast
• D. lower cholesterol

Answer: D

Explanation:
Section: Physiological Integrity
Explanation:
Fiber-rich foods (such as grains, apples, potatoes, and beans) can help lower cholesterol.

NEW QUESTION # 79
Support-system enhancement includes all of the following except:

• A. involving spouse, family, and friends in the care and planning.
• B. exploring life problems of the support-team members.
• C. determining the barriers to using support systems.
• D. discussing ways to help with others who are concerned.

Answer: B

Explanation:
The exploration of life problems of support-team members is not necessary to enhance the support system. Choices 1, 2, and 4 are all enhancements for a support system.Psychosocial Integrity

NEW QUESTION # 80
A client goes to the Emergency Department with acute respiratory distress and the following arterial blood gases (ABGs): pH 7.35, PCO2 40 mmHg, PO2 63 mmHg, HCO3 23, and oxygenation saturation (SaO2) 93%.
Which of the following represents the best analysis of the etiology of these ABGs?

• A. tuberculosis (TB)
• B. hypoxia
• C. pleural effusion
• D. pneumonia

Answer: B

Explanation:
Section: Physiological Integrity
Explanation/Reference:
A combined low PO2 and low SaO2 indicates hypoxia. The pH, PCO2, and HCO3 are normal.
ABGs are not necessarily altered in TB or pleural effusion.
Depending on the degree of the pneumonia, the PO2 and PCO2 might be low because hypoxia stimulates hyperventilation.

NEW QUESTION # 81
A stool culture reveals Shigella. What corollary should the nurse recognize regarding this bacterial infection?

• A. People who have been in contact with the client need to be tested.
• B. Shigella is a bacteria sometimes found in stagnant water.
• C. The nurse should wear a one-way breathing apparatus when giving client care.
• D. Shigella is an airborne infection.

Answer: B

Explanation:
Shigella is a bacteria sometimes found in stagnant water. Transmission of Shigella is typically oral-fecal, so good hand washing and the use of gloves are the best means of prevention when caring for a client with Shigella. The bacteria can be found in food and water contaminated by fecal material. Incidences of Shigella are reportable in many states.
Safety and Infection Control

NEW QUESTION # 82
A client is diagnosed with HIV. Which of the following are antiviral drug classes used in the treatment of HIV/AIDS?

• A. nucleoside reverse transcriptase inhibitors
• B. all of the above.
• C. protease inhibitors
• D. HIV fusion inhibitors

Answer: B

Explanation:
All of the choices are anti-HIV drugs.Safety and Infection Control

NEW QUESTION # 83
A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:

• A. a medication with no first-pass effect.
• B. the medication to be given intravenously.
• C. a loading dose.
• D. a maintenance dose.

Answer: C

Explanation:
A loading or priming dose rapidly establishes a therapeutic plasma drug level. It can be calculated by multiplying the volume of distribution by the desired plasma drug concentration. A maintenance dose maintains a therapeutic level after the loading dose. It takes five drug half-lives to achieve steady state if no loading dose is given. Choice 3 is similar to a maintenance dose. Intravenous administration provides excellent drug bioavailability, but one dose will not achieve a therapeutic plasma level.Pharmacological Therapies

NEW QUESTION # 84
A Hispanic client brings her father to the clinic because he is becoming more forgetful. He is diagnosed with Alzheimer's disease. The woman tells the nurse that she wants to try ginkgo biloba for her father, before using prescription medications.
Which of the following is an appropriate response by the nurse?

• A. "I will let the physician know of your wishes."
• B. "It is wiser to start a prescription."
• C. "You can't expect an herb to treat Alzheimer's."
• D. "That herb won't do your father any good."

Answer: A

Explanation:
Section: Physiological Integrity
Explanation:
The culturally sensitive response is to notify the physician of the family member's wishes and to determine whether it is feasible.
Ginkgo biloba has been shown to be of some benefit in treating dementia.
The other statements are not culturally sensitive.

NEW QUESTION # 85
Which of these scenarios would not be considered a violation of HIPAA laws?

• A. looking up the medical information of a friend not in your care but who gave you permission
• B. looking up only the address (not the medical portion) in the chart of a co-worker who just delivered a baby so you can surprise her with a gift
• C. checking on your spouse's medical record because you are listed as her power of attorney
• D. discussing discharge plans with a patient in a multi-bed recovery room with the curtain drawn around the patient's bed

Answer: D

Explanation:
Section: Safe and Effective Care Environment

NEW QUESTION # 86
An example of an extended care facility is a:

• A. suicide prevention center.
• B. home health agency.
• C. state-owned psychiatric hospital.
• D. nursing facility.

Answer: D

Explanation:
Explanation/Reference:
Explanation:
When an elderly client has been hospitalized for an illness, under Medicare he or she can be transferred to a nursing facility. Health Promotion and Maintenance

NEW QUESTION # 87
The PN enters the room of a patient who is having a tonic-clonic seizure.
What is the first action the nurse should take?

• A. Secure the airway.
• B. Elevate the head of the bed.
• C. Prepare Lorazepam for administration.
• D. Place a tongue depressor in between the patient's teeth.

Answer: A

Explanation:
Section: Physiological Integrity

NEW QUESTION # 88
A patient has a history of cardiac arrhythmia. A nurse has been ordered to give 2 units of blood to this patient. The nurse should take which of the following actions?

• A. Notify the patient's family about the procedure via the telephone.
• B. Decrease the temperature of the blood to be given.
• C. Increase the temperature of the blood to be given.
• D. Prep the patient with pain medication.

Answer: C

Explanation:
Warming the blood will reduce the risk of additional cardiac arrhythmia.

NEW QUESTION # 89
Which of the following represents a normal serum potassium level?

• A. 4.0 mEq/L
• B. 1.5 mEq/L
• C. 6.0 mEq/L
• D. 3.0 mEq/L

Answer: A

Explanation:
Section: Physiological Integrity
Explanation:
Normal serum potassium levels fall in a range of 3.5-5.5mEq/L.
The other choices listed fall below or above this range.

NEW QUESTION # 90
Which of the following lab values is elevated first after a client has a myocardial infarction?

• A. troponin
• B. CPK
• C. SGOT
• D. LDH

Answer: A

Explanation:
The troponin level is the first to rise in a client who has had a myocardial infarction,
followed by CPK, SGOT,
and LDH.Reduction of Risk Potential

NEW QUESTION # 91
When caring for a client with a possible diagnosis of placenta previa, which of the following admission procedures should the nurse omit?

• A. blood specimen collection
• B. urine specimen collection
• C. enema
• D. perineal shave

Answer: C

Explanation:
Section: Physiological Integrity
Explanation:
An enema could dislodge the placenta and increase bleeding.

NEW QUESTION # 92
A 21-year-old college student has just learned that she contracted genital herpes from her sexual partner. After completing the initial history and assessment, the nurse has data concerning areas pertinent to the disease. The data is likely to include all but which of the following?

• A. vaginal discharge
• B. voiding patterns
• C. prior history of varicella
• D. characteristics of lesions

Answer: C

Explanation:
The other choices are common reasons for which clients with herpes seek care.
Physiological Adaptation

NEW QUESTION # 93
Nursing considerations when caring for African- American clients include that:

• A. clients are generally future-oriented.
• B. special hair, skin, and nail care might be required.
• C. fad diets are a cultural norm.
• D. families are generally distant and unsupportive.

Answer: B

Explanation:
Explanation/Reference:
Explanation:
Special hair, skin, and nail care might be required for African-American clients. Psychosocial Integrity

NEW QUESTION # 94
Metformin (Glucophage) is administered to clients with type II diabetes mellitus. Metformin is an example of:

• A. a pancreatic alpha cell stimulant.
• B. a hypoglycemic agent.
• C. an insulin analogue.
• D. an antihyperglycemic agent.

Answer: D

Explanation:
This antihyperglycemic agent prevents hyperglycemia by reducing hepatic glucose output and decreasing glucose absorption from the gut. A hypoglycemic drug stimulates insulin production. Metformin is not a type of insulin. Metformin is not a stimulant of any pancreatic cell.Pharmacological Therapies

NEW QUESTION # 95
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