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encourage activity.
2. Nursing diagnoses mostly differ from medical diagnoses in that they are:
primarily concerned with caring, while medical diagnoses are primarily concerned with curing.
primarily concerned with human response, while medical diagnoses are primarily concerned with
pathology.
primarily concerned with psychosocial parameters, while medical diagnoses are primarily concerned
with physiologic parameters.
3. A patient who received spinal anesthesia four hours ago during surgery is transferred to the surgical
unit and, after one and a half hours, now reports severe incisional pain. The patient's blood pressure is
170/90 mm Hg, pulse is 108 beats/min, temperature is 99 oF (37.2oC), and respirations are 30
breaths/min. The patient's skin is pale, and the surgical dressing is dry and intact. The most appropriate
nursing intervention is to:
place the patient in a reverse Trendelenburg position and open the IV line.
4. To prevent a common, adverse effect of prolonged use of phenytoin sodium (Dilantin), patients taking
the drug are instructed to:
atelectasis.
urinary retention.
6. A 78-year-old patient is scheduled for transition to home after treatment for heart disease. The patient's
spouse, who has chronic obstructive pulmonary disease, plans to care for the patient at home. The
spouse says that their grown children, who live nearby, will help. The best approach to discharge planning
is to:
consult the spouse's healthcare provider about the spouse's ability to care for the patient.
discuss community resources with the spouse and offer to make referrals.
7. During an assessment of a patient who sustained a head injury 24 hours ago, the medical-surgical
nurse notes the development of slurred speech and disorientation to time and place. The nurse's initial
action is to:
informs staff members regularly of how well they are performing their jobs.
a stimulating environment.
sensory deprivation.
sundowning.
10. To prepare a patient on the unit for a bronchoscopic procedure, a medical-surgical nurse administers
the IV sedative. The medical-surgical nurse then instructs the licensed practical nurse to:
Bronchial constriction
Peripheral vasodilation
12. A patient's family does not know the patient's end-of-life care preferences, but assumes that they
know what is best for the patient under the circumstances. This assumption reflects:
justice.
paternalism.
pragmatism.
veracity.
13. Which statement by a patient with diabetes mellitus indicates an understanding of the medication
insulin glargine (Lantus)?
14. Which action occurs primarily during the evaluation phase of the nursing process?
Data collection
17. A medical-surgical nurse, who is caring for a patient with a new diagnosis of cancer, observes the
patient becoming angry with the physicians and nursing staff. The best approach to diffuse the
emotionally charged discussion is to:
arrange time for the patient to speak with another patient with cancer.
18. It is hospital policy to assess and record a patient's pulse before administering digoxin (Lanoxin). By
auditing the nursing records to determine the frequency of compliance with this policy, the quality
assessment and improvement committee is conducting:
a process analysis.
a quality analysis.
a system analysis.
an outcome analysis.
19. The nursing diagnosis for a patient with a myocardial infarction is activity intolerance. The plan of care
includes the patient outcome criterion of:
20. A nursing department in an acute care setting decides to redesign its nursing practice based on a
theoretical framework. The feedback from patients, families, and staff reflects that caring is a key element.
Which theorist best supports this concept?
Erikson
Maslow
Rogers
Watson
21. Which statement by a patient demonstrates an accurate understanding about herbal supplements?
"Herbs may interact with prescribed medications but not other herbs."
"Most herbs have been tested and found to be safe and therapeutic."
"The Food and Drug Administration regulates herbs and allows advertising."
22. For a patient with Crohn's disease, the medical-surgical nurse recommends a diet that is:
high in potassium.
low in potassium.
23. When examining a patient who is paralyzed below the T4 level, the medical-surgical nurse expects to
find:
24. After completing a thorough neurological and physical assessment of a patient who is admitted for a
suspected stroke, a medical-surgical nurse anticipates the next step in the immediate care of this patient
to include: