NR-103: TRANSITION TO THE NURSING PROFESSION EXAM 2

What is a type of nursing education program that is conducted in junior and community colleges that nominally 2 years in length? a. diploma program b. baccalaureate program c. associate degree program d. professional nursing program ANS: c The nurse in a skilled nursing facility is caring for an 80-year-old patient who develops a productive cough with pink, frothy sputum. Which independent interventions should the nurse implement immediately? (Select all that apply.) a. Limit the patient's activity. b. Administer morphine. c. Administer lasix. d. Place the patient in high Fowler position. e. Weigh the patient daily. ANS: A, D Acute pulmonary edema (acute left ventricular failure) is a medical emergency that must be treated promptly. The patient with this condition has severe dyspnea; a cough productive of frothy, pink-tinged sputum; tachycardia; and moist, bubbling respirations with cyanosis. Nursing interventions for acute pulmonary edema include placing the patient in high Fowler position to relieve the dyspnea; administering oxygen, diuretics, morphine, and other prescribed drugs; limiting and monitoring activity; and assessing cardiopulmonary status. Limiting activity and placing the patient in high Fowler do not require a physician's order and should be implemented immediately. Acute pulmonary edema is a medical emergency, and activity necessary to obtain a daily weight is not indicated at this time. Administering morphine and diuretics are dependent nursing interventions. The nurse is educating a patient about cardiomyopathy. The nurse includes information that which circumstance(s) may increase risk for cardiomyopathy? (Select all that apply.) a. Systemic hypertension b. Chronic excessive alcohol consumption c. Pregnancy d. Diabetes e. Systemic infection ANS: A, B, C, E Cardiomyopathy is a group of disorders that result in enlargement of the heart and subsequent inefficient pumping action. Risk factors include systemic hypertension, chronic alcohol consumption, pregnancy, and certain systemic infections. Diabetes is not considered a risk factor for cardiomyopathy. Which factor(s) is/are potential causative agents for arrhythmias? (Select all that apply.) a. Hyperkalemia b. Valvular prolapse c. Infarct damage d. Properly functioning sinoatrial (SA) node e. Excess fluid ANS: A, B, C, E Electrolyte imbalances, especially a high-potassium level, valvular prolapse, heart damage after a heart attack, and fluid overload are all potential causative factors for abnormal heart rhythms. A properly functioning SA node results in normal sinus rhythm. Which statement(s) accurately describe(s) characteristics of normal sinus rhythm (NSR)? (Select all that apply.) a. One atrial contraction (P wave) b. One ventricular contraction (QRS complex) c. One T wave d. Heart rate 60 to 100 e. P wave immediately follows the QRS complex ANS: A, B, C, D The P wave precedes the QRS complex. All other options are seen in NSR. The nurse is performing an initial assessment on a new patient with suspected right- sided heart failure. Which finding(s) is/are consistent with the patient's potential diagnosis? (Select all that apply.) a. Clammy skin b. Splenomegaly c. Abdominal distention d. Wheezing e. Dyspnea ANS: B, C, E Signs and symptoms of right-sided CHF include fatigue, peripheral edema, gastrointestinal congestion and abdominal distention, ascites with liver congestion, splenomegaly, and dyspnea. Clammy skin and wheezing are symptoms of left-sided CHF. The nurse is caring for a 60-year-old African American patient with hypertension. The patient is obese and a smoker. Which modifiable risk factors place this patient at an increased risk for heart disease? (Select all that apply.) a. Age b. Race c. Hypertension d. Obesity e. Smoking ANS: c d e Modifiable risk factors that increase the patient's risk of heart disease include hypertension, obesity, and cigarette smoking. The patient could lessen his risk by strictly controlling blood pressure, losing weight with diet and exercise, and implementing a smoking cessation plan. Age and race are nonmodifiable risk factors for heart disease. The home health nurse is caring for a patient with congestive heart failure (CHF). Which assessment finding should the nurse report immediately to the physician? a. Moderate shortness of breath after walking down the hall b. A 3 pound weight gain over the course of a week c. Heart rate of 104 beats/min after ambulating to the bathroom d. Increase in urinary output to 50 mL in the last hour ANS: B A weight gain without an increase in caloric intake is indicative of fluid retention, which is an indication of worsening heart failure. Moderate shortness of breath after exercise and a mild increase in heart rate after activity are expected. A decrease in urinary output would be of concern. The nurse is caring for several patients on a cardiac care unit. Which patient is most likely to have aortic stenosis? a. 35-year-old with a history of Raynaud disease b. 63-year-old with uncontrolled diabetes c. 73-year-old with a history of hypertension d. 86-year-old with a history of atherosclerosis ANS: D The older 86-year-old patient with atherosclerosis is most likely to have degenerative calcification of the valve. Risk for aortic stenosis increases with age, and congenital valve malformations and rheumatic fever are causes in younger patients. The nurse is caring for a patient who is taking digitalis. The patient complains of increased thirst, and the nurse observes dry mucous membranes. Which additional finding warrants the nurse's immediate attention? a. Sudden, sharp knee pain b. Blurred vision c. Epistaxis d. Chills ANS: B Blurred vision, halos around lights, nausea, vomiting and diarrhea, and fatigue are all indicators of toxicity to digitalis. Assessment is especially important for the dehydrated patient because of the rising potassium level. which teaching point will the nurse include when providing discharge instructions to the patient with a new permanent pacemaker a. you will be able to have an mri for diagnostic purposes b. avoid using microwave ovens c. avoid lifting heavy objects for as long as your physician prescribes d. airport security screening devices may cause your pacemaker to fire incorrectly ANS: C The postoperative patient with a permanent pacemaker can assume normal activity when the physician prescribes. Using the arm for lifting and other activities may dislodge the leads from their positions. MRIs must be avoided since the large magnet can interfere with the pacemaker's function. Microwaves and airport security devices do not affect the pacemaker. the nurse caring for a patient who requires a temporary transvenous pacemaker. which statement indicates that the pt understands the nurses teaching a. i may experience uncomftorable muscle contractions b. this procedure will use general anasthesia c. i will be given a sedative after the procedure d. this device may be left in for six weeks a ANS: A A temporary transvenous pacemaker is placed if a transient rhythm such as heart block develops after a myocardial infarction or drug toxicity. It is important that the patient understands the uncomfortable muscle contractions are normal. Transvenous pacemakers are inserted by fluoroscopy with local anesthesia, and the leads are attached to an external power source. Patient consent is required, and a sedative is given to the patient before the procedure. Epicardial pacemaker wires are often placed during cardiac surgery for quick use should the patient need to be "paced" in the postoperative period. The wires are brought through the chest wall and are attached to an external power source. When the need for the wires is past, the surgeon will pull them out. The device is a short-term solution and is only used until the problem resolved or a permanent device is inserted. which potential hazard is most important for a pt with an automatic implantable cardioverter defribillator to avoid? a. static electricity from synthetic fabric b. airport security detection devices c. constricting clothing and belts d. high altitudes ANS: b electronic wands at airport security check stations can alter the setting on the AICD which statmement accurately explains how calcium channel blocker verapamil assists to correct an arrhythmia? a. the medication desentitizes the heart to the impulse to contract b. the medication increases the strength of the impulse from the atrioventricular c. the medication alters the impulse form the sinoatrial node d. the medication inhibits transmission of the impulse from the av node ANS: d verapamil blocks calcium from the cardiac cells, inhibiting the transmission of the impulse from the av node which disorganized ecg pattern is recognized as the most fatal of all arrhythmias? a. ventricular fibrillation b. premature ventricular beats c. atrial fibrillation d. ventricular tachycardia ANS: a ventricular fibrillation is a disorganized pattern of totally ineffective contractions and no cardiac output. the nurse caring for a patient who is taking amiodarone. what side effect could this patient experience a. sudden increase in temperature b. hypotension c. bradycardia d. depressed ventilation ANS: b hypotension with attendant fatigue is a side affect of amiodarone the nurse is caring for a patient with atrial fibrillation who asks why she needs to take warfarin. which statement best answers the patient question? a. warfarin increases the ejection fraction b. warfarin prevents clots from forming in the atria c. warfarin keeps the atrial fibrillation from involving the ventricles d. warfarin increases the cardiac output ANS: b warfarin keeps clots from forming in the retained blood in the atria left there by the ineffective atrial contractions the nurse is analyzing a patients telemetry strip and observes a sawtooth appearance with no P waves. how should the nurse document this finding a. premature ventricular contraction b. atrial flutter c. ventricular tachycardia d. premature atrial contraction ANS: B Atrial flutter displays a sawtooth appearance generated from small ineffective contractions prior to the QRS complex. An abnormally shaped P wave appears on the electrocardiogram (ECG) before the QRS wave in PAC. PVC is seen as an early beat without a P wave and with a wide QRS complex. VT is seen as three or more PVCs in a row with a ventricular rate of greater than 100 beats/min. the nurse is teaching the patient with an arrhythmia. which statement indicates that the patient requires further teaching? a. ive cut my coffee from ten cups to two cups a day b. i dont drink regular cola drinks anymore c. i have given up drinking those high energy drinks d. ive switched from five cups of coffee to five cups of tea ANS: d the patient with an arrhythmia should decrease caffeine intake. tea has as much caffeine as coffee does the nurse is caring for a pt with a heart rate of 115 beats/min and complaints of shortness of breath. the nurse anticipates that these findings are most likely related which underlying problem a. pulmonary edema b. decreased cardiac output c. impending pneumonia d. increasing anxiety ANS: b when the heart is beating rapidly the stroke volume decreases. this diminishes the cardiac ouput, causing reduced oxygen to tissues and tissue hypoxia the nurse is caring for a patient with congestive heart failure. which intervention should the nurse include in the plan of care a. encourage intake of canned soup b. place the pt in a side lying position to prevent venous pooling c. encourage large meals for increased nutritional impact d. alternate rest with activity ANS: d alternating rest with activity preserves energy. canned soups are high in sodium. patients are more comftorable in a semi fowler position to ease breathing the nurse is caring for a patient with severe heart failure who denies pain and is fearful of taking morphine. which explanation best works to alleviate the patients anxiety about the risk of addiction a. many people with chf use morphine for pain control b. we can treat your pain with aspirin or ibuprofen c. morphine has properties that relieve air hunger in chf patients d. you can refuse to take it ANS: c the primary purpose of morphine is relief of air hunger and anxiety. nsaids do not have the same vasodilation properties as morphine. telling the patient that many chf patients take morphine provides a generalized statement that does not address the pt anxiety. the statement indicates that the nurses teaching about the purpose of an implanted cardioverter- defribillator has been successful? a. the icd will detect bad rhythms and shock my heart into normal rhythm b. i should avoid handled security devices at the airport c. i should ask my doctor how often i should have my icd checked d. i should avoid working on the alternator of my boat ANS: a all statements are correct but it asks about the purpose of the ICD the nurse is caring for a pt with a history of left sided congestive heart failure. which finding leads the nurse to suspect that the pt could be in an acute exacberation of this condition a. abdomen is tight and shiny b. wheezes are present during lung auscultation c. the pupils react sluggishly to light d. the heart rate is irregularly irregular ANS: B Left-sided heart failure causes increased pressure on the lungs and may manifest in wheezing. A tight and shiny abdomen is consistent with ascites, a manifestation of right-sided CHF. Sluggish pupillary reaction is consistent with a neurologic problem, and an irregularly irregular heart rate is consistent with a cardiac arrhythmia like atrial fibrillation. the nurse is caring for a patient with suspected right sided heart failure. which manifestation best supports this potential diagnosis a. wheezing b. orthopnea c. edema d. pallor ANS: c right sided heart failure leads to edema from systemic backup. wheezing, orthopnea, and pallor are indicative of left sided failure which statement by a nurse manager during a staff meeting best demonstrates use of an assertive style of communication? a. i am the manager, and we will do it my way b. im sorry, but your suggestion was useless to solving the problem c. i really dont care, do it the way you think best d. you have made some good points, but i have another suggestion ANS: d select all those items from the list below that constitute barriers to clear communication a. retaliation b. desire for power c. comfort d. increased knowledge e. preoccupation ANS: a b e identify an important similarity between the various types of educational programs for nurses? a. there is a homogeneity of entering students b. no state or national approval is required c. the same courses are taught in all programs d. clinical expierence is required to gain certain knowledge and skills ANS: d select an important element found in baccalaureate nursing programs that is usually not found in other types of nursing education programs? a. use of both classroom and clinical expierences for learning b. limiting enrollment to students with the highest ability c. comprehensive curriculum d. development of the total intellectual skills of the individual ANS: d which contribution of florence nightingale had the greatest impact on nursing education a. recognizing that formal, systematic education in both theory and practice was essential for preperation of high quality nurses b. advocating that all nurses be educated in universities so that care would meet the standards established by the government c. forcing physicians and hospitals to recognize that clinical practice was not as important as the theory based learning obtained in the classroom d. enforcing the requirement that all nursing instructors have a masters degree in nursing to provide the highest quality of education for students ANS: a which statement best describes nursing education in the united states during the 1800s and early 1900s? a. it was high quality with a balance between classroom education and clinical practice b. strict criteria were established for nursing education by the national league of nursing and the american nurses association to guarantee high quality education c. there were no formal nursing education programs during this time period. nurses were trained in apprenticeships only d. there was little or no classroom education, and students learned through hands on experience during their 12 to 14 hour shifts on the hospital units ANS: d identify a major benefit of the diploma type training programs for nurses. a. nurses from diploma programs were assertive and could stand up to a physicians who made unrealistic demands b. nurses from diploma programs were proficient in basic nursing skills and could assume a hospital position with minimal orientation c. nurses trained in diploma programs were often limited to employment in the instituitions where they were trained d. all diploma schools were regulated by the NLN criteria and met strict standards for educating students ANS: b which practice of diploma nursing programs most concerned the state boards of nursing? a. excessive use of classroom time during the program b. mandatory housing of the students in a closed dormitory near the hospital c. use of the students as unpaid hospital personnel during their education programs d. high failure rates of diploma graduates on the national council licensure (NCLEX ) exams ANS: c how can the concept of a career ladder in education best be described? a. specialized programs for associate degree of diploma registered nurses to obtain a baccalaureate degree b. the ability of staff nurses to be promoted based on their clinical skills c. the relationship between one level of nursing education and the next level of education d. after nurses pass the nclex examination, they are all considered professionals ANS: a what are common characteristics usually found in licensed practical nurses ? a. located on college campus, 2 years in length, require no clinical experience b. theory oriented curriculum, wide scope of practice, highly selective admission c. technically oriented, located in vocational technical schools or community colleges, 9 to 12 months in length d. clinical experience in advance care areas; located in community colleges, prepare nurses for professional practice ANS: c which category of advanced practice nurses is the most widely accepted by the public a. expanded practice nurses b. clinical nurse specialists c. certified nurses d. nurse practitioners ANS: d identify the primary position advocated by the 1965 ANA position paper on education for nurses. a. any nursing education program is acceptable as long as the graduates take and pass NCLEX exam b. baccalaureate education should be the basic level of preparation for professional nurses c. associate degree education should be the basic level of preparation for professional nurses d. only nurses education at the master degree or higher level should be considered professional nurses ANS: b what is the most important consequence of the ANA position paper on education for nurses? a. increased numbers of associate degree programs b. large numbers of students graduating with baccalaureate degrees in nursing c. resistance to the proposal by hospitals and diploma nursing programs d. demand for a clear distinction between technical and professional nursing programs ANS: d identify two key requirements for entry into a masters degree nursing program. a. baccalaureate degree in nursing, satisfactory score on the GRE or MAT b. atleast 3 years expierence as an RN, associate degree in nursing c. three letters of reference, certificate of health status d. associate degree in nursing, 3.0 or higher gpa ANS: a what is a trend found in doctoral level programs that have developed since the 1970s? a. movement toward generalization of knowledge b. more emphasis on the clinical that on the academic nature of nursing c. increased use of research based teaching strategies d. movement away from the independence of educational needs ANS: b identify an important function that a nurse serving as a case manager would be required to perform a. overseeing client care during rehabilitation at home b. using provider-centered models to control health care costs c. guiding the care provided by physicians over the course of an illness d. ensuring the high quality of care at all points of interaction with the health-care system ANS: a what is the key element in relationship-centered nursing care? a. focus on care as it is given in the community setting b. use of high level advanced nursing skills in the care of the client c. clients trust in the role and skills of the nurse in the healing process d. responsiveness to societal changes in a consumer driven economy ANS: c identify the primary purpose for the development of the quality and safety education for nurses (QSEN) project a. increase the number of students in nursing programs b. shift nursing education to a more medical model due to increased client aquity c. focus nursing on education on competencies to reduce the number of errors d. decrease the number of associate degree nursing programs ANS: c select all the elements from the list below that are found in the Pew Health Professions Commission Report on the reform for nursing education a. increasing the use of computer technology and interactive software b. preparing all nursing faculty at the doctoral level c. promoting interdisciplinary education d. developing cultural sensitivity e. limiting nursing class size to no more than 50 students f. expanding the scientific basis of the programs ANS: a c d f select all the elements from the list below that were found as assumptions in the ANA position paper on nursing education a. nursing education should meet the increasing need for nurses as quickly as prossible b. the professional practitioner is responsible for the nature and quality of all nursing care clients receive c. education for those in the health-care professions must increase in depth and breadth as scientific knowledge expands d. community colleges are able to prepare nurses just as well as 4 year colleges e. the demand for the services of nurses will continue to increase ANS: b c e select all of the elements from the list below that are QSEN competencies a. quality improvement b. outcome based education c. teamwork and collaboration d. imformatics ANS: a c d during a discussion between the nurse manager and a staff rn about the rns erratic performance on the unit the rn states, after my husband announced that he was leaving me i thought i was dying" identify the best response by the nurse manager. a. tell me how you were feeling b. that was a pretty unrealistic way to feel. there are a lot of fish in the sea c. your personal life should not affect the way you perform your job d. you didnt die, did you? you seem okay now ANS: a a particularly vocal staff nurse on a busy obstetrical