Foundations of Clinical Nursing (Exam 2) Questions And Answers
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Foundations Of Clinical Nursing
Which is most important when caring for a patient with a colostomy stoma?
A. Cleansing the stoma with cool water.
B. Spraying an air freshener in the room.
C. Selecting a colostomy bag with an appropriate sized stomal opening.
D. Wearing sterile gloves when caring for the stoma. - ANS ...
Foundations of Clinical Nursing (Exam 2)
Questions And Answers
Which is most important when caring for a patient with a colostomy stoma?
A. Cleansing the stoma with cool water.
B. Spraying an air freshener in the room.
C. Selecting a colostomy bag with an appropriate sized stomal opening.
D. Wearing sterile gloves when caring for the stoma. - ANS C. Selecting a colostomy bag
with an appropriate sized stomal opening.
Which statement should the nurse use when teaching the patient to avoid foods that have a
laxative effect?
A. "You should avoid applesauce."
B. "You should avoid chocolate."
C. "You should avoid coffee."
D. "You should avoid pasta." - ANS C. "You should avoid coffee."
Which question would take priority when collecting a bowel elimination history for a newly
admitted patient with a medical diagnosis of possible bowel obstruction?
A. "Do you use anything to help move your bowels?"
B. "When was the last time you moved your bowels?"
C. "What color are your usual bowel movements?"
D. "How often do you have a bowel movement?" - ANS B. "When was the last time you
moved your bowels?"
Which independent nursing action facilitates defecation of a hard stool?
A. Applying a lubricant to the anus.
B. Encouraging a sitz bath after defecation.
C. Instilling warm mineral oil into the rectum.
D. Placing a cold compress against the anus. - ANS A. Applying a lubricant to the anus.
Which adaptation is most significant in indicating the presence of a fecal impaction?
A. Odorous flatus
B. Marble-sized, hard, dry stools.
,C. Liquid, fecal seepage, with no passage of stool.
D. Bright, red blood with the passage of stool. - ANS C. Liquid, fecal seepage, with no
passage of stool.
Which is the most appropriate outcome for a hospitalized patient with the nursing diagnosis of
diarrhea?
A. The client will have no more than two bowel movements a day.
B. The client will avoid foods that are high in water-soluble fiber.
C. The client will take Loperamide (Imodium) after each bowel movement.
D. The client will drink at least eight glasses of water per day. - ANS A. The client will have
no more than two bowel movements a day.
Which of the following is detected in a guaiac test of stool?
A. Bile.
B. Bacteria.
C. Ova and Parasites.
D. Occult blood. - ANS D. Occult blood.
The nurse discourages straining on defecation primarily because it could precipitate which of
the following?
A. Incontinence.
B. Heart Dysrhythmias.
C. Fecal Impaction.
D. Constipation. - ANS B. Heart Dysrhythmias.
Which food works best to increase the bulk in fecal material?
A. White bread.
B. White rice.
C. Pasta.
D. Kale. - ANS D. Kale
The excessive use of laxatives should be avoided primarily because it:
A. Causes incontinence.
B. Results in distention of the intestines.
C. Weakens the natural response to defecation
D. Causes abdominal discomfort - ANS D. Causes abdominal discomfort.
, The nurse has reviewed information about the cardiovascular system before caring for a client
with heart disease. The nurse knows that which of the following statements is true concerning
the physiology of the cardiovascular system?
A. Stimulating the parasympathetic system would cause the heart rate to go up.
B. When a person has heart muscle disease, the heart muscles stretch as far as is necessary to
maintain function.
C. The QRS interval on the electrocardiogram (ECG) represents the electrical impulses passing
through the ventricles.
D. When stroke volume decreases, there is a resultant decrease in heart rate. - ANS C. The
QRS interval on the electrocardiogram (ECG) represents the electrical impulses passing
through the ventricles.
The nurse is completing a physical examination for a client who is severely anemic. In
assessing the client's eyes, a sign assessed by the nurse that is consistent with severe anemia
is:
A. Xanthelasma.
B. Petechiae.
C. Corneal arcus.
D. Icteric conjunctiva and sclera. - ANS D. Icteric conjunctiva and sclera.
While obtaining subjective assessment data from a patient with hypertension, the nurse
recognizes that a modifiable risk factor for the development of hypertension is:
A. Consumption of a high-protein diet.
B. A low-calcium diet.
C. A family history of hypertension.
D. Excessive alcohol consumption. - ANS D. Excessive alcohol consumption.
The portion of the vascular system responsible for hemostasis is the:
A. Endothelial layer of the arteries.
B. Smooth muscle of the arterial wall.
C. Thin capillary vessels.
D. Elastic middle layer of the veins. - ANS A. Endothelial layer of the arteries.
During assessment of the client's cardiovascular system the nurse notes a pulse deficit of 21
beats. This finding may be caused by:
A. Gallop rhythms.
B. Cardiac dysrhythmias.
C. Heart murmurs.
D. Pericardial friction rub. - ANS B. Cardiac dysrhythmias.
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