nursing 221 final exam

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  1. The nurse is assessing a patient's pain. The nurse knows that the most reliable indicator of pain would be the :
    Subjective report
  2. The nurse is aware that intimate partner violence screening should occur with which situation
    As a routine part of each health care encounter
  3. a patient tells the nurse that he is allergic to penicillin, What would be the nurse's best response to this information
    "please describe what happens to you when you take penicillin"
  4. The nurse is taking an initial blood pressure on a 72-year old with documented hypertension. How should the nurse proceed
    Inflate the blood pressure cuff 30 mmhg above the point at which the palpated pulse disappears
  5. which of theses statements is true regarding the use of standard precautions in the health care settings
    standard precautions are intended for use with all patients regardless of their risk or presumed infection status
  6. The nurse is caring for a group of medical-surgical patients. The patient most at risk for developing an infection is the patient who
    is recovering from a right total hip arthroplasty
  7. the nurse is taking temperatures in a clinic with a tympanic thermometer. Which statement is true regarding use of the tympanic thermometer
    there is a reduced risk of cross-contamination compared with the rectal route
  8. during the examination , it is often appropriate to offer some brief teaching about the patient's body or the examiner's findings. Which of these statements by the nurse is most appropiate
    your pulse rate is 80 beats per minute. This is within the normal range
  9. The nurse should measure rectal temperatures in which of these patients
    comatose adult
  10. as a mandatory reporter of elder abuse, which of these must be present before a nurse notifies the authorities
    suspicion of elder abuse and or neglect
  11. the nurse is assessing a patient's skin during an office visit. What is the best technique to use to best assess the patient's skin temperature
    Dorsal surface of the hand because the skin is thinner than on the palms
  12. when performing a physical assessment the technique the nurse will use first is
  13. during an interview the nurse states, you mentioned shortness of breath. Tell me more about that." which verbal skill is used with this statement
    open ended question
  14. the nurse is asking an adolescent about illicit substance abuse. the adolescent answers yes i've used marijuana at parties with my friends. what is the next question the nurse should ask
    when was the last time you used marijuanna
  15. when measuring a patient's body temperature, the nurse keeps in mind that body temp is influenced by
    the diurnal cycle
  16. the nurse notices a college is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. The nurse should expect the reading to
    yield a falsely high blood pressure
  17. among many asians there is a belief in the yin yang theory, rooted in the ancient chinese philosophy of tao. the nurse recognizes which statment that most accurately reflects"health" in an asian with this belief
    all aspects of the person are in perfect balance
  18. a patient's weekly blood pressure reading for 2 months have ranged between 124/84 and 136/88, with an average reading of 126/86. the nurse knows that this blood pressure falls within which blood pressure
  19. the patient's record, laboratory studies, objective data and subjective data combine to form the
    data base
  20. a woman who has just discovered that she is pregnant is in the clinic for her obstetric visit. she asks the nurse, how many drinks a day is safe for my baby, the nurse best response is
    no amount of alcohol has been determined safe during pregnacy
  21. the nurse is assessing a 75 year old man, as the nurse begins the mental status portion of the assessment, the nurse exsppects that this patient
    may take a little longer to respond, but his general knowledge and abilities should have declined
  22. A female patient does not speak English well, and the nurse needs to choose an interpreter. Which of the following would be the most appropriate choice?
    a trained interpreter
  23. A patient drifts off to sleep when she is not being stimulated. The nurse can arouse her easily when calling her name, but she remains drowsy during the conversation. The best description of this patient’s level of consciousness would be:
  24. The nurse is reviewing a patient’s nutritional assessment. Which statement is true concerning the nutritional assessment
    It identifies patients who are at risk of malnutrition
  25. A 59-year-old patient tells the nurse that he has ulcerative colitis. He has been having “black stools” for the last 24 hours. How would the nurse best document his reason for seeking care?
    D. J. M. is a 59-year-old male here for having “black stools” for the past 24 hours
  26. A patient tells the nurse that he is very nervous, that he is nauseated, and that he "feels hot." This type of data would be:
  27. During an assessment, the nurse notices that a patient is handling a small charm that is tied to a leather strip around his neck. Which action by the nurse is appropriate?
    Ask the patient about the item and its significance.
  28. A patient tells the nurse that she has had abdominal pain for the past week. What would be the best response by the nurse?
    can you point to where it hurts
  29. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not _____ four unrelated words _____.
    recall:  after 30 min delay

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nursing 221 final exam
2015-12-12 16:01:55
nursing 221

nursing 211 final exam
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