ADULT HEALTH - CARDIO Flashcards
Following treatment for a fracture, a client is now undergoing rehabilitation. His regimen involves performing isometric exercises. Which action is evidence that the client has fully understood the proper technique?
A. The patient exercises both extremities simultaneously
B. The client knows that his heart rate should be monitored while exercising
C. The patient practices forced resistance against stable objects
D. The patient swings his limbs through their full range of motion
Explanation
Rationale: Isometric exercises involve applying pressure against a stable object, like pressing the hands together or pushing an extremity against a wall. It does not include the simultaneous use of the extremities; neither does swinging of limbs. Heart rate monitoring is done with aerobic exercises. The correct answer is option C. Options A, B, and D are incorrect.
Reference:
gnatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The mother of a toddler with Celiac disease is being instructed by the nurse regarding dietary modifications for her child. Which food choice by the mother would indicate a need for further discussion?
A. Rice cakes
B. Restaurant French fries
C. Milk shake
D. Grilled Chicken
Explanation
Choice B is correct. Clients with Celiac disease are advised on a gluten-free diet. While potatoes are naturally free of gluten, French fries made at restaurants aren’t necessarily gluten-free. According to the Celiac Disease Foundation, French fries are among the most easily cross-contaminated food in the restaurants. The majority of fast food joints and restaurants fry these fries with other gluten-filled eats (shared fryers), causing cross-contamination. Among the options above, restaurant based French Fried are the ones to avoid unless they are labeled strictly “Gluten-Free.” Such food choice by the mother requires further discussion and clarification.
Choice A is incorrect. Anything made from brown, white, or wild rice, including rice-based products, such as rice cakes and puffed rice usually, do not contain gluten. Therefore, it is safe for the child to eat Rice cakes.
Choice C is incorrect. Milk does not contain gluten; therefore, it is safe for the child.
Choice D is incorrect. Meat is naturally gluten-free. Chicken does not contain gluten; therefore, it is safe for the child to eat.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
A teenager is diagnosed to be suffering from anorexia nervosa. Upon interviewing her friends, the nurse would expect them to describe the patient to be
A. An under achiever
B. Disorderly
C. Independent
D. Obedient
Explanation
A is incorrect. Teens with anorexia nervosa do well at school. They are mostly achievers in school.
B is incorrect. Anorexic teens are orderly and obedient. They try their best to do what is expected of them.
C is incorrect. Anorexic clients are dependent on others.
D is correct. Teens with anorexia nervosa try their best to do what is expected of them at home and school.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4thEdition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination, 6thEdition. Saunders-Elsevier 2014
The client who is 10 weeks pregnant is complaining to the nurse on duty in the gynecology clinic about her “worsening varicosities.” The nurse would advise her to:
A. Avoid exercise as blood pools in her legs during movement.
B. Wear knee high hose or garters.
C. Avoid citrus fruits.
D. Sleep in side lying position.
Explanation
A is incorrect. Contrary to the statement, exercise promotes venous return when coupled with frequent rest periods.
B is incorrect. The client should avoid wearing knee-high garters as they occlude venous return. Pregnant women are advised to wear elastic support stockings such as TEDS and should be applied up to above the point of enlargement.
C is incorrect. The client should increase her intake of Vitamin C found in citrus fruits as Vitamin C is involved in the formation of blood vessel collagen and endothelium.
D is correct. Sleeping in a side-lying position removes the weight of the fetus on the superior and inferior vena cava, promoting venous return.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
hich of the following lipid levels is out of range and should be reported to the physician?
A. Triglycerides: 75 mg/dL
B. Total cholesterol: 6.5 mmol/L
C. High-density lipoprotein (HDL): 60 mg/dL
D. Low-density Lipoprotein (LDL): 95 mg/dL
Explanation
Correct Answer is B. Lipid profile helps physicians determine the patient’s risk of developing heart disease. It is recommended that individuals have a lipid profile done at least every five years as part of a regular medical exam.
The correct answer is B as 6.5 mmol/L exceeds the “high normal” total cholesterol level. The average Total Cholesterol level is 3.5 to 5.0mmol/L. In milligrams, Total Cholesterol of 200 milligrams per deciliter (mg/dL) or lesser is considered desirable for adults
Choices A, C, and D are incorrect. The normal lipid levels for these tests include:
Triglycerides: 50-150 mg/dL
High-density lipoprotein (HDL): 40-80 mg/dL
Low-density lipoprotein (LDL): 85-125 mg/dL
NCSBN Client Need
Topic: Physiological Integrity; Subtopic: Reduction of Risk Potential
Reference:
Fundamentals of Nursing (Kozier and Erbs)
The nurse has just finished administering two units of Packed Red Blood Cells to a client with anemia. The client’s Hemoglobin and Hematocrit level before the transfusions were given is Hgb 5.5 g/dL and Hematocrit – 26%. The nurse would expect which laboratory values upon the next blood count?
A. approximately Hgb 10.5 g/dL and Hematocrit – 32%
B. approximately Hgb 7.5 g/dL and Hematocrit – 32%
C. approximately Hgb 10 g/dL and Hematocrit – 33%
D. approximately Hgb 13 g/dL and Hematocrit – 33%
Explanation
A is incorrect. This is not an expected value for hemoglobin and hematocrit after infusion of 2 units of PRBCs.
B is correct. Each unit of PRBCs increases the hemoglobin by 1 g/dL and hematocrit by 3% 4-6 hours after completion of blood transfusion. When two units of PRBCs are infused, the nurse expects the Hgb levels to increase by 2 g/dl and Hct levels to increase by 6%.
C is incorrect. This is not an expected value for hemoglobin and hematocrit after infusion of 2 units of PRBCs.
D is incorrect. This is not an expected value for hemoglobin and hematocrit after infusion of 2 units of PRBCs.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
Karch, A. Focus on Nursing Pharmacology, 3rd edition. Lippincott, Williams & Wilkins 2006
The nurse unit manager receives a complaint from a client’s family regarding the care that the client received from the night shift nurse. What would be the manager’s most appropriate initial action?
A. Tell the night charge nurse to ensure the night nurse performs her work
B. Talk to the nurse regarding the complaint and discuss the care provided
C. Discuss the situation with the client’s family making the complaint
D. Take note of the complaint and place it in the employee’s file
Explanation
Rationale: The nurse manager should talk to the client’s family first to let them feel that they are being heard and that she can ask questions to investigate further the complaint and determine whether it is valid or not. Once the manager has determined that the claim is correct, the manager would then talk to the nurse regarding the care that she has provided and ask more questions. The incident may go into the nurse’s file, but not without investigating into the matter first.
Reference
Kelly, P; Marthaler, M; Nursing Delegation, Setting Priorities, and Making Patient Care Assignments, 2nd Edition; Cengage Learning, 2010
A G1P0 client with a blood type A negative is at her 28th-week gestation and was advised a RhoGAM injection today. Which statement by the client indicates the need for further teaching about this therapy?
A. “This shot is meant to prevent my baby from developing antibodies against my blood, right?”
B. “I understand that if we find out my baby is Rh positive, then I’ll need to get another one of these injections.”
C. “This shot should help to protect me in future pregnancies if this baby comes out Rh positive, like her dad.”
D. “This shot will prevent me from becoming sensitized to Rh-positive blood.”
Explanation
Rationale: RhoGAM is administered to Rh-negative mothers to prevent her from producing antibodies against her Rh-positive fetus. Option A indicates that she needs further teaching. If the infant is Rh-positive, the mother needs to receive another dose after delivery to prevent maternal sensitization. This will also protect future pregnancies as the mother’s blood will be free of antibodies against her fetus. RhoGAM prevents maternal awareness of Rh-positive blood. Options B, C, and D are accurate statements and are, therefore, incorrect answers.
Reference:
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
The nurse in the ER is caring for a child having an acute asthma attack. The nurse is reviewing with the mother to determine activities that precipitate the child’s asthma attacks. Which statement by the mother would the nurse provide teaching?
A. My son loves playing trumpet for the grade school band
B. My son rake leaves every Saturday afternoon to help out with the work at home.”
C. My son participates in extracurricular activities
D. My son swims 5 laps twice a week with his friends
Explanation
A is incorrect. Musical instruments such as a trumpet help improve lung function.
B is correct. Raking leaves exposes the child to allergens from the trees. The nurse should advise the mother to find another activity for her child.
C is incorrect. Extracurricular activities are encouraged to promote maturity in the child.
D is incorrect. Swimming is an excellent exercise for the lungs.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
The client’s ABG results came in and it shows the following values: pH 7.38, PaO2 76, PaCO2 39, HCO3 23. What should be the initial action of the nurse?
A. Administer oxygen 6 L/min via nasal cannula.
B. Instruct the client to take deep breaths.
C. Administer sodium bicarbonate intravenously.
D. Check the respiratory status of the client.
Explanation
A is correct. The client’s ABG indicates hypoxia. The normal PaO2 is 80-100; therefore, the nurse should give oxygen to address the situation.
B is incorrect. Hypercapnia or a PaCO2 level higher than 45 mm Hg is an indication to take deep breaths to expel the excess carbon dioxide. The client’s PaCO2 is 39, which does not necessitate deep breathing.
C is incorrect. Intravenous sodium bicarbonate should be administered when the client’s HCO3 level is less than 22.
D is incorrect. Respiratory assessment is not needed in this situation.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The RN is in charge of the unit together with an LPN. Which situation indicates proper delegation of tasks by the RN?
A. The RN delegates to LPN to check the circulation on the child with a forearm cast.
B. The LPN is tasked to feed a one-year old that just had a cleft palate repair.
C. The LPN demonstrates urinary catheterization to the mother of a child with neurogenic bladder.
D. The RN checks if the LPN completed all delegated tasks.
xplanation
A is incorrect. The LPN cannot assess a client. This is a task for the RN.
B is incorrect. The child has just undergone a cleft palate repair. There is a risk for the child to damage his incision site and to aspirate if he/she is fed by untrained personnel. This task is for the RN.
C is incorrect. Demonstrating a procedure to the mother is similar to educating or teaching the client. The LPN is not allowed to perform teaching/education.
D is correct. It is the responsibility of the nurse to evaluate and check if the delegated tasks to the LPN have been performed.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Nugent, P., et al., Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
A diabetic client has just given birth to a male neonate. Which assessment finding by the nurse would warrant nursing intervention?
A. Crying
B. Restlessness
C. Twitchiness
D. Yawning
Explanation
A is incorrect. Crying, Restlessness and Yawning are all normal for the newborn.
B is incorrect. Crying, Restlessness and Yawning are all normal for the newborn.
C is correct. Twitchiness or jitteriness is a sign of seizures in the newborn. The nurse should inform the physician.
D is incorrect. Crying, Restlessness and Yawning are all normal for the newborn.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
The nurse is about to prepare the morning medications for clients on the ward. Which medication should the nurse prepare and administer first?
A. Prednisolone (Deltsone), a glucocorticoid, to a client with inflammatory bowel disease.
B. Rivastigmine (Exelon),an anticholinesterase inhibitor, to a client with dementia.
C. Sucralfate (Carafate), a mucosal barrier agent, for a client with duodenal ulcer.
D. Enoxaparin (Clexane), an anticoagulant, to a client on bed rest after surgery.
Explanation
A is incorrect. This medication can be given 30 minutes before and after the scheduled time. This medication does not have to be the first medication given.
B is incorrect. Exelon can be given within a 30 minute time frame of the scheduled time. This medication does not have to be given first.
C is correct. Sucralfate is a mucosal barrier agent that must be given 30 minutes before the client’s meal. This medication must be given first to achieve its effect.
D is incorrect. Clexane can be given within a 30 minute time frame of the scheduled time. This medication does not need to be administered first.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
The nurse is caring for a client receiving total parenteral nutrition for 2 weeks. Which action by the nurse is the most important?
A. Determining weight changes in the client.
B. Monitoring laboratory results.
C. Maintaining strict asepsis during dressing changes in the IV line.
D. Monitoring of blood glucose levels.
Explanation
A is incorrect. Obtaining the client’s weight is essential to assess the client’s nutritional status. However, this is not the nurse’s priority intervention.
B is incorrect. The nurse should monitor laboratory results to monitor changes in electrolytes. However, this is not a priority action.
C is correct. TPN has high glucose content making it an ideal medium for bacterial growth. The nurse should perform strict asepsis during dressing changes in the TPN line.
D is incorrect. TPN may cause an increase in blood sugar levels in the first 48 hours of administration as the client has not yet adjusted to the glucose load of the patient. However, since it is already two weeks of administering the solution, the client should have already changed to the TPN solution.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
You are caring for a client with a terminal disease and this person has asked for a curandero. What should you do?
A. Refer the family to a religious shop with Bibles and other holy books.
B. Refer the family and the client to a member of the clergy who may be able to help.
C. Give the client a candle and close all of the shades and blinds to darken the room.
D. Arrange for the client to go to a religious service to get this special blessing.
Explanation
Correct Answer is B
Correct. You would refer the family and the client to a member of the clergy who may be able to help. A curandero is a healer who is believed to supernatural powers that can cure the sick. These powers are derived from the fact that many believe that illnesses and diseases occur as the result of evil spirits and a curse from God.
You would not give the client a candle and close all of the shades and blinds to darken the room because this is not consistent with the person’s desire to have a curandero; a curandero is not a particular religious blessing, and it is not a holy book.
Choice A is incorrect. A curandero is not a holy book.
Choice C is incorrect. A curandero is not a religious or spiritual practice that uses a candle and a darkened room.
Choice D is incorrect. A curandero is not a particular religious blessing.
Reference: Berman, Audrey, Snyder, Shirlee, and Geralyn Frandsen. (2016). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice (10th Edition).
A 45-year-old man is rushed to the ER with reports of substernal chest pain and diaphoresis. Cardiac troponin levels were taken and found to be elevated. The ER nurse understands that nursing interventions would focus on which priority?
A. Increase oxygenation to the heart and reduce the heart’s workload
B. Prevent complications and confirm a diagnosis of myocardial infarction
C. Alleviate the patient’s anxiety
D. Pain relief
Explanation
A is correct. The client manifests signs and symptoms of myocardial infarction. The priority for nursing care should be focused on increasing oxygen delivery to the heart and reducing its workload to prevent further damage.
B is incorrect. Confirming the diagnosis should be done; however, since the client is already exhibiting signs of reduced myocardial oxygenation (chest pain), the nurse should prioritize oxygen delivery to the client.
C is incorrect. It is the nurse’s responsibility to alleviate the client’s anxiety; however, the nurse should prioritize oxygenation to the client.
D is incorrect. Pain relief should be important in the care of the patient with myocardial infarction; however, it should not take priority over myocardial oxygenation.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination, 6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
A client has just been diagnosed with a terminal illness. She decides to execute a living will in the unit and asks the nurse to be the witness of the will. What is the most appropriate response by the nurse?
A. “I’m sorry, but under the law, we’re not allowed to witness living wills.”
B. “Let me call the doctor. Maybe he can witness it for you.”
C. “Your family is the only ones that can serve as witnesses.”
D. “Let me call the hospital attorney; he needs to be present when you sign your will.”
Explanation
A is correct. Nurses and other healthcare workers working in the facility where the patient is receiving care are forbidden by law from becoming witnesses.
B is incorrect. This statement is inaccurate. Nurses and other healthcare workers working in the facility where the patient is receiving care are forbidden by law from becoming witnesses.
C is incorrect. This statement is false. Witnesses for the signing of the will can be specific individuals. It does not necessarily mean family only.
D is incorrect. The hospital lawyer is not needed to be present in signing the living will.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
A client is prescribed bed rest by the physician after surgery. The nurse that is taking care of the patient always avoids putting pressure on the back of the client’s knees. The reason for this is to prevent which complication?
A. Cerebral embolism
B. Pulmonary embolism
C. Limb gangrene
D. Coronary Vessel occlusion.
xplanation
A is incorrect. Once a thrombus is dislodged and travels through the circulatory system, the pulmonary capillary bed will be the first small vessels that the embolus will encounter, not the cerebral blood vessels.
B is correct. Once a thrombus is dislodged and travels through the circulatory system, the pulmonary capillary bed will be the first small vessels that the embolus will encounter, resulting in pulmonary embolism.
C is incorrect. Gangrene occurs when the blood supply to the affected limb is compromised. Putting pressure on the back of the client’s knees, like a pillow, does not impair circulation.
D is incorrect. Once a thrombus is dislodged and travels through the circulatory system, the pulmonary capillary bed will be the first small vessels that the embolus will encounter, not the coronary blood vessels.
Reference
Nugent, P., et al., Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
The Licensed Practical Nurse (LPN) informs the nurse that the 1-day post Partum client she is taking care of has changed 3 perineal pads in the last 4 hours. What is the initial action of the nurse?
A. Document the finding.
B. Instruct the LPN to massage the client’s uterus.
C. Assess the patient immediately.
D. Ask the LPN why the nurse was not informed earlier.
Explanation
A is incorrect. Assessment of the client should be done first before investigating whether or not the LPN was negligent.
B is incorrect. Massaging of the uterus must be done by the nurse, not the LPN. However, the nurse needs to assess the patient first for a boggy uterus and confirm excessive bleeding.
C is correct. The initial action of the nurse would be to assess the client first to confirm if she has excessive bleeding.
D is incorrect. The nurse should always verify the information before documenting it.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
A client was brought into the emergency department by his wife because he has been vomiting for three days. The wife is worried because he has grown weak and seems to be having a hard time breathing. The nurse notes that he is hypoventilating and has a respiratory rate of 10 breaths/min. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/min. Consequently, arterial blood gases are drawn, and the nurse reviews the results, expecting to note which of the following?
A. A decreased pH and an elevated CO2
B. An elevated pH and a decreased CO2
C. A decreased pH and a decreased HCO3_
D. An increased pH with an increased HCO3_
Explanation
Rationale: Persistent nausea and vomiting would most likely lead to metabolic alkalosis because of the loss of gastric acid, thus causing the pH and HCO3_to increase. Hypoventilation and tachycardia are some symptoms the patient may experience. Option A reflects a respiratory acidotic condition. Option B reflects a respiratory alkalotic status. Option C reflects a metabolic acidotic status. Therefore, option D is the correct answer.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination, 6thEdition. Saunders-Elsevier 2014
The home health nurse is visiting an elderly client for the first time in his home. Upon assessment of the client, the nurse notices that the client has been taking 12 prescription medications and five over the counter medications. What is the nurse’s most appropriate action?
A. Check for drug interactions.
B. Check for side effects to the client from the medications.
C. Check for any medication duplication.
D. Ask the client if there are family members helping him with his medications.
Explanation
A is incorrect. Checking for drug interactions should be done after determining the duplication of medications.
B is incorrect. The identification of side effects of medications can be made after the duplication of drugs is determined.
C is correct. Checking for any duplication in medication should be the first action of the nurse to eliminate the risk of adverse effects on the client.
D is incorrect. Asking about family members helping with his medications is irrelevant to the problem of polypharmacy as of the moment.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
You are working in an adult telemetry step-down unit and have five patients to manage. You see the following rhythms on the monitor from your patients. Which patient should you assess first? Select the image of the ECG for the patient you would assess first. A. NORMAL SINUS RHYTHM B. UNIFOCAL PVC C. VENTRICULAR TACHYCARDIA D. SINUS TACHYCARDIA
Explanation
Answer: C
A - This patient is in normal sinus rhythm. They are not the priority for assessment.
B - This patient is demonstrating normal sinus rhythm is one unifocal pre ventricular contraction. While the nurse does need to assess them, they are not the priority. PVCs can be well-tolerated, and a singular one is not immediately dangerous.
C - This patient is showing sustained ventricular tachycardia on the monitor. This is a fatal rhythm and the nurse must immediately assess the patient as they could quickly arrest and necessitate a code blue. This is the correct patient to assess first.
D - This patient is in sinus tachycardia. This could be caused by a fever, dehydration, or could be the patient’s baseline. While the nurse should assess the patient and determine the cause of the tachycardia, he is not the priority from the five patients shown.
NCSBN Client Need
Topic: Reduction of Risk Potential Subtopic: Diagnostic Tests
Reference:
Silvestri, L.; Saunders Comprehensive Review for the NCLEX-RN Examination, ed 6, St. Louis, 2014, Elsevier, p. 785-787
The nurse has instructed a patient who has been diagnosed with atrial fibrillation. Which of the following statements by the patient would require to follow up? Select all that apply.
A. “I have an increased risk for a stroke.”
B. “I should weigh myself daily. at the same time.”
C. “I may be prescribed medications such as amiodarone.”
D. “I should wear a mask when I am in public.”
E. “I should follow-up with my primary healthcare provider (PHCP) if I develop shortness of breath.”
Explanation
Correct Answers are B and D. These two statements indicate that the patient needs further follow-up education to correct the misconceptions. The client does not need to weigh themselves daily (Choice B) as that would be applicable for CHF and not for atrial fibrillation. Considering daily in CHF is useful to detect excess fluid retention, which may precede symptoms such as shortness of breath. Wearing a mask in public is unnecessary as the infection is not a concern here ( Choice D).
Choices A, C, and E are incorrect options because these statements indicate correct understanding by the patient and do not require follow-up teaching. Atrial fibrillation is a common dysrhythmia that results in a decrease in an atrial kick. A client with atrial fibrillation is at risk for an ischemic stroke (Choice A) because of the formation of clots in the atrial appendage. Treatment for AFib ranges from medications (diltiazem, amiodarone) to cardiac ablation ( Choice C).
Finally, the client needs to notify the PHCP if they develop dyspnea because this could be an indication of AFib with a rapid ventricular response (RVR), which requires immediate medical attention (Choice E).
NCSBN Client Need:
Topic: Physiological adaptation; Sub-Topic: Alterations in body systems
The patient is receiving instructions from the clinic nurse regarding dietary modifications to help in the treatment of her Cystitis. The nurse is giving her a list of foods to avoid because they irritate her bladder. All of the following are foods that she needs to prevent, except:
A. Coffee
B. Spaghetti
C. Alcohol
D. Cranberry juice
explanation
A is incorrect. Coffee/Caffeine is an irritant to the bladder and should be avoided by patients with Cystitis.
B is incorrect. Spaghetti sauce contains tomatoes which are an irritant to the bladder and should be avoided by patients with Cystitis.
C is incorrect. Alcohol is an irritant to the bladder and should be avoided by patients with Cystitis.
D is correct. Cranberry juice is used to acidify the urine of the patient with Cystitis and should be included in her dietary regimen.
Reference:
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The nurse is caring for an 8 year old boy in the pediatric unit. The nurse, when caring for this age group should be aware that:
A. The child will do something for another if that person does something for the child.
B. The child now follows social standards for the good of all.
C. The child wants to follow rules because of a need to be seen as “good.”
D. The child finds satisfaction in following rules.
Explanation
A is incorrect. This pertains to the pre-conventional stage of moral development. The child will carry out actions to satisfy his needs. If a person does something for the child, the child will do something for the person. This applies to children ages 4-7 years old.
B is incorrect. This is the post-conventional stage. It applies to adolescents. The child now follows social standards for the good of all people.
C is correct. The school-age child aged 7-10 find a need to follow the rules as they want to be a “good” person in their eyes, and for others.
D is incorrect. This applies to the 10-12-year-old, still in the current stage. This is where the child finds satisfaction in following rules.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
A woman comes into the emergency room complaining of insomnia, anxiety, the difficulty of breathing, and a sense of impending doom. After being assessed by the physician, no physiological abnormalities were found. However, the client is still anxious and apprehensive. What is the most appropriate statement by the nurse to the patient?
A. “Don’t worry, you’re safe here. Just try to relax.”
B. “Can you think of anything that happened recently or in the past that might have triggered these feelings?”
C. “We gave you something that should calm you down.”
D. “Take slow, deep breaths and try to relax. Nothing bad will happen to you here.”
Explanation
A is incorrect. This statement disregards the client’s feelings and offers false reassurance. This is an inappropriate response by the nurse.
B is correct. This question offers reassurance and provides an opportunity for the nurse to gain insight into the client’s anxiety. This is an appropriate statement by the nurse.
C is incorrect. Telling the client that you gave him some medication disregards his feelings and does not allow him to discuss those feelings. This statement also offers some form of false reassurance to the client.
D is incorrect. This statement disregards the client’s feelings and offers false reassurance. This is an inappropriate response by the nurse.
Reference
Halter, MJ. Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 7th Ed. St. Louis, MO: Mosby Elsevier; 2014
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
A nurse is reviewing the arterial blood gas results of a client and notes the following: pH 7.45, PCO2 of 30 mm Hg, and HCO3-of 22 mEq/L. Does the nurse know that these results indicate?
A. Metabolic acidosis, compensated
B. Respiratory alkalosis, compensated
C. Metabolic alkalosis, uncompensated
D. Respiratory acidosis, uncompensated
Explanation
The normal pH ranges between 7.35-7.45. A respiratory condition would show an inverse relationship between the PCO2and the pH, as seen in this case. In a metabolic state, the HCO3- would have direct contact with the pH. Because the pH is at 7.45, which is within the normal range, this is an indication that compensation has occurred. Therefore, option B is the correct answer, while options A, C, and D are incorrect.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination, 6thEdition. Saunders-Elsevier 2014
The nurse is discharging the client that has been admitted due to subarachnoid hemorrhage. The client still has some speech and balance deficits. Which referral should the nurse make?
A. Refer the client to hospice care.
B. Refer the client to speech therapy.
C. Refer the client to the physical therapist.
D. Refer the client to a home health agency.
Explanation
A is incorrect. Hospice care is care that is patterned for clients that are terminally ill. The client is not terminally ill.
B is incorrect. Speech therapy aids clients in regaining speech and swallowing abilities. Speech therapy should have been initiated and ongoing while the client is in the hospital admitted.
C is incorrect. Physical therapy aids clients in regaining muscle strength and balance. Physical therapy should have been initiated and ongoing while the client is in the hospital admitted.
D is correct. The client is going home, thus the client needs to be referred to a home health agency so that there is continuity of care even at home.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
The nurse in the neurology ward is taking care of a patient with paraplegia due to spinal cord injury. The nurse is planning for his rehabilitation. Which would be the most effective plan for the patient?
A. The client and the family will have to arrange for the rehabilitation.
B. The plan should be implemented early on in the treatment of the patient
C. The patient should plan for minimal and short term rehabilitation as he will be able to return to his former activities
D. Long term care should be arranged because the client is no longer capable of self-care
Explanation
A is incorrect. The client and the family are not familiar with the options available in the health care system; the nurse should provide need information and support to both the client and his family.
B is correct. Rehabilitation should start early in the treatment. This provides the patient with an optimistic atmosphere and makes the transition to discharge a lot easier.
C is incorrect. The client is being prepared to adapt to a new lifestyle that will have to adjust to his paralysis.
D is incorrect. Self-reliance and independence is the goal of rehabilitation.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
The nurse is caring for a client that is hypothermic and receiving warmed IV fluids. The nurse understands that rewarming must be done slowly due to which primary reason?
A. To prevent burns in the patient.
B. To prevent Ventricular Fibrillation and cardiovascular collapse.
C. To prevent frostbite.
D. To avoid muscle spasms.
Explanation
A is incorrect. Preventing burns is a nursing responsibility of the nurse when warming a patient but is not the main reason why rewarming should be done slowly.
B is correct. Rewarming must be done slowly because the hypothermic client is especially susceptible to the development of ventricular fibrillation and cardiovascular collapse if warmed blood is returned rapidly to a cold heart.
C is incorrect. Frostbite is a product of hypothermia to the extremities, not rewarming.
D is incorrect. Muscle spasms cannot be caused by rewarming.
Reference
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The nurse in the delivery room has just assisted in the delivery of a newborn and is now attempting to deliver the placenta. The nurse understands that expulsion of the placenta would trigger all of the following processes except:
A. Decrease in progesterone.
B. Decrease in estrogen.
C. Increase in prolactin.
D. Production of oxytocin.
Explanation
A is incorrect. This is a correct statement. When the placenta is expelled, this causes a decrease in estrogen and progesterone that causes the anterior pituitary gland to increase prolactin.
B is incorrect. This is a correct statement. When the placenta is expelled, this causes a decrease in estrogen and progesterone that causes the anterior pituitary gland to increase prolactin.
C is incorrect. This is a correct statement. When the placenta is expelled, this causes a decrease in estrogen and progesterone that causes the anterior pituitary gland to increase prolactin.
D is correct. Oxytocin production is stimulated by suckling. Suckling stimulates the posterior pituitary gland to produce oxytocin, causing the release of milk from alveoli into the ducts.
Reference
Nugent, P., et al., Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
A client has been admitted to the hospital with findings of urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement and has returned to normal hydration status if the blood urea nitrogen level is
A. 5 mg/dL
B. 15 mg/dL
C. 27 mg/dL
D. 34 mg/dL
Explanation
Rationale: The average blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in options C and D indicate continued dehydration. Option A reflects a lower than average cost, which may occur with fluid volume overload, among other conditions.
Source: Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
he nurse is about to start total parenteral nutrition to a patient that just undergone major abdominal surgery. The nurse understands that upon hooking the TPN onto the client, the nurse’s priority action would be to:
A. Maintain aseptic technique all throughout handling of the TPN solution
B. Ensure that the IV line where the TPN is attached to is patent.
C. Monitor the client’s kidney function tests.
D. Monitor the client’s glucose levels.
Explanation
A is incorrect. TPN solution is an excellent medium for bacterial growth. The nurse must maintain asepsis during handling of the solution; however, this is not a priority action for the first 24 hours of starting the solution.
B is incorrect. The solution is extremely irritating to the vein. It is optimally given through a central catheter. This is not however, the priority nursing action.
C is incorrect. TPN is not nephrotoxic. There is no need to monitor kidney function tests.
D is correct. The nurse must monitor the client’s blood glucose levels as the TPN has a high glucose content. Hyperglycemia may occur during the first days of TPN.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
A senior RN is supervising a newly registered nurse fresh from the university in the emergency department. Which situation shall the senior RN intervene?
A. The new RN elevates the foot of a 13 year old with a fractured tibia.
B. The new RN calls Child Protective services for the child she suspects of being sexually abused.
C. The new RN checks the tonsils of a drooling 3 year old with sore throat.
D. The new RNgives a nebulization to an 8 year old with asthma.
Explanation
A is incorrect. Elevating the foot to relieve swelling and edema in a fractured foot is an accurate nursing action.
B is incorrect. For any suspected child abuse, the nurse is obligated by law to report the case to Child Protective Services.
C is correct. A child with a sore throat that is drooling may be manifesting epiglottitis. Drooling may indicate that the child is going into respiratory distress and warrants timely intervention by the healthcare team. The senior RN should step in and guide the new RN in what to do.
D is incorrect. Giving a nebulization to a child having an asthma attack relaxes the bronchial walls of the child and improves respiratory status.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
The home health nurse is talking to a client with iron-deficiency anemia. Which meal plan would indicate to the nurse that the client understood her discharge instructions?
A. Roast beef, gelatin salad, green beans, and peach pie
B. Chicken salad, coleslaw, French fries, ice cream
C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisins
D. Pork chop, creamed potatoes, corn, and coconut cake
Explanation
A is incorrect. Roast beef is high in iron; however, the other dishes accompanying the meal are low in iron.
B is incorrect. Chicken and green leafy vegetables are rich in iron; however, french fries and ice cream have low nutritional value.
C is correct. Foods that are high in iron are egg yolks, wheat bread, carrots, green leafy vegetables, and raisins. This is an optimal meal for the client to increase his dietary iron intake.
D is incorrect. Pork chops contain high iron. Potatoes, corn, and coconuts, however, contain low iron.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The nurse is discharging a client with a new sigmoid colostomy. Which statement from the client indicates a need for further teaching?
A. “I will call my doctor immediately if my stoma becomes bluish.”
B. “I can eat what I used to eat when I go back home.”
C. “I need to wear a pouch over my stoma.”
D. “I need to irrigate my colostomy every week with tap water.”
Explanation
A is incorrect. Bluish discoloration of the stoma indicates necrosis and requires immediate action. The client needs to call the physician when this happens. The color of a normal, healthy stoma should be reddish to pink.
B is incorrect. The client can go back to her regular diet once she is discharged as the stoma is already working.
C is incorrect. A colostomy pouch should be worn over the stoma to collect the feces that is coming out of the stoma.
D is correct. A colostomy should be irrigated dated so that the client will have a daily bowel movement. This statement signifies the client needs more teaching.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
The nurse in the postpartum ward is looking at laboratory results of clients that just arrived. The nurse would go to which client immediately?
A. A patient with WBC of 15,000 cu.mm.
B. A patient a Creatinine level of 0.8 mg/dL
C. A patient with a Platelet count of 360,000 cu.mm.
D. A client with a blood glucose of 260 mg/dL
Explanation
A is incorrect. During labor and after birth, the WBC count would rise to 25,000. This is a normal response of the body and should not warrant any concern.
B is incorrect. The serum creatinine level is within normal limits. This does not need any intervention.
C is incorrect. Normal platelet count is 150,000 to 450,000. This is within normal limits.
D is correct. The average blood glucose level is 70 – 120 mg/dL. The client’s blood glucose level is 260, thus warranting the attention and intervention of the nurse.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4th Edition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
The nurse in the Recovery room is anticipating the arrival of a client from the OR after a Thyroidectomy. The nurse is aware of the potential complications of such an operation and prepares all necessary equipment except:
A. Sphygmomanometer, blood pressure cuff, and stethoscope.
B. ECG machine
C. Additional pillows, sandbags
D. Oxygen, suction equipment, intubation supplies and tracheostomy set
Explanation
A is incorrect. The nurse should keep a Sphygmomanometer, blood pressure cuff, and stethoscope for him to assess the patient’s blood pressure frequently. The blood pressure cuff can also be used to evaluate for hypocalcemia by checking for a positive Trousseau’s sign.
B is correct. Although an ECG machine may be needed for checking the patient’s heart rhythm, it is not necessary as of the moment.
C is incorrect. The nurse should keep pillows and sandbags at the bedside to use them as splints for the client’s neck. The nurse needs to immobilize the client’s neck to prevent damage/strain on his suture line.
D is incorrect. The nurse needs to have all these emergency airway equipment at the bedside in the event of respiratory obstruction caused by edema of the glottis.
Reference:
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The unit manager notices that the nurse has been taking an extra 15 minutes for the lunch break thrice in the past week. Which action by the nurse manager is most appropriate?
A. Continue to observe the nurse’s behavior.
B. Make written notes on the nurse’s file.
C. Ask the nurse to check in with her before and after taking his lunch.
D. Mention the incident to the nurse concerned in an informal manner.
Explanation
A is incorrect. The behavior is becoming a pattern and should warrant intervention by the nurse manager. The manager should talk to the concerned nurse regarding the situation.
B is incorrect. This is only the third time that the incident occurred and did not warrant any formal documentation of behavior.
C is incorrect. This is a punitive action for the nurse manager to take. The manager should talk to the nurse first before implementing action.
D is correct. The nurse manager should talk to the nurse regarding the behavior informally. This is to find out the reason behind the issue and provide solutions.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
The nurse is caring for a G4P3 client in active labor that has undergone three Caesarean sections. The client suddenly screams out in pain and immediately quiets down. The nurse’s initial action would be to
A. Prepare the client for delivery
B. Notify the physician
C. Increase the rate of her IV fluids
D. Assess the client’s contraction pattern
Explanation
A is incorrect. The client has ruptured her uterus. There is already no chance for the client to deliver her baby spontaneously because of a ruptured uterus.
B is incorrect. The nurse should initiate measures to stabilize the client first before calling the physician.
C is correct. The client has suffered a ruptured uterus. The client will be at risk for hemorrhage due to the increased vascularity of the uterine structures. The nurse should anticipate this by increasing the rate of IV fluids infusing into the client to counteract the blood loss.
D is incorrect. Due to the rupture of the client’s uterus, the contraction pattern can no longer be assessed.
Reference
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family, 4thEdition; Lippincott, Williams & Wilkins, 2003
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination, 6thEdition. Saunders-Elsevier 2014
A post hemorrhoidectomy client is for discharge. The nurse should highlight which point in the discharge instructions?
A. The proper technique for sitz bath
B. Restricting fluid intake for 24 hours
C. Laxative administration upon discharge
D. Lying in the recumbent position
Explanation
Rationale: It is important that the client expose the operative site to warm, moist heat, such as a sitz bath, 3–4 times a day for several days post hemorrhoidectomy. Option A is therefore the correct answer. Fluid intake of at least 2 liters/day is recommended, thus, option B is incorrect. Stool softeners, instead of laxatives may be prescribed as laxatives may cause diarrhea and increase pain in the rectal area. Option C is therefore incorrect. The patient is also encouraged to assume the side-lying position to reduce pressure on the surgical site and prevent discomfort. Option D is therefore incorrect.
Reference:
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013.
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The nurse is preparing a client for a stress test. Which teaching by the nurse should not be included?
A. The client will be made to wear a device on her ankles that measures blood pressure.
B. The client should wear loose fitting clothes during the test.
C. The client will be walking at a speed of 1.5 - 2 miles per hour.
D. The client can stop the test anytime she wants.
Explanation
A is incorrect. The nurse should tell the client that her performance on the treadmill test is also gauged by measurement of ankle systolic pressure.
B is incorrect. The client should be instructed to wear comfortable clothing during the stress test.
C is incorrect. The client is made to walk on the treadmill at speeds of 1.5 – 2 miles per hour at a grade elevation of 10% - 20% and a time limit of 5 minutes.
D is correct. The client should be informed that exercise will be stopped at the maximal level of exertion or when manifestations become disabling.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
Black, JM, Hawkes, JH; Medical-Surgical Nursing: Clinical Care for Positive Outcomes 8th edition, Nebraska: Elsevier 2009
The nurse is in the screening room of a women’s health clinic. The nurse notices a particular woman that says for the past few months she has back and leg pain, spotting after intercourse with her husband, and vaginal discharge. The nurse suspects:
A. Cervical Cancer
B. Endometrial Cancer
C. Ovarian cancer
D. Vaginitis
Explanation
A is correct. Signs and symptoms of cervical cancer include back and leg pain, spotting between menstrual periods and after intercourse, vaginal discharge, and lengthening of a menstrual period. A Pap Smear is needed to assess cellular changes and check for cancerous and precancerous conditions.
B is incorrect. Endometrial cancer manifests as menorrhagia (excessive menstrual bleeding), low abdominal pain, backache, constipation due to pressure from an enlarging mass. A biopsy is needed to confirm the diagnosis.
C is incorrect. Initial signs and symptoms of ovarian cancer include an increasing abdominal girth due to ovarian enlargement; Constipation, due to rectal pressure from the enlarging mass; Anemia, vomiting, and cachexia.
D is incorrect. A bacterial infection causes vaginitis. Signs and symptoms include pruritus, burning urination, dysuria, dyspareunia, and a foul-smelling vaginal discharge.
Reference
Nugent, P., et al., Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. 20th Edition, Elsevier 2012
A client with prostate cancer is undergoing brachytherapy. His wife is visiting him and asks the nurse if she can spend some time with her husband a little more. The most appropriate response for the nurse should be:
A. The hospital does not allow you to stay for more than the allotted visiting hours.
B. You do not need to stay for longer than you should.
C. Your husband will get better sleep if you go home.
D. You can only stay up to half an hour to protect yourself from the radiation.
Explanation
A is incorrect. This is an apathetic response from the nurse and is an inappropriate response.
B is incorrect. This is an apathetic response from the nurse and is an inappropriate response.
C is incorrect. This response does not address the situation. This is also an apathetic response from the nurse and is an inappropriate response.
D is correct. Clients undergoing brachytherapy have radium implants. They should have limited close contact with a family of up to only 30 minutes a day. The visitors should limit their time of exposure to radium, have adequate distance between them, and use a lead shield against the radium.
Reference
Silvestri, L. Saunders Comprehensive Review for the NCLEX-RN Examination,6th Edition. Saunders-Elsevier 2014
Ignatavicius DD, Workman LM. Medical-Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis, MO: Elsevier; 2013
