Fund questions 43-9-36 Flashcards

1
Q

A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child’s socialization into the American midwestern culture is best described as:

A) Assimilation.
B) Acculturation.
C) Biculturalism.
D) Enculturation.
A

D

Socialization into one’s primary culture as a child is known as enculturation.

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2
Q

A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she:

A) Chose to be bicultural.
B) Adapted to and adopted the American culture.
C) Had an extremely negative experience with the American culture.
D) Gave up part of her ethnic identity in favor of the American culture.
A

B

Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture.

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3
Q

To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own:

A) Motivation and commitment to caring.
B) Social, cultural, and biophysical factors.
C) Engagement in cross-cultural interactions.
D) Background, recognizing her biases and prejudices.
A

D

Cultural awareness is an in-depth self-examination of one’s own background, recognizing biases and prejudices and assumptions about other people.

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4
Q

Which of the following is required in the delivery of culturally congruent care?

A) Learning about vast cultures
B) Motivation and commitment to caring
C) Influencing treatment and care of patients
D) Acquiring specific knowledge, skills, and attitudes
A

D

Specific knowledge, skills, and attitudes are required in the delivery of culturally congruent care.

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5
Q

A registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient?

A) “What are your dietary preferences?”
B) “What time do you typically go to bed?”
C) “Do you bathe and use deodorant more than one time a week?”
D) “Do you have any health issues that we should know about?”
A

C

Nurses need to avoid stereotypes or unwarranted generalizations about any particular group that prevents further assessment of the individual’s unique characteristics.

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6
Q

When action is taken on one’s prejudices:

A) Discrimination occurs.
B) Delivery of culturally congruent care is ensured.
C) Effective intercultural communication develops.
D) Sufficient comparative knowledge of diverse groups is obtained.
A

A

Prejudices associate negative permanent characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs.

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7
Q

A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n):

A) Illness attributed to natural and biological forces.
B) Creation of the student’s interpretation and descriptions of the data.    C)  Influence of socioeconomic factors in morbidity and mortality.
D) Combination of naturalistic, religious, and supernatural modalities.
A

C

Health disparity populations are populations that have a significant increased incidence or prevalence of disease or that have increased morbidity, mortality, or survival rates compared to the health status of the general population.

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8
Q

Culture strongly influences pain expression and need for pain medication. However, cultural pain is:

A) Not expressed verbally or physically.    B)  Expressed only to others from a similar culture.    C)  Usually more intense than physical pain.
D) Suffered by a patient whose valued way of life is disregarded by practitioners.
A

D

Patients suffer cultural pain when health care providers disregard values or cultural beliefs.

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9
Q

Which of the following best represents the dominant values in American society on individual autonomy and self-determination?

A) Physician orders
B) Advance directive
C) Durable power of attorney
D) Court-appointed guardian
A

B

Informed consent and advance directives protect the right of the individual to know and make decisions ensuring continuity of individual autonomy and self-determination.

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10
Q

The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next?

A) Ask the patient how much salt he is consuming each day
B) Discuss the health implications of sodium and hypertension
C) Remind the patient that many foods such as soy sauce contain “hidden” sodium
D) Suggest some low-sodium dietary alternatives
A

A

In an Asian culture spoken messages often have little to do with their meanings. It is important for the nurse to clarify how much salt the patient is consuming in his diet.

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11
Q

A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is:

A) Give her a copy of the city bus schedule.
B) Call her the day before her appointment as a reminder to be on time.
C) Explore what has prevented her from being at the clinic in time for her appointment.
D) Refer her to a clinic that is closer to her home.
A

C

Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. Nurses need to expect conflicts and make adjustments when caring for ethnic groups.

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12
Q

A nursing student is taking postoperative vital signs in the postanesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension?

A) Ashkenazi Jew
B) Chinese American
C) African American
D) Filipino
A

C

Certain genetic disorders are linked with specific ethnic groups such as malignant hypertension among African Americans.

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13
Q

A community health nurse is making a healthy baby visit to a new mother who recently emigrated to the United States from Ghana. When discussing contraceptives with the new mom, the mother states that she won’t have to worry about getting pregnant for the time being. The nurse understands that the mom most likely made this statement because:

A) She won’t resume sexual relations until her baby is weaned.
B) She is taking the medroxyprogesterone (Depo-Provera) shot.
C) Her husband was recently deployed to Afghanistan.
D) She has access to free condoms from the clinic.
A

A

In some African cultures such as in Ghana and Sierra Leone some women will not resume sexual relations with their husbands until the baby is weaned.

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14
Q

During their clinical post-conference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different:

A) Ethnicity.
B) Culture.    C) Heritage.
D) Religion.
A

B

Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. This includes events such as birth, illness, and dying. It is the system of meanings by which people make sense of their experiences.

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15
Q

When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? (Select all that apply.)
A) Do you use any folk remedies?
B) Do you have a family physician?
C) Do you use a Shaman?
D) Does your family have a history of alcohol abuse?

A

A,B,C

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16
Q

Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that:

A) Specially educated personnel make requests.
B) Requests are usually made by the nurse caring for the patient at the time of death.
C) Only patients who have given prior instruction regarding donation become donors.
D) Professionals need to be very selective in whom they ask for organ and tissue donation.
A

A

Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process.

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17
Q

The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed two chemotherapy sessions. Based on the above assessment data, the nurse gathers more information to consider making which of the following nursing diagnoses?

A) Anxiety
B)Hopelessness
C)Spiritual distress
D)Complicated grieving
A

B

The patient exhibits signs and symptoms of hopelessness. Manifestations of hopelessness include withdrawing, not following through with recommended treatment, and losing confidence that anything she does will be of help.

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18
Q

A family member asks a home care nurse what he should do if the patient’s serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life?

A) Encourage the family member to think more positively about the patient’s new therapy
B) Avoid the discussion because it has to do with medical, not nursing, diagnoses
C) Initiate a discussion about advance directives with the patient, family, and health care team
D)Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present

A

D

If you ask the patient first what he or she believes is best, you know how to discuss that option in more detail and give realistic ways of reaching that desired goal. Discussing other possible options after the patient’s preference helps family members know and understand the patient’s wishes.

19
Q

Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care?

A) Practice honesty with everyone, telling patients about their illness, even if the news is not good.
B) Ask family members if they prefer to help with the care of the body after death.
C) Provide postmortem care at the time of death to relieve family members of this difficult job.
D) Value patient self-determination, understanding that each person makes his or her own decisions.
A

B

Giving people options in caregiving allows them to honor their cultural beliefs. Although western health care practices place a high value on honesty, people from some cultural backgrounds regard being told the “truth” as harmful.

20
Q

A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What understanding about communication enhances your therapeutic communication with this patient?

A) Younger patients are usually less talkative about their diagnosis.
B) All patients benefit by talking about their feelings with another person.
C) Avoid discussing illness-related topics with quiet patients.
D) Remain alert for signals that the patient wants to discuss his illness.
A

D

Make no presumptions about this patient other than the fact that he is not yet ready to talk about his situation. However, stay alert for a time when he might want to talk to you. Some people do not work through their problems by talking to others.

21
Q

A woman experiences the loss of a very early–term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can “always try again.” The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing?

A) Delayed
B) Anticipated
C) Exaggerated
D)Disenfranchised
A

D

This woman’s friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem “legitimate.” Thus the woman does not experience sympathy from others and feels disenfranchised.

22
Q

A family member of a recently deceased patient talks casually with the nurse at the time of the patient ’ s death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member?

A) Denial
B) Anticipatory grief
C) Dysfunctional grief
D) Yearning and searching
A

B

If a person has been anticipating a loss for some time, he or she may have already experienced many of the emotions (sadness, shock) commonly associated with death.

23
Q

A self-care goal you set when caring for dying and grieving patients includes:

A) Learning not to take losses so seriously.
B) Limiting involvement with patients who are grieving.
C) Maintaining life balance and reflecting on the meaning of your work.
D) Admitting that you are not well suited to care for people who are grieving and asking the charge nurse not to assign you to care for these patients.
A

C

Maintaining life balance is very important for emotional, spiritual, and physical well-being. Withdrawing or not seeing one’s work with grieving people as serious does not help maintain balance but rather may contribute to numbing feelings.

24
Q

A self-care goal you set when caring for dying and grieving patients includes:

A) Learning not to take losses so seriously.
B) Limiting involvement with patients who are grieving.
C) Maintaining life balance and reflecting on the meaning of your work.
D) Admitting that you are not well suited to care for people who are grieving and asking the charge nurse not to assign you to care for these patients.

A

B

At the end of life religious and cultural expectations are important for the lasting memories held by the family about the way their loved one’s death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations.

25
Q

Which approach to helping grieving people is most consistent with postmodern grief theories?

A) Help the patient identify the tasks to be accomplished during his or her grief.
B) Encourage people to recognize stages of grieving in anticipation of what is to come.
C)Listen carefully to a person’s story of how his or her grief experience is unfolding.
D) Offer general grief timelines to help the person know when a phase will pass.
A

C

Postmodern grief interventions focus on the uniqueness of the patient’s story that unfolds and “writes” itself as the person lives through the experience of loss.

26
Q

A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which of the following nursing responses reflect a helpful understanding of patient self-care at the end of life?

A) “Learning to accept that you can’t perform some activities anymore will bring you more acceptance and peace.”
B) “Which activities are most important to you, and how can you continue to do them?”
C) “People in your life want to help you with things; allow them to do what they want for you.”
D) “Spending more of your time resting or reading will conserve your energy.”
A

B

Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. They know best how to regulate their energy and wishes for how to spend their time.

27
Q

The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now “in hospice.” What does the nurse tell the family member about palliative care? (Select all that apply.)

A) Hospice and palliative care are the same thing.
B) Palliative care is for any patient, any time, any disease, in any setting.
C) Palliative care strategies are primarily designed to treat the patient’s illness.
D) Palliative care interventions relieve the symptoms of illness and treatment.
A

B, D

28
Q

You have identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which general approach do you take to prioritize the nursing diagnoses? (Select all that apply.)

A) Use family members and physician orders as primary resources for prioritizing your actions.
B) Address the nursing diagnosis that most affects the medical diagnosis.
C) Ask the patient to identify the most distressing symptom and first address that diagnosis.
D) Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.
A

C,D

29
Q

Regarding grief in older adults, which understanding helps guide your relationship with an elderly patient?

A) Older adults have usually sustained many losses in life, which influence the current loss.
B) Older adults with a poor memory experience grief less intensely.
C) Older adults generally handle loss better because they have more experience with it.
D) Social support is less important because an older adult’s circle of friends has become smaller.
A

A

Older adults have usually sustained more losses because they have lived longer. For people at any age, each loss influences the way one responds to subsequent losses. The loss of a social network makes it more important to find resources and sources of social support for grieving older adults. Sometimes many losses overpower a person’s coping resources instead of making him or her stronger.

30
Q

Which of the following signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?

A) Oxygen saturation of 95%
B) Difficulty arousing the patient
C) Respiratory rate of 10 breaths/min
D) Pain intensity rating of 5 on a scale of 0 to 10
A

B

Opioid-naive patients may develop a rare adverse effect of respiratory depression, and sedation always occurs before respiratory depression.

31
Q

A health care provider writes the following order for an opioidnaive patient who returned from the operating room following a total hip replacement. “Fentanyl patch 100 mcg, change every 3 days.” Based on this order, the nurse takes the following action:

A) Calls the health care provider, and questions the order
B) Applies the patch the third postoperative day
C) Applies the patch as soon as the patient reports pain
D) Places the patch as close to the hip dressing as possible
A

A

Fentanyl is 100 times more potent than morphine and not recommended for acute postoperative pain.

32
Q

A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication?

A) Stool softener
B) Stimulant laxative
C) H 2 receptor blocker
D) Proton pump inhibitor
A

B

Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administer stimulant laxatives, not simple stool softeners, to prevent and treat constipation.

33
Q

A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question?

A) The drug
 B)The time interval
C) The dose
D) The route
A

b

Controlled- or extended-release opioid formulations such as OxyContin are available for administration every 8 to 12 hours ATC. Health care providers should not order these long-acting formulations prn.

34
Q

The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325) two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?

A) The patient’s level of pain
B) The potential for addiction
C) The amount of daily acetaminophen
D) The risk for gastrointestinal bleeding
A

C

The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone [Percocet]) because it reduces the dose of opioid needed to achieve successful pain control.

35
Q

A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of:

A) Addiction.
B) Tolerance.
C) Pseudoaddiction.
D) Physical dependence.
A

D

Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

36
Q

After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient’ s respiratory rate and depth are within normal limits. The nurse now plans to implement the following action:

A) Discontinue all ordered opioids
B) Close the room door to allow the patient to recover
C) Administer the remaining naloxone over 4 minutes
D) Assess patient’s vital signs every 15 minutes for 2 hours
A

D

Reassess patients who receive naloxone every 15 minutes for 2 hours following drug administration because the duration of the opioid may be longer than the duration of the naloxone and respiratory depression may return.

37
Q

Which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine?

A) Only the patient should push the button.
B) Do not use the PCA until the pain is severe.
C) The PCA prevents overdoses from occurring.
D) Notify the nurse when the button is pushed.
A

A

Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to “push the button” for the patient.

38
Q

A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider’s order reads as follows: “Vicodin 1 tab, per tube, q4 hours, prn.” Which action by the nurse is most appropriate?

A) No action is required by the nurse because the order is appropriate.
B) Request to have the ordered changed to ATC for the first 48 hours.
C) Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn.
D) Begin the Vicodin when the patient shows nonverbal symptoms of pain.
A

B

The American Pain Society (2003) states that, if you anticipate pain for most of the day, you should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.

39
Q

A patient returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. The nurse’s first action is to:

A) Call the patient’s health care provider.
B) Administer pain medication as ordered.
C) Check the patient’s vital signs.
D) Assess the characteristics of the pain.
A

D

It is necessary to monitor pain on a regular basis along with other vital signs. It is important for the nurse to understand that pain assessment is not simply a number.

40
Q

The patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient’s wife says that he can’t be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain?

A) The patient’s wife is the best resource for determining the level of pain since she has been with him continually for the entire day.
B) The patient’s report of pain is the best method for assessing the pain.
C) The patient’s health care provider has the best knowledge of the level of pain that the patient that should be experiencing.
D) The nurse is the most experienced at assessing pain.
A

B

A patient’s self-report of pain is the single most reliable indicator of the existence and intensity of pain.

41
Q

When using ice massage for pain relief, which of the following are correct? (Select all that apply.)

A) Apply ice using firm pressure over skin.
B) Apply ice until numbness occurs and remove the ice for 5 to 10 minutes.
C)  Apply ice until numbness occurs and discontinue application.  
 D)Apply ice for no longer than 10 minutes.
A

A,B

42
Q

When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include?

A) TENS works by causing distraction.
B) TENS therapy does not require a health care provider’s order.
C) TENS requires an electrical source for use.
D) TENS electrodes are applied near or directly on the site of pain.
A

D

TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.

43
Q

While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends:

A) Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs (NSAIDs) to opioids.
B) Using acetaminophen for refractory pain.
C) Limiting the use of opioids because of the likelihood of side effects.
D) Avoiding total sedation, regardless of how severe the pain is.
A

A

The WHO analgesic ladder transitions from the use of nonopioids (NSAIDS) with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.

44
Q

A postoperative patient is currently asleep. Therefore the nurse knows that:

A) The sedative administered may have helped him sleep, but assessment of pain is still needed.
B) The intravenous (IV) pain medication is effectively relieving his pain.
C) Pain assessment is not necessary.
D) The patient can be switched
A

A

Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness and impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. You need to conduct a thorough reassessment.