NURS_347_01_SP25_Exam 3
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Free NURS_347_01_SP25_Exam 3 Questions
1. The nurse advises a visitor complaining of incontinence: "Incontinence is (1) Normal ______. You need to (2) ___"
Normal
Just live with it / See a urologist
- Normal
- Just live with it
- See a urologist
Explanation
Explanation
Correct Answer: (1) Normal (2) See a urologist
While incontinence is common, particularly in older adults, it is not a condition that should simply be accepted without medical evaluation. The nurse correctly identifies that incontinence is a normal occurrence that many people experience, but also appropriately advises the visitor to see a urologist. A urologist can determine the underlying cause and provide effective treatment options, as incontinence is manageable and often treatable.
Why the other options are incorrect:
Just live with it is incorrect and represents poor health advice. Telling someone to simply live with incontinence dismisses a potentially treatable condition and can negatively impact the person's quality of life, dignity, and overall wellbeing.
Correct Answer: (1) Normal (2) See a urologist
While incontinence is common, particularly in older adults, it is not a condition that should simply be accepted without medical evaluation. The nurse correctly identifies that incontinence is a normal occurrence that many people experience, but also appropriately advises the visitor to see a urologist. A urologist can determine the underlying cause and provide effective treatment options, as incontinence is manageable and often treatable.
Why the other options are incorrect:
Just live with it is incorrect and represents poor health advice. Telling someone to simply live with incontinence dismisses a potentially treatable condition and can negatively impact the person's quality of life, dignity, and overall wellbeing.
2. The nurse caring for an immobile older adult patient suspects that the patient is being neglected at home due to several observations obtained during the ongoing assessment. What is the appropriate nursing action in this situation?
-
Discuss the abuse with coworkers to determine what the next step should be.
-
Immediately report the suspected abuse of the patient to the appropriate person.
-
Inform the client's family that the patient is being neglected at home by someone.
-
Avoid reporting the abuse as it would be a privacy and confidentiality violation.
Explanation
Explanation
Correct Answer: (B) Immediately report the suspected abuse of the patient to the appropriate person.
Nurses are mandated reporters, meaning they are legally and ethically obligated to report any suspected abuse, neglect, or exploitation of vulnerable populations including older adults. Upon suspecting neglect, the nurse must immediately report to the appropriate authority such as the charge nurse, social worker, or Adult Protective Services. Prompt reporting ensures the patient's safety and initiates a proper investigation through the appropriate channels.
Why the other options are incorrect:
A. Discussing the suspected abuse with coworkers is inappropriate and unprofessional. It does not constitute a formal report and delays the necessary protective action for the patient.
C. Informing the family directly is not appropriate because the family members themselves may be the perpetrators of the neglect. Notifying them could compromise the investigation and place the patient at further risk.
D. Avoiding reporting abuse based on privacy and confidentiality concerns is incorrect and legally indefensible. Mandated reporting laws supersede general confidentiality obligations when patient safety is at risk.
Correct Answer: (B) Immediately report the suspected abuse of the patient to the appropriate person.
Nurses are mandated reporters, meaning they are legally and ethically obligated to report any suspected abuse, neglect, or exploitation of vulnerable populations including older adults. Upon suspecting neglect, the nurse must immediately report to the appropriate authority such as the charge nurse, social worker, or Adult Protective Services. Prompt reporting ensures the patient's safety and initiates a proper investigation through the appropriate channels.
Why the other options are incorrect:
A. Discussing the suspected abuse with coworkers is inappropriate and unprofessional. It does not constitute a formal report and delays the necessary protective action for the patient.
C. Informing the family directly is not appropriate because the family members themselves may be the perpetrators of the neglect. Notifying them could compromise the investigation and place the patient at further risk.
D. Avoiding reporting abuse based on privacy and confidentiality concerns is incorrect and legally indefensible. Mandated reporting laws supersede general confidentiality obligations when patient safety is at risk.
3. A community health nurse is providing education on child safety. Who does the nurse identify as the highest risk for choking and suffocation?
-
A 3-year-old eating cheerios for a snack
-
A toddler playing with his older brother's wooden blocks
-
A 4-year-old drinking a glass of milk
-
An infant sleeping in the prone position
Explanation
Explanation
Correct Answer: (D) An infant sleeping in the prone position
Infants sleeping in the prone, or face-down, position are at the highest risk for suffocation. This position is the leading risk factor for Sudden Infant Death Syndrome (SIDS) because infants lack the neck strength and motor control to reposition themselves if their airway becomes obstructed by the mattress or bedding. The safe sleep guideline universally recommended is to always place infants on their backs to sleep on a firm, flat surface.
Why Other Options are Incorrect:
A. A 3-year-old eating cheerios carries some choking risk, but cheerios are small, lightweight, and dissolve easily, making them one of the safer snack options for young children. The risk is significantly lower compared to an infant in the prone position.
B. A toddler playing with wooden blocks poses a risk only if the blocks are small enough to be swallowed. Standard wooden blocks are typically too large to be a choking hazard, though supervision is always recommended.
C. A 4-year-old drinking milk presents minimal choking or suffocation risk under normal circumstances. Liquid aspiration is possible but far less immediately life-threatening than an infant sleeping face-down.
Correct Answer: (D) An infant sleeping in the prone position
Infants sleeping in the prone, or face-down, position are at the highest risk for suffocation. This position is the leading risk factor for Sudden Infant Death Syndrome (SIDS) because infants lack the neck strength and motor control to reposition themselves if their airway becomes obstructed by the mattress or bedding. The safe sleep guideline universally recommended is to always place infants on their backs to sleep on a firm, flat surface.
Why Other Options are Incorrect:
A. A 3-year-old eating cheerios carries some choking risk, but cheerios are small, lightweight, and dissolve easily, making them one of the safer snack options for young children. The risk is significantly lower compared to an infant in the prone position.
B. A toddler playing with wooden blocks poses a risk only if the blocks are small enough to be swallowed. Standard wooden blocks are typically too large to be a choking hazard, though supervision is always recommended.
C. A 4-year-old drinking milk presents minimal choking or suffocation risk under normal circumstances. Liquid aspiration is possible but far less immediately life-threatening than an infant sleeping face-down.
4. What stage of sleep is the deepest sleep?
REM
Two
Three
Four
- REM
- Two
- Three
- Four
Explanation
Explanation
Correct Answer: (1) Four
Stage 4 of NREM sleep is the deepest stage of sleep, also known as slow-wave sleep or delta sleep. During this stage, the brain produces predominantly delta waves, which are the slowest and highest amplitude brain waves. A person in Stage 4 sleep is the most difficult to arouse and, if awakened, will typically feel confused and disoriented. This stage is the most physically restorative, promoting tissue repair, immune function, and growth hormone release.
Why Other Options are Incorrect:
REM sleep is associated with vivid dreaming and increased brain activity resembling wakefulness. While it is a distinct and important sleep stage, it is not the deepest in terms of physiological sleep depth and arousal threshold.
Stage Two is a light to moderate NREM sleep stage characterized by sleep spindles and K-complexes. It is not the deepest stage and the person can still be relatively easily awakened.
Stage Three is a transitional deep sleep stage where delta waves begin to appear. While deeper than Stages 1 and 2, Stage 4 is deeper still with predominant delta activity and the greatest difficulty of arousal.
Correct Answer: (1) Four
Stage 4 of NREM sleep is the deepest stage of sleep, also known as slow-wave sleep or delta sleep. During this stage, the brain produces predominantly delta waves, which are the slowest and highest amplitude brain waves. A person in Stage 4 sleep is the most difficult to arouse and, if awakened, will typically feel confused and disoriented. This stage is the most physically restorative, promoting tissue repair, immune function, and growth hormone release.
Why Other Options are Incorrect:
REM sleep is associated with vivid dreaming and increased brain activity resembling wakefulness. While it is a distinct and important sleep stage, it is not the deepest in terms of physiological sleep depth and arousal threshold.
Stage Two is a light to moderate NREM sleep stage characterized by sleep spindles and K-complexes. It is not the deepest stage and the person can still be relatively easily awakened.
Stage Three is a transitional deep sleep stage where delta waves begin to appear. While deeper than Stages 1 and 2, Stage 4 is deeper still with predominant delta activity and the greatest difficulty of arousal.
5. Nurses provide many interventions to prevent falls in health care settings. What would be an appropriate intervention to prevent falls?
-
Lock wheels on beds and wheelchairs.
-
Keep bed in the high position.
-
Apply restraints to all confused clients.
-
Keep the four (4) side rails up at all times.
Explanation
Explanation
Correct Answer: (A) Lock wheels on beds and wheelchairs
Locking wheels on beds and wheelchairs is a standard and appropriate fall prevention intervention. It ensures that the equipment remains stable and does not shift when a patient attempts to transfer or move, significantly reducing the risk of falls.
Why the other options are incorrect:
B. Keeping the bed in the high position actually increases fall risk. Beds should be kept in the lowest position to minimize the distance and impact if a patient falls.
C. Applying restraints to all confused clients is not appropriate and is considered a last resort. Restraints can increase agitation, injury risk, and are subject to strict legal and ethical guidelines.
D. Keeping all four side rails up at all times is considered a form of restraint and is not recommended as it can lead to entrapment injuries and does not automatically prevent falls.
Correct Answer: (A) Lock wheels on beds and wheelchairs
Locking wheels on beds and wheelchairs is a standard and appropriate fall prevention intervention. It ensures that the equipment remains stable and does not shift when a patient attempts to transfer or move, significantly reducing the risk of falls.
Why the other options are incorrect:
B. Keeping the bed in the high position actually increases fall risk. Beds should be kept in the lowest position to minimize the distance and impact if a patient falls.
C. Applying restraints to all confused clients is not appropriate and is considered a last resort. Restraints can increase agitation, injury risk, and are subject to strict legal and ethical guidelines.
D. Keeping all four side rails up at all times is considered a form of restraint and is not recommended as it can lead to entrapment injuries and does not automatically prevent falls.
6. A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. For what type of surgery would the nurse prepare this patient?
-
Major, palliative
-
Minor, diagnostic
-
Major, emergency
-
Minor, elective
Explanation
Explanation
Correct Answer: (C) Major, emergency
A ruptured spleen resulting from trauma is a life-threatening condition requiring immediate surgical intervention. This classifies the surgery as an emergency because it must be performed without delay to preserve the patient's life. It is also classified as major surgery because it involves a vital abdominal organ, carries significant risk, and requires general anesthesia with an extended recovery period.
Why the other options are incorrect:
A. Palliative surgery aims to relieve symptoms and improve comfort rather than treat or cure a condition. A ruptured spleen requires curative intervention, not palliation.
B. Minor diagnostic surgery involves low risk and is typically performed to obtain tissue samples or visualize structures. A ruptured spleen surgery is neither minor nor diagnostic in nature.
D. Elective surgery is planned and scheduled in advance at the convenience of the patient and surgeon. A traumatic rupture of the spleen is an acute emergency and cannot be delayed or scheduled electively.
Correct Answer: (C) Major, emergency
A ruptured spleen resulting from trauma is a life-threatening condition requiring immediate surgical intervention. This classifies the surgery as an emergency because it must be performed without delay to preserve the patient's life. It is also classified as major surgery because it involves a vital abdominal organ, carries significant risk, and requires general anesthesia with an extended recovery period.
Why the other options are incorrect:
A. Palliative surgery aims to relieve symptoms and improve comfort rather than treat or cure a condition. A ruptured spleen requires curative intervention, not palliation.
B. Minor diagnostic surgery involves low risk and is typically performed to obtain tissue samples or visualize structures. A ruptured spleen surgery is neither minor nor diagnostic in nature.
D. Elective surgery is planned and scheduled in advance at the convenience of the patient and surgeon. A traumatic rupture of the spleen is an acute emergency and cannot be delayed or scheduled electively.
7. Based on the information in the chart, the patient is at risk for developing (1) due to (2).
Nurse's Notes — Day 1: Temperature 37.2°C (99°F) Blood pressure 104/56 mmHg Heart rate 98/min Respiratory rate 20/min Oxygen saturation 96% on room air Client has an NG tube in the right nare, placed to intermittent low wall suction, draining moderate green-brown drainage.
respiratory acidosis / hypoxia / metabolic alkalosis
respiratory rate / glucose level / oxygen saturation / nasogastric suctioning / calcium level
- respiratory acidosis
- hypoxia
- metabolic alkalosis
- respiratory rate
- glucose level
- oxygen saturation
- nasogastric suctioning
- calcium level
Explanation
Explanation
Correct Answer: (1) Metabolic Alkalosis (2) Nasogastric Suctioning
The patient has an NG tube on intermittent low wall suction, which is actively draining gastric contents. Gastric fluid is highly acidic and rich in hydrochloric acid (HCl). When this acidic fluid is continuously removed through suctioning, the body loses hydrogen ions and chloride, causing the blood pH to shift toward alkalosis. This results in metabolic alkalosis, a condition where the blood becomes too basic due to loss of acid rather than accumulation of a base.
Why the other options are incorrect:
Respiratory acidosis occurs when there is inadequate ventilation leading to carbon dioxide retention. The patient's respiratory rate of 20/min and oxygen saturation of 96% do not support this as a current risk directly tied to the NG tube.
Hypoxia is not the primary risk here. While the oxygen saturation of 96% is on the lower end of normal, the most clinically significant and directly caused risk based on the NG suctioning is metabolic alkalosis.
Respiratory rate, glucose level, oxygen saturation, and calcium level are not the cause of the developing condition in this scenario. Nasogastric suctioning is the direct causative factor leading to loss of gastric acid and the resulting metabolic alkalosis.
Correct Answer: (1) Metabolic Alkalosis (2) Nasogastric Suctioning
The patient has an NG tube on intermittent low wall suction, which is actively draining gastric contents. Gastric fluid is highly acidic and rich in hydrochloric acid (HCl). When this acidic fluid is continuously removed through suctioning, the body loses hydrogen ions and chloride, causing the blood pH to shift toward alkalosis. This results in metabolic alkalosis, a condition where the blood becomes too basic due to loss of acid rather than accumulation of a base.
Why the other options are incorrect:
Respiratory acidosis occurs when there is inadequate ventilation leading to carbon dioxide retention. The patient's respiratory rate of 20/min and oxygen saturation of 96% do not support this as a current risk directly tied to the NG tube.
Hypoxia is not the primary risk here. While the oxygen saturation of 96% is on the lower end of normal, the most clinically significant and directly caused risk based on the NG suctioning is metabolic alkalosis.
Respiratory rate, glucose level, oxygen saturation, and calcium level are not the cause of the developing condition in this scenario. Nasogastric suctioning is the direct causative factor leading to loss of gastric acid and the resulting metabolic alkalosis.
8. The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply):
-
Falling asleep at inappropriate times
-
Extended time to fall asleep
-
Difficulty staying asleep
-
Feeling tired after a night's sleep
Explanation
Explanation
Correct Answers: (B, C, D)
Insomnia is characterized by difficulty initiating sleep, difficulty maintaining sleep, and non-restorative sleep that leaves the person feeling unrefreshed despite having slept. Extended time to fall asleep reflects sleep onset insomnia. Difficulty staying asleep reflects sleep maintenance insomnia. Feeling tired after a night's sleep indicates that the sleep obtained was not restorative or of adequate quality, which is a recognized manifestation of insomnia.
Why Other Options are Incorrect:
A. Falling asleep at inappropriate times is characteristic of hypersomnia or narcolepsy, not insomnia. Insomnia involves difficulty sleeping, whereas falling asleep unexpectedly during the day reflects excessive and uncontrolled sleepiness, which is the opposite problem.
Correct Answers: (B, C, D)
Insomnia is characterized by difficulty initiating sleep, difficulty maintaining sleep, and non-restorative sleep that leaves the person feeling unrefreshed despite having slept. Extended time to fall asleep reflects sleep onset insomnia. Difficulty staying asleep reflects sleep maintenance insomnia. Feeling tired after a night's sleep indicates that the sleep obtained was not restorative or of adequate quality, which is a recognized manifestation of insomnia.
Why Other Options are Incorrect:
A. Falling asleep at inappropriate times is characteristic of hypersomnia or narcolepsy, not insomnia. Insomnia involves difficulty sleeping, whereas falling asleep unexpectedly during the day reflects excessive and uncontrolled sleepiness, which is the opposite problem.
9. Upon admission to the Medical Surgical floor, the client provides the nurse a document that specifies instructions for their health care team to follow in the event they are unable to communicate their wishes postoperatively. This document is best known as:
-
An advanced surgical care consent
-
An informed consent
-
An advance directive
-
A living will
Explanation
Explanation
An advance directive is a legal document in which a person specifies their healthcare wishes and instructions to guide their medical team in the event they become unable to communicate those decisions themselves. It is a broad term that encompasses various forms of pre-planned healthcare instructions, making it the most accurate and encompassing answer for the document described in this scenario.
Why the other options are incorrect:
A. An advanced surgical care consent is not a recognized legal or medical document. This term does not exist in standard healthcare or legal practice and is therefore incorrect.
B. An informed consent is a document signed before a specific procedure or treatment, confirming that the patient has been educated about the risks, benefits, and alternatives and agrees to proceed. It is not a document that specifies future wishes when communication is impossible.
D. A living will is actually a type of advance directive, specifically addressing end-of-life care wishes such as resuscitation preferences and life-sustaining treatment. While related, it is a subset of the broader advance directive category, making option C the more complete and accurate answer.
An advance directive is a legal document in which a person specifies their healthcare wishes and instructions to guide their medical team in the event they become unable to communicate those decisions themselves. It is a broad term that encompasses various forms of pre-planned healthcare instructions, making it the most accurate and encompassing answer for the document described in this scenario.
Why the other options are incorrect:
A. An advanced surgical care consent is not a recognized legal or medical document. This term does not exist in standard healthcare or legal practice and is therefore incorrect.
B. An informed consent is a document signed before a specific procedure or treatment, confirming that the patient has been educated about the risks, benefits, and alternatives and agrees to proceed. It is not a document that specifies future wishes when communication is impossible.
D. A living will is actually a type of advance directive, specifically addressing end-of-life care wishes such as resuscitation preferences and life-sustaining treatment. While related, it is a subset of the broader advance directive category, making option C the more complete and accurate answer.
10. A nurse is teaching a community group about bicycle safety. Which statement should be included when creating a teaching plan regarding bicycle safety?
-
"Children are not required to wear helmets to be safe."
-
"Any helmet is appropriate for bicycle riding because all children should wear helmets when riding."
-
"The chin strap on the helmet should be adjusted to fit loosely so that it does not choke the child."
-
"Parents are effective role models for children when they also wear helmets while riding."
Explanation
Explanation
Correct Answer: (D) "Parents are effective role models for children when they also wear helmets while riding."
Children learn behaviors by observing and imitating adults, particularly their parents. When parents consistently wear helmets during bicycle riding, they model safe behavior and reinforce the importance of helmet use to their children. This positive role modeling is an effective and research-supported educational strategy for promoting bicycle safety habits in children.
Why the other options are incorrect:
A. Stating that children are not required to wear helmets is factually incorrect and dangerous. Helmets are a critical safety measure that significantly reduce the risk of traumatic brain injury during bicycle accidents.
B. Saying any helmet is appropriate is incorrect. Helmets must be specifically designed and certified for bicycle use and must fit properly to provide adequate protection. A poorly fitted or wrong-type helmet does not offer sufficient safety.
C. Adjusting the chin strap loosely is incorrect and unsafe. The chin strap should be snug and properly fitted so the helmet stays securely in place during a fall or impact. A loose strap renders the helmet ineffective.
Correct Answer: (D) "Parents are effective role models for children when they also wear helmets while riding."
Children learn behaviors by observing and imitating adults, particularly their parents. When parents consistently wear helmets during bicycle riding, they model safe behavior and reinforce the importance of helmet use to their children. This positive role modeling is an effective and research-supported educational strategy for promoting bicycle safety habits in children.
Why the other options are incorrect:
A. Stating that children are not required to wear helmets is factually incorrect and dangerous. Helmets are a critical safety measure that significantly reduce the risk of traumatic brain injury during bicycle accidents.
B. Saying any helmet is appropriate is incorrect. Helmets must be specifically designed and certified for bicycle use and must fit properly to provide adequate protection. A poorly fitted or wrong-type helmet does not offer sufficient safety.
C. Adjusting the chin strap loosely is incorrect and unsafe. The chin strap should be snug and properly fitted so the helmet stays securely in place during a fall or impact. A loose strap renders the helmet ineffective.
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