Question 1

Which of the following is an appropriate step when teaching temperature monitoring in the home?

Accepted Answer

A)  Suggest aspirin to decrease fevers. 
B)  Recommend using only tympanic membrane sensors. 
C)  Encourage the use of alcohol rubs to reduce fevers. 
D)  Demonstrate the technique and have the patient/caregiver perform it. 
A)  Suggest aspirin to decrease fevers. 
B)  Recommend using only tympanic membrane sensors. 
C)  Encourage the use of alcohol rubs to reduce fevers. 
D)  Demonstrate the technique and have the patient/caregiver perform it. D

Question 2

What is the principal difference in tracheostomy care between care given in the acute care setting and care given in the home care environment?

Accepted Answer

A)  In the acute care setting,the inner cannula is cleaned. 
B)  In the home care setting,dressings are not necessary. 
C)  In the acute care setting,hydrogen peroxide is used for cleaning. 
D)  In the home care setting,the procedure may be done with clean technique. 
A)  In the acute care setting,the inner cannula is cleaned. 
B)  In the home care setting,dressings are not necessary. 
C)  In the acute care setting,hydrogen peroxide is used for cleaning. 
D)  In the home care setting,the procedure may be done with clean technique. D

Question 3

Temperatures in the older person are different from those in the younger adult.The nurse knows that older persons' normal temperatures often range less than

Accepted Answer

A)  34.2°C 
B)  34.8°C 
C)  35°C 
D)  36.1°C 
A)  34.2°C 
B)  34.8°C 
C)  35°C 
D)  36.1°C D

Question 4

In preparing to teach a patient how to self-administer mediation,the nurse realizes that many patients who are instructed to self-medicate for preventative care fail to do so.Reasons for this include which of the following rationales? (Select all that apply.)

Accepted Answer

A)  Fear of adverse events 
B)  Inconvenient medication regimens 
C)  Costly prescriptions 
D)  Forgetfulness 
E)  None of the above 
A)  Fear of adverse events 
B)  Inconvenient medication regimens 
C)  Costly prescriptions 
D)  Forgetfulness 
E)  None of the above

Question 5

A patient is discharged and is sent home with enteral feedings.What instructions should the nurse give to the caregiver?

Accepted Answer

A)  Flush the tube out after administering medications. 
B)  Keep the tube loose to allow for patient movement. 
C)  Use sterile technique when preparing and administering feedings. 
D)  Hang enough formula each time to cover 8 to 12 hours of feeding. 
A)  Flush the tube out after administering medications. 
B)  Keep the tube loose to allow for patient movement. 
C)  Use sterile technique when preparing and administering feedings. 
D)  Hang enough formula each time to cover 8 to 12 hours of feeding.

Question 6

When teaching the patient and caregiver about clean intermittent self-catheterization (CISC),why is it important for the nurse to teach about the signs and symptoms of complications?

Accepted Answer

A)  Although rare,complications are always severe. 
B)  It is part of the process; complications almost never occur. 
C)  Urinary complications are common with CISC. 
D)  The only major complication is infection. 
A)  Although rare,complications are always severe. 
B)  It is part of the process; complications almost never occur. 
C)  Urinary complications are common with CISC. 
D)  The only major complication is infection.

Question 7

In teaching the patient how to take his own blood pressure,which of the following is true?

Accepted Answer

A)  Blood pressure cuffs that are too small will give a falsely low reading. 
B)  Blood pressure cuffs that are too large will give a falsely high reading. 
C)  Electronic blood pressure cuffs are just as accurate as other methods. 
D)  The cuff should be placed directly over the skin and not over clothing. 
A)  Blood pressure cuffs that are too small will give a falsely low reading. 
B)  Blood pressure cuffs that are too large will give a falsely high reading. 
C)  Electronic blood pressure cuffs are just as accurate as other methods. 
D)  The cuff should be placed directly over the skin and not over clothing.

Question 8

Of the following types of thermometers available,which is not recommended for home use?

Accepted Answer

A)  Digital 
B)  Tympanic 
C)  Mercury 
D)  Disposable single-use 
A)  Digital 
B)  Tympanic 
C)  Mercury 
D)  Disposable single-use

Question 9

A ___________________ delivers oxygen through a catheter permanently inserted into the trachea,thus allowing the patient to speak and bypassing anatomical dead space.

Accepted Answer

A)  reservoir nasal cannula 
B)  demand pulsing oxygen-delivery systems 
C)  transtracheal oxygen catheter 
D)  nonrebreather mask 
A)  reservoir nasal cannula 
B)  demand pulsing oxygen-delivery systems 
C)  transtracheal oxygen catheter 
D)  nonrebreather mask

Question 10

What should the nurse instruct the patient to do when teaching the patient how to take a temperature?

Accepted Answer

A)  Wait 20 to 30 minutes after smoking or ingesting hot or cold foods. 
B)  Take the temperature immediately upon seeing chills or shivering. 
C)  Wear sterile rubber gloves when taking a rectal temperature. 
D)  Lubricate an oral thermometer with water-soluble lubricant only. 
A)  Wait 20 to 30 minutes after smoking or ingesting hot or cold foods. 
B)  Take the temperature immediately upon seeing chills or shivering. 
C)  Wear sterile rubber gloves when taking a rectal temperature. 
D)  Lubricate an oral thermometer with water-soluble lubricant only.

Question 11

What does the nurse teach the patient and caregiver to do when setting up and changing administration sets for continuous tube feedings to preserve medical asepsis?

Accepted Answer

A)  Add formula to formula already hung to prevent waste. 
B)  Store unused formula at room temperature to prevent spasm. 
C)  Hang only enough formula that will be infused in a 4- to 6-hour period. 
D)  Change the administration set every 48 hours. 
A)  Add formula to formula already hung to prevent waste. 
B)  Store unused formula at room temperature to prevent spasm. 
C)  Hang only enough formula that will be infused in a 4- to 6-hour period. 
D)  Change the administration set every 48 hours.

Question 12

While teaching how to check for gastric residual volume (GRV),the nurse instructs the caregiver to refeed the tube feeding if he or she obtains less than _________ mL of gastric aspirate.

Accepted Answer

A)  250 
B)  300 
C)  350 
D)  500 
A)  250 
B)  300 
C)  350 
D)  500

Question 13

The nurse will train the tracheostomy patient and caregiver that reusable supplies need to be disinfected at least weekly.Which of the following methods is recommended for cleaning tracheostomy supplies at home? (Select all that apply.)

Accepted Answer

A)  Boil reusable (boilable)supplies for 5 minutes.Allow to cool and dry. 
B)  Boil reusable (boilable)supplies for 15 minutes.Allow to cool and dry. 
C)  Soak reusable supplies in equal parts of vinegar and water for 30 minutes.Remove,rinse thoroughly,and dry. 
D)  Soak reusable supplies in prepared solutions of quaternary ammonium chloride compounds according to the manufacturer's instructions.Rinse and dry. 
A)  Boil reusable (boilable)supplies for 5 minutes.Allow to cool and dry. 
B)  Boil reusable (boilable)supplies for 15 minutes.Allow to cool and dry. 
C)  Soak reusable supplies in equal parts of vinegar and water for 30 minutes.Remove,rinse thoroughly,and dry. 
D)  Soak reusable supplies in prepared solutions of quaternary ammonium chloride compounds according to the manufacturer's instructions.Rinse and dry.

Question 14

The patient needs to be taught the signs of hypoxia.Which of the following outcomes are causes of hypoxia? (Select all that apply.)

Accepted Answer

A)  Incorrect flow rate 
B)  Poor oxygen tubing connection 
C)  Use of long oxygen tubing 
D)  Airway plugging 
E)  None of the above 
A)  Incorrect flow rate 
B)  Poor oxygen tubing connection 
C)  Use of long oxygen tubing 
D)  Airway plugging 
E)  None of the above

Question 15

The nurse is teaching the patient about the signs of hypothermia.He or she teaches that signs of hypothermia include which of the following clinical manifestations? (Select all that apply.)

Accepted Answer

A)  Piloerection 
B)  Restlessness 
C)  Cool skin 
D)  Uncontrolled shivering 
A)  Piloerection 
B)  Restlessness 
C)  Cool skin 
D)  Uncontrolled shivering

Question 16

When being taught clean intermittent self-catheterization (CISC),at what interval should the patient be taught to replace the catheter?

Accepted Answer

A)  With each use 
B)  Daily 
C)  Weekly 
D)  Monthly 
A)  With each use 
B)  Daily 
C)  Weekly 
D)  Monthly

Question 17

What should the nurse first assess when preparing to teach a patient and/or caregiver how to read a thermometer?

Accepted Answer

A)  Patient's actual temperature 
B)  Patient's ability to manipulate the thermometer 
C)  Caregiver's temperature 
D)  Patient's ability to take a pulse and respiratory rate 
A)  Patient's actual temperature 
B)  Patient's ability to manipulate the thermometer 
C)  Caregiver's temperature 
D)  Patient's ability to take a pulse and respiratory rate

Question 18

Oxygen-conserving devices (OCDs)reduce the amount of oxygen the patient uses,resulting in an overall cost reduction to the patient.The type of OCD that stores oxygen in a chamber during the expiratory phase of respirations is known as the

Accepted Answer

A)  reservoir nasal cannula. 
B)  demand pulsing oxygen-delivery systems. 
C)  transtracheal oxygen catheter. 
D)  nonrebreather mask. 
A)  reservoir nasal cannula. 
B)  demand pulsing oxygen-delivery systems. 
C)  transtracheal oxygen catheter. 
D)  nonrebreather mask.

Question 19

Information that should be provided to the caregiver of a patient with a nasogastric (NG)tube includes

Accepted Answer

A)  keeping the head of the bed lowered for feedings. 
B)  keeping unused formula at room temperature. 
C)  aspirating every 4 hours when receiving continuous drip feedings. 
D)  returning the gastric contents if the residual exceeds 250 mL. 
A)  keeping the head of the bed lowered for feedings. 
B)  keeping unused formula at room temperature. 
C)  aspirating every 4 hours when receiving continuous drip feedings. 
D)  returning the gastric contents if the residual exceeds 250 mL.

Question 20

The patient is taking levothyroxine (a thyroid medication)for hypothyroidism.What should the nurse instruct the patient to do when teaching the patient how to assess her own blood pressure and pulse?

Accepted Answer

A)  Withhold the medication if her blood pressure is above the normal range or if her pulse is more than 100 beats per minute. 
B)  Withhold the medication if her blood pressure is below the normal range or if her pulse is less than 60 beats per minute. 
C)  Never withhold her medication.Have the patient take it and notify the physician at the next office visit. 
D)  Withhold her medication only if both her blood pressure and pulse rate are too high. 
A)  Withhold the medication if her blood pressure is above the normal range or if her pulse is more than 100 beats per minute. 
B)  Withhold the medication if her blood pressure is below the normal range or if her pulse is less than 60 beats per minute. 
C)  Never withhold her medication.Have the patient take it and notify the physician at the next office visit. 
D)  Withhold her medication only if both her blood pressure and pulse rate are too high.

Exam 43: Self-Care Teaching in the Community

Which of the following is an appropriate step when teaching temperature monitoring in the home?

What is the principal difference in tracheostomy care between care given in the acute care setting and care given in the home care environment?

Temperatures in the older person are different from those in the younger adult.The nurse knows that older persons' normal temperatures often range less than

In preparing to teach a patient how to self-administer mediation,the nurse realizes that many patients who are instructed to self-medicate for preventative care fail to do so.Reasons for this include which of the following rationales? (Select all that apply.)

A patient is discharged and is sent home with enteral feedings.What instructions should the nurse give to the caregiver?

When teaching the patient and caregiver about clean intermittent self-catheterization (CISC),why is it important for the nurse to teach about the signs and symptoms of complications?

In teaching the patient how to take his own blood pressure,which of the following is true?

Of the following types of thermometers available,which is not recommended for home use?

A ___________________ delivers oxygen through a catheter permanently inserted into the trachea,thus allowing the patient to speak and bypassing anatomical dead space.

What should the nurse instruct the patient to do when teaching the patient how to take a temperature?

What does the nurse teach the patient and caregiver to do when setting up and changing administration sets for continuous tube feedings to preserve medical asepsis?

While teaching how to check for gastric residual volume (GRV),the nurse instructs the caregiver to refeed the tube feeding if he or she obtains less than _________ mL of gastric aspirate.

The nurse will train the tracheostomy patient and caregiver that reusable supplies need to be disinfected at least weekly.Which of the following methods is recommended for cleaning tracheostomy supplies at home? (Select all that apply.)

The patient needs to be taught the signs of hypoxia.Which of the following outcomes are causes of hypoxia? (Select all that apply.)

The nurse is teaching the patient about the signs of hypothermia.He or she teaches that signs of hypothermia include which of the following clinical manifestations? (Select all that apply.)

When being taught clean intermittent self-catheterization (CISC),at what interval should the patient be taught to replace the catheter?

What should the nurse first assess when preparing to teach a patient and/or caregiver how to read a thermometer?

Oxygen-conserving devices (OCDs)reduce the amount of oxygen the patient uses,resulting in an overall cost reduction to the patient.The type of OCD that stores oxygen in a chamber during the expiratory phase of respirations is known as the

Information that should be provided to the caregiver of a patient with a nasogastric (NG)tube includes

The patient is taking levothyroxine (a thyroid medication)for hypothyroidism.What should the nurse instruct the patient to do when teaching the patient how to assess her own blood pressure and pulse?

Evidence-Informed Nursing Practice

Transitions in Care

Communication and Collaboration

Documentation and Informatics

Medical Asepsis

Sterile Technique

Vital Signs

Health Assessment

Specimen Collection

Diagnostic Procedures

Safe Patient Handling, transfer, and Positioning

Exercise Mobility

Support Surfaces and Special Beds

Patient Safety

Emergency Preparedness and Disaster Management

Pain Assessment and Management

Palliative Care

Personal Hygiene and Bed Making

Care of the Eye and Ear

Safe Medication Preparation

Nonparenteral Medications

Parenteral Medications

Oxygen Therapy

Performing Chest Physiotherapy

Airway Management

Cardiac Care

Closed Chest Drainage Systems

Emergency Measure for Life Support

Vascular Access and Infusion Therapy

Blood Therapy

Oral Nutrition

Enteral Nutrition

Parenteral Nutrition

Urinary Elimination and Catheterization

Bowel Elimination and Gastric Intubation

Ostomy Care

Preoperative and Postoperative Care

Intraoperative Care

Prevention and Care of Skin Breakdown

Wound Care Management and Dressings

Therapeutic Use of Heat and Cold

Safety in the Community

Filters