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ADN 420 EXAM 2 PRACTICE
QUESTIONS WITH ALL ANSWERS
CORRECT
Thevnursevisvcaringvforvavclientvwhovisvdying.vThevnursevoverhearsvthevclientvsaying, v"God,vifvyouvwillvonlyvletvmevlivevtovseevmyvdaughtervgetvmarried,vIvpromisevIvwillvst artvgoingvtovchurchvagain."vThevnursevunderstandsvthatvthevclientvisvinvwhichvstagev ofvgriefvaccordingvtovKübler-Ross? A.vDepression B.vBargaining C.vAnger D.vDenialv-vcorrectvanswer-B Whenvassessingvavpatientvwhovisvgrieving,vthevnursevidentifiesvseveralvemotionalvin dicators.vWhichvofvthevfollowingvwouldvbevconsistentvwithvthevnurse'svfindings? vSelectvallvthatvapply. 1.vPurposelessvActivity 2.vSelfvBlame 3.vApathy 4.vLackvofvinterest 5.vSocialvwithdrawal 6.vCryingv-vcorrectvanswer-2,3,
Emotionalvindicatorsvofvgrievingvincludevsocialvwithdrawal,vapathy,vandvself- blame.vCrying,vpurposelessvactivity,vandvlackvofvinterestvwouldvbevcategorizedvasvbe havioralvindicators. Avnursevwhovprovidesvcarevonvanvacutevmedicalvunitvhasvobservedvthatvphysiciansv arevfrequentlyvreluctantvtovrefervclientsvtovhospicevcare.vWhatvarevcontributingvfactor svthatvarevknownvtovunderlievthisvtendency?vSelectvallvthatvapply. 1.Financialvpressuresvonvhealthvcarevproviders 2.Clientvreluctancevtovacceptvthisvtypevofvcare 3.Easevofvmakingvavterminalvdiagnosis 4.Advancesvinv"curative"vtreatmentvinvlate-stagevillness 5.Strongvassociationvofvhospicevcarevwithvprolongingvdeathv-vcorrectvanswer-1,2,4v Physiciansvarevreluctantvtovrefervclientsvtovhospice,vandvclientsvarevreluctantvtovacce ptvthisvformvofvcare.vReasonsvincludevthevdifficultiesvinvmakingvavterminalvprognosisv (especiallyvforvthosevclientsvwithvnoncancervdiagnoses),vthevstrongvassociationvofvho spicevwithvdeath,vadvancesvinv"curative"vtreatmentvoptionsvinvlate- stagevillness,vandvfinancialvpressuresvonvhealthvcarevprovidersvthatvmayvcausevthem vtovretainvrathervthanvrefervhospice-eligiblevclients. Whichvofvthevfollowingvwouldvleadvthevnursevtovidentifyvthatvavclientvisvexperiencingv avphysiologicvresponsevtovgrief? A.vCrying B.vChokingvSensation C.vSlowvmovements D.vSadnessv-vcorrectvanswer-B Avchokingvsensationvwouldvbevconsideredvavphysiologicvindicatorvofvgrieving.vSadne ssvwouldvbevanvemotionalvindicator.vSlowvmovementsvandvcryingvwouldvbevconsider edvbehavioralvindicators. Avclientvhasvjustvdiedvfollowingvurosepsisvthatvprogressedvtovsepticvshock.vThevclien t'svspousevsays,v"Ivknewvthisvwasvcoming,vbutvIvfeelvsovnumbvandvhollowvinside."vTh evnursevshouldvknowvthatvthesevstatementsvarevcharacteristicvofvwhat? A.Depressionvstagevofvdying B.Uncomplicatedvgriefvandvmourning C.vAcceptancevstagevofvdying D.vComplicatedvGriefvandvmourningv-vcorrectvanswer-B. Uncomplicatedvgriefvandvmourningvarevcharacterizedvbyvemotionalvfeelingsvofvsadne ss,vanger,vguilt,vandvnumbness;vphysicalvsensations,vsuchvasvhollownessvinvthevsto machvandvtightnessvinvthevchest,vweakness,vandvlackvofvenergy;vcognitionsvthatvincl udevpreoccupationvwithvthevlossvandvavsensevofvthevdeceasedvasvstillvpresent;vandv behaviorsvsuchvasvcrying,vvisitingvplacesvthatvarevremindersvofvthevdeceased,vsocial vwithdrawal,vandvrestlessvoveractivity.vComplicatedvgriefvandvmourningvoccurvatvavpr olongedvtimevaftervthevdeath.vThevspouse'svstatementvdoesvnotvclearlyvsuggestvdepr essionvorvacceptance. Avclientvhasvrespondedvtovthevrecentvdiagnosisvofvlungvcancervbyvmakingvextensivev plansvforvoverseasvtravelvwithvthevclient'svchildren,vdespitevthevfactvthatvthevoncologi stvhasvinformedvthevclientvofvthevextremelyvpoorvprognosis.vThevnursevconsequently vrecognizesvthatvthevclientvisvlikelyvinvthevdenialvstagevofvgrief.vHowvcanvthevnursevb estvfacilitatevadaptivevgrievingvforvthisvclient?
alvhealth,vandvyoungvagevofvthevdeceased.vThevothervoptionsvdovnotvsupportvdifficult vbereavement. Avclientvreportsvavnewvonsetvofvsporadicvepigastricvpain,vyellowvskin,vnausea,vvomiti ng,vweightvloss,vandvfatigue.vThevhealthvcarevprovidervordersvavdiagnosticvworkup,v whichvrevealsvend- stagevgallbladdervcancer.vWhatvnursingvinterventionvshouldvbevusedvtovfacilitatevada ptivevcoping? A.vRefervclientvtovprofessionalvcounseling B.vEncouragevventilationvofvnegativevfeelings C.vProvedvwrittenveducationvforvprescribedvtreatments D.vAssistvwithvADLsv-vcorrectvanswer-A. Referringvthevclientvforvprofessionalvcounselingvwillvfacilitatevadaptivevcoping.vEncou ragingvventilationvofvnegativevfeelingsvwillvallowvforvemotionalvexpression,vbutvmayvn otvfacilitatevcoping.vPhysicalvwell-beingvwillvincreasevself- esteem,vbutvwon'tvnecessarilyvhelpvthevpatientvcopevwithvthevdiagnosis.vProvidingvw rittenveducationvisvforvclientvteaching,vnotvtovfacilitatevcoping. Avhospicevnursevperformsvavfollow- upvtelephonevcallvtovthevspousevofvavclientvwhovdiedvaboutv 1 vyearvago.vThevspousev tellsvthevnurse,v"I'mvalwaysvfeelingvsovsad.vLifevjustvdoesn'tvfeelvworthvliving."vFurthe rvconversationvrevealsvthatvthevspousevisvhavingvtroublevsleepingvandveatingvsincevh ervhusband'svdeathvandvthatvthevspousevisv"drinkingvmorevsincevhevdied."vThevnurse videntifiesvwhichvnursingvdiagnosisvasvthevpriority? A.vComplicatedvGrieving B.vStressvoverload C.vGrieving D.vIneffectivevcopingv-vcorrectvanswer-A.v Complicatedvgrievingvisvcharacterizedvbyvprolongedvfeelingsvofvsadnessvandvfeeling svofvgeneralvworthlessnessvorvhopelessnessvthatvpersistvlongvaftervthevdeath,vprolon gedvsymptomsvthatvinterferevwithvactivities,vorvself- destructivevbehaviorsvsuchvasvalcoholvorvsubstancevabusevandvsuicidalvideationvorv attempts.vThus,vthevnursingvdiagnosisvofvcomplicatedvgrievingvwouldvbevthevpriorityv andvmostvappropriate.vAlthoughvthevclientvmayvbevhavingvtroublevcopingvorvexperien cingvstress,vcomplicatedvgrievingvisvmorevapplicable.vAlthoughvtherevisvnovtimevtable vtovdenotevgrieving,vthevnursingvdiagnosisvofvgrievingvwouldvbevmorevappropriatevinv thevperiodvsurroundingvthevhusband'svdeath,vrathervthanv 1 vyearvlater. Aftervthevphysicianvhasvdiscussedveuthanasiavwithvavterminalvclientvandvfamily,vthev nursevassessesvtheirvunderstandingvofvthevtopic.vWhichvstatementvbyvthevfamilyvindi catesvthatvlearningvhasvoccurred? A.vPassiveveuthanasiavisvtakingvspecificvstepsvtovcausevavclientsvdeath B.vItvisvallvrightvtovstopvdialysis C.vAllowingvthevclientvtovstopveatingv D.vThevdoctorvwillvadministervavlethalvdosevofvbarbituratesv-vcorrectvanswer-B. Activeveuthanasiavisvtakingvspecificvstepsvtovcausevavclient'svdeathv(lethalvdosevofvb arbiturates)vandvhasvbeenvdeemedvbothvimmoralvandvillegalvinvmostvstates.vPassive veuthanasiavisvdefinedvasvwithdrawingvmedicalvtreatmentv(dialysis)vwithvthevintention
vofvcausingvthevclient'svdeathvandvisvmorallyvandvlegallyvjustified.vAllowingvthevclientv tovstopveatingvwouldvbevavformvofvpassiveveuthanasia. Nursingvstudentsvarevreviewingvinformationvaboutvgrievingvandvitsvassessmentvfindin gs.vThevstudentsvdemonstratevanvunderstandingvofvthevinformationvwhenvtheyvidenti fyvwhichvofvthevfollowingvasvavbehavioralvindicator? A.vSadness b.vLongingvforvwhatvwasvlost C.vQuestioningvofvbeliefs D.vForgetfulnessv-vcorrectvanswer-D. Forgetfulnessvisvconsideredvavbehavioralvindicatorvofvgrieving.vSadness,vlongingvforv whatvwasvlost,vandvavquestioningvofvbeliefsvreflectvemotionalvindicators. Avnursevisvcaringvforvavclientvwhovisvscheduledvtovhavevavbelowvthevkneevamputatio n.vThevclientvisvvisiblyvupsetvandvangryvandvshoutsvatvthevnurse.vWhichvofvthevfollow ingvresponsesvwouldvbevmostvappropriate? A.vitsvokayvtovbevangryvandvupset.visvtherevanythingvivcanvdovforvyou? B.vThevdoctorvhasvorderedvyouvavsedativevletvmevgetvitvnow C.vYouvcanvyellvatvmevallvyouvwantvivstillvneedvtovtakevyourvvitals D.vBevquietvyouvmightvupsetvothervclientsv-vcorrectvanswer-A. Clientsvvaryvinvtheirvreactionsvtovthevimpendingvlossvofvavlimb.vThevamountvofvgriefvi svthoughtvtovbevproportionalvtovthevsymbolicvsignificancevofvthevpartvandvthevresulta ntvdegreevofvdisabilityvandvdeformity.vAngervandvdepressionvarevcommonvemotions.v Thevnursevacknowledgesvthevclient'svfeelingsvandvremainsvobjectivevandvnonjudgme ntalvasvthevclientvexpressesvnegativevemotionalvresponses.vTellingvthevclientvthatvitvi svokayvtovbevangryvandvupsetvandvthenvtovoffervhelpvacknowledgesvthevclient'svfeeli ngsvandvprovidesvsupport.vReassuringvthevclientvthatvhisvorvhervreactionvisvnormalvm ayvprovidevcomfort.vThevnursevshouldvnotvshame,vcriticize,vorvtrivializevthevclient'svb ehavior.vTellingvthevclientvthatvhevcanvyellvallvhevwantsvorvtovbevquietvdemeansvthevc lientvandvdoesvnotvaddressvhisvfeelings.vSedatingvthevclientvignoresvthevclient'svfeeli ngs. Avnursevisvassessingvavclientvwithvavterminalvillnessvandvfindsvthatvthevclientvhasvcac hexia.vThevnursevinterpretsvthisvasvindicatingvwhichvofvthevfollowing? A.vExtremevanorexia B.vseverevasthenia C.vStarvation D.vProfoundvproteinvlossv-vcorrectvanswer-D. Cachexiavisvassociatedvwithvanabolicvandvcatabolicvchangesvinvmetabolismvthatvrela tevtovactivityvofvneurohormonesvandvproinflammatoryvcytokines,vresultingvinvprofoun dvproteinvloss.vAlthoughvanorexiavmayvexacerbatevcachexia,vitvisvnotvavprimaryvcaus e.vStarvationvrefersvtovsimplevfoodvdeprivationvandvisvnotvcachexia.vAnorexia- cachexiavsyndrome,vcharacterizedvbyvdisturbancesvinvcarbohydrate,vprotein,vandvfat vmetabolism,vendocrinevdysfunction,vandvanemiavresultsvinvseverevastheniav(lossvofv energy). Friendsvofvtwovteenagersvrecentlyvkilledvinvavcarvaccidentvarevdiscussingvtheirvsense vofvloss.vWhichvcommentvbestvindicatesvthatvthevfriendsvarevtryingvtovmakevsensevof vthevlossvcognitively? A.vIfvonlyvwevhadvstayedvlongervtheyvwouldn'tvhavevbeenvonvthatvroad
orvagitation;vandvcooling,vmottling,vandvcyanosisvofvthevextremitiesvandvdependentva reas. Avpublicvhealthvnursevisvdevelopingvavplanvtovimplementvstrategiesvtovassistvinvlower ingvofvmaternalvandvinfantvmortalityvratesvforvblackvwomenvinvthevUnitedvStates.vWhi chvfactorsvshouldvnotvbevincludedvinvthevplan? A.Therevremainsvavbiasvamongvhealthvcarevprovidersvtowardvblackvwomen. B.Blackvwomenvhavevlimitedvaccessvtovqualityvofvcare. C.Thevsocioeconomicvstatusvofvthevblackvwomenvisvavconsideration. D.Blackvwomenvhavevadequatevobstetricalvinsurancevcoverage.v-vcorrectvanswer-D. ThevmaternalvmortalityvandvmorbidityvratesvforvblackvwomenvinvthevUnitesvStatesvha vevbeenvthreevtovfourvtimesvhighervthanvforvwhitevwomen.vThisvdifferencevinvthevpre gnancy- relatedvmortalityvratiovisvthevlargestvdisparityvinvthevareavofvmaternalvandvchildvhealt h.vResearchersvdovnotventirelyvunderstandvwhatvaccountsvforvthisvdisparity,vbutvsom evsuspectedvcausesvofvthevhighervmaternalvmortalityvratesvforvminorityvwomenvinclu devlowvsocioeconomicvstatus,vlimitedvorvnovinsurancevcoverage,vbiasvamongvhealthv carevproviders,vandvqualityvofvcarevavailablevinvthevcommunity. Thevnursevisvcaringvforvavclientvinvavhospicevfacilityvandvusesvhealingvtouch.vAvfamil yvmembervasksvthevnurse,v"Whatvgoodvisvtouchingvgoingvtovdovwithvcancer?"vWhatvi svthevbestvresponsevbyvthevnurse?vSelectvallvthatvapply. 1.Tovstimulatevwoundvhealing 2.Tovdecreasevpain 3.Tovincreasevanxiety 4.Tovpromotevhealth 5.Tovsupportvend-of-lifev-vcorrectvanswer-1,2,4, Healingvtouchvcanvbevusedvbyvnursesvtovstimulatevwoundvhealing,vdecreasevpain,vpr omotevhealth,vandvsupportvend-of- life.vHealingvtouchvdecreasesvanxiety;vitvdoesvnotvincreasevanxiety. Invassessingvavpostmastectomyvclient,vthevnursevdeterminesvthatvthevclientvisvinvden ial.vThevnursevcanvbestvrespondvby A.Interpretingvthevdenial B.Supportingvthevdenial C.vAcceptingvthevdenial D.vConfrontingvthevdenialv-vcorrectvanswer-C. Whenvavclientvisvfacedvwithvbodyvimagevalterationsvand,vpossibly,vterminalvillnessvan dvdeath,vthevnursevshouldvallowvthevclientvtovexpressvtheirvfeelings.vByvacceptingvth evinitialvdenial,vthevnursevacknowledgesvthevrolevthatvdenialvplaysvinvthevcopingvproc ess.vInterpretingvthevclient'svdenialvandvthenvconfrontingvthevclientvwithvitvwillvincreas evtheirvanxiety,vhindervthevdevelopmentvofvavtrustingvrelationship,vandvdelayvthevclie nt'svacceptancevofvtheirvcondition.vAcceptingvthevclient'svdenialvdoesn'tvimplyvthatvth evnursevsupportsvit. Duringvavhomevcarevvisitvtovavclientvinvhospice,vthevclient'svspousevrevealsvtovthevnu rsevanvunderstandingvthatvthevclient'svdeathvisvinevitable.vRecognizingvthevspousevis vexemplifyingvthevKübler- Rossvstagevofvacceptance,vwhichvstatementvbyvthevnursevisvmostvappropriate?
A.vHavevyouvthoughtvaboutvwhatvyouvwillvdovwhenvyouvfindvyourvspousevaftervhevha svdied? B.vMakevsurevyouvhavevmadevpreviousvarrangementsvwithvthevfuneralvhomevforvburi alvarrangements C.vTellvmevhowvyouvplanvtovreactvwhenvyouvfirstvrealizevthatvyourvspousevisvbreathle ssvandvhasvnovpulsev-vcorrectvanswer-C. Anticipatingvandvplanningvinterventionsvisvavcornerstonevofvend-of- lifevcare.vThevnursevencouragesvcommunicationvandvanticipatoryvgrievingvbyvusingv open- endedvstatementsvsuchvasv"Tellvme.v.v.v."vEffectivevcommunicationvtechniquesvinclu devthevavoidancevofvclosed-endedvstatementsvandvgivingvadvice. Thevnursevmostveffectivelyvexplainsvtovavterminallyvillvclient'svspousevthatvthevfrustrat ionvandvangervthevclientvisvexhibitingvisvassociatedvwithvwhatvaspectvofvdying? A.vAvsymptomvofvpoorvacceptancevofvthevclientsvinevitablevdeath B.vAnvunconsciousvmeansvofvfacilitatingvseparationvwithvlovedvones C.vAnvexpressionvofvavuniversallyvheldvneedvofvthevdying D.vavsignvofvthevangervstagevofvgrievingv-vcorrectvanswer-C. Avnursevisvconductingvavspiritualvassessmentvofvavterminallyvillvclientvusingvthevfourv stepvFICAvprocessvandvasksvthevquestion,v"Whatvgivesvyourvlifevmeaning?"vThevnur sevisvassessingvwhichvofvthevfollowing? A.vFaithvandvbelief B.vImportancevandvinfluence C.vAddressvinvcare D.vCommunityv-vcorrectvanswer-A. Thevquestionvaboutvwhatvgivesvlifevmeaningvprovidesvinformationvaboutvthevclient'svf aithvandvbelief.vImportancevandvinfluencevarevaddressedvbyvquestionsvfocusingvonvt hevrolevfaithvplaysvinvthevclient'svlifevandvhowvhisvorvhervbeliefsvaffectvthevwayvthevcli entvcaresvforvselfvandvillness.vCommunityvisvaddressedvbyvquestionsvfocusingvonvth evclient'svparticipationvinvavspiritualvorvreligiousvcommunityvandvthevsupportvobtained vfromvit.vAddressvinvcarevfocusesvonvhowvthevnursevwouldvintegratevthevissuesvinvol vingvspiritualityvinvthevclient'svcare. Avnursevisvplanningvcarevforvavclientvwhovexperiencedvavstrokevinvthevrightvhemisph erevofvhisvbrain.vWhatvshouldvthevnursevdo? A.Placevthevwheelchairvonvthevclient'svleftvsidevwhenvtransferringvhimvintovavwheelch air. B.Providevclosevsupervisionvbecausevofvthevclient'svimpulsivenessvandvpoorvjudgme nt. C.Supportvthevrightvarmvwithvavslingvorvpillowvtovpreventvsubluxation. D.Anticipatevthevclientvwillvexhibitvsomevdegreevofvexpressivevorvreceptivevaphasia.v
