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CLOSED DOOR COACHING PART 2 Nursing Practice 5 Situation: Gabriel, an 8-year-old first grader, has always relied on his mother’s guidance and care. For the past five months, he has consistently tested her rules when getting ready for school. Despite the time that has passed, he still needs reminders to get dressed fully and often takes his time eating breakfast. He also tends to play with his toys and distracts his sister while she’s playing with blocks. Every day, his mother feels anxious, needing to remind him that the school bus will arrive in just 10 minutes. 1. What is NOT a characteristic of attention deficit hyperactivity disorder (ADHD)? A. Mental retardation B. Overactivity C. Inattentiveness D. Impulsiveness 2. Which of the following behaviors would Gabriel NOT typically exhibit as symptoms of ADHD? A. Moody, sullen, and pouting behavior B. Interrupting others and difficulty taking turns C. Excessive running, climbing, and fidgeting D. Easily distracted and forgetful 3. Gabriel is prescribed pemoline (Cylert) for his ADHD. What side effect should the nurse be aware of? A. Decreased thyroid-stimulating hormones B. Decreased red blood cell count C. Elevated white blood cell count D. Elevated liver function test results 4. What is an effective nursing intervention for managing impulsive and aggressive behaviors associated with conduct disorder in Gabriel? A. Open expression of feelings B. Assertiveness training C. Negotiation of rules D. Consistent limit setting 5. What nursing diagnosis is priority to used when working with Gabriel? A. Ineffective role performance B. Impaired social interaction C. Compromised family coping D. Risk for injury Situation: The nurse is educating Jesu, a client currently prescribed a monoamine oxidase inhibitor (MAOI), about the importance of avoiding foods high in tyramine. 6. Which of the following statements indicates that Jesu needs further teaching? A. "I will have to avoid drinking non-alcoholic beer." B. "I will be able to eat cottage cheese without worrying." C. "I can eat fava beans on this diet." D. I'm so glad I can have pizza as long as I don't order pepperoni. 7. Jesu’s health teaching for Lamotrigine (Lamictal) should include which of the following? A. Take each dose with food to avoid nausea. B. Eat a balanced diet to avoid weight gain. C. Report any rashes to your doctor immediately. D. This drug may cause psychological dependence. 8. Which of the following health teaching concern for the nurse as discharged plan for suicidal patient who had been taking tricyclic antidepressant drugs for 2 weeks and now ready to go home? A. The nurse will need to include teaching regarding signs of neuroleptic malignant syndrome. B. The patient will need regular laboratory work to monitor therapeutic drug levels. C. The nurse will evaluate the risk for suicide by overdose of tricyclic antidepressant. D. The patient may need a prescription for Benadryl to use for side effects. 9. A patient is to take regularly Lithium after discharged. The MOST important information to impart to the patient and his family is that the patient should _______. A. not eat foods which has high tyramine content like cheese, wine and liver B. limit his fluid intake C. have a limited intake of sodium D. have an adequate intake of sodium 10. The patient with diagnosis of Schizophrenia who has been taking Clozapine will inform the patients family that the positive effect of this drug is ______. A. monthly liver function studies change moderately B. psychotic symptoms, such as hearing loss are reduced C. patient develops leukopenia. D. patients energy level and involvement in activities goes up. 11. Which of the following factors is NOT considered essential for creating a safe patient environment? A. Socio-economic needs B. Basic needs are met C. Sanitation is maintained
D. Physical hazards are reduced 12. Which of the following represents an INTERNAL variable that influences an individual's health status, beliefs, or practices? A. Genetics B. Socioeconomic status C. Family structure D. Living situation 13. In a healthcare facility, which of the following is identified as one of the MOST common factors that lead to patient falls? A. Experiencing stress, anxiety, and fatigue B. Leaving the side rails down C. Reaching for items at the bedside D. Performing activities of daily living 14. In the event of a patient falling, what is the nurse's FIRST responsibility? A. Assess the patient's injury B. Write an incident report C. Report the incident to the head nurse D. Notify the physician at once 15. In a healthcare facility, what term describes a structured approach to loss prevention and liability control? A. Quality assurance B. Critical pathways C. Risk management D. Peer review 16. During the physical assessment of a patient who has just experienced a seizure, which of the following actions is considered INAPPROPRIATE? A. Insert intravenous cannula B. Assess the patient's lifestyle C. Assess the patient’s sources of stress D. Identify the patient's daily activities 17. Mark is scheduled for an EEG following his first seizure. What is the BEST instruction the nurse should provide for patient preparation prior to the procedure? A. "Avoid thinking about personal matters for 12 hours before the test." B. "Do not shampoo your hair for 24 hours before the test." C. "Do not eat anything for 12 hours before the test." D. "Avoid stimulants and alcohol for 24 to 48 hours before the test." 18. What signs and symptoms should the nurse EXPECT to observe during a generalized seizure? A. Loss of consciousness, dilated pupils, and muscular stiffening B. Jerking movements of all extremities C. Facial grimacing with patting and smacking of the lips D. Vacant stare with a brief loss of consciousness 19. What is the FIRST priority for a nurse caring for a patient experiencing a seizure? A. Safety B. Airway C. Nutrition D. Mobility 20. Phenytoin (Dilantin) has been prescribed for a patient. What is the APPROPRIATE nursing instruction regarding this medication? A. Give Dilantin intramuscularly B. Administer good oral hygiene C. Dilute IV Dilantin with 5% dextrose D. Maintain a Dilantin level of 30-50 μg/ml Situation: Gloria, a dedicated nurse researcher in the Department of Health, has been tasked with an important study on patient safety practices among nurses in the psychiatric unit. With a timeline of six months, she plans to explore various aspects of safety protocols, identify potential gaps, and evaluate the effectiveness of current practices. 21. After formulating and delimiting the research problem, what should be Gloria's NEXT priority action? A. Develop the theoretical framework of the study B. Formulate the hypothesis C. Plan the research design of the study D. Conduct a literature search on the topic 22. Gloria decides to include only nurses with a minimum of three years of experience as psychiatric nurses in her study. What term describes this decision? A. Concept B. Variable C. Limitation D. Delimitation 23. The statement “The length of service is not associated with the degree of patient safety practices of staff nurses" is an example of a/an ________. A. Variable B. Assumption C. Hypothesis D. Theory 24. Which of the following research designs is the MOST APPROPRIATE for this study if the goal is to examine the relationship between two variables? A. Phenomenological study B. Experimental C. Exploratory D. Correlational
25. Gloria plans to interview the Psychiatric Nurse Manager about the patient safety practices of the nurses. What type of sampling does this scenario represent when she includes those present in the conference room? A. Random B. Purposive C. Convenience D. Quota 26. A cognitive assessment of Belle indicates that, according to Piaget's theory, she is functioning at the concrete operational stage. Which of the following behaviors would the nurse likely observe in Belle? A. Thinks logically and sees possibilities. B. Understands only her own viewpoint. C. Feels her own reasoning should agree with the reasoning of others. D. Makes and tests hypotheses. 27. Given that Belle has difficulty tolerating frustration, what is the PRIMARY goal of the nurse in supporting her? A. Increase her self-esteem B. Cope with anxiety C. Recognize her needs D. Mobilize her resources 28. Which of the following historical factors is MOST likely to have contributed to Belle's post-traumatic stress disorder? A. Unstable relationship with ex-fiancé B. Suicide of her mother C. No gang relationship with peers 29. Considering Belle's hyper-vigilance and worry about her child, nursing interventions should focus on addressing her need for _________. A. Love and belongingness B. Biological integrity C. Psychological security D. Self-esteem 30. In terms of social support therapy, which of the following options is the MOST APPROPRIATE and therapeutic for Belle? A. With appropriate support, live in the community, either independently or in a supervised setting. B. Individualized relationship with a caregiver. C. Highly structured environment with constant aid and supervision. D. Vocational training with moderate supervision but not beyond second-grade academic challenges. 31. When a patient requests to be discharged from the healthcare facility against medical advice (AMA), what is the nurse's appropriate course of action? A. Notify the physician. B. Prevent the patient from leaving. C. Have the patient sign an AMA form. D. Call a security guard to help detain the patient. 32. A nursing assistant provides morning care to a patient. How should the nurse document the care provided by the nursing assistant? A. "Morning care rendered." B. "Morning care rendered by Grace Go, NA." C. "Morning care provided by G.G., nursing assistant." D. "Morning care refused to be given by nursing assistant." 33. After administering the wrong intravenous fluid to a patient, which document should the nurse complete for her immediate supervisor? A. Patient Kardex B. Incident report C. Progress report D. Endorsement record 34. In developing a care plan for a patient with a do-not-resuscitate (DNR) order, which intervention should NOT be included? A. Allow access to individuals who can provide spiritual care. B. Administer pain medications as ordered by the physician. C. Provide usual routine nursing care as ordered by the physician. D. Administer lethal doses of medication as the patient requests. 35. A patient is scheduled for a laminectomy in the morning. When the physician asks the nurse to witness the patient's signing of the consent form, what is the nurse's BEST action? A. Provide emotional support for the patient while the patient signs the consent. B. Ensure the physician explains the risks of the procedure. C. Ensure the physician thoroughly describes the procedure. D. Confirm that the patient is competent, awake, and alert before signing the consent form. Situation: Charge Nurse Tessie oversees the surgical ward, where she is committed to maintaining the highest standards of record management. She meticulously ensures that all patient documentation is accurate, up-to-date, and securely stored. 36. In the case of a patient undergoing elective surgery under general anesthesia, who holds the responsibility for obtaining informed consent? A. Surgeon B. Nurse C. Nurse anesthetist D. Anesthesiologist
37. Which statement by the patient indicates a proper understanding of the surgeon's explanation regarding consent? A. "I refuse to sign the consent form; another family member can sign for me." B. “Now I know what alternative treatments and procedures are.” C. "If I refuse to sign the consent form, other treatment will be withdrawn.” D. "I can't refuse the procedure after the consent is signed." 38. When the ward secretary cannot read a physician's order and asks the nurse for clarification, what is the nurse's BEST action? A. Clarify the order with the pharmacies. B. Clarify the order by calling the physician. C. Interpret the order according to the patient’s previous medication record. D. Clarify the order with junior staff. 39. When preparing to transfuse 500 mL of packed red blood cells postoperatively, what must the nurse check against the blood label? A. Medication administration record B. Wristband in the presence of another nurse C. Medical chart D. Wristband 40. A patient’s wife is extremely anxious about her husband's condition. What is the MOST appropriate INITIAL intervention for the nurse? A. Describe her husband's medical treatment since admission. B. Reassure her that the important fact is her presence. C. Explain the nature of the injury and reassure her that her husband's condition is stable. D. Allow her to verbalize her feelings and concerns. Situation: In the Orthopedic Unit, quality and safety are integral to the daily responsibilities of healthcare professionals. To reinforce this commitment, the nursing staff participates in monthly quality assurance meetings. During these gatherings, several critical questions are addressed to evaluate and enhance patient care practices. 41. Who should participate in quality improvement initiatives within a healthcare setting? A. Everyone B. Management personnel C. Professional healthcare providers D. Patients and their families 42. What is the initial step a nurse should prioritize when launching a nursing improvement project? A. Implement plan to correct the problem B. Determine the nursing standards C. Determine findings if warrant correction D. Collect data, determine if standards are set 43. What is the primary purpose of supervision and delegation within a nursing team to ensure efficient workflow? A. To enhance the quality of nursing care delivery B. To influence the organization's personnel evaluation process C. To increase staff attendance at professional development seminars D. To assign tasks to any available staff member 44. In order to ensure quality nursing care for a patient in skin traction, which intervention should the nurse prioritize for frequent assessment? A. Signs of infection around pin sites B. Indicators of skin breakdown C. Instances of urinary incontinence D. Presence of bowel sounds 45. What type of audit is being conducted by the nursing team that focuses on post-operative patients who developed pressure sores in the orthopedic unit over the past year? A. Retrospective audit B. Process audit C. Concurrent audit D. Outcome audit 46. As a nurse at a Drug Abuse Treatment and Rehabilitation Center, what is the most appropriate initial question to ask a newly admitted person who uses drugs, named Korino? A. How long did you think you could use drugs without being caught? B. Why did you start using illegal drugs? C. Should I avoid asking any questions to prevent a negative reaction? D. Can you describe the amount of drugs you used and their effects on you? 47. Upon data collection he had been falling three times in his math class and Korino was known for substance dependent for three years. What is the MOST APPROPRIATE nursing diagnosis for him? A. Alteration in perception B. Alteration in social interaction C. Ineffective individual coping D. Impaired judgment 48. What effect do meperidine and codeine have that the nurse should understand? A. Increased sexual stimulation B. Pain relief through elevated pain threshold C. Reduced craving for alcohol D. Enhanced concentration and alertness

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