2024 KAPLAN Fundamentals of Nursing Practice Exam With Answers (890 Solved Questions)

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KAPLAN FUNDAMENTALS A & B2024UPDATEDANDEXPERTVERIFIEDANSWERS.Thenursehelpsaclienttocoughanddeepbreatheaftersurgery.Itisdesirablefortheclienttoassume whichposition?Side-lyingProneSupinewithonepillowHighFowler'sHighFowler's-highFowler'sisthebestpositiontodeepbreatheandcough.ExplanationSide-lyingimpedesexpansionoflungs;askclienttotaketwoslow,deepbreaths,inhaling through nose and exhaling through mouth; inhale deeply third time andcough.Pronelyingonabdomen;wouldnotbeabletoexpandlungs;lyingpronewillpreventhipflexion.Supinewithonepillowaskclienttosplintabdominalwoundwithpillow;administeranalgesicpriortoaskingclienttocoughanddeepbreathOverviewCough and Deep Breathe (CDB)-After surgery or immobility for any period oftime, client develops pulmonary disorders; coughing and deep breathing (CDB)will alleviate these problems; client might use an incentive spirometer or just takeseveral deep breathes and cough-deep cough; once mucus is disturbed the clientwill cough it up; CDB is an independent nursing activity; each cycle of CDBincludes at least 3 deep breaths and a deep cough; at least 10 cycles every 1-2hours.

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Thenurseidentifieswhichdietbestmeetstheneedsofapersonwithmultiplewounds?High-protein,low-fat,high-irondietHigh-vitamin C, high-protein, high-carbohydrate dietHigh-vitamin A,high-calcium,high-fatdietHigh-vitaminB,high-protein,low-carbohydratedietHigh-vitamin C, high-protein, high-carbohydrate diet-increased vitamin C isessential to wound healing, and high protein is necessary for tissue growth;carbohydrateisneeded orenergyso theproteinisproperlyutilizedforrepairoftissueExplanationHigh-protein, low-fat, high-iron diet-increased iron appropriate for client withirondeficiencyanemiaHigh-vitaminA,high-calcium,high-fatdiet-vitaminAcontributestonightvisionand growth of bones and teeth; vitamin A found in liver, fish, liver oils, andfortified dairyproductsHigh-vitaminB,high-protein,low-carbohydratediet-highcarbohydratesneededforenergyOverviewWoundHealingDietDiettosupportwoundhealingshouldbehighinprotein,fat,carbohydrates,vitamins (especiallyA,C,E),andminerals (includingzinc).EssentialNursingCarePropernutritionisoneofthemostimportantfactorstoeffectwoundhealing,andcanbeassessedbymonitoringurinaryandbowel eliminationpatterns.Purpose.Promoteswoundhealing.Preventsinfection

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. Influences balanced dietSampleAssociatedNursingDx.ImbalancedNutrition.RiskforImbalancedNutrition.Anxiety.RiskforImpairedFluidVolume.Delayin Wound Healing.DeficientKnowledge.DisturbedBodyImage.ImpairedSkinIntegrity.ImpairedTissueIntegrity. Risk for InfectionImplementation.PostoperativeAssessmentandInterventions.AssesswounddrainageandmaintainprescribedIVfluidinfusionrates.Assessskinturgorandmucousmembranesfordehydration.Monitorweightandpostoperativedietaryprogression(i.e.,fromcleartofullliquids,andsofttoregularfoods).Identifynutritionalneedsandmonitorfornutritionalrisks.Encouragefoodandfluid intakeaccordingto dietaryprogressionoras prescribed..Doublethepatient'srecommendeddietaryallowanceofprotein(from0.8/kg/day)beforetissue evenbeginstoheal.Supplyfruitjuices andhigh-fiberfoods.Adjustthepatient'sgeneralintakeofcarbohydrates,fats,vitamins(especiallyA,C,and E),and minerals(including zinc) according toneeds.Ensurethatpatient'senvironmentisclean,neat,andfreeofodorstopromoteappetite.Encouragepatientto situpinbedorchairformeals,and encouragefamilyparticipationinmeals.Provideprivacywhenpatientisusingthebedpan,urinal,commode,orbathroom.Monitorpatternsofintakeandoutputandassesspatient'sabilitytopassflatusandstool.Palpateabovethesymphispubisif:.Patienthasnotvoidedwithin8hoursaftersurger.Patienthasbeenvoidingfrequentlyinamountsoflessthan50mL.Notifyphysicianofabnormalities.Auscultatebowelsoundsevery4hourswhenthepatientisawaketoassessfor

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returnofperistalsis.Ifbowelsoundsnotaudible,orhigh-pitches,assessabdominaldistention.Administersuppositories,enemas,ormedications,andencourageoralfluidintakeas prescribedExpectedOutcomes.Patentsuccessfullymakestransitionfromfluidstosolidfoodsandmaintainsnormal eliminationpattern.Patient'swound(s)healwithoutcomplication. Patient adheres to dietary needs following release from the hospital(Adapted from Fundamentals of Nursing Made Incredibly Easy, pp. 410-411;Fundamentals ofNursing, Sixth edition, by Taylor et al., pp. 903-904)Background for NursingCarePropernutritionisoneofthemostimportantfactorstoeffectwoundhealing,andcanbeassessedbymonitoringurinaryandboweleliminationpatternsPatientTeaching.Encouragepatienttoactivelyparticipateinnutritionintakepreoperatively.Managefluidbalance;adjustfluid/foodintak.Avoidalcoholandcertainmedication;canalterbody;suseofnutrients.Discusswithpatientpostoperativecomplicationsasdirectrelationtonutrition.Informthatseverityofcomplicationsasdirectrelationtonutrition.Delayedwoundhealing,woundinfectionanddisruptioninintegrityofwound.Fluidimbalances(fromfluidlossduringsurgery,wounddrainage,orsurgicalstress response).Providepatientwithpamphlets/othereducationalresources.DiscusswaysthatastandarddietneedstobeadjustedtoinfluencewoundhealingSpecial Considerations.GeneralConsiderations. An obese patient has lessresistance to infection; poor blood supply; increasedriskforrespiratory,cardiovascular,andgastrointestinalproblems.PediatricConsiderations.Discusswithparentsorguardianswaystoimplementahealthydietintoapediatricpatient'smealplan.Pediatricpatientareespeciallyat riskforimbalancesinfluidvolume(deficitsorexcess)followingsurgery.GeriatricConsiderations.Olderpatientsareespeciallyatriskforfluidimbalances(deficitsorexcess)andmalnutrition followingsurgery

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(Adapted from Fundamentals of Nursing, Sixth edition, by Taylor et al.; pp. 883,886-891, 897-905; 1189, 1192-1193, 1428-1433; Fundamentals of Nursing MadeIncrediblyEasy,pp.410-411Thenurseidentifieswhichlabfindingreflectsthesignsandsymptomsofinfection?Serum creatinine level of 2.4 mg/dLAST(SGOT) 15u/LWhitebloodcellcountof16,000/mm3Whitebloodcellcountof4,000/mm3Whitebloodcellcountof16,000/mm3-normalrangeis5,000-10,000/mm3;elevationindicatesinfectionSerum creatinine level of 2.4 mg/dL-measures renal function; normal is 0.5-1.5mg/dL; elevated inacutekidneyinjuryandchronickidneydiseaseAST(SGOT)15u/L-measures damagetoliverand heart; normal is10-40u/LWhitebloodcellcountof4,000/mm3-indicatespatientbecomingimmunosuppressedOverviewInfectionPresence and growth of a microorganism that causes tissue damage; chain ofinfection includes an infectious agent, reservoir where pathogen can live, portal ofexit thatallows the organism to exit one host, mode of transmission, portal of entryinto the new host, and susceptible host. If an infection is localized, indicationsinclude pain, tenderness and redness at the wound site. If infection is systemic,indications include fever, fatigue, nausea/vomiting, malaise, enlarged, tenderlymph nodes. Treatment: obtain culture and sensitivity of wound,antibiotics/antifungal agents specific to organism(s). While waiting for the cultureandsensitivity,broad-basedantibiotic/antifungalmightbeuseduntiltheresultsareobtainedandthen switchedtotheantibiotic/antifungal appropriateforthe

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organism(s).Nursing considerations: obtain culture and sent to laboratory before startingmedication.Clienteducation:takemedicationasorderedandentirecourseofmedication,returnforfollow-up.Thenurseunderstandswhichbehaviorishelpfultofacilitateaclienttohaveabowel elimination?Engage in sedentary activityIncrease dietary bulkDecreasefluidintakeUseorallaxativesIncrease dietary bulk-foods that contain cellulose, suck as whole wheat bread,fruits,andothergrains,will increasethe bulkinthestoolEngageinsedentaryactivity-shouldengageinregularexerciseDecreasefluidintake-constipationcausedbydecreaseinfluidintake;encourageclient todrinkadequate amountsof fluidUseorallaxatives-chroniclaxativeabuseexacerbatesconstipationOverviewBoweleliminationTo promote adequate bowel elimination, encourage diet highin fiber (fruits,vegetables, nuts, and whole-grains), daily fluid intake of 2,000-3,000mL, engage inregular exercise to improve muscle tone and GI motility, encourage client toestablish aregulartime for defecating.Thenurseknowswhichstatementisanimportantfactaboutwarfarin?It hasaprolongedactionItisnevergivenforprolongedperiodsoftime

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Itmust begiven several times adayto beeffectiveItcan onlybegivenparenterallyIthasaprolongedaction-durationis2-5daysIt is never given for prolonged periods of time-it is given for up to 6 months afteraDVTItmust begiven several timesadaytobeeffective-is givenoncedailyItcanonlybegivenparenterally-isgivenorally;heparinisgiven parenterallyOverviewWarfarinAnticoagulant; action: interferes with synthesis of vitamin K-depending on clottingfactors; side effects: hemorrhage, alopecia (hair loss); nursing considerations:monitor prothrombin test, therapeutic level is 1.5-2 times the control, observe forpetechiae,bleedinggums,bruises,and dark stools; antidote-vitamin KTopromoteeveningrestandsleepforclientswhoareimmobilizedandinbed,itismost importantfor thenursetoprovidewhichcare?PrivacyBack rubsDailybathsDaytimeactivitiesDaytime activities-particularly important for the immobilized and bedriddenclient.It causesthemtonap lessduring theday,andprovides relieffromtension.Itenablesthe clientto relaxandsleep atnightPrivacy-moreimportantthatclientsmaintaindaytimeactivity

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Backrubs-willhelptheclientrelax,butdaytimeactivityismoreimportantDailybaths-bathingand skin carearepartofhygieneofthe clientOverviewRestand SleepRest is a basic physiological need thatallows the body to repair damaged cells,enhances removal of waste products from the body, restores tissue to maximumfunctional ability before another activity is begun. Sleep restores balance amongdifferent parts of the CNS, mediates stress, anxiety and tension, and helps a personcope with daily activities. Disturbances in rest and sleep are caused by stress,medication (hypnotics, antidepressants, stimulants, caffeine, beta-adrenergicblockers,barbiturates,diuretics,andalcohol),unfamiliarand/ornoisyand/orbrightenvironments, daytime sleeping, working shifts, and overeating. Nursing careincludes establishing a database about the client's pattern or rest and sleep, givecare in blocks to allow for uninterrupted periods of rest and sleep, avoidunnecessary lights and noises, comfortable room temperature, non-stimulatingbeverages, promote bedtime routine, encourage daytime activity, limit daytimenaps, reposition client, straighten and replace wrinkled or soiled linens, administerpain mediation,provide diversionary and occupational activities during the day torelieveboredomandutilizenighttimefor sleep.Aclientwithacutepainhasahealthcareprovider'sorderformorphine8mgIVevery 3-4 hrs prn for pain. The client asks the nurse formedication at bedtime.Priortoadministeringthepainmedication,thenurseshouldtakewhichaction?AssumethepainispsychologicalCheckto seeiftheclienthasahistoryofaddictionTryseveralotherpain relief measuresAssesslocation,character,andintensityofpainAssess location, character, and intensity of pain-Determine onset, duration, andsequenceofpain aswellas locationandintensityAssumethepainispsychological-pain is"whateverthepersonsaysit is,andit

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existswheneverthepersonsays itdoes".Assumetheclient'spainisreal.Check to see if the client has a history of addiction-assessment answer, the nurseshould assessthecharacteristicof theclient'spainTry several other painrelief measures-appropriate to use a variety of reliefmeasures, such as relaxation, guided imagery, listening to music, biofeedback.Priortoimplementinganymeasuresforpainreliefthenursemustassesstheclient.OverviewPainManagementPain isoften referred to as the fifth vital sign and is defines as, "Whatever theperson says it is, and it exists whenever the person says it does." Pain can be acuteor chronic. Culture and past experiences with pain are major factors influencingpain experiences. Indications include increased blood pressure and pulse, rapidirregular respiration, pupil dilation, increased perspiration, increased muscletension, apprehension and irritability, grimacing, guarding, and verbalization ofpain. Nursing interventionsinclude establishing a therapeutic relationship,establishing a 24-h pain profile, teach the patient about pain and it's relief, reduceanxietyanfears,providecomfortmeasures,administerpainmedications,andreferfor alternative methods of pain relief. With regard to pain medication, use thepreventive approach (if pain is expected to occur throughout most of a 24-h perioda regular schedule is better than prn because it usually takes smaller doses toalleviatemildpainortopreventoccurrenceofpain.Which action is essential for the nurse to take after administration of preoperativemedication toaclient?Raisethesiderails ofthebed-thiswillpreventinjuryto theclientEnsure the operative permit is signed-cannot be signed once preoperativemedication isadministeredDiscusstheclient'sfeelingsaboutsurgery-safetytakespriorityoverpsychosocialneedsTell the client what to expect in the operating room-this is part of the preoperativeteaching andoccurspriortoadministeringpreoperativemedication

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OverviewPreoperativeChecklistPreoperative checklist includes ensuring that informed consent is signed andattached to the chart, all lab tests, chest x-ray, and EKG have all been completed,performingskin and bowel prep, NPO, administering preoperative medications(sedation,antibiotics),removingdentures,jewelry,andnail polish.A nurse explains to a client how to eat enough protein. The client indicates thechoiceoffood.Basedontheclient'schoice,thenursedeterminesthattheclientneeds moreteaching.What kind offooddoes theclient chooseto eat?Spaghetti and meat sauceOrange juice and white toastRiceandredbeansPeanutbutteronwholewheatbreadOrangejuiceandwhitetoast-juicecontainslittleprotein,mostofitisinthepulp.Breadis madefromwhiteflourandis also limited inprotein contentPeanut butter on whole wheat bread-both peanut butter and whole wheat breadcontain proteinRice and red beans-red beanscontain some proteinSpaghettiandmeatsauce-meatsaucecontainssomeproteinOverviewIncreasedProteinDietDiet in which protein is increased from the normal expected amounts. Protein isused during tissue repair and rebuilding. This diet is used after surgery, fractures,stresstothebody,cancers,andothertimeswhenincreaserepairisrequired.Foodswhich are high in protein include: meat, fish, nuts, cheese, protein powder, andpeanut butter.

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On the first postoperative day, a clientdevelops a fever. The nurse auscultatescracklesbilaterallyinthelowerlobes.Thenurseunderstandswhichcomplicationofsurgeryisprobablydeveloping?Heart failureThrombophlebitisPulmonaryembolismAtelectasisAtelectasis-themostprobablecauseforcracklesbecausesecretionsblockthebronchiolesand thealveoli collapse,causinghypoventilationHeart failure-failure of the cardiac muscle to pump sufficient blood to meet thebody'smetabolicneeds.Manifestationsincludedyspnea,orthopnea(thesensationof breathlessness when in the recumbent position), pleural effusion, dependentedema,andboundingpulses.Thrombophlebitis-manifestationsincludeunilateraledema,warmthandtendernessof lower extremity, swelling tenderness, and localized redness over a vein with anintravenous catheter. Thrombophlebitis (throm-boe-fluh-BY-tis) occurs when ablood clot blocks one or more of your veins, typically in your legs. Rarely,thrombophlebitis (sometimes called phlebitis) can affect veins in yourarms orneck. The affected vein may be near the surface of your skin, causing superficialthrombophlebitis,ordeepwithinamuscle,causingdeepveinthrombosis(DVT).Thrombophlebitis can be caused by trauma, surgery or prolonged inactivity.Superficialthrombophlebitis may occur in people with varicose veins. A clot in adeepveinincreasesyourriskofserioushealthproblems,includingthepossibilityof a dislodged clot (embolus) traveling to your lungs and blocking an artery there(pulmonary embolism). Deep vein thrombosis is usually treated with blood-thinning medications. Superficial thrombophlebitis is sometimes treated withblood-thinning medications,too.Pulmonary embolism-Manifestations include: dyspnea, tachypnea, and pleuriticchestpain

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OverviewPostoperative(PostOp)CareFull system assessment required because anesthesia, immobility, and surgery canaffectanysysteminthebody.Neuropsychosicial(stimulatesclientpostanesthesia)monitor level of consciousness.Cardiovascular (monitor vital signs every 15minutes x4 (1 hour), every 30 minutes x2 (1 hour), every hour x2 (2 hours), theneveryhourorprn) checkpotassiumlevel,monitor central venouspressure.Respiratory (check airway and breath sounds) turn, cough, and deep breathe(unless containdicated i.e. brain, spinal, or eye injury), splint wound, offer painmediction, teach how to use incentive spirometer (hhold mouthpiece in mough,exhale normally, seal lips and inhale slowly and deeply, keep balls or cylinderelevated, exhale and repeat). Gastrointestinal (check bowel sounds in all fourquadrantsfor5minuteseachifnothingisheardandkeepNPOuntilbowelsoundsare present) provide good mouth care while NPO, provide antiemetics for nauseandvomiting, check abdomen for distention, check for passage of flatus and stool.Genitourinary (monitor intake and output, encourage to void, check for bladderdistention, notify healtcare provider if unable to void within 8 hours, catherize ifneeded), monitor for complicaitons (hemorrhage, paralytic ileus, atelectasis,pneumonia, embolism, infection of wound, dehiscence, evisceration, venousthromboembolism (VTE), psychosis). Musculoskeltal get out of bed as soon aspossibleandambulate asmuchaspossible.AnurseexplainstoaclientaboutvitaminC.Whichjuicecontainsthemostvitamin C?FrozengrapefruitjuiceCanned tomato juiceFresh orange juiceCannedapplejuiceFresh orange juice-canned juice is processed in such a way that the vitamin ispartially destroyed. This also happens in freezing, but not as much as with cannedjuice.Freshfoodscontainmorevitamins.CitrusfruitsareagoodsourceofvitaminCand orangejuicecontains morevitaminC than anyothercitrus fruit.

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Cannedapplejuice-containnegligibleamountsofvitaminCCannedtomatojuice-containsmorevitaminCthanapplejuice,butmuchlessthanorangejuiceFrozengrapefruitjuice-containsvitaminC,butlessthanorangejuiceOverviewVitaminC(AscorbicAcid)Necessary for formation of cartilage in connective tissue and essential tomaintenance of integrity of intercellular cement in many tissues, especiallycapillarywalls.Deficiency:scurvy,imperfectformationoffetalskeleton,defectiveteeth,pyorrhea (Periodontitis), anorexia, anemia, injury potential to bones, cells,and blood vessels. RDA for adults is 60mg/day. Excessive high doses can interferewithB12absorption, causeuricosuria(uricacidintheurine),promoteformationof oxalate renal calculi. Food sources include: raw cabbage, young carrots, lettuce,celery, onions, tomatoes, radishes, green peppers, citrus fruits, rutabagas,strawberries,apples,pears,plums,peaches,pineapples,and apricots.A client comes to the emergency roomafter puncturing a foot with a dirty, rustynail. The client states the last Td immunization was 6 years ago. Which of thefollowing actionsshould thenursetakeFIRST?AdministertetanustoxoidDeterminehowmanyTdimmunizationstheclienthasreceivedAdministertetanusimmune globulin (TIG)MonitorforlockjawDetermine how many Td immunizations that client has received-if the clientreceived at least 3 doses of Td, administer tetanus toxoid booster to preventdevelopment of tetanus. If lessthan 3 doses has been received administer Td ANDtetanus immune globulin(TIG)Administertetanustoxioid-shouldfirstdetermineimmunizationhistorybecause

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tetanus is a fatal disease caused by a bacterium that can live for a long time in soiland dirt. It can enter the blood via wounds and can affect the CNS. After a dirtywound,atetanustoxoidbooster(TIG)isgiventoensureprotectionagainsttetanusAdministertetanusimmuneglobulin(TIG)-appropriateactionifclientreceivedless than3dosesof Td orhasdeveloped tetanusMonitor for lockjaw-Lockjaw is the first sign of generalized tetanus. Othermanifestationsincludeopisthotonus,musclerigidity,cramps,andmusclespasms.Givetetanus toxoidto preventthedevelopmentoftetanus.OverviewTetanusAcute infectious disease of the CNS caused by exotoxin of Clostridium tetani.Causespainfulmusclerigidity.Primarypreventionoccursthroughimmunizationand boosters. Administer tetanus immune globulin (TIG) to child notimmunizedor inadequately immunized suffering a puncture wound contaminated with dirt,feces,soil,or saliva.EssentialNursingCareTetanusisanacutetoxicsyndromecausedbyaproteintoxinproducedduringaninfection with Clostridium tetani, aspore-forming anaerobic bacterium. Whiletetanus can be prevented by a vaccine, it can be fatal (1in 10 cases) if it goesuntreated.SignsandsymptomsofTetanusinclude.Painfulmuscularrigidityandspasms.Tighteningofthejawmuscles(lockjaw)prohibitingbreathingandswallowing.Painfulparaoxysmal seizures.Irregularheartbeatandtachycardia.Highsensitivitytoexternalstimuli.Profusesweating.Lowgrade feverTreatmentoftetanusinclude.Activeimmunizationatage2monthswithDtapvaccine.Immunizationscontinueatages4,6,and15-18monthsand4-6years(5doses

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total).Vaccineshouldbegivenevery10 yearsthereafterorwhen apersonpresents withapotentiallycontaminatedwoundTreatment.Tetanusimmuneglobulin(toneutralizetetanustoxin)andtetanustoxoid.Penicillin G(IV).Metronidazole,erythromycin,ortetracyclineforpenicillinallergicpatients.Debridementofopenwoundthroughwhichcontaminationoccurred.Musclerelaxantsandsedative,totreatandmonitorcardiopulmonarystatus.AntiseizuremedicationsasneededNursingCare.Maintainapatientairwayinthechildwithtetanusandassureadequateventilation.Keep emergencyairwayequipment handyincaseofrespiratoryfailure.Monitorvitalsignsfrequently.Maintainaquietenvironmentbyreducingexternalstimulifromlight,soundortouch.Whilethechildisveryill,mentation(mentalactivity)isunaffectedsobesuretoexplain the disease, its treatment, or anyprocedures to allay any anxiety the childmaybe experiencing.. Carefully monitor children with tetanus because they often must take potentmusclerelaxants,andtheresultingparalysiscanmakeitimpossibleforthechildtocommunicateclearlyExpectedOutcomes.PatientistreatedsuccessfullywithoutuntowardcomplicationsandrecoveryiscompleteBackground for Nursing CareBackground.TetanusiscontractedbycontaminationwithC.tetani,whichisfoundinthesoiland animalfeces.. C. tetaniinfects the body through a wound. The anaerobic tetanus bacillireproducewhentheoxygensupplyiscutoffbecausethewoundisdeeporformsacrust (e.g.aswithburns)

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