*NURSING > EXAM > NURS 104 Final Exam 1 Excelsior College ALL ANSWERS 100% CORRECT FALL-2021 LATEST SOLUTION GUARANTEE (All)
A patient states “I would like to be able to decrease my risk for heart disease. I started eating better but there is more I can do.” What would be an appropriate NANDA-I nursing diagnosis for the... RN to apply in this situation? Ineffective role performance Risk-prone health behavior Deficient knowledge Readiness for enhanced health maintenance submitted You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0250 1.25 points possible (graded, results hidden) A team of RNs is researching the occurrence of pressure ulcers throughout the hospital. How does the use of standardized language in electronic health record (EHR) assist with the research? Compliance with privacy is ensured. submitted Data retrieval is efficient. Documentation is easy to understand. Other disciplines clearly understand language. You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0176 1.25 points possible (graded, results hidden) Which technologic strategy is used when an organization needs to investigate changes that have been made in the electronic health record? Password changes submitted Order entry review Audit trails Omission errors summaries You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0251 1.25 points possible (graded, results hidden) When developing the plan of patient care, which nursing order can delegated to the unlicensed assistive personnel (UAP)? Observe skin over bony prominences every 4 hours. Review trends in vital signs every shift. Turn and position every 2 hours; avoid supine positon. submitted Make sure all home care supplies are packed for discharge to home. You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0252 1.25 points possible (graded, results hidden) When developing the patient plan of care, the RN can assign patient care to which member of the health care team? Social worker. Physical Therapist. Registered nurse. Unlicensed assistive personal. submitted You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0179 1.25 points possible (graded, results hidden) The RN demonstrates skill in implementing coordinated nursing care when making which statements to a UAP? Select all that apply. “After you give Ms. Huang her bath today, please report to me what her skin looks like.” “Mr. Lopez’s buttocks were red yesterday. Within the next 30 minutes, turn him and report any redness or open areas to me.” “At the end of the shift, I want you to measure the urine output for Mr. Harding in room 34.” “Take the vital signs now for Mr. Wayne in room 22, Mrs. Payne in room 3, and report them to me. I gave them each blood pressure medications an hour ago.” “Give Ms. Garcia in room 63 a bed bath today and make sure you listen carefully to anything she says. She has been very sad due to the recent death of her sister.” submitted You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0180 1.25 points possible (graded, results hidden) The Licensed Practical Nurse (LPN) is called home for a family emergency and did not finish documenting the wound care given to the patient. The LPN provided the RN a report of interventions performed. Which statement below is correctly documented by the RN for the LPN? “The LPN stated a dry sterile dressing was placed on the patient’s left, lateral foot at 2 PM.” “A dry dressing was applied to the patient’s left lateral foot.” “The LPN placed a dry sterile dressing on the patient’s left lateral foot before leaving.” submitted “The LPN placed a dry sterile dressing on the patient’s lateral left foot.” You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0181 1.25 points possible (graded, results hidden) The nurse enters a room and discovers a patient lying on the floor and moaning. Which entry meets the guidelines for documenting this event? “The patient was emotionally disturbed when found on the floor.” “The patient was found next to the bed so he must have fallen out of the bed.” “The patient was conscious and crying out when found on the floor next to the bed.” submitted “The patient was hurt, crying and found on the floor next to the bed.” You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0182 1.25 points possible (graded, results hidden) Which NANDA-I nursing diagnosis is a priority for the patient that experiences a decrease in blood pressure along with dizziness when changing position from supine to upright? Risk for infection Hypotension Risk for falls submitted Altered vital signs You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0183 1.25 points possible (graded, results hidden) During an assessment of the lower extremities of a patient, the RN is not able to palpate the dorsalis pedis pulse in the right foot. Which intervention should the RN implement next to assess pulse quality? Assess capillary refill. Check the EHR to determine if this is a new finding. submitted Notify the primary care provider. Utilize a Doppler ultrasound device to detect blood flow. You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0253 1.25 points possible (graded, results hidden) When developing a patient plan of care, which is an independent nursing action? Administer a stool softener at bedtime every day. submitted Collaborate with physical therapist to modify activity orders. Provide distraction between doses of pain medication. Request a high fiber diet from nutrition services. You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0185 1.25 points possible (graded, results hidden) According to the American Nurses Association Scope and standards of practice, the RN provides safe, realistic care in a timely manner falls under which stage of the nursing process? Implementation Evaluation Assessment Diagnosis submitted You have used 1 of 1 attempt Some problems have options such as save, reset, hints, or show answer. These options follow the Submit button. Answer submitted. NUR104_M4EQ0186 1.25 points possible (graded, results hidden) Which actions by the unlicensed assistive personnel (UAP) when obtaining a blood pressure on a patient with a low BMI one day following a left mastectomy demonstrate appropriate delegation by the RN? Select all that apply. The UAP selected the appropriate cuff size. Recorded and reported the blood pressure to the RN within one hour. The blood pressure cuff was placed on the patient’s left arm. Noted [Show More]
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