ostomy post quiz sample question

8/13/2019 Ostomy Post Quiz Sample Question

1/64

Ostomy Post Quiz

1) Name some reasons why ostomy surgery may be needed.

a) colon cancerb) abdominal traumac) diverticulitisd) congenital defecte) bladder cancerf) all of these

2) When a patient has a double barrel ostomy, one stoma is pouched to hold stool andthe other stoma is

a) for irrigationb) a mucous fistulac) covered with gauzed) both b & c

3) A loop ostomy can also be called a

a) double barrelb) end ostomyc) temporary ostomy

4) If your patient has a purple, blue, or black stoma you should

a) change to a different type of pouchb) report to MDc) recheck on next shiftd) do nothing, this is normal

5) mechanical breakdown to be added later

6) Treatment for mechanical breakdown is

a) make sure peristomal skin is dryb) change pouch 1 - 2 times per weekc) to hire a mechanicd) both a & b

7) A rash could be caused by a) allergy to pouch adhesiveb) allergy to tape border of pouchc) fungusd) all of these

8) Foods that thicken stool are


2/64

a) riceb) applesaucec) toastd) marshmellowse) all of these

9) foods that cause gas are

a) cornb) beansc) cheesed) pease) all of these

10) Foods that can cause blockage for those with an ileostomy are

a) cornb) dried fruitc) celeryd) popcorne) nutsf) all of these

11) The United Ostomy Association is

a) a support groupb) both a & cc) an association whose members visit new ostomy patients

12) What are the parts of the small intestine

a) duodenumb) jejunumc) ileumd) colone) allf) all except d

13) What medications may be contraindicated for an ileostomate

a) laxativesb) timed released medicationsc) antacidsd) enteric coatede) all of these

14) What type of colostomy can be irrigated

a) anyb) sigmoid


3/64

c) ileostomyd) urostomy

15) what are some contraindications for irrigating

a) young ageb) diarrheac) herniad) transverse colostomye) all of these

16) What devices can you use to help get rid of gas from a pouch besides opening thepouch up ?

A) osto ezeb) filters

17) What are some products that help reduce or eliminate odor

a) na scentb) spray deoderizersc) M9d) all of these

18) who makes support belts for the ostomate in different widths and lengths

a) Marlenb) Coloplastc) Nu Hope

19) The type of pouch used for a urostomy is a

a) drainable pouchb) leg bagc) closed end

20) what can you use for a patient with a hernia

a) a drainable pouchb) a hernia support beltc) an irrigation sleeve

21) What should a urostomy patient use when sleeping

a) leg bagb) adapterc) night drainaged) b & c


4/64

22) Every time an ostomate leaves his or her home they should take

a) biohazard bagb) everything they need to be able to change their pouch and a plastic bag

23) when should a pouch be emptied

a) when fullb) when fullc) when full

24) The best time to change a pouch is

a) when stoma is less active such as 2 hours after a mealb) right after a shower

25) Melt down or undermining is

a) when seal or barrier is brokenb) when it is hot and melts the pouch

26) The best way to tell if you have undermining is

a) by looking at pouch seal to see if area is brownb) look where seal was after taking off pouch to see if there is stool therec) both a & b

27) A sign of impending leakage or undermining is

a) itchingb) burningc)odord) all of these

28) What does the small intestine do

a) absorbs waterb) digests fats and carbohydratesc) absorbs some vitaminsd) b & c

True or Fal

The Patient with an OstomyWritten by AdministratorFriday, 01 April 2011 23:06
http://examsfornursing.com/component/mailto/?tmpl=component&link=aHR0cDovL2V4YW1zZm9ybnVyc2luZy5jb20vY2FuY2VyLW9zdG9teS83NS1vc3RvbXk=http://examsfornursing.com/cancer-ostomy/75-ostomy?tmpl=component&print=1&page=http://examsfornursing.com/cancer-ostomy/75-ostomy?format=pdfhttp://examsfornursing.com/component/mailto/?tmpl=component&link=aHR0cDovL2V4YW1zZm9ybnVyc2luZy5jb20vY2FuY2VyLW9zdG9teS83NS1vc3RvbXk=http://examsfornursing.com/cancer-ostomy/75-ostomy?tmpl=component&print=1&page=http://examsfornursing.com/cancer-ostomy/75-ostomy?format=pdfhttp://examsfornursing.com/component/mailto/?tmpl=component&link=aHR0cDovL2V4YW1zZm9ybnVyc2luZy5jb20vY2FuY2VyLW9zdG9teS83NS1vc3RvbXk=http://examsfornursing.com/cancer-ostomy/75-ostomy?tmpl=component&print=1&page=http://examsfornursing.com/cancer-ostomy/75-ostomy?format=pdf


5/64


6/64


7/64

1. This is only a temporary adjustment for you and the colostomy will bereanastomosed in less than 6 months. 2. A nurse with special training will be in to help you. 3. What is there about your job that you feel you cannot do? 4. Many people feel as you do, but they learn to dress and act and work just likethey did before the surgery.

ANS: 3Open-ended questions without prejudgment or belittling encourage the patient toidentify sources of anxiety and help the patient cope with, adapt to, or problem-solve stressful events.PTS: 1 DIF: Cognitive Level: ComprehensionREF: 407, Nursing Care Plan OBJ: 2TOP: Interpersonal Communication SkillsKEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity

8. The nurse explains to a preoperative patient that a J-pouch analanastomosis procedure has the primary advantage of: 1. no odor.2. easier to irrigate.3. near-normal bowel elimination.4. less problem with diarrhea.

ANS: 3Preoperative teaching includes the expectation of near-normal bowelelimination. As with any bowel elimination, there will be odor and possiblyoccasional diarrhea. There is no need for an irrigation.PTS: 1 DIF: Cognitive Level: Comprehension REF: 401OBJ: 2 TOP: Preoperative Teaching for J-pouchKEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

9. In postoperative teaching to a ureterotomy patient, the nurse wouldinclude information pertaining to: 1. significance of ureteral catheter for the first week.2. appropriate use of karaya gum products.3. daily pouch change schedule.4. changing pouch in the evening before bedtime.

ANS: 1

Information about the ureteral catheter, which will be in place for the first week,is important. Karaya gum products are not used for urinary appliances becauseurine breaks down the karaya. Pouches are changed only every 4 to 6 days toprevent skin irritation. The pouch is best changed in the morning.PTS: 1 DIF: Cognitive Level: Application REF: 412OBJ: 4 TOP: Postoperative Teaching to Ureterotomy PatientKEY: Nursing Process Step: PlanningMSC: NCLEX: Health Promotion and Maintenance


8/64

10. An ostomate asks the nurse what limitations must be observed in theimmediate postoperative period when at home. The most informativeinformation that the nurse can share is: 1. avoidance of heavy lifting for at least 3 months.2. limit fluid intake to no more than 1000 mL/day.3. wear loose clothing, without belts or elastic.4. cover your appliance with plastic sheeting while showering.

ANS: 1 Avoidance of heavy lifting for 3 months is advised. Ostomates should take in atleast 2000 mL of fluid every day. They may wear ordinary c lothes that dont bindthe stoma. Showering is allowed, because the appliance is waterproof.PTS: 1 DIF: Cognitive Level: ApplicationREF: 401, Patient Teaching Plan OBJ: 7TOP: Postoperative Limitations for OstomatesKEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

11. The colostomy patient continues to worry about odor. The nurse canhelp allay those concerns by explaining that odor: 1. only occurs when changing the colostomy appliance.2. is caused by certain foods that can be omitted from the diet.3. is mainly caused by poor hygiene and can be remedied.4. is far more noticeable to the patient than to others.

ANS: 2The problem of odor is a frequent cause of anxiety to the colostomy patient. Gasis the main cause of odor production. Omission of gas-causing foods can reducegas and odor, mainly by the trial and error method. Odor is noticeable to boththe patient and others.PTS: 1 DIF: Cognitive Level: Application REF: 403-404OBJ: 7 TOP: Controlling Odor from a ColostomyKEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity

12. Common surgeries to divert urine may include cutaneousureterostomy, ileal conduit, and ureteroileostomy. In developing a nursingcare plan for any of these patients, the concept that is common to them allis that:

1. a ureterostomy is smaller and lighter in color than an intestinal stoma andurine drainage is expected to be expelled through the stoma continuously.2. the drainage pouch is cleaned with sterile water and soap only, regardless ofhow foul the odor has become.3. the patient should be encouraged to drink about 750 mL water daily.4. the urine will leak through the pouch at night, so care must be taken to protectthe bedclothes.


9/64

ANS: 1To develop an effective plan of care, the nurse must be knowledgeable aboutsurgical procedures and expected outcomes.PTS: 1 DIF: Cognitive Level: Comprehension REF: 409OBJ: 6 TOP: Care Plan DevelopmentKEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

13. The nurse caring for a 2-day postoperative colostomy patient shouldreport immediately if a stoma is assessed as: 1. beefy and red.2. having swelling.3. having a small amount of bleeding around it.4. blue-tinged.

ANS: 4 A stoma should be beefy red. Blue or black coloration is an indication of poorcirculation and should be reported immediately. Swelling and a small amount of

blood around the stoma are normal in early postoperative days.PTS: 1 DIF: Cognitive Level: Application REF: 398OBJ: 4 TOP: Stoma Assessment in ColostomyKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. A baby born without a urinary bladder has a cutaneous ureterostomywith one stoma and a cutaneous ureterostomy has been surgicallycreated. There is one stoma. Discussion with the childs family regardingcare should include which of the following? 1. This urinary diversion is permanent and urine will drain from it continuously. 2. In the future, there will be a second surgery to offer an exit for the urine fromthe other kidney. 3. This pouch needs to be changed only about once a week. 4. You should notify the surgeon if the stoma becomes paler in color.

ANS: 1The babys ureterostomy and drainage of urine are constant. This is apermanent solution because of the lack of a bladder. Both ureters are joined forurine release through the stoma. The pouch will be on continuously and needsto be changed as needed several times a day.PTS: 1 DIF: Cognitive Level: Application REF: 409OBJ: 5TOP: Congenital Indications and Outcomes for Cutaneous Ureterostomy

KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

15. The initial assessment of a patient just returned from surgery forcreation of an Indiana pouch would include :1. drainage of urine from the Penrose drain at the operative site.2. the condition and color of the stoma3. the appearance of mucus in the urine.


10/64


11/64

that he intends to do a lot of traveling. Instructions for travel shouldinclude which of these points? 1. Pack plenty o f extra colostomy supplies in your checked airline luggage.Some places you might visit do not always carry those supplies you will need. 2. Exercise caution with new foods, especially local fruits and vegetables,because they may cause diarrhea or gas. 3. If visiting somewhere where drinking local water is not advised, it is still allright to irrigate the colostomy with the local water. 4. Repeat back to me what we just talked about so that you will be sure andremember carefully everything you have been taught.

ANS: 2Warning about foods in a different country is appropriate. Supplies should beplaced in a carry-on bag for quick access or in the case of lost luggage. Waterthat is not safe to drink is not appropriate as irrigation fluid.PTS: 1 DIF: Cognitive Level: Application REF: 412OBJ: 7 TOP: Discharge Instructions

KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

19. The nurse caring for the immediate postoperative patient with an ilealconduit should report and/or intervene for: 1. lack of bowel sounds.2. distended abdomen.3. mucus present in the urine.4. small amount of blood in the drainage.

ANS: 2The distended abdomen suggests that the GI suction is not effective to preventbowel distention. The nurse must check the efficiency of the suction. Lack ofbowel sounds, mucus in the urine, and a small amount of blood in the drainageis to be expected as normal postoperative assessments.PTS: 1 DIF: Cognitive Level: Application REF: 412OBJ: 3 TOP: Postoperative Care of Ileal ConduitKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

20. The patient asks if rectal suppositories can be used to assist withconstipation problems with his colostomy. The nurse clarifies thatsuppositories: 1. can be used in double-barreled colostomies.

2. cannot be used in a stoma.3. should not ever be used in a colostomy.4. will not penetrate well enough to relieve constipation.

ANS: 2Suppositories can be used effectively in double-barreled colostomies and instomas of a single colostomy.PTS: 1 DIF: Cognitive Level: Application REF: 408


12/64

OBJ: 7 TOP: Use of Rectal SuppositoriesKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

21. The nurse identifies an electrolyte imbalance in a preoperative

ileostomy patient based on the laboratory values of: 1. Na+, 144 mEq/L; K+, 5 mEq/L; HCO3, 26 mEq/L; poor tissue turgor.2. Na+, 140 mEq/L; K+, 4.5 mEq/L; HCO3, 28 mEq/L; no nausea or vomiting,request for pain analgesic q5hr.3. Na+, 160 mEq/L; K+, 2.5 mEq/L; HCO3, 18 mEq/L; confused, and weak.4. Hct, 41 mL/dL; Hgb, 11 g/dL; WBC, 8000/mm3; shallow rapid respirations.

ANS: 3Normal values of electrolytes are Na+ = 140 mEq/L, K+ = 5 mEq/L, HCO3 = 27mEq/L.PTS: 1 DIF: Cognitive Level: Analysis REF: 399OBJ: 2 TOP: Signs of Electrolyte Imbalance

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. The best nursing strategy for encouraging ostomy patient self-carewould be to: 1. plan to change the pouch when family members will be present, have thepatient watch, and listen to the procedure.2. frequently tell the patient that if he or she does not learn stoma self-care, noone is going to do it for them.3. encourage the patient to watch the stoma care procedure, graduallyencouraging participation.4. shield the patient from sight of the stoma until the patient actually asks to seeit.

ANS: 3The goal for teaching ostomates is to assist them to care for themselves withoutpressure or forcing.PTS: 1 DIF: Cognitive Level: AnalysisREF: 407, Nursing Care Plan OBJ: 4TOP: Implementing the Teaching Plan to Encourage Self-CareKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment

23. The nurse clarifies that the condition that would necessitate an ostomywould be: 1. tumor obstructing the digestive tract lumen.2. congenital absence of one ureter.3. chronic diarrhea.4. fracture of the pelvis and pubis.

ANS: 1Obstructions in the GI tract are common indications for a colostomy.


13/64


14/64

All the options are indicators for fluid and electrolyte loss. The loss of baseproducts from the bowel that allow for metabolic acidosis can be a very seriouspostoperative complication.PTS: 1 DIF: Cognitive Level: Analysis REF: 399OBJ: 4 TOP: Assessments for Fluid and Electrolyte LossKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The nurse instructs the patient to be diligent in cleaning fecal matterfrom around the stoma because the fecal matter can cause (select all thatapply): 1. fungal infection.2. bacterial infection.3. yeast infection.4. deterioration of the stoma.5. odor.

ANS: 1, 2, 3, 5

Fecal matter left on the skin and trapped under the pouch can cause fungal,bacterial, and yeast infections as well as odor.PTS: 1 DIF: Cognitive Level: Analysis REF: 399OBJ: 4 TOP: Cleaning Stoma of Fecal MatterKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

3. The 1-day postoperative ileostomy patient is concerned about the factthat there has been no drainage from the ileostomy. The nurse reminds thepatient that (select all that apply): 1. the drainage does not start until about 24 to 48 hours postsurgery.2. the first drainage will have blood in it.3. mucus will be obvious in the early drainage.4. the first drainage is expelled with a great deal of force.5. a large amount of flatus will accompany the first drainage.

ANS: 1, 2, 3Drainage does not begin because of the empty bowel prior to surgery. The firstdrainage appears 24 to 48 hours postsurgery and is accompanied by smallamounts of blood and mucus from the bowel. The first drainage is expelled withlow pressure and very little, if any, gas.PTS: 1 DIF: Cognitive Level: Analysis REF: 398OBJ: 1 TOP: Expected Drainage from an Ileostomy

KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

4. The nurse counsels that complications of the continent pouches (Kockand Indiana) may be (select all that apply): 1. incontinence.2. difficult catheterization.3. pyelonephritis.


15/64

4. rupture of the pouch.5. peritonitis.

ANS: 1, 2, 3The most frequent complications are incontinence, difficult catheterization, andreflux pyelonephritis. Rupture and peritonitis are not threats to the patient fromthis surgery.PTS: 1 DIF: Cognitive Level: Analysis REF: 413OBJ: 7 TOP: Complication of Kock and Indiana Continent PouchesKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

A client suffering with ulcerative colitis has discussed the need for atemporary colostomy to rest the colon and help the healing process. Thecolostomy will be located in the descending colon. The type of stool thatthe client can expect from this stoma is:

Liquid that cannot be regulated

Malodorous and mushy drainage

Increasingly solid

Liquid fecal drainage

After having a t ransverseco los tomy cons t ruc ted fo r co loncancer, d ischarge p lanning fo rhom e care would inc lude teachingabout the os tom y appl iance .Information approp ria te for th isin tervent ion would inc lude:

Instructing the client to report redness, swelling,fever, or pain at the site to the physician forevaluation of infectionNothing can be done about the concerns of odorwith the appliance.Ordering appliances through the client's health careproviderThe appliance will not be needed when traveling.

The nurse has com ple ted the admin is tra t ion of a c leaningenema for a c l ien t be ing pr epared for in tes t ina l surgery.Comp le te docum enta t ion by the nurse of th is eventinc lud es al l bu t which of the fo l lowing assessments?(Select all th at apply.)

Type of solution
http://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014248.cw/hint/10/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014243.cw/hint/5/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014242.cw/hint/4/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014248.cw/hint/10/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014243.cw/hint/5/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014242.cw/hint/4/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014248.cw/hint/10/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014243.cw/hint/5/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014242.cw/hint/4/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014248.cw/hint/10/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014243.cw/hint/5/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014242.cw/hint/4/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014248.cw/hint/10/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014243.cw/hint/5/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014242.cw/hint/4/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014248.cw/hint/10/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014243.cw/hint/5/index.htmlhttp://wps.prenhall.com/chet_kozier_fundamentals_8/61/15680/4014242.cw/hint/4/index.html


16/64


17/64

4. gag reflex.

ANS: 2 Absence of bowel sounds would contraindicate a diet.PTS: 1 DIF: Cognitive Level: Application REF: 263

OBJ: 9 TOP: Postoperative Nursing ImplementationsKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. The technique the nurse should use to change a postoperative dressingis: 1. enteric isolation.2. aseptic technique.3. clean technique.4. respiratory isolation.

ANS: 2 Aseptic technique is important to reduce the risk of infection.PTS: 1 DIF: Cognitive Level: Comprehension REF: 272OBJ: 9 TOP: Postoperative Risk for InfectionKEY: Nursing Process Step: PlanningMSC: NCLEX: Safe, Effective Care Environment

5. The nurse is caring for the postoperative patient who has had spinalanesthesia. The nurse would place highest priority on reporting which ofthese assessments? 1. Complaints of a headache2. Pulse rate of 78 beats per minute3. Voided 300 mL

4. Blood pressure of 126/78

ANS: 1One complication of spinal anesthesia is postspinal headache. It is caused bythe leaking of cerebrospinal fluid at the puncture site.PTS: 1 DIF: Cognitive Level: Analysis REF: 259OBJ: 7 TOP: Regional AnesthesiaKEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

6. The nurse is caring for a postoperative patient. To best prevent deepvein thrombosis (DVT) in this patient, the nurse plans to diligently ensurethat the patient: 1. splints the incision.2. coughs and deep-breathes every 2 hours.3. regularly removes antiembolism stockings.4. ambulates frequently.

ANS: 4DVT is best prevented by early and frequent ambulation of the patient.PTS: 1 DIF: Cognitive Level: Application REF: 263


18/64


19/64

PTS: 1 DIF: Cognitive Level: Application REF: 261OBJ: 8 TOP: Hypoxia KEY: Nursing Process Step: EvaluationMSC: NCLEX: Physiological Integrity

10. The nurse has completed giving discharge instructions to the patient

after a hernia repair. The nurse would determine that the patientunderstands the instructions if he verbalizes that he will: 1. be going back to work tomorrow.2. not change the dressing until he sees his physician in 2 weeks.3. ignore changes in the size of his abdomen.4. report fever, redness, swelling, or increased pain at the incision site.

ANS: 4The patient should report any signs and symptoms of infection (fever, redness,swelling, or pain).PTS: 1 DIF: Cognitive Level: Analysis REF: 271-272OBJ: 10 TOP: Discharge Planning

KEY: Nursing Process Step: EvaluationMSC: NCLEX: Health Promotion and Maintenance

11. The nurse should include the proper use of an incentive spirometer inteaching for a preoperative patient. Postoperative monitoring of thispatient would reveal that the incentive spirometry has been effective if thepatient has: 1. adventitious breath sounds.2. expiratory wheezing.3. thick, green respiratory secretions.4. clear breath sounds.

ANS: 4 An incentive spirometer is used to promote lung expansion, which opensairways, reduces atelectasis, and stimulates coughing to clear secretions.PTS: 1 DIF: Cognitive Level: Comprehension REF: 261, Table 17-2OBJ: 4 TOP: Impaired Gas ExchangeKEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

12. The suprapubic area of a postoperative patient is distended. Thepatient states that he has not voided since surgery about 9 hours ago. Thenurses first action would be to: 1. notify the physician.2. insert a catheter.3. have the patient sit on the side of the bed and try to void.4. prepare the patient to return to surgery.

ANS: 3The patient should be encouraged to try to void in a natural position beforeother measures are taken.PTS: 1 DIF: Cognitive Level: Application REF: 263, Table 17-2


20/64


21/64

awareness without loss of reflexes. A complication may be excessive sedationapproaching that of general anesthesia. The patient should be easily aroused.PTS: 1 DIF: Cognitive Level: Analysis REF: 260OBJ: 6 TOP: Anesthesia KEY: Nursing Process Step: EvaluationMSC: NCLEX: Physiological Integrity

16. A patient diagnosed with colon cancer is being prepared for palliativesurgery to correct an intestinal obstruction. The nurse understands thatpalliative surgery is: 1. the removal and study of tissue to make a diagnosis.2. done to relieve symptoms or improve function without correcting the basicproblem.3. done to remove diseased tissue or to correct defects.4. done to correct serious defects that only affect appearance.

ANS: 2Palliative surgery is done only to relieve symptoms or improve function. It is not

curative.PTS: 1 DIF: Cognitive Level: Knowledge REF: 247OBJ: 1 TOP: Types of SurgeryKEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

17. During the preoperative assessment, it is most important that the nurseask the patient for information about: 1. current address and telephone number.2. food preferences.3. allergies, medications, and past medical conditions.4. bathing and sleep patterns.

ANS: 3If an emergency should arise, any allergies can be determined promptly.Knowledge of the patients medications can enable you to anticipate possibledrug interactions. Past medical conditions may increase surgical risks or requirespecial attention in the perioperative period.PTS: 1 DIF: Cognitive Level: Analysis REF: 248OBJ: 2 TOP: Preoperative AssessmentKEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment

18. The member of the surgical team who administers anesthetics andmonitors the patients status throughout the procedure is the: 1. surgeon.2. circulating nurse.3. perfusionist.4. anesthesiologist.

ANS: 4The anesthesiologist and nurse anesthetist have special training and are the


22/64

members of the surgical team that administers anesthesia and are responsiblefor close patient monitoring during surgery.PTS: 1 DIF: Cognitive Level: Knowledge REF: 258OBJ: 5 TOP: Surgical TeamKEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

19. A nurse is assisting in the transfer of a postoperative patient from thepostanesthesia care unit to the surgical nursing unit. To ensure the safetyof the patient, the nurse would: 1. put the side rails up after moving the patient from the stretcher to the bed.2. ask the patient to move from the stretcher to the bed.3. move the patient rapidly from the stretcher to the bed.4. uncover the patient before transferring from the stretcher to the bed.

ANS: 1The patient will probably still be experiencing residual effects of anesthesia; theside rails should be up to prevent the patient from falling out of bed.

PTS: 1 DIF: Cognitive Level: Application REF: 261OBJ: 9 TOP: Postoperative CareKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment

20. A patient who has just undergone a colon resection complains to thenurse that he felt something pop under his dressing while trying to getout of bed. The nurse removes the dressing and finds that dehiscence ofthe wound has occurred. The nurses first action should be to: 1. replace the dressing; dehiscence is normal.2. call the physician.3. pull the wound edges together and replace the dressing.4. cover the wound with sterile dressings saturated with normal saline.

ANS: 4The first action of the nurse should be to prevent damage from drying of theexposed organs by covering the wound with saline-saturated dressings and thencalling the physician.PTS: 1 DIF: Cognitive Level: Comprehension REF: 263OBJ: 9 TOP: Wound DehiscenceKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

21. A patient has just returned to the surgical unit after varicose veinstripping and ligation. The best technique by the nurse to evaluate painrelief is: 1. checking the patients record for the last dose of pain medicationadministered.2. asking the patient to rate the severity of the pain on a scale of 1 to 10.3. asking the family if they think that the patient is having pain.4. telling the patient to ask for pain medicine when it is needed.


23/64


24/64

3. avoid high-fiber foods.4. limit her activity for the first 3 to 4 days.

ANS: 2The intake of oral fluids and ingestion of a normal diet help stimulate peristalsis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 274OBJ: 9 TOP: Postoperative ComplicationsKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

25. The postanesthesia care nurse is evaluating the patient for possibletransfer to the surgical unit. The following assessment would prevent thepatients transfer: 1. Blood pressure is 126/78 mm Hg.2. Pulse rate is 82 beats per minute.3. Pulse oximeter reading is 85%.4. Respirations are 22 per minute.

ANS: 3The pulse oximeter reading should be 95% to 100%. The patient should not betransferred from the recovery room until the vital signs are stable, respiratory andcirculatory functions are adequate, pain is minimal, he or she is easily wakened,no complications are experienced, and the gag reflex is present.PTS: 1 DIF: Cognitive Level: Analysis REF: 266OBJ: 8 TOP: Postoperative AssessmentKEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Patients with preoperative disorders put them at risk during recovery.The nurse should be aware of disorders that may pose this hazard, whichare (select all that apply): 1. diabetes.2. warfarin therapy.3. fungal skin infection.4. hepatitis C.5. COPD.

ANS: 1, 4, 5Diabetes, hepatitis C, and COPD all complicate recovery related to blood-clottingdeficiencies, respiratory problems, or disturbance in the healing process.Warfarin therapy will have been discontinued well before surgery and fungal skininfections do not pose a threat.PTS: 1 DIF: Cognitive Level: Application REF: 247OBJ: 8 TOP: Conditions That Complicate RecoveryKEY: Nursing Process Step: AssessmentMSC: NCLEX: Health Promotion and Maintenance

2. The patient has an extensive bowel preparation of oral laxatives and


25/64


26/64

c) raising the enema bag so that the solution can be completed quicklyd) clamping the tubing for 30 seconds and restarting the flow at a slower rate

32. Which client position does the nurse use to administer a cleansing enema?

a) dorsal recumbent positionb) supine position with the legs elevatedc) left lateral position with flexed right kneed) right lateral position with flexed left knee

33. A nurse is preparing to administer an intermittent tube feeding through a nasogastric tube(NGT). The nurse assesses gastric residual volume before administering tube feeding to:

a) confirm proper NGT placementb) determine the clients nutritional status c) assess clients fluid and electrolyte status d) evaluate the adequacy of gastric emptying

34. Before administering an intermittent tube feeding, the nurse aspirates 40 ml of undigestedformula from the clients nasogastric tube. Which should the nurse implement as a result of thisfinding?

a) discard the aspirate and record as client output

b) mix with new formula to administer the feedingc) dilute with water and inject into the nasogastric tubed) reinstill the aspirate through the nasogastric tube via gravity using syringe

35. The nurse prepares to teach a client to ambulate with a cane. Before teaching cane-assistedambulation, the priority nursing assessment is to determine that the client has:

a) self-consciousness about using a caneb) full range of motion in lower extremities

c) an adequate level of stamina and energyd) balance, muscle strength, and confidence

Fundamental NCLEX Questions Answers and Rationale


27/64

31) B - The enema fluid should be administered slowly. If the client complains of pain or cramping, theflow is stopped for 30 seconds and restarted at a slower rate. Slow enema administration and

stopping the flow temporarily, if necessary, will decrease the likelihood of intestinal spasm andpremature ejection of the solution. The higher the solution container is held above the rectum,the faster the flow and the greater the force in the rectum. There is no need to discontinue theenema and notify the physician at this time.

32) C - The sigmoid and descending colon are located on the left side. Therefore, the left lateralposition uses gravity to facilitate the flow of solution into the sigmoid and descending colon.

Acute flexion of the right leg allows for adequate exposure of the anus. Options A, B, and D are

incorrect positions because they fail to adequately expose the anus or facilitate infusion of theenema solution.

33) D - All stomach contents are aspirated and measured before administering a tube feeding todetermine the gastric residual volume. If the stomach fails to empty and propel its contentsforward, the tube feeding accumulates in the stomach and increases the clients ri sk ofaspiration. If the aspirated gastric contents exceed the predetermined limit, the nurse withholdsthe tube feeding and collaborates with the provider on a plan of care. Assessing residual does

not confirm placement or assess fluid and electrolyte status. The nurse uses clinical indicatorsincluding serum albumin levels to determine the clients nutritional status.

34) D - After checking residual feeding contents, the nurse reinstills the gastric contents into thestomach by removing the syringe bulb or plunger and pouring the gastric contents via thesyringe into the nasogastric tube. Gastric contents should be reinstilled (unless they exceed anamount of 100 mL or as defined by agenc y policy) in order to maintain the clients fluid andelectrolyte balance. The nurse avoids mixing gastric aspirate with fresh formula to preventcontamination. Because the gastric aspirate is a small volume, it should be reinstilled; however,mixing the f ormula with water can, also, disrupt the clients fluid and electrolyte balance unlessthe nurse determines that the client is dehydrated.

35) D - Assessing the clients balance, strength, and confidence helps determine if the cane is asuitable assistive device for the client. Although body image (self-consciousness) is a


28/64


29/64

a. Hold the feedingb. Reinstill the amount and continue with administering the feedingc. Elevate the clients head at least 45 degrees and administer the feeding d. Discard the residual amount and proceed with administering the feeding

5. A nurse is inserting a nasogastrictube in an adult male client. During the procedure, the client begins to cough and has difficultybreathing. Which of the following is the appropriate nursing action?

a. Quickly insert the tubeb. Notify the physician immediatelyc. Remove the tube and reinsert when the respiratory distress subsidesd. Pull back on the tube and wait until the respiratory distress subsides

6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates thestomach contents and check the contents for pH. The nurse verifies correct tube placement ifwhich pH value is noted?

a. 3.5b. 7.0c. 7.35d. 7.5

7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse shouldinstruct the client to do which of the following just before the nurse removes the tube?

a. Exhale

b. Inhale and exhale quicklyc. Take and hold a deep breathd. Perform a Valsalva maneuver

8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connectedto suction. To administer the medication, the nurse would:

a. Position the client supine to assist in medication absorptionb. Aspirate the nasogastric tube after medication administration to maintain patencyc. Clamp the nasogastric tube for 30 minutes following administration of the medicationd. Change the suction setting to low intermittent suction for 30 minutes after medication

administration

9. A nurse is preparing to care for a female client with esophageal varices who has just has aSengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of thefollowing items must be kept at the bedside at all times?

a. An obturatorb. Kelly clamp


30/64

c. An irrigation setd. A pair of scissors

10. Dr. Smith has determined that the client with hepatitis has contracted the infection formcontaminated food. The nurse understands that this client is most likely experiencing what typeof hepatitis?

a. Hepatitis Ab. Hepatitis Bc. Hepatitis Cd. Hepatitis D

11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirmingthis diagnosis?

a. Elevated hemoglobin levelb. Elevated serum bilirubin levelc. Elevated blood urea nitrogen leveld. Decreased erythrocycle sedimentation rate

12. The nurse is reviewing the physicians orders written for a male client admitted to thehospital with acute pancreatitis. Which physician order should the nurse question if noted on theclients chart?

a. NPO statusb. Nasogastric tube insertedc. Morphine sulfate for pain

d. An anticholinergic medication

13. A female client being seen in a physicians office has just been scheduled for a bariumswallow the next day. The nurse writes down which instruction for the client to follow before thetest?

a. Fast for 8 hours before the testb. Eat a regular supper and breakfastc. Continue to take all oral medications as scheduledd. Monitor own bowel movement pattern for constipation

14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen.The nurse performs which assessment technique next?

a. Palpates the abdomen for sizeb. Palpates the liver at the right rib marginc. Listens to bowel sounds in all for quadrantsd. Percusses the right lower abdominal quadrant


31/64

15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female clientscheduled for a colonoscopy. The client begins to experience diarrhea following administrationof the solution. What action by the nurse is appropriate?

a. Start an IV infusionb. Administer an enemac. Cancel the diagnostic testd. Explain that diarrhea is expected

16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitorsthe client knowing that this client is at risk for which vitamin deficiency?

a. Vitamin Ab. Vitamin B12c. Vitamin Cd. Vitamin E

17. The nurse is reviewing the medication record of a female client with acute gastritis. Whichmedication, if noted on the clients record, would the nurse question?

a. Digoxin (Lanoxin)b. Furosemide (Lasix)c. Indomethacin (Indocin)d. Propranolol hydrochloride (Inderal)

18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse notedthat the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursingintervention is appropriate?

a. Clamp the T tubeb. Irrigate the T tubec. Notify the physiciand. Document the findings

19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessmentfindings would most likely indicate perforation of the ulcer?

a. Bradycardiab. Numbness in the legsc. Nausea and vomitingd. A rigid, board-like abdomen

20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurseabout the purpose of this procedure. Which response by the nurse best describes the purpose


32/64

of a vagotomy?

a. Halts stress reactionsb. Heals the gastric mucosac. Reduces the stimulus to acid secretionsd. Decreases food absorption in the stomach

21. The nurse is caring for a female client following a Billroth II procedure. Which postoperativeorder should the nurse question and verify?

a. Leg exercisesb. Early ambulationc. Irrigating the nasogastric tubed. Coughing and deep-breathing exercises

22. The nurse is providing discharge instructions to a male client following gastrectomy andinstructs the client to take which measure to assist in preventing dumping syndrome?

a. Ambulate following a mealb. Eat high carbohydrate foodsc. Limit the fluid taken with meald. Sit in a high- Fowlers position during meals

23. The nurse is monitoring a female client for the early signs and symptoms of dumpingsyndrome. Which of the following indicate this occurrence?

a. Sweating and pallor

b. Bradycardia and indigestionc. Double vision and chest paind. Abdominal cramping and pain

24. The nurse is preparing a discharge teaching plan for the male client who had umbilicalhernia repair. What should the nurse include in the plan?

a. Irrigating the drainb. Avoiding coughingc. Maintaining bed restd. Restricting pain medication

25. The nurse is instructing the male client who has an inguinal hernia repair how to reducepostoperative swelling following the procedure. What should the nurse tell the client?

a. Limit oral fluidb. Elevate the scrotumc. Apply heat to the abdomend. Remain in a low-fiber diet


33/64

26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis.Which finding, if noted on assessment of the client, would the nurse report to the physician?

a. Hypotensionb. Bloody diarrheac. Rebound tendernessd. A hemoglobin level of 12 mg/dL

27. The nurse is caring for a male client postoperatively following creation of a colostomy.Which nursing diagnosis should the nurse include in the plan of care?

a. Sexual dysfunctionb. Body image, disturbedc. Fear related to poor prognosisd. Nutrition: more than body requirements, imbalanced

28. The nurse is reviewing the record of a female client with Crohns disease. Which stoolcharacteristics should the nurse expect to note documented in the clients record?

a. Diarrheab. Chronic constipationc. Constipation alternating with diarrhead. Stools constantly oozing form the rectum

29. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the

client begins to complain of abdominal cramps. What is the appropriate nursing action?

a. Notify the physicianb. Stop the irrigation temporarilyc. Increase the height of the irrigationd. Medicate for pain and resume the irrigation

30. The nurse is teaching a female client how to perform a colostomy irrigation. To enhance theeffectiveness of the irrigation and fecal returns, what measure should the nurse instruct theclient to do?

a. Increase fluid intakeb. Place heat on the abdomenc. Perform the irrigation in the eveningd. Reduce the amount of irrigation solution1. Answer C . The normal serum amylase level is 25 to 151 units/L. With chronic cases ofpancreatitis, the rise in serum amylase levels usually does not exceed three times the normalvalue. In acute pancreatitis, the value may exceed five times the normal value. Options A and Bare within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.


34/64

2. Answer C . Full liquid food items include items such as plain ice cream, sherbet, breakfastdrinks, milk, pudding and custard, soups that are strained, and strained vegetable juices. A clearliquid diet consists of foods that are relatively transparent. The food items in options A, B, and Dare clear liquids.

3. Answer A . The client with cirrhosis needs to consume foods high in thiamine. Thiamineis present in a variety of foods of plant and animal origin. Pork products are especially rich inthis vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Milkcontains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and Kand folic acid

4. Answer A. Unless specifically indicated, residual amounts more than 100 mL requireholding the feeding. Therefore options B, C, and D are incorrect. Additionally, the feeding is notdiscarded unless its contents are abnormal in color or characteristics.

5. Answer D . During the insertion of a nasogastric tube, if the client experiences difficultybreathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, andwait until the distress subsides. Options B and C are unnecessary. Quickly inserting the tube isnot an appropriate action because, in this situation, it may be likely that the tube has entered thebronchus.

6. Answer A. If the nasogastric tube is in the stomach, the pH of the contents will be acidic.Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightlyacidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.

7. Answer C. When the nurse removes a nasogastric tube, the client is instructed to take andhold a deep breath. This will close the epiglottis. This allows for easy withdrawal through theesophagus into the nose. The nurse removes the tube with one smooth, continuous pull.

8. Answer C. If a client has a nasogastric tube connected to suction, the nurse should wait upto 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time formedication absorption. Aspirating the nasogastric tube will remove the medication justadministered. Low intermittent suction also will remove the medication just administered. Theclient should not be placed in the supine position because of the risk for aspiration.

9. Answer C. When the client has a Sengstaken-Blakemore tube, a pair of scissors must bekept at the clients bedside at a ll times. The client needs to be observed for sudden respiratorydistress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If thisoccurs, the nurse immediately cuts all balloon lumens and removes the tube. An obturator and aKelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be keptat the bedside, but it is not the priority item.

10. Answer A. Hepatitis A is transmitted by the fecal-oral route via contaminated food or


35/64

infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected bloodor body fluids.

11. Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels,elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An

elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level isunrelated to this diagnosis.

12. Answer C. Meperidine (Demerol) rather than morphine sulfate is the medication of choiceto treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A,B, and D are appropriate interventions for the client with acute pancreatitis.

13. Answer A . A barium swallow is an x-ray study that uses a substance called barium forcontrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12hours before the test, depending on physician instructions. Most oral medications also arewithheld before the test. After the procedure, the nurse must monitor for constipation, which canoccur as a result of the presence of barium in the gastrointestinal tract.

14. Answer C. The appropriate sequence for abdominal examination is inspection,auscultation, percussion, and palpation. Auscultation is performed after inspection to ensurethat the motility of the bowel and bowel sounds are not altered by percussion or palpation.Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.

15. Answer D. The solution GoLYTELY is a bowel evacuant used to prepare a client for acolonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and willclear the bowel in 4 to 5 hours. Options A, B, and C are inappropriate actions.

16. Answer B. Chronic gastritis causes deterioration and atrophy of the lining of the stomach,leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost,which results in the inability to absorb vitamin B12. This leads to the development of perniciousanemia. The client is not at risk for vitamin A, C, or E deficiency.

17. Answer C. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can causeulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in aclient with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiacmedication. Propranolol (Inderal) is a -adrenergic blocker. Furosemide, digoxin, andpropranolol are not contraindicated in clients with gastric disorders.

18. Answer D. Following cholecystectomy, drainage from the T tube is initially bloody andthen turns to a greenish-brown color. The drainage is measured as output. The amount ofexpected drainage will range from 500 to 1000 mL/day. The nurse would document the output.

19. Answer D. Perforation of an ulcer is a surgical emergency and is characterized bysudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over


36/64


37/64


38/64

o In the event of fire, the acronym most often used is RACE. (R) Remove the patient. (A) Activate the alarm. (C) Attempt to contain the fire by closing the door. (E) Extinguish the fire ifit can be done safely.

o A registered nurse should assign a licensed vocational nurse or licensed practical nurse toperform bedside care, such as suctioning and drug administration.

o If a patient cant void, the first nursing action should be bladder palpation to assess forbladder distention.

o The patient who uses a cane should carry it on the unaffected side and advance it at thesame time as the affected extremity.

o To fit a supine patient for crutches, the nurse should measure from the axilla to the sole andadd 2" (5 cm) to that measurement.

o Assessment begins with the nurses first encounter with the patient and continues throughoutthe patients stay. The nurse obtains assessment data through the health history, physicalexamination, and review of diagnostic studies.

o The appropriate needle size for insulin injection is 25G and 5/8" long.o Residual urine is urine that remains in the bladder after voiding. The amount of residual urine

is normally 50 to 100 ml.o The five stages of the nursing process are assessment, nursing diagnosis, planning,

implementation, and evaluation.o Assessment is the stage of the nursing process in which the nurse continuously collects data

to identify a patients actual and potential health needs.o Nursing diagnosis is the stage of the nursing process in which the nurse makes a clinical

judgment about individual, family, or community responses to actual or potential healthproblems or life processes.

o Planning is the stage of the nursing process in which the nurse assigns priorities to nursingdiagnoses, defines short-term and long-term goals and expected outcomes, and establishesthe nursing care plan.

o Implementation is the stage of the nursing process in which the nurse puts the nursing careplan into action, delegates specific nursing interventions to members of the nursing team, andcharts patient responses to nursing interventions.

o Evaluation is the stage of the nursing process in which the nurse compares objective andsubjective data with the outcome criteria and, if needed, modifies the nursing care plan.

o Before administering any as needed pain medication, the nurse should ask the patient toindicate the location of the pain.

o Jehovahs Witnesses believe that they shouldnt receive blood components donated by otherpeople.

o To test visual acuity, the nurse should ask the patient to cover each eye separately and toread the eye chart with glasses and without, as appropriate.

o When providing oral care for an unconscious patient, to minimize the risk of aspiration, thenurse should position the patient on the side.

o During assessment of distance vision, the patient should stand 20 (6.1 m) from the chart.o For a geriatric patient or one who is extremely ill, the ideal room temperature is 66 to 76 F

(18.8 to 24.4 C).o Normal room humidity is 30% to 60%.o Hand washing is the single best method of limiting the spread of microorganisms. Once

gloves are removed after routine contact with a patient, hands should be washed for 10 to 15seconds.

o To perform catheterization, the nurse should place a woman in the dorsal recumbent position.o A positive Homans sign may indicate thrombophlebitis.o Electrolytes in a solution are measured in milliequivalents per liter (mEq/L). A milliequivalent

is the number of milligrams per 100 milliliters of a solution.


39/64


40/64


41/64

o For a sigmoidoscopy, the nurse should place the patient in the knee-chest position or Sims position, depending on the physicians preference.

o Maslows hierarchy of needs must be met in the following order: physiologic (oxygen, food,water, sex, rest, and comfort), safety and security, love and belonging, self-esteem andrecognition, and self-actualization.

o When caring for a patient who has a nasogastric tube, the nurse should apply a water-solublelubricant to the nostril to prevent soreness.

o During gastric lavage, a nasogastric tube is inserted, the stomach is flushed, and ingestedsubstances are removed through the tube.

o In documenting drainage on a surgical dressing, the nurse should include the size, color, andconsistency of the drainage (for example, 10 mm of brown mucoid drainage noted ondressing ).

o To elicit Babinskis reflex, the nurse strokes the sole of the patients foot with a moderatelysharp object, such as a thumbnail.

o A positive Babinskis reflex is shown by dorsiflexion of the great toe and fanning out of theother toes.

o When assessing a patient for bladder distention, the nurse should check the contour of thelower abdomen for a rounded mass above the symphysis pubis.

o The best way to prevent pressure ulcers is to reposition the bedridden patient at least every 2hours.

o Antiembolism stockings decompress the superficial blood vessels, reducing the risk ofthrombus formation.

o In adults, the most convenient veins for venipuncture are the basilic and median cubital veinsin the antecubital space.

o Two to three hours before beginning a tube feeding, the nurse should aspirate the patients stomach contents to verify that gastric emptying is adequate.

o People with type O blood are considered universal donors.o People with type AB blood are considered universal recipients.o Hertz (Hz) is the unit of measurement of sound frequency.o Hearing protection is required when the sound intensity exceeds 84 dB. Double hearing

protection is required if it exceeds 104 dB.o Prothrombin, a clotting factor, is produced in the liver.o If a patient is menstruating when a urine sample is collected, the nurse should note this on the

laboratory request.o During lumbar puncture, the nurse must note the initial intracranialpressure and the color of

the cerebrospinal fluid.o If a patient cant cough to provide a sputum sample for culture, a heated aerosol treatment

can be used to help to obtain a sample.o If eye ointment and eyedrops must be instilled in the same eye, the eyedrops should be

instilled first.o When leaving an isolation room, the nurse should remove her gloves before her mask

because fewer pathogens are on the mask.o Skeletal traction, which is applied to a bone with wire pins or tongs, is the most effective

means of traction.o The total parenteral nutrition solution should be stored in a refrigerator and removed 30 to 60

minutes before use. Delivery of a chilled solution can cause pain, hypothermia, venousspasm, and venous constriction.

o Drugs arent routinely injected intramuscularly into edematous tissue because they may notbe absorbed.

o When caring for a comatose patient, the nurse should explain each action to the patient in anormal voice.


42/64


43/64

o Quality assurance is a method of determining whether nursing actions and practices meetestablished standards.

o The five rights of medication administration are the right patient, right drug, right dose, rightroute of administration, and right time.

o The evaluation phase of the nursing process is to determine whether nursing interventionshave enabled the patient to meet the desired goals.

o Outside of the hospital setting, only the sublingual and translingual forms of nitroglycerinshould be used to relieve acute anginal attacks.

o The implementation phase of the nursing process involves recording the patients response tothe nursing plan, putting the nursing plan into action, delegating specific nursing interventions,and coordinating the patients activities.

o The Patients Bill of Rights offers patients guidance and protection by stating theresponsibilities of the hospital and its staff toward patients and their families duringhospitalization.

o To minimize omission and distortion of facts, the nurse should record information as soon asits gathered.

o When assessing a patients health history, the nurse should record the current illnesschronologically, beginning with the onset of the problem and continuing to the present.

o When assessing a patients health history, the nurse should record the current illnesschronologically, beginning with the onset of the problem and continuing to the present.

o A nurse shouldnt give false assurance to a patient.o After receiving preoperative medication, a patient isnt competent to sign an informed consent

form.o When lifting a patient, a nurse uses the weight of her body instead of the strength in her arms.o A nurse may clarify a physicians explanation about an operation or a procedure to a patient,

but must refer questions about informed consent to the physician.o When obtaining a health history from an acutely ill or agitated patient, the nurse should limit

questions to those that provide necessary information.o If a chest drainage system line is broken or interrupted, the nurse should clamp the tube

immediately.o The nurse shouldnt use her thumb to take a patients pulse rate because the thumb has a

pulse that may be confused with the patients pulse.o An inspiration and an expiration count as one respiration.o Eupnea is normal respiration.o During blood pressure measurement, the patient should rest the arm against a surface. Using

muscle strength to hold up the arm may raise the blood pressure.o Major, unalterable risk factors for coronary artery disease include heredity, sex, race, and

age.o Inspection is the most frequently used assessment technique.o Family members of an elderly person in a long-term care facility should transfer some

personal items (such as photographs, a favorite chair, and knickknacks) to the persons roomto provide a comfortable atmosphere.

o Pulsus alternans is a regular pulse rhythm with alternating weak and strong beats. It occurs inventricular enlargement because the stroke volume varies with each heartbeat.

o The upper respiratory tract warms and humidifies inspired air and plays a role in taste, smell,and mastication.

o Signs of accessory muscle use include shoulder elevation, intercostal muscle retraction, andscalene and sternocleidomastoid muscle use during respiration.

o When patients use axillary crutches, their palms should bear the brunt of the weight.o Activities of daily living include eating, bathing, dressing, grooming, toileting, and interacting

socially.


44/64

o Normal gait has two phases: the stance phase, in which the patients foot rests on the ground,and the swing phase, in which the patients foot moves forward.

o The phases of mitosis are prophase, metaphase, anaphase, and telophase.o The nurse should follow standard precautions in the routine care of all patients.o The nurse should use the bell of the stethoscope to listen for venous hums and cardiac

murmurs.o The nurse can assess a patients general knowledge by asking questions such as Who is the

president of the United States?o Cold packs are applied for the first 20 to 48 hours after an injury; then heat is applied. During

cold application, the pack is applied for 20 minutes and then removed for 10 to 15 minutes toprevent reflex dilation (rebound phenomenon) and frostbite injury.

o The pons is located above the medulla and consists of white matter (sensory and motortracts) and gray matter (reflex centers).

o The autonomic nervous system controls the smooth muscles.o A correctly written patient goal expresses the desired patient behavior, criteria for

measurement, time frame for achievement, and conditions under which the behavior willoccur. Its developed in collaboration with the patient.

o Percussion causes five basic notes: tympany (loud intensity, as heard over a gastric airbubble or puffed out cheek), hyperresonance (very loud, as heard over an emphysematouslung), resonance (loud, as heard over a normal lung), dullness (medium intensity, as heardover the liver or other solid organ), and flatness (soft, as heard over the thigh).

o The optic disk is yellowish pink and circular, with a distinct border.o A primary disability is caused by a pathologic process. A secondary disability is caused by

inactivity.o Nurses are commonly held liable for failing to keep an accurate count of sponges and other

devices during surgery.o The best dietary sources of vitamin B6 are liver, kidney, pork, soybeans, corn, and whole-

grain cereals.o Iron-rich foods, such as organ meats, nuts, legumes, dried fruit, green leafy vegetables, eggs,

and whole grains, commonly have a low water content.o Collaboration is joint communication and decision making betweennurses and physicians. Its

designed to meet patients needs by integrating the care regimens of both professions intoone comprehensive approach.

o Bradycardia is a heart rate of fewer than 60 beats/minute.o A nursing diagnosis is a statement of a patients actual or potential health problem that can be

resolved, diminished, or otherwise changed by nursing interventions.o During the assessment phase of the nursing process, the nurse collects and analyzes three

types of data: health history, physical examination, and laboratory and diagnostic test data.o The patients health history consists primarily of subjective data, information thats supplied by

the patient.o The physical examination includes objective data obtained by inspection, palpation,

percussion, and auscultation.o When documenting patient care, the nurse should write legibly, use only standard

abbreviations, and sign each entry. The nurse should never destroy or attempt to obliteratedocumentation or leave vacant lines.

o Factors that affect body temperature include time of day, age, physical activity, phase ofmenstrual cycle, and pregnancy.

o The most accessible and commonly used artery for measuring a patients pulse rate is theradial artery. To take the pulse rate, the artery is compressed against the radius.

o In a resting adult, the normal pulse rate is 60 to 100 beats/minute. The rate is slightly faster inwomen than in men and much faster in children than in adults.


45/64

o Laboratory test results are an objective form of assessment data.o The measurement systems most commonly used in clinical practice are the metric system,

apothecaries system, and household system.o Before signing an informed consent form, the patient should know whether other treatment

options are available and should understand what will occur during the preoperative,intraoperative, and postoperative phases; the risks involved; and the possible complications.The patient should also have a general idea of the time required from surgery to recovery. Inaddition, he should have an opportunity to ask questions.

o A patient must sign a separate informed consent form for each procedure.o During percussion, the nurse uses quick, sharp tapping of the fingers or hands against body

surfaces to produce sounds. This procedure is done to determine the size, shape, position,and density of underlying organs and tissues; elicit tenderness; or assess reflexes.

o Ballottement is a form of light palpation involving gentle, repetitive bouncing of tissues againstthe hand and feeling their rebound.

o A foot cradle keeps bed linen off the patients feet to prevent skin irritation and breakdown,especially in a patient who has peripheral vascular disease or neuropathy.

o Gastric lavage is flushing of the stomach and removal of ingested substances through anasogastric tube. Its used to treat poisoning or drug overdose.

o During the evaluation step of the nursing process, the nurse assesses the patients responseto therapy.

o Bruits commonly indicate life- or limb-threatening vascular disease.o O.U. means each eye. O.D. is the right eye, and O.S. is the left eye.o To remove a patients artificial eye, the nurse depresses the lower lid.o The nurse should use a warm saline solution to clean an artificial eye.o A thready pulse is very fine and scarcely perceptible.o Axillary temperature is usually 1 F lower than oral temperature.o After suctioning a tracheostomy tube, the nurse must document the color,

amount, consistency, and odor of secretions.o On a drug prescription, the abbreviation p.c. means that the drug should be administered after

meals.o After bladder irrigation, the nurse should document the amount, color, and clarity of the urine

and the presence of clots or sediment.o After bladder irrigation, the nurse should document the amount, color, and clarity of the urine

and the presence of clots or sediment.o Laws regarding patient self-determination vary from state to state. Therefore, the nurse must

be familiar with the laws of the state in which she works.o Gauge is the inside diameter of a needle: the smaller the gauge, the larger the diameter.o An adult normally has 32 permanent teeth.o After turning a patient, the nurse should document the position used, the time that the patient

was turned, and the findings of skin assessment.o PERRLA is an abbreviation for normal pupil assessment findings: pupils equal, round, and

reactive to light with accommodation.o When percussing a patients chest for postural drainage, the nurses hands should be

cupped.o When measuring a patient s pulse, the nurse should assess its rate, rhythm, quality, and

strength.o Before transferring a patient from a bed to a wheelchair, the nurse should push the

wheelchairs footrests to the sides and lock its wheels.o When assessing respirations, the nurse should document their rate, rhythm, depth, and

quality.o For a subcutaneous injection, the nurse should use a 5/8" 25G needle.


46/64

o The notation AA & O 3 indicates that the patient is awake, alert, and oriented to person(knows who he is), place (knows where he is), and time (knows the date and time).

o Fluid intake includes all fluids taken by mouth, including foods that are liquid at roomtemperature, such as gelatin, custard, and ice cream; I.V. fluids; and fluids administered infeeding tubes. Fluid output includes urine, vomitus, and drainage (such as from a nasogastrictube or from a wound) as well as blood loss, diarrhea or feces, and perspiration.

o After administering an intradermal injection, the nurse shouldnt massage the area becausemassage can irritate the site and interfere with results.

o When administering an intradermal injection, the nurse should hold the syringe almost flatagainst the patients skin (at about a 15-degree angle), with the bevel up.

o To obtain an accurate blood pressure, the nurse should inflate the manometer to 20 to 30 mmHg above the disappearance of the radial pulse before releasing the cuff pressure.

o The nurse should count an irregular pulse for 1 full minute.o A patient who is vomiting while lying down should be placed in a lateral position to prevent

aspiration of vomitus.o Prophylaxis is disease prevention.o Body alignment is achieved when body parts are in proper relation to their natural position.o Trust is the foundation of a nurse-patient relationship.o Blood pressure is the force exerted by the circulating volume of blood on the arterial walls.o Malpractice is a professionals wrongful conduct, improper discharge of duties, or failure to

meet standards of care that causes harm to another.o As a general rule, nurses cant refuse a patient care assignment; however, in most states,

they may refuse to participate in abortions.o A nurse can be found negligent if a patient is injured because the nurse failed to perform a

duty that a reasonable and prudent person would perform or because the nurse performed anact that a reasonable and prudent person wouldnt perform.

o States have enacted Good Samaritan laws to encourage professionals to provide medicalassistance at the scene of an accident without fear of a lawsuit arising from the assistance.These laws dont apply to care provided in a health care facility.

o A physician should sign verbal and telephone orders within the time established by facility

policy, usually 24 hours.o A competent adult has the right to refuse lifesaving medical treatment; however, the individual

should be fully informed of the consequences of his refusal.o Although a patients health record, or chart, is the health care facilitys physical property, its

contents belong to the patient.o Before a patients health record can be released to a third party, the patient or the patients

legal guardian must give written consent.o Under the Controlled Substances Act, every dose of a controlled drug thats dispensed by the

pharmacy must be accounted for, whether the dose was administered to a patient ordiscarded accidentally.

o A nurse cant perform duties that violate a rule or regulation established by a state licensingboard, even if they are authorized by a health care facility or physician.

o To minimize interruptions during a patient interview, the nurse should select a private room,preferably one with a door that can be closed.

o In categorizing nursing diagnoses, the nurse addresses life-threatening problems first,followed by potentially life-threatening concerns.

o The major components of a nursing care plan are outcome criteria (patient goals) and nursinginterventions.

o Standing orders, or protocols, establish guidelines for treating a specific disease or set ofsymptoms.


47/64

o In assessing a patients heart, the nurse normally finds the point of maximal impulse at thefifth intercostal space, near the apex.

o The S1 heard on auscultation is caused by closure of the mitral and tricuspid valves.o To maintain package sterility, the nurse should open a wrappers top flap away from the body,

open each side flap by touching only the outer part of the wrapper, and open the final flap bygrasping the turned-down corner and pulling it toward the body.

o The nurse shouldnt dry a patients ear canal or remove wax with acotton-tipped applicatorbecause it may force cerumen against the tympanic membrane.

o A patients identification bracelet should remain in place until the patient has been dischargedfrom the health care facility and has left the premises.

o The Controlled Substances Act designated five categories, or schedules, that classifycontrolled drugs according to their abuse potential.

o Schedule I drugs, such as heroin, have a high abuse potential and have no currentlyaccepted medical use in the United States.

o Schedule II drugs, such as morphine, opium, and meperidine (Demerol), have a high abusepotential, but currently have accepted medical uses. Their use may lead to physical orpsychological dependence.

o Schedule III drugs, such as paregoric and butabarbital (Butisol), have a lower abuse potentialthan Schedule I or II drugs. Abuse of Schedule III drugs may lead to moderate or low physicalor psychological dependence, or both.

o Schedule IV drugs, such as chloral hydrate, have a low abuse potential compared withSchedule III drugs.

o Schedule V drugs, such as cough syrups that contain codeine, have the lowest abusepotential of the controlled substances.

o Activities of daily living are actions that the patient must perform every day to provide self-care and to interact with society.

o Testing of the six cardinal fields of gaze evaluates the function of all extraocular muscles andcranial nerves III, IV, and VI.

o The six types of heart murmurs are graded from 1 to 6. A grade 6 heart murmur can be heardwith the stethoscope slightly raised from the chest.

o The most important goal to include in a care plan is the patients goal.o Fruits are high in fiber and low in protein, and should be omitted from a low-residue diet.o The nurse should use an objective scale to assess and quantify pain. Postoperative pain

varies greatly among individuals.o Postmortem care includes cleaning and preparing the deceased patient for family viewing,

arranging transportation to the morgue or funeral home, and determining the disposition ofbelongings.

o The nurse should provide honest answers to the patients questions.o Milk shouldnt be included in a clear liquid diet.o When caring for an infant, a child, or a confused patient, consistency in nursing personnel is

paramount.o The hypothalamus secretes vasopressin and oxytocin, which are stored in the pituitary gland.o The three membranes that enclose the brain and spinal cord are the dura mater, pia mater,

and arachnoid.o A nasogastric tube is used to remove fluid and gas from the small intestine preoperatively or

postoperatively.o Psychologists, physical therapists, and chiropractors arent authorized to write prescriptions

for drugs.o The area around a stoma is cleaned with mild soap and water.o Vegetables have a high fiber content.
http://nclexreviewers.com/nclex-bullets/fundamentals-of-nursing/14247844-maternal-http:/nursingcrib.com/inserting-a-nasogastric-tube/Child-Nursing-Bullets-Nle-Nclex.dochttp://nclexreviewers.com/nclex-bullets/fundamentals-of-nursing/14247844-maternal-http:/nursingcrib.com/inserting-a-nasogastric-tube/Child-Nursing-Bullets-Nle-Nclex.doc


48/64

o The nurse should use a tuberculin syringe to administer a subcutaneous injection of less than1 ml.

o For adults, subcutaneous injections require a 25G 1" needle; for infants, children, elderly, orvery thin patients, they require a 25G to 27G " needle.

o Before administering a drug, the nurse should identify the patient by checking theidentification band and asking the patient to state his name.

o To clean the skin before an injection, the nurse uses a sterile alcohol swab to wipe from thecenter of the site outward in a circular motion.

o The nurse should inject heparin deep into subcutaneous tissue at a 90-degree angle(perpendicular to the skin) to prevent skin irritation.

o If blood is aspirated into the syringe before an I.M. injection, the nurse should withdraw theneedle, prepare another syringe, and repeat the procedure.

o The nurse shouldnt cut the patients hair without written consent from the patient or anappropriate relative.

o If bleeding occurs after an injection, the nurse should apply pressure until the bleeding stops.If bruising occurs, the nurse should monitor the site for an enlarging hematoma.

o When providing hair and scalp care, the nurse should begin combing at the end of the hairand work toward the head.

o The frequency of patient hair care depends on the length and texture of the hair, the durationof hospitalization, and the patients condition.

o Proper function of a hearing aid requires careful handling during insertion and removal,regular cleaning of the ear piece to prevent wax buildup, and prompt replacement of deadbatteries.

o The hearing aid thats marked with a blue dot is for the left ear; the one with a red dot is forthe right ear.

o A hearing aid shouldnt be exposed to heat or humidity and shouldnt be immersed in water.o The nurse should instruct the patient to avoid using hair spray while wearing a hearing aid.o The five branches of pharmacology are pharmacokinetics, pharmacodynamics,

pharmacotherapeutics, toxicology, and pharmacognosy.o The nurse should remove heel protectors every 8 hours to inspect the foot for signs of skin

breakdown.o Heat is applied to promote vasodilation, which reduces pain caused by inflammation.o A sutured surgical incision is an example of healing by first intention (healing directly, without

granulation).o Healing by secondary intention (healing by granulation) is closure of the wound when

granulation tissue fills the defect and allows reepithelialization to occur, beginning at thewound edges and continuing to the center, until the entire wound is covered.

o Keloid formation is an abnormality in healing thats characterized by overgrowth of scar tissueat the wound site.

o The nurse should administer procaine penicillin by deep I.M. injection in the upper outerportion of the buttocks in the adult or in the midlateral thigh in the child. The nurse shouldnt massage the injection site.

o An ascending colostomy drains fluid feces. A descending colostomy drains solid fecal matter.o A folded towel (scrotal bridge) can provide scrotal support for the patient with scrotal edema

caused by vasectomy, epididymitis, or orchitis.o When giving an injection to a patient who has a bleeding disorder, the nurse should use a

small-gauge needle and apply pressure to the site for 5 minutes after the injection.o Platelets are the smallest and most fragile formed element of the blood and are essential for

coagulation.o To insert a nasogastric tube, the nurse instructs the patient to tilt the head back slightly and

then inserts the tube. When the nurse feels the tube curving at the pharynx, the nurse should
http://nursingcrib.com/inserting-a-nasogastric-tube/http://nursingcrib.com/inserting-a-nasogastric-tube/


49/64

tell the patient to tilt the head forward to close the trachea and open the esophagus byswallowing. (Sips of water can facilitate this action.)

o Families with loved ones in intensive care units report that their four most important needs areto have their questions answered honestly, to be assured that the best possible care is beingprovided, to know the patients prognosis, and to feel that there is hope of recovery.

o Double-bind communication occurs when the verbal message contradicts the nonverbalmessage and the receiver is unsure of which message to respond to.

o A nonjudgmental attitude displayed by a nurse shows that she neither approves nordisapproves of the patient.

o Target symptoms are those that the patient finds most distressing.o A patient should be advised to take aspirin on an empty stomach, with a full glass of water,

and should avoid acidic foods such as coffee, citrus fruits, and cola.o For every patient problem, there is a nursing diagnosis; for every nursing diagnosis, there is a

goal; and for every goal, there are interventions designed to make the goal a reality. The keysto answering examination questions correctly are identifying the problem presented,formulating a goal for the problem, and selecting the intervention from the choices providedthat will enable the patient to reach that goal.

o Fidelity means loyalty and can be shown as a commitment to the profession of nursing and tothe patient.

o Administering an I.M. injection against the patients will and without legal authority is battery.o An example of a third-party payer is an insurance company.o The formula for calculating the drops per minute for an I.V. infusion is as follows: (volume to

be infused drip factor) time in minutes = drops/minuteo On-call medication should be given within 5 minutes of the call.o Usually, the best method to determine a patients cultural or spiritual needs is to ask him.o An incident report or unusual occurrence report isnt part of a patients record, but is an in-

house document thats used for the purpose of correcting the problem.o Critical pathways are a multidisciplinary guideline for patient care.o When prioritizing nursing diagnoses, the following hierarchy should be used: Problems

associated with the airway, those concerning breathing, and those related to circulation.o The two nursing diagnoses that have the highest priority that the nurse can assign are

Ineffective airway clearance and Ineffective breathing pattern.o A subjective sign that a sitz bath has been effective is the patients expression of decreased

pain or discomfort.o For the nursing diagnosis Deficient diversional activity to be valid, the patient must state that

hes bored, that he has nothing to do, or words to that effect.o The most appropriate nursing diagnosis for an individual who doesnt speak English is

Impaired verbal communication related to inability to speak dominant language (English).o The family of a patient who has been diagnosed as hearing impaired should be instructed to

face the individual when they speak to him.o Before instilling medication into the ear of a patient who is up to age 3, the nurse should pull

the pinna down and back to straighten the eustachian tube.o To prevent injury to the cornea when administering eyedrops, the nurse should waste the first

drop and instill the drug in the lower conjunctival sac.o After administering eye ointment, the nurse should twist the medication tube to detach the

ointment.o When the nurse removes gloves and a mask, she should remove the gloves first. They are

soiled and are likely to contain pathogens.o Crutches should be placed 6" (15.2 cm) in front of the patient and 6" to the side to form a

tripod arrangement.o Listening is the most effective communication technique.


50/64

o Before teaching any procedure to a patient, the nurse must assess the patients currentknowledge and willingness to learn.

o Process recording is a method of evaluating ones communication effectiveness.o When feeding an elderly patient, the nurse should limit high-carbohydrate foods because of

the risk of glucose intolerance.o When feeding an elderly patient, essential foods should be given first.o Passive range of motion maintains joint mobility. Resistive exercises increase muscle mass.o Isometric exercises are performed on an extremity thats in a cast.o A back rub is an example of the gate-control theory of pain.o Anything thats located below the waist is considered unsterile; a sterile field becomes

unsterile when it comes in contact with any unsterile item; a sterile field must be monitoredcontinuously; and a border of 1" (2.5 cm) around a sterile field is considered unsterile.

o A shift to the left is evident when the number of immature cells (bands) in the bloodincreases to fight an infection.

o A shift to the right is evident when the number of mature cells in the blood increases, asseen in advanced liver disease and pernicious anemia.

o Before administering preoperative medication, the nurse should ensure that an informedconsent form has been signed and attached to the patients record.

o A nurse should spend no more than 30 minutes per 8-hour shift providing care to a patientwho has a radiation implant.

o A nurse shouldnt be assigned to care for more than one patient who has a radiation implant.o Long-handled forceps and a lead-lined container should be available in the room of a patient

who has a radiation implant.o Usually, patients who have the same infection and are in strict isolation can share a room.o Diseases that require strict isolation include chickenpox, diphtheria, and viral hemorrhagic

fevers such as Marburg disease.o For the patient who abides by Jewish custom, milk and meat shouldnt be served at the same

meal.o Whether the patient can perform a procedure (psychomotor domain of learning) is a better

indicator of the effectiveness of patient teaching than whether the patient can simply state the

steps involved in the procedure (cognitive domain of learning).o According to Erik Erikson, developmental stages are trust versus mistrust (birth to 18

months), autonomy versus shame and doubt (18 months to age 3), initiative versus guilt(ages 3 to 5), i

ostomy post quiz sample question

Documents