Introduction to Clinical Nursing
Final Test Solutions
Course Introduction
Introduction to Clinical Nursing provides students with foundational knowledge and skills essential for professional nursing practice in clinical settings. The course covers key concepts such as patient assessment, basic nursing interventions, communication techniques, infection control, and patient safety. Students will learn about the nursing process, ethical and legal considerations, and the importance of evidence-based practice. Emphasis is placed on developing critical thinking and decision-making abilities through simulated clinical experiences, case studies, and hands-on practice. This course prepares students to deliver compassionate, competent, and culturally sensitive care to diverse patient populations.
Recommended Textbook
Clinical Nursing Skills and Techniques 8th Edition by Anne Griffin Perry
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44 Chapters
1316 Verified Questions
1316 Flashcards
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Chapter 1: Using Evidence in Nursing Practice
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) During the application stage of evidence-based practice change, it is important to consider: (Select all that apply.)
A)cost.
B)the need for new equipment.
C)management support.
D)adequate staff.
E)None of above
Answer: A, B, C, D
Q2) The researcher explains how to apply findings in a practice setting for the types of subjects studied in the _________________ section of a research article. Answer: "Clinical Implications"
Clinical Implications
A research article includes a section that explains whether the findings from the study have "clinical implications." The researcher explains how to apply findings in a practice setting for the types of subjects studied.
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Chapter 2: Admitting, Transfer, and Discharge
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25 Verified Questions
25 Flashcards
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Sample Questions
Q1) The patient is scheduled to go home after having coronary angioplasty.What would be the most effective way to provide discharge teaching to this patient?
A)Provide him with information on health care websites.
B)Provide him with written information on what he has to do.
C)Sit and carefully explain what is required before his follow-up.
D)Use a combination of verbal and written information.
Answer: D
Q2) The patient is admitted to the unit for a cardiac catheterization.Which of the following can be delegated to nursing assistive personnel (NAP)? (Select all that apply.)
A)Obtaining admission vital signs
B)Preparing the patient's room
C)Gathering and securing personal care items
D)Orienting patient and family to the nursing unit
Answer: B, C, D
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Chapter 3: Communication
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) Directing the conversation back to patient ideas, feelings, questions, or content is known as ___________________.
Answer: reflection
Reflection or directing back to the patient ideas, feelings, questions, or content validates the nurse's understanding of what the patient is saying and signifies empathy, interest, and respect for the patient.
Q2) The nurse is preparing to give an intramuscular injection to the patient in room 320.The patient care technician comes to the medication room and tells the nurse that the patient in room 316 is very angry with his roommate and is threatening to hit him.How should the nurse respond?
A)Tell the patient care technician to calm the patient down until she can get there.
B)Have the angry patient's roommate moved to another location.
C)Tell the angry patient to calm down until she can get there.
D)Tell the angry patient that he has to act civilized in the hospital, and that's that.
Answer: B
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Chapter 4: Documentation and Informatics
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Sample Questions
Q1) To limit liability, nursing documentation must clearly indicate that the nurse provided individualized, goal-directed nursing care to a patient based on the
Q2) The patient has been transferred to the nursing home from the acute care hospital.A report was called from the hospital and was received by the RN in charge of the nursing home unit.Upon arrival, which approach is used to assess the patient?
A)The Long-Term Care Facility Resident Assessment Instrument
B)The case management model
C)Collaborative pathways
D)The charting by exception model
Q3) Which is a primary difference between home care and hospital care?
A)Documentation systems need to provide information for the home health nurse only.
B)Documentation no longer affects reimbursement.
C)Services are assumed and need less documentation.
D)The patient and the family witness most of the care provided.
Q4) When making written entries in the patient's medical record, describe the nursing care provided and the ____________.
Q5) The abbreviation for every day (___) is no longer used.
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Chapter 5: Vital Signs
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45 Verified Questions
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Sample Questions
Q1) ___________, a subjective symptom, is also referred to as a vital sign, along with the physiological signs.
Q2) The nurse chooses a sphygmomanometer that has a circular gauge and a needle that registers the millimeter calibrations.This type of device is known as a(n) _____ manometer.
A)mercury
B)electronic
C)aneroid
D)direct (invasive)
Q3) _________ is the sound of the pulmonic and aortic valves closing at the end of the systolic contraction.
Q4) The nurse should report an assessment of _____ respirations per minutes for a(n) _____.
A)14; adult patient
B)16; 8-year-old patient
C)25; toddler
D)38; newborn
Q5) The nurse is taking a rectal temperature on an adult patient.She expects to insert the thermometer __________ inches.
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Chapter 6: Health Assessment
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Sample Questions
Q1) Increased visibility of oxyhemoglobin caused by dilation or increased blood flow is known as ________________.
Q2) Which of the following is an unexpected finding after a cardiac assessment?
A)A pulse rate of 72 beats per minute
B)Jugular vein pulsation with the patient supine
C)PMI found at the midclavicular line
D)A sustained swishing sound during systole or diastole
Q3) What technique should the nurse implement for assessment of the carotid artery?
A)Massaging the arteries briskly
B)Using the diaphragm of the stethoscope
C)Palpating each carotid artery separately
D)Placing the patient in a supine position
Q4) The nurse is providing health education to a group of adolescent females.The topic is "Preventing Skin Cancer." As part of the health promotion education, the nurse recommends that they avoid tanning under direct sun at midday and avoid
Q5) The patient has been immobile at home after having had leg trauma in an automobile accident and is now being admitted with calf pain and localized swelling of the calf muscle.One test that is contraindicated in assessment of this patient is testing for _____________.
Page 8
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Chapter 7: Medical Asepsis
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26 Verified Questions
26 Flashcards
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Sample Questions
Q1) Handwashing with soap and water is:
A)the most effective way to reduce the number of bacteria on the nurse's hands.
B)more effective than alcohol-based products for washing hands.
C)necessary for hand hygiene if hands are visibly soiled.
D)not necessary if the nurse wears artificial nails.
Q2) The nurse is preparing to provide care for the patient.Before making patient contact, she washes her hands.This practice is known as __________________.
Q3) An appropriate technique for the nurse to implement for the patient on isolation precautions is to:
A)double-bag all disposable items and linens.
B)put another gown over the one worn if it has become wet.
C)place specimen containers in plastic bags for transport.
D)hand items to be reused directly to a nurse standing outside the room.
Q4) _______________, also known as sterile technique, includes procedures used to eliminate all microorganisms from an area.
Q5) ________________ is the absence of pathogenic (disease-producing) microorganisms.
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Chapter 8: Sterile Technique
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Sample Questions
Q1) An appropriate principle of surgical asepsis is that:
A)the entirety of a sterile package is sterile once it is opened.
B)all of the draped table, top to bottom, is considered sterile.
C)an object held below the waist is considered contaminated.
D)if the sterile barrier field becomes wet, the dry areas are still sterile.
Q2) When performing sterile aseptic procedures, the nurse must create a _____________ in which objects can be handled with minimal risk for contamination.
Q3) Which is the appropriate sequence to use when applying sterile attire?
A)Apply sterile gloves.
B)Secure hair.
C)Don protective eyewear.
D)Apply hair cover.
E)Wash hands.
F)Apply mask.
Q4) A type I hypersensitivity to latex is evident if the nurse assesses:
A)localized swelling.
B)skin redness and itching.
C)runny eyes and nose and cough.
D)tachycardia, hypotension, and wheezing.
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Chapter 9: Safe Patient Handling, Transfer, and Positioning
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31 Verified Questions
31 Flashcards
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Sample Questions
Q1) A nurse should be aware of safety measures to prevent personal injury when lifting or moving patients.An appropriate principle to follow is:
A)bend at the waist for lifting.
B)tighten the stomach muscles and pelvis.
C)keep the weight to be lifted away from the body.
D)carry or hold the weight 1 to 2 feet above the waist.
Q2) Proper alignment for a patient in sitting position includes which of the following?
(Select all that apply.)
A)Head erect
B)Four-inch space between edge of seat and popliteal space
C)Vertebrae straight
D)Both feet elevated
Q3) A nurse is reviewing the patient assignment for the day.Of all the patients, which individual has the greatest potential for injury during transfers?
A)Diabetes mellitus
B)Myocardial infarction
C)A cerebrovascular accident
D)An upper extremity fracture
Q4) Awareness of posture and changes in equilibrium is known as _______________.
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Chapter 10: Exercise and Ambulation
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Sample Questions
Q1) _________________ increase muscle tension but do not change the length of muscle fibers.
Q2) An appropriate technique for the nurse to use when performing range of motion (ROM) exercises is to:
A)repeat each action five times during the exercise.
B)perform the exercises quickly and firmly.
C)support the proximal portion of the extremity being exercised.
D)continue the exercise slightly beyond the point of resistance.
Q3) The patient is performing ROM exercises independently.These are known as __________ exercises.
Q4) While ambulating, the patient becomes light-headed and starts to fall.What should the nurse do first?
A)Call for help.
B)Try to reach for a chair.
C)Ease the patient down to the floor.
D)Push the patient back toward the bed.
Q5) The nurse is concerned that the patient may fall while he is ambulating.To help her maintain control while the patient walks, the nurse may apply a ______________ around the patient's waist.
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Chapter 11: Orthopedic Measures
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) The patient is brought into the emergency department after falling on the ice in her driveway.She is suspected of having a fractured hip.After comparing different available types of traction, she anticipates that which of the following will be used?
A)Bryant's traction
B)Dunlop's traction
C)Buck's extension
D)Gallows traction
Q2) A _______________ is an externally applied structure that holds musculoskeletal tissues in a specific position to permit healing of injuries or fractures or to align malpositioned tissues.
Q3) _________________ may occur when pressure within a casted extremity increases.
Q4) Which type of traction does the nurse anticipate will be used for an adult patient with a fractured humerus?
A)Bryant's traction
B)Dunlop's traction
C)Gallows traction
D)Buck's extension
Q5) An immobilization device used to immobilize and protect a body part is known as a ________.
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Chapter 12: Support Surfaces and Special Beds
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27 Verified Questions
27 Flashcards
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Sample Questions
Q1) Use of the bariatric bed is contraindicated in patients with
Q2) Which of the following is a limitation of the bariatric bed?
A)Lack of an in-bed scale
B)The narrowness of the bed
C)Lack of pressure reduction
D)Increased liability to the institution
Q3) What is the most important factor in preventing and treating pressure ulcers?
A)Proper use of foam or air mattresses
B)Proper utilization of an air-fluidized bed
C)Frequent repositioning of the patient
D)Proper use of a low-air-loss bed
Q4) The major cause of pressure ulcers is ________________.
Q5) After comparing the benefits of the following support surfaces, the nurse realizes that a patient with multiple trauma and/or spinal cord injury is expected to be placed on a(n):
A)Rotokinetic bed.
B)bariatric bed.
C)flotation mattress.
D)air-fluidized mattress.
Page 14
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Chapter 13: Safety and Quality Improvement
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32 Verified Questions
32 Flashcards
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Sample Questions
Q1) __________ are the most common type of inpatient accident.
Q2) The patient is an elderly gentleman who is admitted for a medical problem.While doing his admission assessment, the nurse learns that the patient gets up two to three times a night to use the restroom.The institution has only beds with four side rails.Which of the following is the appropriate rationale for leaving one of the lower side rails down?
A)Falls rarely happen in the inpatient setting.
B)Having all side rails raised increases the occurrence of falling.
C)Side rails have no bearing on whether or not a patient falls.
D)Patient falls rarely result in physical injury.
Q3) After recognizing that a patient has received an electrical shock and removing the source of the shock, what should the nurse do next?
A)Call for assistance.
B)Immediately start CPR.
C)Obtain emergency equipment.
D)Assess for the presence of a pulse.
Q4) Continuous seizure activity that lasts longer than 10 minutes is known as
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15
Chapter 14: Disaster Preparedness
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32 Verified Questions
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Sample Questions
Q1) Why are children particularly vulnerable to environmental toxins? (Select all that apply.)
A)They have stronger immune systems.
B)They take in proportionally larger doses of toxins from food, water, and the air.
C)Their organ systems are less able to remove toxins than adult organs systems.
D)They have a greater number of years of life expectancy.
Q2) The strategic plan of the Centers for Disease Control and Prevention in the event of a disaster first focuses on __________________.
Q3) The patient is admitted to the emergency department with possible smallpox exposure.The patient has never had a smallpox immunization.The nurse prepares to administer a smallpox vaccination, realizing that vaccination:
A)within 3 days of exposure will completely prevent the disease.
B)is effective only if received before exposure.
C)4 to 7 days after exposure will completely prevent the disease.
D)within 3 days will offer only some protection from disease.
Q4) It is recommended that every household prepare a ____________.
Q5) An outbreak of influenza A in the same geographical location is known as an __________.
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Chapter 15: Pain Assessment and Basic Comfort Measures
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Sample Questions
Q1) Pain that extends beyond the period of healing and often lacks an identified pathology is known as _______________.
Q2) Which of the following statements about evaluating patients in pain is true?
A)The best judge of the existence of pain is the nurse.
B)Visible signs always accompany pain.
C)Patients often are hesitant to report pain.
D)Nonpharmacological interventions are better than pain medications.
Q3) The patient is scheduled for surgery late in the afternoon.His postoperative orders include PCA therapy.Which of the following nursing interventions is appropriate to perform?
A)Teach the patient about PCA after the patient comes out of recovery.
B)Teach the patient about PCA before surgery and before preoperative medication administration.
C)Tell the patient not to use PCA unless he can no longer tolerate the pain.
D)Inform the patient's family to watch him carefully and to depress the PCA administration button whenever they think he needs it.
Q4) The _______________ is a potential space between the vertebral bones and the dura mater, the outermost meninges covering the brain and spinal cord.
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Page 17
Chapter 16: Palliative Care
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Sample Questions
Q1) The World Health Organization (2002) defines ___________ as an "approach that improves the quality of life of individuals and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychological, and spiritual problems."
Q2) The patient was brought into the emergency department with a cardiac arrest after suffering multiple gunshot wounds.The patient did not survive even after multiple attempts at resuscitation.The nurse is preparing the body for transport to the morgue by completing hospital procedures for __________________.
Q3) _____________ helps people live as well as possible through the dying process.
Q4) The nurse is preparing to assist the patient at the end stage of her life.To provide comfort for the patient in response to anticipated symptom development, the nurse plans to:
A)decrease the patient's fluid intake.
B)limit the use of pain medication.
C)provide larger meals with more seasoning.
D)determine patient wishes and select appropriate therapies.
Q5) A person experiences an actual _________ when an object or a person can no longer be felt, heard, or experienced.
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Chapter 17: Personal Hygiene and Bed Making
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Sample Questions
Q1) The nurse is caring for a gentleman who has dry skin.When the following interventions are compared, which would be most appropriate for this patient?
A)Limiting the frequency of bathing
B)Using a fat-free soap for washing
C)Using warm water and moisturizers
D)Bathing with hot water to increase blood flow
Q2) When taking a shower in the home setting, the patient at risk for falls may benefit from: (Select all that apply.)
A)installation of grab bars.
B)adhesive strips applied to the tub floor.
C)addition of a shower chair or stool.
D)a hydraulic lift.
Q3) Patients at greatest risk for developing serious foot problems include those with: (Select all that apply.)
A)peripheral neuropathy.
B)peripheral vascular disease.
C)pancreatitis.
D)diabetes.
Q4) The act of chewing is also known as ________________.
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Chapter 18: Pressure Ulcer Care
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Sample Questions
Q1) When evaluating a patient, the nurse observes an unexpected outcome of treatment when the surrounding skin of an ulcer becomes macerated.The nurse should:
A)obtain a wound culture.
B)apply pressure-reducing devices.
C)use dressings with increased moisture absorption.
D)monitor the patient for systemic signs and symptoms.
Q2) In a long-term care facility, how often should the nurse reassess a patient for risk of a pressure ulcer?
A)Every 1 to 2 days
B)Every time the nurse sees the patient
C)Weekly for the first few weeks of stay
D)Monthly for the first 4 months of stay
Q3) Aggressive prevention measures should be implemented for a patient in the general population with a pressure ulcer risk on the Braden Scale of less than or equal to: A)16.
B)18.
C)20.
D)24.
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Chapter 19: Care of the Eye and Ear
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Sample Questions
Q1) The patient is brought into the emergency department after a motor vehicle accident.The patient is unresponsive.The nurse is concerned about whether or not the patient wears contact lenses because contact lenses that are not removed can cause
Q2) In teaching a patient with a new eye prosthesis on how to care for his eye, the nurse informs the patient that: (Select all that apply.)
A)the artificial eye should be checked at least twice a year.
B)the artificial eye should be cleansed daily using an alcohol product.
C)an artificial eye usually is replaced every 5 years.
D)if the prosthesis is not to be reinserted, it should be wrapped in a dry sterile towel.
Q3) The nurse is preparing to provide eye care for a comatose patient.The nurse realizes that comatose patients do not have natural protective mechanisms to protect the cornea.These protective mechanisms include: (Select all that apply.)
A)blinking.
B)squinting.
C)lubrication.
D)dilation.
Q4) ____________ is the complete surgical removal of the eyeball.
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Page 21
Chapter 20: Safe Medication Preparation
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Sample Questions
Q1) The nurse administers 650 mg of acetaminophen (Tylenol) orally to a patient with a pain level of 4 out of 10.The nurse is aware that the onset of action is 30 minutes to 1 hour, the peak action is 1 to 3 hours, and the duration of action is 3 to 8 hours.After _____ hours, the nurse should assess the patient to determine the maximum effectiveness of the drug.
Q2) The patient reports taking an opioid medication in large dosages for the past several years.While in the hospital, the patient is not prescribed the medication and develops tachycardia, hypertension, sweating, and tremors.He becomes confused and experiences visual hallucinations.The nurse recognizes these signs as indicative of
Q3) The intended or desired physiological response to a medication is known as its
Q4) The nurse administers a medication to the wrong patient but the patient suffers no harm from the medication error.What actions should the nurse take? (Select all that apply.)
A)Prepare a written incident report.
B)Document in the nurses' notes that an incident report was completed.
C)Report the incident to a manager only if the patient is harmed.
D)Notify the prescriber.
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Chapter 21: Oral and Topical Medications
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Sample Questions
Q1) Handheld devices that deliver inhaled medication in a fine powder to penetrate lung airways are known as ___________.
Q2) The nurse receives orders on several patients for oral medications.The nurse will question the order on patients with which conditions? (Select all that apply.)
A)History of asthma and difficulty breathing
B)Inability to swallow food
C)Decreased level of consciousness
D)Use of gastric suction
Q3) The nurse is preparing oral medications for administration.Which action by the nurse is appropriate?
A)Using a cutting device to cut scored tablets
B)Unwrapping all of the medications to be given and placing them together in a cup
C)Crushing capsules and enteric-coated medication for easier swallowing
D)Holding the medication cup at eye level to pour a liquid dosage
Q4) The easiest and most desirable way to administer medications is via the _________ route.
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Chapter 22: Parenteral Medications
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Sample Questions
Q1) The student nurse is preparing to administer an IV bolus medication through a small-gauge IV catheter.The student notes that there is no blood return on aspiration.Which action by the student should the nursing instructor question?
A)Checking the IV site for redness and swelling
B)Immediately stopping the IV infusion and removing the IV catheter
C)Checking to see if the IV is infusing without difficulty
D)Injecting the IV medication if no signs of infiltration
Q2) The nurse is preparing to administer an intramuscular injection via the Z-track method.Which action should be taken by the nurse?
A)Pinch the skin between the thumb and the first finger.
B)Insert the needle at a 90-degree angle.
C)Immediately remove the needle after injecting the medication.
D)Release the skin before removing the needle from the site.
Q3) The nurse is preparing to administer an immunization to a toddler.Which action by the nurse is appropriate?
A)Grasp the body of the muscle during injection.
B)Place one hand above the knee and one below the knee to find the site.
C)Have the patient's knee flexed with the foot internally rotated.
D)Ask the mother to hold the toddler on his side.
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Page 24
Chapter 23: Oxygen Therapy
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Sample Questions
Q1) A curved oxygen delivery device with an adjustable strap that fits around the patient's neck is known as a _______________.
Q2) A patient with a nasal cannula at 5 L/min has skin irritation around the nares and complains of a dry mouth and nose.Which action by the student nurse should be questioned by the nursing instructor?
A)Using humidification
B)Applying petroleum-based gel to the nares
C)Providing frequent oral care
D)Asking the physician for an order for sterile nasal saline
Q3) A patient is planning to perform incentive spirometry after abdominal surgery.The nurse should encourage the patient to do which of the following?
A)Get comfortable in a semi-reclined position.
B)Inhale as deeply as possible and then exhale into the incentive spirometry device.
C)Hold the breath for at least 3 seconds before exhaling.
D)Exhale as quickly as possible.
Q4) The ________, also called a Briggs adaptor, connects an oxygen source to an artificial airway such as an endotracheal tube.
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Chapter 24: Performing Chest Physiotherapy
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Sample Questions
Q1) The system that lines the internal lumen of the tracheobronchial tree and consists of a thin layer of mucus that constantly is propelled toward the larynx by cilia is called the
Q2) The nurse is teaching a patient how to use an Acapella device.What instruction should the nurse give to the patient?
A)Take a full deep breath in and fill your lungs.
B)Hold your breath for 5 to 10 seconds after placing the mouthpiece in your mouth.
C)Cough forcefully to clear your lungs while maintaining a tight seal on the mouthpiece.
D)Exhale slowly for 3 to 4 seconds through the device while it vibrates.
Q3) The nurse auscultates the patients' lung fields and notes congestion in several patients.The nurse anticipates that postural drainage may be used for the patient with which condition?
A)Congestive heart failure with pulmonary edema
B)History of cigarette smoking with recent hemoptysis
C)Chronic bronchitis with frequent coughing
D)Pulmonary embolism after a long international flight
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Chapter 25: Airway Management
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Sample Questions
Q1) The nurse is providing nasotracheal suctioning for a 13-year-old patient with secretions in the throat and trachea.Which action by the nurse demonstrates proper technique?
A)Applying sterile petroleum jelly to the distal tip of the suction catheter
B)Applying clean gloves to both hands
C)Inserting the suction catheter 6 to 8 inches during inspiration
D)Suctioning the pharynx first and then the trachea
Q2) The nurse is assessing the risk for aspiration of gastric contents into the lungs resulting in airway obstruction.The nurse identifies patients with which conditions as having increased risk? (Select all that apply.)
A)Presence of a gastrostomy feeding tube
B)History of smoking 2 packs per day for 30 years
C)Head injury with a decreased level of consciousness
D)Stroke with dysphagia
Q3) A patient has extremely copious and thick oral secretions.The nurse provides oropharyngeal suctioning using a _________________ suction device.
Q4) A plastic or rubber tube that is inserted through the nares or mouth past the epiglottis and vocal cords to maintain an airway is known as an
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Chapter 26: Closed Chest Drainage Systems
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Sample Questions
Q1) What is indicated by continuous bubbling in the water-seal chamber with no bubbles noted in the suction control chamber of the drainage system?
A)A leak in the system
B)Normal functioning
C)A drainage obstruction
D)Insufficient suction pressure
Q2) The patient has a chest tube for a pneumothorax.Assessment revealed no continuous bubbling in the water-seal chamber.The nurse finds no loose connections.After the chest tube near the patient is clamped, the bubbling stops.The nurse's first action should be to:
A)apply pressure to the dressing around the chest tube insertion site.
B)move the clamp farther down the tube and note whether bubbling resumes.
C)replace the entire collection tubing and system.
D)increase suction control until bubbling does not resume when the clamp is removed.
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Chapter 27: Emergency Measures for Life Support
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Sample Questions
Q1) While measuring an oral airway for proper fit, the nurse places the airway so that the flange is held parallel to the front teeth with the airway against the patient's cheek.Where is the end of the curve?
A)At the angle of the jaw
B)Above the ear
C)To the level of the nose
D)Upside down
Q2) When applying an automated external defibrillator, the nurse would:
A)connect the cable to the machine, apply the pads, and turn on the power.
B)turn on the power, apply the pads, and connect the cable.
C)turn on the power, connect the cable, and apply the pads.
D)connect the cable, turn on the power, and apply the pads.
Q3) The nurse finds a patient lying on the bathroom floor.The patient is unresponsive and has a pulse but is not breathing.What is the nurse's first action?
A)Give two breaths using mouth-to-mouth without a barrier device.
B)Give two breaths using mouth-to-mouth without a barrier device and watch for chest movement.
C)Give two breaths using a bag-mask device.
D)Start chest compressions until an AED is available.
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Page 29
Chapter 28: Intravenous and Vascular Access Therapy
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Sample Questions
Q1) What should be the next action by the nurse, once an over-the-needle catheter ( ONC ) has been inserted through the skin and into the vein?
A)Loosen the stylet for removal
B)Check for blood return in the flashback chamber
C)Stabilize the catheter and release the tourniquet
D)Advance the catheter until the hub rests at the insertion site
Q2) The patient is expected to require intravenous therapy for several years as treatment for a chronic disease process.Which of the following would be the best choice for venous access in this patient?
A)Peripherally inserted central catheter ( PICC )
B)Nontunneled percutaneous central venous catheter
C)Subcutaneous implanted port
D)Peripheral IV
Q3) Which patient would a nurse anticipate would be a candidate for a peripherally inserted central catheter ( PICC )?
A)An older adult who is having cataracts removed
B)A perinatal patient who is having prolonged labor
C)A neonate requiring blood therapy
D)An adolescent who is having surgery for reduction of a fracture
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Page 30
Chapter 29: Blood Transfusions
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Sample Questions
Q1) A transfusion in which the donor is the patient is known as an ______________ transfusion or autotransfusion.
Q2) The nurse is administering 1 unit of packed red blood cells as ordered by the primary care provider.While the nurse is measuring vital signs 15 minutes after starting the transfusion, the patient complains of chills and back pain.What is the nurse's first action?
A)Stop the blood transfusion and keep the vein patent by administering saline to infuse from the other side of the Y tubing.
B)Slow the blood transfusion and notify the charge nurse.
C)Disconnect the blood tubing from the catheter and replace it with an infusion of normal saline.
D)Stop the blood transfusion and notify the primary care provider.
Q3) The nurse is preparing to administer a unit of blood to a patient using blood tubing.On the blood product side of the Y tubing, she will hang blood.What will she hang on the other side of the Y tubing?
A)Dextrose 5%
B)Normal saline
C)Dextrose 10%
D)Dextrose 5%/normal saline
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Chapter 30: Oral Nutrition
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28 Flashcards
Source URL: https://quizplus.com/quiz/39800
Sample Questions
Q1) The nurse is assessing the patient for nutritional status.Which laboratory value may indicate compromised protein status?
A)Serum albumin level of 4.0 g/dL
B)Prealbumin level of 12 g/dL
C)Total lymphocyte count of 1600 cells/mm<sup>3</sup>
D)Prealbumin level of 35 g/dL
Q2) The nurse is admitting a person to the unit and is assessing the patient's nutritional status.In assessing the patient's nutritional status, the nurse realizes that:
A)body mass index (BMI) is the main indicator of obesity.
B)ideal body is the standard gauge for nutritional status.
C)clinical judgment is required, along with other indicators.
D)the amount of weight change is the main nutritional indicator.
Q3) _______________ is useful for monitoring short-term changes in visceral protein.
Q4) Patients who have a cancer diagnosis, infected or draining wounds, burns, or an elevated temperature for more than 2 days are at elevated _______________ risk.
Q5) ______________ are measures of height; weight; head, arm, and muscle circumferences; and skinfold thickness.
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Chapter 31: Enteral Nutrition
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Sample Questions
Q1) Before insertion of a nasogastric (NG) tube, of which finding should the physician be notified?
A)Patent nares
B)Absent bowel sounds
C)Evident gag reflex
D)Impaired swallowing
Q2) The home health nurse evaluates the provision of intermittent tube feedings by the patient's family member.The nurse notes that additional teaching is required when she notices that the family member:
A)keeps the formula refrigerated between feedings.
B)keeps the feeding tube capped between feedings.
C)begins the feeding before checking tube placement.
D)irrigates the tube with 30 to 60 mL of water before and after feedings.
Q3) Of the patients listed below, which would be a candidate for nasoenteric feeding tube placement?
A)Post-motor vehicle accident victim with a broken nose and jaw
B)Patient with a bleeding ulcer and possible esophageal varices
C)Elderly patient with a diagnosis of failure to thrive and an inability to chew
D)Patient with an esophageal tumor
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Page 33
Chapter 32: Parenteral Nutrition
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Sample Questions
Q1) The nurse is caring for a patient receiving PN.In planning the patient's care for the day, which nursing assessment is most essential?
A)Electrolyte levels
B)Weight
C)Temperature
D)Condition of insertion site
Q2) A patient on PN has gained 4 lbs over a 24-hour period.Given this weight gain, which interpretation by the nurse is most accurate?
A)Increased nutrition from the patient's parenteral infusions
B)Decreased linoleic acid intake
C)Increased fluid loss
D)Fluid retention
Q3) If PN must be discontinued suddenly, hang __________ in water at the same infusion rate to prevent hypoglycemia.
Q4) Which assessment should a nurse expect to see for a patient receiving PN?
A)Weight gain of 1 to 2 pounds per week
B)Serum calcium level of 10 mEq/L
C)Serum potassium level of 2.8 mEq/L
D)Serum glucose level of more than 200 mg/100 mL
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Chapter 33: Urinary Elimination
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Sample Questions
Q1) In assisting a male patient in using a urinal, which of the following actions should the nurse take? (Select all that apply.)
A)Assess for orthostatic hypotension.
B)Assess the patient's normal elimination habits.
C)Assess for periods of incontinence.
D)Prop the urinal in place if the patient is unable to hold it.
E)Always stay with the patient during urinal use.
Q2) A single-lumen catheter that is inserted into the bladder through the urethra only to empty the bladder and then is removed is known as a _______________ catheter.
Q3) Antimicrobial catheters coated with silver or antibiotics have been shown to reduce the incidence of ________________.
Q4) A noninvasive device that is used to provide accurate determination of a patient's bladder volume by first creating an ultrasound image of the patient's bladder and then calculating the urine volume in the bladder is known as a ______________.
Q5) Catheter use in older adults has been associated with increased
Q6) The risk for catheter-associated urinary tract infection can be reduced by using ___________ when inserting the catheter.
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Chapter 34: Bowel Elimination and Gastric Intubation
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Sample Questions
Q1) The patient has increased his fluid and dietary fiber intake and has started a supervised exercise program.However, he is still having problems with constipation.Which of the following would be an effective intervention? (Select all that apply.)
A)Metamucil
B)Milk of magnesia
C)Dulcolax
D)Mineral oil
E)Colace
Q2) The __________ system is an intrarectal catheter that has a retention cuff, an intraluminal balloon, three pilot balloons, anchor straps, and a port for sampling stool.The purpose of this system is to divert feces away from wounds while providing access for administering rectal medications and irrigations.
Q3) The nurse assesses that a patient has a severe fecal impaction.Which action taken by the nurse addresses this problem?
A)Administering laxatives
B)Providing a high-fiber diet
C)Performing a digital removal
D)Administering an enema
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Page 36
Chapter 35: Ostomy Care
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Sample Questions
Q1) The nurse is caring for a patient with an ostomy.The nurse notes that the ostomy is putting out watery effluent.The nurse recognizes that this is indicative of which location?
A)Descending colon
B)Sigmoid colon
C)Ileal portion of the small intestine
D)transverse colon
Q2) When providing care for a patient with a colostomy or an ileostomy, the nurse recognizes that which is an expected assessment finding?
A)A moist, reddish-pink stoma
B)A dry, purplish stoma
C)Erythema on the skin around the stoma
D)No drainage noted from the stoma when washed
Q3) An ostomy that is created from a portion of the ileum to form a stoma through which urine can exit the body is called a(n) _____________.
Q4) The opening created into the abdominal wall for fecal or urinary elimination is known as a _______________.
Q5) The output from a urinary or fecal stoma is called the _______________.
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Page 37
Chapter 36: Preoperative and Postoperative Care
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Sample Questions
Q1) Being overweight or obese increases the risk for many diseases and health conditions, including which of the following? (Select all that apply.)
A)Hypertension
B)Coronary heart disease
C)Sleep apnea
D)Respiratory problems
E)Hypotension
Q2) The nurse is providing the patient with preoperative education.When the nurse informs the patient that she will not be able to wear makeup, the patient states, "But I never go anywhere without my makeup." The nurse's response is based on what rationale?
A)She will speak with the surgeon to see if he will make an exception.
B)The patient may wear makeup if she insists.
C)Makeup makes it difficult for the surgeon to assess the patient.
D)Makeup impedes circulation.
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Chapter 37: Intraoperative Care
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Sample Questions
Q1) The _________________ is a nurse with advanced education who assists the surgeon with the surgical procedure, performing a combination of nursing and delegated medical functions and/or skills.
Q2) Through the use of an antimicrobial agent and sterile brushes or sponges, which of the following occurs? (Select all that apply.)
A)Debris and transient microorganisms are removed from the nails, hands, and forearms.
B)The resident microbial count is reduced to a minimum.
C)The skin is sterilized.
D)Rapid/rebound growth of microorganisms is inhibited.
E)The need to wash between patients is reduced.
Q3) While supervising the surgical team, the charge nurse notices that a team member's nails are long and chipped.Which action should the nurse take next?
A)Allow the team member to complete the task.
B)Remove the team member to have the nails cut.
C)Turn the team member in to the RNFA.
D)Ask the team member why the nails are long and chipped.
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Page 39
Chapter 38: Wound Care and Irrigations
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Sample Questions
Q1) The nurse is educating a patient about his role in wound healing.Which of the following factors, if modified by the patient, can support adequate oxygenation at the tissue level?
A)Age
B)Smoking
C)Underlying cardiopulmonary conditions
D)Hemoglobin
Q2) How does the skin defend the body? (Select all that apply.)
A)Skin serves as a sensory organ for pain.
B)Skin serves as a sensory organ for touch.
C)Skin serves as a sensory organ for temperature.
D)Skin has an acid pH.
E)None of above
Q3) For absorption of heavy exudate from a wound, a nurse selects which of the following dressings?
A)Alginates
B)Hydrogel
C)Hydrocolloid
D)Transparent film
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Page 40
Chapter 39: Dressings, Bandages, and Binders
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Sample Questions
Q1) _______________ dressings are used for wounds that require debridement.
Q2) Which of the following are examples of wounds that heal by secondary intention? (Select all that apply.)
A)Burns
B)Surgical incisions
C)Infected wounds
D)Deep pressure ulcers
Q3) The patient is being sent home from the hospital after a cardiac catheterization.What should the nurse instruct the patient to do first if bleeding should occur at the femoral artery puncture site?
A)Call the physician.
B)Call 9-1-1.
C)Apply pressure to the site.
D)Apply a new bandage.
Q4) What should the nurse remember to do when applying a hydrocolloid dressing?
A)Apply granules after applying the wafer.
B)Never use a secondary dressing.
C)Hold the dressing in place.
D)Use silk tape to hold the dressing in place.
Q5) _____________ dressings cover or hold primary dressings in place.
Page 41
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Chapter 40: Therapeutic Use of Heat and Cold
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Sample Questions
Q1) Assessment of a patient reveals that the area directly under the heating pad is slightly red.How should the nurse respond?
A)Continue the therapy.
B)Apply a cold compress.
C)Reduce the amount of heat.
D)Remove the pad and reassess in 5 minutes.
Q2) When reviewing the documentation of patients on the unit, a nurse determines that one of the patients is at higher risk for injury from a local heat application to an extremity.Which condition poses this risk?
A)Arthritis
B)Renal calculi
C)Pulmonary disease
D)Peripheral neuropathy
Q3) For which patient should the nurse consider an application of cold?
A)Menstrual cramping
B)Infected wound
C)Fractured ankle
D)Degenerative joint disease
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Chapter 41: Home Care Safety
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Sample Questions
Q1) When a caregiver is communicating with a patient, which of the following may facilitate communication? (Select all that apply.)
A)Face the patient who has a hearing impairment.
B)Avoid eye contact.
C)Use simple words.
D)Be aware of nonverbal gestures.
Q2) When teaching an elderly patient about safety in the bathroom, which of the following recommendations should the nurse make?
A)Use bath oils to maintain skin integrity and suppleness.
B)Hang towels on grab bars for easy access.
C)Make sure the bathroom door can be locked from the inside only for privacy.
D)Shower using a shower stool and a handheld sprayer.
Q3) The nurse is assessing a patient for mobility problems that could lead to falls.She has the patient perform a Timed Up and Go (TUG) test.The nurse uses this test to gauge:
A)the patient's ability to perform advanced ambulation maneuvers.
B)whether the patient can walk 30 feet without fatiguing.
C)whether the patient can tolerate the activity for longer than 30 seconds.
D)how quickly the patient can perform the test.
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Chapter 42: Home Care Teaching
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Sample Questions
Q1) While teaching how to check for gastric residual, the nurse instructs the caregiver to delay the tube feeding if he or she obtains more than _________ mL of gastric aspirate.
Q2) Temperatures in the older adult are different from those in the younger adult.The mean oral temperature for older adults often ranges from ____________.
Q3) The patient is taking Synthroid (a thyroid medication) for hypothyroidism.What should the nurse instruct the patient to do when teaching the patient how to assess her own blood pressure and pulse?
A)Withhold the medication if her blood pressure is above the normal range or if her pulse is over 100 beats per minute.
B)Withhold the medication if her blood pressure is below the normal range or if her pulse is less than 60 beats per minute.
C)Never withhold her medication.Have the patient take it and notify the physician at the next office visit.
D)Withhold her medication only if both her blood pressure and pulse rate are too high.
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Chapter 43: Specimen Collection
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Sample Questions
Q1) An appropriate technique for the nurse to implement when preparing for a venipuncture is to:
A)tie the tourniquet in a knot.
B)tie the tourniquet so it can be easily removed.
C)place the tourniquet 6 to 8 inches above the selected site.
D)make the tourniquet tight enough to occlude the distal pulse.
Q2) What should the nurse do after obtaining a sample for ABG?
A)Maintain pressure over the site for 3 to 5 minutes.
B)Check the artery proximal to or above the puncture site.
C)Place the syringe into a plastic bag, and send it to the lab.
D)Apply a cool compress to hematoma formation at the puncture site.
Q3) Localized inflammation, tenderness, warmth at the wound site, and purulent drainage usually signify _______________.
Q4) A patient is concerned because her first guaiac test is positive.What information should the nurse share with the patient?
A)The patient probably has colorectal cancer.
B)The test needs to be repeated after she eats some red meat.
C)The test needs to be repeated at least 3 times.
D)The patient needs a low-residue diet to reduce intestinal abrasions.
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Chapter 44: Diagnostic Procedures
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Sample Questions
Q1) Which is the appropriate patient position for a lumbar puncture?
A)Prone
B)Supine
C)Sims'
D)Lateral recumbent
Q2) The patient has undergone a cardiac catheterization.It has been 2 hours since the catheter and sheath have been removed.Which of the following would be a concern for the nurse recovering the patient after the procedure? (Select all that apply.)
A)Swelling and hardness at the catheter insertion site
B)Complaints of itching and urticaria
C)Urine output less than 30 mL/hour
D)Low back pain radiating to both sides of the body
E)None of above
Q3) _____________________ apply manual compression to prevent bleeding at the arterial site.
Q4) _____________ is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.In addition, no interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.
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