practical nursing final exam Flashcards
pass
A nurse is helping another nurse fasten the knot of a cover gown before assisting a colleague with a dressing change. Which advantage does a cover gown offer?
Its snug-fitting wristbands avoid contamination of the forearms.
A nursing is caring for an older adult client with an indwelling urinary catheter. Which measure is the priority for the nurse to take to prevent urinary tract infections (UTIs)?
placing catheter tubing lower than the client’s bladder
The CDC has identified three new standard precautions for infection control. Which clinical situation is addressed by these new precautions?
A client is scheduled for a lumbar puncture to assess for meningitis.
The nurse is preparing a client who is in droplet isolation for transport to radiology. What is the appropriate nursing intervention(s)? (Select all that apply.)
facilitating interdepartmental coordination about the transport
placing a clean sheet on the stretcher that the client will be transported upon ensuring that the client has a mask on
reminding transporter to utilize droplet precautions
nurse needs to visit the intensive care unit to administer an enema to a client. Which step should the nurse take when using the sterile solution located at the entrance to the intensive care unit?
Pour and discard a small amount of the solution.
A nurse is observing the housekeeping staff when they are cleaning a health care facility. Which principle should the housekeeping staff follow for medical asepsis?
Wet-mop floors to avoid distributing microorganisms.
A labor and delivery nurse will be participating in a client’s emergency caesarean section and intends to apply the principles of surgical asepsis appropriately. Surgical asepsis is most clearly characterized by:
Steps are taken to render an item completely free of microorganisms.
A nurse is caring for a client with acute influenza. The nurse has taken precautions to reduce pathogen transmission. Which method is the most likely way for the influenza virus to be transmitted from one host to another?
talking
Several family members are visiting a client with an antibiotic-resistant infection who has been placed on contact precautions. When the nurse teaches the visitors about wearing gloves and gowns, a family member states, “I don’t want to wear those. I can’t catch anything just by holding my loved one’s hand.” What is the best response to educate the family about infection transmission?
These barriers help prevent the transmission of infection to you or other people.”
A nurse needs to check the vital signs of a client with an infectious disease who is receiving intravenous therapy through an IV pump. Before entering the client’s room, the nurse follows airborne and contact precautions. Which infectious disease does the client have?
SARS
A nurse needs to fix a respirator mask on a client who was exposed to hazardous chemicals at a factory site. Which of the following respirator masks should the nurse carry in the ambulance to fix on the client?
powered air purifying respirator
A client has been swabbed for an antibiotic-resistant microorganism upon admission to the hospital, and the results reveal that she has been colonized. What are the implications of this assessment finding?
The microorganism is present on the client but is not making her sick.
The nurse is caring for four clients. Which client presents the most susceptibility for infection?
46-year old with a foley catheter following anesthesia
The nurse is discussing antiviral medication with a client diagnosed with human immunodeficiency virus (HIV). Which client statement indicates a need for further teaching?
The antiviral medication will cure the virus from my body.”
An older adult client from a long-term care facility is being admitted to the hospital with an infected wound on the left foot. What action should the nurse perform upon admission related to the client’s residential occupancy?
Perform a nasal swab to identify colonization with methicillin-resistant Staphylococcus aureus (MRSA).
A nurse is transporting a client with pulmonary tuberculosis to the x-ray unit. Which precaution is the priority for the nurse to take to prevent the spread of pathogens?
Wear personal protective equipment when transporting the client.
A client has been receiving care in an isolation room in the hospital for several days and is on contact and droplet precautions. How can the nurse best minimize the psychological effects of this client’s illness experience?
plan to have frequent interaction with the client
When caring for a client with a bacterial respiratory infection and an active cough, what action should the nurse take in order to prevent becoming infected?
Wear a mask when caring for the client.
A health care facility has experienced a recent outbreak of infection that is attributable to an antibiotic-resistant microorganism. Which type of client is most likely at increased risk for infection?
elderly
The nurse is planning to provide teaching to a client who is recovering from abdominal surgery. When is the most appropriate time to teach the client?
As the client is sitting quietly, reading a book
When providing care for a client at a healthcare facility, the nurse comes to realize that the client lacks the ability to read or write. Which teaching approach from the following options would be most beneficial for the client?
Use verbal and visual modes of communication.
As the nurse provides care for a client, they notice that the client takes pleasure in reading books and magazines. Which learning domain encompasses the client’s preferred learning style?
Cognitive
While conducting a health teaching session, the nurse observes that the client lacks attentiveness and easily loses concentration. Which technique from the following options would be most suitable for capturing the client’s attention during the education?
Involve the client in an active way.
While providing care for a client, the nurse intends to deliver health education. What specific subject area should the nurse prioritize in their educational efforts?
self-administration of medications
While providing care for a client, the nurse intends to deliver health education. What specific subject area should the nurse prioritize in their educational efforts?
nutrition and dietary instruction
While providing care for a 45-year-old male client who has lost function in both of his legs due to an automobile accident, what initial action should the nurse take to customize the learning experience for the client?
Gather pertinent information from the client.
While providing care for a 60-year-old client who has an inadequate bowel movement regimen, what is the most suitable approach for the nurse to utilize when teaching this client?
Begin the session with a reference to the client’s actual experience.
A client is being discharged to home and will be requiring a portable oxygen concentrator at home to facilitate comfort and recovery. Which member of the interdisciplinary team is most suitable for assisting the client in obtaining medical equipment?
Social worker
A client is admitted to a skilled nursing facility after sustaining fractures from a fall incident. Which interdisciplinary team member is responsible for assessing and developing plans to restore clients’ activities of daily living (ADL) skills, particularly focusing on the motor skills of the upper extremities?
occupational therapist
The client has experienced an acute worsening of multiple sclerosis symptoms. What type of healthcare facility would offer the most suitable care for this client?
skilled
The nurse recognizes that effective communication that is clear and accurate is crucial when clients are being transferred or referred. Which scenario best exemplifies a referral??
The nurse arranges for a client with a diabetic foot ulcer to see a podiatrist in a community.
While temporarily taking over a colleague’s lunch break, a nurse on an orthopedic unit responds to a client’s call light and is asked to assist the client with transferring from the bed to the bathroom. Since the nurse has not previously cared for this client and is uncertain about their current activity orders, which written source would be the most convenient and reliable way to verify the client’s current level of activity?
nursing Kardex
When documenting information about a client’s condition, a nurse mistakenly records the vital signs as 80/120 in the paper chart. What is the most appropriate approach for acknowledging and rectifying the documentation error?
Cross out 80/120 with a single line and place the nurse’s initials above it.
A newly graduated nurse understands that health care records serve as a legal document of evidence. What actions should the nurse take to ensure their charting is legally defensible?
Ensure that the client’s name appears on all pages.
In a problem-oriented medical record maintained by a nurse, which section of the record describes the client’s responses to interventions and any modifications made to the initial plan?
progress notes
The newly hired nursing staff in the medical-surgical unit are undergoing training to adapt to their new computer charting system. During training, the educator emphasized which of the following benefits of electronic health records (EHRs)?
The computer system reduces omissions by prompting the nurse to enter specific information.
The facility has recently transitioned to electronic health records (EHR) for documenting patient information. During an in-service about the use of electronic health records (EHR), the educator emphasized which of the following disadvantages of EHR?
Acquiring proficiency in using the system requires significant time.
A newly graduated nurse has recently started a job at a hospital. The facility has recently transitioned to electronic health records (EHR) for documenting patient information. Which of the following options represents a benefit of utilizing electronic health records (EHRs) in nursing practice?
Medical records can be accessed simultaneously by multiple healthcare providers from various workstations.
A newly hired nurse in the skilled nursing facility is undergoing training to adapt to the facility’s computer charting system. During training, the educator emphasized which of the following limitations of electronic health records (EHRs)?
System upgrades and power or electronic failures can cause downtime, leading to interruptions and delays in documentation and access to the complete record.
A nurse is caring for four clients. Which client has the highest risk of infection?
an older man with an enlarged prostate
When caring for a newborn, the nurse understands that infants and older adults are susceptible to fluctuations in body temperature. What is the most likely cause of temperature fluctuations in the infant?
great surface area relative to mass and very high metabolic rate
At the start of the shift, a nurse measures a client’s blood pressure and records a systolic reading of 130 mmHg and a diastolic reading of 70 mmHg. What does the systolic blood pressure represent?
represents peak pressure in the client’s arteries.
A parent of a 9-year-old child informs the nurse, “I haven’t noticed any fever yet, but my child describes feeling achy and unwell.” During which phase of the fever does the nurse recognize that the child may be experiencing these symptoms?
prodromal
While assessing a client’s vital signs at a healthcare facility, the nurse notes that the client is experiencing excessive sweating. Which region of the brain is responsible for triggering sweating in clients?
hypothalamus
A client who has been admitted with dehydration complains of dizziness when walking. What teaching should the nurse give to the client?
“Dizziness when you change position can occur when fluid volume in the body is decreased.”
A nurse is caring for a client who has a lack of appetite. What is most likely to influence a client’s core body temperature?
proteins
