NUR 337 final Arizona State University-Downtown Phoenix | UPDATED
Questions with 100% Verified Answers
Question:
During a mental status examination, a hospitalized client states
that she cannot remember if she is married or if she has
children.
The nurse would document this as an example of what aspect
of the mental status examination?
Decreased judgment
Decreased level of knowledge
Poor insight
Poor remote memory
Answer:
poor remote memory
Question:
Which of the following are examples of subjective assessment
data? (Select all that apply)
Client states he has "no reason to live."
Client's speech is slow and soft.
Client has jaundiced skin color.
Client can recall three numbers.
Client "meditates for relaxation."
Answer:
Client states he has "no reason to live"
Client "meditates for relaxation"
Question:
While performing a mental status examination on a client, the
nurse notices that the client has a slouched posture.
This information should be documented as part of the client's
______________?
Appearance
,Behavior
Thought Process
Judgment
Answer:
appearance
Question:
Why is it important to label the dressing covering the site of an
intravenous access device with the date, time, and nurse's
initials?
Reminds the nurse when to change the infusion tubing.
Informs the nurse and other staff when the next dressing
change is due.
Reminds the nurse to document the insertion of the device.
Proves that the access site was assessed.
Answer:
Informs the nurse and other staff when the next dressing change is due
Question:
The nurse is performing an IV insertion procedure on a client.
Which of the following actions puts the client at risk?
Select All That Apply.
Verify client's name and birthdate.
Place tape for anchoring the IV on the hospital bed railing or
tray table so that it is handy
Touch the open hub of the IV catheter after removing the
needle
Touch the area that has already been cleansed / prepared for
the IV insertion
Perform hand hygiene
Answer:
Place tape for anchoring the IV on the hospital bed railing or tray table so that it is handy
Touch the open hub of the IV catheter after removing the needle
,Touch the area that has already been cleansed / prepared for the IV insertion
Question:
Which action would the nurse take first if an intravenous (IV)
insertion site appeared red, warm, and swollen?
Apply a heat pack.
Elevate the extremity the IV site is on.
Change the dressing.
Discontinue the infusion.
Answer:
Discontinue the infusion.
Question:
What is the primary - and potentially most serious - danger
related to a broken IV catheter tip?
Pain
Phlebitis
Embolus
Infection
Answer:
Embolus
Question:
What would the nurse do to assess a patient's risk for embolus
when removing a venous access device?
Ask the patient to rate any pain at the site.
Palpate the site for possible edema.
Visualize the tip of the IV catheter.
Inspect for redness.
Answer:
Visualize the tip of the catheter
Question:
, When should the tourniquet be released a second time during
the procedure for insertion of a peripheral intravenous
device?
After flushing the newly-placed IV with sterile saline to verify
patency.
Immediately after observing a "flashback" of blood in the
catheter.
After a "flashback" of blood is observed and the catheter has
been advanced off the stylet.
Immediately after the catheter punctures the skin.
Answer:
After a "flashback" of blood is observed and the catheter has been advanced off the
stylet.
Question:
A client states, "The voices keep telling me that my hands are
dirty." What is the best response by the nurse?
"I don't hear anything; you must be imagining it."
"Maybe you should wash your hands."
"I believe you are hearing the voices but I think it is a part of
your illness because I cannot hear them."
"Yes, I hear that, too. Don't worry, the voices say that to all of
us."
Answer:
"I believe you are hearing the voices but I think it is a part of your illness because I cannot
hear them."
Question:
A client states that she hears voices constantly and that they
interfere with her ability to sleep.
Which intervention suggested by the nurse would be
appropriate and potentially therapeutic for the client?
Drink herbal tea before bedtime.
Take an over-the-counter sleep medication regularly.
Questions with 100% Verified Answers
Question:
During a mental status examination, a hospitalized client states
that she cannot remember if she is married or if she has
children.
The nurse would document this as an example of what aspect
of the mental status examination?
Decreased judgment
Decreased level of knowledge
Poor insight
Poor remote memory
Answer:
poor remote memory
Question:
Which of the following are examples of subjective assessment
data? (Select all that apply)
Client states he has "no reason to live."
Client's speech is slow and soft.
Client has jaundiced skin color.
Client can recall three numbers.
Client "meditates for relaxation."
Answer:
Client states he has "no reason to live"
Client "meditates for relaxation"
Question:
While performing a mental status examination on a client, the
nurse notices that the client has a slouched posture.
This information should be documented as part of the client's
______________?
Appearance
,Behavior
Thought Process
Judgment
Answer:
appearance
Question:
Why is it important to label the dressing covering the site of an
intravenous access device with the date, time, and nurse's
initials?
Reminds the nurse when to change the infusion tubing.
Informs the nurse and other staff when the next dressing
change is due.
Reminds the nurse to document the insertion of the device.
Proves that the access site was assessed.
Answer:
Informs the nurse and other staff when the next dressing change is due
Question:
The nurse is performing an IV insertion procedure on a client.
Which of the following actions puts the client at risk?
Select All That Apply.
Verify client's name and birthdate.
Place tape for anchoring the IV on the hospital bed railing or
tray table so that it is handy
Touch the open hub of the IV catheter after removing the
needle
Touch the area that has already been cleansed / prepared for
the IV insertion
Perform hand hygiene
Answer:
Place tape for anchoring the IV on the hospital bed railing or tray table so that it is handy
Touch the open hub of the IV catheter after removing the needle
,Touch the area that has already been cleansed / prepared for the IV insertion
Question:
Which action would the nurse take first if an intravenous (IV)
insertion site appeared red, warm, and swollen?
Apply a heat pack.
Elevate the extremity the IV site is on.
Change the dressing.
Discontinue the infusion.
Answer:
Discontinue the infusion.
Question:
What is the primary - and potentially most serious - danger
related to a broken IV catheter tip?
Pain
Phlebitis
Embolus
Infection
Answer:
Embolus
Question:
What would the nurse do to assess a patient's risk for embolus
when removing a venous access device?
Ask the patient to rate any pain at the site.
Palpate the site for possible edema.
Visualize the tip of the IV catheter.
Inspect for redness.
Answer:
Visualize the tip of the catheter
Question:
, When should the tourniquet be released a second time during
the procedure for insertion of a peripheral intravenous
device?
After flushing the newly-placed IV with sterile saline to verify
patency.
Immediately after observing a "flashback" of blood in the
catheter.
After a "flashback" of blood is observed and the catheter has
been advanced off the stylet.
Immediately after the catheter punctures the skin.
Answer:
After a "flashback" of blood is observed and the catheter has been advanced off the
stylet.
Question:
A client states, "The voices keep telling me that my hands are
dirty." What is the best response by the nurse?
"I don't hear anything; you must be imagining it."
"Maybe you should wash your hands."
"I believe you are hearing the voices but I think it is a part of
your illness because I cannot hear them."
"Yes, I hear that, too. Don't worry, the voices say that to all of
us."
Answer:
"I believe you are hearing the voices but I think it is a part of your illness because I cannot
hear them."
Question:
A client states that she hears voices constantly and that they
interfere with her ability to sleep.
Which intervention suggested by the nurse would be
appropriate and potentially therapeutic for the client?
Drink herbal tea before bedtime.
Take an over-the-counter sleep medication regularly.
