Test Bank for Clinical Nursing Skills:
A Concept-Based Approach
4th Edition Volume III
by Pearson Education Chapters 1 - 16
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test Bank
P P P P P P P P P P
Chapter 1: Assessment
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1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
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thenurse implement first?
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A) Call the healthcare provider.
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B) Administer pain medication. P P
C) Reassess a new set of vital signs. P P P P P P
D) Turn client from supine to P P P P
lateral.ANSWER: C
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Explanation: A) The nurse will need to reassess the client first, before calling the
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healthcareprovider.
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B) The nurse will need to reassess the client first, before administering pain medication.
P P P P P P P P P P P P
C) The nurse needs to implement a new set of vital signs first when there is a change
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incondition.
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D) The nurse will need to reassess the client first, before moving the client, to avoid making
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thechange in client's condition worse.
P P P P P P
Page Ref: 2 P P
Cognitive Level: Applying P P
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Competencies:
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Patient-Centered Care
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AACN Domains and Comps.: Domain 2: Person-Centered Care
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NLN Competencies: Relationship Centered Care
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2) The nurse is observing the UAP taking the temperature of an unconscious client. Which
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Proutewill the nurse question the UAP using?
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A) Oral
B) Rectal
C) Scanner
D) Tympanic
ANSWER: A
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Explanation: A) The temperature of an unconscious client is never taken by mouth. The rectal,
P P P P P P P P P P P P P P
tympanic, or scanner method is preferred.
P P P P P P
B) The rectal, tympanic, or scanner method is preferred.
P P P P P P P
C) The rectal, tympanic, or scanner method is preferred.
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D) The rectal, tympanic, or scanner method is
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preferred.Page Ref: 24
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Cognitive Level: Applying P P
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
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PStandards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies:
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PSafetyAACN Domains and Comps.: Domain 5: Quality and Safety
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NLN Competencies: Quality & Safety
P P P P
1
, 3) The nurse is changing a 2-month-old client's diaper and notes the client feels warm to
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touch.Which method should the nurse use to check the baby's temperature?
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A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneANSWER: C
P P P
Explanation: A) Oral is used for age 3 or older. P P P P P P P P P
B) The rectal route is the least desirable.
P P P P P P
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
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D) The tympanic membrane may be used for 3 months or
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older.Page Ref: 29
P P P P
Cognitive Level: Applying P P
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
P P P P P P P
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: Safety
P P P P P P P P P P P
AACN Domains and Comps.: Domain 5: Quality and Safety
P P P P P P P P P
NLN Competencies: Quality & Safety
P P P P
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Which
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noninvasive diagnostic test will the nurse implement to know that the client is receiving
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Penough oxygen? P
A) Chest x-ray P
B) Pulse oximeter P
C) Arterial blood gasses P P
D) Assessment of respiratory P P
PrateANSWER: B
P P
Explanation: A) A chest x-ray is not an intervention a nurse completes.
P P P P P P P P P P P
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
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Psaturation, in the blood and provides a pulse reading, which is especially helpful for the
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Pclientwith a respiratory illness or disease.
P P P P P P
C) Arterial blood gases are an invasive diagnostic test.
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D) Assessing a respiratory rate is important for the nurse to implement; however, it is
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Pnot adiagnostic test.
P P P
Page Ref: 21
P P
Cognitive Level: Applying P P
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
P P P P P P P
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencies:
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Informatics
P
AACN Domains and Comps.: Domain 5: Quality and SafetyNLN
P P P P P P P P P
PCompetencies: Quality & Safety P P P
2
A Concept-Based Approach
4th Edition Volume III
by Pearson Education Chapters 1 - 16
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test Bank
P P P P P P P P P P
Chapter 1: Assessment
P P P
1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
P P P P P P P P P P P P P
thenurse implement first?
P P P P
A) Call the healthcare provider.
P P P
B) Administer pain medication. P P
C) Reassess a new set of vital signs. P P P P P P
D) Turn client from supine to P P P P
lateral.ANSWER: C
P P P
Explanation: A) The nurse will need to reassess the client first, before calling the
P P P P P P P P P P P P P
healthcareprovider.
P P
B) The nurse will need to reassess the client first, before administering pain medication.
P P P P P P P P P P P P
C) The nurse needs to implement a new set of vital signs first when there is a change
P P P P P P P P P P P P P P P P
incondition.
P P
D) The nurse will need to reassess the client first, before moving the client, to avoid making
P P P P P P P P P P P P P P P
thechange in client's condition worse.
P P P P P P
Page Ref: 2 P P
Cognitive Level: Applying P P
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
P P P P P P P
Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Competencies:
P P P P P P P P P P
Patient-Centered Care
P P
AACN Domains and Comps.: Domain 2: Person-Centered Care
P P P P P P P
NLN Competencies: Relationship Centered Care
P P P P P
2) The nurse is observing the UAP taking the temperature of an unconscious client. Which
P P P P P P P P P P P P P
Proutewill the nurse question the UAP using?
P P P P P P P
A) Oral
B) Rectal
C) Scanner
D) Tympanic
ANSWER: A
P P
Explanation: A) The temperature of an unconscious client is never taken by mouth. The rectal,
P P P P P P P P P P P P P P
tympanic, or scanner method is preferred.
P P P P P P
B) The rectal, tympanic, or scanner method is preferred.
P P P P P P P
C) The rectal, tympanic, or scanner method is preferred.
P P P P P P P
D) The rectal, tympanic, or scanner method is
P P P P P P
preferred.Page Ref: 24
P P P P
Cognitive Level: Applying P P
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
P PP P P P P P P P P P
PStandards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies:
P P P P P P P P P P
PSafetyAACN Domains and Comps.: Domain 5: Quality and Safety
P P P P P P P P P
NLN Competencies: Quality & Safety
P P P P
1
, 3) The nurse is changing a 2-month-old client's diaper and notes the client feels warm to
P P P P P P P P P P P P P P
touch.Which method should the nurse use to check the baby's temperature?
P P P P P P P P P P P P
A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneANSWER: C
P P P
Explanation: A) Oral is used for age 3 or older. P P P P P P P P P
B) The rectal route is the least desirable.
P P P P P P
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
P P P P P P P P P P P P P P P
D) The tympanic membrane may be used for 3 months or
P P P P P P P P P
older.Page Ref: 29
P P P P
Cognitive Level: Applying P P
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
P P P P P P P
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: Safety
P P P P P P P P P P P
AACN Domains and Comps.: Domain 5: Quality and Safety
P P P P P P P P P
NLN Competencies: Quality & Safety
P P P P
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Which
P P P P P P P P P P P P
noninvasive diagnostic test will the nurse implement to know that the client is receiving
P P P P P P P P P P P P P P
Penough oxygen? P
A) Chest x-ray P
B) Pulse oximeter P
C) Arterial blood gasses P P
D) Assessment of respiratory P P
PrateANSWER: B
P P
Explanation: A) A chest x-ray is not an intervention a nurse completes.
P P P P P P P P P P P
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
P P P P P P P P P P P
Psaturation, in the blood and provides a pulse reading, which is especially helpful for the
P P P P P P P P P P P P P P
Pclientwith a respiratory illness or disease.
P P P P P P
C) Arterial blood gases are an invasive diagnostic test.
P P P P P P P
D) Assessing a respiratory rate is important for the nurse to implement; however, it is
P P P P P P P P P P P P P
Pnot adiagnostic test.
P P P
Page Ref: 21
P P
Cognitive Level: Applying P P
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
P P P P P P P
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencies:
P P P P P P P P P P
Informatics
P
AACN Domains and Comps.: Domain 5: Quality and SafetyNLN
P P P P P P P P P
PCompetencies: Quality & Safety P P P
2
