Test bank clinical nursing skills a concept based approach 4e pearson education

Test Bank for Clinical Nursing Skills:
m m m m m




m A Concept-Based Approach
m m




4th Edition Volume III
m m m




by Pearson Education Chapters 1 - 16
m m m m m m

,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
m m m m m m m m m m m m

,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test Bank
m m m m m m m m m m




Chapter 1: Assessment
m m m




1) A client on the medical/surgical unit complains of sudden chest pains. Which action will the
m m m m m m m m m m m m m m




nurse implement first?
m m m




A) Call the healthcare provider.
m m m




B) Administer pain medication. m m




C) Reassess a new set of vital signs. m m m m m m




D) Turn client from supine to lateral.
m m m m m




ANSWER: C
m m




Explanation: A) The nurse will need to reassess the client first, before calling the healthcare
m m m m m m m m m m m m m m




provider.
m




B) The nurse will need to reassess the client first, before administering pain medication.
m m m m m m m m m m m m




C) The nurse needs to implement a new set of vital signs first when there is a change in
m m m m m m m m m m m m m m m m m




condition.
m




D) The nurse will need to reassess the client first, before moving the client, to avoid making the
m m m m m m m m m m m m m m m m




change in client's condition worse.
m m m m m




Page Ref: 2 m m




Cognitive Level: Applying m m




Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
m m m m m m m




Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Competencies:
m m m m m m m m m m




Patient-Centered Care
m m




AACN Domains and Comps.: Domain 2: Person-Centered Care
m m m m m m m




NLN Competencies: Relationship Centered Care
m m m m m




2) The nurse is observing the UAP taking the temperature of an unconscious client. Which route
m m m m m m m m m m m m m m




will the nurse question the UAP using?
m m m m m m m




A) Oral
B) Rectal
C) Scanner
D) Tympanic
ANSWER: A
m m




Explanation: A) The temperature of an unconscious client is never taken by mouth. The rectal,
m m m m m m m m m m m m m m




tympanic, or scanner method is preferred.
m m m m m m




B) The rectal, tympanic, or scanner method is preferred.
m m m m m m m




C) The rectal, tympanic, or scanner method is preferred.
m m m m m m m




D) The rectal, tympanic, or scanner method is preferred.
m m m m m m m




Page Ref: 24
m m m




Cognitive Level: Applying m m




Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards:
m mm m m m m m m m m m m




mNursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies: SafetyAACN
m m m m m m m m m m m




Domains and Comps.: Domain 5: Quality and Safety
m m m m m m m m




NLN Competencies: Quality & Safety
m m m m




1

, 3) The nurse is changing a 2-month-old client's diaper and notes the client feels warm to touch.
m m m m m m m m m m m m m m m




Which method should the nurse use to check the baby's temperature?
m m m m m m m m m m m




A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneANSWER: C
m m m




Explanation: A) Oral is used for age 3 or older. m m m m m m m m m




B) The rectal route is the least desirable.
m m m m m m




C) The axillary route may not be as accurate as other routes for detecting fevers in children.
m m m m m m m m m m m m m m m




D) The tympanic membrane may be used for 3 months or older.
m m m m m m m m m m




Page Ref: 29
m m m




Cognitive Level: Applying m m




Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
m m m m m m m




Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: Safety
m m m m m m m m m m m




AACN Domains and Comps.: Domain 5: Quality and Safety
m m m m m m m m m




NLN Competencies: Quality & Safety
m m m m




4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Which
m m m m m m m m m m m m




noninvasive diagnostic test will the nurse implement to know that the client is receiving enough
m m m m m m m m m m m m m m m




moxygen?
A) Chest x-ray m




B) Pulse oximeter m




C) Arterial blood gasses m m




D) Assessment of respiratory m m




rateANSWER: B
m m m




Explanation: A) A chest x-ray is not an intervention a nurse completes.
m m m m m m m m m m m




B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
m m m m m m m m m m m




msaturation, in the blood and provides a pulse reading, which is especially helpful for the client
m m m m m m m m m m m m m m m




with a respiratory illness or disease.
m m m m m m




C) Arterial blood gases are an invasive diagnostic test.
m m m m m m m




D) Assessing a respiratory rate is important for the nurse to implement; however, it is not a
m m m m m m m m m m m m m m m




diagnostic test.
m m




Page Ref: 21m m




Cognitive Level: Applying m m




Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
m m m m m m m




Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencies:
m m m m m m m m m m




Informatics
m




AACN Domains and Comps.: Domain 5: Quality and SafetyNLN
m m m m m m m m m




mCompetencies: Quality & Safety m m m




2