TEST BANK
All Chapters Included
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education
Test BankChapter 1: Assessment
1) A client on the medical/surgical unit complains of sudden chest pains. Which
action will thenurse implement first?
A) Call the healthcare provider.
B) Administer pain medication.
C) Reassess a new set of vital signs.
D) Turn client from supine to
lateral.ANSWER : C
Explanation: A) The nurse will need to reassess the client first, before calling
the healthcareprovider.
B) The nurse will need to reassess the client first, before administering pain medication.
C) The nurse needs to implement a new set of vital signs first when there
is a change incondition.
D) The nurse will need to reassess the client first, before moving the client, to
avoid making thechange in client's condition worse.
Page Ref: 2
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN
Competencies:Patient-Centered Care
AACN Domains and Comps.: Domain 2: Person-
Centered CareNLN Competencies: Relationship
Centered Care
2) The nurse is observing the UAP taking the temperature of an unconscious client.
Which routewill the nurse question the UAP using?
A) Oral
B) Rectal
3
, C) Scanner
D) Tympan
ic
ANSWER :
A
Explanation: A) The temperature of an unconscious client is never taken by
mouth. The rectal,tympanic, or scanner method is preferred.
B) The rectal, tympanic, or scanner method is preferred.
C) The rectal, tympanic, or scanner method is preferred.
D) The rectal, tympanic, or scanner method is
preferred.Page Ref: 24
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection
Control Standards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN
Competencies: SafetyAACN Domains and Comps.: Domain 5: Quality and Safety
NLN Competencies: Quality & Safety
3) The nurse is changing a 2-month-old client's diaper and notes the client feels
warm to touch.Which method should the nurse use to check the baby's
temperature?
A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneANSWER :
C
Explanation: A) Oral is used for age 3 or older.
B) The rectal route is the least desirable.
C) The axillary route may not be as accurate as other routes for detecting fevers in
children.
D) The tympanic membrane may be used for 3 months
4
All Chapters Included
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education
Test BankChapter 1: Assessment
1) A client on the medical/surgical unit complains of sudden chest pains. Which
action will thenurse implement first?
A) Call the healthcare provider.
B) Administer pain medication.
C) Reassess a new set of vital signs.
D) Turn client from supine to
lateral.ANSWER : C
Explanation: A) The nurse will need to reassess the client first, before calling
the healthcareprovider.
B) The nurse will need to reassess the client first, before administering pain medication.
C) The nurse needs to implement a new set of vital signs first when there
is a change incondition.
D) The nurse will need to reassess the client first, before moving the client, to
avoid making thechange in client's condition worse.
Page Ref: 2
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN
Competencies:Patient-Centered Care
AACN Domains and Comps.: Domain 2: Person-
Centered CareNLN Competencies: Relationship
Centered Care
2) The nurse is observing the UAP taking the temperature of an unconscious client.
Which routewill the nurse question the UAP using?
A) Oral
B) Rectal
3
, C) Scanner
D) Tympan
ic
ANSWER :
A
Explanation: A) The temperature of an unconscious client is never taken by
mouth. The rectal,tympanic, or scanner method is preferred.
B) The rectal, tympanic, or scanner method is preferred.
C) The rectal, tympanic, or scanner method is preferred.
D) The rectal, tympanic, or scanner method is
preferred.Page Ref: 24
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection
Control Standards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN
Competencies: SafetyAACN Domains and Comps.: Domain 5: Quality and Safety
NLN Competencies: Quality & Safety
3) The nurse is changing a 2-month-old client's diaper and notes the client feels
warm to touch.Which method should the nurse use to check the baby's
temperature?
A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneANSWER :
C
Explanation: A) Oral is used for age 3 or older.
B) The rectal route is the least desirable.
C) The axillary route may not be as accurate as other routes for detecting fevers in
children.
D) The tympanic membrane may be used for 3 months
4
