A client with acute hemorrhagic anemia is to receive four units of packed red blood
cells (RBCs) as rapidly as possible. Which intervention is most important for the
nurse to implement?
Obtain the pre-transfusion hemoglobin level.
Prime the tubing and prepare a blood pump set-up.
Monitor vital signs every 15 minutes for the first hour.
Ensure the accuracy of the blood type match.
Give this one a try later!
, Ensure the accuracy of the blood type match.
At the time of the first dressing change, the client refuses to look at her
mastectomy incision. The nurse tells the client that the incision is healing well, but
the client refuses to talk about it. Which is the best response to this client's silence?
"It is normal to feel angry and depressed, but the sooner you deal with this surgery,
the better you will feel."
"Looking at your incision can be frightening, but facing this fear is a necessary part of
your recovery."
"It is OK if you don't want to talk about your surgery. I will be available when you are
ready."
"I will ask a woman who has had a mastectomy to come by and share her experiences
with you."
Give this one a try later!
"It is OK if you don't want to talk about your surgery. I will be available
when you are ready."
On admission, a client presents a signed living will that includes a Do Not
Resuscitate (DNR) prescription. When the client stops breathing, the nurse
performs cardiopulmonary resuscitation (CPR) and successfully revives the client.
What legal issues could be brought against the nurse?
Assault.
Battery.
Malpractice.
False imprisonment.
Give this one a try later!
, Battery.
During the admission interview, which technique is most efficient for the nurse to
use when obtaining information about signs and symptoms of a client's primary
health problem?
Restatement of responses.
Open-ended questions.
Closed-ended questions.
Problem-seeking responses.
Give this one a try later!
Closed-ended questions.
A postoperative client will need to perform daily dressing changes after discharge.
Which outcome response best demonstrates the client's readiness to manage
wound care after discharge?
Asking relevant questions regarding the dressing change.
Stating theability to complete the wound care regimen.
Demonstrating the wound care procedure correctly.
Showing all the necessary supplies for wound care.
Give this one a try later!
Demonstrating the wound care procedure correctly.
, The unlicensed assistive personnel (UAP) working on a chronic neuro unit asks the
nurse to help determine the safest way to transfer an older client with left-sided
weakness from the bed to the chair. Which method describes the correct transfer
procedure for this client?
Place the chair at a right angle to the bed on the client's left side before moving.
Assist the client to a standing position, then place the right hand on the armrest.
Have the client place the left foot next to the chair and pivot to the left before sitting.
Move the chair parallel to the right side of the bed, and stand the client on the right
foot.
Give this one a try later!
Move the chair parallel to the right side of the bed, and stand the client on
the right foot.
At the beginning of the shift, the nurse assesses a client who is admitted from the
post-anesthesia care unit (PACU). When should the nurse document the client's
findings?
At the beginning, middle, and end of the shift.
After client priorities are identified for the development of the nursing care plan.
At the end of the shift so full attention can be given to the client's needs.
Immediately after the assessments are completed.
Give this one a try later!
Immediately after the assessments are completed.
The nurse plans to obtain health assessment information from a primary source.
Which option is a primary source for the completion of the health assessment?
cells (RBCs) as rapidly as possible. Which intervention is most important for the
nurse to implement?
Obtain the pre-transfusion hemoglobin level.
Prime the tubing and prepare a blood pump set-up.
Monitor vital signs every 15 minutes for the first hour.
Ensure the accuracy of the blood type match.
Give this one a try later!
, Ensure the accuracy of the blood type match.
At the time of the first dressing change, the client refuses to look at her
mastectomy incision. The nurse tells the client that the incision is healing well, but
the client refuses to talk about it. Which is the best response to this client's silence?
"It is normal to feel angry and depressed, but the sooner you deal with this surgery,
the better you will feel."
"Looking at your incision can be frightening, but facing this fear is a necessary part of
your recovery."
"It is OK if you don't want to talk about your surgery. I will be available when you are
ready."
"I will ask a woman who has had a mastectomy to come by and share her experiences
with you."
Give this one a try later!
"It is OK if you don't want to talk about your surgery. I will be available
when you are ready."
On admission, a client presents a signed living will that includes a Do Not
Resuscitate (DNR) prescription. When the client stops breathing, the nurse
performs cardiopulmonary resuscitation (CPR) and successfully revives the client.
What legal issues could be brought against the nurse?
Assault.
Battery.
Malpractice.
False imprisonment.
Give this one a try later!
, Battery.
During the admission interview, which technique is most efficient for the nurse to
use when obtaining information about signs and symptoms of a client's primary
health problem?
Restatement of responses.
Open-ended questions.
Closed-ended questions.
Problem-seeking responses.
Give this one a try later!
Closed-ended questions.
A postoperative client will need to perform daily dressing changes after discharge.
Which outcome response best demonstrates the client's readiness to manage
wound care after discharge?
Asking relevant questions regarding the dressing change.
Stating theability to complete the wound care regimen.
Demonstrating the wound care procedure correctly.
Showing all the necessary supplies for wound care.
Give this one a try later!
Demonstrating the wound care procedure correctly.
, The unlicensed assistive personnel (UAP) working on a chronic neuro unit asks the
nurse to help determine the safest way to transfer an older client with left-sided
weakness from the bed to the chair. Which method describes the correct transfer
procedure for this client?
Place the chair at a right angle to the bed on the client's left side before moving.
Assist the client to a standing position, then place the right hand on the armrest.
Have the client place the left foot next to the chair and pivot to the left before sitting.
Move the chair parallel to the right side of the bed, and stand the client on the right
foot.
Give this one a try later!
Move the chair parallel to the right side of the bed, and stand the client on
the right foot.
At the beginning of the shift, the nurse assesses a client who is admitted from the
post-anesthesia care unit (PACU). When should the nurse document the client's
findings?
At the beginning, middle, and end of the shift.
After client priorities are identified for the development of the nursing care plan.
At the end of the shift so full attention can be given to the client's needs.
Immediately after the assessments are completed.
Give this one a try later!
Immediately after the assessments are completed.
The nurse plans to obtain health assessment information from a primary source.
Which option is a primary source for the completion of the health assessment?
