TESTBANK i
CLINICAL NURSING SKILLS:
i i i i
A Concept-Based Approach
i i i i
4th Edition, Pearson Education
ii
ii ii
TESTBANK i
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
ii ii ii ii ii ii ii ii ii ii ii
Education
ii
Table of Contents
ii ii
Chapter 1. Assessment
ii ii
Chapter 2. Caring Interventions
ii ii ii
Chapter 3. Comfort
ii ii
Chapter 4. Elimination
ii ii
Chapter 5. Fluids and Electrolytes
ii ii ii ii
Chapter 6. Infection
ii ii
Chapter 7. Intracranial Regulation
ii ii ii
Chapter 8. Metabolism
ii ii
Chapter 9. Mobility
ii ii
Chapter 10. Nutrition
ii ii
Chapter 11. Oxygenation
ii ii
Chapter 12. Perfusion
ii ii
Chapter 13. Perioperative Care
ii ii ii
Chapter 14. Reproduction
ii ii
Chapter 15. Safety
ii ii
Chapter 16. Tissue Integrity
ii ii ii
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test Bank
ii ii ii ii ii ii ii ii ii ii
Chapter 1: Assessment
ii ii ii
1) A client on the medical/surgical unit complains of sudden chest pains. Which action will the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
nurse implement first?
ii ii ii
A) Call the healthcare provider. ii ii ii
B) Administer pain medication. ii ii
C) Reassess a new set of vital signs. ii ii ii ii ii ii
D) Turn client from supine to lateral. ii ii ii ii ii
Answer: C
ii i i
Explanation: A) The nurse will need to reassess the client first, before calling the healthcare
i i ii ii ii ii ii ii ii ii ii ii ii ii ii
provider.
ii
B) The nurse will need to reassess the client first, before administering pain medication.
ii ii ii ii ii ii ii ii ii ii ii ii
C) The nurse needs to implement a new set of vital signs first when there is a change in
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
condition.
ii
D) The nurse will need to reassess the client first, before moving the client, to avoid making the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
change in client's condition worse.
ii ii ii ii ii
Page Ref: 2
ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ii i i i i ii ii ii ii ii
Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN
i i ii ii ii ii ii ii ii ii
Competencies: Patient-Centered Care
ii ii ii
AACN Domains and Comps.: Domain 2: Person-Centered Care
ii ii ii i i ii ii ii
NLN Competencies: Relationship Centered Care
ii ii i i ii ii
2) The nurse is observing the UAP taking the temperature of an unconscious client. Which route
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
will the nurse question the UAP using?
ii ii ii ii ii ii ii
A) Oral
B) Rectal
C) Scanner
D) Tympanic
Answer:
ii
A
i i
Explanation: A) The temperature of an unconscious client is never taken by mouth. The rectal,
i i ii ii ii ii ii ii ii ii ii ii ii ii ii
tympanic, or scanner method is preferred.
ii ii ii ii ii ii
B) The rectal, tympanic, or scanner method is preferred.
ii ii ii ii ii ii ii
C) The rectal, tympanic, or scanner method is preferred.
ii ii ii ii ii ii ii
D) The rectal, tympanic, or scanner method is preferred.
ii ii ii ii ii ii ii
Page Ref: 24
ii ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
ii i i ii ii ii ii ii ii ii ii
Standards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies:
ii i i ii ii ii ii ii ii ii ii ii
Safety AACN Domains and Comps.: Domain 5: Quality and Safety
ii ii ii ii ii i i ii ii ii ii
NLN Competencies: Quality & Safety
ii i i i i ii ii
1
, 3) The nurse is changing a 2-month-old client's diaper and notes the client feels warm to touch.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Which method should the nurse use to check the baby's temperature?
ii ii ii ii ii ii ii ii ii ii ii
A) Oral
B) Rectal
C) Axillary
D) Tympanic membrane i
Answer: C
ii i i
Explanation: A) Oral is used for age 3 or older. i i i i ii ii ii ii ii ii ii ii
B) The rectal route is the least desirable.
ii ii ii ii ii ii
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
D) The tympanic membrane may be used for 3 months or older.
ii ii ii ii ii ii ii ii ii ii
Page Ref: 29
ii ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ii i i i i ii ii ii ii ii
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies:
i i ii ii ii ii ii ii ii ii ii
Safety AACN Domains and Comps.: Domain 5: Quality and Safety
ii ii ii ii ii i i ii ii ii ii
NLN Competencies: Quality & Safety
ii i i i i ii ii
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Which
ii ii ii ii ii ii ii ii ii ii ii ii
noninvasive diagnostic test will the nurse implement to know that the client is receiving enough
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
oxygen?
ii
A) Chest x-ray ii
B) Pulse oximeter ii
C) Arterial blood gasses ii ii
D) Assessment of respiratory rate ii ii i
Answer: B
ii i i
Explanation: A) A chest x-ray is not an intervention a nurse completes.
i i i i ii ii ii ii ii ii ii ii ii ii
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
ii ii ii ii ii ii ii ii ii ii ii
saturation, in the blood and provides a pulse reading, which is especially helpful for the client
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
with a respiratory illness or disease.
ii ii ii ii ii ii
C) Arterial blood gases are an invasive diagnostic test.
ii ii ii ii ii ii ii
D) Assessing a respiratory rate is important for the nurse to implement; however, it is not a
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
diagnostic test.
ii ii
Page Ref: 21
ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ii i i i i ii ii ii ii ii
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencies:
i i ii ii ii ii ii ii ii ii ii
Informatics
ii
AACN Domains and Comps.: Domain 5: Quality and Safety
ii ii ii i i ii ii ii ii
NLN Competencies: Quality & Safety
ii ii i i ii ii
2
CLINICAL NURSING SKILLS:
i i i i
A Concept-Based Approach
i i i i
4th Edition, Pearson Education
ii
ii ii
TESTBANK i
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearson
ii ii ii ii ii ii ii ii ii ii ii
Education
ii
Table of Contents
ii ii
Chapter 1. Assessment
ii ii
Chapter 2. Caring Interventions
ii ii ii
Chapter 3. Comfort
ii ii
Chapter 4. Elimination
ii ii
Chapter 5. Fluids and Electrolytes
ii ii ii ii
Chapter 6. Infection
ii ii
Chapter 7. Intracranial Regulation
ii ii ii
Chapter 8. Metabolism
ii ii
Chapter 9. Mobility
ii ii
Chapter 10. Nutrition
ii ii
Chapter 11. Oxygenation
ii ii
Chapter 12. Perfusion
ii ii
Chapter 13. Perioperative Care
ii ii ii
Chapter 14. Reproduction
ii ii
Chapter 15. Safety
ii ii
Chapter 16. Tissue Integrity
ii ii ii
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test Bank
ii ii ii ii ii ii ii ii ii ii
Chapter 1: Assessment
ii ii ii
1) A client on the medical/surgical unit complains of sudden chest pains. Which action will the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
nurse implement first?
ii ii ii
A) Call the healthcare provider. ii ii ii
B) Administer pain medication. ii ii
C) Reassess a new set of vital signs. ii ii ii ii ii ii
D) Turn client from supine to lateral. ii ii ii ii ii
Answer: C
ii i i
Explanation: A) The nurse will need to reassess the client first, before calling the healthcare
i i ii ii ii ii ii ii ii ii ii ii ii ii ii
provider.
ii
B) The nurse will need to reassess the client first, before administering pain medication.
ii ii ii ii ii ii ii ii ii ii ii ii
C) The nurse needs to implement a new set of vital signs first when there is a change in
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
condition.
ii
D) The nurse will need to reassess the client first, before moving the client, to avoid making the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
change in client's condition worse.
ii ii ii ii ii
Page Ref: 2
ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ii i i i i ii ii ii ii ii
Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN
i i ii ii ii ii ii ii ii ii
Competencies: Patient-Centered Care
ii ii ii
AACN Domains and Comps.: Domain 2: Person-Centered Care
ii ii ii i i ii ii ii
NLN Competencies: Relationship Centered Care
ii ii i i ii ii
2) The nurse is observing the UAP taking the temperature of an unconscious client. Which route
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
will the nurse question the UAP using?
ii ii ii ii ii ii ii
A) Oral
B) Rectal
C) Scanner
D) Tympanic
Answer:
ii
A
i i
Explanation: A) The temperature of an unconscious client is never taken by mouth. The rectal,
i i ii ii ii ii ii ii ii ii ii ii ii ii ii
tympanic, or scanner method is preferred.
ii ii ii ii ii ii
B) The rectal, tympanic, or scanner method is preferred.
ii ii ii ii ii ii ii
C) The rectal, tympanic, or scanner method is preferred.
ii ii ii ii ii ii ii
D) The rectal, tympanic, or scanner method is preferred.
ii ii ii ii ii ii ii
Page Ref: 24
ii ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
ii i i ii ii ii ii ii ii ii ii
Standards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies:
ii i i ii ii ii ii ii ii ii ii ii
Safety AACN Domains and Comps.: Domain 5: Quality and Safety
ii ii ii ii ii i i ii ii ii ii
NLN Competencies: Quality & Safety
ii i i i i ii ii
1
, 3) The nurse is changing a 2-month-old client's diaper and notes the client feels warm to touch.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Which method should the nurse use to check the baby's temperature?
ii ii ii ii ii ii ii ii ii ii ii
A) Oral
B) Rectal
C) Axillary
D) Tympanic membrane i
Answer: C
ii i i
Explanation: A) Oral is used for age 3 or older. i i i i ii ii ii ii ii ii ii ii
B) The rectal route is the least desirable.
ii ii ii ii ii ii
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
D) The tympanic membrane may be used for 3 months or older.
ii ii ii ii ii ii ii ii ii ii
Page Ref: 29
ii ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ii i i i i ii ii ii ii ii
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies:
i i ii ii ii ii ii ii ii ii ii
Safety AACN Domains and Comps.: Domain 5: Quality and Safety
ii ii ii ii ii i i ii ii ii ii
NLN Competencies: Quality & Safety
ii i i i i ii ii
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Which
ii ii ii ii ii ii ii ii ii ii ii ii
noninvasive diagnostic test will the nurse implement to know that the client is receiving enough
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
oxygen?
ii
A) Chest x-ray ii
B) Pulse oximeter ii
C) Arterial blood gasses ii ii
D) Assessment of respiratory rate ii ii i
Answer: B
ii i i
Explanation: A) A chest x-ray is not an intervention a nurse completes.
i i i i ii ii ii ii ii ii ii ii ii ii
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
ii ii ii ii ii ii ii ii ii ii ii
saturation, in the blood and provides a pulse reading, which is especially helpful for the client
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
with a respiratory illness or disease.
ii ii ii ii ii ii
C) Arterial blood gases are an invasive diagnostic test.
ii ii ii ii ii ii ii
D) Assessing a respiratory rate is important for the nurse to implement; however, it is not a
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
diagnostic test.
ii ii
Page Ref: 21
ii ii
Cognitive Level: Applying ii i i i i
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ii i i i i ii ii ii ii ii
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencies:
i i ii ii ii ii ii ii ii ii ii
Informatics
ii
AACN Domains and Comps.: Domain 5: Quality and Safety
ii ii ii i i ii ii ii ii
NLN Competencies: Quality & Safety
ii ii i i ii ii
2
