12TH EDITION
• AUTHOR(S)PATRICIA A. POTTER;
ANNE G. PERRY; PATRICIA A.
STOCKERT; AMY HALL; WENDY
R. OSTENDORF
TEST BANK
,Question 1
A nurse enters a client's room and finds the client sitting on the
edge of the bed stating, "I feel dizzy." What is the nurse's
priority action?
A. Assist the client back into bed safely.
B. Obtain the client's blood pressure after 30 minutes.
C. Encourage the client to walk to improve circulation.
D. Ask the client whether dizziness has occurred before.
Correct Answer: A
Rationale:
The priority is client safety. A client experiencing dizziness is at
immediate risk for falling. The nurse should first assist the client
back into bed or a safe seated position before performing
additional assessments. After ensuring safety, the nurse should
assess vital signs, investigate the cause, and notify the provider
if indicated.
Question 2
A nurse is preparing to administer oral medications. Which
action best demonstrates safe medication administration?
A. Confirm the client's identity using two approved identifiers
before administering the medication.
B. Ask the roommate to verify the client's name.
,C. Administer medications according to room number.
D. Confirm the medication after administration is complete.
Correct Answer: A
Rationale:
Using at least two approved client identifiers before medication
administration is a fundamental patient safety practice that
helps prevent medication errors. Room numbers and
confirmation from another client are not acceptable identifiers,
and verification must occur before—not after—administration.
Question 3
A hospitalized client tells the nurse, "I'm worried about my
upcoming surgery." Which response by the nurse is most
therapeutic?
A. "Many people feel anxious before surgery. Tell me what
concerns you the most."
B. "There's nothing to worry about because your surgeon is
excellent."
C. "You should try not to think about it."
D. "Everything will be fine."
Correct Answer: A
Rationale:
Acknowledging the client's feelings and encouraging further
discussion demonstrates therapeutic communication. False
, reassurance, minimizing concerns, or discouraging discussion
may interfere with trust and emotional support.
Question 4
A nurse observes unlicensed assistive personnel (UAP)
transferring a client from the bed to a chair without locking the
wheelchair brakes. What is the nurse's best action?
A. Stop the transfer immediately and ensure the brakes are
locked.
B. Wait until the transfer is complete before providing feedback.
C. Report the UAP to the nurse manager immediately.
D. Ignore the behavior because the client was not injured.
Correct Answer: A
Rationale:
The nurse's priority is preventing client harm. Immediately
correcting the unsafe action protects the client from injury.
Feedback and education should follow once the client's safety
has been ensured.
Question 5
A nurse is caring for a client who has a newly inserted urinary
catheter. Which intervention is most effective in reducing the
risk of catheter-associated urinary tract infection?
A. Keep the drainage bag below the level of the bladder.
B. Disconnect the drainage tubing daily for cleaning.