Nurs 311 Questions And Answers With Verified Tests

A dependent, confused patient is being given a bedpan. How can the nurse best ensure the patient's safety? - Raise the side rails on the bed before leaving the room. A male patient on bed rest is permitted to stand to use the urinal. Which action would the nurse take to ensure his safety before helping him to a standing position? - Determine his risk for orthostatic hypotension A nurse is caring for a patient who has just had major abdominal surgery to resect a portion of his colon. What is the most reliable sign that the patient has significant postoperative pain? - The patient rates his pain a 7 on a scale of 0 to 10. A nursing assistive personnel (NAP) is preparing to weigh a resident in a skilled nursing facility. The patient is usually weighed in street clothing and socks, with his shoes off. The patient is currently wearing street clothing with shoes and socks. What will the NAP do to ensure that the patient's weight is correctly measured? - Take off the patient's shoes, but leave his socks on. A patient has consumed three 100-mL cups of ice chips and 4 ounces of ginger ale. What will nursing assistive personnel (NAP) document as this patient's oral intake? - 270 mL. Three 100-mL cups of ice chips would be 150 mL of fluid, and 4 ounces of ginger ale would be 120 mL of fluid. The intake would be documented as 270 mL A patient is admitted to your unit for dehydration. Which of the following assessments would the nurse identify as a possible sign of fluid imbalance? - Reduced turgor of the skin. skin remains suspended, peaked, or "tented" for a few seconds, and then slowly returns to place A patient is prescribed continuous oxygen saturation monitoring. The nurse would confirm that the alarms have been set to which limits? - Low of 85% and high of 100% A patient is told the home care nurse will be measuring and recording intake and output (I&O) at home. What will the home care nurse do first? - Explain to the patient why I&O has been ordered.A patient who weighs 200 lbs. needs to be moved up in bed with the aid of a friction-reducing device. The nurse will prepare for this move by assembling how many caregivers? - At least three A patient will be moved up in bed with the use of a friction-reducing device. How will the nurse place this device under the patient? - Roll the patient from side to side, and place the device under the drawsheet. A patient with a herniated disk is scheduled for surgery to fuse two vertebrae in her cervical spine. Which activity is most likely to be a palliative factor for this patient? - Performing neck, back, and shoulder exercises prescribed by a physical therapist A patient with a nasogastric tube, an intravenous infusion line, and an indwelling urinary catheter needs to be placed on the bedpan. Which action would the nurse take first to ensure the patient's safety? - Obtain help to place the patient on the bedpan. A patient with type 2 diabetes mellitus tells the nurse that he has been testing his own blood glucose level six times per day for the past 3 years. What is the most appropriate action for the nurse to take? - Observe the patient's testing technique for accuracy. It is useful to evaluate the patient's technique to ensure that he receives accurate results. After assisting with a bedpan, the nurse notes that the patient's stool is streaked with bright-red blood. What would the nurse do first? - Ask if the patient has a history of hemorrhoids. Asking whether the patient has a history of hemorrhoids is the most appropriate initial response, followed by documentation of the observation and notification of the patient's health care provider. After bacteria are cultured from a midstream urine specimen, what is accomplished by sensitivity testing? - Determines which antibiotic agent is most effective in killing the bacteria After determining the proper size stocking and assessing the patient's circulatory status, a nurse delegates the application of elastic stockings to nursing assistive personnel (NAP). The nurse discovers that the NAP has been using moisturizer on the patient's legs before applying the stockings. What is the best action by the nurse? - Instruct NAP to use a small amount of cornstarch or powder.