with 100% Correct Answers
A nurse is leading an education session about disposing of biohazardous materials.
Which of the following instructions should the nurse include in the teaching?
Use isopropyl alcohol to clean blood spills
Discard empty blood bags in a bedside trash can
Break used needles before discarding them
Place soiled linen in a single linen bag - AnswerPlace soiled linen in a single linen bag
INCORRECT:
Use isopropyl alcohol to clean blood spills--> use chlorine bleach
A nurse is planning an in-service training session about nutrition. Which of the following
pieces of information should the nurse include?
Fat breaks down into amino acids
Protein serves as an energy source when other sources are inadequate
Glucose breaks down into ammonia
Carbohydrates provide 9cal/g of energy - AnswerProtein serves as an energy source
when other sources are inadequate
INCORRECT:
Fat breaks down into amino acids-->PROTEIN does
Glucose breaks down into ammonia
--> PROTEIN does
Carbohydrates provide 9cal/g of energy
-->
carbs= 4 cal/g of energy
fat= 9 cal/g of energy
A nurse is preparing to administer a cleaning enema to a patient. Which of the following
actions should the nurse plan to take?
,Insert the rectal tuber 15.2 cm (6in)
Wear sterile gloves to insert the tubing
Position the client on his left side
Hold the solution bag 91 cm (36in) above the client's rectum - AnswerPosition the
client on his left side
INCORRECT:
--> insert 7-10cm (3-4in)
Clean gloves
Hold the bag 30cm (12 in) above
A nurse is assessing a client's incision and observes the drainage to be blood-tinged.
Which of the following terms should the nurse use to document this finding?
Sanguineous
Purulent
Serous
Hyperemia - AnswerSanguineous
(contains large amounts of red blood cells indicating that damaged capillaries are
escaping from the plasma)
INCORRECT:
Purulent= thicker than other drainages (pus)
Serous= serum; clear portion of the blood
Hyperemia= not drainage
A nurse is reviewing the use of side rails with an assistive personnel. Which of the
following statements by the AP indicates that further teaching is required?
"I should not leave all 4 side rails up unless there is a prescription for restraints"
"An alert client will be safest if I raise the 2 upper side rails at the head of the bed"
"If a client seems confused, Ill raise 4 side rails so that he doesn't hurt himself"
"If a client is sedated, I should raise all 4 side rails to prevent a fall out of bed" -
Answer"If a client seems confused, Ill raise 4 side rails so that he doesn't hurt himself"
(this would put them at greater risk for injury)
, A home health nurse is visiting an older adult client with severe dementia. The client's
son, who serves as her primary caregiver, reports "exhausted" from working part-time
and caring for his mother at home. Which of the following options should the nurse
suggest to the caregiver?
Rehabilitation
Assisted living facility
Respite care
Adult day care facility - AnswerRespite care
(service for caregivers who need time to rest from multiple responsibilities related to the
care of a family member who needs assistance)
INCORRECT:
Adult day care facility--> for clients who need minimal assistance
A nurse is caring for a client who is receiving intermittent enteral feedings through an
NG tube. The specific gravity of the clients urine is 1.035. Which of the following actions
should the nurse take?
Deliver the formula at a slower rate
Request a lower-fat formula
Provide more water with feedings
Instill a lactose-free formula - AnswerProvide more water with feedings
A nurse is collecting health history data from a client who is deaf and uses ALS to
communicate. The nurse will be working with an ASL interpreter. Which of the following
actions should the nurse take when working with the interpreter?
Face away from the client to avoid distraction
Pace speech to allow time for the interpreter to convey the words
Make eye contact with the interpreter when explaining the procedure
Stand in the background while the interpreter translates the message - AnswerPace
speech to allow time for the interpreter to convey the words
A nurse is preparing to administer eye drops to a client following surgery. Which of the
following actions should the nurse take when instilling the eye drops?
Drop the eye medication into the lower conjunctival sac
Apply gently pressure to the out opening of the eye for 2 min
Hold the eyedropper 0.5 cm (0.2 in) from the cornea