TEST BANK
CONCEPT-BASED CLINICAL NURSING SKILLS
2ND EDITION
CHAPTER NO. 01: FOUNDATIONS OF SAFE CLIENT CARE
MULTIPLE CHOICE QUESTION & ANSWERS
1. To meet a requirement of the 2021 American Association of Colleges of Nursing Essentials,
what topic does nursing faculty focus on throughout the curriculum?
a. Nursing process
b. Safety science
c. Ergonomics
d. Information technology
ANS: B
The 2021 AACN Essentials states that “Provision of safe, quality care necessitates knowing
and using established and emerging principles of safety science in care delivery” (p. 43).
Nursing students are taught to use the nursing process, but this is not confined to patient
safety. Ergonomics is a subset of safety science that studies people and their work
environments. Information technology can be used to improve safety.
DIF: Cognitive Level: Remembering TOP: Integrated Process: Teaching-Learning
2. A nurse meets the assigned clients at the start of a shift. After performing hand hygiene and
introducing one’s self, what does the nurse do next?
a. Begin a head-to-toe assessment.
b. Identify the client using two identifiers.
c. Assess the client for pain.
d. Ensure the call light is within reach.
ANS: B
, A critical task in healthcare for safety, client identification is paramount for preventing errors.
After performing hand hygiene and introducing him- or herself, the nurse identifies the client
using two unique identifiers. The head-to-toe and pain assessments come shortly afterward.
The nurse ensures the client can reach the call light prior to leaving the room.
DIF: Cognitive Level: Understanding TOP: Nursing Process: Assessment
3. A nurse has worked with the same client for 2 days. When entering the room to administer
medications, the nurse performs hand hygiene. What action does the nurse take next?
a. Provide any needed teaching.
b. Ask if the client has any care requests.
c. Assess vital signs and pain.
d. Identify the client using two identifiers.
ANS: D
Every time the client is to receive medication, diagnostic studies, or any other healthcare
intervention, the nurse must identify the client using two unique identifiers, even if the client
is well known to the nurse. Assessments, teaching, and determining client requests would
come afterward.
DIF: Cognitive Level: Applying TOP: Nursing Process: Assessment
4. A nurse’s neighbor states “My father got a nosocomial infection after surgery!” What does the
nurse understand happened to the client?
a. The client received contaminated blood products.
b. The client nearly died from a postoperative infection.
c. The client acquired an infection while in the hospital.
d. The client received poor preoperative skin preparation.
ANS: C
, A nosocomial infection is one acquired in the hospital. It does not designate how the infection
occurred, so the client might have become infected through contaminated blood products or
from poor preoperative skin preparation. It does not mean the client had a life-threatening
infection, only that is occurred in hospital.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching-Learning
5. A nurse is making rounds on clients at risk for infection. Which client does the nurse see
first?
a. A client with an intravenous (IV) line
b. A client who has a central line
c. A client with an indwelling bladder catheter
d. A client with an IV and bladder catheter
ANS: D
One of the biggest risk factors for hospital acquired infections (HAIs) is the presence of
invasive lines. The more lines, the more risk. The client with both an IV and a catheter has the
highest risk. The clients with an IV or a catheter have less risk.
DIF: Cognitive Level: Applying TOP: Nursing Process: Assessment
6. A nursing manager concerned about the infection rate on the unit wants to implement
measures to reduce the transmission of infectious organisms. What action by the manager is
best?
a. Provide a stethoscope dedicated to each client.
b. Ensure gloves are well-stocked in each room.
c. Restrict all plants and fresh foods from rooms.
d. Screen all visitors for contagious illnesses.
ANS: A
, In the chain of infection, one of the most important components is the mode of transmission.
Stethoscopes can serve as a mode of indirect contact transmission unless they are disinfected
appropriately between clients. Providing each client with an individual stethoscope will
reduce this risk. Gloves are important, but they can become contaminated too and serve as a
mode of transmission. Plants and fresh foods are an uncommon source of transmission unless
the client is immunosuppressed. Screening visitors for contagious illness is an unrealistic
long-term action plan.
DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation
7. A nurse is observing a student nurse. What action by the student demonstrates the need for
more education on Standard Precautions?
a. The student performs hand hygiene before all client contacts.
b. The student conscientiously wears gloves when taking vital signs.
c. The student confirms that urine possibly contains infectious microbes.
d. The student wears a gown when cleaning liquid stool off the client.
ANS: B
Standard Precautions operates under the principle that all bodily fluids other than sweat could
potentially contain infectious microbial agents that pose a risk to the healthcare worker.
Contact with skin, if free of those fluids, does not require wearing gloves, so the nurse would
provide more education to the student. Hand hygiene is the first step of Standard Precautions.
The student is being prudent by confirming a possible source of contamination. Nurses
determine which infection prevention practice to use based upon the type of client–nurse
interaction and the possibility of exposure to blood, other body fluids, or pathogens, so
wearing a gown while cleaning liquid stool is appropriate.
DIF: Cognitive Level: Analyzing TOP: Nursing Process: Evaluation
CONCEPT-BASED CLINICAL NURSING SKILLS
2ND EDITION
CHAPTER NO. 01: FOUNDATIONS OF SAFE CLIENT CARE
MULTIPLE CHOICE QUESTION & ANSWERS
1. To meet a requirement of the 2021 American Association of Colleges of Nursing Essentials,
what topic does nursing faculty focus on throughout the curriculum?
a. Nursing process
b. Safety science
c. Ergonomics
d. Information technology
ANS: B
The 2021 AACN Essentials states that “Provision of safe, quality care necessitates knowing
and using established and emerging principles of safety science in care delivery” (p. 43).
Nursing students are taught to use the nursing process, but this is not confined to patient
safety. Ergonomics is a subset of safety science that studies people and their work
environments. Information technology can be used to improve safety.
DIF: Cognitive Level: Remembering TOP: Integrated Process: Teaching-Learning
2. A nurse meets the assigned clients at the start of a shift. After performing hand hygiene and
introducing one’s self, what does the nurse do next?
a. Begin a head-to-toe assessment.
b. Identify the client using two identifiers.
c. Assess the client for pain.
d. Ensure the call light is within reach.
ANS: B
, A critical task in healthcare for safety, client identification is paramount for preventing errors.
After performing hand hygiene and introducing him- or herself, the nurse identifies the client
using two unique identifiers. The head-to-toe and pain assessments come shortly afterward.
The nurse ensures the client can reach the call light prior to leaving the room.
DIF: Cognitive Level: Understanding TOP: Nursing Process: Assessment
3. A nurse has worked with the same client for 2 days. When entering the room to administer
medications, the nurse performs hand hygiene. What action does the nurse take next?
a. Provide any needed teaching.
b. Ask if the client has any care requests.
c. Assess vital signs and pain.
d. Identify the client using two identifiers.
ANS: D
Every time the client is to receive medication, diagnostic studies, or any other healthcare
intervention, the nurse must identify the client using two unique identifiers, even if the client
is well known to the nurse. Assessments, teaching, and determining client requests would
come afterward.
DIF: Cognitive Level: Applying TOP: Nursing Process: Assessment
4. A nurse’s neighbor states “My father got a nosocomial infection after surgery!” What does the
nurse understand happened to the client?
a. The client received contaminated blood products.
b. The client nearly died from a postoperative infection.
c. The client acquired an infection while in the hospital.
d. The client received poor preoperative skin preparation.
ANS: C
, A nosocomial infection is one acquired in the hospital. It does not designate how the infection
occurred, so the client might have become infected through contaminated blood products or
from poor preoperative skin preparation. It does not mean the client had a life-threatening
infection, only that is occurred in hospital.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching-Learning
5. A nurse is making rounds on clients at risk for infection. Which client does the nurse see
first?
a. A client with an intravenous (IV) line
b. A client who has a central line
c. A client with an indwelling bladder catheter
d. A client with an IV and bladder catheter
ANS: D
One of the biggest risk factors for hospital acquired infections (HAIs) is the presence of
invasive lines. The more lines, the more risk. The client with both an IV and a catheter has the
highest risk. The clients with an IV or a catheter have less risk.
DIF: Cognitive Level: Applying TOP: Nursing Process: Assessment
6. A nursing manager concerned about the infection rate on the unit wants to implement
measures to reduce the transmission of infectious organisms. What action by the manager is
best?
a. Provide a stethoscope dedicated to each client.
b. Ensure gloves are well-stocked in each room.
c. Restrict all plants and fresh foods from rooms.
d. Screen all visitors for contagious illnesses.
ANS: A
, In the chain of infection, one of the most important components is the mode of transmission.
Stethoscopes can serve as a mode of indirect contact transmission unless they are disinfected
appropriately between clients. Providing each client with an individual stethoscope will
reduce this risk. Gloves are important, but they can become contaminated too and serve as a
mode of transmission. Plants and fresh foods are an uncommon source of transmission unless
the client is immunosuppressed. Screening visitors for contagious illness is an unrealistic
long-term action plan.
DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation
7. A nurse is observing a student nurse. What action by the student demonstrates the need for
more education on Standard Precautions?
a. The student performs hand hygiene before all client contacts.
b. The student conscientiously wears gloves when taking vital signs.
c. The student confirms that urine possibly contains infectious microbes.
d. The student wears a gown when cleaning liquid stool off the client.
ANS: B
Standard Precautions operates under the principle that all bodily fluids other than sweat could
potentially contain infectious microbial agents that pose a risk to the healthcare worker.
Contact with skin, if free of those fluids, does not require wearing gloves, so the nurse would
provide more education to the student. Hand hygiene is the first step of Standard Precautions.
The student is being prudent by confirming a possible source of contamination. Nurses
determine which infection prevention practice to use based upon the type of client–nurse
interaction and the possibility of exposure to blood, other body fluids, or pathogens, so
wearing a gown while cleaning liquid stool is appropriate.
DIF: Cognitive Level: Analyzing TOP: Nursing Process: Evaluation
