Test Bank for Clinical Nursing Skills:
ii ii
K ii
K ii
K ii
A Concept-Based Approach
ii ii
K ii
4th Edition Volume III
ii ii ii
by Pearson Education Chapters 1 - 16
ii
K ii ii
K ii ii
K ii
K
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearsonii
K K K K K K K K K K K
,Clinical Nursing Skills: A Concept- K K K K
Based Approach, 4e (Pearson) Education Test BankiiChapter 1: Assessment
K K K K K K K K
1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
K K K K K K K K K K K K K
K theiinurse implement first? K K
A) Call the healthcare provider.K K K
B) Administer pain medication. K K
C) Reassess a new set of vital signs. K K K K K K
D) Turn client from supine to la K K K K K
teral.iiANSWER: C K
Explanation: A) The nurse will need to reassess the client first, before calling the healthcarep
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rovider.
B) The nurse will need to reassess the client first, before administering pain medication.
K K K K K K K K K K K K
C) The nurse needs to implement a new set of vital signs first when there is a chan
K K K K K K K K K K K K K K K K
ge iniicondition.
K
D) The nurse will need to reassess the client first, before moving the client, to avoid maki
K K K K K K K K K K K K K K K
ng theiichange in client's condition worse.
K K K K K
Page Ref: 2 K K
Cognitive Level: Applying K
Client Need/Sub: K
Physiological Integrity: Reduction of Risk Potential Sta K K K K K K
ndards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Comp
K K K K K K K K K K
etencies:Patient-Centered Care K
AACN Domains and Comps.: Domain 2: Person-
K K K K K K
Centered CareiiNLN Competencies: Relationship Centered Care
K K K K K
2) The nurse is observing the UAP taking the temperature of an unconscious client. Whi
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ch routeiiwill the nurse question the UAP using?
K K K K K K K
A) Oral
B) Rectal
C) Scanner
D) Tympanic
iiANSWER:
A
Explanation: A) The temperature of an unconscious client is never taken by mouth. The rect
K K K K K K K K K K K K K K
al,tympanic, or scanner method is preferred. K K K K K
B) The rectal, tympanic, or scanner method is preferred.
K K K K K K K
C) The rectal, tympanic, or scanner method is preferred.
K K K K K K K
D) The rectal, tympanic, or scanner method is pr
K K K K K K K
eferred.Page Ref: 24 K K
Cognitive Level: Applying K
Client Need/Sub: K
Safe and Effective Care Environment: Safety and Infection Control Stan K K K K K K K K K
dards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies: SafetyA
K K K K K K K K K K K
ACN Domains and Comps.: Domain 5: Quality and Safety
K K K K K K K K
NLN Competencies:
K Quality & Safety K K
1
, 3) The nurse is changing a 2-month-
K K K K K
old client's diaper and notes the client feels warm to touch.Which method should the nurse u
K K K K K K K K K K K K K K K
se to check the baby's temperature?
K K K K K
A) Oral
B) Rectal
C) Axillary
D) Tympanic membra K
neiiANSWER:
C
Explanation: A) Oral is used for age 3 or older. K K K K K K K K
B) The rectal route is the least desirable.
K K K K K K
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
K K K K K K K K K K K K K K K
D) The tympanic membrane may be used for 3 months or old
K K K K K K K K K K
er.Page Ref: 29 K K
Cognitive Level: Applying K
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
K K K K K K
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: Safe
K K K K K K K K K K K
tyAACN Domains and Comps.: Domain 5: Quality and Safety
K K K K K K K K
NLN Competencies: K Quality & Safety K K
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Wh
K K K K K K K K K K K K
ichiinoninvasive diagnostic test will the nurse implement to know that the client is receiving eK K K K K K K K K K K K K K
nough oxygen? K
A) Chest x-ray K
B) Pulse oximeter K
C) Arterial blood gasses K K
D) Assessment of respiratory r K K K
ateiiANSWER: B K
Explanation: A) A chest x-ray is not an intervention a nurse completes. K K K K K K K K K K K K K
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
K K K K K K K K K K K K
saturation, in the blood and provides a pulse reading, which is especially helpful for the cl
K K K K K K K K K K K K K K K
ientiiwith a respiratory illness or disease. K K K K K
C) Arterial blood gases are an invasive diagnostic test. K K K K K K K
D) Assessing a respiratory rate is important for the nurse to implement; however, it is n
K K K K K K K K K K K K K K
ot aiidiagnostic test.
K K
Page Ref: 21 K K
Cognitive Level: Applying K
Client Need/Sub: K
Physiological Integrity: Reduction of Risk Potential Standar K K K K K K
ds: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competen
K K K K K K K K K K
cies:Informatics
AACN Domains and Comps.: Domain 5: Quality and Safety NL
K K K K K K K K K
N Competencies: Quality & Safety
K K K K
2
ii ii
K ii
K ii
K ii
A Concept-Based Approach
ii ii
K ii
4th Edition Volume III
ii ii ii
by Pearson Education Chapters 1 - 16
ii
K ii ii
K ii ii
K ii
K
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Pearsonii
K K K K K K K K K K K
,Clinical Nursing Skills: A Concept- K K K K
Based Approach, 4e (Pearson) Education Test BankiiChapter 1: Assessment
K K K K K K K K
1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
K K K K K K K K K K K K K
K theiinurse implement first? K K
A) Call the healthcare provider.K K K
B) Administer pain medication. K K
C) Reassess a new set of vital signs. K K K K K K
D) Turn client from supine to la K K K K K
teral.iiANSWER: C K
Explanation: A) The nurse will need to reassess the client first, before calling the healthcarep
K K K K K K K K K K K K K K
rovider.
B) The nurse will need to reassess the client first, before administering pain medication.
K K K K K K K K K K K K
C) The nurse needs to implement a new set of vital signs first when there is a chan
K K K K K K K K K K K K K K K K
ge iniicondition.
K
D) The nurse will need to reassess the client first, before moving the client, to avoid maki
K K K K K K K K K K K K K K K
ng theiichange in client's condition worse.
K K K K K
Page Ref: 2 K K
Cognitive Level: Applying K
Client Need/Sub: K
Physiological Integrity: Reduction of Risk Potential Sta K K K K K K
ndards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Comp
K K K K K K K K K K
etencies:Patient-Centered Care K
AACN Domains and Comps.: Domain 2: Person-
K K K K K K
Centered CareiiNLN Competencies: Relationship Centered Care
K K K K K
2) The nurse is observing the UAP taking the temperature of an unconscious client. Whi
K K K K K K K K K K K K K
ch routeiiwill the nurse question the UAP using?
K K K K K K K
A) Oral
B) Rectal
C) Scanner
D) Tympanic
iiANSWER:
A
Explanation: A) The temperature of an unconscious client is never taken by mouth. The rect
K K K K K K K K K K K K K K
al,tympanic, or scanner method is preferred. K K K K K
B) The rectal, tympanic, or scanner method is preferred.
K K K K K K K
C) The rectal, tympanic, or scanner method is preferred.
K K K K K K K
D) The rectal, tympanic, or scanner method is pr
K K K K K K K
eferred.Page Ref: 24 K K
Cognitive Level: Applying K
Client Need/Sub: K
Safe and Effective Care Environment: Safety and Infection Control Stan K K K K K K K K K
dards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies: SafetyA
K K K K K K K K K K K
ACN Domains and Comps.: Domain 5: Quality and Safety
K K K K K K K K
NLN Competencies:
K Quality & Safety K K
1
, 3) The nurse is changing a 2-month-
K K K K K
old client's diaper and notes the client feels warm to touch.Which method should the nurse u
K K K K K K K K K K K K K K K
se to check the baby's temperature?
K K K K K
A) Oral
B) Rectal
C) Axillary
D) Tympanic membra K
neiiANSWER:
C
Explanation: A) Oral is used for age 3 or older. K K K K K K K K
B) The rectal route is the least desirable.
K K K K K K
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
K K K K K K K K K K K K K K K
D) The tympanic membrane may be used for 3 months or old
K K K K K K K K K K
er.Page Ref: 29 K K
Cognitive Level: Applying K
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
K K K K K K
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: Safe
K K K K K K K K K K K
tyAACN Domains and Comps.: Domain 5: Quality and Safety
K K K K K K K K
NLN Competencies: K Quality & Safety K K
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Wh
K K K K K K K K K K K K
ichiinoninvasive diagnostic test will the nurse implement to know that the client is receiving eK K K K K K K K K K K K K K
nough oxygen? K
A) Chest x-ray K
B) Pulse oximeter K
C) Arterial blood gasses K K
D) Assessment of respiratory r K K K
ateiiANSWER: B K
Explanation: A) A chest x-ray is not an intervention a nurse completes. K K K K K K K K K K K K K
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
K K K K K K K K K K K K
saturation, in the blood and provides a pulse reading, which is especially helpful for the cl
K K K K K K K K K K K K K K K
ientiiwith a respiratory illness or disease. K K K K K
C) Arterial blood gases are an invasive diagnostic test. K K K K K K K
D) Assessing a respiratory rate is important for the nurse to implement; however, it is n
K K K K K K K K K K K K K K
ot aiidiagnostic test.
K K
Page Ref: 21 K K
Cognitive Level: Applying K
Client Need/Sub: K
Physiological Integrity: Reduction of Risk Potential Standar K K K K K K
ds: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competen
K K K K K K K K K K
cies:Informatics
AACN Domains and Comps.: Domain 5: Quality and Safety NL
K K K K K K K K K
N Competencies: Quality & Safety
K K K K
2