Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition Volume III by Pearson Education Chapters 1 - 16  

Test Bank for Clinical Nursing Skills:
A Concept-Based Approach
4th Edition Volume III
by Pearson Education Chapters 1 - 16

,Testl2Bankl2forl2Clinicall2Nursingl2Skills:l2Al2Concept-Basedl2Approachl24thl2Editionl2Pearson2l

,Clinicall2Nursingl2Skills:l2Al2Concept-
Basedl2Approach,l24el2(Pearson)l2Educationl2Testl2Bank2lChapterl21:l2Assessment

1) Al2clientl2onl2thel2medical/surgicall2unitl2complainsl2ofl2suddenl2chestl2pains.l2Whichl2actionl2wi
lll2thel2nursel2implementl2first?
A) Calll2thel2healthcarel2provider.
B) Administerl2painl2medication.
C) Reassessl2al2newl2setl2ofl2vitall2signs.
D) Turnl2clientl2froml2supinel2tol2later
al.l2ANSWER:l2 C
Explanation:l2A)l2Thel2nursel2willl2needl2tol2reassessl2thel2clientl2first,l2beforel2callingl2thel2healt
hcarel2provider.
B) Thel2nursel2willl2needl2tol2reassessl2thel2clientl2first,l2beforel2administeringl2painl2medication.
C) Thel2nursel2needsl2tol2implementl2al2newl2setl2ofl2vitall2signsl2firstl2whenl2therel2isl2al2ch
angel2inl2condition.
D) Thel2nursel2willl2needl2tol2reassessl2thel2clientl2first,l2beforel2movingl2thel2client,l2tol2avoidl2maki
ngl2thel2changel2inl2client'sl2conditionl2worse.
Pagel2Ref:l22
Cognitivel2Level:l 2 Applying
Clientl2Need/Sub:l 2 Physiologicall2Integrity:l2Reductionl2ofl2Riskl2Potential
Standards:l2Nursingl2Process:l2Assessmentl2|l2Learningl2Outcome:l21.1l2|l2QSENl2Competenci
es:l2Patient-Centeredl2Care
AACNl2Domainsl2andl2Comps.:l2Domainl22:l2Person-
Centeredl2Carel2NLNl2Competencies:l2 Relationshipl2Centeredl2Care

2) Thel2nursel2isl2observingl2thel2UAPl2takingl2thel2temperaturel2ofl2anl2unconsciousl2client.l2Whichl
2routel2willl2thel2nursel2questionl2thel2UAPl2using?

A) Oral
B) Rectal
C) Scanner
D) Tympanicl2
ANSWER:l2 A
Explanation:l2A)l2Thel2temperaturel2ofl2anl2unconsciousl2clientl2isl2neverl2takenl2byl2mouth.l2Thel2re
ctal,l2tympanic,l2orl2scannerl2methodl2isl2preferred.
B) Thel2rectal,l2tympanic,l2orl2scannerl2methodl2isl2preferred.
C) Thel2rectal,l2tympanic,l2orl2scannerl2methodl2isl2preferred.
D) Thel2rectal,l2tympanic,l2orl2scannerl2methodl2isl2prefer
red.l2Pagel2Ref:l224
Cognitivel2Level:l 2 Applying
Clientl2Need/Sub:l2l2l2 Safel2andl2Effectivel2Carel2Environment:l2Safetyl2andl2Infectionl2Controll2Stan
dards:l2 Nursingl2Process:l2Evaluationl2|l2Learningl2Outcome:l21.1l2|l2QSENl2Competencies:l2Safetyl2A
ACNl2Domainsl2andl2Comps.:l2 Domainl25:l2Qualityl2andl2Safety
NLNl2Competencies:l 2 Qualityl2&l2Safety



1

, 3) Thel2nursel2isl2changingl2al22-month-
oldl2client'sl2diaperl2andl2notesl2thel2clientl2feelsl2warml2tol2touch.l2Whichl2methodl2shouldl2thel2nu
rsel2usel2tol2checkl2thel2baby'sl2temperature?
A) Oral
B) Rectal
C) Axillary
D) Tympanicl2membran
el2ANSWER:l2 C
Explanation:l 2 A)l2Orall2isl2usedl2forl2agel23l2orl2older.
B) Thel2rectall2routel2isl2thel2leastl2desirable.
C) Thel2axillaryl2routel2mayl2notl2bel2asl2accuratel2asl2otherl2routesl2forl2detectingl2feversl2inl2children.
D) Thel2tympanicl2membranel2mayl2bel2usedl2forl23l2monthsl2orl2o
lder.l2Pagel2Ref:l229
Cognitivel2Level:l 2 Applying
Clientl2Need/Sub:l 2 Physiologicall2Integrity:l2Reductionl2ofl2Riskl2Potential
Standards:l2 Nursingl2Process:l2Evaluatingl2|l2Learningl2Outcome:l21.2l2|l2QSENl2Competencies:l2Saf
etyl2AACNl2Domainsl2andl2Comps.:l2 Domainl25:l2Qualityl2andl2Safety
NLNl2Competencies:l 2 Qualityl2&l2Safety

4) Al2clientl2comesl2inl2withl2exacerbationl2ofl2chronicl2obstructivel2pulmonaryl2diseasel2(COPD).l2W
hichl2noninvasivel2diagnosticl2testl2willl2thel2nursel2implementl2tol2knowl2thatl2thel2clientl2isl2receivin
gl2enoughl2oxygen?
A) Chestl2x-ray
B) Pulsel2oximeter
C) Arteriall2bloodl2gasses
D) Assessmentl2ofl2respiratoryl2ra
tel2ANSWER:l 2 B
Explanation:l 2 A)l2Al2chestl2x-rayl2isl2notl2anl2interventionl2al2nursel2completes.
B) Al2pulsel2oximeterl2providesl2al2noninvasivel2methodl2ofl2measuringl2oxygenation,l2orl2oxyge
nl2saturation,l2inl2thel2bloodl2andl2providesl2al2pulsel2reading,l2whichl2isl2especiallyl2helpfull2forl2t
hel2clientl2withl2al2respiratoryl2illnessl2orl2disease.
C) Arteriall2bloodl2gasesl2arel2anl2invasivel2diagnosticl2test.
D) Assessingl2al2respiratoryl2ratel2isl2importantl2forl2thel2nursel2tol2implement;l2however,l2itl2i
sl2notl2al2diagnosticl2test.
Pagel2Ref:l221
Cognitivel2Level:l 2 Applying
Clientl2Need/Sub:l 2 Physiologicall2Integrity:l2Reductionl2ofl2Riskl2Potential
Standards:l2Nursingl2Process:l2Implementationl2|l2Learningl2Outcome:l21.3l2|l2QSENl2Competencie
s:l2Informatics
AACNl2Domainsl2andl2Comps.:l2 Domainl25:l2Qualityl2andl2Safetyl2NL
Nl2Competencies:l2 Qualityl2&l2Safety




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