CORRECT ANSWERS.
Which event would require a nurse to complete and file an incident report?
a. The nurse, preparing an intravenous infusion, notes that the battery of an intravenous infusion pump
is not working.
b. a client has a seizure.
c. When a visitor suddenly becomes weak and dizzy, the nurse checks the visitor's blood pressure and
takes the visitor to the emergency department for treatment.
d. The nurse determines that a client would benefit from the use of a walker to ambulate. answer c
A community health nurse working in a school setting is concerned because parents are not participating
in health activities designed to promote child safety. What is the “most appropriate” initial action for the
nurse to take?
a. Implementing a child safety program
b. Determining the appropriateness of the planned health activity
c. Performing an analysis of health problems related to child safety
d. Planning a focused child safety program - answer b
A nurse is preparing a chemotherapy infusion to be administered to a client with a diagnosis of Hodgkin's
disease. Which precaution should the nurse take while working with this intravenous (IV) infusion?
a. Wearing gloves and a mask
b. Wearing gloves and a gown
c. Wearing gloves, a mask, and a head covering
d. Wearing gloves, a mask, and eye protection - answer d
A home health nurse is visiting a client with tuberculosis (TB). Which action by the client tells the nurse
that the client understands the necessary respiratory precautions to be taken at home?
a. Wearing an oxygen mask at all times
, b. Staying secluded in the bedroom
c. Disposing of contaminated tissues in a container with a leak-proof bag
d. Keeping the house closed up to minimize the spread of disease - answer c
Which of these interventions does a nurse manager, reviewing infection control interventions with the
nursing staff, tell the staff will reduce reservoirs of infection? “Select all that apply”
a. Changing dressings that become wet or soiled
b. Placing capped needles and syringes in puncture-resistant containers
c. Using soap and water to remove drainage, dried secretions, or excess perspiration from a client's skin
d. Emptying urinary drainage systems (Foley catheter drainage) on each shift unless prescribed otherwise
by a physician
e. Placing tissues and soiled dressings in paper bags
f. Keeping bedside table surfaces clean and dry - answer a, c, d, and f
A nurse provides instruction to a new nursing assistant regarding the application of a restraint to a client.
The nurse watches as the nursing assistant applies the restraint. What observation tells the nurse that
the nursing assistant is using correct procedure?
a. The assistant secures the restraint in such a way that it is impossible to slip a finger between the
restraint & the client's skin.
b. The assistant applies a tie knot in the restraint strap.
c. The assistant attaches the restraint straps securely to the side rails.
d. The assistant applies the restraint so that the strap does not tighten when force is applied against it. -
answer d
A nurse receives a telephone call from the admissions office & is told that a client scheduled for an
internal radiation implant will be admitted to the nursing unit. Which of the following precautions does
the nurse include in the client's plan of care?
a. Wearing gloves when emptying the client's bedpan
b. Allowing the client to ambulate in the hall only once a day
c. Placing used linen in double bags and sending a bag to the laundry room every evening
d. Placing the client in a semiprivate room at the end of a hallway - answer a
A home care nurse is instructing a client in the use of ice packs to treat an eye injury. What does the
nurse instruct the client to do?
a. Wrap a plastic bag filled with ice in a pillowcase and place it on the eye
b. Avoid the use of commercially prepared ice bags