Test Bank for Clinical Nursing Skills: A Concept-Based Approach (4th Edition, Volume III) – Pearson Education | Complete Chapters 1–16 with Verified Answers

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 Pearson
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,Clinical Nursing Skills: A Concept-
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Based Approach, 4e (Pearson) Education Test BankChapter 1: Assessment
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1) A client on the medical/surgical unit complains of sudden chest pains. Which action will then
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urse implement first?
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A) Call the healthcare provider.jw jw jw



B) Administer pain medication. jw jw



C) Reassess a new set of vital signs. jw jw jw jw jw jw



D) Turn client from supine to lateral.jw jw jw jw jw jw



ANSWER: C jw



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.
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C) The nurse needs to implement a new set of vital signs first when there is a change in
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condition.
D) The nurse will need to reassess the client first, before moving the client, to avoid making thec
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hange in client's condition worse.
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Cognitive Level: Applying jw j w



Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Competencies:P
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atient-Centered Care jw



AACN Domains and Comps.: Domain 2: Person-
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Centered CareNLN Competencies: Relationship Centered Care
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2) The nurse is observing the UAP taking the temperature of an unconscious client. Which route
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will the nurse question the UAP using?
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A) Oral
B) Rectal
C) Scanner
D) Tympanic jw



ANSWER: A jw



Explanation: A) The temperature of an unconscious client is never taken by mouth. The rectal,ty
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mpanic, or scanner method is preferred.
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B) The rectal, tympanic, or scanner method is preferred.
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C) The rectal, tympanic, or scanner method is preferred.
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D) The rectal, tympanic, or scanner method is preferred.
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Cognitive Level: Applying jw j w



Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards:
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Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies: SafetyAACN Domai
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ns and Comps.: Domain 5: Quality and Safety
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NLN Competencies: Quality & Safety
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1

, 3) The nurse is changing a 2-month-
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old client's diaper and notes the client feels warm to touch.Which method should the nurse use
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to check the baby's temperature?
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A) Oral
B) Rectal
C) Axillary
D) Tympanic membrane jw jw



ANSWER: C jw



Explanation: A) Oral is used for age 3 or older. j w jw jw jw jw jw jw jw jw



B) The rectal route is the least desirable.
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C) The axillary route may not be as accurate as other routes for detecting fevers in children.
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D) The tympanic membrane may be used for 3 months or older.
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Cognitive Level: Applying jw j w



Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: SafetyA
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ACN Domains and Comps.: Domain 5: Quality and Safety
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NLN Competencies: Quality & Safety
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4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Whichno
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ninvasive diagnostic test will the nurse implement to know that the client is receiving enough oxy
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gen?
A) Chest x-ray jw



B) Pulse oximeter jw



C) Arterial blood gasses jw jw



D) Assessment of respiratory rate jw jw jw jw



ANSWER: B jw



Explanation: A) A chest x-ray is not an intervention a nurse completes.
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B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen sat
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uration, in the blood and provides a pulse reading, which is especially helpful for the clientwit
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h a respiratory illness or disease.
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C) Arterial blood gases are an invasive diagnostic test.
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D) Assessing a respiratory rate is important for the nurse to implement; however, it is not a
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diagnostic test. jw



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Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencies:Inf
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ormatics
AACN Domains and Comps.: Domain 5: Quality and SafetyNLN Co
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mpetencies: Quality & Safety jw jw jw




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