TEST BANK For Clinical Nursing Skills: A Concept-Based Approach, 4th Edition Volume III by Pearson Education, Verified Chapters 1 - 16, Complete Newest Version

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

,Test70Bank70for70Clinical70Nursing70Skills:70A70Concept-
Based70Approach704th70Edition70Pearson70

,Clinical70Nursing70Skills:70A70Concept-
Based70Approach,704e70(Pearson)70Education70Test70Bank70Chapter701:70Assessment

1) A70client70on70the70medical/surgical70unit70complains70of70sudden70chest70pains.70Which70a
ction70will70the70nurse70implement70first?
A) Call70the70healthcare70provider.
B) Administer70pain70medication.
C) Reassess70a70new70set70of70vital70signs.
D) Turn70client70from70supine70to70la
teral.70ANSWER:70 C
Explanation:70A)70The70nurse70will70need70to70reassess70the70client70first,70before70calling70t
he70healthcare70provider.
B) The70nurse70will70need70to70reassess70the70client70first,70before70administering70pain70medication.
C) The70nurse70needs70to70implement70a70new70set70of70vital70signs70first70when70there7
0is70a70change70in70condition.
D) The70nurse70will70need70to70reassess70the70client70first,70before70moving70the70client,70to70av
oid70making70the70change70in70client's70condition70worse.
Page70Ref:702
Cognitive70Level:7 0 Applying
Client70Need/Sub:7 0 Physiological70Integrity:70Reduction70of70Risk70Potential
Standards:70Nursing70Process:70Assessment70|70Learning70Outcome:701.170|70QSEN70Com
petencies:70Patient-Centered70Care
AACN70Domains70and70Comps.:70Domain702:70Person-
Centered70Care70NLN70Competencies:70 Relationship70Centered70
Care

2) The70nurse70is70observing70the70UAP70taking70the70temperature70of70an70unconscious70client.
70Which70route70will70the70nurse70question70the70UAP70using?
A) Oral
B) Rectal
C) Scanner
D) Tympanic
70ANSWER:7
0A
Explanation:70A)70The70temperature70of70an70unconscious70client70is70never70taken70by70mouth.
70The70rectal,70tympanic,70or70scanner70method70is70preferred.
B) The70rectal,70tympanic,70or70scanner70method70is70preferred.
C) The70rectal,70tympanic,70or70scanner70method70is70preferred.
D) The70rectal,70tympanic,70or70scanner70method70is70pr
eferred.70Page70Ref:7024
Cognitive70Level:7 0 Applying
Client70Need/Sub:707070 Safe70and70Effective70Care70Environment:70Safety70and70Infection70Cont
rol70Standards:70 Nursing70Process:70Evaluation70|70Learning70Outcome:701.170|70QSEN70Compet
encies:70Safety70AACN70Domains70and70Comps.:70 Domain705:70Quality70and70Safety
NLN70Competencies:7 0 Quality70&70Safety




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, 3) The70nurse70is70changing70a702-month-
old70client's70diaper70and70notes70the70client70feels70warm70to70touch.70Which70method70should7
0the70nurse70use70to70check70the70baby's70temperature?
A) Oral
B) Rectal
C) Axillary
D) Tympanic70membran
e70ANSWER:70 C
Explanation:7 0 A)70Oral70is70used70for70age70370or70older.
B) The70rectal70route70is70the70least70desirable.
C) The70axillary70route70may70not70be70as70accurate70as70other70routes70for70detecting70fevers70in70childr
en.
D) The70tympanic70membrane70may70be70used70for70370months7
0or70older.70Page70Ref:7029
Cognitive70Level:7 0 Applying
Client70Need/Sub:7 0 Physiological70Integrity:70Reduction70of70Risk70Potential
Standards:70 Nursing70Process:70Evaluating70|70Learning70Outcome:701.270|70QSEN70Competenci
es:70Safety70AACN70Domains70and70Comps.:70 Domain705:70Quality70and70Safety
NLN70Competencies:7 0 Quality70&70Safety

4) A70client70comes70in70with70exacerbation70of70chronic70obstructive70pulmonary70disease70(CO
PD).70Which70noninvasive70diagnostic70test70will70the70nurse70implement70to70know70that70the70cl
ient70is70receiving70enough70oxygen?
A) Chest70x-ray
B) Pulse70oximeter
C) Arterial70blood70gasses
D) Assessment70of70respiratory70r
ate70ANSWER:70 B
Explanation:7 0 A)70A70chest70x-ray70is70not70an70intervention70a70nurse70completes.
B) A70pulse70oximeter70provides70a70noninvasive70method70of70measuring70oxygenation,70or7
0oxygen70saturation,70in70the70blood70and70provides70a70pulse70reading,70which70is70especiall
y70helpful70for70the70client70with70a70respiratory70illness70or70disease.
C) Arterial70blood70gases70are70an70invasive70diagnostic70test.
D) Assessing70a70respiratory70rate70is70important70for70the70nurse70to70implement;70howeve
r,70it70is70not70a70diagnostic70test.
Page70Ref:7021
Cognitive70Level:7 0 Applying
Client70Need/Sub:7 0 Physiological70Integrity:70Reduction70of70Risk70Potential
Standards:70Nursing70Process:70Implementation70|70Learning70Outcome:701.370|70QSEN70Compe
tencies:70Informatics
AACN70Domains70and70Comps.:70 Domain705:70Quality70and70Sa
fety70NLN70Competencies:70 Quality70&70Safety




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