All Solved Correct.
Nurse enters the room of a female client and ask how she is doing, client states "I'm a little
nervous this morning". What would be the nurses best reply? - Answer "Can you tell me more
about how you are feeling?"
A nurse observes a client pacing the halls, and it appears as if the client has been crying. What is
the appropriate action? - Answer Validate perceptions with the client
The nurse is assessing the client who has an onset of severe back pain of an unknown origin.
Which would the nurse ask to encourage discussion? - Answer What do you think caused the
onset of your back pain?
In which of the following situations would the nurse be more justified in implementing trial-and-
error problem solving? - Answer The nurse is attempting to landmark an obese clients apical
pulse
A client comes to the ED complaining of severe chest pain. The nurse ask the client questions
and takes VS. Which step in the nursing process is this? - Answer Assesing
A nurse is examining a child 2 years old. Asked on her findings, she initiates a care plan for a
potential problem with normal growth and development. Which step of the nursing process
identifies actual and potential problems? - Answer Diagnosing
Self evaluation is a method that nurses use to promote their own development and to grow in
confidence in their nursing roles. The process is refereed to as what? - Answer Reflective
practice
Profuse smoke is coming out of the heating unit in a patient's room. What should
the nurse do first? - Answer Move the patient out of the room
The nurse is providing instructions to the unlicensed assistive personnel (UAP) who will be
caring for a client with hand restraints. The nurse asks the UAP to repeat the instructions to
ensure that the UAP understands the care. Which statement, if made by the UAP, indicated an
understanding of the care for this client? - Answer "I need to remove the restraints at least
, After correctly positioning a client for a urinary catheterization procedure, the nurse sets up a
sterile field and places the kit supplies on the area. The nurse hears a page to respond to
another client who has fallen in the hallway. Which of the following would be the most
appropriate nursing actions? - Answer Ensure the clients safety, discard the sterile equipment,
and resound to the other client.
A patient's stool specimen is positive for Clostridium difficile. Which isolation precautions
should the nurse institute for this patient? - Answer Contact
A nurse is following the principles of medical asepsis when performing patient care in a hospital
setting. Which nursing action performed by the nurse follows these recommended guidelines? -
Answer The nurse moves the patient table away from the nurse's body when wiping it off after
a meal
The nurse has opened the sterile supplies and put on two sterile gloves to complete a sterile
dressing change, a procedure that requires surgical asepsis. Which action by the nurse is
appropriate? - Answer Consider the outer 1 in of the sterile field as contaminated.
The nurse caring for patients in a hospital setting institutes CDC standard precaution
recommendations for which category of patients? - Answer All patients receiving care in
hospitals
A nurse must make an unoccupied bed. Which nursing action is most important? - Answer
Ensure that the bottom of the sheet is free of wrinkles
The nurse us providing hygiene to a patient with peripheral neuropathy. The nurse should: -
Answer Wash the feet with lukewarm water and dry well.
A nurse is providing for the hygiene and grooming needs for an obese patient who easily
becomes short of breath when moving about. Which is the most important nursing
intervention? - Answer Assessing response to activity
A client who is unconscious needs frequent mouth care. While performing mouth care, the
nurse tale care to place the client in which of the following positions? - Answer Side-lying
Which action would the nurse take to use a wide base of support when assisting a client to get