TEST BANK q s s s s q s s s s
CLINICAL NURSING SKILLS: qq qq
Asq s s q s s Concept-Based sq s s q s s Approach
4th ssq s s q s s
Edition, Pearson Education
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TEST BANK q s s s s q s s s
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition
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PearsonEducation
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Table of Contents
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Chapter 1. Assessment
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Chapter 2. Caring Interventions
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Chapter 4. Elimination
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Chapter 5. Fluids and Electrolytes
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Chapter 7. Intracranial Regulation
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Chapter 9. Mobilityss ss
Chapter 10. Nutrition
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Chapter 11. Oxygenation
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Chapter 12. Perfusion
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Chapter 13. Perioperative Care
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Chapter 15. Safety ss ss
Chapter 16. Tissue Integrity
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,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test
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Bank Chapter 1: Assessment
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1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
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the nurse implement first?
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A) Call the healthcare provider.ss ss ss
B) Administer pain medication. ss ss
C) Reassess a new set of vital signs. ss ss ss ss ss ss
D) Turn client from supine to ss ss ss ss
lateral.Answer: C
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Explanation: A) The nurse will need to reassess the client first, before calling the
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healthcareprovider.
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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
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incondition.
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D) The nurse will need to reassess the client first, before moving the client, to avoid making
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thechange in client's condition worse.
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Page Ref: 2 ss ss
Cognitive Level: Applying ss
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN
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Competencies:Patient-Centered Care
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AACN Domains and Comps.: Domain 2: Person-Centered
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Care NLN Competencies: Relationship Centered Care
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2) The nurse is observing the UAP taking the temperature of an unconscious client. Which
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route will the nurse question the UAP using?
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A) Oral
B) Rectal
C) Scanner
D) Tympanic q
Answer:
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A
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Explanation: A) The temperature of an unconscious client is never taken by mouth. The
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rectal, t ympanic, 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
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preferred.Page Ref: 24
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Cognitive Level: Applying ss
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
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Standards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN
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Competencies: SafetyAACN Domains 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-old client's diaper and notes the client feels warm to
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touch.Which method should the nurse use to check the baby's temperature?
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A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneAnswer:
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C ss
Explanation: A) Oral is used for age 3 or older. ss ss ss ss ss ss ss ss
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
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older.Page Ref: 29
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Cognitive Level: Applying ss
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies:
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SafetyAACN 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).
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Which noninvasive diagnostic test will the nurse implement to know that the client is receiving
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enough oxygen?
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A) Chest x-ray ss
B) Pulse oximeter ss
C) Arterial blood gasses ss ss
D) Assessment of respiratory ss ss
rateAnswer: B
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Explanation: A) A chest x-ray is not an intervention a nurse completes. ss ss ss ss ss ss ss ss ss ss
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
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saturation, in the blood and provides a pulse reading, which is especially helpful for the
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client with 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
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not a diagnostic test.
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Page Ref: 21 ss ss
Cognitive Level: Applying ss
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN
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Competencies:Informatics
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AACN Domains and Comps.: Domain 5: Quality and
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SafetyNLN Competencies: Quality & Safety
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2
CLINICAL NURSING SKILLS: qq qq
Asq s s q s s Concept-Based sq s s q s s Approach
4th ssq s s q s s
Edition, Pearson Education
ss ss
TEST BANK q s s s s q s s s
,Test Bank for Clinical Nursing Skills: A Concept-Based Approach 4th Edition
ss ss ss ss ss ss ss ss ss ss
PearsonEducation
ss
Table of Contents
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Chapter 1. Assessment
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Chapter 2. Caring Interventions
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ss Chapter 3. Comfortss ss
Chapter 4. Elimination
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Chapter 5. Fluids and Electrolytes
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ss Chapter 6. Infection
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Chapter 7. Intracranial Regulation
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ss Chapter 8. Metabolism
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Chapter 9. Mobilityss ss
Chapter 10. Nutrition
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Chapter 11. Oxygenation
ss ss
Chapter 12. Perfusion
ss ss
Chapter 13. Perioperative Care
ss ss ss
ss Chapter 14. Reproduction
ss ss
Chapter 15. Safety ss ss
Chapter 16. Tissue Integrity
ss ss ss
,Clinical Nursing Skills: A Concept-Based Approach, 4e (Pearson) Education Test
ss ss ss ss ss ss ss ss ss
Bank Chapter 1: Assessment
ss q ss ss
1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
ss ss ss ss ss ss ss ss ss ss ss ss ss
the nurse implement first?
ss qq ss ss
A) Call the healthcare provider.ss ss ss
B) Administer pain medication. ss ss
C) Reassess a new set of vital signs. ss ss ss ss ss ss
D) Turn client from supine to ss ss ss ss
lateral.Answer: C
ss s s
Explanation: A) The nurse will need to reassess the client first, before calling the
ss ss ss ss ss ss ss ss ss ss ss ss ss
healthcareprovider.
ss
B) The nurse will need to reassess the client first, before administering pain medication.
ss ss ss ss ss ss ss ss ss ss ss ss
C) The nurse needs to implement a new set of vital signs first when there is a change
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
incondition.
ss
D) The nurse will need to reassess the client first, before moving the client, to avoid making
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
thechange in client's condition worse.
ss ss ss ss ss
Page Ref: 2 ss ss
Cognitive Level: Applying ss
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ss ss ss ss ss ss
Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN
ss ss ss ss ss ss ss ss ss ss
Competencies:Patient-Centered Care
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AACN Domains and Comps.: Domain 2: Person-Centered
ss ss ss ss ss ss
Care NLN Competencies: Relationship Centered Care
ss qq ss s s ss ss
2) The nurse is observing the UAP taking the temperature of an unconscious client. Which
ss ss ss ss ss ss ss ss ss ss ss ss ss
route will the nurse question the UAP using?
ss qq ss ss ss ss ss ss
A) Oral
B) Rectal
C) Scanner
D) Tympanic q
Answer:
s s
A
s s
Explanation: A) The temperature of an unconscious client is never taken by mouth. The
ss ss ss ss ss ss ss ss ss ss ss ss ss
rectal, t ympanic, or scanner method is preferred.
ss q ss ss ss ss ss
B) The rectal, tympanic, or scanner method is preferred.
ss ss ss ss ss ss ss
C) The rectal, tympanic, or scanner method is preferred.
ss ss ss ss ss ss ss
D) The rectal, tympanic, or scanner method is
ss ss ss ss ss ss
preferred.Page Ref: 24
ss ss ss
Cognitive Level: Applying ss
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
ss ss ss ss ss ss ss ss ss
Standards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN
ss s s ss ss ss ss ss ss ss ss
Competencies: SafetyAACN Domains and Comps.: Domain 5: Quality and Safety
ss ss ss ss ss s s ss ss ss ss
NLN Competencies: Quality & Safety
ss ss ss
1
, 3) The nurse is changing a 2-month-old client's diaper and notes the client feels warm to
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
touch.Which method should the nurse use to check the baby's temperature?
ss ss ss ss ss ss ss ss ss ss ss
A) Oral
B) Rectal
C) Axillary
D) Tympanic
membraneAnswer:
ss q
C ss
Explanation: A) Oral is used for age 3 or older. ss ss ss ss ss ss ss ss
B) The rectal route is the least desirable.
ss ss ss ss ss ss
C) The axillary route may not be as accurate as other routes for detecting fevers in children.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
D) The tympanic membrane may be used for 3 months or
ss ss ss ss ss ss ss ss ss
older.Page Ref: 29
ss ss ss
Cognitive Level: Applying ss
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ss ss ss ss ss ss
Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies:
s s ss ss ss ss ss ss ss ss ss
SafetyAACN Domains and Comps.: Domain 5: Quality and Safety
ss ss ss ss s s ss ss ss ss
NLN Competencies: Quality & Safety
ss ss ss
4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD).
ss ss ss ss ss ss ss ss ss ss ss
Which noninvasive diagnostic test will the nurse implement to know that the client is receiving
ss q ss ss ss ss ss ss ss ss ss ss ss ss ss
enough oxygen?
ss ss
A) Chest x-ray ss
B) Pulse oximeter ss
C) Arterial blood gasses ss ss
D) Assessment of respiratory ss ss
rateAnswer: B
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Explanation: A) A chest x-ray is not an intervention a nurse completes. ss ss ss ss ss ss ss ss ss ss
B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
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saturation, in the blood and provides a pulse reading, which is especially helpful for the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
client with a respiratory illness or disease.
ss q ss ss ss ss ss
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
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not a diagnostic test.
ss ss q ss
Page Ref: 21 ss ss
Cognitive Level: Applying ss
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
ss ss ss ss ss ss
Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN
ss ss ss ss ss ss ss ss ss ss
Competencies:Informatics
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AACN Domains and Comps.: Domain 5: Quality and
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SafetyNLN Competencies: Quality & Safety
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2
