CLINICAL WEEK 1 QUIZ QUESTIONS

The nurse has assisted the bedbound client to place the urinal between the legs. The nurse instructs the client to place the penis into the urinal. After covering the client with the bed linens, what would be the nurse's next action? Pull the privacy curtain closed and stand by the bedside until the client is finished urinating. Monitor the client during voiding to ensure the urinal is used correctly. Wait outside the client's door and listen to determine when voiding is complete. Place the call bell and toilet paper next to the client and instruct the client to call when finished urinating.

Place the call bell and toilet paper next to the client and instruct the client to call when finished urinating.

The nurse is changing the linens on a client's bed. What is the nurse's primary objective for this nursing action? Prepare the client to receive visitors Tidy up the client's room Remove soiled linens Provide client comfort

Provide client comfort

The nurse has placed the rolled, soiled linens in the laundry hamper. What should be the nurse's next action? Place the clean bottom sheet in center of bed. Replace soiled gloves with new ones. Remove gloves, unless indicated for transmission precautions. Scrub the mattress with antimicrobial cleaner.

Remove gloves, unless indicated for transmission precautions.

Which includes practices used to render and keep objects and areas free from microorganisms? Medical asepsis Hand hygiene Surgical asepsis Clean technique

Surgical asepsis

The nurse performs hand hygiene using an alcohol-based handrub after exiting a client's room. The nurse does not touch another surface or client until what has occurred? Hand hygiene performance has been documented. Twenty to thirty seconds of hand rubbing has occurred. The antiseptic has evaporated from the skin. The hands have been dried with a paper towel.

The antiseptic has evaporated from the skin.

When washing the hands with soap and water what is an appropriate action for the nurse to perform?

The nurse keeps the hands lower than the elbows to allow water to flow toward fingertips. When hand washing, the nurse washes jewelry, usually restricted to only a wedding band, before starting; jewelry can harbor microorganisms and contaminants. Next, the nurse would turn on the water, apply soap to the hands, and rub it in using a circular motion. After thoroughly cleaning the hands, the nurse would then clean under the nails. The nurse does not lean on the sink as this can lead to contamination.

The nurse determines that the sterile field has been contaminated when which action occurs? The field is above waist level. The nurse reaches around the sterile field. A sterile object falls within the 1-in (2.5-cm) border of the field. The nurse turns his or her back to the field.

The nurse turns his or her back to the field.

A group of students are demonstrating the skill for hand washing. What would indicate a need for additional teaching? The students wash their hands for 15 seconds prior to drying them. The students use warm water to complete the hand washing skill. The students keep their hands lower than their elbows throughout the skill. The students rub their hands firmly with soap using a circular motion.

The students wash their hands for 15 seconds prior to drying them

A nurse is assisting a client with the use of a urinal. The nurse recognizes that which statement about the use of a urinal is true? Both male and female clients commonly void into a urinal in the bathroom to facilitate measurement of urinary output. Unless contraindicated, nurses should encourage clients to stand to use a urinal. If nocturnal incontinence is anticipated, a urinal can be placed between the legs while the client is asleep. Urinals must be replaced every 24 hours to reduce the risk of infection.

Unless contraindicated, nurses should encourage clients to stand to use a urinal.

Which would be the best choice of a device for urinary elimination for a 42-year-old male client who is on bed rest following knee surgery? Fracture bedpan Bedpan Bedside commode Urinal

Urinal

A group of nurses are reviewing information about asepsis. Which statement by the group demonstrates the need for additional review? "Items below waist level are considered contaminated." "Reaching over a sterile field contaminates the sterile field." "Any items coming into contact with a sterile field must be sterile." "Turning a back to a sterile field maintains the sterility of the field."

"Turning a back to a sterile field maintains the sterility of the field."

When applying a condom catheter to a client, how much space would the nurse leave between the tip of the penis and the end of the condom? 3 to 4 in (7.5 to 10 cm) 2 to 3 in (5 cm to 7.5 cm) 1 to 2 in (2.5 to 5 cm) ½ to 1 in (1.25 to 2.5 cm)

1 to 2 in (2.5 to 5 cm)

The nurse is applying a condom catheter to a client who is urinating frequently and unable to control his urination following surgery. Which accurately describes the correct procedure for this application? Apply the condom sheath loosely enough so that one finger can be placed between the penis and the condom catheter. Apply the condom sheath tightly around the penis to prevent leakage. Apply the condom sheath securely enough to prevent leakage, but not so tight as to restrict blood flow. Apply the condom sheath loosely on the penis to prevent blood flow restriction.

Apply the condom sheath securely enough to prevent leakage, but not so tight as to restrict blood flow.

The nurse provides care to a sedated client with soiled sheets. Which action does the nurse take to move the client? Ask for help from a staff member. Use a client hydraulic lift. Place pillows behind the client's back. Pull the client from side to side.

Ask for help from a staff member.

The nurse is preparing to make a bed occupied by a client who is on bedrest. What is the first action the nurse would take in this procedure? Identify the client. Perform hand hygiene. Provide for privacy. Check the client's chart.

Check the client's chart.

Which are basic principles of surgical asepsis? Select all that apply. Avoid talking, coughing, sneezing, or reaching over a sterile field. Hold sterile objects at hip level or above. Only a sterile object can touch another sterile object. Forceps soaked in disinfectant can be used to add items to a sterile field. Consider the outer 1-inch (2.5 centimeters) edge of a sterile field to be contaminated. Never turn the back on a sterile field.

Consider the outer 1-inch (2.5 centimeters) edge of a sterile field to be contaminated. Never turn the back on a sterile field. Avoid talking, coughing, sneezing, or reaching over a sterile field. Only a sterile object can touch another sterile object.

The nurse is performing hand washing using soap and water after providing client care. The nurse has performed hand hygiene using soap and water. What action would the nurse take next? Dry the hands with a paper towel. Apply an oil-free lotion to both hands. Turn off the water at the faucet. Use an alcohol-based handrub.

Dry the hands with a paper towel.

When a client cannot be turned on the side, what recommended nursing action would the nurse perform, with assistance from another nurse, to replace the soiled linens once they have been removed? Fold two bottom linens in half and place one at the top of the bed and one at the bottom. Apply the bottom sheet, securing it at the bottom of the bed. Ease the clean linens under the client, from the top to the bottom of the bed. Pull the clean linens under the client from the bottom to the top of the bed.

Ease the clean linens under the client, from the top to the bottom of the bed.

When monitoring a client with a condom catheter, the nurse finds that the catheter will not stay on the client. What would be the initial recommended step for this situation? Document the incident and notify the health care provider. Lubricate the penis and reapply the condom catheter. Discard the old catheter and apply a new one. Ensure that the condom catheter is the right size.

Ensure that the condom catheter is the right size.

The nurse is changing a client's bedding while the client is out of the room getting an X-ray. What would the nurse do with the reusable linens? Fold the bedding in fourths on the bed and place them on the overbed table. With the assistance of another nurse, fold the linens in fourths on the bed and then place them on a clean chair. Fold the bedding in half on the bed and then place them at the bottom of the bed. Fold the linens in fourths on the bed and then hang them over a clean chair.

Fold the linens in fourths on the bed and then hang them over a clean chair.

A nurse is preparing to perform hand hygiene using an alcohol-based handrub. When applying the product, the nurse would place the product at which location? On the back of the non-dominant hand On each of the fingertips In the palm of one hand Between each finger

In the palm of one hand

The nurse uses perineal cleansing wipes for the client who has had a bowel movement. Which action does the nurse take? Alternate wipes with reusable wash cloths. Use multiple wipes to create a thicker wipe. Change to a clean wipe after each stroke. Flush cleansing wipes after perineal care is complete.

Change to a clean wipe after each stroke.

An older adult woman has been in the hospital for more than 1 week. While assessing her intravenous catheter port, the nurse finds a staph infection, which has developed in the past day or so. This infection is an example of which type of infection? Health care-associated infection Sexually transmitted infection Respiratory infection Droplet infection

Health care-associated infection

A nurse is preparing to use an alcohol-based handrub for hand hygiene. After applying the appropriate amount of product, the nurse would rub the hands together for at least how long? 45 second 90 seconds 120 seconds 15 seconds

15 seconds

The nurse prepares the sterile tray for indwelling catheter insertion while wearing sterile gloves. The nurse then pulls the client's blankets away from the pelvis to begin catheter insertion. What action should the nurse take next? Begin cleansing the meatus with antiseptic. Position the catheter kit closer to the client. Change into a new pair of sterile gloves. Dispose of the catheter kit and begin again.

Change into a new pair of sterile gloves.

The nurse is changing the linens for a client who could not be turned on the side due to a surgical incision on the right hip and pain from a fall in the left hip. What nursing intervention would be appropriate for this client? Change the bed linens from the top to the bottom. Change the bed linens from the left to the right side. Do not change the bed linens until the client is experiencing less pain. Change the bed linens from the bottom to the top.

Change the bed linens from the top to the bottom.

A nurse demonstrates the correct use of hand hygiene using an alcohol-based handrub for which situation? Select all that apply. After applying a clean, dry dressing After using the restroom Before entering a client's room Before eating a meal After removing gloves

Before entering a client's room After applying a clean, dry dressing After removing gloves

The nurse cleans the client after a bowel movement and notes stool on the gloves. The nurse has not finished cleaning the client. What action should the nurse take? Change into a new pair of gloves. Continue to complete care. Use a wipe to clean gloves. Avoid touching clean linen.

Change into a new pair of gloves.

How should the nurse open the bottom sheet when making an unoccupied bed? Fold in half in the center Fanfold to the side Fanfold to the center Fold in thirds to the side

Fanfold to the center

How would the nurse remove the top linens when making an occupied bed? Arrange the client's gown for privacy and roll the linens to the bottom of the bed. Have the client hold onto the bath blanket and reach under it to remove the linens. Have the client hold onto the bath blanket and reach under it to remove all linens except the top sheet. Fanfold the linens at the bottom of the bed and remove them to the chair.

Have the client hold onto the bath blanket and reach under it to remove the linens.

Where should the nurse roll soiled linens when removing them from an unoccupied bed? On the bedside table On the floor Inside the bottom sheet Inside the top sheet

Inside the bottom sheet

The nurse is preparing to change the linens from the top to the bottom for a client who cannot be turned on the side. Which accurately describes a recommended step in this procedure when removing the soiled linens? Raise the client's legs and roll the linens from the bottom of the bed to the client's buttocks. Sit the client up and roll the soiled linens from the top of the bed until they meet the client's backside. Keep the blanket in place over the client to provide privacy and remove the top sheet. Help the client to a supine position in the bed and pull the sheets from the top to the bottom of the bed.

Keep the blanket in place over the client to provide privacy and remove the top sheet.

What is the most important advantage of using a condom catheter versus an indwelling catheter? Less potential for infection. Less potential for skin breakdown. Can be used to obtain a sterile urine specimen. Provides more privacy for the client.

Less potential for infection.

The nurse is applying a condom catheter to an older adult client who has become incontinent of urine following hip surgery. In what position would the nurse place the client when applying this device? Standing. Sitting upright. Lying on side. Lying flat.

Lying flat.

The nurse is making a bed occupied by a client. How would the nurse position the client when loosening bottom bed linens? Lying prone Sitting up Lying on one side Lying flat

Lying on one side

The nurse making an occupied bed. Under which body part of the client would the nurse place the drawsheet? Buttocks Feet Midsection Head

Midsection

The client experiences leakage around the condom catheter. Which action does the nurse perform? Place an incontinence brief on the client. Ask the client to use the urinal to void. Insert an indwelling urinary catheter. Obtain the correct supplies and replace it.

Obtain the correct supplies and replace it.

A nurse must change the linens on a bed while it is occupied. Which actions should the nurse take? Select all that apply. Grasp the mattress and shift it down to the foot of the bed. Place a bath blanket over the client. Put on gloves before removing soiled linens. Secure clean top linens under the head of the mattress. Help the client turn toward the opposite side of the bed and fan-fold soiled lines as close to the client as possible. Place soiled linen on the floor.

Place a bath blanket over the client. Help the client turn toward the opposite side of the bed and fan-fold soiled lines as close to the client as possible. Put on gloves before removing soiled linens.

The nurse has placed a urinal between the legs of a client and instructed him to place himself onto the urinal. After covering the client with the bed linens, what would be the nurse's next action? Pull the privacy curtain closed and stand by the bedside until the client is finished. Place the call bell and toilet paper next to the client and instruct him to call when he is finished. Monitor the client while he is voiding to ensure he is using the urinal correctly. Pull the privacy curtain closed and wait in the bathroom for the client to finish.

Place the call bell and toilet paper next to the client and instruct him to call when he is finished.

The nurse is disposing the contents of the client's urinal. What is the correct procedure for cleaning the urinal? Put on clean gloves, rinse the urinal with an antimicrobial cleanser, and dry with paper towel. Put on clean gloves, rinse the urinal with alcohol, and dry with paper towel. Put on clean gloves, rinse the urinal with water, and dry with paper towel. Send the urinal to be disinfected according to facility policy.

Put on clean gloves, rinse the urinal with water, and dry with paper towel.

When making an occupied bed, the nurse positions and tucks in the bottom linens on one side of the bed. What would be the nurse's next action? Move to other side of bed. Push the client to the other side of the bed. Remove the old linens out from under the client. Raise the side rail.

Raise the side rail.

The nurse prepares for a sterile dressing change on one end of the table by opening a sterile field and dropping the supplies onto it. The nurse needs to gather additional supplies remaining on the other side of the table. What action does the nurse take? Prepare a second sterile field to cover the entire table surface. Take a few steps around the table to pick up the additional supplies. Discard the current sterile field and supplies and begin again. Reach toward the other end of the table and pick up the supplies.

Take a few steps around the table to pick up the additional supplies.

The nurse uses soap and water for hand hygiene. Which action demonstrates proper handwashing? Washing to 1 in (2.5 cm) below the elbows Drying the hands, then fingers Using a rubbing, circular motion Keeping the hands above the elbows

Using a rubbing, circular motion