NS 119 Exam 4 Practice questions

A charge nurse is assigning client care for four clients. Which of the following tasks should the nurse assign to a PN? A. Creating a plan of care for a client who is recovering following a stroke. B. Assessing a pressure injury on a client who is on bed rest C. Providing NG suctioning for a client who has pneumonia D. Teaching a client who has asthma to use a metered-dose inhaler

C

A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following should the manager include in the plan? (Select all that apply) A. Skill proficiency B. Assignment to a preceptor C. Budgetary principles D. Computerized charting E. Socialization into unit culture F. Facility policies and procedures

A, B, D, E, F

A nurse manager is assigning care of a client who is being admitted from the PACU following thoracic surgery. The nurse manager should assign the client to which of the following staff members? A. Charge nurse B. Registered Nurse C LPN D. CNA

B

An RN on a medical-surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN? A. obtain vital signs for a client who is 2 hour post-op following a cardiac catheterization. B. Administer a unit of packed red blood cells (RBCs) to a client who has cancer C. Instruct a client who is scheduled for discharge in the performance of wound care D. Develop a plan of care for a newly admitted client who has pneumonia.

A

A nurse manager is observing the actions of a nurse they are supervising. Which of the following actions by the nurse requires the nurse manager to intervene? (Select all that apply) A. reviewing the health care record of a client assigned to another nurse B. Making a copy of a client's most current laboratory results for the provider during rounds C. Providing information about a client's condition to hospital clergy D. Discussing a client's condition over the phone with an individual who has provided the client's information code E. Participating in walking rounds that involve the exchange of client-related information outside clients' rooms.

A, B, C, E

A nurse manager is providing information about the audit process to members of the nursing team. Which of the following should the nurse manager include? (select all) A. A structure audit evaluates the setting and resources available to provide care. B. An outcome audit evaluates the results of the nursing care provided C. A root cause analysis is indicated when a sentinel event occurs D. Retrospective audits are conducted while the client is receiving care E. After data collection is completed, it is compared to a benchmark

A, B, C, E

A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (Select all that apply.) A. Verifying that a client understands what is done during a cardiac catheterization B. Discussing treatment options for a terminal diagnosis C. Informing members of the health care team that a client has do-not-resuscitate status D. Reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about his care based on the nurse's recommendations

A, C, d

A nurse witnesses an AP they are supervising reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if the urinal is not used more carefully next time. Which of the following torts is the AP committing. A. Assault B. Battery C. False imprisonment D. Invasion of privacy

A. Assault

A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the manager demonstrating? A. Avoidance B. Smoothing C. Cooperating D. Negotiating

A. Avoidance

A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The nurse educator evaluates the teaching as effective when the newly licensed nurse states the client who has heat stroke will have which of the following? A. Hypotension B. Bradycardia C. Clammy skin D. Bradypnea

A. Hypotension

A nurse is caring for a client who has a history of falls. Which of the following actions is the nurse's priority? A. Complete a fall-risk assessment B. educate the client and family about fall risks. C. Eliminate safety hazards from the client's environment D. Make sure the client uses assistive aids in their possessions.

A. complete a fall risk assessment

A case manager is discussing critical pathways with a group of newly hired nurses. Which of the following statements indicates understanding? A. The time to fill out the pathways often increases the cost of care. B. The pathway shows an estimate of the number of days the client will be hospitalized. C. Deviance from the pathway is a sign of improved care quality. D. The pathway includes information about the client's history.

B

A nurse manager is reviewing with nurses on the unit in the care of a client who has had a seizure. Which of the following statements by a nurse requires further instruction? A. I will place client on side B. I will go to the nurses station for assistance C. I will note the time that the seizure begins D. I will prepare to insert an airway

B

A nurse eduator is teaching staff members about facility protocol in the event of a tornado. Which of the following should the nurse include? (select all that apply) A. Open doors to client rooms B. Place blankets over clients who are confined to beds. C. Move beds away from windows. D. Draw shades and close drapes E. Instruct ambulatory clients in the hallways to return to their rooms

B, C, D

A nurse is caring for a client who has chest pain. The client says "I am going home immediately." Which of the following actions should the nurse take? (Select all that apply). A. Notify the client's family of their intent to leave the facility B. Document the client's intent to leave the facility against medical advice. C. Explain to the client the risks involved if they choose to leave. D. Ask the client to sign a form relinquishing responsibility of the facility E.Prevent the client from leaving the facility until the provider arrives

B, C, D

A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP (Assistive personnel). Which of the following information should the nurse share with the AP? A. The roommate ambulates independently B. The client ambulates wearing slippers over antiembolic stockings. C. The client uses a front-wheeled walker when ambulating D. The client had pain medication 30 minutes ago E. The client is allergic to codeine F. The client ate 50% of breakfast this morning (Select all that apply)

B, C, D

A home health nurse is discussing the dangers of food poisoning with a client. Which of the following information should the nurse include? (Select all that apply) A. Most food poisoning is caused by a virus B. Immunocompromised individuals are at increased risk for complications from food poisoning C. Clients who are at high risk should eat or drink only pasteurized dairy products D. Healthy individuals usually recover from the illness in a few weeks. E. Handling raw and fresh food separately can prevent food poisoning

B, C, E

A nurse is preparing an in-service program about delegation. Which of the following are components of the five rights of delegation (select all that apply) A. Right place B. Right supervision and evaluation C. Right direction and communication D. right documentation E. Right circumstances

B, C, E

A nurse is providing discharge instructions to a client who has a prescription for oxygen use at home. Which of the following information should the nurse include? (select all that apply) A. Family members who smoke must be at least 10 ft from the client when oxygen is in use B. Nail polish should not be used near a client who is receiving oxygen. C. A "No Smoking" sign should be placed on the front door. D. Cotton bedding and clothing should be replaced with items made from wool. E. A fire extinguisher should be readily available in the home.

B, C, E

A nurse is preparing to transfer a client who is 72 hr postoperative to a long-term care facility. Which of the following information should the nurse include in the transfer report? (select all that apply) A. Type of anesthesia used B. Advance directives status C. Vital signs on day of admission D. Medical diagnosis E. Need for specific equipment

B, D, E

A nurse who has just assumed the role of unit manager is examining her skills in interprofessional collaboration. Which of the following actions support interprofessional collaboration? (select all that apply) A. Use aggressive communication when addressing the team. B. Recognize the knowledge and skills of each member of the team. C. Ensure that a nurse is assigned to serve as the group facilitator for all interprofessional meetings. D. Encourage the client and family to participate in the team meeting E. Support the team member requests for referral.

B, D, E

A nurse is caring for a child who is being treated in the Emergency department following a head contusion from a fall. History reveals the child lives at home with one parent. The provider's discharge instructions include waking the child every hour to assess for indications of a possible head injury. In which of the following situations should the nurse intervene and attempt to prevent discharge? A. The parent states they do not have insurance or money for a follow-up visit. B. The child states, "my head hurts and I want to go home." C. The nurse smells alcohol on the parent's breath D. The parent verbalizes fear about taking the child home and requests they be kept overnight.

C

A nurse is caring for a client who is scheduled for surgery. The client hands the nurse information about advance directives and says, "here, I don't need this. I am too young to worry about life sustaining measures and what I want done for me." What should we do? A. Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time. B. Explain to the client that you never know what can happen during surgery and to fill the papers out just in case. C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives D. Inform the client that surgery cannot be conducted unless the advance directives forms are completed

C

A nurse is caring for multiple clients during a mass casualty event. Which of the following clients is the nurse's priority? A. A client who received crush injuries to the chest and abdomen and is expected to die B. A client who has a 4 inch laceration to the head C. A client who has partial-thickness and full-thickness burns to his face, neck and chest D. A client who has a fractured fibula and tibia

C

A nurse is participating in quality improvement study of a procedure frequently performed on the unit. Which of the following information will provide data regarding the efficacy of the procedure? A. Frequency with which procedure is performed B. Client satisfaction with performance of procedure C. Incidence of complications related to procedure D. Accurate documentation of how procedure was performed

C

An occupational health nurse is caring for an employee who was exposed to an unknown dry chemical, resulting in a chemical burn. Which of the following interventions should the nurse include in the plan of care? A. Irrigate the affected area with running water B. Was the affected area with soap C. Brush the chemical off the skin and clothing D. Leave the clothing in place until emergency personnel arrive

C

A nurse on a med-surg unit is informed that a mass casualty event occurred in the community and that it is necessary to discharge stable clients to make beds available for injury victims. Which of the following clients should the nurse recommend for discharge? (Select all that apply) A. A client who is dehydrated and receiving IV fluid and electrolytes B. A client who has a nasogastric tube to treat a small bowel obstruction C. A client who is scheduled for elective surgery D. A client who has chronic hypertension and a blood pressure of 135/85 E. A client who has acute appendicitis and is scheduled for an appendectomy

C, D

A nurse is assisting with the discharge planning for a client. Which of the following actions should the nurse take? (Select all that apply) A. Determine the client's need for home medical equipment. B. Provide a list of all the medications the client received in the facility C. Obtain printed instructions for medication self-administration. D. Provide the family with a list of community agencies that can provide assistance E. Discuss the importance of attending follow-up appointments.

C, D, E

A nurse is caring for a client who fell at a nursing home. The client is oriented to person, place, and time and can follow directions. Which of the following actions should the nurse take to decrease the risk of another fall (Select all) A) Place a belt restraint on the client when they are sitting on the bedside commode. B) Keep the bed in its lowest position with all side rails up C) Make sure that the client's call light is within reach D) Provide the client with non-skid footwear E) complete a fall risk assessment.

C, D, E

A nurse on a med-surg unit has received change of shift report and will care for four clients. Which of the following tasks should the nurse assign to a CNA? A. Updating the plan of care for a client who is postoperative B. Reinforcing teaching with a client who is learning to walk using a quad cane C. Reapplying a condom catheter for a client D. Applying a sterile dressing to a pressure injury

C, because teaching, updating plan of care and applying sterile dressing are all nurses job.

A PN ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. Complete an incident report. B. Delegate this task to the PN. C. Ask the AP if they need assistance D. Notify the nurse manager.

C.

A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? A. call the provider B. ask a staff member for assistance getting the client back in bed. C. inspect the client for injuries D. instruct the client to ask for help if they need to get out of bed

C. Inspect for injuries

A nurse observes smoke coming from under the door of the staff's lounge. Which of the following actions is the nurse's priority? A. Extinguish the fire. B. Activate the fire alarm C. Move clients who are nearby D. Close all open doors on the unit.

C. move clients who are nearby

A nurse educator is conducting a parenting class for new guardians of infants. Which of the following statements made by a participant indicates understanding? A I will set my water heater at 130 F B. Once my baby can sit up they should be safe in the bathtub C. I will place my baby on their stomach to sleep. D. Once my infant starts to push up, I will remove the mobile from over the crib

D

A nurse is reviewing a client's health care record and discovers that the client's DNR prescription has expired. The client's condition is not stable. Which of the following actions should the nurse take? A. Assume that the client does not want to be resuscitated and take no action if they experience cardiac arrest. B. Write a note on the front of the provider prescription sheet asking that the DNR be prescribed C. Anticipate that CPR will be instituted if the client goes into cardiopulmonary arrest. D. Call the provider to determine whether the prescription should be immediately reinstated.

D

A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPPA C. Patient Self-Determination Act D. Patient care Partnership.

D

A home health nurse is discussing the dangers of carbon monoxide poisoning with a client. Which of the following information should the nurse include A. Carbon monoxide has a distinct odor B. Water heaters should be inspected every 5 years C. the lungs are damaged from carbon monoxide inhalation D. Carbon monoxide binds with hemoglobin in the body

D.

A security officer is reviewing actions to take in the event of a bomb threat by phone to a group of nurses. Which of the following statements by a nurse indicates understanding? A. I will get the caller off the phone as soon as possible so I can alert the staff. B. I will begin evacuating clients using the elevators C. I will not ask any questions and just let the caller talk D. I will listen for background noise

D.

A nurse discovers a small paper fire in a trash can in a client's bathroom. The client has been taken to safety and the alarm has been activated. Which of the following actions should the nurse take? A. Open the windows in the client's room to allow smoke to escape B. Obtain a class C fire extinguisher to extinguish the fire. C. Remove all electrical equipment from the client's room D. Place wet towels along the base of the door to the client's room.

D. place wet towels along the base of the door to the clients room.