NRS 100 QUIZ 3

The nursing team consists of a nurse in charge, a Registered Nurse, and a nursing assistant. Which task should be delegated to the Registered Nurse rather than the nursing assistant? Obtaining routine vital signs Providing discharge teaching Ambulating a stable client in the hall Transporting a client to another location for an x-ray examination

Providing discharge teaching

A nurse wants to present information about flu immunizations to the older adults in the community. Which type of communication should the nurse use? Small group Public Intrapersonal Interpersonal

Public

The nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse should assign priority to which client? A client complaining of muscle aches, a headache, and history of seizures A client with chest pain who states that he just ate pizza that was made with a very spicy sauce A client who twisted her ankle when rollerblading and is requesting medication for pain A client with a minor laceration on the index finger sustained while cutting an eggplant

A client with chest pain who states that he just ate pizza that was made with a very spicy sauce

A nurse is prioritizing care for four patients. Which patient should the nurse see first? A patient with a slight temperature A patient with a healed abdominal incision A patient needing teaching about medications A nurse is prioritizing care for four patients. Which patient should the nurse see first? A patient with a slight temperature A patient with a healed abdominal incision A patient needing teaching about medications A patient with difficulty breathing

A patient with difficulty breathing ABCD!!!!!!!!!!!!!!!!!!!!!!!

Clients with trauma, chest pain, severe respiratory distress or cardiac arrest, limb amputation, and acute neurological deficits and those who have sustained chemical splashes to the eyes are classified as emergent and are the highest priority.

A client experiencing chest pain is always classified as priority 1 until a myocardial infarction has been ruled out.

The nurse is assigned to care for four clients. In planning client rounds, which client should the nurse assess first? A client scheduled for a chest x-ray after insertion of a nasogastric tube A client with asthma who requested a breathing treatment during the previous shift A client requiring daily dressing changes of a recent surgical incision A postoperative client preparing for discharge with a new medication

A client with asthma who requested a breathing treatment during the previous shift

A nurse manager considers that there are "Five Rights of Delegation." Which is a right of delegation in addition to right task, right person, right communication, and right time? Place Route Feedback Supervision

Supervision

Which is the most important reason why a nursing assistant must fully understand how to implement a delegated procedure? Be capable of completing the procedure safely. Have the knowledge to explain the procedure to a client. Have the correct information when teaching the procedure to another nursing assistant. Be proficient enough to perform the procedure quickly.

Be capable of completing the procedure safely.

A nurse is taking a history on a patient who cannot speak English. Which action will the nurse take to provide effective care? Refer to a speech therapist. Find a mental health nurse specialist. Obtain an interpreter. Let a close family member talk.

Obtain an interpreter.

The nurse performs a cultural assessment with a patient from a different culture. Which action should the nurse take first? Tell the patient what the nurse already knows about the patient's culture. Request an interpreter before interviewing the patient. Ask the patient about any affiliation with a particular cultural group. Wait until a family member is available to help with the assessment.

Ask the patient about any affiliation with a particular cultural group.

A first-year nursing student in the clinical area is given an appropriate client assignment by the instructor. Which should the student nurse do? Accept the role of leader of the client's health-care team. Complete the care indicated on the client's plan of care. Help other students to complete their assigned tasks whenever necessary. Assume accountability for the tasks that are assigned by the instructor.

Assume accountability for the tasks that are assigned by the instructor. Students should not help other students unless specifically assigned to do so by the instructor or preceptor. An exception occurs when assistance is needed to ensure client safety in an emergency.

A client is to be discharged from the hospital. Which discharge task can be delegated to a nursing assistant? Teaching the client how to measure weight using a standing scale Demonstrating to the client how to safely use a walker Determining if the client knows how to measure fluid intake Obtaining the client's temperature, pulse, and respiratory rate

Obtaining the client's temperature, pulse, and respiratory rate

Which health-care professional is best prepared to track a client's progress through the health-care system? Home-care nurse Primary nurse Nurse manager Case manager

Case manager

The nurse is giving a bed bath to an assigned client when an assistive personnel (AP) enters the client's room and tells the nurse that another assigned client is in pain and needs pain medication. Which is the most appropriate nursing action? Finish the bed bath and then administer the pain medication to the other client. Ask the AP to find out when the last pain medication was given to the client. Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client. Ask the AP to tell the client in pain that medication will be administered as soon as the bed bath is complete.

Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client.

A nurse is using SURETY to facilitate active listening. What is the focus of the letter R? Continuously provide reassurance to the patient Projection of a sense of relaxation Implementing reminisce to support memory Demonstrating respect for the patient

Projection of a sense of relaxation

When delegating a specific procedure to a client care aide, the aide refuses to perform the procedure. Which should the nurse do first? Explore why the client care aide refused to perform the procedure. Send the client care aide to the procedure manual to review the procedure. Assign the procedure to another client care aide. Explain that it is part of the client care aide's job description.

Explore why the client care aide refused to perform the procedure. The nurse must first explore the reason for the nurse aide's refusal to perform the procedure. The employee may have an acceptable reason for refusing to comply. When the reason is identified, then the nurse manager can take an informed action.

A nursing team leader delegates a wound irrigation to a Licensed Practical Nurse (LPN). It has been a long time since the LPN performed this procedure. Which should the nursing team leader do to ensure client safety? Verbally describe how to perform the procedure to the LPN. Delegate the procedure to another LPN. Have the LPN demonstrate how to perform the procedure. Assign another LPN to assist with the procedure.

Have the LPN demonstrate how to perform the procedure.

The nurse asks a patient where their pain is located, and the patient responds by pointing to the area of pain. Which form of communication did the patient use? Intonation Nonverbal Vocabulary Verbal

Nonverbal

A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? There is a decreased frequency of morbidity. There is an increased level of health. There is a decreased mortality rate. There is an increased incidence of disease.

There is an increased incidence of disease.

The nurse is caring for a patient who speaks a different language. If an interpreter is not available, which action by the nurse is appropriate? Use gestures or pictures to demonstrate meaning. Talk slowly so that each word is clearly heard. Speak loudly in close proximity to the patient's ears. Repeat important words so that the patient recognizes their significance.

Use gestures or pictures to demonstrate meaning.

A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first? Assessing own biases and attitude Developing cultural skills Learning about the world view of others Understanding organizational forces

assessing own biases and attitude