Fundamentals 1 ATI

A nurse is reinforcing preoperative teaching with a client who is scheduled for arthroplasty in the next month and might require a blood transfusion. The client expresses concern about the risk of acquiring an infection from the blood transfusion. Which of the following suggestions should the nurse make? "Ask your provider to prescribe epoetin before the surgery." "You should take iron supplements prior to the surgery." "Request a family member donate blood for you." "Donate autologous blood before the surgery."

"Donate autologous blood before the surgery." Autologous blood transfusion is the collection and reinfusion of the client's own blood. With preoperative autologous blood donation, the blood is drawn from the client 3 to 5 weeks before an elective surgical procedure and stored for transfusion at the time of the surgery. Autologous blood is the safest form of blood transfusion; exclusive use of a client's own blood eliminates exposure to transfusion-transmitted infection.

A nurse in an oncology clinic is collecting data for a client who is undergoing treatment for ovarian cancer. Which of the following statements by the client indicates she is experiencing psychological distress? "My parents are retired, and they have come to help out with our children." "I am going to ask my husband to go to counseling with me." "I keep having nightmares about my upcoming surgery." "My girlfriends bought me a nice wig."

"I keep having nightmares about my upcoming surgery."

A nurse is reinforcing teaching with a group of older adults about expected changes of aging. Which of the following statements by a group member indicates that the teaching has been effective? "I should expect my heart rate to take longer to return to normal after exercise as I get older." "Urinary incontinence is something I will have to live with as I grow older." "I can expect to have less ear wax as I get older." "My stomach will empty more quickly after meals as I grow older."

"I should expect my heart rate to take longer to return to normal after exercise as I get older." Older adults experience decreased cardiac output, which causes increased pulse rate during exercise. However, the pulse rate also takes longer to return to normal after exercise. Older adults also have buildup of cerumen in ears which leads to hearing loss, Incontence is NOT normal and should be reported to be investigated and treated, there is also a decreased gastric emptying in older adults

A nurse is reinforcing teaching with an older adult client who has constipation. Which of the following statements should the nurse include in the teaching? "Drink a minimum of 1,000 milliliters of fluid daily." "Increase your intake of refined-fiber foods." "Sit on the toilet 30 minutes after eating a meal." "Take a laxative every day to maintain regularity."

"Sit on the toilet 30 minutes after eating a meal." Increased peristalsis occurs after food enters the stomach. Sitting on the toilet 30 min after eating a meal, regardless of feeling the urge to defecate, is a recommended method of bowel retraining to treat constipation. Patients should consume a minimum of 1,500 mL of fluid to prevent constipation, eat coarse-fiber and whole grains rather than refined -fiber foods

A nurse is caring for a client who has type 1 diabetes mellitus and is resistant to learning self-injection of insulin. Which of the following statements should the nurse make? "Tell me what I can do to help you overcome your fear of giving yourself injections." "I am sure your provider will not be pleased that you refuse to give yourself insulin injections." "It's okay. I'm sure your partner will be able to learn how to give you the insulin injections." "You won't be able to go home unless you learn to give yourself insulin injections."

"Tell me what I can do to help you overcome your fear of giving yourself injections." This response illustrates the therapeutic communication technique of clarifying and offering of self. It is important for the nurse to allow the client to express feelings and fears and to support the client in learning how to give the injections.

A nurse is instructing an assistive personnel (AP) about proper hand hygiene. Which of the following statements by the AP indicates an understanding of the teaching? "There are times I should use soap and water rather than an alcohol-based hand rub to clean my hands." "I will use cold water when I wash my hands to protect my skin from becoming too dry." "I will apply friction for at least 10 seconds while washing my hands." "After washing my hands I will dry them from the elbows down."

"There are times I should use soap and water rather than an alcohol-based hand rub to clean my hands." While alcohol-based hand rubs are as effective as soap and water in providing proper hand hygiene, the Center for Disease Control and Prevention recommends washing hands with soap and water at certain times, such as when the hands are visibly soiled with dirt or body fluids. Nurse and AP should also: use warm water, use effective friction for at least 15 to 20 seconds , dry from the cleanest area (fingertips) to up to elbows

A nurse observes an assistive personnel (AP) preparing to obtain blood pressure with a regular size cuff for a client who is obese. Which of the following explanations should the nurse give the AP? "The reading will be inaudible if the cuff is too small for the client." "The width of the cuff bladder should be 75 percent of the circumference of the client's arm ." "As long as the cuff will circle the arm the reading will be accurate." "Using a cuff that is too small will result in an inaccurately high reading."

"Using a cuff that is too small will result in an inaccurately high reading." Blood pressure cuffs come in various sizes, and the correct size cuff is necessary to obtain a reliable measurement. Blood pressure readings can be falsely high if the cuff is too small for the client.

A nurse is caring for an older adult client who becomes agitated when the nurse requests that the client's dentures be removed prior to surgery. Which of the following responses should the nurse make? "It's for your safety. Dentures can slip and block your airway during surgery." "You wouldn't want your teeth to be lost or broken during surgery, would you?" "The anesthesiologist requires everyone to remove their dentures." "What worries you about being without your teeth?"

"What worries you about being without your teeth This response by the nurse is therapeutic because it validates the client's feelings of agitation and seeks a reason for it.

Examples of infection of a patient with diabetic foot pain

- edema - increased neutrophils

Signs of dehydration

- elevated specific urine gravity (normal range is 1.005-1.030 - having a weak pulse -Have hypotension aka low blood pressure

A nurse is measuring an adult client's tympanic temperature. Which actions should the nurse take?

- the nurse should use circular motion to insert the probe until it fits snugly into the ear canal -For adults, pull pinna slightly upward and backward -Aim the probe slightly anteriorly toward the eardrum

Where is the apical pulse located?

5th intercostal space and below the left nipple line

A nurse is collecting data for the health history of a client who is postoperative and has paralytic ileus. Which of the following findings should the nurse expect? Frequent bowel sounds with flatus Absent bowel sounds with distention Hyperactive bowel sounds with diarrhea Normal bowel sounds with increased peristalsis

Absent bowel sounds with distention Paralytic ileus is an immobile bowel. With this disorder, bowel sounds are absent and the abdomen is distended.

A nurse is caring for a child who is postoperative following a tonsillectomy. Which of the following actions should the nurse take? Encourage the child to cough frequently to clear congestion from anesthesia. Place a heating pad at the child's neck for comfort. Administer analgesics to the child on a routine schedule throughout the day and night. Provide the child with ice cream when oral intake is initiated.

Administer analgesics to the child on a routine schedule throughout the day and night. To soothe the client's throat following a tonsillectomy, the nurse should administer pain medication routinely around the clock. The nurse can provide the medication rectally or intravenously to avoid the oral route. Ice could also be used to soothe

A nurse is planning weight loss strategies for a group of clients who are obese. Which of the following actions by the nurse will improve the clients' commitment to a long-term goal of weight loss? Attempt to increase the clients' self-motivation. Keep detailed records of each client's progress. Test client learning after each teaching session Avoid discussing areas that might cause client anxiety.

Attempt to increase the clients' self-motivation. Motivation to learn is important in improving a client's commitment to achievement of a health goal, as well as increasing the amount and speed of learning.

A nurse is drawing blood for laboratory testing from a client that results in a blood spill on her gloved hand. The client has no documented bloodstream infection. Which of the following actions should the nurse take? Wash the gloved hands and then throw the gloves away. Prepare an incident report to document the event. Carefully remove the gloves and follow with hand hygiene. Ask the provider to order a blood culture to determine the risk of infection.

Carefully remove the gloves and follow with hand hygiene.

Importance of bleach

Chlorine bleach acts as a disinfectant and is recommended for cleaning and disinfecting areas and objects in the hospital setting. It is recommended for blood spills because it is effective in killing the HIV virus.

A nurse is reviewing adult cardiopulmonary resuscitation (CPR) with a newly licensed nurse. Which of the following steps should the nurse identify as the first response when performing CPR? Call for assistance. Begin chest compressions. Confirm unresponsiveness. Give rescue breaths.

Confirm unresponsiveness.

This skin disorder has pruritis and reddened, fluid filled vesicles on her lower leg

Contact dermatitis

A nurse is measuring vital signs for a client and notices an irregularity in the pulse. Which of the following actions should the nurse take? Measure the pulse using a Doppler ultrasound stethoscope. Check the client's pedal pulses. Count the apical pulse rate for 1 full minute, and describe the rhythm in the chart. Take the pulse at each peripheral site and count the rate for 30 seconds.

Count the apical pulse rate for 1 full minute, and describe the rhythm in the chart. If the peripheral pulse is irregular, the nurse should auscultate the apical pulse for 60 seconds to obtain an accurate rate. The nurse should document the irregularity in the client's medical record. -Check pedal pulses- determines the client's circulation in lower extremities -Use a Doppler ultrasound stethoscope for a pulse that is nonpalpable -Palpate all peripheral pulses to determine the equality of blood perfusion to the extremities

A nurse on a medical surgical unit is admitting a client. Which of the following information should the nurse document in the client's record first? Data collection for the client Plan of care for the client Nursing interventions performed for the client Data collection for the client

Data collection for the client

If a newly admitted patient has hearing loss the nurse should do what first?

Describe the environment to the patient

A nurse is caring for a client who is unstable and has vital signs measured every 15 minutes by an electronic blood pressure machine. The nurse notices the machine begins to measure the blood pressure at varied intervals and the readings are inconsistent. Which of the following actions should the nurse take? Turn on the machine every 15 min to measure the client's blood pressure. Record only blood pressure readings needed for the 15-min intervals. Obtain manual and automatic readings and compare them. Disconnect the machine and measure the blood pressure manually every 15 min.

Disconnect the machine and measure the blood pressure manually every 15 min. If the nurse questions the reliability of the monitoring equipment , a manual process should be used . Also, malfunctioning equipment can pose a safety risk for the client, so it must be tagged and removed.

What is echinacea used for?

Echinacea supposedly reduces the manifestations and duration of colds and flu-like illnesses through short-term stimulation of the immune system.

A nurse is caring for a client who has a terminal illness. The client asks several questions about the nurse's religious beliefs related to death and dying. Which of the following actions should the nurse take? Change the topic because the client is trying to divert attention from the illness to the nurse. Encourage the client to express his thoughts about death and dying. Tell the client that religious beliefs are a personal matter. Offer to contact the client's minister or the facility's chaplain.

Encourage the client to express his thoughts about death and dying.

A nurse is collecting data for a client who has decreased circulation in his left leg. Which of the following actions should the nurse take first? Evaluate pedal pulses. Obtain a medical history. Measure vital signs. Ask the client if he is experiencing any pain in the leg.

Evaluate pedal pulses. For a client who has decreased circulation in the leg, evaluating pedal pulses is critical in order to determine adequate blood supply to the foot. The nurse should apply the safety and risk reduction priority-setting framework when caring for this client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. This framework assigns priority to the factor posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client.

Which patient is at risk for fluid volume deficit

Gastroenteritis causes diarrhea and vomiting, so it can be a significant source of fluid loss. The nurse should identify this client as having a risk for fluid volume deficit.

Fundamentals 1 A nurse is collecting data for a client who has had diarrhea and decreased urination for several days. Which of the following actions should the nurse take to determine if the client is dehydrated? Push on a fingernail bed until it blanches, release it, and observe how long it takes the skin to become pink. Grasp a skin fold on the chest under the clavicle, release it, and note whether it springs back. Press the skin in above the ankle for 5 seconds, release it, and note the depth of the impression. Measure the skin fold thickness at the upper arm using a pair of calibrated skinfold calipers.

Grasp a skin fold on the chest under the clavicle, release it, and note whether it springs back. The nurse should use this technique for collecting data on skin turgor. If the client has good turgor and is properly hydrated, the skin will immediately return to normal; with dehydration, the skin will remain tented. The nurse can also collect data on skin turgor by grasping a skin fold on the back of the forearm.

What could be possible symptoms of dehydration

Hypotension Furrowed tongue Poor skin turgor Tachycardia Dark yellow concentrated urine

A nurse is administering a tap water enema to a client who is constipated. During the administration of the enema, the client states he is having abdominal cramps. Which of the following actions should the nurse take to relieve the client's discomfort?

If nausea or cramping occurs, the nurse should slow the flow of water, leaving the tube in place. The nurse should then raise the solution container when the cramping has passed.

A client sues for negligence after falling , what could determine the nurses liability for the clients injury?

In court, the standard that determines negligence is how a reasonably prudent nurse with the same education and experience would have performed under the same circumstances.

A nurse is collecting data for an adult client. Identify the correct sequence of steps used for data collection of the abdomen. (Move the sequence of steps into the box on the right, placing them in the selected order of performance. Use all the steps.) Inspection Palpation Percussion Auscultation

Inspect, Auscultate, Percuss, Palpate The appropriate sequence for the nurse to perform the abdominal data collection is to inspect, auscultate, percuss, and then palpate. This sequence prevents altering the bowel sounds and causing false results. The appropriate sequence for any other data collection for an adult client is inspection, palpation, percussion, and auscultation.

What should you do if a patient cant see to go the bathroom and wants to prevent falls

Keep a night light in the clients room

Why should you not keep the bedrails up

Keeping the side rails in the uppermost position poses the risk of the client becoming entangled in them or trying to climb over them rather than waiting for assistance. This action would increase her risk for falling.

A nurse is receiving a client from the PACU who is postoperative following abdominal surgery. Which of the following actions should the nurse take to transfer the client from the stretcher to the bed? Lock the wheels on the bed and stretcher. Instruct the client to raise his arms above his head. Elevate the stretcher 2.5 cm (1 in) above the height of the bed. Log roll the client.

Lock the wheels on the bed and stretcher.

A nurse is preparing a client who is scheduled for a hysterectomy for transport to the operating room when the client states she no longer wants to have the surgery. Which of the following actions should the nurse take? Tell the client it is too late for her to change her mind because the surgery is already scheduled. Telephone the operating room and cancel the surgery. Inform the client's family about the situation. Notify the provider about the client's decision.

Notify the provider about the client's decision.

Identify goals for client care.Identifying goals for client care is part of the nursing process; however, there is another action the nurse should carry out first. Obtain client information.

Obtain client information.

A charge nurse is observing a newly licensed nurse perform tracheostomy care for a client. Which of the following actions by the newly licensed nurse requires intervention? Obtaining hydrogen peroxide for the tracheostomy care Obtaining cotton balls for the tracheostomy care Obtaining sterile gloves for the tracheostomy care Obtaining a sterile brush for the tracheostomy care

Obtaining cotton balls for the tracheostomy care Cotton ball particles can be aspirated into the tracheostomy opening, possibly causing tracheal abscess. The charge nurse should intervene for this action. Trach care requires sterile gloves, half-strength peroxide and sterile pipe cleaners

A nurse is preparing to provide tracheostomy care for a client. Which of the following actions should the nurse take first? Open all sterile supplies and solutions. Stabilize the tracheostomy tube. Don sterile gloves. Perform hand hygiene.

Perform hand hygiene According to evidence-based practice, the nurse should first perform hand hygiene before touching the client or performing any skills, such as tracheostomy care. This is vital because contamination of the nurse's hands is a primary source of infection.

A nurse is auscultating the heart sounds of a client who has developed chest pain that worsens with inspiration. The nurse hears a high-pitched scratching sound with the diaphragm of the stethoscope placed at the third intercostal space of the left sternal border. Which of the following heart sounds should the nurse document? Audible click Murmur Third heart sound Pericardial friction rub

Pericardial friction rub A pericardial friction rub has a scratching, grating, or squeaking leathery sound. It tends to be high frequency and best heard with the diaphragm of the stethoscope at the third intercostals space of the left sternal border. A pericardial friction rub is a manifestation of pericardial inflammation and can be heard with infective pericarditis, myocardial infarction, following cardiac surgery or trauma, and with some autoimmune problems, such as rheumatic fever. The client who develops pericarditis typically has chest pain which becomes worse with inspiration or coughing and which may be relieved by sitting up and leaning forward.

A nurse is obtaining the blood pressure in a client's lower extremity. Which of the following actions should the nurse take? Auscultate for the blood pressure at the dorsalis pedis artery. Measure the blood pressure with the client sitting on the side of the bed. Place the cuff 7.6 cm (3 in) above the popliteal artery. Place the bladder of the cuff over the posterior aspect of the thigh.

Place the bladder of the cuff over the posterior aspect of the thigh. This is the correct position for the nurse to place the bladder of the cuff when measuring a lower extremity blood pressure.

A nurse on a rehabilitation unit is preparing to transfer a client who is unable to walk from a bed to a wheelchair. Which of the following techniques should the nurse use? Stand toward the client's stronger side. Instruct the client to lean backward from the hips. Place the wheelchair at a 45° angle to the bed. Assume a narrow stance with feet 15 cm (6 in) apart.

Place the wheelchair at a 45° angle to the bed. Positioning the wheelchair at a 45° angle allows the client to pivot, lessening the amount of rotation required.

What does race stand for in a fire?

R- rescue the clients A-Activate the fire alarm C-Confine the fire E-Extinguish the fire

A nurse is preparing to perform oral care for a client who is unresponsive. Which of the following actions should the nurse plan to take? Place the client supine. Keep both side rails up. Raise the level of the bed. Inspect the client's mouth using a finger sweep.

Raise the level of the bed. The nurse should raise the bed to allow for the use of proper body mechanics and reduce the risk of self-injury.

A nurse is caring for an older adult client who is violent and attempting to disconnect her IV lines. The provider prescribes soft wrist restraints. Which of the following actions should the nurse take while the client is in restraints? Tie the restraints to the side rails. Perform range-of-motion exercises to the wrists every 3 hr. Remove the restraints one at a time. Obtain a PRN prescription for the restraints.

Remove the restraints one at a time. - The nurse should remove one restraint at a time for a client who is violent -nurses should perform range-of-motion exercises ever 2 hrs instead of 3 - The nurse should NOT tie restraints to the bed because it could injure patient if lowered

A nurse is assisting with planning a community campaign about seasonal influenza. Which of the following plans should be included as a secondary prevention strategy? Holding a community clinic to administer influenza immunizations. Screening groups of older adults in nursing care facilities for early influenza manifestations. Educating parents of young children about the dangers of influenza. Finding rehabilitation programs for older adults who have complications from influenza

Screening groups of older adults in nursing care facilities for early influenza manifestations. Screening older adults who have some manifestations of illness to determine if they have influenza is an example of secondary prevention. Secondary prevention is focused on preventing complications of an illness or providing care to prevent illness from becoming severe.

A nurse at a screening clinic is collecting data for a client who reports a history of a heart murmur related to aortic valve stenosis. At which of the following anatomical areas should the nurse place the stethoscope to auscultate the aortic valve? Fifth intercostal space just medial to the midclavicular line Second intercostal space to the left of the sternum Fifth intercostal space to the left of the sternum Second intercostal space to the right of the sternum

Second intercostal space to the right of the sternum The aortic valve is located in the second intercostal space to the right of the sternum. Aortic stenosis produces a midsystolic ejection murmur that can be heard clearly at the aortic area with the client leaning forward.

Do not schedule any nursing care on Saturdays to which group of people

Seventh-Day Adventist

A nurse is caring for a client who is in the terminal stage of cancer. Which of the following actions should the nurse take when she observes the client crying? Contact the family and ask them to stay with the client. Offer to call the client's minister. Sit and hold the client's hand. Leave the room and allow the client to cry privately.

Sit and hold the client's hand. With this action, the nurse uses the therapeutic communication techniques of silence, touch, and offering of self to the client.

A nurse is planning to obtain the vital signs of a 2-year-old child who is experiencing diarrhea and who may have a right ear infection. Which of the following routes should the nurse use to obtain the temperature? Rectal Tympanic Oral Temporal

Temporal The temporal artery route, while not as accurate as the rectal route for obtaining a precise body temperature, is non-invasive and can be used to obtain a temperature in a toddler who may have an ear infection and who is having diarrhea. The nurse should place the probe behind the ear if the client is diaphoretic, but should avoid placing it over an area covered with hair. Oral is not appropriate for kids under the age of 3

What is respite care

Temporary care The purpose is to give family members temporary relief from the stress of providing care for a family member. Respite care programs help make alternative arrangements so caregivers have time off to attend to their own needs.

What does a guaiac test do

Test feces for blood

A nurse is reinforcing teaching of postoperative deep breathing and coughing exercises with a client who will have emergency surgery for appendicitis. Which of the following statements indicates a lack of readiness to learn by the client? The client asks the nurse to repeat the instructions before attempting the exercises. The client reports severe pain. The client asks the nurse how often deep breathing should be done after surgery. The client tells the nurse that this exercise will probably be painful after surgery.

The client reports severe pain.

What is the most important thing to determine when transferring a patient

The clients current weight -bearing status ​This is the most important information the nurse needs to know to identify the safest method of transfer.

A nurse is reinforcing teaching with a client who has heart failure about how to reduce his daily intake of sodium. Which of the following factors is the most important in determining the client's ability to learn new dietary habits? The involvement of the client in planning the change The emphasis the provider places on the dietary changes The learning theory the nurse uses to teach the dietary changes The extent of the dietary changes planned for the client

The involvement of the client in planning the change According to evidence-based practice, client involvement in planning dietary changes is the most important factor in the client's ability to learn new habits.

During a change-of-shift report, a nurse sees that a client's IV bag of 0.9% sodium chloride has 900 mL of fluid left in it. The nurse makes rounds 30 min later and notes that the IV bag is empty. Which of the following actions should the nurse take?

The nurse should collect data immediately to identify any indications of fluid-volume excess. To do so, the nurse should listen to the client's lungs for dyspnea and rales.

What do you do if a patient attempts to leave the facility?

The nurse should inform the client that leaving is against medical advice (AMA), ask him to sign the facility's AMA form, and document the situation in the client's medical record.

Which factors should a nurse consider when giving TPN

The nurse should monitor the IV insertion site for signs of infection

A nurse on a medical-surgical unit is washing her hands prior to assisting with a surgical procedure. Which of the following actions by the nurse demonstrates proper surgical hand-washing technique? The nurse washes each part of her hands with five strokes. The nurse washes from the elbows down to the hands. The nurse washes with her hands held higher than her el

The nurse washes with her hands held higher than her elbow The nurse who is performing a surgical hand-washing technique should wash with her hands held higher than the elbows so that water and soapsuds can drain away from the clean area toward the dirty area.

A nurse is witnessing a client signing an informed consent form for surgery. Which of the following describes what the nurse is affirming by this action? The client fully understands the provider's explanation of the procedure. The client has been informed about the risks and benefits of the procedure. The nurse witnessed the provider's explanation of the procedure. The signature on the preoperative consent form is the client's.

The signature on the preoperative consent form is the client's. The nurse acts as a witness to attest that it is the client's signature on the preoperative consent form. It is the responsibility of the provider who will perform the procedure to obtain consent by explaining the procedure along with the associated risks and benefits.

A nurse's sibling had a diagnostic test performed at the facility where the nurse is employed. Now the sibling asks the nurse to look up the results in the computer. In replying to the sibling, the nurse realizes that disclosing the test result is

There is no legal or professional basis for a nurse-client relationship between them. Therefore, it would be a breach of confidentiality for the nurse to access this information, as she has no direct involvement in her sibling's health care.

What should you do if a patient wants to see their medical record?

They would have to sign a written request to access the record

True or false UAP are allowed to administer an enema?

True

UAP not allowed to administer medications T or F

True only licensed nurses can administer medications

A nurse is caring for a client who requires a chest x-ray. What should the nurse do first

Use 2 patient identifiers

What delivers a specific concentration of oxygen constantly?

Venturi mask

What is pallative care

care specialized for people living with serious illness

What does an adequate carotid pulse indicate

circulation to the brain

A nurse is performing an iv what is an indication of phlebitis (inflammation of the vein)

erythema which is redness , pain , and swelling

Neck vein distention is a manifestation of

fluid-volume excess

A nurse is collecting data from a client who reports abdominal pain. Further findings reveal the client has a temperature of 39.2° C (102.6° F), a heart rate of 105/min, a soft nontender abdomen, and menses overdue by 2 days. Which of the following findings should be the nurse's priority? Heart rate of 105 Soft, nontender abdomen Temperature

temperature Elevated temperature is an emergent physiological need which requires priority intervention by the nurse. The nurse should consider Maslow's Hierarchy of Needs, which includes five levels of priority when answering this item.

How much oxygen does a nasal cannula deliver?

​A nasal cannula delivers a relatively low concentration of oxygen (24% to 44%).

a nurse is caring for a client with a new diagnosis of diabetes . Which shows affective teaching?

​Explore the clients feelings about dietary modifications. This teaching intervention allows the client to express his acceptance of this change and focuses on affective learning.

What should a nurse do if she is preparing medications and she has to leave the room to help someone else?

​Locking the medication in a secured area until the nurse returns to finish the preparation is the proper action for the nurse to take. This allows the nurse to continue where she left of in the steps of the 6 Rights of Medication and decreases the probability for error.

Dressing change requires gown with a patient with HIV T Or F

​Standard precautions require the nurse to wear appropriate personal protective equipment when there is a risk of contact with body fluids. While performing a dressing change on a client who is HIV positive, the nurse should wear appropriate personal protective equipment, which includes a gown.

How high should you hold a cleansing enema

​The nurse holding the container of solution 12 to 18 inches above the anus is correct to allow a greater force of fluid flowing to properly cleanse the colon.

What is veracity

​Veracity is the duty to tell the truth. The nurse violated the ethical principle of veracity when she chose not to report the error instead of being truthful about medication error