Funds CMS
A nurse is instructing a client about collecting a 24-hr urine specimen for creatinine clearance. Which of the following statements should the nurse identify as an indication that the client understands the procedure?
"I'll make sure to keep the collection bottle in the container of ice they gave me."
A nurse is preparing to change a dressing on a client who is receiving negative pressure wound therapy (NPWT). Which sequence of action should the nurse plan to take?
-Turn off the vacuum on the NPWT device and administer the prescribed analgesic.-Remove the soiled dressing and perform hand hygiene-Apply sterile or clean gloves and irrigate the wound.- Apply a skin protectant or a barrier film to the skin around the wound.- Please prepared foam into the wound bed and covered with a transparent dressing.- Connect the tubing to transparent film and turn on the NPWT unit.
A nurse on a surgical unit is receiving a client who had abdominal surgery from the postanesthesia care unit. Which of the following assessments should the nurse make first?
Airway
A nurse is supervising a newly licensed nurse who is caring for a client with streptococcal pharyngitis and is on transmission-based precautions. Which of the following actions by the newly licensed nurse indicates an understanding of droplet precautions?
Assigning another client with the same infection to share the room with the client
A nurse is assessing a client who is undergoing a physical examination. Following the inspection, which of the following techniques should the nurse use next when assessing the client's abdomen?
Auscultation
A nurse is collecting a urine specimen for culture and sensitivity for a client who has a urinary tract infection. The client has an indwelling urinary catheter in place. Which of the following actions should the nurse take? A. Withdraw the specimen from the drainage bag B. Cleanse the collection port with soap and water C. Place the specimen in a clean specimen cup D. Clamp the tubing below the collection port
Clamp the tubing below the collection port. The nurse should clamp the tubing below the collection port to allow fresh, uncontaminated urine to collect before withdrawing the specimen through the port and placing it in a sterile specimen cup.
A nurse is caring for a client who has peripheral edema. The nurse should identify that which of the following nutrients regulates extracellular fluid volume?
Sodium
A nurse is performing an otoscopic examination of a client's right ear. The light reflex is visible in the right lower quadrant of the tympanic membrane. Which of the following actions should the nurse take in response to this finding?
Document this as an expected finding
As a nurse is preparing to administer liquid medication from a bottle to a client. Which of the following actions should the nurse take?
Hold the medication bottle with the label against the palm of the hand when pouring
A nurse is caring for a client who has a stage II pressure ulcer. Which of the following wound dressings should the nurse apply to the ulcer?
Hydrocolloid
A nurse is receiving a client from the PACU who is postoperative following abdominal surgery. Which of the following actions should the nurse perform to transfer the client from the stretcher to the bed?
Lock the wheels on the bed and stretcher.
A nurse is caring for a client who begins having a tonic-clonic seizure while sitting in a chair at the bedside. Which of the following actions should the nurse take first?
Lower the client to the floor
A nurse is preparing a client who is scheduled for a hysterectomy for transport to the operating room. The client states she no longer wants to have the surgery. Which of the following actions should the nurse take?
Notify the provider of the client's decision.
A nurse is planning to document care provided for a client. Which of the following abbreviations should the nurse use?
PC for after meals
A nurse is caring for a client who has chronic kidney disease. The kidneys regulate body fluids as well as assisting with which of the following functions?
Regulation of acid-base balance
A nurse is screening a client who has an S-shaped spinal column with unequal shoulder heights. The nurse should identify these findings as manifestations of which of the following abnormalities?
Scoliosis
A nurse is planning care for an adult client who has fluid volume excess. Which of the following interventions should the nurse plan to include to monitor the client's weight?
Weigh the client on arising
A nurse is auscultating a client's lungs and identifies rhonchi over the trachea and bronchi. Which of the following actions should the nurse take?
Encourage the client to cough
A nurse is performing eye irrigation for a client who was exposed to smoke and ash. Which of the following actions should the nurse take?
Exert pressure on the bony prominences when holding the eyelids open
