Lab Exam Review
A nurse is attempting to flush the IV saline lock for a client. The client reports pain above the catheter site. Which of the following actions should the nurse take? A. Remove the IV saline lock. B. Apply firm pressure to the plunger of the syringe during the IV flush to improve patency. C. Apply a warm compress to the IV site. D. Inject the solution more slowly while flushing the IV saline lock.
Answer: A not functioning- remove, place new somewhere else B- do not use if patient is reporting pain C- ice to decrease swelling/pain D- do not use
Which of the following is an appropriate technique for the nurse to use when performing sterile gloving? A. Put the glove on the nondominant hand first. B. Interlock the hands after both gloves are applied. C. Pull the cuffs down on both gloves after gloving. D. Grasp the outside cuff of the other glove with the gloved hand.
Answer: B A- gloving dominant hand first improves dexterity C- cuffs usually fall down after application D- sterile touching sterile prevents contamination
A nurse is teaching a new group of unlicensed assistive personnel (AP) about the importance of hand hygiene. Which of the following statements should the nurse include? A. "If you wear gloves, you do not have to wash your hands." B. "Rub all surfaces of your hands with an alcohol rub for 20 to 30 seconds." C. "Use an alcohol rub when your hands are visibly soiled." D. "If you don't have an infection, your hands won't infect others."
Answer: B, rub until hands are dry, about 20-30 seconds A- hand hygiene before donning gloves and after removing gloves C- need soap and water when hands are visibly soiled D- hands can transmit pathogens that can harm others even if that pathogen hasn't harmed you
When inserting a rectal thermometer, the nurse encounters resistance. The nurse should: A. apply mild pressure to advance. B. ask the patient to take deep breaths. C. remove the thermometer immediately. D. remove the thermometer and reinsert it gently.
Answer: C A- never force it- prevent trauma B- ask patient to breath slow and relax to relax the rectal sphincter D- do not immediately reinsert
The nurse is teaching a patient how to measure medication dosages at home. The prescription is written for 30 mL of the medication. Which household measurement will the nurse teach the patient to use? A. Drops B. Teaspoon C. Tablespoon D. Cup
Answer: C 1 tablespoon = 15 ml so 2 tablespoons = 30ml B- 1 tsp = 5 ml D- 1 cup = 8 ounces = 240 ml
Which site is used to auscultate blood pressure? A. Radial B. Ulnar C. Brachial D. Temporal
Answer: C brachial artery for BP A- radial for pulse B- ulnar for pulse C- temporal for pulse or temperature
An appropriate procedure for the nurse to use when applying an elastic stocking is to: A. remove the stockings every 24 hours. B. keep the tops of the stockings rolled down slightly. C. turn the stocking inside out to apply from the toes up. D. wash stockings daily and dry in a dryer.
Answer: C easier application A- removed every shift to assess skin B- do not roll stockings partially down- has constricting effect and can impede venous return D- lay flat to dry
A patient is concerned because her first guaiac test is positive. What information should the nurse share with the patient? A. The patient probably has colorectal cancer. B. The test needs to be repeated after she eats some red meat. C. The test needs to be repeated at least 3 times. D. The patient needs a low-residue diet to reduce intestinal abrasions.
Answer: C single positive result does not confirm bleeding or cancer A- need at least 3 times and more in depth diagnosis B- meat free diet- red mean may be false positive D- high residue
Handwashing with soap and water is: A. the most effective way to reduce the number of bacteria on the nurse's hands. B. more effective than alcohol-based products for washing hands. C. necessary for hand hygiene if hands are visibly soiled. D. not necessary if the nurse wears artificial nails.
Answer: C soap and water when visibly soiled A- soap may increase bacteria counts on skin B- alcohol based more effective D- artificial nails increased bacteria on finger tips
A patient is well known to the hospital staff from previous admissions and is prone to wandering at night. For patient safety, the physician writes an order for "belt restraint prn." What should the nurse do upon reviewing this order? A. Apply a belt restraint on the patient as needed. B. Have the patient sign an "informed consent" form. C. Inform the physician that "prn" restraint orders are unacceptable. D. Obtain a signed "informed consent" from a family member.
Answer: C time limited order is necessary A- not as needed B and D- informed consent not necessary for restraints in hospital
A provider prescribes a sublingual medication for a client who has an NG tube in place. Which of the following actions should the nurse take? A. Request a prescription for an oral formulation of the medication. B. Administer the crushed medication through the NG tube. C. Dissolve the medication in water and give it through the NG tube. D. Administer the medication under the client's tongue.
Answer: D under tongue (sublingual) for direct absorption, avoids the gut A- no need to request a change B- exposing to gastric juices can inactivate the medication C- exposing to gastric juices can inactivate the medication
A nurse is preparing to administer penicillin IM to an adult client. Which of the following angles should the nurse use for injection into the client's ventrogluteal muscle? A. 45° B. 60° C. 75° D. 90°
Answer: D, IM injections are 90 degrees to deposit deep into muscle A- 45 degrees is subcutaneous injections B- 60 degrees is not muscle, difficult to estimate that angle C- 75 degrees is not muscle, difficult to estimate that angle
A nurse has completed care procedures for a client who requires airborne precautions. Which of the following items of personal protective equipment (PPE) should the nurse remove first? A. Mask B. Gloves C. Gown D. Goggles
Answer: B most contaminated, remove first Order for removal: gloves, gown, goggles, mask
While ambulating, the patient becomes light-headed and starts to fall. What should the nurse do first? A. Call for help. B. Try to reach for a chair. C. Ease the patient down to the floor. D. Push the patient back toward the bed.
Answer: C
A nurse is reinforcing teaching with a client about using transdermal patches at home. Which of the following statements should the nurse identify as an indication that the client understands the teaching? A. "I will remove the old patch and apply a new one in the same location." B. "I will press the patch securely in place on my forearm." C. "I will clean and dry the area before applying the patch." D. "I will use lotion on irritated skin before applying a new patch in that area."
Answer: C skin should be clean and dry before applying patch A- apply new patch in a different location/position B- should place on trunk, abdomen, back, buttock D- lotion can interfere with absorption
Before administering a medication to a client, the nurse must identify the client. Which of the following methods of identification should the nurse use? A. Ask a family member to verify the client's identity. B. Check the client's name on the medication administration record (MAR). C. Verify the client's room number. D. Ask the client's full name and date of birth.
Answer: D, two identifiers- name, date of birth, ID number, photo ID A- use primary source (patient) when able B- need to compare to another identifier C- room number not an acceptable identifier
The nurse is checking gastric residual on a patient who has a continuously running tube feeding and finds that the patient has a 600-mL gastric residual volume (GRV). How should the nurse respond? A. Stop the tube feeding. B. Slow the tube feeding. C. Continue the tube feeding at the same rate. D. Increase the rate of the tube feeding.
Answer: A stop feeding if residual >500ml
When assessing a patient, a nurse notes that the skin distal to a restraint is pale and cool to the touch. Which of the following interventions will the nurse perform first? A. Remove the restraint. B. Loosen the restraint. C. Obtain a larger restraint D. Reapply the restraint with more padding.
Answer: A altered neurovascular status- remove restraints and notify provider B- loosening may not effectively restore adequate circulation C and D- improperly sized restraint may not provide protection needed
A nurse is preparing to transfer a client from a bed to a chair. Which of the following actions should the nurse take first? A. Determine if the client can bear weight. B. Place a transfer belt on the client. C. Position the bed at an appropriate height. D. Assist the client to a seated position.
Answer: A assess first
A nurse is preparing to administer a pre-packaged oral medication to a client and complete the final medication check. At which of the following times or places should the nurse perform this final check? A. At the client's bedside before administration B. In the area where the nurse obtained the medication C. At the time of documentation D. At the nurses' station while reviewing the provider's prescription
Answer: A at bedside while reviewing package label B- this is location of first and second checks C- document after giving- check before giving D- not yet obtained med, can't check it
When planning care for a patient who has a colostomy, which intervention is important for the nurse to perform when pouching the colostomy? A. Leave an intact skin barrier in place for 3 to 7 days. B. Use soap and water to cleanse the peristomal skin. C. Empty the pouch when it is two-thirds full. D. Use tape to secure pouches that have minor leaks.
Answer: A avoid unnecessary changing to minimize irritation B- warm tap water- avoid soap (leaves residue, interferes with adhesion) C- empty pouch when 1/3 to ½ full D- if leaking, change pouch
The nurse is preparing oral medications for administration. Which action by the nurse is appropriate? A. Using a cutting device to cut scored tablets B. Unwrapping all of the medications to be given and placing them together in a cup C. Crushing capsules and enteric-coated medication for easier swallowing D. Holding the medication cup at eye level to pour a liquid dosage
Answer: A cutting device results in more even split B- wrappers maintain cleanliness and identify drug/dose C- capsules and coated meds can't be crushed D- place cup at eye level on flat surface
A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. Which of the following actions should the nurse take? A. Attach a humidifier bottle to the base of the flow meter. B. Remove the nasal cannula while the client eats. C. Secure the oxygen tubing to the bed sheet near the client's head. D. Apply petroleum jelly to the nares as needed to soothe mucous membranes.
Answer: A humidifier for 4L or more B- can eat with nasal cannula in place C- secure tubing to clothing D- water soluble lubricant not petroleum jelly
A nurse is measuring a client's oral temperature. The client informs the nurse that he has just eaten some ice chips. Which of the following actions should the nurse take? A. Wait 30 min and return to measure the oral temperature B. Provide the client a sip of warm water, wait 5 min, and measure the temperature. C. Document that the nurse was unable to measure the client's temperature. D. Proceed to measure the oral temperature.
Answer: A ice chips may artificially lower reading B- reading may be inaccurate C- responsibility to measure D- wait and measure later
In caring for a patient who has a pouch for a urinary diversion, which nursing intervention is essential? A. Empty the pouch when it is one-third to one-half full. B. Remove the ureteral stents after 2 days. C. Pouch the stoma with the patient sitting up. D. Dispose of used pouches in the toilet.
Answer: A if more full, weight of pouch may disrupt seal B- surgeon removes stents C- pouch while semi reclining D- clogs toilet
A nurse is providing teaching to a group of unlicensed assistive personnel (UAP) about hand hygiene. Which of the following statements by one of the UAPs indicates a need for further teaching? A. "As long as I change gloves between clients, it is not necessary to wash my hands." B. "I should wash my hands before I provide client care." C. "I will not wear artificial nails when providing client care." D. "It is acceptable to use alcohol-based hand products after most client contact."
Answer: A need hand hygiene after removing gloves
A nurse is caring for a client who is receiving oxygen at 2 L/min via a nasal cannula. The nurse recognizes the client is receiving which of the following inspired oxygen concentration? A. 28% B. 36% C. 50% D. 70%
Answer: A room air is 21%, 1L is 24% then 4% more for each additional liter of oxygen B- 4L nasal cannula C- simple face mask for 5L or more (40-60%) D- nonrebreather mask for 10L or more (60% and more)
A nurse is providing discharge teaching to a client has a new prescription for a metered dose inhaler (MDI). Which of the following instructions should the nurse include in the teaching? A. Shake the inhaler for 3 to 5 seconds. B. Rinse the mouth with mouthwash after inhaling the medication. C. Wait 2 min between inhalations. D. Press down twice on the MDI canister.
Answer: A shaking mixes the medication B- rinse with tap water so med does not irritate mucosa (mouthwash can further dry the mouth) C- wait 20-30 seconds between inhalations, not 2 minutes D- press down once to release dose
The patient is to receive a medication via the sublingual route. Which action by the nurse is appropriate? A. Placing the medication under the tongue B. Crushing the medication before administration C. Offering the patient a glass of orange juice after administration D. Using sterile technique to administer the medication
Answer: A sublingual- under tongue B- do not crush- SL is designed to dissolve C- no liquids until after SL med completely dissolved D- mouth is not sterile- sterile technique not necessary
The patient has been hospitalized for several days and has received multiple intravenous antibiotic medications. This morning, the patient had three episodes of severe, foul-smelling diarrhea. The nurse should institute: A. contact precautions. B. standard precautions only. C. Airborne precautions D. Droplet precautions
Answer: A suspect C.Diff infection
The nurse is preparing an injection of 0.45 mL of medication for a pediatric patient. Which syringe is most appropriate? A. 1-mL B. Insulin syringe C. 3-mL syringe D. 10-mL syringe
Answer: A tuberculin syringe 1ml B- insulin syringe in units not ml C and D- not as accurate for small volumes
How should the nurse identify a patient before obtaining a laboratory specimen? A. Use at least two patient identifiers. B. Look at the chart before entering the room. C. Ask the patient his name. D. Check the patient's armband twice.
Answer: A two identifiers needed
Before entering the room of a patient on isolation where all protective barriers are required, the nurse first puts on the: A. Gown B. Gloves C. Eyewear D. Mask/respirator
Answer: A Applying PPE: gown, mask, eyewear, gloves
When providing care for a patient with a colostomy or an ileostomy, the nurse recognizes that which is an expected assessment finding? A. A moist, reddish-pink stoma B. A dry, purplish stoma C. Erythema on the skin around the stoma D. No drainage noted from the stoma when washed
Answer: A B- purple/dry may mean necrotic C- skin should be intact and free of irritation D- stoma normally drains liquid, stool, flatus
The nurse explains to the patient that the incentive spirometer is used to promote which of the following outcomes? A. Lung expansion B. Reduced likelihood of vascular complications C. Incisional healing D. Expectoration of mucus
Answer: A B- repositioning reduces vascular complications C- incentive spirometer does not help with incisional healing D- coughing used to promote expectoration
A nurse is assisting an older adult client who sometimes loses her balance while walking. Which of the following devices should the nurse use when helping the client ambulate? A. Gait belt B. Jacket harness C. Four-wheel walker D. Cane
Answer: A, gait belt keeps center of gravity stable and helps maintain balance to prevent falls B- jacket harness is used to keep a patient from falling out of a chair C- wheeled walker increases risk of fall for patient who loses balance D- cane increases risk of fall for patient who loses balance
A nurse is helping an older adult client ambulate in the hallway for the first time since admission. The client has brought her standard walker from home. To ensure proper use of the walker and the safety of the client, which of the following actions should the nurse take? A. Check that the client lifts the walker and then places it down in front of her. B. Walk in front of the client to guide her in moving the walker. C. Have the client move one leg forward with the walker. D. Make sure that the upper bar of the walker is level with the client's waist.
Answer: A, lift walker and advance it then set it down- wide base of support while she moves forward B- walk slightly behind and to the side of patient C- move walker first then move foot while bearing weight on other foot and arms D- top of walker should be below waist, elbows bent 30 degrees
A newly licensed nurse is applying prescribed wrist restraints on a client. Which of the following actions should the nurse take? A. Secure the restraints using a quick-release tie. B. Ensure four fingers fit under the restraints to prevent constriction. C. Secure the restraints to the lowest bar of the side rail. D. Anticipate removing the restraints every 4 hr.
Answer: A, quick release for easy removal in emergency B- 2 fingers not 4 C- attach to area of bed frame that moves with patient, not side rail D- remove restraints every 2 hours not every 4 hours
An unlicensed assistive personnel (UAP) reports a client's vital signs as tympanic temperature 37.1° C (98.8° F), pulse 92/min, respiratory rate 18/min, and BP 98/58 mm Hg. Which of the following vital signs should the nurse re-measure? A. BP B. Respiratory rate C. Pulse rate D. Temperature
Answer: A, the BP is low, the nurse is accountable, need to verify anything unusual B- RR normal 12-20 C- Pulse normal 60-100 D- Temp normal 36-38 celsius
The patient has been sleeping and has been lying on his right side. The nurse is ready to take his temperature using a tympanic thermometer. She needs to insert the thermometer into his __ ear. A. left B. right C. either D. neither
Answer: A Lying on right ear, may cause falsely elevated temp if taken in right ear
The nurse is teaching a patient how to use a metered-dose inhaler without a spacer. Which action by the patient demonstrates correct use of the device? A. Being careful not to shake the canister B. Positioning the mouthpiece in front of the mouth while not touching the lips C. Depressing the canister fully, waiting 3 to 5 seconds, then inhaling slowly and deeply D. Taking another puff of the medication within 10 seconds
Answer: B 2-4cm in front of open mouth, lips not touching A- should shake before administering C- depress while inhaling for 3-5 seconds D- wait 20-30 seconds between doses
When caring for a patient who has been restrained, how often will the nurse perform an assessment? A. Every 15 minutes B. Every 30 minutes C. Every hour D. Every 2 hours
Answer: B assess every 30 minutes
A patient requires a sterile dressing change for a mid-abdominal surgical incision. An appropriate intervention for the nurse to implement in maintaining sterile asepsis is to: A. put sterile gloves on before opening sterile packages. B. discard items that may have been in contact with the area below waist level. C. place the povidone-iodine bottle well within the sterile field. D. place sterile items on the very edge of the sterile drape.
Answer: B below waist is contaminated A- outside package not sterile- use clean gloves C- providone-iodine not sterile- require separate work surface D- edges contaminated- place sterile items in middle
A nurse caring for a client who has an infected wound removes a dressing saturated with blood and purulent drainage. How should the nurse dispose of the dressing material? A. Discard the dressing in the bedside trash receptacle B. Dispose of the dressing in a biohazardous waste container. C. Enclose the dressing in a single clear plastic bag and discard in the bedside trash receptacle. D. Double-bag the dressing in clear bags and label it "biohazard".
Answer: B dressing with blood and drainage is potentially infective- dispose as biohazardous A- regular trash could transmit pathogens to others C- not labeled as biohazardous D- need specific biohazard bag and container
A nurse is preparing to measure a client's level of oxygen saturation and observes edema of both hands and thickened toe nails. The nurse should apply the pulse oximeter probe to which of the following locations? A. Finger B. Earlobe C. Toe D. Skin fold
Answer: B earlobe is rarely edematous, least affected by decreased blood flow, greater accuracy measuring oxygen saturation A- edema interferes with capillary circulation, oximeter may not be able to get accurate reading C- nail thickening may interfere with accurate reading D- skin fold may not have adequate capillary circulation of hemoglobin to get accurate reading
The nurse is preparing an intramuscular injection for a thin elderly patient. The nurse is aware that the maximum volume most likely tolerated by this patient is which amount? A. 1 mL B. 2 mL C. 3 mL C. 5 mL
Answer: B elderly and thin patients tolerate max 2ml -normal adult can tolerate 2-5ml in larger muscles -unusual to administer more than 3ml because body does not absorb it well
The nurse is applying for a job at a local hospital. She wants to look her best for the interview and decides to wear artificial nails. She does this knowing that artificial nails: A. are appropriate in the ICU setting as long as the nurse washes her hands frequently. B. can lead to fungal growth under the nail. C. can actually lower the bacterial count on the hands because they cover the natural nail. D. are banned only in areas where patients are critically ill.
Answer: B fungal growth due to moisture trapped between natural nail and artificial nail A- ICU patients high risk for infection C- more likely to have pathogens on finger tips D- all persons are at risk for infection
A nurse is preparing to transfer a client who has left-sided weakness from the bed to a chair. Which of the following actions should the nurse plan to take? A. Raise the client's bed to the nurse's waist level. B. Use a gait belt to stand and pivot the client. C. Instruct the client to place his hands around the nurse's neck during the transfer. D. Place the chair on the client's weak side.
Answer: B gait belt decreases risk of injury to patient and nurse A- bed should be in lowest position so patient is closest to floor C- push up from bed with hands- not around neck D- place chair on patient's strong side so patient can use strong leg to stand and pivot
A nurse is assisting a client during ambulation when the client begins to fall. Which of the following actions should the nurse take? A. Assume a narrow base of support. B. Lower the client to the floor. C. Lean the client toward the wall. D. Provide support by holding the client's arm.
Answer: B gently lower client to floor A- want wide base of support (not narrow) C- leaning patient will affect their balance, makes the fall more difficult to control, increased risk of injury D- harder to support patient, can cause shoulder dislocation
The nurse is preparing to administer medication to a patient who is alert and oriented. When medications are reviewed with the patient, the patient states that he does not take metoprolol. Which action by the nurse is most appropriate? A. Ignore the patient's statement and give the medication. B. Withhold the medication. C. Convince the patient that the doctor ordered it, and he should take it. D. Give the medication and check the order afterward.
Answer: B if questions, do not ignore concerns- withhold until able to recheck
The nurse is preparing to provide a complete bed bath to a patient who has a running IV. She places a bath blanket over the patient and: A. removes the gown from the arm with the IV first B. removes the gown from the arm without the IV first. C. removes the gown after the bath to keep the patient warm. D. readjusts the IV rate before removing the gown.
Answer: B keep line intact to maintain a close system (prevent entry of microorganisms)
A nurse is teaching a client's partner about how to obtain a blood pressure reading. Which of the following actions by the partner indicates a need for further instruction? A. Wraps the blood pressure cuff snugly around the client's arm B. Places the client's arm above the level of the client's heart C. Checks the instrument gauge to ensure the reading starts at zero D. Centers the cuff bladder over the client's brachial artery
Answer: B place arm at heart level for accurate reading
What should the nurse do before starting a patient's bed bath? A. Lower the bed. B. Offer the bedpan or urinal. C. Partially undress the patient. D. Place the head of the bed in high-Fowler's position.
Answer: B prevent interruption of bath for voiding A- raise bed to comfortable working height C- remove clothing, use bath blanket to cover patient D- head of bed 30-45 degrees
To assist the patient to a sitting position on the side of the bed, what should the nurse do first? A. Raise the height of the bed. B. Raise the head of the bed 30 degrees. C. Turn the patient onto the side facing away from the nurse. D. Move the patient's legs over the side of the bed.
Answer: B raise head of bed to decrease work to raise supine patient to sitting position A- bed should be in lowest position C- turn patient to face nurse after raising head of bed D- position legs after raising head of bed and turning patient
A nurse is developing a plan of care for a client who has a stage 3 pressure ulcer. Which of the following interventions should the nurse include in the plan? A. Apply a heat lamp twice a day. B. Reposition the client at least every 2 hr. C. Clean the wound with hydrogen peroxide solution. D. Massage reddened areas with dressing changes.
Answer: B reposition to reduce pressure A- heat lamp is drying, want moisture for increased healing C- hydrogen peroxide is drying, dot not promote healing D- massaging can damage fragile capillaries and increase tissue necrosis
The patient is an elderly male with severe kyphosis who is immobile from a stroke several years earlier. He has been admitted for severe dehydration. The nurse must turn the patient frequently to prevent complications of immobility. What does the nurse realize? A. This patient should be turned onto his back for meals. B. This patient may have to be turned more frequently than every 2 hours. C. This patient may be allowed to remain in his favorite position as long as he doesn't complain of discomfort. D. Skin breakdown is not an issue for this patient.
Answer: B risk for skin breakdown- need for more frequent position changes A- severe kyphosis cannot lie supine
The nurse enters the patient's room to give medications. Which action is most appropriate to identify the "right patient"? A. Ask the patient to state his name. B. Ask the patient to state his name and birth date. C. Ask the primary nurse to identify the patient. D. Say the patient's name and date of birth and request patient validation.
Answer: B two identifiers
A nurse is preparing to perform hand hygiene. Which of the following actions should the nurse take? A. Adjust the water temperature to feel hot. B. Apply 4 to 5 mL of liquid soap to the hands. C. Hold the hands higher than the elbows. D. Rub hands and arms to dry.
Answer: B, 4-5ml liquid soap is adequate amount to produce lather and kill microorganisms A- use warm water not hot to decrease loss of protective oil on skin C- should hold hand lower than elbow D- pat hands dry without rubbing- rubbing leads to chapped skin and breakdown
A nurse is planning care for a client who has a decreased level of consciousness. The client is receiving continuous enteral feedings via a gastrostomy tube due to an inability to swallow. Which of the following is the priority action by the nurse? A. Observe client's respiratory status. B. Elevate the head of the client's bed 30° to 45° C. Monitor intake and output every 8 hr. D. Check residual volume every 4 to 6 hr.
Answer: B, elevate head of bed to promote gastric emptying and decrease risk of aspiration A, C, and D are all appropriate but not priority
A nurse is removing personal protective equipment (PPE) after giving direct care to a client who requires isolation. Which of the following PPE items should the nurse remove first? A. Gown B. Gloves C. Face shield D. Mask
Answer: B, gloves most contaminated, remove first Removal order: gloves, gown, face shield, mask
A nurse is teaching an unlicensed assistive personnel (UAP) about using personal protective equipment while caring for clients. Which of the following statements should the nurse identify as an indication that the UAP understands the instructions? A. "I will wear gloves whenever I am in contact with clients." B. "I will wear gloves and a gown when bathing a client who has open skin lesions." C. "I will wear gloves to minimize the number of times I have to wash my hands." D. "I will wear gloves when measuring a client's blood pressure."
Answer: B, open skin lesions could involve bodily fluids A- do not need to wear gloves unless coming into contact with bodily fluids C- Need to change gloves and perform hand hygiene between tasks and between patients D- Do not need to wear gloves unless coming into contact with bodily fluids
A nurse is working with a licensed practical nurse (LPN) to care for a client who is receiving a continuous IV infusion. Which of the following findings reported by the LPN indicates to the nurse the client has phlebitis at the IV insertion site? A. "The infusion rate has stopped but the tubing is not kinked." B. "The area surrounding the insertion site feels warm to the touch." C. "There is fluid leaking around the insertion site." D. "There is no blood return when the tubing is aspirated."
Answer: B, should feel cool- warmth means infection or phlebitis A, C, and D are all associated with infiltration not phlebitis
A nurse is providing teaching to a new nurse about caring for clients with restraints. Which of the following statements by the new nurse indicates an understanding of the teaching? A. "I will tie restraints in double knots." B. "I will tie a restraint to the portion of the bed that moves when the head of the bed is moved." C. "I will ensure that restraints fit tightly against the client." D. "I will put four side rails up if a client is confused."
Answer: B A- need quick release, not double knots C- can interfere with ventilation or circulation D- all 4 side rails causes additional confusion and increased risk of injury
The nurse is preparing a liquid medication. Which action is most appropriate? A. Pour the liquid medication toward the label. B. Draw the liquid quickly into a syringe. C. Place the medication cup on a flat surface at eye level. D. Measure the poured liquid to the top of the meniscus.
Answer: C accurately see amount at base of meniscus A- pour away from label so label does not get wet B- draw slowly to prevent air bubbles D- based of meniscus
When teaching about the procedure for capillary puncture, the nurse instructs a patient to: A. hold the finger upright. B. use the central tip of the finger. C. allow the antiseptic to dry completely. D. vigorously squeeze the end of the finger
Answer: C alcohol left on skin can cause hemolysis A- hold finger in dependent position B- puncture lateral side of finger, not central tip D- gently massage toward puncture site to increase blood flow
An appropriate principle of surgical asepsis is that: A. the entirety of a sterile package is sterile once it is opened. B. all of the draped table, top to bottom, is considered sterile. C. an object held below the waist is considered contaminated. D. if the sterile barrier field becomes wet, the dry areas are still sterile.
Answer: C below waist is contaminated A- once opened, 1 inch border unsterile B- table drapes sterile only at table level D- sterile barrier that gets wet is contaminated
A nurse is administering an oral medication to an older adult client. The client states, "The pill I always take is green. I don't take an orange pill." Which of the following responses should the nurse make? A. "Sometimes the same pill comes in a different color." B. "Let me explain the purpose of the medication." C. "I will check your medication order again." D. "This is the medication that your doctor wants you to take."
Answer: C check order to prevent error A- check- don't just justify B- check first then explain D- check- don't just justify
The home health nurse evaluates the provision of intermittent tube feedings by the patient's family member. The nurse notes that additional teaching is required when she notices that the family member: A. keeps the formula refrigerated between feedings. B. keeps the feeding tube capped between feedings. C. begins the feeding before checking tube placement. D. irrigates the tube with 30 to 60 mL of water before and after feedings.
Answer: C check placement before each use
A nurse is giving change-of-shift report using SBAR to the oncoming nurse on a client who has a traumatic brain injury. Which of the following information should the nurse include in the background segment of SBAR? A. Glasgow results B. Intracranial pressure readings C. Code status D. Plan of care changes for upcoming shift
Answer: C code status included in background A- Glasgow under assessment B- intracranial pressure under assessment D- plan or care under recommendations
A nurse is assessing an IV infusion site on an infant's left hand. Which of the following findings should the nurse identify as an indication of an infiltration? A. Blood in the IV tubing B. Absence of blanching at the insertion site C. Edema in the palm of the hand D. Warmth around the insertion site
Answer: C edema, pallor, coolness indicate collection of fluid leaking into subcutaneous tissue- infiltration A- can indicate disconnection of catheter from tubing B- blanching indicates infiltration D- warmth indicates phlebitis
The nurse is teaching a patient how to use a flow-oriented incentive spirometer (IS) the night before abdominal surgery. Which statement by the patient indicates an understanding of the procedure? A. "I need to get the balls to the top as quickly as possible." B. "Quick rapid breaths are the most effective when the incentive spirometer is used." C. "I need to keep the balls elevated as long as possible." D. "The balls must be elevated to be effective."
Answer: C ensure maximal sustained inhalation A and B- slow inhalation improves lung expansion D- even if balls do not elevate, exercise is still helpful
The patient is an elderly gentleman who has been on bed rest for the past several days. When getting the patient up, the nurse should: A. tell the patient not to move his legs when dangling. B. tell the patient to hold his breath while dangling. C. raise the head of the bed and allow a few minutes before dangling. D. have the patient stand without dangling.
Answer: C go slowly to avoid gravity induced decrease in blood pressure A- moving legs promotes venous return B- take deep breaths when dangling D- dangling is intermediate step for assessment to prevent injury
During his initial screening, the patient's blood pressure was noted to be elevated. Two months after the first assessment, he was noted to have a blood pressure of 150/92 and 166/96 at different times during the visit. It is now a month and a half later, and the nurse is concerned because the patient's initial blood pressure on this visit was 154/94. She is preparing to take a second blood pressure, understanding that another reading in this range could lead to a diagnosis of: A. hypotension. B. prehypertension. C. hypertension. D. orthostatic hypotension.
Answer: C hypertension is BP>140/90 on separate readings A- hypotension is systolic BP<90 B- prehypertension would be less than hypertensive, high risk for hypertension, need lifestyle changes D- orthostatic hypotension is decrease in BP when changing to an upright position
The nurse is caring for a patient with an ostomy. The nurse notes that the ostomy is putting out watery effluent. The nurse recognizes that this is indicative of which location? A. Descending colon B. Sigmoid colon C. Ileal portion of the small-intestine D. Transverse colon
Answer: C ileostomy- stool will be watery to thick liquid A and B- similar to normal consistency D- still will be thick liquid to semi formed
When discussing the collection of a clean-voided urine specimen, it is important for the nurse to instruct the patient to: A. use a clean specimen cup. B. collect 100 to 150 mL of urine for testing. C. void some urine first and then collect the sample. D. wash the perineal area with soap and water immediately before voiding.
Answer: C initiate urine stream then pass container into stream A- sterile specimen cup (not clean) B- 90-120ml D- antiseptic solution (not soap and water)
While giving the patient a bed bath, the nurse notices a reddened area on the patient's coccyx. The nurse should: A. decrease the temperature of the bath water. B. massage the reddened area to decrease the redness. C. apply topical moisturizing agents to the area. D. ignore the redness because it will return to normal soon.
Answer: C moisture helps A- decreased water temperature causes chilling B- do not massage- causes more damage D- do not ignore- indicates injury
A nurse is caring for a client who is receiving oxygen therapy via a nasal cannula. The nurse explains to the client that this method of oxygen delivery does which of the following? A. Delivers a constant rate of a specific concentration of oxygen B. Delivers a high concentration of oxygen C. Delivers a low concentration of oxygen D. Restricts the client's ability to eat, speak, or drink
Answer: C nasal cannula low concentration of oxygen 24-44% A- venturi mask B- nonrebreather mask D- face mask
The nurse is teaching a family member of an obese patient how to administer a subcutaneous insulin injection to the patient. Which instruction should be included in the teaching plan? A. Carefully massage the site after the injection to aid absorption. B. Draw the medication into a tuberculin syringe with a 27-gauge needle. C. Insert the needle quickly and firmly at a 90-degree angle. D. Rotate injection sites between the abdomen, thighs, and upper arms.
Answer: C obese patient- pinch skin, insert 90 degrees A- massage can damage underlying tissue B- need to use insulin syringe D- rotate sites within region- maintains consistent insulin absorption day to day
The patient has eyedrops ordered daily to both eyes. Which action by the nurse is appropriate when administering the medication? A. Carefully place the drop on the cornea. B. Wipe the eye with a tissue after placing the eyedrop. C. Hold the eyedropper about 1 to 2 cm above the eye. D. Instruct the patient to squeeze the eye shut after instillation.
Answer: C prevents accidental contact of dropper to eye, decreases risk of injury and transmission of organisms A- drops on cornea stimulate blink reflex B- place tissue below eyelid so med that escapes is absorbed D- squeezing eyes forces med out
A nurse is providing preoperative teaching for a client who will undergo surgery. The nurse explains that the client will wear antiembolism stockings during and after the procedure. When the client asks what the stockings do, which of the following responses should the nurse make? A. "They protect your legs and heels from skin breakdown." B. "They help keep you warm after your surgery." C. "They improve your circulation to keep blood from pooling in your legs."
Answer: C promote venous return from legs, preventing venous thrombosis and peripheral edema A and B- not intended purpose
A nurse is orienting a new unlicensed assistive personnel (UAP) to the unit. For which of the following actions should the nurse intervene? A. Wears a gown when entering the room of a client who requires contact precautions B. Dons gloves to empty a urinary drainage device C. Washes and rinses her hands for 10 seconds D. Wears a respirator mask when entering the room of a client who requires airborne precautions
Answer: C should wash hands for at least 20 seconds A- contact precautions requires gowns B- wear gloves when in contact with bodily fluids D- airborne precautions require respirator mask
An appropriate technique for the nurse to implement when moving a patient out of bed to a chair with a mechanical lift is to: A. Lower the height of the bed B. Lower the head of the bed C. Place the sling from shoulders to knees D. Keep the check valve open when the patient is seated in the chair
Answer: C shoulders to knees supports body weight equally A- raise height of bed for nurse body mechanics B- raise head of bed to place patient in sitting position D- close valves after patient in chair to avoid injury
While washing the patient's face, the nurse should: A. wash the eyes using soap and warm water. B. wash the eyes from outer canthus to inner canthus. C. wash the eyes with plain warm water. D. use the same portion of the washcloth.
Answer: C warm water only A- no soap- irritates eyes B- inner to outer- prevents secretions from entering duct D- uses separate sections to decrease infection transmission
A nurse is caring for a client who is postoperative and has a prescription for antiembolic stockings. Which of the following actions should the nurse take? A. Apply the stockings while the client is sitting in a chair. B. Remove the stockings once each day. C. Check the stockings for wrinkles. D. Measure the size of the client's foot.
Answer: C wrinkles can increase risk of skin breakdown or decrease circulation A- apply in bed to decrease risk for dependent edema B- remove stockings every shift to assess skin D- measure circumference of calf and thigh to determine size before obtaining stockings
A patient is planning to perform incentive spirometry after abdominal surgery. The nurse should encourage the patient to do which of the following? A. Get comfortable in a semi-reclined position. B. Inhale as deeply as possible and then exhale into the incentive spirometry device. C. Hold the breath for at least 3 seconds before exhaling D. Exhale as quickly as possible.
Answer: C A- most erect position tolerated to promote lung expansion B- exhale then inhale through device D- slow deep breath in, hold it, exhale normally
The patient is an elderly man who has just been admitted for a probable stroke. The patient is nonverbal and does not respond to requests but is able to turn himself in bed. The nurse notices that the patient likes to lie on his right side, and soon after being turned by the nursing staff, the patient turns back to his right side. The nurse in this case should: A. allow the patient to lie on his right side continuously because he seems comfortable. B. prevent the patient from lying on his right side until he no longer wishes to lie on that side. C. frequently assess the patient and turn him more frequently D. allow the patient to lie on his right side until a pressure ulcer develops and he can no longer lie on that side.
Answer: C A- not turning increases risks of immobility B- decreased number of sides available for turning, decreased comfort D- prevent ulcers
What should the nurse do once she recognizes that the patient has phlebitis at his intravenous (IV) catheter site? A. Reduce the IV flow rate. B. Elevate the affected extremity. C. Place a moist warm compress over the site. D. Adjust the additive in the current IV.
Answer: C A- stop infusion and discontinue IV site, start new IV if IV therapy still indicated B- elevate for infiltration to reduce edema D- stop the infusion
A nurse is caring for a client who came to the emergency department with abdominal distention and is now on the medical-surgical unit with an NG tube in place to low gastric suction. The client is reporting anxiety, discomfort, and a feeling of bloating. Which of the following actions is the nurse's priority? A. Request a prescription for a medication to ease the client's anxiety. B. Irrigate the NG tube with 100 mL of sterile water. C. Check to see if the suction equipment is working. D. Remove and reinsert the NG tube.
Answer: C, assess- if suction malfunctioning, adjust/replace it A- may be necessary at some point but not priority B- not first action D- not first action
A nurse is preparing a client's evening dose of risperidone when the tablet falls on the countertop. Which of the following actions should the nurse take? A. Use the tablet's packaging to pick it up from the counter. B. Wash the tablet off with alcohol and place it in a clean medication cup. C. Discard the tablet and obtain another dose of medication. D. Place the tablet directly into a medication cup.
Answer: C, follow medical asepsis for medication administration- if dropped, may be contaminated, must discard A- may still be contaminated B- tablets begin to disintegrate when wet D- may still be contaminated
A nurse on a medical unit is teaching a group of unlicensed assistive personnel about handling clients' bed linens safely. Which of the following instructions should the nurse include? A. Return any fresh linen not used for a client to the linen supply area. B. Use double bagging to remove soiled linen from the client's room. C. Tie linen bags securely at the top. D. Fill linen bags with as much soiled linen as possible.
Answer: C, keep soiled linen from contaminating surfaces or hands of future bag handlers A- any linen needs laundering before using for another patient B- double bagging does not prevent/control infection D- overfilling bags increases risk of spilling and contaminating
A nurse is providing oral care for a client who is immobile. Which of the following actions should the nurse take? A. Use a stiff toothbrush to clean the client's teeth. B. Use the thumb and index finger to keep the client's mouth open. C. Turn the client on his side before starting oral care. D. Apply petroleum jelly to the client's lips after oral care.
Answer: C, side position helps fluids run out of mouth by gravity, prevents aspiration/choking A- soft toothbrush not stiff to avoid gum injury B- use oral airway to keep mouth open, not fingers D- use water soluble lubricant not petroleum jelly
A nurse is caring for a client who has an infection. The nurse should use which of the following strategies to prevent the transmission of the client's infection? A. Changing the client's bed linens each day B. Encouraging the client to consume a high-protein diet C. Performing hand hygiene before, during, and after direct contact with the client D. Placing the client in a room with positive-pressure airflow
Answer: C A- changing linens maintains clean environment but does not stop transmission of infection B- high protein diet helps patient fight infection but does not prevent transmission D- positive pressure keeps pathogens from entering room (used for immunocompromised patients) but will not prevent transmission out from infected patient's room
A nurse is preparing to administer ophthalmic solution to a client. Which of the following actions should the nurse take? A. Instill the drops into the inner canthus. B. Approach the client's eye from below it. C. Hold the ophthalmic solution 2 cm (3/4 in) above the lower conjunctival sac. D. Ask the client to look down when instilling the solution.
Answer: C A- instill into the outer third of the conjunctival sac beneath the lower lid B- approach eye from side- less likely to blink D- ask patient to look up to ceiling- less likely to blink
An appropriate method of assessing a patient's respirations is for the nurse to: A. place the bed flat B. remove all supplemental oxygen sources from documentation. C. explain to the patient that respirations are being assessed. D. gently place the patient's hand in a relaxed position over the upper abdomen.
Answer: D A- prefer head of bed 45-60 degrees for full ventilation B- documentation should include supplemental oxygen C- inconspicuous assessment prevents alteration of rate/depth
A nurse is preparing to move a client who is only partially able to assist up in bed. Which of the following methods should the nurse plan to use? A. One nurse lifting as the client pushes with his feet B. Two nurses lifting the client under the shoulders C. One nurse lifting the client's legs as the client uses a trapeze bar D. Two nurses using a friction-reducing device
Answer: D (example- draw sheet)- reduces risk of injury to nurse and patient A- still need additional assistance B- lifting under shoulders puts strain on nurse and the patient C- still need additional assistance
A nurse is teaching a client's adult son about how to position the client when administering enteral feedings at home. Which of the following statements by the son indicates an understanding of the teaching? A. "I will allow him to be in the position where he is most comfortable during the feeding." B. "I will elevate the head of the bed 10 degrees during the feeding." C. "I will turn him on his left side during the feeding." D. "I will have him sit in his chair during the feeding."
Answer: D Fowlers position or sitting to promote gravitational flow, prevent aspiration of fluid into lung A- needs to be upright B- head of bed should be 30 degrees or more C- right side lying if can't be upright
What should the nurse do when discontinuing a peripheral intravenous (IV) catheter? Withdraw the catheter quickly. Keep the hub perpendicular to the skin. Apply pressure to the site for 1 minute. Inspect the catheter for intactness after removal.
Answer: D Note tip integrity and length A- withdraw using slow steady motion B- keep hub parallel to skin C- apply pressure 2-3 minutes, secure gauze with tape
The nurse has just inserted a nasogastric (NG) feeding tube into a patient. What should the nurse do to definitely ascertain that the tube is in the stomach or in the intestine? A. Test the pH of the contents. B. Use a carbon dioxide sensor. C. Lower the head of the bed to 15 degrees. D. Obtain an order for a xray.
Answer: D chest xray verifies placement A- pH testing helpful after xray confirmation B- CO2 sensor helpful after xray confirmation C- raise head of bed to 30 degrees minimum- does not verify placement but helps prevent aspiration
A nurse is assessing a client who has a wrist restraint applied. For which of the following findings should the nurse loosen the restraint? A. The client has a capillary refill of less than 2 seconds. B. The client has full range of motion in her wrist. C. The client is attempting to remove the restraint. D. The client's hand is cool and pale.
Answer: D cool and pale due to decreased blood flow- loosen restraint and exercise limb A and B- expected findings, no need to loosen C- ensure safety, do not loosen
The nurse is to administer several medications to a patient via a nasogastric (NG) tube. What should the nurse do first? A. Add the medications to the tube feeding being given. B. Crush all tablets and capsules before administration. C. Administer all of the medications mixed together. D. Check for placement of the NG tube.
Answer: D decreases risk of introducing fluids into respiratory tract A- never add meds to tube feeding B- not all tabs and capsules should be crushed C- give meds separately and flush 10ml in between (some meds are not compatible, decreases risk of clogging tube)
The nurse is teaching a patient how to inject low-molecular-weight heparin. What instruction should be included in the teaching plan? A. The injection can be given in the abdomen or the upper thighs. B. Before injecting the medication, be sure to expel the air bubble in the syringe. C. After inserting the needle, pull back on the plunger of the syringe before injecting the medication. D. After injecting the medication, apply gentle pressure to the injection site for 30 to 60 seconds.
Answer: D gentle pressure prevents bleeding at site A- abdomen minimizes pain and bruising B- prefilled syringe air bubble should not be expelled C- aspiration not necessary or recommended
A nurse is administering an IM injection to a client who has hepatitis C. Before placing the syringe and needle in a puncture-resistant container, which of the following actions should the nurse take? A. Recap the needle. B. Place the cap on the bedside table and slide the needle into the cap. C. Wrap the needle with gauze. D. Dispose of the needle uncapped.
Answer: D immediately place uncapped needle in sharps container A- recapping used needle inappropriate due to risk of needle stick B- still considered recapping, not appropriate for used needle C- unnecessary and increases risk for needle stick
A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which of the following actions should the nurse take? A. Assess the pedal pulses for a full minute. B. Assess the pedal pulses with a Doppler device. C. Assess the apical pulse with a Doppler device. D. Assess the apical pulse for a full minute.
Answer: D irregular pulse- count for 60 seconds A and B- assess apical pulse not pedal B and C- unless apical is difficult to auscultate, no need to use Doppler
A nurse is observing an unlicensed assistive personnel (UAP) changing the linens on the bed of a client who is immobile. Which of the following actions by the UAP should the nurse identify as an indication of the need to intervene? A. Raises the bed to waist level B. Rolls the client to one side of the bed C. Lowers the side rail on the side of the bed closest to the AP D. Reaches over the bed to straighten the fitted sheet
Answer: D poor body mechanics- one side at a time A- reach without straining to bend B- make one side of bed then roll patient back C- lower rail to make it easier- keep rail up on side the patient is turned toward to prevent injury
A charge nurse observes a nurse administer intermittent tube feedings via an NG tube to a client. Which of the following actions should prompt the charge nurse to intervene? A. The nurse initiates the feeding after aspirating 50 mL of gastric residual. B. The nurse irrigates the NG tube with tap water after feeding. C. The nurse administers the feeding through a syringe barrel by gravity. D. The nurse allows the client to rest in a supine position during feeding.
Answer: D raise head of bed to 30 degrees to prevent aspiration during feeding A- withhold feeding if residual >100ml B- flush after feeding to prevent clogging C- adjust flow by raising or lowering syringe
A nurse is caring for a client who has returned to the unit following a surgical procedure. The client's oxygen saturation is 85%. Which of the following actions should the nurse take first? A. Administer oxygen at 2 L/min. B. Administer prescribed analgesic medication. C. Encourage coughing and deep breathing. D. Raise the head of the bed.
Answer: D raising head of bed uses gravity to decrease pressure on diaphragm, allows increased lung expansion, promotes patent airway A- assess first, try less invasive interventions first B- not first action to help with oxygen saturation C- do after raising the head of the bed
When caring for a patient who has an arm or leg restraint in place, how often will the nurse remove the restraint? A. Every 15 minutes B. Every 30 minutes C. Every hour D. Every 2 hours
Answer: D remove every 2 hours
A nurse is preparing an in-service presentation for a group of newly licensed nurses about the use of restraints. Which of the following should the nurse include as a criterion for applying restraints? A. The provider must renew a restraint prescription every 8 hr. B. The client must understand the need for the restraints. C. The restraints should promote the client's safety and prevent injuries. D. The nurse has already considered alternatives to restraints.
Answer: D restraints are a last resort- consider alternatives first A- renew order every 24 hours B- patients in restraints are often confused- should not expect/require understanding C- restraints can cause injuries
The nurse is caring for a patient who has an ostomy. The nurse notices that the effluent ranges from a thick liquid to a semi-formed stool. The nurse recognizes that this is indicative of which location? A. Descending colon B. Ileal portion of the small-intestine C. Sigmoid colon D. Transverse or ascending colon
Answer: D thick liquid to semi formed A and C- similar to normal B- watery to thick liquid
When medications are administered, which action by the nurse is appropriate? A. Administering medications prepared by another nurse B. Using sterile technique for nonparenteral medications C. Leaving medication at the bedside when the patient is in the bathroom D. Documenting the reason for medication refusal
Answer: D when refusing- determine reason, educate, document, notify provider A- never administer med prepared by another nurse B- clean technique for nonparenteral, sterile technique for parenteral C- remain with patient as patient takes med, do not leave meds at bedside
A nurse is preparing to administer three liquid medications to a client who has an NG tube with intermittent suction. Which of the following actions should the nurse take? A. Mix the three medications together prior to administering. B. Dilute each medication with 10 mL of tap water. C. Reattach the suction directly after administering the medication. D. Pinch the tube prior to attaching the medication syringe.
Answer: D, after detaching the NG tube from suction, need to pinch/kink tube to prevent distention from air entering tube A- administer each med separately, flush with 15-30ml to ensure patient receives entire dose B- only dilute if indicated, use sterile water because tap water contains contaminants that can interact with meds C- clamp tube for 30 minutes after administering meds to allow time for med to absorb so it's not lost by suction
A nurse is preparing to administer the hepatitis B vaccine to a client. Which of the following techniques should the nurse use to locate the deltoid muscle? A. Locate the center of the arm between the elbow and the shoulder. B. Find the center of the anterior aspect of the thigh. C. Locate the middle third of the anterior thigh between the greater trochanter of the femur and the lateral femoral condyle. D. Place one finger across the acromion process and measure 3 fingerbreadths below to the midpoint and center of the lateral aspect of the upper arm.
Answer: D, identifies deltoid muscle for injection site A- not specific, maybe not muscle B- rectus femoris site, not deltoid C- vastus lateralis site, not deltoid
A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes? A. To confirm the placement of the NG tube B. To remove gastric acid that might cause dyspepsia C. To determine the client's electrolyte balance D. To identify delayed gastric emptying
Answer: D, if delayed emptying, should avoid overfeeding/distention A- test pH of residual to confirm placement B- return residual to stomach unless >100ml C- need lab testing of blood to determine electrolyte
A nurse in a long-term care facility is observing an unlicensed assistant personnel (UAP) changing the linen for a client who has fecal incontinence. Which of the following actions indicates that the UAP understands the principles of infection control? A. Shakes the soiled linen to remove any toilet paper remnants B. Places the soiled linen on the floor before bagging it C. Holds the soiled linen against her body while carrying it to the linen bag D. Places clean linen that touched the floor in the soiled linen bag
Answer: D, linen that touches floor needs laundering A- never shake linen- air currents spread pathogens B- never place on floor- spreads pathogen and needs to be handled twice C- hold linen away from body to prevent spreading pathogens to clothes
