The nurse is preparing the morning assignments. Which assessment could the nurse delegate to unlicensed assistive personnel? 1. Neurological assessment 2. Musculoskeletal assessment 3. Vital signs assessment 4. Female genital assessment ANSWER Correct Answer: 3 Rationale 1: The UAP cannot perform a neurological assessment. Rationale 2: The UAP cannot perform a musculoskeletal assessment. Rationale […]
A client is anxious about receiving general anesthesia for a surgical procedure. What should the nurse explain are the advantages of having this type of anesthesia? 1. The client remains conscious. 2. Respiratory rate can be regulated easily. 3. It is used for minor surgical procedures. 4. The anesthesia can be adjusted to the length […]
A client comes to the emergency department with a temperature of 104°F. Which assessment findings should the nurse use to determine if this client is experiencing heat stroke? 1. Delirious 2. Pale and dizzy 3. Skin warm and flushed 4. No evidence of sweating 5. Had been playing tennis in the sun ANSWER Correct […]
The nurse is about to palpate the client’s abdomen to determine the margins of the liver. The pri-mary reason for using the bimanual palpation method is to: 1. Minimize client discomfort 2. Minimize lower hand desensitivity 3. Assist in manipulation of the organ 4. Facilitate quick assessment of the abdomen ANSWER ANS: 2 When […]
The nurse is discussing skin care with a group of early teens (ages 13 to 15). Which of the fol-lowing is the most therapeutic response to the question, “How can I keep from getting bad skin?” 1. “Bad skin is a part of being a teenager; but don’t make it worse with poor hygiene habits.” […]
Regulatory interventions were initiated to reduce the rise in health care costs. These interventions include: 1. Prospective payment systems 2. State limits on health care fees 3. Federal guidelines for treatment 4. Court review of insurance coverage ANSWER ANS: 1 As a means to reduce health care costs, in 1983 Congress established the prospective […]
The nurse researcher is considering whether the findings of a project may present uncertain results in the clinical area. The criteria this researcher is reflecting on would be which of the following? 1. Significance 2. Researchability 3. Confidentiality 4. Variables ANSWER Correct Answer: 2 Rationale 1: Significance deals with whether the research problem has […]
A nurse implementing effective communication guidelines during an assessment interview when: 1. Looking directly at the client to ensure good eye contact. 2. Managing the conversation to avoid periods of silence. 3. Providing personal experiences to help the client focus. 4. Sitting in a chair next to the client who is in bed. 5. Keeping […]
Following a brain attack, the 45-year-old female client was very confused She was having diffi-culty responding appropriately to the nurse and to her family members. The client’s daughter was concerned that her mother was suffering from a mental breakdown, even though she had no history of mental illness. The best information that the nurse can […]
The UAP reports a small skin tear on the client’s forearm that occurred during a routine turn. After assessing the wound the nurse should take which action? 1. Obtain a transparent dressing for the UAP to place on the wound. 2. Request a consult with the wound care nurse. 3. Cleanse the wound and apply […]
