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RN Nursing School · Fundamentals · 573 questions

Safe, Effective Care Environment practice questions

Every question below is free to read with its full rationale. For timed sets, the rest of the bank and progress tracking on Safe, Effective Care Environment, practise in the app.

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  1. 1A nurse is assisting with triage following a mass casualty incident. Which client should be assigned a red tag?Answer →
  2. 2A newly licensed nurse has forgotten their password and asks another nurse to access the computer system for them so they can document care before transferring the client to another unit. Which of the following responses should the nurse make?Answer →
  3. 3A nurse is assisting with teaching a class on leadership. The nurse should include that which of the following are characteristics of laissez-faire leaders?Answer →
  4. 4The nurse manager is reviewing the unit census on a medical unit. Which action should concern the charge nurse?Answer →
  5. 5A nurse does not assist with ambulation of a postoperative client on the first day after surgery. The client falls and fractures a hip. What charge might be brought against the nurse?Answer →
  6. 6A new nurse plans care for a client with a brain injury who is experiencing increased intracranial pressure (ICP). The nurse has never cared for a client with ICP before, so the nurse refers to the policy and procedure manual on the hospital's intranet to determine appropriate care of the client. Which critical thinking attitude is reflected in the nurse's action?Answer →
  7. 7Select the 4 findings that require immediate follow-up.Answer →
  8. 8Which component of the MORAL decision-making model involves identifying all available alternatives?Answer →
  9. 9The occupational health nurse provides training to a nursing unit experiencing a rise in needlestick injuries. Which nurse behavior(s) demonstrate effective learning? Select all that apply.Answer →
  10. 10What is the most effective way to prevent the spread of pathogens?Answer →
  11. 11A nurse is caring for a client who has severe rheumatoid arthritis in her hands and is unable to feed herself. For which of the following health care team members should the nurse request a referral from the provider?Answer →
  12. 12Which client should nurse assign to UAP for ambulation?Answer →
  13. 13What type of law regulates the practice of nursing?Answer →
  14. 14A nurse is preparing to transfer a client who is immobile and weighs 104.3 kg (230 lb) from the bed to a stretcher. Which of the following actions should the nurse plan to take?Answer →
  15. 15A nurse manager has purchased a bladder scanner for the unit and assigns a nurse to function as a "super-user" to train others on the pursuit. Which standard of professional performance is the 'super-user' demonstrating?Answer →
  16. 16A nurse has accidentally punctured his finger with a needle he used to give an IM injection to a client. Which of the following actions should the nurse take?Answer →
  17. 17A nurse is caring for a client who has influenza and isolation precautions in place. Which of the following actions should the nurse take to prevent the spread of infection?Answer →
  18. 18A nurse is assisting a patient to ambulate for the first time after surgery. The patient becomes pale, diaphoretic, and reports dizziness. BP drops from 124/78 to 86/52 upon standing. The nurse's immediate action should be to:Answer →
  19. 19A nurse is using the family as a system approach to provide care to a patient. What should the nurse do?Answer →
  20. 20A client is scheduled for surgery in the morning, and the night shift nurse plans preoperative care. The nurse reads in the client's electronic health record that the client is HIV positive, but the client denies the diagnosis. The nurse suspects the client is lying, and to keep colleagues safe, the nurse calls the client's spouse to verify the diagnosis. How has the nurse breached the professional nursing code of ethics?Answer →
  21. 21A nurse is providing discharge teaching about oxygen equipment safety for a client. Which of the following information should the nurse include in the teaching?Answer →
  22. 22A nurse is caring for a client following bilateral knee replacement surgery and they require assistance with dressing. The nurse should report this information to which of the following interdisciplinary team members?Answer →
  23. 23A nurse is reinforcing teaching with a group of assistive personnel (AP) about infection control measures on the unit. The nurse should remind the APs that which of the following is the most effective way to prevent the spread of pathogens during client care?Answer →
  24. 24The nurse is caring for a client who has experienced a significant change in their condition after receiving medication. Which reporting tool should the nurse use to inform the healthcare provider about the client's condition?Answer →
  25. 25A nurse is planning care for a client who is scheduled for an intravenous pyelogram. Which of the following actions is appropriate for the nurse to include?Answer →
  26. 26What is the nurse's best action?Answer →
  27. 27A client is worried about safe water consumption for their upcoming camping trip. Which client statement should concern the nurse?Answer →
  28. 28A nurse is collaborating with a risk management team about potential legal issues involving client care. The nurse should identify that which of the following situations is an example of negligence?Answer →
  29. 29Which client should the nurse assess first?Answer →
  30. 30A nurse is removing a wound dressing that is saturated with blood and purulent drainage. Which of the following methods should the nurse use when disposing of the soiled dressing?Answer →
  31. 31A nurse is orienting a newly licensed nurse to charting by exception (CBE). Which documentation entry indicates the newly licensed nurse needs further teaching?Answer →
  32. 32A nurse is caring for a client with a central venous catheter (CVC). Which action by the nurse is most appropriate to prevent central line-associated bloodstream infections?Answer →
  33. 33Which of the following is a legal requirement for a nurse when a client wishes to leave the hospital against medical advice (AMA)?Answer →
  34. 34The nurse manager observes a staff nurse preparing to insert a urinary catheter without performing hand hygiene. What action should the nurse manager take?Answer →
  35. 35A nurse is working with two assistive personnel (AP). The nurse notes that one of the APs has been taking long breaks and making personal phone calls. Which of the following statements should the nurse make to resolve this conflict?Answer →
  36. 36A nurse is preparing to transfer a client from a bed to a chair. Which of the following actions should the nurse take?Answer →
  37. 37To ensure client safety, a nurse manager is planning to observe a newly licensed nurse perform a straight catheterization on a client. In which of the following roles is the nurse manager functioning?Answer →
  38. 38Based on the change of shift report, which client should the nurse assess first?Answer →
  39. 39The nurse educator is conducting a class for unlicensed assistive personnel (UAP). Which action indicates that a UAP understands gloving procedures?Answer →
  40. 40A registered nurse is assigning tasks to a licensed practical nurse (LPN) on a medical-surgical unit. Which of the following tasks is appropriate to delegate to the LPN?Answer →
  41. 41A nurse is developing a care plan for an older adult client who requires assistance to transfer from the bed to a chair after a hip fracture. The nurse writes a SMART goal to improve mobility. Which statement best demonstrates the attainable element of a SMART goal?Answer →
  42. 42During transfer to the medical unit, a client who experienced an acute change in level of consciousness became increasingly confused and combative, justifying soft wrist restraints for the client's upper and lower extremities. Which intervention is most important for the nurse to implement on admission?Answer →
  43. 43A nurse manager observes a nurse documenting a client assessment in the EHR. Which action by the nurse requires intervention by the nurse manager?Answer →
  44. 44The electronic medical record (EMR) computer shuts down while the nurse is entering the client's physical assessment data. Which should the nurse do first?Answer →
  45. 45A lawsuit has been brought against a nurse for malpractice. The client fell and suffered a skull fracture, resulting in a longer hospital stay and need for rehabilitation. Which element of liability does this description of the client's injuries represent in terms of proof of malpractice?Answer →
  46. 46A nurse is admitting a client who is at risk for falls to a medical-surgical unit. Which of the following actions should the nurse take?Answer →
  47. 47A nurse is reinforcing teaching about delegation with a newly licensed nurse indicates understanding? Which of the following statements if made by the newly licensed nurseAnswer →
  48. 48Which of the following is the ethical concept that promotes the concept of doing no harm?Answer →
  49. 49A client is postoperative day 1 after carpal tunnel release. Which finding requires immediate follow-up?Answer →
  50. 50Which of the four concepts common in all nursing theories is the most important to nursing?Answer →
  51. 51A nurse is assessing a client who has left-sided weakness following a stroke. Which of the following findings is the nurse's priority?Answer →
  52. 52A client recovering from a gastrointestinal infection has met all the set goals related to resolution of fever and Improvement in hydration status. What should the nurse do next?Answer →
  53. 53The nurse orienting a new patient to the unit would include:Answer →
  54. 54A nurse assesses a postoperative client and notes new numbness and cool toes in the affected leg. The nurse documents "continue to monitor" and does not notify the provider. The client later requires emergency treatment. Which legal issue is most consistent with this situation?Answer →
  55. 55Before developing a procedure, a nurse reviews all current research-based literature on insertion of a nasogastric tube. What type of nursing will be practiced based on this review?Answer →
  56. 56The nurse is assisting a client with an ileostomy appliance to shower. Which personal protective equipment (PPE) must the nurse use? Select all that apply.Answer →
  57. 57A nurse inserts an indwelling urinary catheter for a client who is preoperative. Three days later, the client develops a urinary tract infection. The nurse should identify that the client has which of the following types of infections?Answer →
  58. 58A nurse is assessing a client who is receiving a blood transfusion. The nurse notes lung crackles, hypoxia, and distended neck veins. Which of the following actions should the nurse take? (Select all that apply.)Answer →
  59. 59The nurse is triaging patients at the scene of an accident. Which patient is considered to be emergent?Answer →
  60. 60A nurse is assisting with teaching a newly licensed nurse about incident reports. Which of the following information should the nurse include?Answer →
  61. 61A nurse enters the room of a client who has a seizure disorder. The client is sitting in a chair and begins to experience a seizure. Which of the following actions should the nurse take first?Answer →
  62. 62A nurse is performing an admission assessment of a client. Which of the following actions should the nurse take when reconciling the client's medications?Answer →
  63. 63A nurse is preparing discharge planning for a client who underwent knee surgery. Which action best demonstrates effective discharge planning to ensure a smooth transition to home care?Answer →
  64. 64An assistive personnel (AP) asks a nurse what precautions he should take when measuring the vital signs of a client who has pneumonia. Which of the following responses should the nurse make?Answer →
  65. 65To ensure client safety, a nurse manager is planning to observe a newly licensed nurse perform a straight catheterization on a client. In which of the following roles is the nurse manager functioning?Answer →
  66. 66When the newly diagnosed client with insulin-dependent diabetes reports never having received instruction on the administration of injections, how will the nurse record this concern for use in care planning?Answer →
  67. 67A nurse is working in the pediatric intensive care unit. Which situation displays the ethical principle of justice?Answer →
  68. 68A nurse is caring for a client who is HIV-positive and is 1 day postoperative following an appendectomy. Which of the following actions requires the nurse to wear a gown as personal protective equipment (PPE)?Answer →
  69. 69A nurse is caring for a client who is to undergo a total knee arthroplasty. Which of the following actions should the nurse take when participating in the informed consent process?Answer →
  70. 70A client is questioning the need for surgery. The client asks the nurse, "What should I do?" Which answer by the nurse is based on advocacy?Answer →
  71. 71A nurse is caring for a client who had a stroke and coughs frequently when swallowing. The nurse should request a referral to which of the following members of the interdisciplinary team?Answer →
  72. 72A nurse is caring for a newly admitted client. What action should the nurse take first?Answer →
  73. 73A nurse is reinforcing teaching about delegation to an assistive personnel (AP) with a newly licensed nurse. Which of the following statements should the nurse include in the teaching?Answer →
  74. 74Which member(s) of the interprofessional collaborative team are included when discussing a client's treatment plan and projected outcomes? Select all that apply.Answer →
  75. 75A nurse is caring for a client who has recently been admitted to the hospital. Which action(s) should the nurse take to foster a positive relationship with the client's family? Select all that apply.Answer →
  76. 76The nurse should first address the client's risk for__ [blank1]__ due to the client's__ [blank2]__.Answer →
  77. 77A nurse administered pain medication to a client 45 minutes ago. Which action should the nurse take to evaluate the effectiveness of the medication?Answer →
  78. 78As a member of the healthcare team, the LPN understands that discharge planning for the hospitalized patient begins:Answer →
  79. 79The nurse implements a change in the approach to client care after gathering evidence in support of the new approach. Which action should the nurse take next?Answer →
  80. 80A nurse is planning care for a client with late-stage dementia who frequently becomes disoriented and attempts to leave the unit. Which intervention promotes client safety?Answer →
  81. 81The nurse is preparing to perform an eye irrigation as ordered for a client with an eye infection. Which action should be included in the plan to reduce the risk of complications?Answer →
  82. 82A home health nurse is teaching a client about home safety. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.)Answer →
  83. 83A home health nurse is teaching a client about home safety. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.)Answer →
  84. 84A nurse manager overhears a nurse telling a client, "I will administer your medication by injection if you don't swallow your pills." The nurse manager should identify that the nurse is committing which of the following torts?Answer →
  85. 85A nurse provides client care within a philosophy of ethical decision-making and professional expectations. What is the nurse using as a framework for practice?Answer →
  86. 86Rank the following activities according to the order in which they should be implemented. (Arrange the first activity on top and the last activity on the bottom.)Answer →
  87. 87A nurse is collecting data for a newly admitted client. Which of the following actions should the nurse take next?Answer →
  88. 88A nurse is documenting information in a computerized health record. Which of the following nursing actions jeopardizes client confidentiality?Answer →
  89. 89A nurse working on a medical-surgical unit suspects that several clients have Clostridium difficile (C. difficile) when they all develop watery diarrhea. Which of the following actions should the nurse plan to take while waiting for the client's lab results?Answer →
  90. 90A nurse on a medical-surgical unit is assisting with the admission of a client who has vision loss. Which of the following actions is the nurse's priority?Answer →
  91. 91The nurse cares for clients in the long-term care unit. The nurse is assisting a client with impaired vision to ambulate in the hallways. Which actions by the nurse are most appropriate for the nurse to perform? Select all that apply.Answer →
  92. 92A nurse is assessing a 4-year-old child brought to the emergency department with bruising. Which finding is most concerning for possible physical abuse?Answer →
  93. 93A nurse is providing discharge teaching for a client Who Will be receiving oxygen therapy at home. Which Of the following instructions should the nurse include in the teaching?Answer →
  94. 94A nurse is assisting with the admission of a client who has leukemia. Which of the following transmission-based precautions should the nurse implement?Answer →
  95. 95A nurse is working with a terminal pediatric client. While the parents are out of the room, the client asks the nurse if they are going to die. Which ethical principle requires the nurse to be honest with the client?Answer →
  96. 96A nurse is preparing a client for a procedure. Which of the following is an acceptable identifier to use identify the client?Answer →
  97. 97A nurse is working with an assistive personnel (AP) who refuses a client assignment. When resolving this conflict, which of the following comments is appropriate for the nurse to make?Answer →
  98. 98A nurse is preparing to collect a sterile urine specimen for culture and sensitivity from a client with an indwelling urinary catheter. Which action should the nurse take?Answer →
  99. 99Complete the following sentence by using the lists of options. The nurse should first address the client's risk for __ due to the client's Select...Answer →
  100. 100A nurse calls the provider about an adult client whose pain is not relieved by the current medication. The provider gives a new prescription over the phone. Which documentation action by the nurse is appropriate?Answer →
  101. 101A nurse is receiving report on a group of clients. Using the ABCDE priority framework, which of the following clients should the nurse see first?Answer →
  102. 102A nurse in an emergency department is caring for a client who is unconscious and requires surgery. There is no one available to give consent for the treatment. Which of the following actions should the nurse take?Answer →
  103. 103A nurse prepares to care for a client arriving to the unit who has been diagnosed with methicillin-resistant staphylococcus aureus (MRSA). For each potential nursing action, click to specify whether the action is appropriate or not appropriate.Answer →
  104. 104A nurse manager overhears a nurse telling a client, "I will administer your medication by injection if you don't swallow your pills." The nurse manager should identify that the nurse is committing which of the following torts?Answer →
  105. 105The nurse observes newly employed unlicensed assistive personnel (UAP) checking the temperature of an adult client using a tympanic thermometer. The UAP pulls the client's auricle up and back and prepares to insert the thermometer. Which action should the nurse implement?Answer →
  106. 106What action should a client take to reduce the risk of lead exposure?Answer →
  107. 107A nurse is caring for a 10-year-old child who has recurrent UTIs. Which of the following statements by the child should cause the nurse to suspect child maltreatment?Answer →
  108. 108A nurse is preparing to give an SBAR report for a postoperative client who has developed sudden confusion and low oxygen saturation. Which assessment detail should the nurse include in the "Assessment" portion to effectively communicate the client's current condition?Answer →
  109. 109A nurse is teaching a client about recognizing signs and symptoms of systemic and localized infection to notify the provider. Which of the following manifestations are associated with a localized infection versus a systemic infection? For each manifestation, indicate whether it is associated with a Localized Infection or a Systemic Infection.Answer →
  110. 110At 1000, the nurse enters the client's room. The first action the nurse should take is to A followed by BAnswer →
  111. 111Which medication error prevention technique(s) would have helped to avoid this error? Select all that apply.Answer →
  112. 112A home health nurse is conducting a home-safety risk appraisal for an older adult client. Which of the following findings should the nurse identify as a safety risk for the client? (Select All that Apply.)Answer →
  113. 113A nurse is caring for a client following bilateral knee replacement surgery and they require assistance With dressing. The nurse should report this information to which of the following interdisciplinary team members?Answer →
  114. 114To ensure client safety, a nurse manager is planning to observe a newly licensed nurse perform a straight catheterization on a client. In which of the following roles is the nurse manager functioning?Answer →
  115. 115A nurse is caring for a client who is scheduled for a cardiac catheterization. Which of the following allergies is most important for the nurse to report?Answer →
  116. 116A newly licensed nurse has forgotten their password and asks another nurse to access the computer system for them so they can document care before transferring the client to another unit. Which of the following responses should the nurse make?Answer →
  117. 117What goal should nurse manager set related to preventing falls?Answer →
  118. 118A nurse is giving a presentation about client confidentiality to a group of newly licensed nurses. Which of the following actions should he use as an example of a violation of confidentiality?Answer →
  119. 119The nurse inserts a prescribed urinary catheter into the client's urethra after the client has refused the procedure. The client suffers an injury. The client may sue the nurse for which type of tort?Answer →
  120. 120Which documentation displays the use of an approved abbreviation?Answer →
  121. 121A nurse is caring for a client who has a history of illicit IV drug use and asks that this information not be shared with their family. Which of the following responses should the nurse make?Answer →
  122. 122What is the best way for a nurse to protect themselves from disciplinary action?Answer →
  123. 123The home health nurse is reviewing the personal care needs of an older adult client who lives alone. Which client assessment finding(s) indicates the need to assign unlicensed assistive personnel (UAP) to provide routine foot care and file the client's toenails? Select all that apply.Answer →
  124. 124A nurse is preparing documentation for a client who is being discharged and has a referral for home health. Which of the following documents should the nurse plan to include for the referral?Answer →
  125. 125What further action should nursing student take?Answer →
  126. 126At 1330, the nurse draws blood for the laboratory prescriptions and calls for a STAT chest x-ray (CXR). Which assessment finding(s) should the nurse need to document at 1330? Select all that apply.Answer →
  127. 127Nurses who assist clients to deal holistically with their health care needs at the end of their lives work primarily in which health care delivery system?Answer →
  128. 128A nurse is assisting with teaching a class on ethical principles. The nurse should include that protecting a client's safety by not causing harm refers to which of the following ethical principles?Answer →
  129. 129A client with unstable angina needs a cardiac catheterization, so the healthcare provider (HCP) explains the risks and benefits of the procedure, and then leaves to set up for the procedure. When the nurse presents the consent form for signature, the client hesitates and asks how the wires will keep the heart going. Which action should the nurse take?Answer →
  130. 130A nurse is using the Braden Scale to assess a client's risk for a pressure injury. Which of the following findings should the nurse identify as the greatest risk for developing a pressure injury?Answer →
  131. 131A nurse is providing discharge teaching about safety considerations to an older adult client who lives at home. The client has heart failure and a new prescription for hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching?Answer →
  132. 132A nurse is caring for a client who has influenza and isolation precautions in place. Which of the following actions should the nurse take to prevent the spread of infection?Answer →
  133. 133During self-evaluation, a nurse identifies a need to enhance their critical thinking skills in clinical practice. Which strategy should the nurse implement to improve these skills?Answer →
  134. 134A registered nurse (RN) is caring for four clients on a step-down unit and is planning to delegate tasks to the unlicensed assistive personnel (UAP). Which task is appropriate for the RN to delegate to the UAP?Answer →
  135. 135In general, how do most people view change?Answer →
  136. 136The nurse is assisting to lift a client from a wheelchair after surgery. To ensure safe mobility, which action should the nurse take?Answer →
  137. 137Which action is most important for the nurse to document when caring for a client with mitten restraints?Answer →
  138. 138The nurse educator is conducting a class for unlicensed assistive personnel (UAP). Which action indicates that a UAP understands gloving procedures?Answer →
  139. 139A nurse is caring for a newly admitted client who has vertigo and is at risk for falls. Which of the following actions should the nurse take?Answer →
  140. 140A nurse overhears two staff members in the facility elevator discussing a client's care. Which of the following federal statutes does this violate?Answer →
  141. 141An older adult client with unintentional weight loss and a decline in physical health reports skipping meals to save money for prescribed medications. Which action is best for the home health nurse to take?Answer →
  142. 142The nurse received shift report on a group of clients. Which client should the nurse assess first?Answer →
  143. 143A client with unstable angina needs a cardiac catheterization, so the healthcare provider (HCP) explains the risks and benefits of the procedure, and then leaves to set up for the procedure. When the nurse presents the consent form for signature, the client hesitates and asks how the wires will keep the heart going. Which action should the nurse take?Answer →
  144. 144A client living in a low-income neighborhood reports difficulty accessing healthcare services. Which action(s) should the nurse take? Select all that apply.Answer →
  145. 145Which part of the nursing process requires foundational knowledge to recognize abnormalities?Answer →
  146. 146A new grad RN is assigned to administer nasal medications to a stable post-operative patient who has expressed slight discomfort. The supervising RN needs to ensure safety. Which of the following should the supervising RN verify before delegating the task?Answer →
  147. 147A nurse administering an injection to a patient sustains a needlestick from the contaminated needle. What is the first thing the nurse should do?Answer →
  148. 148Which nursing action upholds autonomy?Answer →
  149. 149A nurse observes another nurse administer a PRN pain medication and then leave the client's room without documenting the medication or the client's response. The nurse is concerned this could lead to a medication error and harm the client. Which professional concept requires the nurse to address this concern?Answer →
  150. 150A nurse is preparing an in-service presentation about preventing health care-associated infections (HAIs). The nurse should include which of the following as a common cause of these infections?Answer →
  151. 151Which intervention should the registered nurse (RN) perform?Answer →
  152. 152A nurse is assessing a patient admitted to the hospital with complaints of left-sided weakness and difficulty speaking. Which assessment contains the data that best represent a nursing assessment?Answer →
  153. 153A nurse is caring for a post-surgical client ready to be discharged home. The client's vital signs are stable, the incision is healing well with no redness or swelling, and the client's most recent pain level is 2 on a 0–10 scale. What can the nurse infer from the objective data collected during the assessment?Answer →
  154. 154The nurse instructs an outpatient female patient preparing for an abdominal ultrasonography that prior to the procedure, she should:Answer →
  155. 155A nurse is changing the bed linen of a client admitted to the health care facility. Which isolation precaution should the nurse follow?Answer →
  156. 156Which intervention should be included as the nurse cleanses a wound?Answer →
  157. 157A nurse is planning care for a client who has a prescription for extremity restraints to both wrists. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)Answer →
  158. 158A nurse is reinforcing teaching with an assistive personnel (AP) about using personal protective equipment while caring for clients. Which of the following statements should the nurse identify as an indication that the AP understands the instructions?Answer →
  159. 159A nurse's inadvertent medication error results in a severe allergic reaction and prolongs the client's hospitalization. The client could rightfully sue the nurse for which of the following?Answer →
  160. 160The nurse is on the way to work and witnesses a motor vehicle accident. The nurse has a first aid kit in the car. No emergency medical personnel have arrived. What actions by the nurse would be protected by Good Samaritan laws? Select all that apply.Answer →
  161. 161A home health nurse is assessing the home environment of an older adult client who has osteoporosis. For which of the following findings should the nurse intervene?Answer →
  162. 162Which statement indicates need for further hand-hygiene teaching?Answer →
  163. 163A nurse in an emergency department is caring for a client who is unconscious and requires surgery. There is no one available to give consent for the treatment. Which of the following actions should the nurse take?Answer →
  164. 164Which resource utilization habit should nurses use?Answer →
  165. 165A client states, "I would prefer to have a female nurse perform my assessments because of my religious beliefs." What response by the nurse demonstrates the ethical principle of autonomy?Answer →
  166. 166A nurse evaluates a client wearing compression stockings for deep vein thrombosis (DVT) prophylaxis. Which finding requires follow-up?Answer →
  167. 167A nurse is discussing the process of obtaining provider prescriptions with a newly licensed nurse. Which of the following interventions requires a prescription?Answer →
  168. 168A nurse is caring for a client who had a stroke and coughs frequently when swallowing. The nurse should request a referral to which of the following members of the interdisciplinary team?Answer →
  169. 169A nurse enters a client's room to perform a focused assessment. Which of the following client information should the nurse use to properly identify the client?Answer →
  170. 170A newly licensed nurse has forgotten their password and asks another nurse to access the computer system for them so they can document care before transferring the client to another unit. Which of the following responses should the nurse make?Answer →
  171. 171A nurse is preparing to set up a sterile field. Which of the following actions should the nurse take?Answer →
  172. 172The nurse preparing a patient for a magnetic resonance imaging (MRI) should determine if the patient has:Answer →
  173. 173A 79-year-old client is admitted to the emergency department with respiratory distress. The client has diminished breath sounds bilaterally and arterial blood gas results indicate respiratory acidosis. Using the ABC prioritization framework, which nursing diagnosis should the nurse address first?Answer →
  174. 174The nurse is reviewing the client's medical record. Which of the following actions should the nurse take?Answer →
  175. 175A nurse is performing care for several clients with the help of an assistive personnel (AP). Which task should the nurse ask the AP to perform first?Answer →
  176. 176A nurse is evaluating an assistive personnel (AP) who is changing a client's bed linens. Which of the following actions by the AP demonstrates medical asepsis?Answer →
  177. 177A nurse is arrested for possession of illegal drugs. What kind of law is involved with this type of activity?Answer →
  178. 178A nurse is caring for a client who has a temperature of 39.7°C (103.5°F) and has a prescription for a hypothermia blanket. The nurse should monitor the client for which of the following adverse effects of the hypothermia blanket?Answer →
  179. 179A client is diagnosed with hospital-acquired catheter-associated urinary tract infection (CAUTI). The culture shows that the organism is methicillin-resistant staphylococcus aureus (MRSA). The client's blood pressure is 112/74, heart rate 80, respiratory rate 18, temperature 101.9 °F (38.8 °C), and 02 saturation 97%. As the nurse plans care for the client's new diagnosis, what is most important for the nurse to include in the plan as an initial intervention?Answer →
  180. 180The nurse is preparing an in-service on Health Insurance Portability and Accountability Act (HIPAA) violations. Which example should the nurse use to demonstrate a HIPAA violation?Answer →
  181. 181A nurse is caring for a client who has a terminal illness and has a living will that contains a do-not-resuscitate prescription. The client's partner says to the nurse, "I want my partner to be resuscitated if needed." Which of the following responses should the nurse make?Answer →
  182. 182A nurse is reviewing a client's medication list during admission. The client reports using a homeopathic product that is not listed in the electronic health record. What is an appropriate nursing action?Answer →
  183. 183A nurse-manager is implementing Shared Governance. What is the primary goal?Answer →
  184. 184A nurse opens a unit-dose of a prescribed medication prior to administering it to a client. The client refuses to take the medication. Which of the following actions should the nurse take?Answer →
  185. 185A nurse is caring for a client who had a stroke and coughs frequently when swallowing. The nurse should request a referral to which of the following members of the Interdisciplinary team?Answer →
  186. 186Select the 4 findings that require immediate follow-up.Answer →
  187. 187The charge nurse is observing a new nurse administering care during new hire orientation at the hospital. Which activity by the new nurse indicates correct body movement and posture to reduce the risk for injury?Answer →
  188. 188A nurse is reviewing with another nurse a method of documentation that includes data, action, and response (DAR) when charting client care. Which of the following methods of documentation is the nurse referring to?Answer →
  189. 189Which mode of value transmission is most likely to lead to confusion and conflict?Answer →
  190. 190A nurse fails to administer a medication that prevents seizures, and the client has a seizure. The nurse is in violation of the Nurse Practice Act. What type of law has the nurse violated?Answer →
  191. 191A nurse identifies a small fire in a client's room. After moving the client to safety, which of the following is the next action the nurse should take?Answer →
  192. 192A patient suspected of bacterial meningitis presents with fever, headache, and neck stiffness. What is the nurse's priority action?Answer →
  193. 193A nurse is caring for a client who is a practicing Jehovah's Witness. The health care provider prescribes two units of packed red blood cells based on the client's low hemoglobin and hematocrit levels. The nurse states to the health care provider that it is unethical to go against the client's beliefs even though the client's blood counts are very low. What is the best description of the nurse's intentions?Answer →
  194. 194Which situation constitutes breach of confidentiality?Answer →
  195. 195A nurse is completing an assessment on a newly admitted client. The nurse should collect subjective information such as (1) _____ and (2) _____, as well as objective information such as (3) _____.Answer →
  196. 196A nurse is transferring a client who has had a stroke to a rehabilitation facility. Which of the following information should the nurse include while using the SBAR tool to provide a report to the accepting nurse?Answer →
  197. 197A nurse is reviewing client assessment data to determine problems and issues related to fall risk. Which 2 assessment findings should the nurse identify as a potential fall risk? Identify two assessment findings.Answer →
  198. 198A nurse is reviewing ethical principles with a nursing colleague. Which of the following statements by the nursing colleague indicates an understanding of ethical principles?Answer →
  199. 199A nurse is assisting with teaching a class on leadership. The nurse should include that which of the following types of leaders uses rewards to meet goals?Answer →
  200. 200A client nearing the end-of-life requests that the client be given no food or fluids. The physician orders the insertion of a nasogastric tube to feed the client. What is the primary concern of the nurse providing care?Answer →
  201. 201A nurse is reviewing HIPAA policy. Which action is a violation?Answer →
  202. 202According to Maslow's basic human needs hierarchy, which needs are the most basic?Answer →
  203. 203Which is a current trend to watch in health care delivery?Answer →
  204. 204Which finding is concerning about incident report?Answer →
  205. 205A nurse is assisting with the admission of a client who has tuberculosis with a productive cough. Which type of isolation precautions should the nurse initiate for the client?Answer →
  206. 206A nurse preceptor corrects the graduate nurse who is applying restraints to a patient. Which action by the new nurse requires correction by the preceptor?Answer →
  207. 207A 70-year-old client is admitted to the medical unit with a diagnosis of renal stones and history of hypotension and knee replacement. Alert and oriented X3. Lungs clear to auscultation in all lobes. Regular heart rate and rhythm. Lower extremity pulses palpable. No edema noted. Skin warm and dry with old scars noted to bilateral knees. Abdomen soft and non-tender. Continent of bowel and bladder. Baseline vital signs: BP 100/66, heart rate 78, respiratory rate 16, temperature 97.9°F (36.6°C) and O2 saturation 96% on room air. Client reports going to the bathroom frequently. Which of the following should the nurse include in the plan of care? Select all that apply.Answer →
  208. 208A person who has been brought to the emergency room after being struck by a car insists on leaving, although the doctor has advised him to be hospitalized overnight. The nurse caring for this patient should:Answer →
  209. 209A nurse in an emergency department is assessing a client who reports right lower quadrant pain, nausea, and vomiting for the past 48 hr. Which of the following actions should the nurse take first?Answer →
  210. 210A nurse manager overhears a nurse telling a client, "I will administer your medication by injection if you don't swallow your pills." The nurse manager should Identify that the nurse is committing which of the following torts?Answer →
  211. 211The nurse is admitting a client during a time when the electronic medical record system is down, requiring the nurse to document on paper. What action should the nurse take to protect the client's confidential information?Answer →
  212. 212A nurse is preparing to administer a newly prescribed antibiotic to an older adult client with chronic kidney disease. The nurse notes that the ordered dose is higher than recommended for clients with reduced renal function and contacts the provider to clarify the prescription before administering the medication. Which ethical principle is the nurse demonstrating?Answer →
  213. 213A health care facility determined that a nurse employed on a medical unit was documenting care that was not being given, and subsequently reported the action to the State Board of Nursing. How might this affect the nurse's license to practice nursing?Answer →
  214. 214A nurse is teaching a class on leadership. The nurse should include that which of the following are characteristics of situational leaders?Answer →
  215. 215The nurse is assisting to lift a client from a wheelchair after surgery. To ensure safe mobility, which action should the nurse take?Answer →
  216. 216For each client finding, indicate if the finding has Improved or Declined.Answer →
  217. 217A newly licensed nurse is caring for an alert client who has a signed advance directive refusing intubation. The provider instructs the nurse to prepare for intubation "just in case". The nurse feels anxious, frustrated, and powerless but continues with the assigned tasks. Which term best describes the nurse's experience?Answer →
  218. 218A nurse is reinforcing teaching with a newly licensed nurse about health care-associated infections (HAIS). Which Of the following examples should the nurse include as examples of HAIs?Answer →
  219. 219Critical thinking... (Select all that apply)Answer →
  220. 220The nurse uses a sterile syringe to obtain a urine specimen from a client's indwelling urinary catheter. After placing the specimen in a biohazard bag, the nurse transports the specimen to the laboratory. During which part of this procedure should the nurse wear gloves?Answer →
  221. 221A nurse is caring for a group of clients. For which of the following tasks should the nurse plan to wear protective eye equipment? (Select all that apply.)Answer →
  222. 222The ANA Code of Ethics for Nurses was created to support which of the following foundational purpose(s)? Select all that apply.Answer →
  223. 223A nurse is planning to use the nursing process to care for a client who is experiencing grief. Which of the following actions should the nurse take first?Answer →
  224. 224A client has been diagnosed with influenza and placed on droplet precautions. Which intervention is essential to limit transmission of infection during transportation to another department?Answer →
  225. 225A nurse is planning care for a client who has a newly placed percutaneous endoscopic gastrostomy (PEG) tube and is agitated and confused. The provider prescribes bilateral wrist restraints. Which of the following actions should the nurse plan to take?Answer →
  226. 226A home health nurse is providing instructions for a client about fire safety within the home. Which of the following information should the nurse include in the teaching?Answer →
  227. 227A nurse is collaborating with a risk management team about potential legal issues involving client care. The nurse should identify that which of the following situations is an example of negligence?Answer →
  228. 228The first two actions the nurse should take are__ [blank1]__ and__ [blank2]__.Answer →
  229. 229What should the nurse prioritize when client wants to leave AMA?Answer →
  230. 230Complete the following sentence by using the lists of options. The first two actions the nurse should take are __ and __.Answer →
  231. 231Prior to the nurse transporting the patient to have a magnetic resonance imaging (MRI), the nurse must confirm that the patient:Answer →
  232. 232A nurse is providing a handoff report to the oncoming shift nurse. Which of the following actions should the nurse take to ensure continuity of client care?Answer →
  233. 233A nurse promises to return in 10 minutes to assist a client with showering, but does not come back until an hour later due to an emergency. Which ethical principle is being violated?Answer →
  234. 234A nurse is providing client care in a hospital setting. Who has full legal responsibility and accountability for the nurse's actions?Answer →
  235. 235A nurse is providing care to a client. Prior to exiting the client's room, the nurse ensures the client's bed is locked and their call light is within reach. Which of the following QSEN competencies is the nurse demonstrating?Answer →
  236. 236A medical-surgical nurse is caring for a client with a high risk for falls. Which action should the nurse take to promote environmental safety in the client's room?Answer →
  237. 237The nurse is prioritizing care for four clients. Which client should the nurse assess first?Answer →
  238. 238Which specimen collection should a registered nurse (RN) delegate to a licensed practical nurse (LPN) rather than an unlicensed assistive personnel (UAP)?Answer →
  239. 239Which of the following is objective data?Answer →
  240. 240A nurse is preparing to transfer a client who is immobile and weighs 104.3 kg (230 lb) from the bed to a stretcher. Which of the following actions should the nurse plan to take?Answer →
  241. 241Which is an example of nonmaleficence?Answer →
  242. 242A nurse is caring for an older adult client. Which of the following instructions should the nurse provide to decrease the risk of falls?Answer →
  243. 243A nurse is planning to use best practices to perform dressing changes. According to the steps of evidence-based practice (EBP), which of the following steps should the nurse plan to perform first?Answer →
  244. 244A nurse manager makes all of the decisions for staff activities. What type of leadership is demonstrated by this action?Answer →
  245. 245Which interventions can the nurse implement to help minimize the risk of falls in a client who has been identified as a high risk for falls?Answer →
  246. 246Which client would the nurse identify as having the greatest risk for latex allergies?Answer →
  247. 247A nurse administers the wrong medication to a client. After collecting data from the client. the nurse contacts the provider and completes an incident report. Which of the following components of professionalism is the nurse demonstrating?Answer →
  248. 248A nurse is reviewing privacy practices with a group of newly hired staff members. Which actions demonstrate compliance with HIPAA privacy regulations in a clinical setting? (Select All that Apply.)Answer →
  249. 249An alert, oriented male client is refusing a life-saving surgery because he does not want to live with a colostomy the rest of his life. His wife adamantly disagrees and tells her husband that their religious beliefs do not allow him to make such a decision. Which explanation should the nurse provide the wife?Answer →
  250. 250A nurse calls the physician regarding a client with a temperature of 102°F. The provider orders acetaminophen 650 mg PO every 6 hours for temperature greater than 101.5°F. What action ensures accuracy of the phone order?Answer →
  251. 251A nurse in an emergency department is caring for a client who is unconscious and requires surgery. There is no one available to give consent for the treatment. Which of the following actions should the nurse take?Answer →
  252. 252What action should the nurse take?Answer →
  253. 253The provider enters the following orders. The nurse should clarify which order BEFORE implementing? Provider Orders: 1. 0.9% Normal Saline IV at 125 mL/hr 2. Seizure precautions – padded rails, O₂ at bedside, suction ready 3. Hypertonic 31% Sodium Chloride via peripheral IV at 500 mL/hr 4. Serum sodium, Basic Metabolic Panel STAT and q4h 5. Strict I&O; notify provider if urine output < 30 mL/hrAnswer →
  254. 254A nurse is caring for a 72-year-old client with mild neurocognitive impairment who refuses a recommended blood transfusion. Which action is most appropriate for the nurse to take?Answer →
  255. 255A nurse is considering delegation using the Delegation Decision-Making Process (DDMP). Which factors should the nurse consider to enhance clear communication? Select all that apply.Answer →
  256. 256A journalist asks the nurse working in the emergency department (ED) about the condition of a local politician recently admitted to the medical center following a publicly reported building fire. Which action should the nurse take?Answer →
  257. 257A nurse-manager is using the principles of Theory Z to manage a nursing unit. Which of the following actions should the nurse-manager take?Answer →
  258. 258According to the Centers for Disease Control (CDC) what are some of the main safety concerns for Nurses? Select all that apply.Answer →
  259. 259Match the activity with the most appropriate person to do the activity. Each row must have one option selected.Answer →
  260. 260The nurse is caring for a client with a written DNR order. The nurse assesses and finds the client is not breathing. What nursing intervention is appropriate?Answer →
  261. 261The nurse is caring for a group of four clients. Which client should the nurse address first?Answer →
  262. 262A nurse is assigned a client who has been admitted to the health care facility with high fever. Which nursing skill should the nurse use at the first contact with the client?Answer →
  263. 263The charge nurse teaches a new floor nurse about care for a client's dialysis fistula. How should the charge nurse tell the new nurse to intervene when no bruit is heard, and no thrill is felt at the fistula site?Answer →
  264. 264When preparing a sterile field, which action(s) by the nurse would compromise the sterility? Select all that apply.Answer →
  265. 265A nursing student is performing a wound irrigation procedure. Which personal protective equipment (PPE) should the student prioritize wearing to prevent exposure to bodily fluids?Answer →
  266. 266A nurse is preparing to reposition a client who has a lower back injury. Which of the following actions should the nurse take?Answer →
  267. 267A nurse identifies that an older adult client is experiencing orthostatic hypotension. What should the nurse recommend to reduce fall risks in the home?Answer →
  268. 268A nurse is caring for a client on a medical-surgical unit who is attempting to leave the facility. Which of the following actions should the nurse take?Answer →
  269. 269A nurse is reviewing documentation completed by a newly licensed nurse. Which entry indicates a need for further teaching?Answer →
  270. 270A nurse is assigning care to an assistive personnel (AP). Which of the following tasks should the nurse delegate to the AP?Answer →
  271. 271When examining a patient, the nurse remembers to follow which principle of Standard Precautions?Answer →
  272. 272A nurse is caring for a client. One of the client's family members requests to view the client's medical record. Which of the following responses should the nurse make?Answer →
  273. 273A nurse is caring for a client who has influenza and isolation precautions in place. Which of the following actions should the nurse take to prevent the spread of infection?Answer →
  274. 274Which patient should the nurse assign to a private room?Answer →
  275. 275A nurse is evaluating a newly licensed nurse's understanding of advance directives. The newly licensed nurse should identify that which of the following individuals is responsible for deciding whether a client is capable of making their own decisions regarding medical treatment?Answer →
  276. 276A nurse is triaging care for clients in the emergency department. Which client requires immediate attention?Answer →
  277. 277A nurse is preparing to collect health history data during a client's admission. Which of the following questions should the nurse ask to promote this discussion?Answer →
  278. 278Who is legally responsible for a medication error?Answer →
  279. 279The nurse has assigned an unlicensed assistive personnel (UAP) to assist bathing a client who has influenza and is on droplet precautions. The UAP requests a change in assignment, informing that she has not yet been fitted for a particulate mask. Which action should the nurse take?Answer →
  280. 280What are example(s) of indirect care? Select all that apply.Answer →
  281. 281Which mask is required for TB care?Answer →
  282. 282A nurse has provided care to a patient. Which entry should the nurse document in the patient's record?Answer →
  283. 283A home health nurse is assessing the home environment of an older adult client who has osteoporosis. For which of the following findings should the nurse intervene?Answer →
  284. 284A client is admitted with pneumonia and has a recent history of methicillin-resistant staphylococcus aureus (MRSA). The client is placed in isolation. While caring for the client, which item should the nurse place in a designated biohazard bag before it is removed from the room?Answer →
  285. 285The nurse caring for a client is documenting a SOAP note. In which section should the nurse document the client's vital signs?Answer →
  286. 286A nurse on a medical-surgical unit hears an assistive personnel (AP) tell a client, "If you don't stay in bed, I will tie you down." The AP has not touched the client. This behavior is most indicative of which legal issue?Answer →
  287. 287A student with influenza has fever, vomiting, and body aches. What stage of infection is this?Answer →
  288. 288The emergency department (ED) nurse is entering the room to perform a focused examination. A student nurse will assist in the examination. The nurse educates the student about standard precautions. For each statement, click to indicate whether the statement is true or false. Each row must have one option selected.Answer →
  289. 289A client is admitted with dry mouth, headache, chest pain and constipation. Which client finding requires priority follow-up by the nurse?Answer →
  290. 290A nurse is caring for a client on a medical-surgical unit. Which of the following actions should the nurse take to maintain the client's confidentiality?Answer →
  291. 291A nurse is inserting an intravenous catheter for a client which 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?Answer →
  292. 292A nurse is preparing to set up a sterile field. Which of the following actions should the nurse take?Answer →
  293. 293A patient who has undergone endoscopy is fully awake and asks the nurse for something to drink. After confirming that liquids are allowed on the primary care provider order sheet, the nurse should:Answer →
  294. 294A nurse is preparing to insert an indwelling urinary catheter for an adult client on a medical-surgical unit. Which action is most important to minimize the risk of a health care-associated infection?Answer →
  295. 295A client with an unknown identity is brought to the emergency department unconscious after a severe head injury and multiple fractures. An emergency craniotomy is urgently required. Given the client's inability to provide informed consent, what is the nurse's best action regarding consent for the surgical procedure?Answer →
  296. 296Which action describes a focused nursing assessment?Answer →
  297. 297A nurse is developing a care plan for an older adult client who has been experiencing frequent falls at home. Which action should the nurse include?Answer →
  298. 298A client is being discharged postsurgery. Which information provided by the client requires additional instruction by the nurse?Answer →
  299. 299The client is at high risk for 1 due to the client's 2.Answer →
  300. 300Which action should nurse take?Answer →
  301. 301A nurse participating in informed consent for a patient's surgical procedure would expect to do which of the following?Answer →
  302. 302A nurse is planning care for a client who has contact precautions in place. Which of the following actions should the nurse plan to take when removing soiled linens from the client's room?Answer →
  303. 303The home health nurse is reviewing the personal care needs of an older adult client who lives alone. Which client assessment finding(s) indicates the need to assign an unlicensed assistive personnel (UAP) to provide routine foot care and file the client's toenails? Select all that apply.Answer →
  304. 304Who is considered to be the founder of professional nursing?Answer →
  305. 305The nurse cares for a client who takes a potassium-wasting diuretic. The client's potassium level today is 3.1 (Reference: 3.5-5.2 mEq/L), and the client reports feeling lightheaded when getting out of bed. Which action by the nurse is best to ensure the client's immediate safety?Answer →
  306. 306Complete the following sentence by using the lists of options. The first two actions the nurse should take are select and selectAnswer →
  307. 307What legal document designates an agent to make healthcare decisions?Answer →
  308. 308A client receives the wrong medication in error. The nurse who made the medication error should do which of the following first?Answer →
  309. 309Which tasks can be delegated to an unlicensed assistive personnel (UAP)? Select all that applyAnswer →
  310. 310A nurse manager is educating new nurses about lateral violence in the workplace. Which behavior(s) indicate lateral violence? Select all that apply.Answer →
  311. 311A nurse is using a sterile swab from a culture swab kit to obtain a specimen for culture from a client's infected wound. Which of the following actions should the nurse take?Answer →
  312. 312A nurse is preparing to perform a sterile dressing change for a client. Which of the following actions should the nurse plan to take?Answer →
  313. 313A nurse enters the room of a client who has a seizure disorder. The client is sitting in a chair and begins to experience a seizure. Which of the following actions should the nurse take first?Answer →
  314. 314A nurse teaches a patient how to perform a fingerstick blood glucose test. After the teaching, the nurse asks the patient to demonstrate the procedure. Which best describes the nurse's action?Answer →
  315. 315An adult client has been hospitalized for the past three weeks due to complications experienced following elective surgery. When the client's condition first began to deteriorate, the client's spouse reminded the healthcare provider (HCP) that the client has a living will explaining the desire for a natural death. The HCP does not agree with the client's living will and refuses to honor it. Which action should the nurse take?Answer →
  316. 316A nurse is educating a client about the significant level of pain they can expect after surgery. Which ethical principle has the nurse demonstrated?Answer →
  317. 317The nurse enters the room to find the IV bag and tubing are empty and the central line cap is slightly loose. The patient suddenly complains of chest pain, shortness of breath, and becomes anxious. Which actions should the nurse take first?Answer →
  318. 318A nurse is explaining the purpose of informed consent to a client who is about to undergo surgery. Which of the following statements should the nurse make?Answer →
  319. 319A nurse at the competent stage in Benner's Novice to Expert model is assigned a group of patients in a busy acute care unit. How should the nurse prioritize and manage care to demonstrate competence in this clinical setting?Answer →
  320. 320A nurse requests that an assistive personnel (AP) change all the linens and give bed baths to four clients on the unit. The previous day, the AP was not able to complete these same tasks. Which of the following actions should the nurse take in addressing this situation?Answer →
  321. 321A nurse is assisting with teaching a newly licensed nurse about professionalism. The nurse should include that which of the following demonstrates unprofessional behavior by a nurse?Answer →
  322. 322Which information is accurate about the Affordable Care Act (ACA)? Select all that apply.Answer →
  323. 323A nurse is providing change-of-shift report to another nurse for a client using the Introduction, Situation, Background, Assessment and Recommendation (ISBARR) communication tool. Which of the following information should the nurse include as part of the situation component of this communication tool?Answer →
  324. 324A nurse is caring for a group of clients on an infectious disease unit. The nurse should wear an N95 respirator mask when caring for a client who has which of the following disorders?Answer →
  325. 325A charge nurse recognizes that the new RN is in need of further education regarding delegation when the charge nurse overhears the new RN make which statement to the UAP?Answer →
  326. 326A nurse is caring for multiple patients when an unexpected change in one patient's condition occurs, requiring immediate intervention. How should the nurse apply advanced time management principles during the implementation phase to ensure safe and effective care?Answer →
  327. 327An on-duty nurse discovers that a colleague is taking patients' medicines. According to the Nurse Practice Acts, what should the nurse do?Answer →
  328. 328A nurse is caring for a client who is experiencing a tonic-clonic seizure. Which of the following actions should the nurse take?Answer →
  329. 329A nurse is planning care for a client Who has a newly placed percutaneous endoscopic gastrostomy (PEG) tube and is agitated and confused. The provider prescribes bilateral wrist restraints. Which of the following actions should the nurse plan to take?Answer →
  330. 330A nurse is educating a new graduate nurse about accountability. Which information should the nurse include?Answer →
  331. 331A nurse is caring for a client whose end-of-life wishes conflict with those of their family. Which of the following actions should the nurse take first?Answer →
  332. 332The nurse working on a medical-surgical unit is administering 1800 medications. When the nurse enters the client's room, they have not consumed the dinner delivered at 1530 and have scheduled medications that need to be taken with food. The client states, "I don't eat dinner this early. My family always eats dinner around 8 PM." Which action by the nurse is most appropriate?Answer →
  333. 333A nurse manager is conducting an in-service training about lateral violence related to backbiting behavior towards staff members. Which of the following statements by a staff member indicates an understanding of the teaching? (Select all that apply.)Answer →
  334. 334A nurse evaluates a client's progress toward expected outcomes in a person-centered plan of care at the scheduled evaluation time. The nurse determines the outcomes have not been achieved. Which action should the nurse take next?Answer →
  335. 335A nurse is providing an in-service to a group of newly licensed nurses on the Nurse Practice Act (NPA). Which of the following is the first step in defining the scope of nursing in the NPA practice?Answer →
  336. 336A nurse is educating a parent regarding car seat safety for their 6-month-old infant. Which statement made by the parent indicates that further education is needed? (Select All that Apply.)Answer →
  337. 337A nurse is evaluating a newly licensed nurse's understanding of advance directives. The newly licensed nurse should identify that which of the following individuals is responsible for deciding whether a client is capable of making their own decisions regarding medical treatment?Answer →
  338. 338The client reports they are having second thoughts about surgery and question whether they want to go through with it. The nurse notifies the healthcare provider and the procedure is canceled. Which principle in the nursing code of ethics is the nurse upholding?Answer →
  339. 339A nurse is conducting an in-service for staff members about the Emergency Medical Treatment and Active Labor Act. Which Of the following statements by a staff member indicates an understanding of this act?Answer →
  340. 340A nurse is caring for a client who acquired hepatitis A from consuming contaminated food. The client's mouth is an example of which of the following links in the chain of infection?Answer →
  341. 341Which patient should the nurse place in the room furthest from the nurses' station?Answer →
  342. 342A nurse has completed morning care for a client who requires airborne precautions. Which of the following items of personal protective equipment (PPE) should the nurse remove first?Answer →
  343. 343When evaluating the effectiveness of a client's nursing care, the nurse first reviews the expected outcomes identified in the plan of care (POC). Which action should the nurse take next?Answer →
  344. 344A nurse is caring for a client with advanced dementia who cannot communicate. What action is most appropriate to ensure proper identification of the client?Answer →
  345. 345A nurse is caring for a client who requires airborne precautions. The nurse is preparing to leave the client's room following a dressing change. Which of the following pieces of personal protective equipment should the nurse remove first?Answer →
  346. 346The nurse has four clients that require a bladder scan. Which client is appropriate for delegation to the unlicensed assistive personnel (UAP)?Answer →
  347. 347A nurse is assisting with an in-service about hospital-acquired injuries to a group of staff. Which of the following conditions should the nurse include in the teaching as an example of a hospital-acquired injury?Answer →
  348. 348Given the registered nurse (RN) is working with a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP), which task should be delegated to the LPN?Answer →
  349. 349The nurse enters the room of a client with a Clostridium difficile (C-diff) infection to administer an IV antibiotic. The unlicensed assistive personnel (UAP) is in the room cleaning the client's buttocks and reports the client has been incontinent with diarrhea. The UAP is wearing gloves but not a gown. Which action should the nurse implement first?Answer →
  350. 350A nurse is assisting a client who has generalized weakness out of bed to a wheelchair. Which of the following actions should the nurse take?Answer →
  351. 351A nurse has been named as a defendant in a lawsuit. With whom should the nurse discuss the case?Answer →
  352. 352Which client/task assigned to UAP is inappropriate?Answer →
  353. 353The nurse has assigned unlicensed assistive personnel (UAP) to assist bathing a client who has influenza and is on droplet precautions. The UAP requests a change in assignment, informing that she has not yet been fitted for a particulate mask. Which action should the nurse take?Answer →
  354. 354While assessing a newly admitted client with left-sided weakness, the client's wife reports that the client has fallen at home three times in the past six months. To increase activity and prevent falls while the client is hospitalized, the nurse reinforces proper transfer techniques with the spouse. Place the actions to be taken when transferring the client from the bed to a chair in the correct order, from first to last.Answer →
  355. 355A nurse is caring for a client who has a prescription for a home health assessment. Which of the following actions should the nurse take?Answer →
  356. 356A nurse is caring for a client who is receiving a continuous IV infusion via an infusion pump that is malfunctioning. Which of the following actions should the nurse take?Answer →
  357. 357A registered nurse assigns the task of tracheostomy suctioning of a client to the licensed practical nurse (LPN). The LPN informs the nurse that the LPN has never performed the procedure on a client. Which is the most appropriate response from the registered nurse?Answer →
  358. 358Given the charge nurse is working with a Licensed Practical Nurse (LPN) and an unlicensed assistive personnel (UAP), which tasks should be delegated to the LPN? (Select all that apply)Answer →
  359. 359A nurse is teaching a group of newly licensed nurses about the Braden scale. Which of the following responses by a newly licensed nurse indicates an understanding of the teaching?Answer →
  360. 360A nurse identifies a small fire in a client's room. After moving the client to safety, which of the following is the next action the nurse should take?Answer →
  361. 361The risk management nurse is evaluating the unit for safety risks. Which environmental finding requires action?Answer →
  362. 362Which of the following are important nursing considerations during a paracentesis procedure? Select all that applyAnswer →
  363. 363A nurse is reviewing laboratory values for a client. Which of the following findings indicates the presence of an infection?Answer →
  364. 364A nurse is prioritizing care for four clients. Which client should be seen first?Answer →
  365. 365A nurse is caring for a client who requires airborne precautions. The nurse is preparing to leave the client's room following a dressing change. Which of the following pieces of personal protective equipment should the nurse remove first?Answer →
  366. 366A nurse is preparing to conduct a research study involving human participants. Which action best demonstrates the nurse's adherence to ethical principles of informed consent?Answer →
  367. 367A nurse is leaving the room after performing oral suctioning on a patient that is on contact and airborne precautions. In which order will the nurse perform doffing the personal protective equipment (PPE)? 1. Remove N95 respirator 2. Take off goggles 3. Remove gloves 4. Take off gown 5. Perform hand hygieneAnswer →
  368. 368A nurse is preparing to assess several clients in the hospital. The nurse should adhere to which principle(s) when assessing clients?Answer →
  369. 369An unlicensed assistive personnel (UAP) is assigned to take the vital signs of a client with pertussis for whom droplet precautions have been implemented. The UAP requests a change in assignment, verbalizing they have not been fitted for a particulate filter mask. Which action should the nurse take?Answer →
  370. 370A nurse reviews home safety strategies with a client who lives alone and has impaired vision. Which client statement indicates further education is required?Answer →
  371. 371Which step of the nursing process is the nurse performing when educating a client about how to do a blood glucose check?Answer →
  372. 372What is one way in which nurses can help shape health care reform?Answer →
  373. 373A nurse is preparing to dispose of a needle after administering an intramuscular injection to a client who has hepatitis C. Which of the following actions should the nurse take?Answer →
  374. 374A nurse is removing an isolation gown that has waist ties in the front after caring for a client who requires contact precautions. Which of the following steps should the nurse take?Answer →
  375. 375A nurse is planning an interview for a newly admitted client and plans to include the client's family members. Which of the following methods should the nurse use to determine who to include in the interview?Answer →
  376. 376An older adult has total care of the spouse, who has debilitating rheumatoid arthritis. The couple voices concern over the pain and stress associated with the condition. What type of care might the nurse suggest to help the couple?Answer →
  377. 377The nurse is caring for a patient in an intensive care unit who needs a bath. Which priority action will the nurse take to decrease the potential for a health care-associated infection?Answer →
  378. 378At what point during hospital-based care does planning for discharge begin?Answer →
  379. 379Complete the following sentence by choosing from the list of options. The scope of nursing practice defines the who of what nurses are legally permitted to perform. This is based on the nurseAnswer →
  380. 380In which step of the Clinical Judgment Measurement Model does the nurse focus on carrying out planned nursing interventions?Answer →
  381. 381seeks to avoid causing harm to clients in all situations. What is this principle known as?Answer →
  382. 382A nurse delegates the application of wrist restraints for a client who is confused to an assistive personnel (AP). The AP padded the wrist restraints and secured the straps to the bed frame with a double knot. Which of the following actions should the nurse take?Answer →
  383. 383The infection prevention nurse provides a staff in-service on the prevention of catheter-associated urinary tract infections (CAUTI). For each staff statement, click to specify whether the statement demonstrates effective learning or requires further education.Answer →
  384. 384The nurse received shift report on several clients. Which client should the nurse assess first?Answer →
  385. 385A nurse caring for a client with a surgical wound asks the surgical resident to come and further assess the wound deterioration. Which part of the ISBAR communication process is the nurse using?Answer →
  386. 386Which of the following actions are part of the isolation precautions for this client?Answer →
  387. 387Complete the sentence by using the drop down lists. The nurse is preparing to communicate client information during a transition of care. The nurse communication tool is ________ most appropriate for communication with the ________.Answer →
  388. 388Which statement accurately describes advocacy, responsibility, accountability, and confidentiality in professional nursing practice?Answer →
  389. 389A nurse is providing a handoff report to the oncoming shift nurse. Which of the following actions should the nurse take to ensure continuity of client care?Answer →
  390. 390Which precaution is required for active TB?Answer →
  391. 391Patients are at risk for which of the following safety concerns while in healthcare facilities? Select all that applyAnswer →
  392. 392The nurse is caring for a client with type 2 diabetes mellitus who had surgery for a large bowel resection with a colostomy placement. The client has now developed hyperglycemia which requires self injections of insulin after discharge. When designing the postoperative plan of care, which outcome statement should the nurse use?Answer →
  393. 393A nurse observes another nurse performing a procedure in the incorrect sequence. The procedure does not harm the client. Which of the following actions should the nurse take first?Answer →
  394. 394A nurse on a medical unit is caring for a client who suddenly becomes confused and drowsy. Additional data includes pulse 90/min, respiratory rate 22/min, BP 132/84 mm Hg, and temperature 36.8° C (98.2° F). Which of the following actions should the nurse perform?Answer →
  395. 395A patient's condition warrants a transfer from intensive care to a regular nursing unit in the same acute care facility. Before assisting with the patient's move, the nurse notes that the transfer has been authorized by the:Answer →
  396. 396A nurse is caring for a group of clients. In which situation is the nurse demonstrating the ethical principle of nonmaleficence?Answer →
  397. 397Which individual is accountable for the safety of the patient when the assignment was delegated by the registered nurse (RN) to the unlicensed assistive personnel (UAP)?Answer →
  398. 398A patient has approximately 6 months to live and asks about a do not resuscitate (DNR) order. Which statements by the nurse give the patient correct information? (Select all that apply.)Answer →
  399. 399The nurse in the emergency department received shift report on a group of clients. Place the clients in the order the nurse should assess them.Answer →
  400. 400A nurse is providing discharge teaching for a client who will be receiving oxygen therapy at home. Which of the following instructions should the nurse include in the teaching?Answer →
  401. 401The nurse is changing bed linens for a client with human immunodeficiency virus (HIV). The linens are heavily soiled with blood. What action should the nurse take?Answer →
  402. 402A charge nurse is providing an in-service to a group of nurses about the components of informed consent. Which of the following information should the nurse include?Answer →
  403. 403Which are common reasons why people resist change? (Select all that apply.)Answer →
  404. 404What is the purpose of transfer (gait) belts?Answer →
  405. 405When caring for a client on airborne precautions which item of personal protective equipment (PPE) is the last to be removed?Answer →
  406. 406The patient is found to be unresponsive and not breathing. Which pulse site will the nurse use?Answer →
  407. 407Which nursing care task is acceptable for a registered nurse to delegate to the unlicensed assistive personnel (UAP)?Answer →
  408. 408The nurse is assigned to the following four clients. Which patient should the nurse assess FIRST?Answer →
  409. 409Which question is most important for a nurse to ask an older adult client who has reported increased weakness and new bruises?Answer →
  410. 410A nurse is planning care for a client who is scheduled for an intravenous pyelogram. Which of the following actions is appropriate for the nurse to include?Answer →
  411. 411A nurse is discussing the process of evidence-based practice (EBP) with a newly licensed nurse. Which of the following statements made by the newly licensed nurse indicates an understanding of the process?Answer →
  412. 412A nurse is teaching a home care client and the family about using prescribed oxygen. What is a critical factor that must be included in teaching?Answer →
  413. 413The nurse's responsibility with informed consent is which of the following?Answer →
  414. 414A client has viral hepatitis A and hepatic encephalopathy. An unlicensed assistive personnel (UAP) is assigned to help the client with a bath. Which information should the nurse reinforce with the UAP?Answer →
  415. 415Which nursing intervention is the priority during an active tonic-clonic seizure?Answer →
  416. 416A nurse is caring for a group of clients on a medical-surgical unit. The nurse delegates various tasks the clients require to another licensed practical nurse (LPN) and an assistive personnel (AP). The nurse should identify that the responsibility for making sure the client received the plan of care specifies belongs to which of the following team members?Answer →
  417. 417With whom should a nurse should share her password for access to the facility's computer system?Answer →
  418. 418The nurse is preparing the client for surgery. Which three findings require follow-up prior to surgery? Select 3 answers.Answer →
  419. 419A nurse has taken a telephone order from a physician for an emergency medication. The dose of the medication is abnormally high. What should the nurse do next?Answer →
  420. 420Review the electronic health record. Which data represents the implementation phase of the nursing process?Answer →
  421. 421A nurse is preparing to set up a sterile field. Which of the following actions should the nurse take?Answer →
  422. 422Complete the following sentence by using the lists of options. The nurse should first address the client's risk for due select to the client's selectAnswer →
  423. 423A nurse is caring for a client who is a celebrity in the area. A person claiming to be a family member inquires about the medical details of the client. The nurse reveals the information but later comes to find out that the person was not a family member. The nurse has violated:Answer →
  424. 424A nurse caring for a client who requires isolation has just finished a care procedure. Which of the following pieces of personal protective equipment (PPE) should the nurse remove last?Answer →
  425. 425A female client arrives in the emergency department (ED) with a wrist fracture that she sustained during an altercation with her boyfriend. Approximately 30 minutes after receiving an opioid analgesic, the nurse asks the client to rate her pain on a scale from 0 to 10. Which action should the nurse implement?Answer →
  426. 426Match each ethical principle to the appropriate description.Answer →
  427. 427A client admitted with AIDs complains of night sweats and recently "coughed up some blood." What is the nurse's most appropriate action?Answer →
  428. 428A nurse is documenting using the subjective, objective, assessment, and plan (SOAP) charting model for a client who reports nausea after starting a new medication. Which entry belongs in the P (Plan) component?Answer →
  429. 429A nurse is assessing a client who had a cerebrovascular accident (CVA) and is preparing for discharge home. Which factor(s) should the nurse evaluate to determine the client's ability to manage self-care at home? Select all that apply.Answer →
  430. 430A nurse at a pediatric hotline receives a call from a mother who plans to administer aspirin to a toddler for a fever and wants to know the dosage. Which of the following statements by the nurse is an appropriate response?Answer →
  431. 431The charge nurse is reviewing how to safely transfer clients with a new staff nurse. Which statement by the staff nurse indicates a need for further teaching?Answer →
  432. 432Which action should the nurse take next after the patient received a new peripherally inserted central catheter (PICC)?Answer →
  433. 433A nurse is collaborating with a risk management team about potential legal issues involving client care. The nurse should identify that which of the following situations is an example of negligence?Answer →
  434. 434Which of the following is a primary characteristic of a Magnet hospital?Answer →
  435. 435A nurse is reinforcing teaching with a 4-year-old child who is on airborne precautions about activities he can do while in the hospital. Which of the following activities should the nurse include in the teaching?Answer →
  436. 436Which action is most important for the nurse to document when caring for a client with mitten restraints?Answer →
  437. 437A 67-year-old woman had major abdominal surgery yesterday. She has IV lines, a urinary catheter, and an abdominal wound dressing, and she is receiving PRN pain medication. The end-of-shift report that best shows the patient's status is:Answer →
  438. 438Which action would best facilitate individualized plan of care?Answer →
  439. 439A nurse is caring for a client who is scheduled for an elective surgical procedure. Which of the following actions should the nurse take regarding informed consent?Answer →
  440. 440A nurse is planning care for a newly admitted client with multiple chronic conditions. Which action best exemplifies the planning step of the nursing process?Answer →
  441. 441A nurse is planning care for a client who reports having a latex allergy. Which of the following interventions should the nurse include in the plan?Answer →
  442. 442The registered nurse (RN) is working alongside a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP). Which task should the nurse delegate to the UAP?Answer →
  443. 443A nurse is assisting with the admission of a client who requires droplet precautions due to pertussis. Which of the following isolation precautions should the nurse take while caring for this client?Answer →
  444. 444A charge nurse is making client care assignments. Which client is most appropriate for a licensed practical nurse (LPN)?Answer →
  445. 445A client is receiving a blood transfusion and begins to experience chills and back pain. Which action should the nurse take first?Answer →
  446. 446Which client should nurse assess first?Answer →
  447. 447A nurse is providing discharge teaching about safety considerations to an older adult client who lives at home. The client has heart failure and a new prescription for hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching?Answer →
  448. 448A nurse is caring for a client who is experiencing a tonic-clonic seizure. Which of the following actions should the nurse take?Answer →
  449. 449A nurse is assigned to care for a group of clients and is prioritizing their care. Which client should be the nurse's priority?Answer →
  450. 450A client newly diagnosed with HIV says, "Don't tell my partner." What is the nurse's best response?Answer →
  451. 451Which is an example of the evaluation step of the nursing process?Answer →
  452. 452A nurse is caring for a client who was placed on isolation precautions for active pulmonary tuberculosis (TB). Which of the following actions should the nurse plan to take? (Select all that apply.)Answer →
  453. 453Which of the following is protected by the Nurse Practice Act?Answer →
  454. 454A nurse is caring for a client who has severe rheumatoid arthritis in her hands and is unable to feed herself. For which of the following health care team members should the nurse request a referral from the provider?Answer →
  455. 455Which ethical principle does the bone marrow biopsy present?Answer →
  456. 456At 1000, when the nurse enters the client's room, the first action the nurse should take is to [blank1], followed by [blank2].Answer →
  457. 457A nurse is caring for a client who is in contact isolation. When exiting the client's room, in what order should the nurse take the following steps when removing her personal protective equipment? (Move the nursing actions into the box on the right, placing them in the selected order of performance. All steps must be used.)Answer →
  458. 458Which nursing action represents the Planning step of the ADPIE process for a client with increased knee stiffness and decreased range of motion with difficulty ambulating in the morning?Answer →
  459. 459A nurse is responding to a rapid change in a patient's condition and needs to notify the healthcare provider. The nurse plans to use the ISBARR communication tool. Which of the following actions by the nurse demonstrates correct use of ISBARR? (Select all that apply.)Answer →
  460. 460Which action should the nurse take?Answer →
  461. 461For each potential client problem, indicate high or low priority.Answer →
  462. 462A nurse overhears two staff members in the facility elevator discussing a client's care. Which of the following federal statutes does this violate?Answer →
  463. 463Which task should the RN delegate to the licensed practical nurse (LPN)?Answer →
  464. 464A home health nurse is assessing the home environment of an older adult client who has osteoporosis. For which of the following findings should the nurse intervene?Answer →
  465. 465The wound care nurse is preparing to change the client's dressing. For each technique item, click to indicate whether the technique is indicated or not indicated. Each row must have one option selected.Answer →
  466. 466A client who is paraplegic is admitted with a foul-smelling drainage from a sacral ulcer. The client is suspected to have a methicillin resistant Staphylococcus aureus (MRSA) infection. Which nursing intervention(s) should the nurse include in the plan of care (POC)? Select all that apply.Answer →
  467. 467Which of the following describes the planning phase of the nursing process?Answer →
  468. 468A nurse is caring for a client. Complete the following sentence by using the lists of options. At 1000, the nurse enters the client's room. The first action the nurse should take is to [A] followed by [B]Answer →
  469. 469The nurse is caring for a patient with an incision. Which actions will best indicate an understanding of medical and surgical asepsis for a sterile dressing change?Answer →
  470. 470A nurse on a medical-surgical unit is caring for a client who asks to review his medical record. Which of the following responses should the nurse make?Answer →
  471. 471A nurse is assessing the home environment of a client with a seizure disorder. Which finding requires further evaluation to reduce the risk of injury during a seizure?Answer →
  472. 472A nurse is providing discharge teaching about safety considerations to an older adult client who lives at home. The client has heart failure and a new prescription for hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching?Answer →
  473. 473A nurse is making assignments for a group of medically stable clients for the upcoming shift. Which of the following should the nurse identify is within the range of function and delegate to an assistive personnel (AP)?Answer →
  474. 474What is the primary purpose of standards of nursing practice?Answer →
  475. 475A nurse is planning care for a client who has contact precautions in place. Which of the following actions should the nurse plan to take when removing soiled linens from the client's room?Answer →
  476. 476A nurse is developing a care plan for a client who has recently been diagnosed with diabetes mellitus. Which indirect nursing intervention should the nurse perform?Answer →
  477. 477A nurse is assisting with teaching a class on leadership. The nurse should include that which of the following types of leaders identifies common values to empower employees?Answer →
  478. 478A nurse is caring for a client who is exhibiting violent behavior and requires the application of wrist restraints. Which of the following actions should the nurse take?Answer →
  479. 479A charge nurse is providing an in-service to a group Of nurses about the components Of informed consent. Which Of the following information should the nurse include?Answer →
  480. 480A newly licensed nurse has forgotten their password and asks another nurse to access the computer system for them so they can document care before transferring the client to another unit. Which of the following responses should the nurse make?Answer →
  481. 481A nurse is caring for a client who is competent, refuses further treatment, and asks to sign out of the hospital against medical advice (AMA). The nurse notifies the charge nurse, who tells the nurse that the provider has recommended restraining the client, if necessary, to keep her from leaving the hospital. The nurse refuses to implement the action based on the knowledge that restraining this client would be committing which of the following torts?Answer →
  482. 482A nurse is reinforcing teaching with a newly licensed nurse about the purpose of documentation in the client's health record. Which of the following information should the nurse include?Answer →
  483. 483A parent always thanks clerks at the grocery store. The parent's child, age 6 years, echoes the thank you. The child is demonstrating what mode of value transmission?Answer →
  484. 484A nurse is admitting a client to the emergency department. Which of the following would the nurse complete first when using the clinical judgment process?Answer →
  485. 485Which step of the nursing process does this reflect?Answer →
  486. 486A client is admitted with pneumonia and has a recent history of methicillin-resistant staphylococcus aureus (MRSA). The client is placed in isolation. While caring for the client, which item should the nurse place in a designated biohazard bag before it is removed from the room?Answer →
  487. 487A nurse manager has encountered resistance to a planned change. What is one way the nurse can overcome the resistance?Answer →
  488. 488Which is a tenet of Maslow's basic human needs hierarchy?Answer →
  489. 489What task should nurse delegate to LPN?Answer →
  490. 490Select the 4 findings that require immediate follow-up.Answer →
  491. 491Which of the following is true regarding NUR 1132 lab quizzes? Select all that apply.Answer →
  492. 492The charge nurse observes a practical nurse (PN) measuring the waist circumference of a client who has expressed a concern about health problems related to obesity. Which action should the nurse implement?Answer →
  493. 493Which procedure carries the highest risk for healthcare-associated infection?Answer →
  494. 494A nurse is preparing to delegate tasks to an assistive personnel (AP). The nurse should identify which of the following as one of the five rights of delegation?Answer →
  495. 495If a student achieves an 80% overall course percentage, but performs unsatisfactorily in the clinical experience, which of the following is true?Answer →
  496. 496A nurse is caring for a client who has been receiving antibiotics for 10 days. The client reports frequent loose stools. Which of the following actions should the nurse take?Answer →
  497. 497A healthcare organization requires nurses to chart by exception. Which assessment should the nurse document?Answer →
  498. 498Put the parts of Hand-off Report in the correct orderAnswer →
  499. 499During treatment with chemotherapy for leukemia, the nurse should remove which item that the family has brought into the patient's room?Answer →
  500. 500A nurse is preparing to transfer a patient from bed to a wheelchair using a gait belt. Which action demonstrates correct body mechanics by the nurse?Answer →
  501. 501A family member is demonstrating wound care using sterile technique. Which action indicates to the nurse that additional teaching is needed?Answer →
  502. 502A nurse is assisting with the admission of a client who has meningococcal pneumonia. Which of the following isolation precautions should the nurse initiate?Answer →
  503. 503A nurse is implementing a pressure injury prevention plan for a patient who is bedridden and incontinent. Which actions should the nurse include? (Select all that apply)Answer →
  504. 504Which nursing intervention should the registered nurse perform first when caring for the patient on a hospital unit who has fallen?Answer →
  505. 505The nurse is assessing a client and identifies several clinical problems. Which finding should the nurse address first?Answer →
  506. 506Which intervention is most appropriate for the nurse to take in the patient with neutropenia?Answer →
  507. 507A colleague asks a nurse why it is the primary reason to study nursing theory. How should the nurse respond?Answer →
  508. 508A nurse is caring for a client on a medical-surgical unit. Which of the following actions should the nurse take to maintain the client's confidentiality?Answer →
  509. 509A nurse is planning care for a client who has a prescription for extremity restraints to both wrists. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)Answer →
  510. 510A nurse is caring for a client Who is receiving a continuous IV infusion Via an infusion pump that is malfunctioning. Which Of the following actions should the nurse take?Answer →
  511. 511The nurse has become aware of missing narcotics in the patient care area. Which ethical principle obligates the nurse to report the missing medications?Answer →
  512. 512A nurse Identifies a small fire in a client's room. After moving the client to safety, which of the following is the next action the nurse should take?Answer →
  513. 513The nurse is caring for a client reporting pain. The nurse tells the client that the pain medication is due in one hour and promises that they will be back then to administer the pain medication. One hour later the nurse comes back to the client's room and provides the pain medication. Which ethical principle did the nurse demonstrate?Answer →
  514. 514A nurse manager provided staff education about client rights. Which statement by a staff nurse indicates further education is needed?Answer →
  515. 515A nurse enters the room of a client who has a seizure disorder. The client is sitting in a chair and begins to experience a seizure. Which of the following actions should the nurse take first?Answer →
  516. 516A nurse is caring for a group of clients. Which client is appropriate for a physical therapy consult?Answer →
  517. 517A nurse is caring for a client who has measles. Which of the following infection control precautions should the nurse implement?Answer →
  518. 518A patient on bed rest keeps getting out of bed. What is the initial intervention?Answer →
  519. 519What is the primary purpose of the ANA Code of Ethics for Nurses?Answer →
  520. 520A nurse is admitting a client who is at risk for falls to a medical-surgical unit. Which of the following actions should the nurse take?Answer →
  521. 521Which is the nurse's best legal safeguard?Answer →
  522. 522A hospitalized client asks the nurse for "some aspirin for my headache." There is no order for aspirin for this client. What will the nurse do?Answer →
  523. 523Which of the following ethical principles is being practiced when a nurse keeps a promise made to a client?Answer →
  524. 524A nurse is assisting with the admission of a client who has leukemia. Which of the following transmission-based precautions should the nurse implement?Answer →
  525. 525Which procedure requires the application of sterile gloves by the nurse?Answer →
  526. 526A nurse is caring for several clients on a medical-surgical unit. Which of the following client care situations requires the nurse to complete an incident report?Answer →
  527. 527A nurse is assisting with a sterile dressing change for a postoperative client. While reaching for sterile gauze, the nurse accidentally lowers the sterile item below waist level. Which action should the nurse take?Answer →
  528. 528A nurse is caring for a client who requires airborne precautions. The nurse is preparing to leave the client's room following a dressing change. Which of the following pieces of personal protective equipment should the nurse remove first?Answer →
  529. 529A charge nurse is reinforcing teaching with a newly licensed nurse about fall prevention strategies when caring for clients. Which of the following information should the nurse include in the teaching?Answer →
  530. 530A nurse is caring for a client who requires contact precautions. Which of the following actions should the nurse take?Answer →
  531. 531An assistive personnel (AP) asks a nurse what precautions he should take when measuring the vital signs of a client who has pneumonia. Which of the following responses should the nurse make?Answer →
  532. 532Choose the examples of Good Documentation rather than Vague Documentation. Select all that apply. Example of Good Documentation (quantifies, detailed description)Answer →
  533. 533A nurse is reinforcing teaching with a group of newly licensed nurses about preventing needlestick injuries. Which of the following actions should the nurse recommend?Answer →
  534. 534A nurse on a medical-surgical unit suspects that a coworker may be under the influence of alcohol while on duty. What is the most appropriate initial action by the nurse?Answer →
  535. 535A nurse is caring for a client who has a prescription for a blood transfusion. Which of the following actions should the nurse take?Answer →
  536. 536The nurse is assessing a client for admission. Which action(s) should the nurse take to abide by standard precautions? (Select all that apply.)Answer →
  537. 537Which of the following actions are part of the isolation precautions for this client? Select all that apply.Answer →
  538. 538Physiological changes associated with aging place the older adult at particular risk for which safety concern?Answer →
  539. 539A nurse is caring for a client who has severe rheumatoid arthritis in her hands and is unable to feed herself. For which of the following health care team members should the nurse request a referral from the provider?Answer →
  540. 540When preparing to administer a unit of packed red blood cells to a client. Which action is the priority before starting the transfusion?Answer →
  541. 541The nurse is preparing to give an end-of-shift report to the oncoming nurse. Which report process should the nurse prepare to give to the nurse who will take care of the client.Answer →
  542. 542A nurse on a medical-surgical unit is asked by a family member to share details about a client's diagnosis and treatment plan. The family member states they are "helping make decisions" for the client. Which action by the nurse best demonstrates compliance with nursing laws?Answer →
  543. 543A client aged 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. The nurse communicates the client's wish to the family and health care team. This is an example of what ethical principle?Answer →
  544. 544A nurse is conducting an in-service for staff members about the Emergency Medical Treatment and Active Labor Act. Which of the following statements by a staff member indicates an understanding of this act?Answer →
  545. 545Which patient in the eye clinic should the nurse assess first?Answer →
  546. 546A nurse is instructing a newly licensed nurse about the scope and standard of nursing practice. Which of the following describes standards of practice?Answer →
  547. 547A nurse is reinforcing teaching with an assistive personnel (AP) about using personal protective equipment while caring for clients. Which of the following statements should the nurse identify as an indication that the AP understands the instructions?Answer →
  548. 548A nursing student is performing tracheostomy suctioning under sterile conditions. Which action should prompt the nurse to intervene due to a break in sterility?Answer →
  549. 549Which is the most frequent reason for revocation or suspension of a nurse's license?Answer →
  550. 550The nurse assesses a client's radial pulse. The left radial pulse is 2+ normal, and the right radial pulse is 1+ weak and thready. The nurse is unsure of the findings. What should the nurse do next?Answer →
  551. 551A nurse is reinforcing teaching with a group of assistive personnel (AP) about hand hygiene. Which of the following statements by an AP should the nurse identify as an indication that the AP requires further teaching?Answer →
  552. 552A nurse is admitting a client who is at risk for falls to a medical-surgical unit. Which of the following actions should the nurse take?Answer →
  553. 553A nurse is evaluating an assistive personnel (AP) who is changing a client's bed linens. Which of the following actions by the AP demonstrates medical asepsis?Answer →
  554. 554Which step(s) indicate that the nurse is following recommended procedure for handwashing? Select all that apply.Answer →
  555. 555Which response by the nurse is most appropriate?Answer →
  556. 556A nurse is preparing to lift a heavy object. Which of the following actions by the nurse indicates an understanding of body mechanics?Answer →
  557. 557A healthcare organization requires nurses to chart by exception. Which assessment should the nurse document?Answer →
  558. 558A nurse is caring for a client who is postoperative. Which of the following actions should the nurse take to help prevent an incisional infection?Answer →
  559. 559The nurse cares for several clients in the emergency department on a cold winter day. Which client should the nurse identify as having the highest risk for hypothermia?Answer →
  560. 560A nurse enters a client's room to perform a focused assessment. Which Of the following client information should the nurse use to properly identify the client?Answer →
  561. 561A newly licensed nurse has forgotten their password and asks another nurse to access the computer system for them so they can document care before transferring the client to another unit. Which of the following responses should the nurse make?Answer →
  562. 562A nurse is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA) in an abdominal wound. The nurse enters the room to check the client's pulse. Which of the following items should the nurse wear?Answer →
  563. 563A nurse working in a new state reviews the Nurse Practice Act (NPA) to ensure compliance with legal nursing standards. Which action best demonstrates the nurse applying knowledge of the NPA to maintain safe and legal practice?Answer →
  564. 564A nurse is preparing an in-service presentation about preventing health care-associated infections (HAIs). The nurse should include which of the following as a common cause of these infections?Answer →
  565. 565The nurse is working in a community clinic where resources are limited. A new vaccine has become available, but there is only a small supply. What action should the nurse take to demonstrate the ethical principle of justice?Answer →
  566. 566A nurse is caring for a client who has just been diagnosed with diabetes mellitus. What action should the nurse take first?Answer →
  567. 567During admission, a nurse orients an older adult to the hospital room. What is the priority for safety?Answer →
  568. 568A nurse is preparing to administer treatment to a 16-year-old client in the emergency department. Which of the following situations allows the nurse to proceed without parental or guardian consent?Answer →
  569. 569A patient admitted to the acute care facility through the emergency department has jewelry and a large amount of money. The most efficient intervention about these valuables would be:Answer →
  570. 570The nurse is caring for a group of medical-surgical patients. Which patient is most at risk for developing an infection?Answer →
  571. 571The nurse knows that when a patient is admitted she needs to get a detailed assessment of the patient along with vital signs, and a height and weight. Why does this information matter?Answer →
  572. 572The client's fall is the fourth in one month on the unit. The nurse manager is concerned and would like to do a quality improvement project to address unit falls. Click to indicate steps/actions, in order, for a quality improvement project. Each column must have only one response selected.Answer →
  573. 573A parent arrives in the emergency department with a crying infant. The nurse observes the child has well demarcated bilateral burns from feet to mid calfs. What is the nurse's legal obligation?Answer →