Test Bank For
Skills in Clinical Nursing, 9th Edition by Audrey T. Berman, Shirlee J. Snyder
Chapter 1-34
Chapter 1 Essential Skills
1) The nurse is caring for a client who developed an infection after admission to the hospital.
Which term should the nurse use when documenting this infection? nursing | Nursing/Integrated
1. Nosocomial infection
2. Bacterial infection
3. Health care-associated infection
4. Therapeutic infection
Answer: 1
Explanation: 1. A nosocomial infection is an infection that originates specifically in the hospital.
2. Not enough information is provided to determine whether the infection is bacterial in nature.
3. A health care-associated infection can originate in any health care setting.
4. There is no such thing as a therapeutic infection.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: V.B.1. Demonstrate effective use of technology and
standardized practices that support safety and quality | AACN Essential Competencies: II.5.
Participate in quality and client safety initiatives, recognizing that these are complex system
issues that involve individuals, families, groups, communities, populations, and other members
of the health care team | NLN Competencies: Knowledge and Science: Knowledge:
Relationships between knowledge/science and quality and safe client care | Nursing/Integrated
Concepts: Nursing Process: Assessment
Learning Outcome: 1. Define the key terms used in essential skills and equipment that protect
nurses and clients.
2) The nurse is caring for a group of clients. For which situation should the nurse use a Situation,
Background, Assessment, and Recommendation (SBAR) process? Select all that apply.
1. Discharging a client
2. Transferring a client to another unit
3. Contacting the primary care provider
4. Changing from day to evening shift
5. Informing family members of client status
Answer: 2, 3, 4
Explanation: 1. The SBAR is not used for discharging a client.
2. The SBAR is used to enhance the safety of the client in situations where nurses are
communicating with other members of the health care team, such as when transferring the client
to another unit.
3. The SBAR is used to enhance the safety of the client in situations where nurses are
communicating with other members of the health care team, such as when contacting the primary
care provider.
4. The SBAR is used to enhance the safety of the client in situations where nurses are
communicating with other members of the health care team, such as when conducting change-of-
shift report.
5. The SBAR is not used for notifying family members of the client's status.
1
Copyright © 2021 Pearson Education, Inc.
,Page Ref: 14
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Management of Care
Standards: QSEN Competencies: V.B.1. Demonstrate effective use of technology and
standardized practices that support safety and quality | AACN Essential Competencies: II.5.
Participate in quality and client safety initiatives, recognizing that these are complex system
issues that involve individuals, families, groups, communities, populations, and other members
of the health care team | NLN Competencies: Knowledge and Science: Knowledge:
Relationships between knowledge/science and quality and safe client care | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 1. Define the key terms used in essential skills and equipment that protect
nurses and clients.
3) A client with HIV/AIDS is being treated for a Pneumocystis carinii infection. In order to
reduce the spread of infection, in which of the following areas should the nurse instruct this
client?
1. Engaging in self-care
2. Respiratory hygiene/cough etiquette
3. The use of sexual barriers
4. Standard precautions
Answer: 2
Explanation: 1. Teaching self-care might be indicated for this client, but it is not related to
reducing the spread of infection.
2. The client with a respiratory infection would benefit most from learning how to use respiratory
hygiene/cough etiquette in order to reduce the risk of spreading infection to others.
3. Although teaching the use of sexual barriers would reduce the risk of sexually transmitted
infections, it is not the priority need at this time.
4. Standard precautions are used by the health care provider and are not generally taught to
clients.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Safety and Infection Control
Standards: QSEN Competencies: V.B.2. Demonstrate effective use of strategies to reduce risk of
harm to self or others | AACN Essential Competencies: IX.7. Provide appropriate patient
teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and
health literacy considerations to foster patient engagement in their care | NLN Competencies:
Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and
safe client care | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching and
Learning
Learning Outcome: 1. Define the key terms used in essential skills and equipment that protect
nurses and clients.
4) The nurse reviews the care needs for assigned clients. Which task would be appropriate for the
nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply.
1. Measuring vital signs
2. Measuring and recording intake and output
3. Postmortem care
4. Providing telephone advice
5. Weighing the client
2
Copyright © 2021 Pearson Education, Inc.
,Answer: 1, 2, 3, 5
Explanation: 1. Vital sign measurement is an appropriate task to delegate to the UAP.
2. Recording intake and output is an appropriate task to delegate to the UAP.
3. Providing postmortem care is an appropriate task to delegate to the UAP.
4. Tasks requiring advanced education such as assessment, interpretation of data, planning client
care, or evaluating care are not delegated to the UAP. Telephone advice involves gathering data,
analysis, and planning care, which would all be beyond the scope of practice.
5. Weighing the client is an appropriate task to delegate to the UAP.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Management of Care
Standards: QSEN Competencies: II.B.5. Assume role of team member or leader based on the
situation | AACN Essential Competencies: IX.14. Demonstrate clinical judgment and
accountability for patient outcomes when delegating to, and supervising, other members of the
health care team | NLN Competencies: Teamwork: Practice-Know-How: Function competently
within one's own scope of practice as leader or member of the health care team and manage
delegation effectively | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2. Recognize when it is appropriate to assign skills to unlicensed assistive
personnel.
5) The nurse observes the newly hired unlicensed assistive person (UAP) performing routine
client care. Which behavior should indicate the UAP understands the use of personal protective
equipment?
1. The UAP removes the gown first and then gloves after providing care.
2. The UAP applies gloves before emptying the client's indwelling catheter bag, then removes
gloves and washes hands before measuring urine output.
3. The UAP applies gloves to clean the client's dentures, then removes gloves and performs hand
hygiene prior to bathing the client.
4. The UAP wears gown and gloves when performing postmortem care.
Answer: 3
Explanation: 1. Gloves are removed before removing the gown.
2. Gloves should not be removed until after measuring urine output and rinsing the measuring
container and returning it to its storage location.
3. Gloves are required when providing denture care but are not required for bathing the client.
4. Gloves should be worn when performing postmortem care, but a gown is generally not
required.
Page Ref: 10-13
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment; Safety and Infection Control
Standards: QSEN Competencies: V.B.2. Demonstrate effective use of strategies to reduce risk of
harm to self or others | AACN Essential Competencies: II.5. Participate in quality and client
safety initiatives, recognizing that these are complex system issues that involve individuals,
families, groups, communities, populations, and other members of the health care team | NLN
Competencies: Context and Environment: Practice-Know-How: Apply health promotion/disease
prevention strategies | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 4. Describe factors that affect the use of personal protective equipment such
as gowns, masks, eyewear, and gloves.
3
Copyright © 2021 Pearson Education, Inc.
, 6) The nurse is caring for a client with a deep draining abdominal wound. For which factor
should the nurse wear a mask and goggles when caring for this client?
1. The wound is infected.
2. The client is confused and disoriented.
3. The wound is covered by wet-to-damp dressings.
4. The client is HIV-positive.
Answer: 2
Explanation: 1. The client who is confused and disoriented might not cooperate with care and
could cause splashing of wound drainage, so the nurse should wear a mask and goggles when
caring for this client. The other factors would cause the nurse to don gloves and a gown but
would not lead to the use of mask and goggles.
2. The client who is confused and disoriented might not cooperate with care and could cause
splashing of wound drainage, so the nurse should wear a mask and goggles when caring for this
client. The other factors would cause the nurse to don gloves and a gown but would not lead to
the use of mask and goggles.
3. The client who is confused and disoriented might not cooperate with care and could cause
splashing of wound drainage, so the nurse should wear a mask and goggles when caring for this
client. The other factors would cause the nurse to don gloves and a gown but would not lead to
the use of mask and goggles.
4. The client who is confused and disoriented might not cooperate with care and could cause
splashing of wound drainage, so the nurse should wear a mask and goggles when caring for this
client. The other factors would cause the nurse to don gloves and a gown but would not lead to
the use of mask and goggles.
Page Ref: 11
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Safety and Infection Control
Standards: QSEN Competencies: V.B.2. Demonstrate effective use of strategies to reduce risk of
harm to self or others | AACN Essential Competencies: II.5. Participate in quality and client
safety initiatives, recognizing that these are complex system issues that involve individuals,
families, groups, communities, populations, and other members of the health care team | NLN
Competencies: Context and Environment: Practice-Know-How Apply health promotion/disease
prevention strategies | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 4. Describe factors that affect the use of personal protective equipment such
as gowns, masks, eyewear, and gloves.
7) The nurse is reviewing tasks to delegate after receiving hand-off communication. Which
procedure could the nurse safely delegate to the unlicensed assistive personnel (UAP)?
1. Making a nursing diagnosis
2. Assisting a client to a bedside commode
3. Performing assessments on client
4. Giving the client pain medication
Answer: 2
Explanation: 1. Tasks requiring advanced education such as assessment, interpretation of data,
planning client care, or evaluating care are not delegated to the UAP. Formulating a nursing
diagnosis is not a task that can be delegated to the UAP.
2. Assisting a client to a bedside commode is an activity that can be delegated to the UAP.
3. Tasks requiring advanced education such as assessment, interpretation of data, planning client
care, or evaluating care are not delegated to the UAP. Assessment is not a task that can be
delegated to the UAP.
4. Tasks requiring advanced education such as assessment, interpretation of data, planning client
4
Copyright © 2021 Pearson Education, Inc.
Skills in Clinical Nursing, 9th Edition by Audrey T. Berman, Shirlee J. Snyder
Chapter 1-34
Chapter 1 Essential Skills
1) The nurse is caring for a client who developed an infection after admission to the hospital.
Which term should the nurse use when documenting this infection? nursing | Nursing/Integrated
1. Nosocomial infection
2. Bacterial infection
3. Health care-associated infection
4. Therapeutic infection
Answer: 1
Explanation: 1. A nosocomial infection is an infection that originates specifically in the hospital.
2. Not enough information is provided to determine whether the infection is bacterial in nature.
3. A health care-associated infection can originate in any health care setting.
4. There is no such thing as a therapeutic infection.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: V.B.1. Demonstrate effective use of technology and
standardized practices that support safety and quality | AACN Essential Competencies: II.5.
Participate in quality and client safety initiatives, recognizing that these are complex system
issues that involve individuals, families, groups, communities, populations, and other members
of the health care team | NLN Competencies: Knowledge and Science: Knowledge:
Relationships between knowledge/science and quality and safe client care | Nursing/Integrated
Concepts: Nursing Process: Assessment
Learning Outcome: 1. Define the key terms used in essential skills and equipment that protect
nurses and clients.
2) The nurse is caring for a group of clients. For which situation should the nurse use a Situation,
Background, Assessment, and Recommendation (SBAR) process? Select all that apply.
1. Discharging a client
2. Transferring a client to another unit
3. Contacting the primary care provider
4. Changing from day to evening shift
5. Informing family members of client status
Answer: 2, 3, 4
Explanation: 1. The SBAR is not used for discharging a client.
2. The SBAR is used to enhance the safety of the client in situations where nurses are
communicating with other members of the health care team, such as when transferring the client
to another unit.
3. The SBAR is used to enhance the safety of the client in situations where nurses are
communicating with other members of the health care team, such as when contacting the primary
care provider.
4. The SBAR is used to enhance the safety of the client in situations where nurses are
communicating with other members of the health care team, such as when conducting change-of-
shift report.
5. The SBAR is not used for notifying family members of the client's status.
1
Copyright © 2021 Pearson Education, Inc.
,Page Ref: 14
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Management of Care
Standards: QSEN Competencies: V.B.1. Demonstrate effective use of technology and
standardized practices that support safety and quality | AACN Essential Competencies: II.5.
Participate in quality and client safety initiatives, recognizing that these are complex system
issues that involve individuals, families, groups, communities, populations, and other members
of the health care team | NLN Competencies: Knowledge and Science: Knowledge:
Relationships between knowledge/science and quality and safe client care | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 1. Define the key terms used in essential skills and equipment that protect
nurses and clients.
3) A client with HIV/AIDS is being treated for a Pneumocystis carinii infection. In order to
reduce the spread of infection, in which of the following areas should the nurse instruct this
client?
1. Engaging in self-care
2. Respiratory hygiene/cough etiquette
3. The use of sexual barriers
4. Standard precautions
Answer: 2
Explanation: 1. Teaching self-care might be indicated for this client, but it is not related to
reducing the spread of infection.
2. The client with a respiratory infection would benefit most from learning how to use respiratory
hygiene/cough etiquette in order to reduce the risk of spreading infection to others.
3. Although teaching the use of sexual barriers would reduce the risk of sexually transmitted
infections, it is not the priority need at this time.
4. Standard precautions are used by the health care provider and are not generally taught to
clients.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Safety and Infection Control
Standards: QSEN Competencies: V.B.2. Demonstrate effective use of strategies to reduce risk of
harm to self or others | AACN Essential Competencies: IX.7. Provide appropriate patient
teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and
health literacy considerations to foster patient engagement in their care | NLN Competencies:
Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and
safe client care | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching and
Learning
Learning Outcome: 1. Define the key terms used in essential skills and equipment that protect
nurses and clients.
4) The nurse reviews the care needs for assigned clients. Which task would be appropriate for the
nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply.
1. Measuring vital signs
2. Measuring and recording intake and output
3. Postmortem care
4. Providing telephone advice
5. Weighing the client
2
Copyright © 2021 Pearson Education, Inc.
,Answer: 1, 2, 3, 5
Explanation: 1. Vital sign measurement is an appropriate task to delegate to the UAP.
2. Recording intake and output is an appropriate task to delegate to the UAP.
3. Providing postmortem care is an appropriate task to delegate to the UAP.
4. Tasks requiring advanced education such as assessment, interpretation of data, planning client
care, or evaluating care are not delegated to the UAP. Telephone advice involves gathering data,
analysis, and planning care, which would all be beyond the scope of practice.
5. Weighing the client is an appropriate task to delegate to the UAP.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Management of Care
Standards: QSEN Competencies: II.B.5. Assume role of team member or leader based on the
situation | AACN Essential Competencies: IX.14. Demonstrate clinical judgment and
accountability for patient outcomes when delegating to, and supervising, other members of the
health care team | NLN Competencies: Teamwork: Practice-Know-How: Function competently
within one's own scope of practice as leader or member of the health care team and manage
delegation effectively | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2. Recognize when it is appropriate to assign skills to unlicensed assistive
personnel.
5) The nurse observes the newly hired unlicensed assistive person (UAP) performing routine
client care. Which behavior should indicate the UAP understands the use of personal protective
equipment?
1. The UAP removes the gown first and then gloves after providing care.
2. The UAP applies gloves before emptying the client's indwelling catheter bag, then removes
gloves and washes hands before measuring urine output.
3. The UAP applies gloves to clean the client's dentures, then removes gloves and performs hand
hygiene prior to bathing the client.
4. The UAP wears gown and gloves when performing postmortem care.
Answer: 3
Explanation: 1. Gloves are removed before removing the gown.
2. Gloves should not be removed until after measuring urine output and rinsing the measuring
container and returning it to its storage location.
3. Gloves are required when providing denture care but are not required for bathing the client.
4. Gloves should be worn when performing postmortem care, but a gown is generally not
required.
Page Ref: 10-13
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment; Safety and Infection Control
Standards: QSEN Competencies: V.B.2. Demonstrate effective use of strategies to reduce risk of
harm to self or others | AACN Essential Competencies: II.5. Participate in quality and client
safety initiatives, recognizing that these are complex system issues that involve individuals,
families, groups, communities, populations, and other members of the health care team | NLN
Competencies: Context and Environment: Practice-Know-How: Apply health promotion/disease
prevention strategies | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 4. Describe factors that affect the use of personal protective equipment such
as gowns, masks, eyewear, and gloves.
3
Copyright © 2021 Pearson Education, Inc.
, 6) The nurse is caring for a client with a deep draining abdominal wound. For which factor
should the nurse wear a mask and goggles when caring for this client?
1. The wound is infected.
2. The client is confused and disoriented.
3. The wound is covered by wet-to-damp dressings.
4. The client is HIV-positive.
Answer: 2
Explanation: 1. The client who is confused and disoriented might not cooperate with care and
could cause splashing of wound drainage, so the nurse should wear a mask and goggles when
caring for this client. The other factors would cause the nurse to don gloves and a gown but
would not lead to the use of mask and goggles.
2. The client who is confused and disoriented might not cooperate with care and could cause
splashing of wound drainage, so the nurse should wear a mask and goggles when caring for this
client. The other factors would cause the nurse to don gloves and a gown but would not lead to
the use of mask and goggles.
3. The client who is confused and disoriented might not cooperate with care and could cause
splashing of wound drainage, so the nurse should wear a mask and goggles when caring for this
client. The other factors would cause the nurse to don gloves and a gown but would not lead to
the use of mask and goggles.
4. The client who is confused and disoriented might not cooperate with care and could cause
splashing of wound drainage, so the nurse should wear a mask and goggles when caring for this
client. The other factors would cause the nurse to don gloves and a gown but would not lead to
the use of mask and goggles.
Page Ref: 11
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment; Safety and Infection Control
Standards: QSEN Competencies: V.B.2. Demonstrate effective use of strategies to reduce risk of
harm to self or others | AACN Essential Competencies: II.5. Participate in quality and client
safety initiatives, recognizing that these are complex system issues that involve individuals,
families, groups, communities, populations, and other members of the health care team | NLN
Competencies: Context and Environment: Practice-Know-How Apply health promotion/disease
prevention strategies | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 4. Describe factors that affect the use of personal protective equipment such
as gowns, masks, eyewear, and gloves.
7) The nurse is reviewing tasks to delegate after receiving hand-off communication. Which
procedure could the nurse safely delegate to the unlicensed assistive personnel (UAP)?
1. Making a nursing diagnosis
2. Assisting a client to a bedside commode
3. Performing assessments on client
4. Giving the client pain medication
Answer: 2
Explanation: 1. Tasks requiring advanced education such as assessment, interpretation of data,
planning client care, or evaluating care are not delegated to the UAP. Formulating a nursing
diagnosis is not a task that can be delegated to the UAP.
2. Assisting a client to a bedside commode is an activity that can be delegated to the UAP.
3. Tasks requiring advanced education such as assessment, interpretation of data, planning client
care, or evaluating care are not delegated to the UAP. Assessment is not a task that can be
delegated to the UAP.
4. Tasks requiring advanced education such as assessment, interpretation of data, planning client
4
Copyright © 2021 Pearson Education, Inc.
