A nurse is caring for a client who has a chest tube. Which of the following actions
should the nurse take?
a. Place the chest tube drainage system above the level of the client's heart
b. Tape the connections on the client's chest tube
c. Strip the client's chest tube every 4 hours
d. Loop the tubing of the chest tube on the clients bed
Give this one a try later!
b. Tape the connections on the client's chest tube
Rationale: The connections on the chest tube should be securely taped to
reduce the risk of disconnection which can cause air to enter the client's
pleural cavity
A nurse is performing a mobility assessment on a client. Which of the following actions
should the nurse take first?
,a. Ask the client to stand for 5 seconds
b. Ask the client to place their feet on the floor
c. Ask the client to sit on the edge of the bed for 2 minutes
d. Ask the client to march in place
Give this one a try later!
c. Ask the client to sit on the edge of the bed for 2 minutes
Rationale: According to evidence-based practice, the first step the nurse
should take when performing a mobility assessment is to ask the client to sit
on the edge of the bed for 2 minutes
A nurse is teaching a class about reducing the risk of medication errors. Which of the
following information should the nurse include?
a. Provide the nurse administering medication with an identifying vest
b. Wait to document medications given to client until the end of a shift
c. Remove medications from automatic dispensing systems before they are reviewed
by pharmacists
d. Prepare medications for multiple clients at the same time
Give this one a try later!
a. Provide the nurse administering medication with an identifying vest
Rationale: The nurse should provide the nurse administering medications
with a vest to indicate they should not be interrupted. Interruptions while
dispensing medications can result in medication administration errors
A nurse is assessing a client who has COPD. Which of the following findings should
the nurse expect?
, a. Spoon nails
b. Peripheral edema
c. Pleural friction rub
d. Barrel chest
Give this one a try later!
d. Barrel chest
Rationale: Barrel chest is an expected finding in a client who has COPD due
to hyperinflation of the lungs
A nurse is caring for a group of clients. Which of the following clients should the nurse
identify is at highest risk for developing a pressure injury?
a. A client who is alert and responsive and eats 25% of each meal
b. A client who is unresponsive to verbal commands and changes position
occasionally
c. A client who is receiving enteral feeding and can change their position
independently
d. A client who makes frequent slight changes in position and walks occasionally
Give this one a try later!
b. A client who is unresponsive to verbal commands and changes position
occasionally
Rationale: This client is at the greatest risk for a pressure injury because they
have a very limited sensory perception. The nurse should monitor the client
for a pressure injury
should the nurse take?
a. Place the chest tube drainage system above the level of the client's heart
b. Tape the connections on the client's chest tube
c. Strip the client's chest tube every 4 hours
d. Loop the tubing of the chest tube on the clients bed
Give this one a try later!
b. Tape the connections on the client's chest tube
Rationale: The connections on the chest tube should be securely taped to
reduce the risk of disconnection which can cause air to enter the client's
pleural cavity
A nurse is performing a mobility assessment on a client. Which of the following actions
should the nurse take first?
,a. Ask the client to stand for 5 seconds
b. Ask the client to place their feet on the floor
c. Ask the client to sit on the edge of the bed for 2 minutes
d. Ask the client to march in place
Give this one a try later!
c. Ask the client to sit on the edge of the bed for 2 minutes
Rationale: According to evidence-based practice, the first step the nurse
should take when performing a mobility assessment is to ask the client to sit
on the edge of the bed for 2 minutes
A nurse is teaching a class about reducing the risk of medication errors. Which of the
following information should the nurse include?
a. Provide the nurse administering medication with an identifying vest
b. Wait to document medications given to client until the end of a shift
c. Remove medications from automatic dispensing systems before they are reviewed
by pharmacists
d. Prepare medications for multiple clients at the same time
Give this one a try later!
a. Provide the nurse administering medication with an identifying vest
Rationale: The nurse should provide the nurse administering medications
with a vest to indicate they should not be interrupted. Interruptions while
dispensing medications can result in medication administration errors
A nurse is assessing a client who has COPD. Which of the following findings should
the nurse expect?
, a. Spoon nails
b. Peripheral edema
c. Pleural friction rub
d. Barrel chest
Give this one a try later!
d. Barrel chest
Rationale: Barrel chest is an expected finding in a client who has COPD due
to hyperinflation of the lungs
A nurse is caring for a group of clients. Which of the following clients should the nurse
identify is at highest risk for developing a pressure injury?
a. A client who is alert and responsive and eats 25% of each meal
b. A client who is unresponsive to verbal commands and changes position
occasionally
c. A client who is receiving enteral feeding and can change their position
independently
d. A client who makes frequent slight changes in position and walks occasionally
Give this one a try later!
b. A client who is unresponsive to verbal commands and changes position
occasionally
Rationale: This client is at the greatest risk for a pressure injury because they
have a very limited sensory perception. The nurse should monitor the client
for a pressure injury
