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A nurse assesses a patient's radial pulse rate to be 110 beats/min and regular. What
action by the nurse is best?
A- Assess the patient for causes of tachycardia
B- Take an apical heart rate and compare the two
C- Notify the patient's health care provider
D- Document the findings in the patient's chart
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A- Assess the patient for causes of tachycardia
The nurse is caring for a school-aged child who has injured the right leg after a
bicycle accident. Which signs and symptoms will the nurse assess for to determine if
the child is experiencing a localized inflammatory response?
A- Malaise, anorexia, enlarged lymph nodes, and increased white blood cells
B- Chest pain, shortness of breath, and nausea and vomiting
,C- Dizziness and disorientation to time, date, and place
D- Edema, redness, tenderness, and loss of function
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D- Edema, redness, tenderness, and loss of function
The nurse is cleansing a wound site. As the nurse administers the procedure, which
intervention should be included?
A- Allow the solution to flow from the most contaminated to the least contaminated
B- Scrub vigorously when applying a noncytotoxic solution to the skin
C- Cleanse in a direction from the least contaminated area
D- Utilize clean gauze and clean gloves to cleanse a site
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C- Cleanse in a direction from the least contaminated area
The patient is experiencing pain and asks for medication, which has been ordered by
the provider. The nurse first assesses the vital signs and finds the blood pressure to be
144/82 mmHg, Pulse 88/min., and respirations 24/min. The nurse should:
A- Give the medication as ordered
B- Check again that the patient has pain
C- Withhold the medication
D- Wait 20 min. and check the vital signs again before giving the medication
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A- Give the medication as ordered
, The unit manager observes the new staff nurse perform the following actions for a
patient with isolation precautions. Which of the following actions should the unit
manager address and correct with the new nurse?
A- Keeping a thermometer, stethoscope and BP cuff in the patient's room.
B- Documenting the precautions required in the patient's record
C- Using a particulate respirator mask for the patient who has tuberculosis
D- Coming out of the room in the PPE to quickly get another dressing
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D- Coming out of the room in the PPE to quickly get another dressing
The range for normal temperature is:
96.8 - 98.9
97.6 - 99.5
96.8 - 99.5
98.6 - 99.8
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96.8 - 99.5
Medical asepsis refers to all except?
Reduces the spread of microorganisms
Objects referred to as clean or dirty
Eliminates all pathogens
Clean technique
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