PRACTICE QUESTIONS DETAILED
SOLUTIONS
◉ A nurse on a med-surg unit has received change-of-shift report & will
care for 4 clients. Which of the following client's needs may the nurse
assign to an assistive personnel (AP)?
A. Feeding a client who was admitted 24 hrs ago w/aspiration
pneumonia
B. Reinforcing teaching w/a client who is learning to walk using a quad
cane
C. Reapplying a condom catheter for a client who has urinary
incontinence
D. Applying a sterile dressing to a pressure ulcer Answer: C. Reapplying
a condom catheter for a client who has urinary incontinence
Rationale: The application of a condom catheter is a noninvasive,
routine procedure that the nurse may delegate to the AP
◉ A nurse is delegating the ambulation of a client who had knee
arthroplasty 5 days ago to an AP. Which of the following information
should the nurse share with the AP? Select All.
,A. The roommate is up independently.
B. The client ambulates w/his slippers on over his antiembolic stockings
C. The client uses a front-wheeled walker when ambulating
D. The client had pain medication 30 min ago
E. The client is allergic to codeine
F. The client ate 50% of his breakfast this morning Answer: B, C, D
◉ An RN is making assignments for client care to a LPN at the
beginning of the shift. Which of the following assignments should the
LPN question?
A. Assisting a client who is 24hr postop to use an incentive spirometer
B. Collecting a clean-catch urine specimen from a client who was
admitted on the previous shift
C. Providing nasopharyngeal suctioning for a client who has pneumonia
D. Replacing the cartridge and tubing on a PCA pump Answer: D.
Replacing the cartridge and tubing on a PCA pump
Rationale: The RN is responsible for the PCA pump
◉ A nurse is preparing an in-service program about delegation. Which
of the following elements should she identify when presenting the 5
rights of delegation? Select all.
,A. Right client
B. Right supervision/evaluation
C. Right direction/communication
D. Right time
E. Right circumstances Answer: B, C, E
A and D are rights of medication administration
◉ A nurse manager of a med-surg unit is assigning care responsibilities
for the oncoming shift. A client is awaiting transfer back to the unit from
the PACU following thoracic surgery. To which staff member should the
nurse assign to this client?
A. Charge nurse
B. RN
C. LPN
D. AP Answer: B. RN
A client returning from surgery requires assessment and establishment of
a plan of care. RNs are responsible for this, especially if the client is
potentially unstable.
◉ A nurse observes an AP reprimanding a client for not using the urinal
properly. The AP tells him she will put a diaper on him if he does not
, use the urinal more carefully next time. Which of the following torts is
the AP committing?
A. Assault
B. Battery
C. False imprisonment
D. Invasion of privacy Answer: A. Assault
By threatening the client, the AP is committing assault.
◉ An adult client who is competent tells the nurse that he is thinking
about leaving the hospital against medical advice. The nurse believes
that this is not in the client's best interest, so she administers a PRN
sedative med that the client has not requested along w/his usual meds.
Which of the following tort has the nurse committed?
A. Assault
B. False imprisonment
C. Negligence
D. Breach of confidentiality Answer: B. False imprisonment
The nurse gave the med as a chemical restraint to keep the client from
leaving the facility against medical advice. The client did not consent.