Module 4 EAQ'S
The nurse is caring for a geriatric patient with back pain. Which actions should the nurse
perform during the process of implementation? - Answer -Give the patient emotional
support.
-Provide a back rub for the patient
-Reposition the patient on his or her side
An elderly diabetic patient is admitted to the hospital with a chronic non-healing ulcer.
The nurse inspects the color of the ulcer and measures its diameter daily. The nurse
finds that the ulcer does not have an odor. The patient is taking antibiotics prescribed by
the primary healthcare provider. What are the evaluative measures in relation to the
ulcer in this case? - Answer Odor in the ulcer
Color of the ulcer
Diameter of the ulcer
A nurse caring for a patient with pneumonia sits the patient up in bed and suctions the
patient's airway. After suctioning, the patient describes some discomfort in his
abdomen. The nurse auscultates the patient's lung sounds and gives him a glass of
water. Which of the following would be appropriate evaluative criteria used by the
nurse? - Answer Patient's lungs are clear to auscultation in bases.
Patient's rate and depth of breathing are normal with head of bed elevated.
The nurse is caring for a geriatric patient who needs assistance with ambulation. The
nurse sets the goal as 'The patient will ask for assistance by using the call light before
getting out of bed.' The nurse determines that the goal is partially met. What should the
nurse do to help the patient meet the goal completely? - Answer Use a bed alarm so the
patient asks for help.
Revise the goals of the current plan of care.
Which of the following actions should the nurse perform when asked to administer a
procedure that the she is unfamiliar with? - Answer Collect all equipment necessary for
the procedure.
Get help from a nurse experienced in the procedure
Seek information about the procedure
How many rights of delegation are required to support safe delegation of patient care? -
Answer Five
The nurse enters a patient's room, and the patient asks if he can get out of bed and
transfer to a chair. The nurse takes precautions to use safe patient handling techniques
,Module 4 EAQ'S
and transfers the patient. This is an example of which physical care technique? -
Answer Protecting a patient from injury
A health care facility reports a high incidence of intravenous line infections. Which is the
best nursing intervention to promote quality improvement? - Answer Do evidence-based
research to determine best practices
A nurse is assessing a patient at home post splenectomy. The patient tells the nurse
that he realizes that strain on the incision site could cause tearing of the stitches.
Nevertheless, the nurse finds that some of the patient's stitches are pulled out. What
should be the most appropriate nursing action? - Answer Ask if the patient understands
which activities can cause strain at the incision site.
While caring for a patient, the nurse determines that the patient's goals are not being
met. The nurse modifies the care plan and adds further interventions. Which phase of
the nursing process led to modification of the care plan? - Answer Evaluation
The nurse is planning care for a patient with severe anxiety. What is the best reference
source to use in developing a plan of care that would include evidence-based research?
- Answer Handheld point-of-care references
What are the advantages of electronic health records (EHRs)? - Answer Provide easy
access to patient records
Reduce possible transcriptional errors
Decrease likely communication gaps
Decrease time to transfer information
The nurse reviews a patient's medical record and sees that tube feedings are to begin
after a feeding tube is inserted. In recent experiences, the nurse has seen patients on
the unit develop diarrhea from tube feedings. The nurse consults with the dietitian and
physician to determine the initial rate that will be ordered for the feeding to lessen the
chance of diarrhea. This is an example of what type of direct care measure? - Answer
Controlling for an adverse reaction
A nurse is asked to perform a complex intervention for a patient. However, the nurse is
unable to perform it successfully. What would be the appropriate action by the nurse? -
Answer Ask for assistance from a senior nurse.
A nurse is starting on the evening shift and is assigned to care for a patient with a
diagnosis of impaired skin integrity related to pressure and moisture on the skin. The
patient is 72 years old and had a stroke. The patient weighs 250 pounds and is difficult
to turn. As the nurse makes decisions about how to implement skin care for the patient,
, Module 4 EAQ'S
which of the following actions does the nurse implement? - Answer Determine the
probability of all possible consequences
Review all possible consequences associated with each possible nursing action
Review the set of all possible nursing interventions for the patient's problem
Which of the Six Rights of Medication Administration would prevent another nurse from
duplicating the administration of a medication? - Answer Right Documentation
A group of nursing students is learning the importance of documentation and that
documentation is the last step of the evaluation process. Which of the following should
the nurse do when communicating the patient's progress with the patient and the family
members? - Answer Share the patient's medical results with the patient.
Follow agency guidelines about sharing medical information.
Inform the patient's family about the patient's progress, with the patient's permission
A nurse is caring for a 40-year-old patient undergoing chemotherapy. The patient
complains of vomiting. Which statement is an appropriate goal statement for the
patient's problem? - Answer The patient will stop vomiting in 2 hours.
What are different types of dependent nursing interventions? - Answer Standing orders
Medication treatment
Medication administration
Which nursing intervention indicates that the nurse is providing direct care - Answer
Counseling
A diabetic patient has undergone knee joint replacement surgery. What are the
appropriate nursing actions to avoid any complications in the patient during the
immediate postoperative period? - Answer Reposition the patient frequently
Administer analgesics to the patient
Use pressure relief devices if necessary
A nurse is managing indirect care activities in a hospital. Which is an example of this
type of activity? - Answer Infection control
The nurse instructor is evaluating the student nurses' negotiation techniques. Which
nursing ability is the nurse instructor evaluating? - Answer Advocacy
The nurse is caring for a geriatric patient with back pain. Which actions should the nurse
perform during the process of implementation? - Answer -Give the patient emotional
support.
-Provide a back rub for the patient
-Reposition the patient on his or her side
An elderly diabetic patient is admitted to the hospital with a chronic non-healing ulcer.
The nurse inspects the color of the ulcer and measures its diameter daily. The nurse
finds that the ulcer does not have an odor. The patient is taking antibiotics prescribed by
the primary healthcare provider. What are the evaluative measures in relation to the
ulcer in this case? - Answer Odor in the ulcer
Color of the ulcer
Diameter of the ulcer
A nurse caring for a patient with pneumonia sits the patient up in bed and suctions the
patient's airway. After suctioning, the patient describes some discomfort in his
abdomen. The nurse auscultates the patient's lung sounds and gives him a glass of
water. Which of the following would be appropriate evaluative criteria used by the
nurse? - Answer Patient's lungs are clear to auscultation in bases.
Patient's rate and depth of breathing are normal with head of bed elevated.
The nurse is caring for a geriatric patient who needs assistance with ambulation. The
nurse sets the goal as 'The patient will ask for assistance by using the call light before
getting out of bed.' The nurse determines that the goal is partially met. What should the
nurse do to help the patient meet the goal completely? - Answer Use a bed alarm so the
patient asks for help.
Revise the goals of the current plan of care.
Which of the following actions should the nurse perform when asked to administer a
procedure that the she is unfamiliar with? - Answer Collect all equipment necessary for
the procedure.
Get help from a nurse experienced in the procedure
Seek information about the procedure
How many rights of delegation are required to support safe delegation of patient care? -
Answer Five
The nurse enters a patient's room, and the patient asks if he can get out of bed and
transfer to a chair. The nurse takes precautions to use safe patient handling techniques
,Module 4 EAQ'S
and transfers the patient. This is an example of which physical care technique? -
Answer Protecting a patient from injury
A health care facility reports a high incidence of intravenous line infections. Which is the
best nursing intervention to promote quality improvement? - Answer Do evidence-based
research to determine best practices
A nurse is assessing a patient at home post splenectomy. The patient tells the nurse
that he realizes that strain on the incision site could cause tearing of the stitches.
Nevertheless, the nurse finds that some of the patient's stitches are pulled out. What
should be the most appropriate nursing action? - Answer Ask if the patient understands
which activities can cause strain at the incision site.
While caring for a patient, the nurse determines that the patient's goals are not being
met. The nurse modifies the care plan and adds further interventions. Which phase of
the nursing process led to modification of the care plan? - Answer Evaluation
The nurse is planning care for a patient with severe anxiety. What is the best reference
source to use in developing a plan of care that would include evidence-based research?
- Answer Handheld point-of-care references
What are the advantages of electronic health records (EHRs)? - Answer Provide easy
access to patient records
Reduce possible transcriptional errors
Decrease likely communication gaps
Decrease time to transfer information
The nurse reviews a patient's medical record and sees that tube feedings are to begin
after a feeding tube is inserted. In recent experiences, the nurse has seen patients on
the unit develop diarrhea from tube feedings. The nurse consults with the dietitian and
physician to determine the initial rate that will be ordered for the feeding to lessen the
chance of diarrhea. This is an example of what type of direct care measure? - Answer
Controlling for an adverse reaction
A nurse is asked to perform a complex intervention for a patient. However, the nurse is
unable to perform it successfully. What would be the appropriate action by the nurse? -
Answer Ask for assistance from a senior nurse.
A nurse is starting on the evening shift and is assigned to care for a patient with a
diagnosis of impaired skin integrity related to pressure and moisture on the skin. The
patient is 72 years old and had a stroke. The patient weighs 250 pounds and is difficult
to turn. As the nurse makes decisions about how to implement skin care for the patient,
, Module 4 EAQ'S
which of the following actions does the nurse implement? - Answer Determine the
probability of all possible consequences
Review all possible consequences associated with each possible nursing action
Review the set of all possible nursing interventions for the patient's problem
Which of the Six Rights of Medication Administration would prevent another nurse from
duplicating the administration of a medication? - Answer Right Documentation
A group of nursing students is learning the importance of documentation and that
documentation is the last step of the evaluation process. Which of the following should
the nurse do when communicating the patient's progress with the patient and the family
members? - Answer Share the patient's medical results with the patient.
Follow agency guidelines about sharing medical information.
Inform the patient's family about the patient's progress, with the patient's permission
A nurse is caring for a 40-year-old patient undergoing chemotherapy. The patient
complains of vomiting. Which statement is an appropriate goal statement for the
patient's problem? - Answer The patient will stop vomiting in 2 hours.
What are different types of dependent nursing interventions? - Answer Standing orders
Medication treatment
Medication administration
Which nursing intervention indicates that the nurse is providing direct care - Answer
Counseling
A diabetic patient has undergone knee joint replacement surgery. What are the
appropriate nursing actions to avoid any complications in the patient during the
immediate postoperative period? - Answer Reposition the patient frequently
Administer analgesics to the patient
Use pressure relief devices if necessary
A nurse is managing indirect care activities in a hospital. Which is an example of this
type of activity? - Answer Infection control
The nurse instructor is evaluating the student nurses' negotiation techniques. Which
nursing ability is the nurse instructor evaluating? - Answer Advocacy
