BV Quiz #2: Alternative Format
A nurse is caring for a 2-month-old in the pediatric emergency department. The mother
reports the child has had vomiting and watery diarrhea for the last 24 hours. The nurse
notes the child is lethargic with a sunken fontanel and dry mouth. Place the anticipated
nursing interventions in order of priority.
-Apply a urine bag to collect urine.
-Start an IV and begin giving fluids.
-Obtain vital signs including weight.
-Draw blood for lab tests. - ANS-1. Obtain vital signs including weight.
2. Start an IV and begin giving fluids.
3. Apply a urine bag to collect urine.
4. Draw blood for lab tests.
Read the following order from a physician. After reading the order, note which of the
following nursing actions is most appropriate? "Administer 500 mg ceftriaxone p.o. now
and q 6 hrs x 24 hours for infection prevention. - ANS-Contact the physician to clarify
the order
The medical/surgical unit consists of a registered nurse (RN), licensed practical nurse
(LPN), and 2 unlicensed nursing assistants. Which of the following tasks should the
supervisor assign to the LPN? - ANS--Assessing bowel sounds for changes in a stable
client who is two days post operative following a hysterectomy
-Reinforcing diabetic teaching on insulin injections for a client with newly diagnosed type
1 diabetes mellitus
-Inserting a urinary catheter
Which of the following strategies should be included to minimize the risk of breaking
confidentiality? - ANS--Always log off a computer after use
-Never discuss a client's condition outside of the hospital environment
Which of the following is a benefit associated with electronic medication administration
records? - ANS--Improves access to information
-Reduces the risk of medication administration errors
A nurse is delegating assignments for a nursing team that includes unlicensed assistive
personnel (UAP). Which of the following tasks should the nurse delegate to an UAP? -
ANS--Bathe a client who had an amputation 2 days ago
, -Assist a client to ambulate using a gait belt
-Measure and document a client's intake and output
The nurse is assigning tasks to unlicensed assistive personnel (UAP). Which of the
following tasks is appropriate to assign to a UAP? - ANS--Ambulating a stable three-day
post-hip replacement client in the hallway
-Checking bedside blood glucose levels for a client
-Change the urinary pad on a client who has been incontinent
The nurse is assigning clients on a medical-surgical floor. Which clients would be
appropriate to assign a Licensed Vocational Nurse (LVN)? - ANS--A client who is two
days post-op following a cholecystectomy
-A client who was admitted two days ago with a broken arm following a fall and is set to
be discharged tomorrow
-A client who was admitted with hypertensive crisis three days ago and has had blood
pressure controlled via oral medications
Several nurses who work at the same hospital are communicating on social media.
Which of the following posts by one of the nurses violates client confidentiality? -
ANS--I'm pretty sure the client's spouse is angry that drunk driving was the cause of that
femur fracture.
-I boiled my clothes after caring for the new client with scabies.
-I will send you a private message about that sad client with terminal cancer.
A nurse is working in a busy urban emergency department understands that the
following clients have a right to be informed about all aspects of their care and to
participate in making decisions about that care? - ANS--A 17 y/o F client who presents
with a positive pregnancy test and vaginal bleeding.
-A 60 y/o client with HTN, DM, and chest pain who is seen in an urgent care setting.
-A 40 y/o client with peritonitis admitted to the ICU with impending respiratory failure
requiring urgent intubation and mechanical ventilation.
-An 89 y/o client with with multi-infarct dementia and pneumonia who is disoriented to
place and time.
A nurse is caring for a client with diarrhea who has tested positive for C. diff antigen in
stool. Which of the following measures is indicated to prevent the spread of this
pathogenic organism? - ANS--Wash hands with soap and water
-Wear a disposable gown while caring for the client
A nurse is caring for a 2-month-old in the pediatric emergency department. The mother
reports the child has had vomiting and watery diarrhea for the last 24 hours. The nurse
notes the child is lethargic with a sunken fontanel and dry mouth. Place the anticipated
nursing interventions in order of priority.
-Apply a urine bag to collect urine.
-Start an IV and begin giving fluids.
-Obtain vital signs including weight.
-Draw blood for lab tests. - ANS-1. Obtain vital signs including weight.
2. Start an IV and begin giving fluids.
3. Apply a urine bag to collect urine.
4. Draw blood for lab tests.
Read the following order from a physician. After reading the order, note which of the
following nursing actions is most appropriate? "Administer 500 mg ceftriaxone p.o. now
and q 6 hrs x 24 hours for infection prevention. - ANS-Contact the physician to clarify
the order
The medical/surgical unit consists of a registered nurse (RN), licensed practical nurse
(LPN), and 2 unlicensed nursing assistants. Which of the following tasks should the
supervisor assign to the LPN? - ANS--Assessing bowel sounds for changes in a stable
client who is two days post operative following a hysterectomy
-Reinforcing diabetic teaching on insulin injections for a client with newly diagnosed type
1 diabetes mellitus
-Inserting a urinary catheter
Which of the following strategies should be included to minimize the risk of breaking
confidentiality? - ANS--Always log off a computer after use
-Never discuss a client's condition outside of the hospital environment
Which of the following is a benefit associated with electronic medication administration
records? - ANS--Improves access to information
-Reduces the risk of medication administration errors
A nurse is delegating assignments for a nursing team that includes unlicensed assistive
personnel (UAP). Which of the following tasks should the nurse delegate to an UAP? -
ANS--Bathe a client who had an amputation 2 days ago
, -Assist a client to ambulate using a gait belt
-Measure and document a client's intake and output
The nurse is assigning tasks to unlicensed assistive personnel (UAP). Which of the
following tasks is appropriate to assign to a UAP? - ANS--Ambulating a stable three-day
post-hip replacement client in the hallway
-Checking bedside blood glucose levels for a client
-Change the urinary pad on a client who has been incontinent
The nurse is assigning clients on a medical-surgical floor. Which clients would be
appropriate to assign a Licensed Vocational Nurse (LVN)? - ANS--A client who is two
days post-op following a cholecystectomy
-A client who was admitted two days ago with a broken arm following a fall and is set to
be discharged tomorrow
-A client who was admitted with hypertensive crisis three days ago and has had blood
pressure controlled via oral medications
Several nurses who work at the same hospital are communicating on social media.
Which of the following posts by one of the nurses violates client confidentiality? -
ANS--I'm pretty sure the client's spouse is angry that drunk driving was the cause of that
femur fracture.
-I boiled my clothes after caring for the new client with scabies.
-I will send you a private message about that sad client with terminal cancer.
A nurse is working in a busy urban emergency department understands that the
following clients have a right to be informed about all aspects of their care and to
participate in making decisions about that care? - ANS--A 17 y/o F client who presents
with a positive pregnancy test and vaginal bleeding.
-A 60 y/o client with HTN, DM, and chest pain who is seen in an urgent care setting.
-A 40 y/o client with peritonitis admitted to the ICU with impending respiratory failure
requiring urgent intubation and mechanical ventilation.
-An 89 y/o client with with multi-infarct dementia and pneumonia who is disoriented to
place and time.
A nurse is caring for a client with diarrhea who has tested positive for C. diff antigen in
stool. Which of the following measures is indicated to prevent the spread of this
pathogenic organism? - ANS--Wash hands with soap and water
-Wear a disposable gown while caring for the client
