TEST BANK For Clinical Nursing Skills: A Concept-Based Approach, 4th Edition Volume III by Pearson Education, Verified Chapters 1 - 16, Complete Newest Version

Test Bank for Clinical Nursing Skills:
A Concept-Based Approach
4th Edition Volume III
by Pearson Education Chapters 1 - 16

,Test Bank for Clinical Nursing Skills: A Concept-
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Based Approach 4th Edition Pearson
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,Clinical Nursing Skills: A Concept- 9K 9K 9K 9K



Based Approach, 4e (Pearson) Education Test BankChapter 1: Assessment
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1) A client on the medical/surgical unit complains of sudden chest pains. Which action will
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thenurse implement first?
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A) Call the healthcare provider. 9K 9K 9K



B) Administer pain medication. 9K 9K



C) Reassess a new set of vital signs. 9K 9K 9K 9K 9K 9K



D) Turn client from supine to latera 9K 9K 9K 9K 9K



l.ANSWER: C
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Explanation: A) The nurse will need to reassess the client first, before calling the healthc
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areprovider. K
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B) The nurse will need to reassess the client first, before administering pain medication.
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C) The nurse needs to implement a new set of vital signs first when there is a chang
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e incondition.
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D) The nurse will need to reassess the client first, before moving the client, to avoid making
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thechange in client's condition worse.
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Page Ref: 2 9K 9K



Cognitive Level: Applying 9K 9 K



Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Assessment | Learning Outcome: 1.1 | QSEN Competenci
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es:Patient-Centered Care
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AACN Domains and Comps.: Domain 2: Person-
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Centered CareNLN Competencies: Relationship Centered Care
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2) The nurse is observing the UAP taking the temperature of an unconscious client. Which r
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outewill the nurse question the UAP using?
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A) Oral
B) Rectal
C) Scanner
D) Tympani
cANSWER:
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A
Explanation: A) The temperature of an unconscious client is never taken by mouth. The rect
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al,tympanic, or scanner method is preferred.
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B) The rectal, tympanic, or scanner method is preferred.
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C) The rectal, tympanic, or scanner method is preferred.
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D) The rectal, tympanic, or scanner method is preferre
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d.Page Ref: 24
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Cognitive Level: Applying 9K 9 K



Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Stand
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ards: Nursing Process: Evaluation | Learning Outcome: 1.1 | QSEN Competencies: SafetyA
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ACN Domains and Comps.: Domain 5: Quality and Safety
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NLN Competencies: Quality & Safety
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1

, 3) The nurse is changing a 2-month-
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old client's diaper and notes the client feels warm to touch.Which method should the nurse
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use to check the baby's temperature?
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A) Oral
B) Rectal
C) Axillary
D) Tympanic membran 9K



eANSWER: C
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Explanation: A) Oral is used for age 3 or older. 9 K 9K 9K 9K 9K 9K 9K 9K 9K



B) The rectal route is the least desirable.
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C) The axillary route may not be as accurate as other routes for detecting fevers in children.
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D) The tympanic membrane may be used for 3 months or old
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er.Page Ref: 29
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Cognitive Level: Applying 9K 9 K



Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Evaluating | Learning Outcome: 1.2 | QSEN Competencies: Saf
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etyAACN Domains and Comps.: Domain 5: Quality and Safety
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NLN Competencies: Quality & Safety
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4) A client comes in with exacerbation of chronic obstructive pulmonary disease (COPD). Whi
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chnoninvasive diagnostic test will the nurse implement to know that the client is receiving en
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ough oxygen? 9K



A) Chest x-ray 9K



B) Pulse oximeter 9K



C) Arterial blood gasses 9K 9K



D) Assessment of respiratory rat 9K 9K 9K



eANSWER: B
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Explanation: A) A chest x-ray is not an intervention a nurse completes.
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B) A pulse oximeter provides a noninvasive method of measuring oxygenation, or oxygen
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saturation, in the blood and provides a pulse reading, which is especially helpful for the cli
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entwith a respiratory illness or disease.
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C) Arterial blood gases are an invasive diagnostic test.
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D) Assessing a respiratory rate is important for the nurse to implement; however, it is n
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ot adiagnostic test.
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Page Ref: 21 9K 9K



Cognitive Level: Applying 9K 9 K



Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
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Standards: Nursing Process: Implementation | Learning Outcome: 1.3 | QSEN Competencie
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s:Informatics
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AACN Domains and Comps.: Domain 5: Quality and SafetyNL
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N Competencies: Quality & Safety
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