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A charge nurse is explaining the various
stages of the lifespan to a group of newly
licensed nurses. Which of the following
examples should the nurse include as
a developmental task for middle adult-
hood?
d. the client expresses concerns about
a. the client evaluates their behavior after
the next generation
a social interaction
b. the client states they are learning to
trust others
c. the client wishes to find meaningful
friendships
d. the client expresses concerns about
the next generation
When entering a client's room to change
a surgical dressing, a nurse notes that
the client is coughing and sneezing.
Which of the following actions should the
nurse take when preparing the sterile
field?
a. keep the sterile field at least 6ft away
c. place a mask on the client to limit
from the client's bedside
the spread of microbes into the surgical
b. instruct the client to refrain from
wound
coughing and sneezing during the dress-
ing change
c. place a mask on the client to limit
the spread of microbes into the surgical
wound
d. keep a box of facial tissues nearby
for the client to use during the dressing
change
A nurse is wearing sterile gloves in
preparation for performing a sterile pro-
cedure. Which of the following objects
can the nurse touch without breaching
sterile technique? (select all that apply)
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a. a bottle containing a sterile solution
b. the edge of the sterile drape at the c. the inner wrapping of an item on the
base of the field sterile field
c. the inner wrapping of an item on the d. an irrigation syringe on the sterile field
sterile field e. one gloved hand with the other gloved
d. an irrigation syringe on the sterile field hand
e. one gloved hand with the other gloved
hand
A nurse is reviewing hand hygiene tech-
niques with a group of assistive person-
al (AP). Which of the following instruc-
tions should the nurse include when dis-
cussing handwashing? (select all that
apply)
b. wash the hands with soap and water
for at least 15 seconds
a. apply 3-5 mL of liquid soap to dry
d. use a clean paper towel to turn off
hands
hand faucets
b. wash the hands with soap and water
for at least 15 seconds
c. rinse the hands with hot water
d. use a clean paper towel to turn off
hand faucets
e. allow the hands to air dry after washing
A nurse has prepared a sterile field for
assisting a provider with a chest tube
insertion. Which of the following events
should the nurse recognize as contam- b. the nurse moistens a cotton ball with
inating the sterile field? (select all that sterile normal saline and places it on the
apply) sterile field
c. the procedure is delayed 1hr because
a. the provider drops a sterile instrument the provider receives an emergency
onto the near side of the sterile field d. the nurse turns to speak to someone
b. the nurse moistens a cotton ball with who enters through the door behind the
sterile normal saline and places it on the nurse
sterile field
c. the procedure is delayed 1hr because
the provider receives an emergency
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d. the nurse turns to speak to someone
who enters through the door behind the
nurse
e. the client's hand brushes against the
outer edge of the sterile field
A nurse is caring for a client who fell at
a nursing home. The client is orientated
to person, place, and time and can follow
directions. Which of the following actions
should the nurse take to decrease the
risk of another fall? (select all that apply)
c. make sure that the client's call light is
within reach
a. place a belt restraint on the client when
d. provide the client with nonskid
they are sitting on the bedside commode
footwear
b. keep the bed at its lowest position with
e. complete a fall risk assessment
all side rails up
c. make sure that the client's call light is
within reach
d. provide the client with nonskid
footwear
e. complete a fall risk assessment
A nurse observes smoke coming from
under the door of the staff's lounge.
Which of the following actions is the
nurse's priority?
c. move clients who are nearby
a. extinguish the fire
b. activate the fire alarm
c. move clients who are nearby
d. close all open doors in the unit
A nurse is caring for a client who has
a history of falls. Which of the following
actions is the nurse's priority?
a. complete a fall-risk assessment
a. complete a fall-risk assessment
b. educate the client and family about fall
risks
c. eliminate safety hazards from the
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client's environment
d. make sure the client uses assistive
aids in their possession
A nurse is reviewing safety measures
with the parent of an 8-month-old in-
fant. Which of the following statements
by the parent indicates an understanding
of safety for the infant?
a. "My baby loved to play with the crib a. "My baby loved to play with the crib
gym, but I took it out of the crib" gym, but I took it out of the crib"
b. "I just bought soft mattress so my baby
will sleep better"
c. "My baby really like sleeping on the
fluffy pillow we just got"
d. "I put the baby's car seat out of the way
on the table after I put him in it"
A nurse is reviewing car seat safety
with the parents of a 1-month-old in-
fant. When reviewing car seat use, which
of the following instructions should the
nurse include?
a. Use a car seat that has a three-point b. position the car seat so that the infant
harness system is rear-facing
b. position the car seat so that the infant
is rear-facing
c. secure the car seat in the front passen-
ger seat of the vehicle
d. convert to a booster seat after 12
months
The mother of a 7-month-old infant tells
the nurse at the pediatric clinic that her
baby has been fussy with occasional
loose stools since she started feeding
him fruits and vegetables. Which of the
following responses should the nurse
make? (select all that apply)