NURS 120 proctored
A nurse is delegating client care assignment for the shift. which of the following tasks
should the nurse delegate to an AP?
-perform wound irrigation for a client
-evaluate pain relief for a client following the administration of pain meds
-measure and record intake and output for a client
-teach a client about low-Na foods - answer measure and record intake and output for a
client
a nurse is providing discharge teaching about clean intermittent self-catheterization a
client who has benign prostatic hyperplasia. which of the following instructions should
the nurse include - answeruse soap and water to wash the catheter after each us
a nurse on the postpartum unit is caring for a group of clients with an AP. which of the
following tasks should the nurse plan to delegate to the AP?
a. Observe an area of redness on the breast of a client who is 1 day postpartum.
b . Change the perineal pad of a client who just transferred from labor and delivery.
c. Provide a sitz bath to a client who has a fourth degree laceration and is 2 days
postpartum.
d. Monitor vital signs during admission of a client who has a gestational hypertension -
answerprovide a sitz bath to a client who has a fourth-degree laceration and is 2 days
postpartum
a nurse is caring for a client who falls in his room. after the nurse assesses the client.
notifies the client's provider, and completes an incident report, which of the following
actions should the nurse take?
a. make a copy of the incident report for the provider
b.submit the incident report to the risk manager
c.place the incident report in the client's chart
d.document in the chart that incidence report has been filed - answersubmit the incident
report to the risk manager
a nurse is caring for a client who is scheduled for surgery. the nurse's role in regard to
informed consent is which of the following? - answerDetermining the client's level of
understanding about the procedure
a charge nurse is observing a nurse insert an indwelling urinary catheter into a female
client. for which of the following actions by the nurse should the charge nurse
intervene? - answerthe nurse separates the client's labia with her dominant hand
,a nurse is providing teaching to an assistive personnel about caring for clients with
restraints. which of the following statements by the AP indicates the an understanding of
the teaching - answeri will tie a restraint to the portion of the bed that moves when the
head of the bed is moved
a nurse is providing postmortem care for a client. identify the sequence of steps the
nurse should follow - answer-make sure the provider has certified the client's dead
-verify the client's organ and tissue donation status
-remove medical equipment from the client
-cleanse the body while adhering to body fluid precautions
-attach ID tags to the body
a nurse in a long term facility is planning care for several clients. which of the following
activities should the nurse delegate to the LPN? - answerschedule a diagnostic study
for a client
a nurse is caring for a client with a tracheostomy. the client's partner has been taught to
perform suctioning. which of the following actions by the partner should indicate to the
nurse a readiness for the client's discharge? - answerperforming the procedure
independently
a nurse is reviewing the goals of the nurse-client therapeutic relationship with a client
who is seeking counseling. which of the following information should the nurse include
in this discussion - answerThe client achieves optimal personal growth
A nurse manager hears a staff nurse on the unit speak openly about her dislike of a new
policy regarding client care. When discussing the issue with the nurse, which of the
following statements by the nurse manager is appropriate?
A. You should support this policy change because it is based on EBP
B. Being open to change is an expectation for nurses who work on this unit
C. Why didnt you voice your concerns before the new policy was initiated?
D. Lets talk about your concerns about the new policy - answerD. Lets talk about your
concerns about the new policy
a nurse is caring for a client who is at risk for falls. which of the following actions should
the nurse take - answer-teach the client to use the call light
-keep the clients bed in the lowest position
-place fall-risk ID band on the clients wrist
a nurse is organizing care for a group of clients. which of the following tasks should the
nurse delegate to the AP? - answerassisting a client who is 12 hr postop following an
appendectomy to use a bed pan
a nurse is teaching a class on torts. the nurse should instruct the class that
administering an antibiotic medication to a competent client after the client has refused
it is an example of which of the following torts? - answerbattery
, a nurse in an urgent care clinic is studying the developmental stages of various clients.
in which of the following clients should the nurse expect to see manifestation of autism -
answertoddler
a nurse who his left-handed is preparing to perform a straight catheterization for a client.
which of the following actions should the nurse take - answerraise the bed to a
comfortable height
a nurse is caring for a client who is confused and has pulled out her peripheral IV
catheter three times. which of the following actions should the nurse consider -
answerplace mitten restraints on the client's hand
a nurse is providing discharge teaching to a client who was recently diagnosed with a
latex allergy. which of the following client statements indicates an understanding of the
teaching? - answer"I will use ink pens for writing"
A nurse is providing care to a client who is on strict bed rest following surgery. The
nurse assists the pt to the bedside commode and the client sustains an injury to the
operative area. Which of the following types of torts has the nurse committed?-battery-
negligence-malpractice-assault - answernegligence
a nurse in an outpatient mental health unit is planning care for a client who is in
restraints. which of the following findings should indicate to the nurse that the client is
ready to reintegrate into the unit - answerthe client follows directions
a nurse is caring for a client who is cognitively impaired and repeatedly pulls on his NG
tube. which of the following actions should the nurse take before requesting a
prescription for restraints - answer-assist the client with toileting at frequent intervals
-use an electronic position-sensitive device
-provide diversionary activities for the client
-involve the family in the client's care
A nurse is discussing the norming stage of the group development process with a
student nurse. Which of the following statements by the student indicates an
understanding of the discussion?
-"This stage involves constructive efforts on the part of the group members."
-"This stage is when testing occurs to identify boundaries of interpersonal behaviors."
-"Consensus evolves in this stage."
-"Resistance is evident as subgroups for in this stage." - answerConsensus evolves in
this stage."
a nurse is teaching a client who is to begin medicated treatment of tuberculosis. the
nurse should instruct the client that which of the following herbal supplements can
interact adversely with the treatment - answerechinacea
A nurse is delegating client care assignment for the shift. which of the following tasks
should the nurse delegate to an AP?
-perform wound irrigation for a client
-evaluate pain relief for a client following the administration of pain meds
-measure and record intake and output for a client
-teach a client about low-Na foods - answer measure and record intake and output for a
client
a nurse is providing discharge teaching about clean intermittent self-catheterization a
client who has benign prostatic hyperplasia. which of the following instructions should
the nurse include - answeruse soap and water to wash the catheter after each us
a nurse on the postpartum unit is caring for a group of clients with an AP. which of the
following tasks should the nurse plan to delegate to the AP?
a. Observe an area of redness on the breast of a client who is 1 day postpartum.
b . Change the perineal pad of a client who just transferred from labor and delivery.
c. Provide a sitz bath to a client who has a fourth degree laceration and is 2 days
postpartum.
d. Monitor vital signs during admission of a client who has a gestational hypertension -
answerprovide a sitz bath to a client who has a fourth-degree laceration and is 2 days
postpartum
a nurse is caring for a client who falls in his room. after the nurse assesses the client.
notifies the client's provider, and completes an incident report, which of the following
actions should the nurse take?
a. make a copy of the incident report for the provider
b.submit the incident report to the risk manager
c.place the incident report in the client's chart
d.document in the chart that incidence report has been filed - answersubmit the incident
report to the risk manager
a nurse is caring for a client who is scheduled for surgery. the nurse's role in regard to
informed consent is which of the following? - answerDetermining the client's level of
understanding about the procedure
a charge nurse is observing a nurse insert an indwelling urinary catheter into a female
client. for which of the following actions by the nurse should the charge nurse
intervene? - answerthe nurse separates the client's labia with her dominant hand
,a nurse is providing teaching to an assistive personnel about caring for clients with
restraints. which of the following statements by the AP indicates the an understanding of
the teaching - answeri will tie a restraint to the portion of the bed that moves when the
head of the bed is moved
a nurse is providing postmortem care for a client. identify the sequence of steps the
nurse should follow - answer-make sure the provider has certified the client's dead
-verify the client's organ and tissue donation status
-remove medical equipment from the client
-cleanse the body while adhering to body fluid precautions
-attach ID tags to the body
a nurse in a long term facility is planning care for several clients. which of the following
activities should the nurse delegate to the LPN? - answerschedule a diagnostic study
for a client
a nurse is caring for a client with a tracheostomy. the client's partner has been taught to
perform suctioning. which of the following actions by the partner should indicate to the
nurse a readiness for the client's discharge? - answerperforming the procedure
independently
a nurse is reviewing the goals of the nurse-client therapeutic relationship with a client
who is seeking counseling. which of the following information should the nurse include
in this discussion - answerThe client achieves optimal personal growth
A nurse manager hears a staff nurse on the unit speak openly about her dislike of a new
policy regarding client care. When discussing the issue with the nurse, which of the
following statements by the nurse manager is appropriate?
A. You should support this policy change because it is based on EBP
B. Being open to change is an expectation for nurses who work on this unit
C. Why didnt you voice your concerns before the new policy was initiated?
D. Lets talk about your concerns about the new policy - answerD. Lets talk about your
concerns about the new policy
a nurse is caring for a client who is at risk for falls. which of the following actions should
the nurse take - answer-teach the client to use the call light
-keep the clients bed in the lowest position
-place fall-risk ID band on the clients wrist
a nurse is organizing care for a group of clients. which of the following tasks should the
nurse delegate to the AP? - answerassisting a client who is 12 hr postop following an
appendectomy to use a bed pan
a nurse is teaching a class on torts. the nurse should instruct the class that
administering an antibiotic medication to a competent client after the client has refused
it is an example of which of the following torts? - answerbattery
, a nurse in an urgent care clinic is studying the developmental stages of various clients.
in which of the following clients should the nurse expect to see manifestation of autism -
answertoddler
a nurse who his left-handed is preparing to perform a straight catheterization for a client.
which of the following actions should the nurse take - answerraise the bed to a
comfortable height
a nurse is caring for a client who is confused and has pulled out her peripheral IV
catheter three times. which of the following actions should the nurse consider -
answerplace mitten restraints on the client's hand
a nurse is providing discharge teaching to a client who was recently diagnosed with a
latex allergy. which of the following client statements indicates an understanding of the
teaching? - answer"I will use ink pens for writing"
A nurse is providing care to a client who is on strict bed rest following surgery. The
nurse assists the pt to the bedside commode and the client sustains an injury to the
operative area. Which of the following types of torts has the nurse committed?-battery-
negligence-malpractice-assault - answernegligence
a nurse in an outpatient mental health unit is planning care for a client who is in
restraints. which of the following findings should indicate to the nurse that the client is
ready to reintegrate into the unit - answerthe client follows directions
a nurse is caring for a client who is cognitively impaired and repeatedly pulls on his NG
tube. which of the following actions should the nurse take before requesting a
prescription for restraints - answer-assist the client with toileting at frequent intervals
-use an electronic position-sensitive device
-provide diversionary activities for the client
-involve the family in the client's care
A nurse is discussing the norming stage of the group development process with a
student nurse. Which of the following statements by the student indicates an
understanding of the discussion?
-"This stage involves constructive efforts on the part of the group members."
-"This stage is when testing occurs to identify boundaries of interpersonal behaviors."
-"Consensus evolves in this stage."
-"Resistance is evident as subgroups for in this stage." - answerConsensus evolves in
this stage."
a nurse is teaching a client who is to begin medicated treatment of tuberculosis. the
nurse should instruct the client that which of the following herbal supplements can
interact adversely with the treatment - answerechinacea
