A nurse is reviewing information about the Health Insurance Portability and
Accountability Act (HIPAA) with a newly licensed nurse. Which of the
... [Show More] following statements by the newly
licensed nurse indicates a need for further teaching?
A. "Information about a client can be disclosed to family members at any time." ANSWER
B. "HIPAA established regulations of individually identifiable health information in verbal, electronic, or
written form."
C. "A client's address would be an example of personally identifiable information." D. "HIPAA is a federal
law, not a state law."
2. A nurse is preparing to perform hand hygiene. Which of the following actions should the nurse take?
A. Adjust the water temperature to feel hot.
B. Apply 4 to 5 mL of liquid soap to the hands. ANSWER
C. Hold the hands higher than the elbows.
D. Rub hands and arms to dry.
3. A nurse is administering nasal decongestant drops for a client. Which of the following actions should the
nurse take?
A. Tell the client to blow her nose gently before the instillation. ANSWER
B. Assist the client to a side-lying position.
Downloaded by: taty1370 | [email protected]
Distribution of this document is illegal
C. Hold the dropper 2 cm (1 in) above the naris.
D. Instruct the client to stay in the same position for 2 min.
4. A newly licensed nurse is applying prescribed wrist restraints on a client. Which of the following actions
should the nurse take?
A. Secure the restraints using a quick-release tie. ANSWER
B. Ensure four fingers fit under the restraints to prevent constriction.
C. Secure the restraints to the lowest bar of the side rail.
D. Anticipate removing the restraints every 4 hr.
5. The family of an older adult client brings him to the emergency department after finding him
wandering outside. During the initial assessment, the nurse notes that the client flinches when she palpates his
abdomen yet responds to questions only by nodding and smiling. Which of the following factors should the nurse
identify as a likely explanation for the client's behavior?
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Downloaded by: taty1370 | [email protected]
Distribution of this document is illegal
A. He is hard of hearing.
B. Pain ANSWER
C. Confusion
D. Language barrier
6. A nurse is preparing a client for outpatient surgery. After the nurse inserts the IV catheter, the client
reports pain in the insertion area. Which of the following actions should the nurse take?
A. Remove the catheter and insert another into a different site. ANSWER
B. Administer an analgesic PO.
C. Request a prescription for placement of a central venous access device.
D. Administer a local anesthetic.
7. A client smoking in his bathroom has dropped a cigarette butt into a wastepaper basket, which begins
to smolder. Which of the following actions is the nurse’s priority? A. Close the fire doors on the unit.
B. Activate the fire alarm.
C. Move any clients in the immediate vicinity. ANSWE [Show Less]