A nurse on a medical-surgical unit is admitting a client. Which of the following
information should the nurse document in the client’s record
... [Show More] first?
Assessment
A nurse is witnessing a client sign an informed consent form for surgery. Which
of the following describes what the nurse is affirming by this action?
The signature on the preoperative consent form is the client’s
A nurse on a medical-surgical unit is washing her hands prior to assisting with a
surgical procedure. Which of the following actions by the nurse demonstrates
proper surgical hand-washing techniques?
The nurse washes with her hands held higher than her elbows.
A nurse at a screening clinic is assessing a client who reports a history of a heart
murmur related to aortic valve stenosis. At which of the following anatomical
areas should the nurse place the stethoscope to auscultate the aortic valve?
Second intercostal space to the right of the sternum
A nurse is measuring vital signs for a client and notices an irregularity in the
pulse. Which of the following actions should the nurse take?
Count the apical pulse rate for 1 full minute, and describe the rhythm in
the chart.
A nurse is caring for an older adult client who becomes agitated when the nurse
requests the client’s dentures be removed prior to surgery. Which of the
following responses should the nurse make?
“What worries you about being without your teeth?”
A nurse is caring for a client who has a terminal illness. The client asks several
questions about the nurse’s religious beliefs related to death and dying. Which
of the following actions should the nurse take?
Encourage the client to express his thoughts about death and dying
A nurse is caring for a client who has Type 1 diabetes mellitus and is resistant to
learning self-injection of insulin. Which of the following statements should the
nurse make?
“Tell me what I can do to help you overcome your fear of giving yourself
injections.”
A charge nurse is teaching adult cardiopulmonary resuscitation (CPR) to a
group of newly licensed nurses. Which of the following actions should the
charge nurse teach as the first response in CPR?
Confirm unresponsiveness.
A community health nurse is preparing a campaign about seasonal influenza.
Which of the following plans should the nurse include as a secondary
prevention?
Screening groups of older adults in nursing care facilities for early
influenza manifestations
A nurse is preparing to provide tracheostomy care for a client. Which of the
following actions should the nurse take first?
Perform hand hy [Show Less]