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35 Cards in this Set

  • Front
  • Back

A charge nurse is observing a newly hired nurse prepare a sterile field which of the following indicates to the charge nurse that was sterile field is contaminated

Sterile field is open on a wet surface

A nurse is providing teaching to a client who is receiving chemotherapy which of the following statements indicates an understanding of the teaching

I will disinfect my toothbrush weekly

Proper technique of using a walker

Uses a lifting motion to move the walker

A nurse is caring for a client who has tuberculosis which of the following actions should the nurse take

One place the client and a negative pressure room to wear gloves when assisting the client with oral care 3.use antimicrobial sanitizer for hand hygiene

What is an important precaution to take when caring for a client who has diarrhea due to shigella

Wash hands before and after client contact

To prevent infection when inserting an IV catheter

Thread the IV catheter so that the hub rests at the insertion site

Instructions for a home oxygen concentrator

Check the cord routinely for phrase or tearing. Consider purchasing a generator for power back up. Monitor for signs of hypoxia

Which of the following would indicate to a nurse the need to suction a clients tracheostomy

Irritability

How do you perform a Romberg test

Have the client stand with arms at side and feet together

Inflate a blood pressure cuff 30 above the last measurement on the man o meter at which you are able to palpate a pulse

30 beyond the last measurement

A patient with a pressure ulcer would be expected to have a serum albumin level of

3 grams per deciliter. Indicating protein deficiency

Teaching a client about techniques to promote sleep

Consume a light snack of carbohydrates at bedtime

During a wound irrigation

Cleanse the wound from the center outwards

If intake is 2600 milliliters of fluids

Expected output would be 2500 milliliters

A clear liquid diet does not include

Orange sherbet


However black coffee is a clear liquid.

Potential indication of abuse

Presence of bruises on the arms in various stages of healing

When is talking to a client with hearing loss

Rephrase rather than repeat misunderstood information

Technique and I should use when performing nasotracheal suction for a client

Apply intermittent section when withdrawing the catheter

What should be used to irrigate an NG tube

0.9% sodium chloride

A patient with tuberculosis

Negative airflow room

The patient with c diff

Have visitors wear gown and gloves. Wash hands with soap and water not only alcohol-based hand sanitizer

Inserting the NG tube

As a client take sips of water to promote insertion of the NG tube into the esophagus

Recognized at the at the site as infiltration

Skin blanching

Decline receiving continuous tube feeding via NG tube has three episodes of vomiting in 12 hours Nursing action should be

Aspirate for residual

Behavioral signs of dysphagia

Storing food in the mouth

Initiate and enteral feeding through a PEG tube

This falls within that are in scope of practice

The patient has a cerebrovascular accident and is unable to bear his own weight

Use a hydraulic lift and have an AP help move the client

Range of motion exercises to promote neck rotation

Have patient move their head from side to side

Preparing to transfer a client from the bed to the stretcher using a slide board

The nurse should lower the head of the bed

Protocol in preparation for suctioning a client with a new tracheostomy

Select a suction catheter that is half the size of the lumen

If a patient develops phlebitis during receiving IV fluids remove the catheter in place a warm compress over the IV site

Ditto

Teaching regarding the use of a cane

Maintain 2 points of support on the floor

If a patient has difficulty voiding after the removal of an indwelling urinary catheter

pour warm water over the client perineum

A patient has an order for 5 units of regular insulin and 10 units of NPH insulin to be mixed together and administered subcutaneously

1 inject air into the vial of NPH without touching the solution in order to withdraw the desired amount of medication later. To the nursery next inject air into the vial of regular insulin, and then with a draw the appropriate amount of medication. Next lunar should place the needle into the NPH insulin vials and with a draw the correct amount of medication. The nurse should follow these steps to prevent contaminating the regular insulin with NPH insulin

A good plan of care for an older adult client who is at risk for falls

Implement a regular toileting schedule