Question 1

The nurse should heat the water for an eye compress to a temperature of no more than:

Accepted Answer

A)  95° F. 
B)  110° F. 
C)  115° F. 
D)  120° F. 
A)  95° F. 
B)  110° F. 
C)  115° F. 
D)  120° F. D

Question 2

Before inserting a nasogastric tube,the nurse should measure from the:

Accepted Answer

A)  tip of the nose to the earlobe to the xiphoid process. 
B)  bridge of the nose to the xiphoid process. 
C)  nose to the top of the ear to the stomach. 
D)  clavicular notch to the stomach. 
A)  tip of the nose to the earlobe to the xiphoid process. 
B)  bridge of the nose to the xiphoid process. 
C)  nose to the top of the ear to the stomach. 
D)  clavicular notch to the stomach. A

Question 3

Hot moist compresses have which positive effect(s)? (Select all that apply.)

Accepted Answer

A)  Improvement of circulation 
B)  Relief of edema 
C)  Consolidation of exudate 
D)  Enhancement of scabbing 
E)  Relief of pain 
A)  Improvement of circulation 
B)  Relief of edema 
C)  Consolidation of exudate 
D)  Enhancement of scabbing 
E)  Relief of pain A,B,C

Question 4

When preparing to administer blood,the nurse should select a needle with a gauge of:

Accepted Answer

A)  25. 
B)  22. 
C)  21. 
D)  18. 
A)  25. 
B)  22. 
C)  21. 
D)  18.

Question 5

The nurse is alert for a serious condition called ___________ that results from pathogens being introduced into the blood stream.

Accepted Answer

septicemia
Septicemia is a con

Question 6

When a patient asks if he can keep the hot application on his leg all the time,the nurse reminds him that long-term heat can:

Accepted Answer

A)  cause extreme vasoconstriction. 
B)  increase possibility of infection. 
C)  cause the blood pressure to increase. 
D)  damage epithelial cells. 
A)  cause extreme vasoconstriction. 
B)  increase possibility of infection. 
C)  cause the blood pressure to increase. 
D)  damage epithelial cells.

Question 7

When irrigating an ear,the nurse should perform which intervention(s)? (Select all that apply.)

Accepted Answer

A)  Heat the water to 115° F. 
B)  Pull the auricle back firmly and hold it. 
C)  Place the tip of the syringe loosely in the ear canal. 
D)  Introduce fluid with a slow,gentle irrigation. 
E)  Use a stronger flow if a vegetable foreign body is present. 
A)  Heat the water to 115° F. 
B)  Pull the auricle back firmly and hold it. 
C)  Place the tip of the syringe loosely in the ear canal. 
D)  Introduce fluid with a slow,gentle irrigation. 
E)  Use a stronger flow if a vegetable foreign body is present.

Question 8

A nurse should instill eye irrigation from the inner to the outer canthus to:

Accepted Answer

A)  avoid harming the sclera. 
B)  include the conjunctiva in the irrigation. 
C)  keep the pupil constricted. 
D)  protect the nasolacrimal ducts. 
A)  avoid harming the sclera. 
B)  include the conjunctiva in the irrigation. 
C)  keep the pupil constricted. 
D)  protect the nasolacrimal ducts.

Question 9

When an order for eye irrigation is received,the nurse can delegate the procedure to:

Accepted Answer

A)  the patient. 
B)  another nurse. 
C)  a nursing assistant. 
D)  a family member. 
A)  the patient. 
B)  another nurse. 
C)  a nursing assistant. 
D)  a family member.

Question 10

The appliance that connects to an IV drip and delivers a continuous irrigation to the eye is known as a ________ _________ _________.

Accepted Answer

Morgan therapeutic lens
A Morg

Question 11

The nurse notes an edematous area around the insertion site of an IV that is cool to the touch and the skin of which appears blanched.Based on these assessment findings,the nurse's first priority is to:

Accepted Answer

A)  apply warm compresses to the area. 
B)  notify the charge nurse. 
C)  stop the infusion. 
D)  reposition the arm to improve the fluid flow. 
A)  apply warm compresses to the area. 
B)  notify the charge nurse. 
C)  stop the infusion. 
D)  reposition the arm to improve the fluid flow.

Question 12

While teaching a patient about the signs of IV therapy-associated phlebitis,the nurse reminds the patient that the area will be:

Accepted Answer

A)  warm,edematous,and red. 
B)  painful and cyanotic. 
C)  painless and numb. 
D)  edematous and cool. 
A)  warm,edematous,and red. 
B)  painful and cyanotic. 
C)  painless and numb. 
D)  edematous and cool.

Question 13

When an older adult patient with chronic emphysema comes to the emergency department in respiratory distress,the nurse should begin O2 per nasal cannula at:

Accepted Answer

A)  2 L/min. 
B)  2.5 L/min. 
C)  3 L/min. 
D)  4 L/min. 
A)  2 L/min. 
B)  2.5 L/min. 
C)  3 L/min. 
D)  4 L/min.

Question 14

During insertion of a Foley catheter,the patient grimaces as the balloon is inflated.The nurse should:

Accepted Answer

A)  withdraw the catheter. 
B)  ask the patient to bear down. 
C)  continue to inflate the balloon. 
D)  advance the catheter into the bladder. 
A)  withdraw the catheter. 
B)  ask the patient to bear down. 
C)  continue to inflate the balloon. 
D)  advance the catheter into the bladder.

Question 15

The wife of a patient with a cuffed tracheostomy asks why the cuff is inflated intermittently.The nurse replies that the purpose of the inflated cuff is to:

Accepted Answer

A)  prevent regurgitation after meals. 
B)  hold the trachea open until it is completely healed. 
C)  dilate the tracheal opening for passage of secretions. 
D)  prevent aspiration when eating. 
A)  prevent regurgitation after meals. 
B)  hold the trachea open until it is completely healed. 
C)  dilate the tracheal opening for passage of secretions. 
D)  prevent aspiration when eating.

Question 16

If a patient has a transfusion reaction,the nurse should perform the following interventions in which priori order?
1.Take and record vital signs.
2.Notify physician and blood bank.
3.Stop the transfusion.
4.Monitor urine output.
5.Return blood and tubing to the blood bank.
Put a comma between each solve choice (1,2,3,4,etc.).

Accepted Answer

3,1,2,5,4
3,1,2,5,4
The correct sequence

Question 17

The nurse explains to a patient that an Aquathermia pad differs from a traditional heating pad in that the Aquathermia pad:

Accepted Answer

A)  can be folded to fit the anatomical location snugly. 
B)  can be placed under the patient. 
C)  has circulating water for temperature control. 
D)  can be left on for as long as 2 hours. 
A)  can be folded to fit the anatomical location snugly. 
B)  can be placed under the patient. 
C)  has circulating water for temperature control. 
D)  can be left on for as long as 2 hours.

Question 18

The nurse explains routine catheter care to the nursing assistant as:

Accepted Answer

A)  cleansing the first 2 inches of the catheter with soap and water every shift. 
B)  disinfecting the entire catheter with alcohol every shift. 
C)  lubricating the catheter with antiseptic lotion every 24 hours. 
D)  cleansing the meatal-catheter junction every 24 hours. 
A)  cleansing the first 2 inches of the catheter with soap and water every shift. 
B)  disinfecting the entire catheter with alcohol every shift. 
C)  lubricating the catheter with antiseptic lotion every 24 hours. 
D)  cleansing the meatal-catheter junction every 24 hours.

Question 19

After a Foley catheter has been removed,the nurse should assess the patient carefully for:

Accepted Answer

A)  hemorrhage. 
B)  constipation. 
C)  urinary retention. 
D)  bladder spasm. 
A)  hemorrhage. 
B)  constipation. 
C)  urinary retention. 
D)  bladder spasm.

Question 20

When a patient receiving IV fluid therapy shows an increase in blood pressure and has bilateral crackles,the nurse's first priority is to:

Accepted Answer

A)  raise the head of the bed. 
B)  slow the infusion. 
C)  turn the patient to the left side. 
D)  notify the charge nurse. 
A)  raise the head of the bed. 
B)  slow the infusion. 
C)  turn the patient to the left side. 
D)  notify the charge nurse.

Exam 20: Selected Nursing Skills

The nurse should heat the water for an eye compress to a temperature of no more than:

Before inserting a nasogastric tube,the nurse should measure from the:

Hot moist compresses have which positive effect(s)? (Select all that apply.)

When preparing to administer blood,the nurse should select a needle with a gauge of:

The nurse is alert for a serious condition called ___________ that results from pathogens being introduced into the blood stream.

When a patient asks if he can keep the hot application on his leg all the time,the nurse reminds him that long-term heat can:

When irrigating an ear,the nurse should perform which intervention(s)? (Select all that apply.)

A nurse should instill eye irrigation from the inner to the outer canthus to:

When an order for eye irrigation is received,the nurse can delegate the procedure to:

The appliance that connects to an IV drip and delivers a continuous irrigation to the eye is known as a ________ _________ _________.

The nurse notes an edematous area around the insertion site of an IV that is cool to the touch and the skin of which appears blanched.Based on these assessment findings,the nurse's first priority is to:

While teaching a patient about the signs of IV therapy-associated phlebitis,the nurse reminds the patient that the area will be:

When an older adult patient with chronic emphysema comes to the emergency department in respiratory distress,the nurse should begin O2 per nasal cannula at:

During insertion of a Foley catheter,the patient grimaces as the balloon is inflated.The nurse should:

The wife of a patient with a cuffed tracheostomy asks why the cuff is inflated intermittently.The nurse replies that the purpose of the inflated cuff is to:

The nurse explains to a patient that an Aquathermia pad differs from a traditional heating pad in that the Aquathermia pad:

The nurse explains routine catheter care to the nursing assistant as:

After a Foley catheter has been removed,the nurse should assess the patient carefully for:

When a patient receiving IV fluid therapy shows an increase in blood pressure and has bilateral crackles,the nurse's first priority is to:

the Evolution of Nursing

Legal and Ethical Aspects of Nursing

Communication

Vital Signs

Physical Assessment

Nursing Process and Critical Thinking

Documentation

Cultural and Ethnic Considerations

Life Span Development

Loss, grief , dying, and Death

Admission, Transfer, and Discharge

Medical-Surgical Asepsis and Infection Prevention and Control

Surgical Wound Care

Safety

Body Mechanics and Patient Mobility

Pain Management, Comfort, Rest, and Sleep

Complementary and Alternative Therapies

Hygiene and Care of the Patient’s Environment

Specimen Collection and Diagnostic Examination

Basic Nutrition and Nutrition Therapy

Fluids and Electrolytes

Mathematics Review and Medication Administration

Emergency First Aid Nursing

Health Promotion and Pregnancy

Labor and Delivery

Care of the Mother and Newborn

Care of the High-Risk Mother, Newborn, and Family with Special Needs

Health Promotion for the Infant, Child, and Adolescent

Basic Pediatric Nursing Care

Care of the Child with a Physical Disorder

Care of the Child with a Mental or Cognitive Disorder

Health Promotion and Care of the Older Adult

Basic Concepts of Mental Health

Care of the Patient with a Psychiatric Disorder

Care of the Patient with an Addictive Personality

Home Health Nursing

Long-Term Care

Rehabilitation Nursing

Hospice Care

Professional Roles and Leadership

Filters

The appliance that connects to an IV drip and delivers a continuous irrigation to the eye is known as a ____ _ _____.

When an older adult patient with chronic emphysema comes to the emergency department in respiratory distress,the nurse should begin O₂ per nasal cannula at: