A nurse has delegated various client care tasks to the assistive personnel on the
care team. Which of the following actions by the AP should the nurse identify
as correct?
~ Donning a mask to measure the vital signs of a patient with pertussis
A nurse is reinforcing teaching about hospice ca...
A nurse is caring for a client who just died and practiced the islamic faith.
Which of the following cultural practices should the nurse expect?
✓~ The client face should be toward mecca.
A nurse is assisting with a client who has active Tb. Which of the following
actions should the nurse plan to take?
✓~ Assign the client to a negative pressure airflow room.
A nurse is assisting with the plan of care for a client who has a bacterial
infection and a persistant oral temperature of 38.9 * C (102 F). Which of the
following interventions should the nurse include in the plan of care to treat the
fever?
✓~ Administer acetaminophen
,A nurse is contributing to the plan of care for a client who has a positive throat
culture for streptococci. Which of the following interventions should the nurse
recommend to be included in the plan of care?
✓~ Ensure that the client wears a surgical mask during transportation thoughout
the facility.
A nurse is planning care for a client who is disoriented and at risk for falls.
Which of the following interventions should the nurse include?
✓~ Place the client in a room near the nurses station.
Ensure that the client is wearing non skid slippers.
Reinforce teaching about how to use the call bell.
A nurse is contributing to a plan of care for a client who has a new prescription
for a wrist restraint. Which of the following actions should the nurse include in
the plan?
✓~ Pad bony prominences on the wrist.
, A nurse is reinforcing teaching with a client who has a partial hearing loss about
how to modify the home environment. Which of the following is a priority
modification that the nurse should include?
✓~ Flashing smoke alarm
A nurse is caring for four clients who are required to provide informed consent
for treatment. The nurse should identify that which of the following clients is
able to provide informed consent?
✓~ An 18 year old client who has acute appendicitis.
A nurse is reviewing the medical record of a client who has heart failure. The
nurse should identify which of the following lab results as an indication that the
client has fluid volume excess?
✓~ BUN 8mg/dL
A nurse is moving a client up in bed with assistance of a second nurse. Which of
the following actions should the nurse take?
✓~ Place feet apart with the foot nearest the clients bed in front of the other foot.
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