Exam (elaborations)
VSIM EXAM 1 QUESTIONS AND ANSWERS
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VSIM EXAM 1 QUESTIONS AND ANSWERS
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VSIM EXAM 1 QUESTIONS AND ANSWERSWhen performing hand hygiene, when is it necessary to use soap and water instead of
an alcohol-based hand rub? - Answers -After using the restroom
Rationale: Wash with soap and water when hands are visibly soiled or contaminated
with body fluids, when exposure to potential spore-forming pathogens is suspected or
proven, and after the restroom.
When considering hand hygiene, which action will best remove a possible
microorganism reservoir? - Answers -Removing any rings
Rationale: Rings can serve as places for microorganisms to hide, and should be
removed prior to hand washing and donning of gloves.
What actions are appropriate when donning personal protection equipment (PPE) for
contact isolation? (Select all that apply.) - Answers -Put on gown, being sure to securely
tie or fasten.
Perform hand hygiene.
Don gloves.
Mr. Griffin is receiving enoxaparin sodium therapy. Which assessment data would the
nurse report to the patient's health care provider to ensure his postoperative safety? -
Answers -Moderate amount of gum bleeding after completing oral hygiene.
Rationale: The nurse should report the information concerning the bleeding gums to the
health care provider since it indicates a possible complication of the enoxaparin therapy.
Which intervention ordered for Mr. Griffin poses the greatest risk for injury? - Answers -
Daily complete blood count (CBC)
Rationale: The daily blood draw for the CBC is most problematic since bleeding at the
site may occur.
Which nursing interventions will have the greatest impact on minimizing the spread of
methicillin-resistant Staphylococcus aureus (MRSA) among patients on a surgical unit?
(Select all that apply.) - Answers -Instituting meticulous handwashing technique.
Implementing standard precautions.
Using appropriate personal protective equipment (PPE).
Rationale: The nurse can minimize the spread of MRSA by implementing effective
handwashing techniques and standard precautions, and by using appropriate PPEs.
Mr. Griffin's surgical care includes anticoagulation therapy. Which diagnostic blood
count indicates a risk for spontaneous bleeding and should be reported to his health
care provider immediately? - Answers -Platelet of <50,000/ul
, Rationale: A platelet count below 50,000/ul can cause spontaneous bleeding.
When following the proper procedure for removing gloves that are a part of contact
precautions, where should the first removed inverted glove be stored while the second
glove is being removed? - Answers -In the palm of the gloved hand
Which piece of personal protection equipment (PPE) should be removed only after
leaving the patient's room? - Answers -Respiratory mask
Rationale: Except for a respirator mask, remove all personal protective equipment at the
patient's doorway or in the anteroom. Remove a respirator mask after leaving the
patient's room and closing the door.
What is the final step in removing personal protective equipment (PPE) when caring for
a patient requiring droplet precautions? - Answers -Perform hand hygiene
Rationale: The final step in the process of removing PPEs for any type of precautions is
proper hand hygiene.
What complications is Edith Jacobson at risk for because of her age and hip fracture?
(Select all that apply.) - Answers -Pressure ulcers, mental deterioration, and pneumonia
Rationale: Pneumonia, pressure ulcers, and mental deterioration are all risk factors for
the patient due to her hip fracture.
The nurse comes into the room and observes Edith Jacobson moaning and guarding
her leg. What should the nurse do next? - Answers -Administer pain medication
Rationale: The nurse should administer the medication after completing a pain and
respiratory assessment.
Which statement by the nurse indicates a need for further education related to a
focused neurovascular assessment of Edith Jacobson? - Answers -I am going to check
the pulses in your unaffected limb.
Rationale: A neurovascular assessment on Edith Jacobson would include assessing for
changes in circulation, oxygenation, and nerve function. The nurse should check
peripheral pulses for presence, rate, and quality on both limbs and compare.
Antiembolism stockings often have an inspection window. Which statement by the nurse
indicates understanding of the purpose of the inspection window? - Answers -I will place
the inspection window on top of the foot so I can easily access capillary refill,
temperature, and pulses of the patient's feet.
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