This is a comprehensive and detailed practice material/testbank that contains practice questions and answers on chapter 27; patient and quality for Nur 130.
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1. A home health nurse is performing a home assessment for safety. Which comment by the
patient will cause the nurse to follow up?
a. “Every December is the time to change batteries on the carbon monoxide detector.”
b. “I will schedule an appointment with a chimney inspector next week.”
c. “If I feel dizzy when using the heater, I need to have it inspected.”
d. “When it is cold outside in the winter, I will use a nonvented furnace.”
ANS: D
Using a nonvented heater introduces carbon monoxide into the environment and decreases the
available oxygen for human consumption and the nurse should follow up to correct this behavior.
Checking the chimney and heater, changing the batteries on the detector, and following up on
symptoms such as dizziness, nausea, and fatigue are all statements that are safe and appropriate
and need no follow-up.
2. The nurse is caring for an older-adult patient admitted with nausea, vomiting, and diarrhea due
to food poisoning. The nurse completes the health history. Which priority concern will require
collaboration with social services to address the patient’s health care needs?
a. The electricity was turned off 3 days ago.
b. The water comes from the county water supply.
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c. A son and family recently moved into the home.
d. This home is not furnished with a microwave oven.
ANS: A
Electricity is needed for refrigeration of food, and lack of electricity could have contributed to
the nausea, vomiting, and diarrhea due to food poisoning. This discussion about the patient’s
electrical needs can be referred to social services. Foods that are inadequately prepared or stored
or subject to unsanitary conditions increase the patient’s risk for infections and food poisoning,
and an assessment should include storage practices. The water supply, the increased number of
individuals in the home, and not having a microwave may or may not be concerns but do not
pertain to the current health care needs of this patient.
3. The patient has been diagnosed with a respiratory illness and reports shortness of breath. The
nurse adjusts the temperature to facilitate the comfort of the patient. At which temperature range
will the nurse set the thermostat?
a. 60° to 64° F
b. 65° to 75° F
c. 15° to 17° C
d. 25° to 28° C
ANS: B
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A person’s comfort zone is usually between 18.3° and 23.9° C (65° and 75° F). The other ranges
are too low or too high and do not reflect the average person’s comfort zone.
4. A homeless adult patient presents to the emergency department. The nurse obtains the
following vital signs: temperature 94.8° F, blood pressure 106/56, apical pulse 58, and
respiratory rate 12. Which vital sign should the nurse address immediately?
a. Respiratory rate
b. Temperature
c. Apical pulse
d. Blood pressure
ANS: B
The temperature indicates the patient is experiencing hypothermia. Homeless individuals are
more at risk for hypothermia. While all the vital signs are low, the most critical vital sign at this
time is the temperature.
5. A nurse is teaching the patient and family about wound care. Which technique will the nurse
teach to best prevent transmission of pathogens?
a. Wash hands
b. Wash wound
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c. Wear gloves
d. Wear eye protection
ANS: A
One of the most effective methods for limiting the transmission of pathogens is the medically
aseptic practice of hand hygiene. The most common means of transmission of pathogens is by
the hands. While washing the wound is needed, the best method to prevent transmission is hand
hygiene. Wearing gloves and possibly eye protection help protect the nurse, but handwashing is
best for limiting the transmission of pathogens.
6. The nurse is monitoring for Never Events. Which finding indicates the nurse will report a
Never Event?
a. No blood incompatibility occurs with a blood transfusion.
b. A surgical sponge is left in the patient’s incision.
c. Pulmonary embolism after lung surgery
d. Stage II pressure ulcer
ANS: B
The Centers for Medicare and Medicaid Services names select serious reportable events as Never
Events (i.e., adverse events that should never occur in a health care setting). A surgical sponge
left in a patient’s incision is a Never Event. No blood incompatibility reaction is safe practice.
Pulmonary embolism after certain orthopedic procedures is like a total knee and hip replacement.
Stage III and IV pressure ulcers are Never Events.
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