|
Practice
Questions
Information provided by Kaplan Test Prep
| Safe
& Effective Care Environment |
1. |
|
The
nurse is caring for patients on the surgical floor
and has just received report from the previous shift.
Which of the following patients should the nurse
see FIRST? |
| |
| |
| |
|
|
| |
A. |
A 35-year-old admitted
three hours ago with a gunshot would; 1.5 cm area
of dark drainage noted on the dressing |
| |
| |
B. |
A 43-year-old who had
a masectomy tow days ago; 23 cc of serosanguinous
fluid noted in the Jackson-Pratt drain |
| |
| |
C. |
A 59-year-old with a
collapsed lung due to an accident; no drainage noted
in the previous eight hours |
| |
| |
D. |
A 62-year-old who had
an abdominal-perineal resection three days ago;
patient complains of chills |
| |
| |
|
|
| |
|
|
| |
|
The
correct answer is D. |
| |
A. |
A 35-year-old admitted
three hours ago with a gunshot would; 1.5 cm area
of dark drainage noted on the dressing – does
not indicate acute bleeding; small amount of blood |
| |
| |
| |
B. |
A 43-year-old who had
a masectomy tow days ago; 23 cc of serosanguinous
fluid noted in the Jackson-Pratt drain – expected
outcome |
| |
| |
C. |
A 59-year-old with a
collapsed lung due to an accident; no drainage noted
in the previous eight hours – indicates
resolution |
| |
| |
D. |
A 62-year-old who had
an abdominal-perineal resection three days ago;
patient complains of chills – CORRECT:
at risk for peritonitis; should be assessed for
further symptoms of infection |
| |
| |
| |
2. |
|
A
25-year old man is admitted to the hospital with
a diagnosis of acquired immune deficiency syndrome
(AIDS). He is being treated for pneumocystis carinii
pneumonia. The nurse evaluates the care provided
to this patient by other members of the health care
team. The nurse should intervene in which of the
following situations? |
| |
| |
| |
| |
| |
|
|
| |
A. |
A housekeeper
cleans up spilled blood with a bleach solution |
| |
| |
B. |
A nursing
student takes the patient’s blood pressure
wearing a mask and gloves |
| |
| |
C. |
A technician
wears gloves to perform a venipuncture |
| |
| |
D. |
A nurse
attendant allows visitors to enter his room without
masks |
| |
| |
|
|
| |
|
|
| |
|
The
correct answer is B. |
| |
A. |
A housekeeper cleans
up spilled blood with a bleach solution –
appropriate activity, solution
of 1:10 sodium hypochlorite, or bleach with water,
kills AIDS virus |
| |
| |
| |
B. |
A nursing student takes
the patient’s blood pressure wearing a mask
and gloves – CORRECT:
inappropriate practice; mask and gloves necessary
only when possibility of contact with blood and
body fluids; when taking a BP very low risk for
contact with blood and body fluids, behavior insensitive
to patient’s feelings, does not promote trust |
| |
| |
| |
| |
| |
C. |
A technician wears gloves
to perform a venipuncture – safe
practice, barrier precaution used to prevent skin
and mucous-membrane exposure if contact with blood
or other body fluids of any patient anticipated. |
| |
| |
| |
| |
D. |
A nurse
attendant allows visitors to enter his room without
masks – appropriate
activity: visitors do not need masks, PCP parasite
found in lungs of healthy people, thought to cause
subclinical pulmonary infection worldwide, only
dangerous to immunosuppressed patients; sick people
not permitted to visit patient |
| |
| |
| |
| |
3. |
|
The
nurse is caring for patients in the outpatient clinic.
Which of the following phone calls should the nurse
return first? |
| |
| |
|
|
| |
A. |
A client
with hepatitis A who states “My arms and legs
are itching.” |
| |
| |
B. |
A client
with a cast on the right leg who states, “
I have a funny feeling in my right leg.” |
| |
| |
C. |
A client
with osteomylitis of the spine who states, “
I am so nauseous that I can’t eat.”
|
| |
| |
D. |
A client
with rheumatoid arthritis who states, “ I
am having trouble sleeping.” |
| |
| |
|
|
| |
|
|
| |
|
The
correct answer is B. |
| |
A. |
A client with hepatitis
A who states “My arms and legs are itching.”
– caused by accumulation
of bile salts under the skin; treat with calamine
lotion and antihistamines |
| |
| |
| |
B. |
A client
with a cast on the right leg who states, “
I have a funny feeling in my right leg.”—CORRECT:
may indicate neurovascular compromise; requires
immediate assessment |
| |
| |
| |
C. |
A client
with osteomylitis of the spine who states, “
I am so nauseous that I can’t eat.”
– requires follow-up,
but not highest priority |
| |
| |
D. |
A client
with rheumatoid arthritis who states, “ I
am having trouble sleeping.” – requires
assessment, but not a priority |
| |
Next 3 Questions
|
