Deck 1: Foundational Skills

Question 1

The nurse is assisting the health care provider insert a chest tube into a client with a hemothorax following a motor vehicle crash.Which would the nurse don in order to assist with this procedure?

A)Sterile gown
B)Sterile gloves
C)Mask with eye shield
D)Mask
E)Clean gown

Answer 1

Mask with eye shield
Clean gown

Question 2

Which items will the nurse use with all clients to prevent the transmission of potentially infective organisms among the nurse,client,and other individuals?

A)Hand hygiene
B)Standard precautions
C)Personal protective equipment
D)Isolation procedures
E)Antimicrobial soap

Answer 2

Hand hygiene
Standard precautions
Personal protective equipment

Question 3

The nurse observes the newly hired unlicensed assistive personnel (UAP)performing routine client care.Which behaviors would indicate the UAP understands the use of personal protective equipment?

A)The UAP removes his gown first and then his gloves after providing care.
B)The UAP applies gloves before emptying the client's indwelling catheter bag,then removes gloves and washes hands before measuring urine output.
C)The UAP applies gloves to clean the client's dentures,then removes gloves and performs hand hygiene prior to bathing the client.
D)The UAP wears gown and gloves when performing postmortem care.

Answer 3

The UAP applies gloves to clean the client's dentures,then removes gloves and performs hand hygiene prior to bathing the client.

Question 4

The nurse is caring for a client with a medical diagnosis of HIV/AIDS admitted to the hospital with Pneumocystis carinii infection.In order to reduce the spread of infection,which is the priority nursing intervention?

A)Teaching the client to provide self-care
B)Teaching respiratory/cough etiquette
C)Teaching the use of sexual barriers
D)Teaching the use of standard precautions

Question 5

The nurse is caring for a client with a deep draining abdominal wound.Which factor would require the nurse to wear a mask and goggles when caring for this client?

A)The wound is infected.
B)The client is confused and disoriented.
C)The wound is covered by wet-to-damp dressings.
D)The client is HIV-positive.

Question 6

The nurse would don clean disposable gloves in which situation?

A)When providing denture care
B)When bathing a client
C)When applying antiemboli stockings
D)When assessing vital signs

Question 7

The nurse is caring for a client who developed an infection after admission to the hospital.Which term would the nurse use when documenting this infection?

A)Nosocomial infection
B)Bacterial infection
C)Health care-associated infection
D)Therapeutic infection

Question 8

The nurse is called into a client's room by the unlicensed assistive personnel (UAP),who informs the nurse that the obstetric client has no pulse or respirations and has profuse vaginal bleeding.Which is the priority action by the nurse?

A)Apply gloves and assess the client for pulse and respirations.
B)Assess the client for pulse and respirations,instruct UAP to notify code team while donning personal protective equipment,and begin CPR.
C)Quickly assess pulse and respirations,next assess for bleeding,call for the code team,and then apply personal protective equipment before beginning CPR.
D)Apply gown,gloves,mask,and goggles,then assess client for pulse,respirations,and bleeding.

Question 9

The nurse is working in a day care center for infants with special needs where there recently has been an outbreak of viral conjunctivitis.Which instruction by the nurse to the staff is the best way to stop the spread of this infection?

A)Require all children with conjunctivitis to stay home until there is a reduction in drainage.
B)Require all children with an infection to be on otic antibiotics for at least 24 hours prior to returning to school.
C)Isolate all children with conjunctivitis in the same room away from those who are not infected.
D)Perform hand hygiene after providing personal care for all children.

Question 10

Nurses must care for several clients during each shift.Which action by the nurse demonstrates appropriate hand hygiene?

A)Putting on gloves
B)Washing hands with soap and water
C)Wiping hands off when entering room
D)Using the client's soap on hands

Question 11

The nurse would use a Situation,Background,Assessment,and Recommendation (SBAR)process in which situations?

A)Discharging a client
B)Transferring a client to another unit
C)Contacting the primary care provider
D)Changing from day to evening shift
E)Informing family members of client status

Question 12

The charge nurse is observing a staff nurse caring for a client with extensive burns.Which action by the staff nurse would indicate the need for further teaching regarding infection-control procedures?

A)The nurse wears gloves and gown when dressing the client's wounds.
B)The nurse wears gloves when bathing the client.
C)The nurse wears gown,gloves,and mask when assisting the physician with debridement of the wound.
D)The nurse wears gloves when teaching a family member how to meet the client's nutritional needs after discharge.

Question 13

When planning care for a client,the nurse uses which equipment?

A)Personal protective equipment
B)Sterile gloves
C)Biohazard suit
D)Mask and eyewear

Question 14

The nurse,working in an emergency department,is preparing to care for a client admitted with a traumatic amputation of the left hand.Which personal protective equipment would the nurse wear?

A)Gloves
B)Gown and gloves
C)Gown,gloves,and mask
D)Gloves and mask

Question 15

The nurse observing the unlicensed assistive personnel (UAP)using alcohol-based rubs for hand hygiene would recognize that further teaching is required when the UAP performs which act?

A)Rubs palm against palm when washing hands.
B)Applies a palmful of product into cupped hands.
C)Interlaces fingers palm to palm.
D)Dries hands with clean paper towel.

Question 16

Which tasks would be appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)?

A)Taking vital signs
B)Measuring and recording intake and output
C)Postmortem care
D)Providing telephone advice
E)Weighing the client

Question 17

The nurse is caring for a client on respiratory isolation and will use which protective equipment?

A)Face mask
B)Gown only
C)Gloves only
D)Mask and gloves

Question 18

The registered nurse effectively delegates which procedure to the unlicensed assistive personnel (UAP)?

A)Making a nursing diagnosis
B)Assisting a client to bedside commode
C)Performing assessments on client
D)Giving the client pain medication

Question 19

The nurse wearing personal protective equipment would take which article off first?

A)Gown
B)Gloves
C)Mask
D)Gloves and gown at the same time

Question 20

The nurse is assisting the health care provider with the insertion of a chest tube.Which personal protective equipment would the nurse don?

A)Sterile gloves,gown,and mask
B)Clean gloves,gown,and mask with eye shield or goggles
C)Sterile gloves,gown,and mask with eye shields or goggles
D)Clean gloves,gown,and mask

Question 21

The nurse working in the emergency department is caring for a client who has projectile vomiting.The nurse is wearing personal protective equipment (PPE).How would the nurse properly discard the PPE?

A)All PPE would be discarded in the hazardous waste container whenever leaving the client's room,and new PPE would be donned when returning to the room.
B)The nurse could wear the same PPE if only leaving the room briefly and discard in the hazardous waste container when the client is transferred to the floor.
C)The nurse removes the PPE and places it just inside the room to put back on when reentering the client's room,then discards into the hazardous waste container when the client is transferred.
D)If the PPE is soiled,the nurse discards it when leaving the room,but if it is not visibly contaminated,the nurse can reapply the same PPE when reentering the client's room.

Question 22

Why is it critically important for the nurse to document all client care activities in the medical record?

A)To facilitate continuity of care
B)To promote effective care
C)To meet legal and accreditation requirements
D)To prove care was completed
E)To provide data for research and reimbursement

Question 23

Which equipment would the nurse not place in the sharps container?

A)Scalpels
B)Lancets
C)Bloody bandage
D)Needles

Question 24

The nurse is exposed to the client's blood and body fluids via an accidental used needlestick.Which would be appropriate nursing documentation of the event?

A)Document "Nurse stuck by used needle" in the client's medical record.
B)Document "Accidental exposure of nurse to blood and body fluid" in the client's medical record.
C)There is no need to document the exposure as long as the nurse takes the proper actions and notifies the charge nurse.
D)Completion of an incident report.

Question 25

The nurse assists the health care provider with the collection of cerebrospinal fluid.Which is an important safety measure for the nurse to follow immediately after collection of the sample?

A)Maintain sterility of the procedure tray.
B)Discard all sharps in a puncture-proof container.
C)Label specimens and send to the lab.
D)Remove PPE and discard.

Question 26

The nurse assists a health care provider with the collection of cerebrospinal fluid via a lumbar puncture.Which would not be included in the nurse's documentation of this procedure?

A)Specimen collection and disposition
B)Health care provider's contamination of first needle,requiring the nurse to obtain a second needle
C)Client response during and after the procedure
D)Sterile technique followed throughout the collection process

Question 27

The nurse has just changed a client's surgical dressing.Which action by the nurse would follow standard precaution guidelines for proper disposal of contaminated materials?

A)The old dressing is discarded in the trash can.
B)The unsoiled disposable gown is removed and discarded in the hazardous waste container.
C)The gloves are discarded in the trash can.
D)The mask is discarded in the trash can.