Q: A nurse is evaluating a client's response to a new antihypertensive medication. The client's blood pressure is now 110/70 mmHg. Which formula represents the calculation of pulse pressure?

$$\text{Pulse Pressure} = \text{Systolic BP} - \text{Diastolic BP}$$

Question 1

Which of the following actions best breaks the 'mode of transmission' link in the chain of infection when caring for multiple clients in a hospital setting?

Accepted Answer

Using alcohol-based hand rub before and after each client contact

Question 2

A nurse is preparing to insert a urinary catheter. Which technique must be used to prevent infection during this procedure?

Accepted Answer

Surgical asepsis (sterile technique)

Question 3

A client has redness and warmth at an IV insertion site. Which step of the nursing process is the nurse performing when documenting these findings?

Accepted Answer

Assessment

Question 4

A nurse is developing a care plan for a client at risk for falls. Which of the following is a high-priority intervention based on risk management principles?

Accepted Answer

Complete a validated fall-risk assessment and communicate mobility status to the team

Question 5

A nurse is caring for a client with a multidrug-resistant organism (MDRO). Which of the following is the most effective way to prevent transmission to other clients?

Accepted Answer

Disinfect shared equipment before reuse

Question 6

Which statement best describes the difference between medical and surgical asepsis?

Accepted Answer

Medical asepsis reduces the number and spread of microorganisms; surgical asepsis maintains an area free from all microorganisms

Question 7

A nurse is assisting a client with a complete bed bath. Which client would most appropriately receive this type of bath?

Accepted Answer

A ventilator-dependent patient who is totally confined to bed

Question 8

A nurse is teaching a client with diabetes about foot care. Which of the following instructions is most important to prevent diabetic foot ulcers?

Accepted Answer

Check feet daily for red spots, cuts, swelling, and blisters

Question 9

A nurse is preparing to move a client up in bed. Which principle of body mechanics should be applied to reduce injury risk?

Accepted Answer

Bend at the hips and knees, keep the load close, and pivot with the feet

Question 10

A nurse is evaluating a client's response to a new antihypertensive medication. The client's blood pressure is now 110/70 mmHg. Which formula represents the calculation of pulse pressure?

Accepted Answer

$$	ext{Pulse Pressure} = 	ext{Systolic BP} - 	ext{Diastolic BP}$$

Question 11

A nurse is caring for a client with a suspected deep vein thrombosis (DVT). Which assessment finding requires immediate reporting?

Accepted Answer

New unilateral calf enlargement, redness, warmth, and pain

Question 12

A nurse is delegating hygiene care to a NAP. Which task should NOT be delegated?

Accepted Answer

Assessing skin integrity for a diabetic patient

Question 13

A nurse is teaching a client to use a cane. Which instruction is correct?

Accepted Answer

Hold the cane on the stronger side and move it with the weaker leg

Question 14

A nurse is caring for a client with impaired mobility. Which exercise type is most appropriate when the client can move their joints independently?

Accepted Answer

Active range-of-motion (ROM) exercises

Question 15

A nurse is assessing a client's vital signs. The client has a respiratory rate of 8 breaths/min. Which term best describes this finding?

Accepted Answer

Bradypnea

Question 16

A nurse is caring for a client at risk for aspiration during oral hygiene. Which bed position is safest for this client?

Accepted Answer

Head of bed raised 30-45 degrees

Question 17

A nurse is documenting a client's statement: 'I feel dizzy when I stand up.' Which type of data is this?

Accepted Answer

Subjective data

Question 18

A nurse is caring for a client who begins to fall while ambulating. What is the nurse's priority action?

Accepted Answer

Widen base of support, protect the head, and lower the client gently down the leg

Question 19

A nurse is reviewing a client's blood pressure readings: 140/90 mmHg, 135/85 mmHg, and 120/80 mmHg. According to course definitions, which reading indicates hypertension?

Accepted Answer

140/90 mmHg

Question 20

A nurse is caring for a client with a pressure ulcer risk. During hygiene care, redness is noted over the coccyx. What is the correct nursing action?

Accepted Answer

Complete a pressure-ulcer assessment and document the findings

Integrated Nursing Practice 1: Foundations for Personal Health and Patient Care

Guida di studio - Domande di pratica

Study guide - Flashcard