A nurse assesses a client who has open lesions. Which action should the nurse take first?
a. Put on gloves.
b. Ask the client about his or her occupation.
c. Assess the client's pain.
d. Obtain vital signs.
ANS: A
Nurses should wear gloves as part of Standard Precautions when examining skin that is not intact. The other options should be completed after gloves are put on.
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The nurse is explaining to a patient that there are shock absorbers in his back to cushion the spine and to help it move. The nurse is referring to his:
a. Vertebral column. b. Nucleus pulposus. c. Vertebral foramen. d. Intervertebral disks.
A trained nurse uses the technique of "Rolfing" to break up tension in patient body structures. What type of CAT is being used by this nurse?
A) Therapeutic Touch C) acupuncture B) therapeutic massage D) healing touch
Although each clinical agency may use different documentation formats, nurses need to realize that the purpose of documentation is which of the following? Select all that apply
A. To aid in clinical research B. To maintain a legal and financial record of care C. To include a step-by-step description of how to perform procedures D. To guide professional and organizational performance improvement
What does the nurse teach the patient and caregiver to do when setting up and changing administration sets for continuous tube feedings to preserve medical asepsis?
a. Add formula to formula already hung to prevent waste. b. Store unused formula at room temperature to prevent spasm. c. Hang only enough formula that will be infused in a 4- to 6-hour period. d. Change the administration set every 48 hours.