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NURS 327 Medical Surgical Nursing > Skills Questions > Flashcards

Flashcards in Skills Questions Deck (18)
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1
Q

What technique is appropriate when administering a blood transfusion?

a.	 administer medication through the IV line with the blood

b.	 administer medication through the IV line with the blood

c.	 clear the IV tubing with NS after the blood infuses

d.	 administer a blood product with clots through a filter line
A

Correct
c.
clear the IV tubing with NS after the blood infuses

2
Q

Which nursing intervention is common to all central venous access devices?

a.	 use clean technique to change dressings

b.	 routine flushing with saline solution

c.	 place the client in a prone postition prior to dressing change

d.	 change the IV site every 3 days
A

b.

routine flushing with saline solution

3
Q

After teaching a patient on the use of patient-controlled analgesia (PCA), the nurse determines that the patient understands the use of the PCA pump when the patient states:

a.	 "The PCA pump will only give me the prescribed amount of pain medication even if I push the

button too soon.”

b.	 "It is OK for my family to press the button for me if I am too tired to do it myself."

c.	 "The medication in the pump may not be strong enough so the health care provider a bolus of

subcutaneous medication.”

d.	 "I have to be careful not to push the button too many times or I will overdose myself.”
A

a.
“The PCA pump will only give me the prescribed amount of pain medication even if I push the

button too soon.”

4
Q

Which client would the RN anticipate to be a candidate for placement of a peripherally inserted central catheter (PICC)?

a.	 a 72-year-old client having cataracts removed

b.	 a 50-year-old who will require extended antibiotic therapy

c.	 a 20-year-old woman experiencing prolonged labor

d.	 a 15-year-old who will have surgery for the reduction of a femur fracture
A

a 50-year-old who will require extended antibiotic therapy

5
Q

The RN assesses the patient’s intravenous site and notes that the vein appears red and feels cordlike when palpated. The patient’s IV is running slowly. What is the RN’s appropriate intervention?

a.	 assess the patient for signs of headache and neck vein distention

b.	 irrigate the IV site with Heparin to break up a clot

c.	 discontinue the IV and apply a warm compress to decrease inflammation

d.	 irrigate the IV with normal saline
A

c. discontinue the IV and apply a warm compress to decrease inflammation

6
Q

A patient on your unit requires a nasogastric tube. Which of the following would indicate the need for a nasogastric tube?

a.
to provide an access for intravenous infusion

b.	 to prepare the throat for endotracheal intubation

c.	 to decompress and remove fluid from the stomach

d.	 to remove and neutralize poisons from the lungs
A

c.

7
Q

The RN is inserting an NG tube and the tube has passed the oropharynx. Which patient instruction is appropriate?

a.	 "Take a deep breath."

b.	 "Swallow this water."

c.	 "Bear down with your throat and abdominal muscles."

d.	 "Close your eyes and relax, I am almost finished."
A

b

8
Q

The RN is preparing to discontinue the NG tube. What technique should the RN employ?

Answers:
a.
aspirate all contents of the stomach before removing the NG tube

b.
pull the NG tube out 1 cm at a time until completely removed

Correctc.
irrigate the NG tube with 10 mL water prior to removal

d.
remove the NG tube before bowel sounds are present

A

c.

irrigate the NG tube with 10 mL water prior to removal

9
Q

Which of the following solutions is used to clean the skin surrounding a tracheostomy site?

a.
tap Water

b.	 alcohol

c.	 sterile Water

d.	 chlorhexidine
A

c. sterile water

10
Q

Which of the following instructions should you provide to a patient prior to collecting a sputum culture?

a.	 cough deeply several times until sputum is noted

b.	 inhale deeply 2-3 times and cough with exhalation

c.	 inhale and exhale normally then induce cough

d.	 cough then inhale and exhale normally
A

b. inhale deeply 2-3 times and cough with exhalation

11
Q

A patient vomits as a nurse is inserting his oropharyngeal airway. What would be the appropriate intervention in this situation?

a.	 remove the airway, turn the patient to the side and provide mouth suction, if necessary

b.	 immediately remove the airway and reinsert it because it has probably inadvertently caused the

gag reflex

c.	 leave the airway in place and notify the physician for further instructions

d.	 ask the patient to extend the neck slightly to adjust the airway
A

a.

remove the airway, turn the patient to the side and provide mouth suction, if necessary

12
Q

You are suctioning a patient with a tracheostomy. During suctioning, you note that the patient’s pulse oximetry decreases to 75%. What should your next action be?

A

STOP SUCTIONING!

13
Q

When a nurse is suctioning a tracheostomy which of the following personal protective equipment is required?

a.	 sterile gloves and a mask with eye protection

b.	 sterile gloves and disposable gown

c.	 clean gloves and a mask without eye protection

d.	 clean gloves and a surgical gown
A

sterile gloves and a mask with eye protection

14
Q

You receive an order to insert a foley catheter in a patient who just had an episode of bowel incontinence. Which of the following is an appropriate action on the part of the nurse?

a.	 insert the foley catheter using sterile technique prior to addressing the fecal incontinence

b.	 clean the patient's buttocks/genitals with soap and water prior to foley insertion

c.	 assess the urethra of the patient prior to addressing the fecal incontinence

d.	 none of the above
A

b.

clean the patient’s buttocks/genitals with soap and water prior to foley insertion

15
Q

The nurse should assist a female patient into which of the following positions prior to foley catheter insertion?

a.	 prone position with hyperextension of hips

b.	 dorsal recumbent position with flexed knees

c.	 high Fowler's with knees extended

d.	 reverse Trendelenburg
A

b.

dorsal recumbent position with flexed knees

16
Q

Which of the following supplies are required to apply an external condom catheter?

a.	 clean gloves

b.	 sterile gloves

c.	 betadine solution for cleaning

d.	 syringe with sterile water
A

a.

clean gloves

17
Q

The nurse is inserting a foley catheter in an uncircumcised male patient. Which of the following actions on the part of the nurse is inappropriate?

a.	 utilization of sterile technique during insertion of the catheter

b.	 placing the urinary collection bag below the level of the bladder

c.	 continued retraction of the foreskin following catheter insertion

d.	 educating the patient about the need for the foley catheter prior to the procedure
A

continued retraction of the foreskin following catheter insertion

18
Q

The nurse is inflating the balloon following foley catheter insertion and the patient reports extreme pain during inflation. What should the nurse do?

A

STOP INFLATING THE BALLOON!