Chapter 24: Communication
.Which types of nurses make the best communicators with patients?
a. Those who learn effective psychomotor skills
b. Those who develop critical thinking skills
c. Those who like different kinds of people
d. Those who maintain perceptual biases
2. A nurse believes that the nurse-patient relationship is a partnership and that both are equal
participants. Which term should the nurse use to describe this belief?
a. Critical thinking
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b. Authentic
c. Mutuality
d. Attend
3. A nurse wants to present information about flu immunizations to the older adults in the
community. Which type of communication should the nurse use?
a. Public
b. Small group
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c. Interpersonal
d. Intrapersonal
4. A nurse is using therapeutic communication with a patient. Which technique will the nurse
use to ensure effective communication?
a. Interpersonal communication to change negative self-talk to positive self-talk
b. Small group communication to present information to an audience
c. Electronic communication to assess a patient in another city
d. Intrapersonal communication to build strong teams
5. A nurse is standing beside the patient’s bed. Nurse: How are you doing?
feel good.
Patient: I don’t
Which element will the nurse identify as feedback?
a. Nurse
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b. Patient
c. How are you doing?
d. I don’t feel good.
6. A nurse is sitting at the patient’s bedside taking a nursing history. Which zone of personal
space is the nurse using?
a. Socio-consultative
b. Personal
c. Intimate
d. Public
7. A smiling patient angrily states, “I will not cough and deep breathe.” How will the nurse
interpret this finding?
a. The patient’s denotative meaning is wrong.
b. The patient’s personal space was violated.
c. The patient’s affect is inappropriate.
d. The patient’s vocabulary is poor.
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8. The nurse asks a patient where the pain is, and the patient responds by pointing to the area
of pain. Which form of communication did the patient use?
a. Verbal
a. Nonverbal
b. Intonation
d. Vocabulary
9. A patient has been admitted to the hospital numerous times. The nurse asks the patient to
share a personal story about the care that has been received. Which interaction is the nurse
using?
a. Nonjudgmental
b. Socializing
c. Narrative
d. SBAR
10. Before meeting the patient, a nurse talks to other caregivers about the patient. Which
phase of the helping relationship is the nurse in with this patient?
a. Preinteraction
b. Orientation
c. Working
d. Termination
11. During the initial home visit, a home health nurse lets the patient know that the visits are
expected to end in about a month. Which phase of the helping relationship is the nurse in with
this patient?
a. Preinteraction
b. Orientation
c. Working d. Termination
12. A nurse and a patient work on strategies to reduce weight. Which phase of the helping
relationship is the nurse in with this patient?
a. Preinteraction
b. Orientation
c. Working
d. Termination
13. A nurse uses SBAR when providing a hands-off report to the oncoming shift. What is the
rationale for the nurse’s action?
a. To promote autonomy
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b. To use common courtesy
c. To establish trustworthiness
d. To standardize communication
14. A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is
now having chest pain with a pulse rate of 108. Which piece of data will the nurse use for
“B” when using SBAR?
a. Having chest pain
b. Pulse rate of 108
c. History of angina
d. Oxygen is needed
15. A patient just received a diagnosis of cancer. Which statement by the nurse demonstrates
empathy?
a. “Tomorrow will be better.”
b. “This must be hard news to hear.”
c. “What’s your biggest fear about this diagnosis?”
d. “I believe you can overcome this because I’ve seen how strong you are.”
16. A nurse is taking a history on a patient who cannot speak English. Which action will the
nurse take?
a. Obtain an interpreter.
b. Refer to a speech therapist.
c. Let a close family member talk.
d. Find a mental health nurse specialist.
17. A nurse is using SOLER to facilitate active listening. Which technique should the nurse
use for R?
a. Relax
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b. Respect
c. Reminisce
d. Reassure
18. An older-adult patient is wearing a hearing aid. Which technique should the nurse use to
facilitate communication?
a. Chew gum.
b. Turn off the television.
c. Speak clearly and loudly.
d. Use at least 14-point print.
19. When making rounds, the nurse finds a patient who is not able to sleep because of surgery
in the morning. Which therapeutic response is most appropriate?
a. “You will be okay. Your surgeon will talk to you in the morning.”
b. “Why can’t you sleep? You have the best surgeon in the hospital.”
c. “Don’t worry. The surgeon ordered a sleeping pill to help you sleep.”
d. “It must be difficult not to know what the surgeon will find. What can I do to help?”
20. Which situation will cause the nurse to intervene and follow up on the nursing assistive
personnel’s (NAP) behavior?
a. The nursing assistive personnel is calling the older-adult patient “honey.”
b. The nursing assistive personnel is facing the older-adult patient when talking.
c. The nursing assistive personnel cleans the older-adult patient’s glasses gently.
d. The nursing assistive personnel allows time for the older-adult patient to respond.
21. A confused older-adult patient is wearing thick glasses and a hearing aid. Which
intervention is the priority to facilitate communication?
a. Focus on tasks to be completed.
b. Allow time for the patient to respond.
c. Limit conversations with the patient.
d. Use gestures and other nonverbal cues.
22. The staff is having a hard time getting an older-adult patient to communicate. Which
technique should the nurse suggest the staff use?
a. Try changing topics often.
a. Allow the patient to reminisce.
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b. Ask the patient for explanations.
c. Involve only the patient in conversations.
23. A nurse is implementing nursing care measures for patients’ special communication
needs. Which patient will need the most nursing care measures?
a. The patient who is oriented, pain free, and blind
b. The patient who is alert, hungry, and has strong self-esteem
c. The patient who is cooperative, depressed, and hard of hearing
d. The patient who is dyspneic, anxious, and has a tracheostomy
24. A patient is aphasic, and the nurse notices that the patient’s hands shake intermittently.
Which nursing action ismost appropriate to facilitate communication?
a. Use a picture board.
b. Use pen and paper.
c. Use an interpreter.
d. Use a hearing aid.
25. Which behavior indicates the nurse is using a process recording correctly to enhance
communication with patients?
a. Shows sympathy appropriately
a. Uses automatic responses fluently
b. Demonstrates passive remarks accurately
c. Self-examines personal communication skills
26. A patient says, “You are the worst nurse I have ever had.” Which response by the nurse is
most assertive?
a. “I think you’ve had a hard day.”
b. “I feel uncomfortable hearing that statement.”
c. “I don’t think you should say things like that. It is not right.”
d. “I have been checking on you regularly. How can you say that?”
MULTIPLE RESPONSE
1. Which behaviors indicate the nurse is using critical thinking standards when
communicating with patients? (Select all that apply.)
a. Instills faith
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b. Uses humility
c. Portrays self-confidence
d. Exhibits supportiveness
e. Demonstrates independent attitude
2. A nurse is implementing nursing care measures for patients with challenging
communication issues. Which types of patients will need these nursing care measures?
(Select all that apply.)
a. A child who is developmentally delayed
b. An older-adult patient who is demanding
c. A female patient who is outgoing and flirty
d. A male patient who is cooperative with treatments
e. An older-adult patient who can clearly see small print
f. A teenager frightened by the prospect of impending surgery
MATCHING
A nurse is using AIDET to communicate with patients and families. Match the letters of the
acronym to the behavior a nurse will use.
b. Nurse describes procedures and tests.
c. Nurse lets the patient know how long the procedure will last.
c. Nurse recognizes the person with a positive attitude.
a. Nurse thanks the patient.
b. Nurse tells the patient “I am an RN and will be managing your care.”
Chapter 25: Patient Education
Chapter 25: Patient Education Potter et al.: Fundamentals of Nursing, 9th
Edition MULTIPLE CHOICE
1. A nurse is teaching a patient’s family member about permanent tube feedings at home.
Which purpose of patient education is the nurse meeting?
a. Health promotion
b. Illness prevention
c. Restoration of health
d. Coping with impaired functions
2. A nurse is teaching a group of healthy adults about the benefits of flu immunizations.
Which type of patient education is the nurse providing?
b. Health analogies
c. Restoration of health
d. Coping with impaired functions
e. Promotion of health and illness prevention
3. A nurse’s goal is to provide teaching for restoration of health. Which situation indicates the
nurse is meeting this goal?
a. Teaching a family member to provide passive range of motion for a stroke patient
b. Teaching a woman who recently had a hysterectomy about possible adoption
c. Teaching expectant parents about changes in childbearing women
d. Teaching a teenager with a broken leg how to use crutches
4. A nurse attends a seminar on teaching/learning. Which statement indicates the nurse has a
good understanding of teaching/learning?
a. “Teaching and learning can be separated.”
b. “Learning is an interactive process that promotes teaching.”
c. “Teaching is most effective when it responds to the learner’s needs.”
d. “Learning consists of a conscious, deliberate set of actions designed to help the teacher.”
5. A nurse is determining if teaching is effective. Which finding best indicates learning has
occurred?
a. A nurse presents information about diabetes.
b. A patient demonstrates how to inject insulin.
c. A family member listens to a lecture on diabetes.
d. A primary care provider hands a diabetes pamphlet to the patient.
6. A nurse is teaching a patient about the Speak Up Initiatives. Which information should the
nurse include in the teaching session?
a. If you still do not understand, ask again.
b. Ask a nurse to be your advocate or supporter.
c. The nurse is the center of the health care team.
d. Inappropriate medical tests are the most common mistakes.
ANS: A Answers available at: http://bit.ly/3chskZ8
If you still do not understand, ask again is part of the S portion of the Speak Up Initiatives.
Speak up if you have questions or concerns. You (the patient) are the center of the health care
team, not the nurse. Ask a trusted family member or friend to be your advocate (advisor or
supporter), not a nurse. Medication errors are the most common health care mistakes, not
inappropriate medical tests.
DIF:Understand (comprehension)REF:337
OBJ: Identify the role of the nurse in patient education. TOP: Teaching/Learning
MSC: Safety and Infection Control
7. A nurse teaches a patient with heart failure healthy food choices. The patient states that
eating yogurt is better than eating cake. Which element represents feedback?
a. The nurse
b. The patient
c. The nurse teaching about healthy food choices
d. The patient stating that eating yogurt is better than eating cake
.
TOP: Teaching/Learning MSC: Basic Care and Comfort
8. While preparing a teaching plan, the nurse describes what the learner will be able to
accomplish after the teaching session about healthy eating. Which action is the nurse
completing?
a. Developing learning objectives
b. Providing positive reinforcement
c. Presenting facts and knowledge
d. Implementing interpersonal communication
9. A patient learns that a normal adult heartbeat is 60 to 100 beats/min after a teaching
session with a nurse. In which domain did learning take place?
a. Kinesthetic
b. Cognitive
c. Affective
d. Psychomotor
10. A nurse is trying to help a patient begin to accept the chronic nature of diabetes. Which
teaching technique should the nurse use to enhance learning?
a.
Lecture
b.
Role play
c.
Demonstration
d.
Question and answer sessions
11. A nurse is describing a patient’s perceived ability to successfully complete a task. Which
term should the nurse use to describe this attribute?
b. Self-efficacy
c. Motivation
d. Attentional set
e. Active participation
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ANS: A
Self-efficacy, a concept included in social learning theory, refers to a person’s perceived
ability to successfully complete a task. Motivation is a force that acts on or within a person
(e.g., an idea, an emotion, a physical need) to cause the person to behave in a particular way.
An attentional set is the mental state that allows the learner to focus on and comprehend a
learning activity. Learning occurs when the patient is actively involved in the educational
session.
DIF:Understand (comprehension)REF:340
OBJ:Identify basic learning principles.TOP:Teaching/Learning
MSC:Health Promotion and Maintenance
12. A toddler is going to have surgery on the right ear. Which teaching method is most
appropriate for this developmental stage?
a. Encourage independent learning.
b. Develop a problem-solving scenario.
c. Wrap a bandage around a stuffed animal’s ear.
d. Use discussion throughout the teaching session.
13. A nurse is preparing to teach a patient about smoking cessation. Which factors should the
nurse assess to determine a patient’s ability to learn?
a. Sociocultural background and motivation
b. Stage of grieving and overall physical health
c. Developmental capabilities and physical capabilities
d. Psychosocial adaptation to illness and active participation
14. A nurse is teaching a patient about heart failure. Which environment will the nurse use?
a. A darkened, quiet room
b. A well-lit, ventilated room
c. A private room at 85° F temperature
d. A group room for 10 to 12 patients with heart failure
15. Which assessment finding will cause the nurse to begin teaching a patient because the
patient is ready to learn?
a. A patient has the ability to grasp and apply the elastic bandage.
b. A patient has sufficient upper body strength to move from a bed to a wheelchair.
c. A patient with a below-the-knee amputation is motivated about how to walk with assistive
devices.
d. A patient has normal eyesight to identify the markings on a syringe and coordination to
handle a syringe.
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16. A nurse is teaching a patient with a risk for hypertension how to take a blood pressure.
Which action by the nurse is the priority?
a. Assess laboratory results for high cholesterol and other data.
b. Identify that teaching is the same as the nursing process.
c. Perform nursing care therapies to address hypertension.
d. Focus on a patient’s learning needs and objectives.
17. A patient has heart failure and kidney failure. The patient needs teaching about dialysis.
Which nursing action ismost appropriate for assessing this patient’s learning needs?
a. Assess the patient’s total health care needs.
b. Assess the patient’s health literacy.
c. Assess all sources of patient data.
d. Assess the goals of patient care.
18. A nurse is teaching a patient about hypertension. In which order from first to last will the
nurse implement the steps of the teaching process?
1. Set mutual goals for knowledge of hypertension. 2. Teach what the patient wants to
know about hypertension. 3. Assess what the patient already knows about hypertension. 4.
Evaluate the outcomes of patient education for hypertension.
19. A patient had a stroke and must use a cane for support. A nurse is preparing to teach the
patient about the cane. Which learning objective/outcome is most appropriate for the nurse to
include in the teaching plan?
a. The patient will walk to the bathroom and back to bed using a cane.
b. The patient will understand the importance of using a cane.
c. The patient will know the correct use of a cane.
d. The patient will learn how to use a cane.
20. Which learning objective/outcome has the highest priority for a patient with lifethreatening, severe food allergies that require an EpiPen (epinephrine)?
a. The patient will identify the main ingredients in several foods.
b. The patient will list the side effects of epinephrine.
c. The patient will learn about food labels.
d. The patient will administer epinephrine.
21. After a teaching session on taking blood pressures, the nurse tells the patient, “You took
that blood pressure like an experienced nurse.” Which type of reinforcement did the nurse
use?
a. Social acknowledgment
b. Pleasurable activity
c. Tangible reward
d. Entrusting
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22. A patient with heart failure is learning to reduce salt in the diet. When will be the best
time for the nurse to address this topic?
a. At bedtime, while the patient is relaxed
b. At bath time, when the nurse is cleaning the patient
c. At lunchtime, while the nurse is preparing the food tray
d. At medication time, when the nurse is administering patient medication
23. A nurse is teaching a patient who has low health literacy about chronic obstructive
pulmonary disease (COPD) while giving COPD medications. Which technique is most
appropriate for the nurse to use?
b. Use complex analogies to describe COPD.
c. Ask for feedback to assess understanding of COPD at the end of the session.
d. Offer pamphlets about COPD written at the eighth grade level with large type.
e. Include the most important information on COPD at the beginning of the session.
24. A nurse is teaching a culturally diverse patient with a learning disability about nutritional
needs. What must the nurse do first before starting the teaching session?
a. Obtain pictures of food.
b. Get an interpreter.
c. Establish a rapport.
d. Refer to a dietitian.
25. A nurse is teaching an older-adult patient about strokes. Which teaching technique is
most appropriate for the nurse to use?
a. Speak in a high tone of voice to describe strokes.
b. Use a pamphlet about strokes with large font in blues and greens.
c. Provide specific information about strokes in short, small amounts.
d. Begin the teaching session facing the teaching white board with stroke information.
26. A patient who is going to surgery has been taught how to cough and deep breathe. Which
evaluation method will the nurse use?
a. Return demonstration
b. Computer instruction
c. Verbalization of steps
d. Cloze test
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27. A patient has been taught how to change a colostomy bag but is having trouble measuring
and manipulating the equipment and has many questions. What is the nurse’s next action?
a. Refer to a mental health specialist.
b. Refer to a wound care specialist.
28. A nurse is teaching a patient about healthy eating habits. Which learning
objective/outcome for the affective domain will the nurse add to the teaching plan?
a. The patient will state three facts about healthy eating.
b. The patient will identify two foods for a healthy snack.
c. The patient will verbalize the value of eating healthy.
d. The patient will cook a meal with low-fat oil.
Which question/statement will best assess the patient’s ability to learn?
a. “What do you want to know about strokes?”
b. “Please read this handout and tell me what it means.”
c. “Do you feel strong enough to perform the tasks I will teach you?”
d. “On a scale from 1 to 10, tell me where you rank your desire to learn.”
30. A nurse is preparing to teach a kinesthetic learner about exercise. Which technique will
the nurse use?
a. Let the patient touch and use the exercise equipment.
b. Provide the patient with pictures of the exercise equipment.
c. Let the patient listen to a video about the exercise equipment.
MULTIPLE RESPONSE
1. A nurse is asked by a co-worker why patient education/teaching is important. Which
statements will the nurse share with the co-worker? (Select all that apply.)
a. “Patient education is an essential component of safe, patient-centered care.”
b. “Patient education is a standard for professional nursing practice.”
c. “Patient teaching falls within the scope of nursing practice.”
d. “Patient teaching is documented and part of the chart.”
e. “Patient education is not effective with children.”
f. “Patient teaching can increase health care costs.”
2. A nurse is preparing to teach patients. Which patient finding will cause the nurse to
postpone a teaching session? (Select all that apply.)
b. The patient is hurting.
c. The patient is fatigued.
d. The patient is mildly anxious.
e. The patient is asking questions.
f. The patient is febrile (high fever).
g. The patient is in the acceptance phase.
Chapter 29: Infection Prevention and Control
9th Edition MULTIPLE CHOICE
Potter et al.: Fundamentals of Nursing,
1. The nurse and a new nurse in orientation are caring for a patient with pneumonia. Which
statement by the new nurse will indicate a correct understanding of this condition?
e. “An infectious disease like pneumonia may not pose a risk to others.”
f. “We need to isolate the patient in a private negative-pressure room.”
g. “Clinical signs and symptoms are not present in pneumonia.”
h. “The patient will not be able to return home.”
2. The patient and the nurse are discussing Rickettsia rickettsii—Rocky Mountain spotted
fever. Which patient statement to the nurse indicates understanding regarding the mode of
transmission for this disease?
e. “When camping, I will use sunscreen.”
f. “When camping, I will drink bottled water.”
3. The nurse is providing an educational session for a group of preschool workers. The nurse
reminds the group about the most important thing to do to prevent the spread of infection.
Which information did the nurse share with the preschool workers?
e. Encourage preschool children to eat a nutritious diet.
f. Suggest that parents provide a multivitamin to the children.
g. Clean the toys every afternoon before putting them away.
h. Wash their hands between each interaction with children.
4. The nurse is admitting a patient with an infectious disease process. Which question
will be most appropriate for a nurse to ask about the patient’s susceptibility to this
infectious process?
c. “Do you have a spouse?”
d. “Do you have a chronic disease?”
e. “Do you have any children living in the home?”
f. “Do you have any religious beliefs that will influence your care?”
5. The patient experienced a surgical procedure, and Betadine was utilized as the surgical
prep. Two days postoperatively, the nurse’s assessment indicates that the incision is red and
has a small amount of purulent drainage. The patient reports tenderness at the incision site.
The patient’s temperature is 100.5° F, and the WBC is 10,500/mm3. Which action should the
nurse take first?
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e. Plan to change the surgical dressing during the shift.
f. Utilize SBAR to notify the primary health care provider.
g. Reevaluate the temperature and white blood cell count in 4 hours.
h. Check to see what solution was used for skin preparation in surgery.
6. The nurse is providing an education session to an adult community group about the effects
of smoking on infection. Which information is most important for the nurse to include in the
educational session?
e. Smoke from tobacco products clings to your clothing and hair.
f. Smoking affects the cilia lining the upper airways in the lungs.
g. Smoking can affect the color of the patient’s fingernails.
h. Smoking tobacco products can be very expensive.
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7. A female adult patient presents to the clinic with reports of a white discharge and itching in
the vaginal area. A nurse is taking a health history. Which question is the priority?
e. “When was the last time you visited your primary health care provider?”
f. “Has this condition affected your eating habits in any way?”
g. “What medications are you currently taking?”
h. “Are you able to sleep at night?”
8. The nurse is caring for a school-aged child who has injured the right leg after a bicycle
accident. Which signs and symptoms will the nurse assess for to determine if the child is
experiencing a localized inflammatory response?
c. Malaise, anorexia, enlarged lymph nodes, and increased white blood cells
d. Chest pain, shortness of breath, and nausea and vomiting
e. Dizziness and disorientation to time, date, and place
f. Edema, redness, tenderness, and loss of function
9. Which interventions utilized by the nurse will indicate the ability to recognize a localized
inflammatory response?
a. Vigorous range-of-motion exercises
e. Turn, cough, and deep breathe
f. Orient to date, time, and place
g. Rest, ice, and elevation
10. The nurse is caring for a group of medical-surgical patients. Which patient is most at risk
for developing an infection?
e. A patient who is in observation for chest pain
f. A patient who has been admitted with dehydration
g. A patient who is recovering from a right total hip surgery
h. A patient who has been admitted for stabilization of heart problems
11. The nurse is caring for a patient with leukemia and is preparing to provide fluids through
a vascular access (IV) device. Which nursing intervention is a priority in this procedure?
c. Review the procedure with the patient.
d. Position the patient comfortably.
e. Maintain surgical aseptic technique.
f. Gather available supplies.
12. The nurse is caring for an adult patient in the clinic who has been evacuated and is a
victim of flooding. The nurse teaches the patient about rest, exercise, and eating properly and
how to utilize deep breathing and visualization. What is the primary rationale for the nurse’s
actions related to the teaching?
e. Topics taught are standard information taught during health care visits.
f. The patient requested this information to teach the extended family members.
g. Stress for long periods of time can lead to exhaustion and decreased resistance to infection.
h. These techniques will help the patient manage the pain and loss of personal belongings.
13. The nurse is caring for a patient who is susceptible to infection. Which instruction will the
nurse include in an educational session to decrease the risk of infection?
e. Teaching the patient about fall prevention
f. Teaching the patient to take a temperature
c. Teaching the patient to select nutritious foods
d. Teaching the patient about the effects of alcohol
14. A diabetic patient presents to the clinic for a dressing change. The wound is located on
the right foot and has purulent yellow drainage. Which action will the nurse take to prevent
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the spread of infection?
d. Position the patient comfortably on the stretcher.
e. Explain the procedure for dressing change to the patient.
f. Review the medication list that the patient brought from home.
g. Don gloves and other appropriate personal protective equipment.
15. A patient presents with pneumonia. Which priority intervention should be included in the
plan of care for this patient?
e. Observe the patient for decreased activity tolerance.
f. Assume the patient is in pain and treat accordingly.
g. Provide the patient ice chips as requested.
d.
ANS: A
16. The nurse is caring for a patient in an intensive care unit who needs a bath. Which
priority action will the nurse take to decrease the potential for a health care–associated
infection?
a. Use local anesthetic on reddened areas.
e. Use nonallergenic tape on dressings.
f. Use a chlorhexidine wash.
g. Use filtered water.
–associated infection will the nurse report?
a. Vector
e. Exogenous
f. Endogenous
g. Suprainfection
18. The patient has contracted a urinary tract infection (UTI) while in the hospital. Which
action will most likely increase the risk of a patient contracting a UTI?
e. Reusing the patient’s graduated receptacle to empty the drainage bag.
f. Allowing the drainage bag port to touch the graduated receptacle.
g. Emptying the urinary drainage bag at least once a shift.
h. Irrigating the catheter infrequently.
e. Uses surgical aseptic technique to suction an airway
f. Uses a clean technique for inserting a urinary catheter
g. Uses a cleaning stroke from the urinary meatus toward the rectum
h. Uses a sterile bottled solution more than once within a 24-hour period
20. The nurse is caring for a patient in labor and delivery. When near completing an
assessment of the patient’s cervix, the electronic infusion device being used on the
intravenous (IV) infusion alarms. Which sequence of actions is mostappropriate for the nurse
to take?
e. Complete the assessment, remove gloves, and silence the alarm.
f. Discontinue the assessment, silence the alarm, and assess the intravenous site.
g. Complete the assessment, remove gloves, wash hands, and assess the intravenous infusion.
h. Discontinue the assessment, remove gloves, use hand gel, and assess the intravenous
infusion.
21. The nurse is dressed and is preparing to care for a patient in the perioperative area. The
nurse has scrubbed hands and has donned a sterile gown and gloves. Which action will
indicate a break in sterile technique?
e. Touching clean protective eyewear
f. Standing with hands above waist area
g. Accepting sterile supplies from the surgeon
h. Staying with the sterile table once it is open
22. The nurse is caring for a patient with an incision. Which actions will best indicate an
understanding of medical and surgical asepsis for a sterile dressing change?
d. Donning clean goggles, gown, and gloves to dress the wound
e. Donning sterile gown and gloves to remove the wound dressing
f. Utilizing clean gloves to remove the dressing and sterile supplies for the new dressing
g. Utilizing clean gloves to remove the dressing and clean supplies for the new dressing
23. The nurse is caring for a patient in the endoscopy area. The nurse observes the technician
performing these tasks. Which observation will require the nurse to intervene?
e. Washing hands after removing gloves
f. Disinfecting endoscopes in the workroom
transfer the endoscope
d. Placing the endoscope in a container for transfer
24. The nurse is caring for a patient who is at risk for infection. Which action by the nurse
indicates correct understanding about standard precautions?
e. Teaches the patient about good nutrition
f. Dons gloves when wearing artificial nails
g. Disposes an uncapped needle in the designated container
h. Wears eyewear when emptying the urinary drainage bag
25. The nurse is caring for a patient who has just delivered a neonate. The nurse is checking
the patient for excessive vaginal drainage. Which precaution will the nurse use?
d. Contact
e. Droplet
f. Standard
g. Protective environment
26. The nurse is caring for a patient in the hospital. The nurse observes the nursing assistive
personnel (NAP) turning off the handle faucet with bare hands. Which professional practice
principle supports the need for follow-up with the NAP?
a. The nurse is responsible for providing a safe environment for the patient.
e. Different scopes of practice allow modification of procedures.
f. Allowing the water to run is a waste of resources and money.
g. This is a key step in the procedure for washing hands.
ands. Which action is best for the nurse to take next?
f. Wash hands with an antimicrobial soap and water.
g. Clean hands with wipes from the bedside table.
h. Use an alcohol-based waterless hand gel.
i. Wipe hands with a dry paper towel.
Answers available at: http://bit.ly/3chskZ8
28. The nurse is performing hand hygiene before assisting a health care provider with
insertion of a chest tube. While washing hands, the nurse touches the sink. Which action will
the nurse take next?
g. Inform the health care provider and recruit another nurse to assist.
h. Rinse and dry hands, and begin assisting the health care provider.
i. Extend the handwashing procedure to 5 minutes.
j. Repeat handwashing using antiseptic soap.
in the transport carrier, what is the next step in handling the instruments used during the
procedure?
d. Sending to central sterile for cleaning and sterilization
e. Sending to central sterile for cleaning and disinfection
f. Sending to central sterile for cleaning and boiling
g. Sending to central sterile for cleaning
30. The nurse is observing a family member changing a dressing for a patient in the home
health environment. Which observation indicates the family member has a correct
understanding of how to manage contaminated dressings?
c. The family member places the used dressings in a plastic bag.
d. The family member saves part of the dressing because it is clean.
e. The family member removes gloves and gathers items for disposal.
d. The family member wraps the used dressing in toilet tissue before placing in trash.
31. The nurse is caring for a group of patients. Which patient will the nurse see first?
a.
A patient with Clostridium difficile in droplet precautions
e. A patient with tuberculosis in airborne precautions
f. A patient with MRSA infection in contact precautions
g. A patient with a lung transplant in protective environment precautions
32. The home health nurse is teaching a patient and family about hand hygiene in the home.
Which situation will cause the nurse to emphasize washing hands before and after?
f. Shaking hands
g. Performing treatments
h. Opening the refrigerator
i. Working on a computer
33. The surgical mask the perioperative nurse is wearing becomes moist. Which action will
the perioperative nurse take next?
d. Apply a new mask.
e. Reapply the mask after it air-dries.
f. Change the mask when relieved by next shift.
g. Do not change the mask if the nurse is comfortable.
34. The nurse is caring for a patient on contact precautions. Which action will be most
appropriate to prevent the spread of disease?
e. Place the patient in a room with negative airflow.
f. Wear a gown, gloves, face mask, and goggles for interactions with the patient.
g. Transport the patient safely and quickly when going to the radiology department.
h. Use a dedicated blood pressure cuff that stays in the room and is used for that patient only.
35. The nurse is caring for a patient who has cultured positive for Clostridium difficile.
Which action will the nurse take next?
e. Instruct assistive personnel to use soap and water rather than sanitizer.
f. Wear an N95 respirator when entering the patient room.
g. Place the patient on droplet precautions.
h. Teach the patient cough etiquette.
36. The nurse is changing linens for a postoperative patient and feels a prick in the left hand.
A nonactivated safe needle is noted in the linens. For which condition is the nurse most at
risk?
c. Diphtheria
d. Hepatitis B
d.
Clostridium difficile
Methicillin-resistant Staphylococcus aureus
37. The nurse is caring for a patient who has a bloodborne pathogen. The nurse splashes
blood above the glove to intact skin while discontinuing an intravenous (IV) infusion. Which
step(s) will the nurse take next?
e. Obtain an alcohol swab, remove the blood with an alcohol swab, and continue care.
f. Immediately wash the site with soap and running water, and seek guidance from the
manager.
g. Do nothing; accidentally getting splashed with blood happens frequently and is part of the
job.
h. Delay washing of the site until the nurse is finished providing care to the patient.
38. Which process will be required after exposure of a nurse to blood by a cut from a used
scalpel in the operative area?
e. Placing the scalpel in a needle safe container
f. Testing the patient and offering treatment to the nurse
g. Removing sterile gloves and disposing of in kick bucket
h. Providing a medical evaluation of the nurse to the manager
39. The nurse is caring for a patient who needs a protective environment. The nurse has
provided the care needed and is now leaving the room. In which order will the nurse remove
the personal protective equipment, beginning with the first step?
1. Remove eyewear/face shield and goggles.
close door. 3. Remove gloves.
2. Perform hand hygiene, leave room, and
4. Untie gown, allow gown to fall from shoulders, and do not touch outside of gown; dispose
of
5. Remove mask by strings; do not touch outside of mask.
supplies and equipment in designated receptacles.
6. Dispose of all contaminated
40. The nurse manager is evaluating current infection control data for the intensive care unit.
The nurse compares past patient data with current data to look for trends. The nurse manager
examines the infection chain for possible solutions. In which order will the nurse arrange the
items for the infection chain beginning with the first step?
6. A portal of exit from the reservoir
MULTIPLE RESPONSE
1. The nurse is caring for a patient in protective environment. Which actions will the nurse
take? (Select all that apply.)
f. Wear an N95 respirator when entering the patient’s room.
g. Maintain airflow rate greater than 12 air exchanges/hr.
h. Place in special room with negative-pressure airflow.
i. Open drapes during the daytime.
e. the patient’s interests.
f. Place dried flowers in a plastic vase.
2. The nurse is assessing a new patient admitted to home health. Which questions will be
most appropriate for the nurse to ask to determine the risk of infection? (Select all that
apply.)
e. “Can you explain the risk for infection in your home?”
f. “Have you traveled outside of the United States?”
g. “Will you demonstrate how to wash your hands?”
h. “What are the signs and symptoms of infection?”
i. “Are you able to walk to the mailbox?”
j. “Who runs errands for you?”
3. The circulating nurse in the operating room is observing the surgical technologist while
applying a sterile gown and gloves to care for a patient having an appendectomy. Which
behaviors indicate to the nurse that the procedure by the surgical technologist is correct?
(Select all that apply.)
e. Ties the back of own gown
f. Touches only the inside of gown
g. Slips arms into arm holes simultaneously
h. Extended fingers fully into both of the gloves
i. Uses hands covered by sleeves to open gloves
j. Applies surgical cap and face mask in the operating suite
4. The nurse is preparing to insert a urinary catheter. The nurse is using open gloving to apply
the sterile gloves. Which steps will the nurse take? (Select all that apply.)
e. While putting on the first glove, touch only the outside surface of the glove.
f. With gloved dominant hand, slip fingers underneath second glove cuff.
g. Remove outer glove package by tearing the package open.
h. Lay glove package on clean flat surface above waistline.
i. Glove the dominant hand of the nurse first.
j. After second glove is on, interlock hands.
5. The nurse has received a report from the emergency department that a patient with
tuberculosis will be coming to the unit. Which items will the nurse need to care for this
patient? (Select all that apply.)
e. Private room
f. Negative-pressure airflow in room
g. Surgical mask, gown, gloves, eyewear
h. N95 respirator, gown, gloves, eyewear
i. Communication signs for droplet precautions
j. Communication signs for airborne precautions
6. The nurse and the student nurse are caring for two different patients on the medicalsurgical unit. One patient is in airborne precautions, and one is in contact precautions. The
nurse explains to the student different interventions for care. Which information will the
nurse include in the teaching session? (Select all that apply.)
e. Dispose of supplies to prevent the spread of microorganisms.
f. Wash hands before entering and leaving both of the patients’ rooms.
g. Be consistent in nursing interventions since there is only one difference in the precautions.
h. Apply the knowledge the nurse has of the disease process to prevent the spread of
microorganisms.
i. Have patients in airborne precautions wear a mask during transportation to other
departments. Check the working order of the negative-pressure room for the
airborne precaution patient on admission a
j. discharge.
Answers available at: http://bit.ly/3chskZ8