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The nurse is teaching a client about the use of syringes and needles for home administration of medications. Which action by the client indicates an understanding of standard precautions?
- A. Wears gloves to dispose of the needle and syringe.
- B. Dons a face mask before administering the medication.
- C. Washes hands before handling the needle and syringe.
- D. Removes the needle before discarding used syringes.
Correct Answer: C
Rationale: Hand hygiene prevents infection.
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An unlicensed assistive personnel (UAP) is assigned to feed a client who has received a prescription to institute droplet precautions for a bacterial meningitis infection. The UAP requests a change in assignment, reporting having not yet been fitted for a particulate filter mask. Which action should the nurse take?
- A. Send the UAP to be fitted for a particulate filter mask immediately.
- B. Instruct the UAP that a standard face mask is sufficient.
- C. Before changing assignments, determine which staff members have fitted particulate filter masks.
- D. Advise the UAP to wear a standard face mask to obtain vital signs.
Correct Answer: B
Rationale: Standard mask suffices for droplet precautions.
The nurse notices a client grimacing while moving from the bed to a chair, but when asked about the pain, the client denies having any pain. Which intervention should the nurse implement first?
- A. Administer PRN oral pain medication.
- B. Ask the client what is causing the grimacing.
- C. Monitor the client’s nonverbal behavior.
- D. Review the pain medications prescribed.
Correct Answer: B
Rationale: Clarifying nonverbal cues ensures accuracy.
A nurse is reviewing error prevention techniques that would have helped to avoid a medication error. Which technique is most effective?
- A. Double check all dosage calculations.
- B. nusually large or small doses.
- C. Compare the medication label to the order.
- D. Use at least 2 client identifiers before administering a dose.
- E. Involve and educate clients in medication administration.
Correct Answer: D
Rationale: Identifiers prevent misidentification.
A child has experienced several episodes of vomiting. After the nurse reviews the need to provide only clear liquids, the parent of the child reports making clear liquid popsicles out of flavored gelatin for the child. Which information should the nurse obtain about the popsicles?
- A. How many popsicles are available.
- B. The color and flavor of gelatin used.
- C. If the popsicles are completely frozen.
- D. Whether they contain pulp or fruit.
Correct Answer: C
Rationale: Pulp or fruit ensures clear liquid compliance.
Which intervention should the nurse include in the plan of care for a terminally ill client who is weak, mouth breathing, and refusing anything to eat or drink?
- A. Record the client’s daily weight.
- B. Maintain in high Fowler’s position.
- C. Keep mucous membranes moist.
- D. Report any change in urine color.
Correct Answer: C
Rationale: Moist membranes enhance comfort.