Nokea
The occupational health nurse is teaching a group of unlicensed assistive personnel how to practice appropriate ergonomics. It would be appropriate for the nurse to recommend that
- A. your feet are firmly on the floor while you are sitting in a chair
- B. Your feet are close together as you move or transfer a client.
- C. heavy objects are held far away from your body to achieve balance.
- D. you should squat to lift objects off of the ground.
- E. your neck should be extended as you look at the computer monitor.
Correct Answer: A,D
Rationale: Feet on the floor and squatting to lift reduce strain. A wide stance, holding objects close, and neutral neck position are correct ergonomic practices.
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The nurse is performing a focused physical assessment on a client's gastrointestinal system. Place the following actions in the order in which they should be performed, starting from first to last.
- A. Place pillows beneath the client's knees.
- B. Ask the client to void.
- C. Inspect the abdomen.
- D. Palpate the abdomen.
- E. Auscultate all four quadrants of the abdomen.
- F. Position the client supine with the knees bent and the arms at their side.
Correct Answer: B,F,C,E,D
Rationale: The correct order is: ask to void (B), position supine (F), inspect (C), auscultate (E), palpate (D). Voiding and positioning prepare the client, and inspection precedes auscultation to avoid altering bowel sounds. Pillows are not standard.
The nurse is prioritizing caring for four assigned clients. Based on the pulse (P), respiratory rate (R), and blood pressure (BP) provided, which of the clients should the nurse follow up with first?
- A. P: 109; R: 26; BP: 110/70 mmHg
- B. P: 90; R: 12; BP: 99/54 mmHg
- C. P: 100; R: 18; BP: 161/98 mmHg
- D. P: 88; R: 14; BP: 166/52 mmHg
Correct Answer: B
Rationale: BP 99/54 mmHg indicates hypotension, requiring immediate follow-up. Tachycardia/tachypnea, hypertension, and wide pulse pressure are concerning but less urgent.
The nurse is participating in a committee changing the hospital security plan. Which of the following statements by the nurse would be appropriate to make? Select all that apply.
- A. Open visitation should be implemented in the newborn nursery.
- B. Visitors should always wear a badge while in the hospital
- C. Oral temperatures should be obtained for all visitors
- D. Hand sanitizing stations should be offered throughout the facility
- E. Disaster drills should be conducted to ensure staff competency
Correct Answer: B,D,E
Rationale: Visitor badges, hand sanitizing stations, and disaster drills enhance security. Open visitation in nurseries and visitor temperature checks are impractical or unsafe.
The nurse is caring for a client who is two days postoperative following a right femoral popliteal bypass surgery. The client reports worsening pain, and the assessment showed swelling and ecchymosis at the incision sites. The nurse should initially
- A. Apply pressure to sites with sandbag
- B. Palpate pedal pulses
- C. Assess for signs of claudication
- D. Apply warm compress to incision sites
Correct Answer: B
Rationale: Worsening pain, swelling, and ecchymosis at the incision sites suggest possible complications such as hematoma or compromised vascular flow. Palpating pedal pulses is the priority to assess the patency of the bypass graft and ensure adequate distal perfusion. Applying pressure or warm compresses could exacerbate bleeding or swelling, and claudication assessment is less urgent than confirming vascular integrity.
The nurse observes sparks fly from a client's bathroom light. Which action should the nurse take first?
- A. Obtain a fire extinguisher
- B. Close the bathroom door
- C. Remove the client from the room
- D. Activate the fire alarm
Correct Answer: C
Rationale: Removing the client from the room prioritizes safety in a potential fire hazard. Other actions follow after ensuring client safety.