Nokea
Which are appropriate examples of cost-effective care? Select all that apply.
- A. Considering the inside of the sterile glove wrapper as a small sterile field
- B. Donning clean, rather than sterile, gloves to remove a client’s dressing
- C. Returning opened, unused supplies from a client’s room to the central supply room
- D. Reusing a tourniquet for multiple clients unless it is visibly soiled
- E. Using remaining sterile saline in a bottle opened 48 hours ago before discarding
Correct Answer: A,B
Rationale: Using the glove wrapper as a sterile field and clean gloves for dressing removal reduce waste without compromising safety. Returning supplies, reusing tourniquets, and using old saline risk contamination or infection.
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The nurse enters the room of a woman who had a vaginal hysterectomy three days ago and finds her crying. What is the best initial approach for the nurse?
- A. Ask her what seems to be troubling her
- B. Reassure her that feeling depressed is normal after this type of surgery
- C. Tell her that the nurse will ask the doctor to order hormones for her
- D. Leave the room so she can work out her feelings
Correct Answer: A
Rationale: Asking about her concerns opens therapeutic communication, addressing her emotional needs directly and empathetically.
The nurse is caring for an adult who has atrial fibrillation and osteoporosis. Atenolol is prescribed. The nurse should expect that this medication was prescribed to:
- A. decrease elevated blood pressure.
- B. decrease inflammation.
- C. relieve pain.
- D. slow the heart rate.
Correct Answer: D
Rationale: Atenolol, a beta-blocker, is used in atrial fibrillation to control heart rate, reducing rapid ventricular response.
The nurse is reinforcing health promotion education to the parents of a toddler. Which statement by a parent requires the nurse to clarify teaching?
- A. I will offer my child options rather than asking yes or no questions
- B. I will wait at least 15 minutes after a play period to offer a meal to my child
- C. If my child is having a tantrum, I will have them sit in a quiet area for a short time-out
- D. If my child refuses a meal, I will have them stay at the table until they eat half the food.
Correct Answer: B
Rationale: Waiting 15 minutes after play to offer a meal is unnecessary and may disrupt healthy eating habits. Offering options and using time-outs are age-appropriate parenting strategies.
The nurse is caring for a client who has subclavian central venous access. Which nursing intervention is most important to prevent the spread of infection to this client?
- A. Frequent hand hygiene
- B. No artificial nails
- C. Use of chlorhexidine bath wipes
- D. Wearing personal protective equipment
Correct Answer: A
Rationale: Frequent hand hygiene is the most effective intervention to prevent infection in central venous access, reducing pathogen transmission. No artificial nails and chlorhexidine wipes are supportive, but hand hygiene is primary. PPE is situational.
A client at 20 weeks gestation reports 'running to the bathroom all the time,' pain with urination, and foul-smelling urine. Which question is most important for the nurse to ask when assessing the client?
- A. Are you having any pain in your lower back or flank area?
- B. Do you wipe from front to back after urinating?
- C. Have you found that you urinate more frequently since becoming pregnant?
- D. Have you had a urinary tract infection in the past?
Correct Answer: A
Rationale: Back or flank pain suggests pyelonephritis, a serious complication of UTI in pregnancy, requiring urgent evaluation. Hygiene, frequency, and history are relevant but less critical than assessing for systemic infection.