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Exhibits

The nurse is preparing to set up the oxygen administration and apply the simple face mask. Which should the nurse do before applying the face mask? Select that apply.

Perform hand hygiene

Brush the client's teeth

Check the skin around the face

Identify the client using 2 client identifiers

Assess respiratory function

Don gloves

Determine if the client needs to go to the bathroom

Answer and Explanation

Correct Answer : A,C,D,E

A. Performing hand hygiene is crucial to prevent the spread of infection before any patient interaction or procedure.
B. Brushing the client’s teeth is not necessary before applying an oxygen mask and does not pertain to immediate care.
C. Checking the skin around the face is important to ensure there are no irritations or breakdowns that could affect the mask's fit and the patient's comfort.
D. Identifying the client using 2 identifiers is a critical safety step to ensure the correct patient receives the intended care.
E. Assessing respiratory function is important to determine the severity of the client’s condition and the appropriate oxygen delivery method.
F. Donning gloves is not required for applying a simple face mask unless there is potential for contact with blood or bodily fluids.
G. Determining if the client needs to go to the bathroom is not directly related to applying the face mask and should be assessed but is not critical before mask application.

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Correct Answer is A

Explanation

A. Isolating the client is the most critical action to prevent the potential spread of COVID-19 to others, especially since the client is exhibiting symptoms consistent with the virus.
B. While counseling family members is important, it is secondary to ensuring the immediate safety of others in the healthcare setting.
C. Reporting results is necessary for public health tracking but does not take precedence over immediate isolation measures.
D. Teaching the client preventive measures is important, but again, it should follow ensuring isolation to mitigate any risk of exposure to others.

A. Turn, cough, and deep breathe every 2 hours. B. Observe pupil response of the right eye. C. Sleep flat in a supine position. D. Administer a stool softener.

Correct Answer is B

Explanation

A. While deep breathing exercises are important after surgery, they are not specific to cataract extraction recovery; the focus should be on eye care.
B. Observing the pupil response of the right eye can help detect any issues with the right eye post-surgery, ensuring the patient monitors both eyes' health effectively.
C. Clients are generally advised to avoid sleeping flat and may be instructed to sleep in a specific position to prevent pressure on the operated eye, often in a semi-reclined position.
D. Administering a stool softener can be important for some postoperative patients, but it is not a primary concern following cataract surgery unless specifically indicated for that client.

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Exhibits The nurse is preparing to set up the oxygen administration and apply the simple face mask. Which should the nurse do before applying the face mask? Select that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client presents to the emergency department with muscle aches, headache, fever, and describes a recent loss of taste and smell. The nurse obtains a nasal swab for COVID-19 testing. Which action is most important for the nurse to take?

Correct Answer is A

Explanation

Which information should the nurse include when giving discharge instructions to a client following a left eye cataract extraction with a lens implant?

Correct Answer is B

Explanation

Which approach is best for the nurse to use when directing a client with Huntington's disease to the hospital cafeteria?

The client with Clostridium difficile in the stool receives a prescription for vancomycin PO. Which action should the nurse take before administering the first dose?

A client receives a prescription for ophthalmic ketorolac. Prior to administering the medication, the nurse should review the medical record for which condition?

A client with emphysema is reporting difficulty in breathing and exhibiting audible wheezing. The nurse administers albuterol as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate intervention by the nurse?

A client with multiple sclerosis (MS) fell while walking to the bathroom. Upon transfer to the intensive care unit, the client is confused and has had projectile vomiting twice. Which intervention should the nurse implement first?

A client who has had a laryngectomy and tracheostomy frequently expectorates copious amounts of purulent secretions. When changing the ties of the tracheostomy tube, which action is most important for the nurse to take?

Exhibits

The nurse is preparing to set up the oxygen administration and apply the simple face mask. Which should the nurse do before applying the face mask? Select that apply.