Fundamentals of Nursing Practice Quiz 29

Answer: D – The inside of the glove is considered sterile

Explanation: The inside of the glove is always considered to be clean, but not sterile.

Answer: A – Waist tie and neck tie at the back of the gown

Explanation: The back of the gown is considered clean, the front is contaminated. So, after removing gloves and washing hands, the nurse should untie the back of the gown; slowly move backward away from the gown, holding the inside of the gown and keeping the edges off the floor; turn and fold the gown inside out; discard it in a contaminated linen container; then wash her hands again.

Answer: B – Discard all used uncapped needles and syringes in an impenetrable protective container

Explanation: According to the Centers for Disease Control (CDC), blood-to-blood contact occurs most commonly when a health care worker attempts to cap a used needle, Therefore, used needles should never be recapped; instead they should be inserted in a specially designed puncture resistant, labeled container, Wearing gloves is not always necessary when administering an I.M. injection, Enteric precautions prevent the transfer of pathogens via feces.

Answer: A – Massaging the reddened area with lotion

Explanation: Nurses and other healthcare professionals previously believed that massaging a reddened area with lotion would promote venous return and reduce edema to the area. However, research has shown that massage only increases the likelihood of cellular ischemia and necrosis to the area.

Answer: B – Blood typing and cross-matching

Explanation: Before a blood transfusion is performed, the blood of the donor and recipient must be checked for compatibility. This is done by blood typing (a test that determines a person’s blood type) and cross-matching (a procedure that determines the compatibility of the donor’s and recipient’s blood after the blood types has been matched). If the blood specimens are incompatible, hemolysis and antigen-antibody reactions will occur.

Answer: A – Potential for clot formation

Explanation: Platelets are disk-shaped cells that are essential for blood coagulation. A platelet count determines the number of thrombocytes in blood available for promoting hemostasis and assisting with blood coagulation after injury, It also is used to evaluate the patient’s potential for bleeding; however, this is not its primary purpose. The normal count ranges from 150,000 to 350000 / mm 3. A count of 100000 / mm 3 or less indicates a potential for bleeding; count of less than 20000 / mm 3 is associated with spontaneous bleeding.

Answer: D – 25,000/mm³

Explanation: Leukocytosis is any transient increase in the number of white blood cells (leukocytes) in the blood. Normal WBC counts range from 5,000 to 100000 / mm 3. Thus, a count of 25000 / mm 3 indicates leukocytosis.

Answer: A – Hypokalemia

Explanation: Fatigue, muscle cramping, and muscle weaknesses are symptoms of hypokalemia (an inadequate potassium level), which is a potential side effect of diuretic therapy. The physician usually orders supplemental potassium to prevent hypokalemia in patients receiving diuretics, Anorexia is another symptom of hypokalemia, Dysphagia means difficulty swallowing.

Answer: A – No contradictions exist for this test

Explanation: Pregnancy or suspected pregnancy is the only contraindication for a chest X-ray. However, if a chest X-ray is necessary, the patient can wear a lead apron to protect the pelvic region from radiation, Jewelry, metallic objects, and buttons would interfere with the X-ray and thus should not be worn above the waist, A signed consent is not required because a chest X-ray is not an invasive examination, Eating, drinking and medications are allowed because the X-ray is of the chest, not the abdominal region.

Answer: A – Early in the morning

Explanation: Obtaining a sputum specimen early in this morning ensures an adequate supply of bacteria for culturing and decreases the risk of contamination from food or medication.