A nurse enters a client's room to perform a focused assessment. Which of the following client information should the nurse use to properly identify the client?

Room number

Telephone number

Patient’s name

Diagnosis

Answer and Explanation

The Correct Answer is C

A.   Using the room number to identify a patient is not reliable since many clients may share it.
B.   The telephone number is not typically used for client identification during assessments.
C.   The nurse should use the client's name to properly identify the client before performing any assessment or intervention. This is a standard safety measure that helps to prevent errors and ensure quality care.
D.   The diagnosis is important for providing appropriate care but is not used for client identification during assessments.

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Correct Answer is C

Explanation

A. While this technique can sometimes be helpful, it's not the first-line intervention for postoperative urinary retention. Encouraging fluids is a more fundamental step.

B. Lying supine may make it more difficult for the client to void. Sitting upright or ambulating to the bathroom may be more effective.
C. Encouraging fluids helps maintain adequate urine output, which is essential for preventing urinary retention after surgery. Dehydration can worsen the difficulty voiding.
D. Catheterization should be considered only after other interventions to promote voiding have been attempted and failed, as it carries the risk of infection and discomfort.

A. The newly licensed nurse uses a paper towel to turn off the faucet after washing their hands. B. The newly licensed nurse uses an alcohol-based hand rub and begins patient care before their hands dry. C. The newly licensed nurse uses soap and cold water to wash their hands. D. The newly licensed nurse uses an alcohol-based hand rub to clean visibly soiled hands.

Correct Answer is A

Explanation

A. This action prevents recontamination of the hands after handwashing, which is an essential component of maintaining medical asepsis.
B. It is recommended to allow alcohol-based hand rub to dry completely before engaging in patient care to ensure effectiveness.

C. While handwashing with soap and water is appropriate, cold water may not be as effective as warm water for removing contaminants.
D. Alcohol-based hand rubs are not sufficient for cleaning visibly soiled hands; soap and water are required in such cases.

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A nurse enters a client's room to perform a focused assessment. Which of the following client information should the nurse use to properly identify the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 6 hr postoperative following abdominal surgery and is having difficulty voiding. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is observing a newly licensed nurse care for a client who is at increased risk for infection. Which of the following actions indicate the newly licensed nurse is following recommended medical asepsis practices?

Correct Answer is A

Explanation

A nurse is administering an intramuscular injection to a client using the Z-track method. Which of the following actions should the nurse take?

A charge nurse is observing a staff nurse performing a wound irrigation for a client who has a pressure injury. Which of the following actions by the staff nurse indicates an understanding of the procedure?

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