to remove a clients gown when she has an intravenous line the nurse should
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Nursing Elites

NCLEX-PN

Safe and Effective Care Environment Nclex PN Questions

1. When removing a client's gown with an intravenous line, what should the nurse do?

Correct answer: C

Rationale: The correct action when removing a client's gown with an intravenous line is to thread the bag and tubing through the gown sleeve while keeping the line intact. This method ensures that the system remains sterile and reduces the risk of infection. Temporarily disconnecting the tubing at a point close to the client or from the container introduces the potential for contamination. Cutting the gown with scissors should only be done in emergencies as it is not a standard practice and can compromise the integrity of the intravenous line. Therefore, the most appropriate and safe method is to thread the bag and tubing through the gown sleeve.

2. Regardless of their practice area, nurses should be concerned with:

Correct answer: C

Rationale: All nurses should be concerned with preventing the transmission of microorganisms to themselves and others. A primary way to achieve this is through asepsis. Nursing practice emphasizes providing a safe environment to shield clients, family, and healthcare providers from infections. Choices A, B, and D are incorrect. While drug-resistant bacteria, critical microorganisms, and overprescription of bacteriostatic drugs are important, nurses' primary focus should be on preventing microorganism transmission to ensure safety and well-being.

3. In an emergency situation, the nurse determines whether a client has an airway obstruction. Which of the following does the nurse assess?

Correct answer: A

Rationale: In an emergency situation, assessing the client's ability to speak is crucial in determining airway obstruction. If a client can speak, it indicates that the airway is patent and not completely obstructed. Choices B and C, assessing the ability to hear and oxygen saturation, are not directly indicative of an airway obstruction. Choice D, adventitious breath sounds, may be present in conditions like asthma or pneumonia but are not specific to determining an airway obstruction.

4. What should be the first action upon the discovery of an electrical fire?

Correct answer: A

Rationale: The correct initial action upon discovering an electrical fire is to disconnect the electrical power if it can be done safely. This helps prevent the fire from spreading through the electrical system. Smothering the fire with a blanket is not recommended for electrical fires as it can fuel the fire. Saturating the source with water or other liquids is also not advised as it can lead to electric shock or spread the fire. Activating the fire alarm is important, but it should be done after disconnecting the power to prevent further escalation of the fire.

5. Why would a nurse employed at a hospital be asked by a nurse manager to review the organizational chart?

Correct answer: B

Rationale: The correct answer is 'To be familiar with the organization's line of authority.' Organizational charts provide a visual representation of the chain of command, reporting relationships, and structure within an organization. This helps employees understand who they report to, who reports to them, and the overall hierarchy. Choice A is incorrect because understanding the geographic area served is more about the organization's scope, not depicted in an organizational chart. Choice C is incorrect as it relates to the organization's reason for existence, usually found in its mission statement. Choice D is incorrect as beliefs and values are linked to the organization's culture, not typically shown in an organizational chart.

Similar Questions

A 51-year-old client with amyotrophic lateral sclerosis (Lou Gehrig disease) is admitted to the hospital because his condition is deteriorating. The client tells the nurse that he wants a do-not-resuscitate (DNR) order. The nurse should provide the client with which information?
If a visitor accidentally knocks over a plastic pleural drainage system connected to a client, causing it to crack, what should the nurse do first?
What can happen if a restraint is attached to a side rail or other movable part of the bed?
Which of the following statements by an adult child of a client with late-stage Alzheimer's disease indicates a need for further teaching by the nurse?
A health care provider informs a nurse that the husband of an unconscious client with terminal cancer will not grant permission for a do-not-resuscitate (DNR) order. The health care provider tells the nurse to perform a 'slow code' and let the client 'rest in peace' if she stops breathing. How should the nurse respond?

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