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Extract:

The nurse on the floor will perform peripheral IV site insertion.


Question 1 of 5

Her performance is based on:

Correct Answer: B

Rationale: Nursing Standards of Practice guide safe and competent IV insertion.

Extract:


Question 2 of 5

Which fetal heart monitor pattern can indicate cord compression?

Correct Answer: A

Rationale: Variable decelerations are associated with umbilical cord compression, which can intermittently reduce fetal blood flow. The other patterns are related to different fetal conditions. Reduction of Risk Potential

Question 3 of 5

Order: Vancomycin HCl 1 g in 250 mL DW IVPB, infuse in 90 min. Calculate the flow rate in drops per minute. The drop factor is 20 gtt/mL.

Correct Answer: A

Rationale: 250 mL ÷ 90 min = 2.777 mL/min. 2.777 mL/min × 20 gtt/mL = 55.56 gtt/min, rounded to 56 gtt/min. Other options are incorrect.

Extract:

A client who had previously signed the consent for liver biopsy has changed his mind and no longer wants the procedure.


Question 4 of 5

The best initial response by the nurse would be:

Correct Answer: B

Rationale: Exploring the reason for refusal respects the patient's autonomy and facilitates informed decision-making.

Extract:


Question 5 of 5

A patient with borderline personality disorder is exhibiting self-harming behaviors. Which of the following interventions is most appropriate?

Correct Answer: B

Rationale: Providing immediate medical care for injuries ensures safety and addresses physical harm, the priority in self-harming behaviors. Ignoring, punishing, or only discussing feelings delays critical intervention.

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