Skills in Clinical Nursing 8th Edition By Audrey J. Berman- Shirlee Snyder – Test Bank

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) The nurse is caring for a client requiring mobility assistance. The physician orders Lofstrand
crutches, and the client asks what the crutch looks like. Which of the following would be the best
description? 1) A) A crutch that rests just under the axilla with a hand bar B) A crutch that has a cuff for the upper arm C) A crutch that extends to the forearm and has a metal cuff around the forearm to stabilize the
wrist D) A crutch with a rubber tip to prevent slippage on a floor surface

Answer: C

2 describes a platform crutch, and option 4 describes the tip found on all crutch
types.
Cognitive Level: Knowledge
Client Need: Safe, Effective Care Environment
Nursing Process: Implementation C) Option 3 describes a Lofstrand crutch. Option 1 describes an axillary crutch, option
2 describes a platform crutch, and option 4 describes the tip found on all crutch
types.
Cognitive Level: Knowledge
Client Need: Safe, Effective Care Environment
Nursing Process: Implementation D) Option 3 describes a Lofstrand crutch. Option 1 describes an axillary crutch, option
2 describes a platform crutch, and option 4 describes the tip found on all crutch
types.
Cognitive Level: Knowledge
Client Need: Safe, Effective Care Environment
Nursing Process: Implementation Objective: Learning Outcome 11-1: Define the key terms used in the skills of mobilization. 1
2) The nurse is caring for a client who had a cerebrovascular accident (CVA) and is paralyzed on the
right side of the body. The nurse documents this as: 2) A) Quadriplegia. B) Paraplegia. C) Hemiplegia. D) Essential paralysis. Answer: C Explanation: A) Paralysis on the left or right half of the body is hemiplegia. Paraplegia is paralysis
of two extremities, while quadriplegia is paralysis of four extremities. Infantile
paralysis is a form of spinal paralysis, and is also known as acute poliomyelitis.
Cognitive Level: Knowledge
Client Need: Physiological Integrity
Nursing Process: Implementation B) Paralysis on the left or right half of the body is hemiplegia. Paraplegia is paralysis
of two extremities, while quadriplegia is paralysis of four extremities. Infantile
paralysis is a form of spinal paralysis, and is also known as acute poliomyelitis.
Cognitive Level: Knowledge
Client Need: Physiological Integrity
Nursing Process: Implementation C) Paralysis on the left or right half of the body is hemiplegia. Paraplegia is paralysis
of two extremities, while quadriplegia is paralysis of four extremities. Infantile
paralysis is a form of spinal paralysis, and is also known as acute poliomyelitis.
Cognitive Level: Knowledge
Client Need: Physiological Integrity
Nursing Process: Implementation D) Paralysis on the left or right half of the body is hemiplegia. Paraplegia is paralysis
of two extremities, while quadriplegia is paralysis of four extremities. Infantile
paralysis is a form of spinal paralysis, and is also known as acute poliomyelitis.
Cognitive Level: Knowledge
Client Need: Physiological Integrity
Nursing Process: Implementation Objective: Learning Outcome 11-1: Define the key terms used in the skills of mobilization.

3) The client is recovering from a fractured left femur, and has just had the cast removed. The nurse
assists the client to ambulate by: 3) A) Standing on the client’s left side. B) Standing on the client’s right side. C) Standing behind the client and holding the client’s belt. D) Standing in front of the client and having the client lean on the nurse’s shoulders. Answer: A

4) The nurse is assisting the client to ambulate in the hall when the client suddenly says she feels very
lightheaded. The nurse’s priority action is to: 4) A) Quickly escort the client back to the room and into bed. B) Call for help to escort the client back to the room. C) Assist the client to sit on the nearest chair with her head between her legs, and go to find
assistance. D) Assist the client to a horizontal position on the floor if no chair is available. Answer: D

5) The nurse is planning to delegate ambulation of the client to the unlicensed assistive personnel
(UAP). In order to provide proper instructions to the UAP, the nurse: 5) A) Will ambulate the client first and then have the UAP ambulate the client. B) Quizzes the UAP to assure he understands how to ambulate the client. C) Assesses the client’s ability. D) Observes the client as she ambulates. Answer: C

6) The client needs to ambulate using a walker. Which of the following could the nurse safely delegate
to the UAP? 6) A) The UAP cannot ambulate a client who requires assistive devices. B) Teach the client how to use the walker. C) Evaluate the client’s ability to use the walker properly. D) Ambulate using the walker once the client demonstrates adequate skill. Answer: D

7) The nurse is assisting the client into a wheelchair. When seating the client in the chair, the nurse: 7) A) Unlocks the wheels. B) Positions the calf supports and lowers the footplate. C) Applies the seat belt. D) Asks the client to sit far back in the chair. Answer: D

8) The nurse is transporting the client in a wheelchair, and comes to a downward incline. The nurse
transports the client down the incline by: 8) A) Applying the brakes on one of the chair’s wheels. B) Pushing the wheelchair forward while pulling back on the handles. C) Putting her body between the wheelchair and the bottom of the incline and walking
backwards down the slope. D) Zigzagging sideways down the incline so the wheelchair is always pointing at a 45-degree angle to the slope. Answer: C

9) The nurse is ambulating with a client who is moderately weak, and applies support by: 9) A) Interlocking his forearm with the client’s closest forearm. B) Wrapping the arm closest to the client around the client’s waist. C) Holding on to the client’s waistband on his robe. D) Holding the client under the axilla. Answer: A

10) Which of the following methods would be the proper way for the nurse to teach a client to walk
with a cane? 10) A) Hold the cane on the stronger side of the body and move the cane forward, then move the
weak leg forward. B) Hold the cane on the weaker side and move the weak leg forward, then follow with the cane. C) Hold the cane on the stronger side, step forward with the weak leg, and then move the cane
forward as the stronger leg moves forward. D) Hold the cane on the weaker side, step forward with the weak leg, and then move the cane
forward as the stronger leg moves forward. Answer: A