The nurse is caring for a client who is receiving bolus feedings through a nasogastric tube.  The nurse has aspirated the gastric contents and measured 175 ml of residual fluid.  The nurse should first: a. hold the feeding and report the findings to the team leaderb. inform the oncoming nurse during shift reportc. dispose of the gastric contents in the client’s commode and continue with administration of the tube feedingd. flush the tube with 120 ml of water

The nurse assessing a patient’s wound notes pale red watery drainage. How will the nurse most accurately document this finding? a. Serous drainageb. Purulent drainagec. Sanguineous drainaged. Serosanguineous drainage  

Infiltration of the intravenous infusion is suspected when the: a. drip rate speeds up suddenlyb. erythema and warmth are present in the surrounding areac. tissue near insertion is cool and edematousd. a rash and itching are noted at the site  

During the nurse’s initial rounds, a client receiving a tube feeding complains of nausea and has abdominal distention. What intervention would the nurse perform first? a. Auscultate for bowel sounds and palpate abdomen for massesb. Record observations and continue to assess other clients on your teamc. Check for residual and hold feeding for one hour if residual is greater than 150 mld. Increase the tube feeding by 10ml/hr to complete the infusion  

There is more than one way to check for nasogastric tube placement. One way is to test the PH of the gastric content. What would you expect the gastric content PH to be? a. Between 8-12b. Between 5-8c. Between 0.1-0.5d. Between 1-5  

The interval from the onset of nonspecific signs and symptoms to more specific symptoms is what stage of an infection? a. Convalescentb. Illnessc. Prodromald. Incubation

The infection control health care provider plans an in-service on control of health care–associated infections. What should be the focus of this program? a. Observing nurses caring for patientsb. Screening patients who are admitted to the hospitalc. Educating hospital personnel about aseptic practicesd. Discharging infectious patients from the hospital  

The infection control officer is observing hospital staff for appropriate use of aseptic technique. What observation demonstrates the need for more instruction on surgical asepsis? a. Facing the sterile fieldb. Placing a sterile dressing on a sterile fieldc. Touching the edges of the sterile field with sterile glovesd. Keeping gloved hands above the waist

If a drainage tube or Penrose drain is present in the area of a wound, the nurse should: a. not touch it because it may become dislodgedb. remove the drain to clean the areac. not document on the client’s chart that a drain is presentd. clean the area around it carefully, using a circular motion

The Mexican ban on American immigration to Texas: