Skin/wound
The nurse would identify which patient as having an increased risk of wound dehiscence? Select all that apply
A. A malnourished patient
B. A obese patient
C. A young adult
D. A female patient
E. A patient with a wound infection.
A a malnourished patient
b. an obese patient
e. a patient with a wound infection
Which factor would be noted as part of the general survey component of a physical assessment? Select all that apply.
A. Age
B. Lung sounds
C. Body odor
D. Signs of abuse
E. Race
A, C, D, E
Tylenol
acetaminophen
1 gram is __ mg
1000mg
The nurse is providing instructions to a client about foods that are high in potassium. The nurse should tell the client that which food has the highest potassium content?
1. Milk
2. Apple
3. Spinach
4. Pound Cake
3. Spinach
A patient who underwent a hysterectomy 10 days ago comes in for a follow up visit. The patient notices purulent drainage at the incision site. The nurse suspects wound infection and performs assessment for confirmation. Which clinical finding would the nurse evaluate? Select all that apply.
a. pain
b. redness
c. paleness
d. tenderness
e. cold sensation
a. pain
b. redness
d. tenderness
ABCDE assessment of skin stands for:
Asymmetry, Border, Color, Diameter, Evolving
coumadin
warfarin
1 lb is __ ounces
16 ounces
A nurse is using physical restraints for a patient in the medical-surgical unit. For which possible reason would the nurse use restraints on the patient? Select all that apply.
A. Physically aggressive to the nurse.
B. Trying to remove medical devices.
C. Verbally aggressive to the nurse.
D. Sedated and needs to be protected from falling out of bed.
E. Being prepared for a routine physical assessment.
A and B
While assessing a patient with a sacral pressure injury, which finding would the nurse use to support labeling the wound as a stage 2 pressure injury.
a. presence of a pink wound bed
b. presence of non-blanchable erythema
c. presence of a tunnel in the wound
d. presence of a lip around the wound
a.
Which action would the nurse take during the working phase of a patient interview? Select all that apply.
A. Focuses on the purpose of the interaction
B. Assess both verbal and non verbal cues
C. Assesses the patient's educational needs.
D. Uses a variety of communication techniques.
E. Summarizes key findings of the physical exam.
ABCD
lipitor
atorvastatin
1 kg is __ pounds
2.2 pounds
Which assessment would a nurse persform fist when caring for an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion?
A. The amount of family support
B. A 3 day diet recall
C. A thorough physical assessment
D. Threats to safety in the house
C. A thorough physical assessment
While performing a focused wound assessment on a patient, which finding would the nurse evaluate?
Select all that apply.
a. outflow of pus
b. cause of the wound
c. overall skin condition
d. location of the wound
e. characteristics of the wound bed
Outflow of pus
location of the wound
characteristics of the wound bed
PERRLA stands for:
pupils equal round reactive to light and accommodate
Advil
Ibuprofen
1 pm in military time
1300
Which task can the RN delegate to the unlicensed assistive personnel (UAP) when caring for a patient who sustained injuries in a motor vehicle accident?
A. Evaluating the patient's lab results.
B. Completing a physical assessment.
C. Preparing a diet plan for the patient.
D. Feeding the patient meals and snacks.
D. feeding the patient meals and snacks
During the follow up visit after an appendectomy, the patient reports a 'popping sensation' at the surgical suture line. The nurse identifies excessive drainage from the surgical wound. Which action would the nurse take for this patient? Select all that apply.
a. Use lactated ringer's solution to clean the wound.
b. apply heat to the incision for 15 minutes every 4 hours.
c. instruct the patient to cough and deep breath to reduce anxiety.
d. moisten gauze with sterile normal saline and cover the wound
e. notify the health care provider about the patient's condition.
D. moisten the gauze with sterile normal saline and cover the wound
E. notify the health care provider about the patient' condition.
The nurse begins the assessment of a patient's breath sounds and notes diminished breath sounds at the base of the right lung. What action should the nurse take next?
A. Refer the patient for a chest x ray
B. Listen to the base of the patient's left lung.
C. Notify the patient's primary care provider.
D. Palpate the patient's lung fields bilaterally.
B.
dilaudid
hydromorphone
True or false: A unit of heparin is the same quantity as a unit of insulin.
False. A unit of heparin is not the same quantity as a unit of insulin; units are medications specific.
The preoperative client expresses anxiety. Which statement by the nurse is most appropriate at the time?
A. "Let me tell you what the surgery is all about."
B. "It is normal to feel nervous before surgery."
C. What have you been told so far about your surgery, and what part(s) make you nervous?
D. Your surgeon will explain the entire surgical procedure to you beforehand, so don't worry.
C.