BURNS
When assessing a patient who spilled hot oil on the right leg and foot, the nurse note's that the skin is dry, pale, hard skin. The patients states that the burn is not painful. What term would the nurse use to document the burn depth?
FULL- THICKNESS SKIN DESTRUCTION
Select all the patients that would be placed in droplet precautions.
A: a 5 year old with chicken pox.
B: a 36 year old with pertussis
C: a 25 year old with scarlet fever
D: a 56 year old with tuberculosis
E: a 69 year old with streptococcal pharyngitis
F: a 89 year old with C.Diff
B: a 36 year old with pertussis
C: a 25 year old with scarlet fever
E: a 69 year old with streptococcal pharyngitis
A 73 year old patient with a stroke experiences facial drooping on the right side and right sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find?
A: impulsive behavior
B: right- sided neglect
C: hyperactive left-sided tendon reflexes
D: difficulty comprehending instructions
D: difficulty comprehending instructions
What contact precaution is used for C-Diff?
Contact plus
What is shock?
inadequate tissue perfusion
Which patient should the nurse assess first?
A: a patient with smoke inhalation who has wheezes and altered mental status.
B: a patient with full thickness leg burns who has a dressing change scheduled.
C: a patient with abdominal burns who is complaining of level 8 pain.
D: a patient with 40% total body surface area (TBSA) burns who is receiving IV fluids at 500 ml/hr.
A: A PATIENT WITH SMOKE INHALATION WHO HAD WHEEZES AND ALTERED MENTAL STATUS.
A 6 year old female patient is diagnosed with Varicella. What type of isolation precautions will be initiated for this patient?
Airborne and Contact
Which stroke risk factor for a 48 year old male patient in the clinic is most important for the nurse to address?
A: the patient is 25 pounds above the ideal weight.
B: the patient drinks a glass of red wine with dinner daily.
C: the patient's usual blood pressure is 170/94 mm Hg.
D: the patient works at a desk and relaxes by watching television.
C: the patient's usual blood pressure is 170/94 mm Hg.
When does the emergency care start?
What is the difference between crystalloids and colloids?
Crystalloids: lactated ringers or normal saline
Colloids: albumin and blood products
A patient is scheduled for surgery to graft a burn injury on the arm. Which of the following statement should the nurse include when instructing the patient prior to the procedure?
A: " you will begin to perform exercises to promote flexibility and reduce contractures after five days."
B: " you will need to report any itching, as it might signal infection."
C: " performing the procedure near the end of the hospitalization will reduce the incidence of infection and improve success of the procedure."
D: " the procedure will be performed in your room."
A: " you will begin to perform exercises to promote flexibility and reduce contractures after five days."
Select all the conditions that warrant airborne precautions?
A: norovirus
B: Hepatitis A
C: measles
D: varicella
E: disseminated varicella zoster
F: tuberculosis
G: whooping cough
H: RSV
I: epiglottitis
C: measles
D: varicella
E: disseminated varicella zoster
F: tuberculosis
A patient with left sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?
A: complete blood count (CBC)
B: chest x-ray
C: 12 lead ECG
D: CT scan
D: CT scan
What are some penetrating traumas?
gunshot wound
stab wound
impaled object
A nurse is caring for a patient who is experiencing hypovolemic shock. What is the primary positing for this patient?
modified trendelenburg
The family of a patient with third-degree burns wants to know why the "scabs are being cut off" of the patients leg. What is the most appropriate response by the nurse to this family?
A: " the scabs are really old burned tissue and need to be removed to promote healing."
B: " i'll ask the doctor to come and talk with you about the treatment plan."
C: " the patient asked for the scabs to be removed."
D: " the scabs are removed to check for blood flow to the burned area."
A: " the scabs are really old burned tissue and need to be removed to promote healing."
A patient is diagnosed with Hepatitis A and is incontinent of stool. What type of precautions would be initiated?
Contact Precautions
The nurse is caring for a patient who has been experiencing stroke symptoms for 60 minutes. Which action can the nurse delegate to a LPN?
A: assess the patient's gag and cough reflexes.
B: determine when the stroke symptoms began.
C: administer the prescribed short acting insulin
D: infuse the prescribed IV metoprolol
C: administer the prescribed short acting insulin
Fat embolisms are most common with a fracture involving which bones?
long bone
Manifestations of neurogenic shock?
parasympathetic stimulation
dry, warm skin
hypotension with bradycardia
The nurse is teaching a patient with a partial-thickness wound how to wear his elastic pressure garment. How would the nurse instruct the patient to wear this garment?
23.5 hours a day
Donning and Doffing order of PPE.
Donning: gown, mask, goggles, gloves
Doffing: gloves, goggles, gown, mask
A 70 year old female patient with left sided hemiparesis arrives by ambulance to the emergency department. Which action should the nurse take first?
A: monitor the blood pressure
B: send the patient for a CT scan.
C. check the respiratory rate and effort
D: assess the Glasgow coma scale score.
C. check the respiratory rate and effort
What are the three categories of triage?
Emergency
Priority
Non- Urgent
when does septic shock happen?
after sepsis