Trading Comps Modeling Exam – Wall Street Prep (WSP)
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Which combination of client responses would the nurse determine represents the highest risk
for the development of pressure injuries?
a. Incontinence; inability to move independently
b. Periodic diaphoresis; occasional sliding down in bed
c. Minimal reaction to painful stimuli; receiving tube feedings
d. Spending extensive time in a chairbody mass index (BMI) of 23
a
Which rationale supports the nursing intervention to turn the client with paraplegia every to 2
hours? a. To maintain client comfort
b. To prevent development of pressure injuries
c. To prevent contractures of the extremities
d. To improve venous circulation in the lower extremities
b
While assessing the client for a pressure injury, the nurse identifies exposed bone and tendons
Which stage would the nurse document for this pressure injury?
a. l
b. ll
c. lll
d. lv
d
The nurse is teaching a nursing student about interventions that reduce the risk of pressure
ulcers in a clientWhich statements made by the nursing student indicate effective Select all that
apply. One, some , or all responses may be correct.
1. " I will elevate the head of the client's bed to no more than 30 degrees .
2. " I will ensure that the client is turned and repositioned at least every 2 hours"
, 3. " I will advise the client to apply talc directly to the perineum .
4. "I will ensure that the client's fluid intake is 2000 to 100 mL/day; "
5. "I will teach the client to refrain from eating a highprotein and calorie diet."
1, 2, 4
Which instruction from the nurse to an 80-year-old client with thinning of a subcutaneous layer
would be beneficial?
a. Dress warmly in cold weather.
b. Use soaps with high fat content.
c. Change the position of bed once every 5 hours. d. Apply moisturizer 2 hours after bathing .
a
A client has a stage pressure injury. Which nursing intervention can prevent further injury by
eliminating shearing force?
a. Maintain the head of the bed at 30 degrees or less .
b. Use draw sheets to pull up, transfer , and position the client .
c. Reposition the client every 2 hours, propping with pillows.
d. Perform passive range -of-motion exercises every 8 hours.
b
In which area of the body will the nurse most likely discover a pressure injury in a client who is
maintained in the low-Fowler position excessively? a. Elbows
b. Occiput
c. Hium
d. Sacrum
d
Which meal is most appropriate for a client with a large pressure injury?
a. Hamburger with french fries
b. Turkey meatloaf with brown rice
c. Pasta and tomato sauce with a side salad
d. Grilled chicken, steamed spinach, and a side of orange slices
d
Which intervention would be included in the plan of care for the prevention of a pressure
injury?
| Guaranteed Pass | 100% Rated | Real Exam Questions
Complete with Verified A+ Answers
Which combination of client responses would the nurse determine represents the highest risk
for the development of pressure injuries?
a. Incontinence; inability to move independently
b. Periodic diaphoresis; occasional sliding down in bed
c. Minimal reaction to painful stimuli; receiving tube feedings
d. Spending extensive time in a chairbody mass index (BMI) of 23
a
Which rationale supports the nursing intervention to turn the client with paraplegia every to 2
hours? a. To maintain client comfort
b. To prevent development of pressure injuries
c. To prevent contractures of the extremities
d. To improve venous circulation in the lower extremities
b
While assessing the client for a pressure injury, the nurse identifies exposed bone and tendons
Which stage would the nurse document for this pressure injury?
a. l
b. ll
c. lll
d. lv
d
The nurse is teaching a nursing student about interventions that reduce the risk of pressure
ulcers in a clientWhich statements made by the nursing student indicate effective Select all that
apply. One, some , or all responses may be correct.
1. " I will elevate the head of the client's bed to no more than 30 degrees .
2. " I will ensure that the client is turned and repositioned at least every 2 hours"
, 3. " I will advise the client to apply talc directly to the perineum .
4. "I will ensure that the client's fluid intake is 2000 to 100 mL/day; "
5. "I will teach the client to refrain from eating a highprotein and calorie diet."
1, 2, 4
Which instruction from the nurse to an 80-year-old client with thinning of a subcutaneous layer
would be beneficial?
a. Dress warmly in cold weather.
b. Use soaps with high fat content.
c. Change the position of bed once every 5 hours. d. Apply moisturizer 2 hours after bathing .
a
A client has a stage pressure injury. Which nursing intervention can prevent further injury by
eliminating shearing force?
a. Maintain the head of the bed at 30 degrees or less .
b. Use draw sheets to pull up, transfer , and position the client .
c. Reposition the client every 2 hours, propping with pillows.
d. Perform passive range -of-motion exercises every 8 hours.
b
In which area of the body will the nurse most likely discover a pressure injury in a client who is
maintained in the low-Fowler position excessively? a. Elbows
b. Occiput
c. Hium
d. Sacrum
d
Which meal is most appropriate for a client with a large pressure injury?
a. Hamburger with french fries
b. Turkey meatloaf with brown rice
c. Pasta and tomato sauce with a side salad
d. Grilled chicken, steamed spinach, and a side of orange slices
d
Which intervention would be included in the plan of care for the prevention of a pressure
injury?
