Verified Q&A | Latest Update | 100% Pass Success
1. Describe the significance of assessing capillary refill time in post-operative
patients.
Capillary refill time indicates peripheral perfusion and can help
identify circulatory issues.
Capillary refill time assesses the patient's respiratory function.
Capillary refill time measures the patient's blood pressure.
Capillary refill time is used to evaluate muscle strength.
2. A nurse is assisting with triage following a mass casualty event. The nurse
should recommend that which of the following clients be attended to first?
A client who has an open fracture of the femur and a 5.1cm(2in)
laceration in the thigh
A client who has partial-thickness burns to the arms and reports
severe pain
A client who is unconscious with a closed head injury and whose
pupils are fixed and dilated
A client who has a crush injury to the pelvis and whose pedal pulse
in the right foot are absent
3. A nurse is evaluating assessment findings of a client's skin. The nurse should
identify that which of the following findings is associated with a possible
infection?
Papules
Bulla
Vesicles
, Wheals
4. What should a nurse do immediately after receiving a telephone prescription
for morphine?
Call the pharmacy to verify the prescription
Administer the medication without confirmation
Document the prescription in the patient's chart
Repeat the details of the prescription back to the provider
5. If a nurse observes a client with a high fever and elevated heart and
respiratory rates, what immediate nursing action should be prioritized?
Increase the patient's fluid intake without further assessment.
Perform a full physical examination before taking any action.
Document the vital signs and wait for the physician's orders.
Administer antipyretics as ordered and monitor the patient's
response.
6. A nurse educator is teaching a module on proper body mechanics during
employee orientation. Which of the following statements by a newly hired
nurse indicates the need for further teaching?
"To broaden my base of support, I should spread my feet apart."
"My line of gravity should fall outside my base of support."
"The lower my center of gravity, the more stability I have."
"When I lift an object, I should hold it as close to my body as
possible."
,7. A patient has an apical pulse of 92/min and a radial pulse of 76/min. What is
the pulse deficit, and what might this indicate about the patient's
cardiovascular status?
Pulse deficit is 16/min, indicating normal cardiovascular function.
Pulse deficit is 92/min, indicating tachycardia.
Pulse deficit is 16/min, which may indicate potential cardiovascular
issues.
Pulse deficit is 76/min, suggesting bradycardia.
8. What specific aspect of circulation should the nurse assess in a post-
operative patient with knee surgery?
Blood pressure
Respiratory rate
Capillary refill time
Heart rate
9. What is one group of individuals that is at increased risk for complications
from food poisoning?
Immunocompromised individuals
Elderly individuals
Children under five
Healthy adults
, 10. A nurse learned that a client was taken to the hospital with carbon monoxide
poisoning after neglecting to turn off the car parked in the garage. Which of
the following would be the most appropriate intervention to suggest at the
next nursing visit?
Encourage the client to leave one window open a crack, so there is
always a constant supply of fresh air from outside the home.
Suggest that the family move to a house with a detached garage.
Teach the family the symptoms of breathing carbon monoxide gas so
they can act quickly to get out of the house.
Advise the client to install a carbon monoxide detector in the
home.
11. What is the primary purpose of assessing a client's thyroid gland during a
physical examination?
To assess lung capacity and respiratory function.
To measure blood pressure and heart rate.
To check for signs of dehydration.
To evaluate thyroid function and detect abnormalities.
12. A home health nurse is discussing the dangers of food poisoning with a
client. Which of the following pieces of information should the nurse
include?
Handing raw and fresh food separately can prevent food poisoning
Pts. who are at high risk should eat or drink only pasteurized dairy
products
Healthy individuals usually recover within a few weeks