NUR417 / NUR 417 EXAM 3 Care of Adult II | Test
Questions and Answers | Latest Update 2026/2027 |
Graded A+ | Verified (Concordia, St. Paul)
This Exam contains:
100% Guarantee Pass.
Expert Verified Explanation
Multiple choice (single best answer)
Select All That Apply (SATA)
Fill-in-the-blank
Case Studies/Scenario-Based Questions
The nurse caring for an older adult suspects elder abuse. Which action is appropriate?
A. Collect proof of abuse before notifying the authorities.
B. Confront the caretakers about the suspicion of abuse.
C. Notify the authorities of the suspected elder abuse.
D. Report the abuse if the older adult gives permission.
ANSWER
C. The nurse is a mandatory reporter of elder abuse and should notify the authorities of
suspected elder abuse.The nurse does not need proof of abuse before calling the
authorities.The nurse should not confront the caretakers if elder abuse is suspected.The
nurse does not need permission from the elder before calling the authorities.
You are working with a child and suspect physical abuse. What is your primary legal
responsibility?
A. Document your assessment thoroughly and accurately.
B. Report the abuse to local authorities.
C. Refer the family to support groups.
D. Assist the family in identifying resources and support systems.
Answer
, B - The nurse should report her suspicions to the local authorities so they can
investigate. The law makes it mandatory to report any suspected child abuse. All other
options are important in dealing with patient and the family, but they would not be the
priority of the nurse.
The nurse monitors a patient in the emergency department after chest tube placement
for a hemopneumothorax. The nurse is most concerned if which assessment finding is
observed?
a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Complaint of pain with each deep inspiration
d. Subcutaneous emphysema at the insertion site
Answer
b. 400 mL of blood in the collection chamber
The large amount of blood may indicate that the patient is in danger of developing
hypovolemic shock. An air leak would be expected immediately after chest tube
placement for a pneumothorax
A patient experiences a chest wall contusion as a result of being struck in the chest with
a baseball bat. The emergency department nurse would be most concerned if which
finding is observed during the initial assessment?
a. Paradoxical chest movement c. Heart rate of 110 beats/minute
b. Complaint of chest wall pain d. Large bruised area on the chest
Answer
a. Paradoxical chest movement
Paradoxical chest movement indicates that the patient may have flail chest, which can
severely compromise gas exchange and can rapidly lead to hypoxemia. When a person
has a flail chest, the nurse should stabilize the chest with positive pressure and call a
surgeon for surgery.
Which action should the nurse plan to prevent aspiration in a high-risk patient? a.
Turn and reposition an immobile patient at least every 2 hours.
,b. Place a patient with altered consciousness in a side-lying position.
c. Insert a nasogastric tube for feeding a patient with high calorie needs.
d. Monitor respiratory symptoms in a patient who is immunosuppressed.
ANSWER
b. Place a patient with altered consciousness in a side-lying position.
With loss of consciousness, the gag and cough reflexes are depressed, and aspiration
is more likely to occur. The risk for aspiration is decreased when patients with a
decreased level of consciousness are placed in a side-lying or upright position.
An occupational health nurse works at a manufacturing plant where there is potential
exposure to inhaled dust. Which action recommended by the nurse is intended to
prevent lung disease?
a. Treat workers with pulmonary fibrosis.
b. Teach about symptoms of lung disease.
c. Require the use of protective equipment.
d. Monitor workers for coughing and wheezing.
Answer
c. Require the use of protective equipment.
When assessing a patient who has just arrived after an automobile accident, the
emergency department nurse notes tachycardia and absent breath sounds over the
right lung. For which intervention will the nurse prepare the patient? a. Emergency
pericardiocentesis
c. Bronchodilator administration
b. Stabilization of the chest wall
d. Chest tube connected to suction
Answer
d. Chest tube connected to suction
The patient's history and absent breath sounds suggest a right-sided pneumothorax or
hemothorax, which will require treatment with a chest tube and drainage to suction.
A patient describes his involvement in a situation that the nurse suspects demonstrates
the sexual abuse of a child. What is the nurse's initial response?
, A. Verify that the event actually occurred.
B. Consider the negative effects of breeching patient trust.
C. Report the suspected abuse to the appropriate agency.
D. Notify the health care provider of the statemen
Answer
Report the suspected abuse to the appropriate agency. Correct
The nurse is legally obligated to report suspected and actual sexual abuse of children to
police or appropriate agencies. All states have mandatory child abuse reporting
statutes. It is not the nurse’s responsibility to verify the event. The primary concern is for
the child, even if that means compromising confidentiality.
A patient is admitted to the emergency department with an open stab wound to the left
chest. What action should the nurse take?
a. Keep the head of the patient's bed positioned flat.
b. Cover the wound tightly with an occlusive dressing.
c. Position the patient so that the left chest is dependent.
d. Tape a nonporous dressing on three sides over the wound.
Answer
d. Tape a nonporous dressing on three sides over the wound.
The dressing taped on three sides will allow air to escape when intrapleural pressure
increases during expiration, but it will prevent air from moving into the pleural space
during inspiration
The nurse is caring for a patient who has a right-sided chest tube after a right lower
lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive
personnel (UAP)?
a. Document the amount of drainage every 8 hours.
b. Obtain samples of drainage for culture from the system.
c. Assess patient pain level associated with the chest tube.
d. Check the water-seal chamber for the correct fluid level.
a. Document the amount of drainage every 8 hours.
Questions and Answers | Latest Update 2026/2027 |
Graded A+ | Verified (Concordia, St. Paul)
This Exam contains:
100% Guarantee Pass.
Expert Verified Explanation
Multiple choice (single best answer)
Select All That Apply (SATA)
Fill-in-the-blank
Case Studies/Scenario-Based Questions
The nurse caring for an older adult suspects elder abuse. Which action is appropriate?
A. Collect proof of abuse before notifying the authorities.
B. Confront the caretakers about the suspicion of abuse.
C. Notify the authorities of the suspected elder abuse.
D. Report the abuse if the older adult gives permission.
ANSWER
C. The nurse is a mandatory reporter of elder abuse and should notify the authorities of
suspected elder abuse.The nurse does not need proof of abuse before calling the
authorities.The nurse should not confront the caretakers if elder abuse is suspected.The
nurse does not need permission from the elder before calling the authorities.
You are working with a child and suspect physical abuse. What is your primary legal
responsibility?
A. Document your assessment thoroughly and accurately.
B. Report the abuse to local authorities.
C. Refer the family to support groups.
D. Assist the family in identifying resources and support systems.
Answer
, B - The nurse should report her suspicions to the local authorities so they can
investigate. The law makes it mandatory to report any suspected child abuse. All other
options are important in dealing with patient and the family, but they would not be the
priority of the nurse.
The nurse monitors a patient in the emergency department after chest tube placement
for a hemopneumothorax. The nurse is most concerned if which assessment finding is
observed?
a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Complaint of pain with each deep inspiration
d. Subcutaneous emphysema at the insertion site
Answer
b. 400 mL of blood in the collection chamber
The large amount of blood may indicate that the patient is in danger of developing
hypovolemic shock. An air leak would be expected immediately after chest tube
placement for a pneumothorax
A patient experiences a chest wall contusion as a result of being struck in the chest with
a baseball bat. The emergency department nurse would be most concerned if which
finding is observed during the initial assessment?
a. Paradoxical chest movement c. Heart rate of 110 beats/minute
b. Complaint of chest wall pain d. Large bruised area on the chest
Answer
a. Paradoxical chest movement
Paradoxical chest movement indicates that the patient may have flail chest, which can
severely compromise gas exchange and can rapidly lead to hypoxemia. When a person
has a flail chest, the nurse should stabilize the chest with positive pressure and call a
surgeon for surgery.
Which action should the nurse plan to prevent aspiration in a high-risk patient? a.
Turn and reposition an immobile patient at least every 2 hours.
,b. Place a patient with altered consciousness in a side-lying position.
c. Insert a nasogastric tube for feeding a patient with high calorie needs.
d. Monitor respiratory symptoms in a patient who is immunosuppressed.
ANSWER
b. Place a patient with altered consciousness in a side-lying position.
With loss of consciousness, the gag and cough reflexes are depressed, and aspiration
is more likely to occur. The risk for aspiration is decreased when patients with a
decreased level of consciousness are placed in a side-lying or upright position.
An occupational health nurse works at a manufacturing plant where there is potential
exposure to inhaled dust. Which action recommended by the nurse is intended to
prevent lung disease?
a. Treat workers with pulmonary fibrosis.
b. Teach about symptoms of lung disease.
c. Require the use of protective equipment.
d. Monitor workers for coughing and wheezing.
Answer
c. Require the use of protective equipment.
When assessing a patient who has just arrived after an automobile accident, the
emergency department nurse notes tachycardia and absent breath sounds over the
right lung. For which intervention will the nurse prepare the patient? a. Emergency
pericardiocentesis
c. Bronchodilator administration
b. Stabilization of the chest wall
d. Chest tube connected to suction
Answer
d. Chest tube connected to suction
The patient's history and absent breath sounds suggest a right-sided pneumothorax or
hemothorax, which will require treatment with a chest tube and drainage to suction.
A patient describes his involvement in a situation that the nurse suspects demonstrates
the sexual abuse of a child. What is the nurse's initial response?
, A. Verify that the event actually occurred.
B. Consider the negative effects of breeching patient trust.
C. Report the suspected abuse to the appropriate agency.
D. Notify the health care provider of the statemen
Answer
Report the suspected abuse to the appropriate agency. Correct
The nurse is legally obligated to report suspected and actual sexual abuse of children to
police or appropriate agencies. All states have mandatory child abuse reporting
statutes. It is not the nurse’s responsibility to verify the event. The primary concern is for
the child, even if that means compromising confidentiality.
A patient is admitted to the emergency department with an open stab wound to the left
chest. What action should the nurse take?
a. Keep the head of the patient's bed positioned flat.
b. Cover the wound tightly with an occlusive dressing.
c. Position the patient so that the left chest is dependent.
d. Tape a nonporous dressing on three sides over the wound.
Answer
d. Tape a nonporous dressing on three sides over the wound.
The dressing taped on three sides will allow air to escape when intrapleural pressure
increases during expiration, but it will prevent air from moving into the pleural space
during inspiration
The nurse is caring for a patient who has a right-sided chest tube after a right lower
lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive
personnel (UAP)?
a. Document the amount of drainage every 8 hours.
b. Obtain samples of drainage for culture from the system.
c. Assess patient pain level associated with the chest tube.
d. Check the water-seal chamber for the correct fluid level.
a. Document the amount of drainage every 8 hours.
