NR 304 Exam 1 Review Questions with 100% Correct Answers

Your patient is sent to the ED for complaints of pain, redness and edema of the LLE with a diagnosis of r/o DVT. In the ER the patient will have diagnostic testing complete to confirm the providers diagnosis. To screen for DVT you would: A) Measure circumference of the ankle B) Check temperature with the palm of hand. C) Compress dorsalis pedis pulse, looking for blood return D) Measure widest point with a tape measure Correct Answer D) Measure widest point with a tape measure You are a nursing student on a medical unit. A new admission requires a complete assessment; however your clinical instructor asks you to assess the lymphatic system of the patient. Which of the following organs aids the lymphatic system? A) Liver, lymph nodes, and stomach B) Pancreas, small intestine and stomach C) Spleen, tonsils and thymus D) Pancreas, spleen and tonsils Correct Answer C) Spleen, tonsils and thymus You assess a patient who has 4+ edema of the right leg. What is the best way to document this finding? A) Mild pitting, no perceptible swelling of the leg B) Moderate pitting, indentation subsides rapidly C) Deep pitting, leg looks swollen D) Very deep pitting, indentation lasts a long time Correct Answer D) Very deep pitting, indentation lasts a long time A nurse is caring for a client who is experiencing diarrhea. Which physiological response to diarrhea should the nurse be most concerned about? A) Dehydration B) Malnutrition C) Excoriated skin D) Urinary Incontinence Correct Answer A) Dehydration A client presents to the outpatient complaining of calf pain. The client reports returning from an airplane trips the previous day. Which should the nurse assess first? A) The nurse should auscultate the lung fields and heart sounds B) The nurse should determine the length of the airplane trip