download full file at http://testbankinstant.com
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,download full file at http://testbankinstant.com
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,download full file at http://testbankinstant.com
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, Chapter 1:critical thinking ,critical judgment and the nursing process
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1. The nurse is caring for four clients on a medical–surgical unit. Which client should the
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nurse see initially?
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1. A client admitted with hepatitis A who has had severe diarrhea for the last
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24 hours co co
2. A client admitted with pneumonia who is has small amounts of yellow
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productive sputum
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3. A client admitted with fever of unknown origin (FUO) who has been
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without fever for the last 48 hours
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4. A client admitted with a wound infection whose WBC is 8,500 mm3
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Answer: 1 co
Rationale: The nurse must decide which client should be seen on the initial rounds of the
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day. The nurse must remember that the first client to be seen should be the
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client who needs the attention of the nurse initially. A client with hepatitis A
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does experience diarrhea, but diarrhea for the last 24 hours could cause the
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client to have a problem with dehydration and experience a state of fluid
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volume deficit.
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Cognitive Level: Application
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Client Needs: Safe, Effective Care Environment
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Nursing Process: Planning
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2. The nurse is preparing to administer influenza vaccines to a mass drive-through clinic.
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Which statement by a client would indicate further questioning prior to giving the
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client the influenza vaccine?
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1. ―I am allergic to horse hair.‖
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2. ―I try to get my vaccine every year.‖
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3. ―I am not allergic to anything except eggs.‖
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4. ―My husband had a severe allergic reaction after he received his influenza
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vaccine.‖
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Answer: 3 co
Rationale: Influenza vaccines are recommended for person at high risk for serious
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sequelae of influenza. The nurse should be aware that client with a sensitivity to
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eggs should not receive the vaccine. Vaccines prepared from chicken or duck
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embryos are contraindicated in clients who are allergic to eggs.
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Cognitive Level: Application
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download full file at http://testbankinstant.com co co co co
co co co co
,download full file at http://testbankinstant.com
co co co co
,download full file at http://testbankinstant.com
co co co co
, Chapter 1:critical thinking ,critical judgment and the nursing process
co co co co co co co co
1. The nurse is caring for four clients on a medical–surgical unit. Which client should the
co co co co co co co co co co co co co co
nurse see initially?
co co co
1. A client admitted with hepatitis A who has had severe diarrhea for the last
co co co co co co co co co co co co co
24 hours co co
2. A client admitted with pneumonia who is has small amounts of yellow
co co co co co co co co co co co
productive sputum
co co
3. A client admitted with fever of unknown origin (FUO) who has been
co co co co co co co co co co co
without fever for the last 48 hours
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4. A client admitted with a wound infection whose WBC is 8,500 mm3
co co co co co co co co co co co
Answer: 1 co
Rationale: The nurse must decide which client should be seen on the initial rounds of the
co co co co co co co co co co co co co co co
day. The nurse must remember that the first client to be seen should be the
co co co co co co co co co co co co co co co
client who needs the attention of the nurse initially. A client with hepatitis A
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does experience diarrhea, but diarrhea for the last 24 hours could cause the
co co co co co co co co co co co co co
client to have a problem with dehydration and experience a state of fluid
co co co co co co co co co co co co co
volume deficit.
co co
Cognitive Level: Application
co co
Client Needs: Safe, Effective Care Environment
co co co co co
Nursing Process: Planning
co co co
2. The nurse is preparing to administer influenza vaccines to a mass drive-through clinic.
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Which statement by a client would indicate further questioning prior to giving the
co co co co co co co co co co co co co
client the influenza vaccine?
co co co co
1. ―I am allergic to horse hair.‖
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2. ―I try to get my vaccine every year.‖
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3. ―I am not allergic to anything except eggs.‖
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4. ―My husband had a severe allergic reaction after he received his influenza
co co co co co co co co co co co
vaccine.‖
co
Answer: 3 co
Rationale: Influenza vaccines are recommended for person at high risk for serious
co co co co co co co co co co co
sequelae of influenza. The nurse should be aware that client with a sensitivity to
co co co co co co co co co co co co co co
eggs should not receive the vaccine. Vaccines prepared from chicken or duck
co co co co co co co co co co co co
embryos are contraindicated in clients who are allergic to eggs.
co co co co co co co co co co
Cognitive Level: Application
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download full file at http://testbankinstant.com co co co co
