2023/2024 EXAM WITH CORRECT
QUESTIONS AND VERIFIED ANSWERS -
ALREADY GRADED A+
A nurse is caring for a client who has a stage III pressure ulcer on the heel. When
preparing to irrigate the wound, which of the following actions should the nurse take
first?
Obtain the prescribed irrigation solution.
Don personal protective equipment.
Check the client's pain level.
Place a waterproof pad under the client's extremity. - ANS✔✔--Check the client's
pain level.
A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the
following actions should the nurse plan to take first?
Obtain sample menus from the dietitian to give to the client.
Ask the client to identify the types of foods she prefers.
Identify the recommended range for the client's blood glucose level.
Discuss long-term complications that can result from nonadherence to the dietary plan. -
ANS✔✔--Ask the client to identify the types of foods she prefers.
the nurse should first ask the client about individual food preferences to provide an
opportunity for the nurse to include these foods in her diet. Involving the client in the
planning will help promote her adherence to the dietary plan.
A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood
glucose reading of 48 mg/dL. Which of the following findings should the nurse expect?
Kussmaul respirations
Diaphoresis
Decreased skin turgor
Ketonuria - ANS✔✔--Diaphoresis
a client who has a blood glucose level below 70 mg/dL to exhibit manifestations of
hypoglycemia. Expected findings associated with hypoglycemia include weakness,
hunger, diaphoresis, nausea, shakiness, and confusion
A nurse is caring for a client who is 72 hr postoperative following an above-the-knee
amputation. Which of the following actions should the nurse take?
, Elevate the residual limb on a soft pillow.
Assist the client to a prone position every 4 hr.
Reapply a bandage to the residual limb every 12 hr.
Apply dressings to the site in a proximal-to-distal direction. - ANS✔✔--Assist the
client to a prone position every 4 hr.
because it reduces the risk of flexion contractures.
A nurse is providing teaching to a client who has gout and urolithiasis. The client asks
how to prevent future uric acid stones. Which of the following suggestions should the
nurse make? (Select all that apply.)
A. Take allopurinol as prescribed.
B. Exercise several times a week.
C. Limit intake of foods high in purine.
D. Decrease daily fluid intake.
E. Avoid citrus juices. - ANS✔✔--Take allopurinol as prescribed.
Exercise several times a week.
Limit intake of foods high in purine.
A nurse in an emergency department is assessing a client who sustained a fall off of a
roof. Which of the following findings should the nurse identify as an indication of a
basilar skull fracture?
A depressed fracture of the forehead
Clear fluid coming from the nares
Motor loss on one side of the body
Bleeding from the top of the scalp - ANS✔✔--Clear fluid coming from the nares
The nurse should identify cerebrospinal fluid, which appears as a clear fluid, coming
from the nares or ears as an indication of a basilar skull fracture.
A nurse is teaching a client how to perform a breast self exam (BSE). The nurse should
identify which of the following findings as an indication of breast cancer?
Lumps that are mobile and tender upon palpation prior to a menstrual period
Multiple round masses that are tender and found in both breasts
Bilaterally darkened areolas
A nontender, hard lump that is palpated in one breast - ANS✔✔--A nontender, hard
lump that is palpated in one breast
A nurse is providing discharge teaching about improving gas exchange to a client who
has emphysema. Which of the following instructions should the nurse include in the
teaching?
Use pursed-lip breathing during periods of dyspnea.