Detailed Answer Key RN 231 Quiz 4_Cloned_Assessment - $16.49   Add to cart

Exam (elaborations)

Detailed Answer Key RN 231 Quiz 4_Cloned_Assessment

1. A nurse is caring for a client admitted to the emergency department with extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should be aware that initially the client is at greatest risk for 2. A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is pending an escharotomy. The client's spouse asks the nurse what the procedure entails. Which of the following nursing statements is appropriate? . 3. A group of college students was attending a weekend football rally when one of the students stumbled and fell into the bonfire. Although several friends quickly intervened, the client sustained partial-thickness burns to both lower legs, chest, and both forearms. Which of the following is the priority nursing action when the client is brought into the emergency room? 4. A nurse in an emergency department is caring for a client who has burns on the front and back of both his legs and arms. Using the rule of nines the nurse should document burns to which percentage of the client’s total body surface area (TBSA)? 5. A nurse is caring for a client who has full-thickness burns all over 75% of his body. Which of the following methods is appropriate to accurately monitor the cardiovascular system? 6. A nurse is developing a plan of care for a client who is rehabilitating from major burns. Which of the following should the nurse include to provide emotional support? : . 7. A nurse is assessing the depth and extent of a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the first priority when assessing the severity of the burn? . 8. A nurse is monitoring the fluid replacement of a client who has sustained burns. Which of the following fluids is used in the first 24 hr following a burn injury? . 9. A nurse is caring for a client with burns to face, ears, and eyelids. Which of the following is the priority finding to report to the provider? 10. A client arrives at the emergency department following an explosion at a chemical plant. He has deep partial- and full-thickness chemical burns over more than 25% of his body surface area. What is the nurse’s priority intervention for this client? 11. A nurse is planning care for a client who has a GI bleed. Which of the following actions should the nurse take first? . 12.A A nurse is caring for a client who has peptic ulcer disease. The nurse knows to monitor the client for which of the following findings as an indication of the complication of gastrointestinal perforation? 13.A A nurse is caring for a client who just had an upper gastrointestinal endoscopic procedure. Which of the following is the assessment priority for this client? 14. A client is admitted with an active upper gastrointestinal (GI) bleed. After inserting a NG tube into the client, which of the following findings should the nurse anticipate? 15.A A client is receiving pancreatic enzymes as a digestive aid. The nurse should tell the client expect which of the following gastrointestinal changes? 16.A A triage nurse in an emergency department is caring for a client who has a gunshot wound to the right side of her chest. The nurse notes a thick dressing on the chest and a sucking noise coming from the wound. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take initially? 17.A A nurse in an emergency department is caring for a client who was bitten on the left leg by a poisonous snake. The client has placed elastic bandages snuggly above and below the bite marks and is in no apparent distress. The nurse should 18. Following a suicide bombing at a shopping mall, an unidentified, unconscious client is admitted to the emergency department with an acute intra-abdominal hemorrhage. The nurse should recognize that consent for the surgery 19. A client is admitted to the emergency room with a respiratory rate of seven per min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm HG Saturation 80% Bicarbonate 28 mEq/L 20.A A nurse is triaging clients in the emergency department. Which of the following clients should the nurse request the provider should see first? ………………………………………CONTINUED……………………………………

Preview 3 out of 23  pages

ANTHONY79

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 450,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

$ 16.49
  • (0)
  Add to cart