n LEMONE
n & BURKE’S n n
MEDICAL- SURGICAL NURSING: CLINICAL
n n n n
REASONING IN HOSPITAL CLIENT CARE 7TH
n n n n n n
EDITION/ALL CHAPTERS 1-52
n n n
,Chapter 1 n
1. The ncaregiver nis ncaring nfor nfour nHospital nclients non na nmedical–surgical
nunit. nWhichnHospital nclient nshould nthe ncaregiver nsee ninitially?
1. A nHospital nclient nadmitted nwith nhepatitis nA nwho nhas nhad
nsevere ndiarrhea n for nthen
last n24 nhours
2. A nHospital nclient nadmitted nwith npneumonia nwho nis nhas
nsmall namounts nofn yellow nproductive nsputum
3. A nHospital nclient nadmitted nwith nfever nof nunknown
norigin n(FUO) nwho nhasn been nwithout nfever n for nthe nlast
n 48 nhours
4. A nHospital nclient nadmitted nwith na nwound ninfection nwhose
WBC nis n8,500 nmm3nACCURATE nANSWER:-1
n
Reasoning:->>>The ncaregiver nmust ndecide nwhich nHospital nclient nshould nbe
nseen non ntheninitial nrounds nof nthe nday. nThe ncaregiver nmust nremember
nthat nthe nfirst
Hospital nclient nto nbe nseen nshould nbe nthe nHospital nclient nwho nneeds
nthe nattention nof nthe ncaregiver ninitially. nA nHospital nclient nwith
nhepatitis nA ndoes nexperience ndiarrhea,n but ndiarrhea nfor nthe nlast n24
nhours ncould ncause n the nHospital n client nto nhave na nproblem nwith
dehydration nand nexperience na nstate nof nfluid nvolume ndeficit.
n
Cognitive nLevel: nApplication
Hospital nclient nNeeds: nSafe, nEffective nCare
nEnvironmentn Nursing nProcess: nPlanning
2. The ncaregiver nis npreparing nto nadminister ninfluenza nvaccines nto na nmass
ndrive-n
through nclinic. nWhich nstatement nby na nHospital nclient nwould nindicate
nfurther nquestioning nprior nton
giving nthe nHospital nclient nthe ninfluenza
nvaccine?
1. “I nam nallergic nto nhorse nhair.”
2. “I ntry nto nget nmy nvaccine nevery nyear.”
3. “I nam nnot nallergic nto nanything nexcept neggs.”
4. “My nhusband nhad na nsevere nallergic nreaction nafter nhe nreceived
nhis ninfluenzan vaccine.”
ACCURATE nANSWER:-3
,Reasoning:->>>Influenza nvaccines nare nrecommended nfor nperson nat nhigh nrisk
nfor nserious nsequelae nof ninfluenza. nThe ncaregiver nshould nbe naware
nthat nHospital n client nwith nan
sensitivity nto neggs nshould nnot nreceive nthe
nvaccine. nVaccines nprepared nfrom nchicken nor nduck nembryos nare
ncontraindicated nin nHospital nclients nwho n are nallergic nto n eggs.
Cognitive nLevel: nApplication
Hospital nclient nNeeds: nSafe, nEffective nCare
nEnvironmentn Nursing nProcess: nAssessment
3. The ncaregiver nis ncaring nfor nfour nHospital nclients non na nmedical–surgical
nunit. nThe n secretary ngives n the ncaregiver n the nmorning nlabs. nWhich n of n the
nfollowing nlabs nwould nrequire nthat nthe ncaregiver ncall nthe nphysician nand
ninform nthe nhealthcare nprovider nabout nthe n Hospital nclient’s nabnormalities?
1. n WBC n14,600 nmm3
2. Serum nprotein n6.9 ng/dL
3. I n& nD n(incision nand ndrainage) nshowing nno ngrowth nfor nthe nlast n24 nhours
4. Albumin n4.2
g/dLnACCURATE
n
ANSWER:-1
n
Reasoning:->>>When nthe ncaregiver nis ncaring nfor nseveral nHospital nclients,
nall nof nthe nlabs n
should nbe nchecked nfrequently nthroughout nthe nshift nto
nassess nfor nany nabnormalities. nThe nWBC nin noption n1 nis nabnormal. n(Normal
nWBC n4,000–10,000 nmm .) nAll nof nthe nother nlab n results nare nwithin nacceptable
3
nrange; ntherefore, nthe nresults nshould nnot nbe n called nin nto nthen
physician.
Cognitive nLevel:
nApplicationnHospital
nclient nNeeds: nPhysiologic
nIntegrity nNursing
nProcess:
Assessment
4. The ncaregiver nis norienting na nnew ngraduate. nThe ncaregiver nis
nreinforcing nthe nimportance n of nstandard nprecautions. nWhich n of nthe
nfollowing nobservations nby nthe ncaregiver nwould nrequire nfurther
neducation nregardingn standard nprecautions?
, 1. The ngraduate ncaregiver nunderstands nto nwash nhands
nwhenn entering nand nexiting nthe nHospital nclient’s nroom.
2. The ngraduate ncaregiver nwears ngloves nwhen nserving nbreakfast
trays nto nvarious nHospital nclients.
n
3. The ngraduate ncaregiver nwears na ngown, ngloves, nand ngoggles
nwhenn suctioning na nHospital nclient.
4. The ngraduate ncaregiver nleaves nall nsupplies nin nthe nroom nof
nan
Hospital nclient nwho nis nin ncontact nisolation.
ACCURATE nANSWER:-2
Reasoning:->>>The ncaregiver nmust nhave nan nunderstanding nof nstandard
nprecautions. nPrevention nis nthe nmost nimportant nmeasure nto nprevent
nnosocomial ninfections. nStandard nprecautions nwere npublished nin n1996
nthat nprovide nguidelines
for nthe nhandling nof nblood nand nother nbody nfluids. nThese nguidelines
nare nused nwith nall nHospital nclients, nregardless nof nwhether nthey nhave na
nknown ninfectious ndisease. nStandard n precautions nare nused
by nall nhealthcare nworkers nwho nhave ndirect ncontact nwith nHospital
nclients nor nwith ntheir nbody nfluids. nIt nis nnot nnecessary nfor nthe
ncaregiver nto nwear ngloves nwhile ndelivering n food ntrays nto nthe nHospital
nclient, nbecause nthere n is nnot ncontact nwith nthe nHospital nclient.
Cognitive nLevel: nApplication
Hospital nclient nNeeds: nSafe, nEffective nCare
nEnvironmentn Nursing nProcess: nEvaluation
5. The nadmitting ndepartment nalerts nthe ncaregiver non na nmedical–surgical nunit
nthatn
a nHospital nclient nwith nactive ntuberculosis n(TB) nis nbeing nadmitted nto nthe
nunit. nWhich ntype n of nisolation nis nappropriate nbased non nthe nHospital nclient’s
ndiagnosis?
1. Standard nprecautions
2. Airborne nprecautions
3. Droplet nprecautions
4. Contact
precautionsnACCURATE
n
ANSWER:-2
n
Reasoning:->>>In naddition nto nhandwashing nand nstandard nprecautions, nthe