• NUR 445 EXAM 09/20/2026
NUR 445 EXAM 3 2025 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+/ARIZONA COLLEGE
OF NURSING
A nurse is providing teaching to a client who has a prescription for heat therapy for Tx of cellulitis of the right
lower leg. Which of the following client statements indicates an understanding of the teaching?
A. "I will sit on the side of the tub and soak my right leg two times every day."
B. "I'll keep a heating pad on the calf of my right leg when I am lying down."
P 1
, • NUR 445 EXAM 09/20/2026
C. "I'll place my leg under a heat lamp every 3 hours."
D. "I'll wrap a warm, wet towel around my right calf every 4 hours." - Correct Answer :ANS: D. "I'll wrap a warm,
wet towel around my right calf every 4 hours."
Rationale: Moist heat is more effective than dry heat in treating cellulitis. Moist heat relieves the manifestations
of inflammation by increasing blood flow to the affected area. The nurse should instruct the client to elevate the
right leg 8 to 15 cm (3 to 6 in) above the level of the heart and apply warm, moist heat to the site every 2 to 4 hr.
A nurse is assessing a client who is 48 hr post-op following abdominal surgery. Which of the following findings
should the nurse report to the provider?
A. Blood pressure 102/66 mm Hg
B. Straw-colored urine from an indwelling urinary catheter
C. Yellow-green drainage on the surgical incision
D. Respiratory rate 18/min - Correct Answer :ANS: C. Yellow-green drainage on the surgical incision
Rationale: Thick yellow-green drainage is indicative of an infection and should be reported immediately.
A nurse is planning care for an older adult client who is at risk for developing pressure ulcers. Which of the
following interventions should the nurse use to help maintain the integrity of the client's skin?
A. Use a transfer device to lift the client up in bed.
B. Apply cornstarch to keep sensitive skin areas dry.
C. Massage the skin over the client's bony prominences.
D. Elevate the head of the bed no more than 45°. - Correct Answer :ANS: A. Use a transfer device to lift the
client up in bed.
Rationale: Using a lifting device prevents dragging the client's skin across the bed linens, which can cause
abrasions.
P 2
, • NUR 445 EXAM 09/20/2026
A nurse is assessing a client who has had staples removed from an abdominal wound postoperatively. The nurse
notes separation of the wound edges with copious light-brown serous drainage. Which of the following actions
should the nurse perform first?
A. Check the client's vital signs.
B. Assess the client's pain level.
C. Cover the wound with a moist, sterile gauze dressing.
D. Obtain a culture and sensitivity of the wound drainage. - Correct Answer :ANS: C. Cover the wound with a
moist, sterile gauze dressing.
Rationale: The client's wound has dehisced, or opened along the suture line, and is now draining. The primary
clinical objective in managing a dehisced wound is to keep it clean and moist and manage any exudate. The
nurse's priority action therefore is to cover the wound with a moist, sterile, saline-soaked gauze dressing.
A nurse is caring for a child who has acute appendicitis. Which of the following results should the nurse
anticipate when reviewing this client's lab values?
A. WBC 17,000/mm3
B. Neutrophils 3,000/mm3
C. RBC 4.2 million/mm3
D. Lymphocytes 3,000/mm3 - Correct Answer :ANS: A. WBC 17,000/mm3
Rationale: The expected reference range for a WBC count for a child is 5,000 to 10,000/mm3. A WBC count of
17,000/mm3 is elevated. The nurse should expect to see an elevated WBC count because appendicitis is an acute
bacterial infection.
A nurse is caring for client who has human immunodeficiency virus (HIV). Which of the following types of
isolation should the nurse implement to prevent the transmission of HIV?
A. Protective isolation
B. Droplet precautions
C. Standard precautions
D. Airborne precautions - Correct Answer :ANS: C. Standard precautions
P 3
, • NUR 445 EXAM 09/20/2026
Rationale: Standard precautions should be implemented with every client to prevent the spread of infection
transmitted by direct or indirect contact with infectious blood or body fluids. Because HIV is spread through
blood and bodily fluids, standard precautions are appropriate. (pg. 330 Recommendations for Preventing HIV
transmission by Health Care Workers Box)
A nurse is teaching a client who has human immunodeficiency virus (HIV) about how the virus is transmitted.
Which of the following statements should the nurse include the teaching?
A. "HIV can be transmitted as soon as a person develops manifestations."
B. "HIV can be transmitted to anyone who has had contact with infected blood."
C. "HIV is transmitted through the respiratory route via droplets."
D. "HIV is transmitted only during the active phase of the virus." - Correct Answer :ANS: B. "HIV can be
transmitted to anyone who has had contact with infected blood."
Rationale: The concentration of the virus is highest in blood but also has been isolated in other body fluids,
including sputum, saliva, cerebrospinal fluid, urine, and semen. Clients who have HIV are cautioned to practice
safe sex, avoid donating blood, and abstain from sharing needles with others. (pg. 327)
A nurse is caring for a client following an abdominal surgery. The client has a prescription for dressing changes
every 4 hr and PRN. Which of the following objects should the nurse use to reduce skin irritation around the
incision area?
A. Montgomery straps
B. Enzymes
C. Alcohol swabs
D. A transparent dressing - Correct Answer :ANS: A. Montgomery straps
Rationale: Montgomery straps are adhesive strips that are applied to the skin on either side of the surgical
wound. The strips have holes so the two sides of the dressing can be tied together and re-opened for dressing
changes without having to remove the adhesive strips. If Montgomery straps are unavailable, the nurse can
place strips of hydrocolloid dressing on either side of the wound and place the tape across the dressing onto the
hydrocolloid strips.
P 4
NUR 445 EXAM 3 2025 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+/ARIZONA COLLEGE
OF NURSING
A nurse is providing teaching to a client who has a prescription for heat therapy for Tx of cellulitis of the right
lower leg. Which of the following client statements indicates an understanding of the teaching?
A. "I will sit on the side of the tub and soak my right leg two times every day."
B. "I'll keep a heating pad on the calf of my right leg when I am lying down."
P 1
, • NUR 445 EXAM 09/20/2026
C. "I'll place my leg under a heat lamp every 3 hours."
D. "I'll wrap a warm, wet towel around my right calf every 4 hours." - Correct Answer :ANS: D. "I'll wrap a warm,
wet towel around my right calf every 4 hours."
Rationale: Moist heat is more effective than dry heat in treating cellulitis. Moist heat relieves the manifestations
of inflammation by increasing blood flow to the affected area. The nurse should instruct the client to elevate the
right leg 8 to 15 cm (3 to 6 in) above the level of the heart and apply warm, moist heat to the site every 2 to 4 hr.
A nurse is assessing a client who is 48 hr post-op following abdominal surgery. Which of the following findings
should the nurse report to the provider?
A. Blood pressure 102/66 mm Hg
B. Straw-colored urine from an indwelling urinary catheter
C. Yellow-green drainage on the surgical incision
D. Respiratory rate 18/min - Correct Answer :ANS: C. Yellow-green drainage on the surgical incision
Rationale: Thick yellow-green drainage is indicative of an infection and should be reported immediately.
A nurse is planning care for an older adult client who is at risk for developing pressure ulcers. Which of the
following interventions should the nurse use to help maintain the integrity of the client's skin?
A. Use a transfer device to lift the client up in bed.
B. Apply cornstarch to keep sensitive skin areas dry.
C. Massage the skin over the client's bony prominences.
D. Elevate the head of the bed no more than 45°. - Correct Answer :ANS: A. Use a transfer device to lift the
client up in bed.
Rationale: Using a lifting device prevents dragging the client's skin across the bed linens, which can cause
abrasions.
P 2
, • NUR 445 EXAM 09/20/2026
A nurse is assessing a client who has had staples removed from an abdominal wound postoperatively. The nurse
notes separation of the wound edges with copious light-brown serous drainage. Which of the following actions
should the nurse perform first?
A. Check the client's vital signs.
B. Assess the client's pain level.
C. Cover the wound with a moist, sterile gauze dressing.
D. Obtain a culture and sensitivity of the wound drainage. - Correct Answer :ANS: C. Cover the wound with a
moist, sterile gauze dressing.
Rationale: The client's wound has dehisced, or opened along the suture line, and is now draining. The primary
clinical objective in managing a dehisced wound is to keep it clean and moist and manage any exudate. The
nurse's priority action therefore is to cover the wound with a moist, sterile, saline-soaked gauze dressing.
A nurse is caring for a child who has acute appendicitis. Which of the following results should the nurse
anticipate when reviewing this client's lab values?
A. WBC 17,000/mm3
B. Neutrophils 3,000/mm3
C. RBC 4.2 million/mm3
D. Lymphocytes 3,000/mm3 - Correct Answer :ANS: A. WBC 17,000/mm3
Rationale: The expected reference range for a WBC count for a child is 5,000 to 10,000/mm3. A WBC count of
17,000/mm3 is elevated. The nurse should expect to see an elevated WBC count because appendicitis is an acute
bacterial infection.
A nurse is caring for client who has human immunodeficiency virus (HIV). Which of the following types of
isolation should the nurse implement to prevent the transmission of HIV?
A. Protective isolation
B. Droplet precautions
C. Standard precautions
D. Airborne precautions - Correct Answer :ANS: C. Standard precautions
P 3
, • NUR 445 EXAM 09/20/2026
Rationale: Standard precautions should be implemented with every client to prevent the spread of infection
transmitted by direct or indirect contact with infectious blood or body fluids. Because HIV is spread through
blood and bodily fluids, standard precautions are appropriate. (pg. 330 Recommendations for Preventing HIV
transmission by Health Care Workers Box)
A nurse is teaching a client who has human immunodeficiency virus (HIV) about how the virus is transmitted.
Which of the following statements should the nurse include the teaching?
A. "HIV can be transmitted as soon as a person develops manifestations."
B. "HIV can be transmitted to anyone who has had contact with infected blood."
C. "HIV is transmitted through the respiratory route via droplets."
D. "HIV is transmitted only during the active phase of the virus." - Correct Answer :ANS: B. "HIV can be
transmitted to anyone who has had contact with infected blood."
Rationale: The concentration of the virus is highest in blood but also has been isolated in other body fluids,
including sputum, saliva, cerebrospinal fluid, urine, and semen. Clients who have HIV are cautioned to practice
safe sex, avoid donating blood, and abstain from sharing needles with others. (pg. 327)
A nurse is caring for a client following an abdominal surgery. The client has a prescription for dressing changes
every 4 hr and PRN. Which of the following objects should the nurse use to reduce skin irritation around the
incision area?
A. Montgomery straps
B. Enzymes
C. Alcohol swabs
D. A transparent dressing - Correct Answer :ANS: A. Montgomery straps
Rationale: Montgomery straps are adhesive strips that are applied to the skin on either side of the surgical
wound. The strips have holes so the two sides of the dressing can be tied together and re-opened for dressing
changes without having to remove the adhesive strips. If Montgomery straps are unavailable, the nurse can
place strips of hydrocolloid dressing on either side of the wound and place the tape across the dressing onto the
hydrocolloid strips.
P 4
