ASSESSMENT QUIZ
A nurse in a long-term care facility enters the day room and finds the window curtains on
fire. Clients are panicking and the room is filling with smoke. Indicate the emergency
actions the nurse must take. (Move the steps into the box on the right, placing them in the
order of performance. Use all the steps.) - CORRECT ANSWER-- Remove the clients from
the room
- Activate the fire alarm
- Close the door
- Extinguish the fire
A nurse is assessing a client following the application of an aquathermia pad. Which of the
following is the first indication to the nurse that the client is experiencing a superficial burn
injury to the application site?
A. Blistering
B. Erythema
C. Eschar
D. Absence of pain - CORRECT ANSWER-B. Erythema
Erythema is an indication that the client has experienced a superficial burn with damage
limited to the epidermis. Other manifestations include edema, pain, and increased
sensitivity to heat.
A nurse is assessing a client who is experiencing prostatic hypertrophy. Which of the
following findings associated with urinary retention should the nurse expect? (Select all
that apply.) - CORRECT ANSWER-- Report of feeling pressure
- Tenderness over the symphysis pubis
- Distended bladder
, - Voiding 30 mL frequently
Clinical findings of urinary retention include frequent voiding of 25 to 60 mL of urine.
A nurse is teaching a client who has diabetes about which dietary source should provide
the greatest percentage of calories. Which of the following statements indicates the client
understands the teaching?
A. "Most of my calories each day should be from fats."
B. "I should eat more calories from complex carbohydrates than anything else."
C. "Simple sugars are needed more than other calorie sources."
D. "Protein should be my main source of calories." - CORRECT ANSWER-"I should eat more
calories from complex carbohydrates than anything else."
The client who has diabetes should consume the majority of calories from complex
carbohydrates, such as whole grains, fruits, and vegetables.
A nurse is providing discharge teaching to a client who was recently diagnosed with a latex
allergy. Which of the following client statements indicates an understanding of the
teaching?
A. "I will apply elastic bandages to cuts."
B. "I will use dishwashing gloves when cleaning the dishes."
C. "I will buy balloons for my son's birthday."
D. "I will use ink pens for writing." - CORRECT ANSWER-"I will use ink pens for writing."
The client understands pencil erasers contain latex and should use pens for writing
instead.