in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
Chapter 1
• The nurse is caring for four clients on a medical–surgical unit. Which
client should the nurse see initially?
1. A client admitted with hepatitis A who has had severe
diarrhea for the last 24 hours
2. A client admitted with pneumonia who is has small
amounts of yellow productive sputum
3. A client admitted with fever of unknown origin (FUO)
who has been without fever for the last 48 hours
4. A client admitted with a wound infection whose WBC is
8,500 mm3
Answer: 1
Rationale: The nurse must decide which client should be seen on the
initial rounds of the day. The nurse must remember that the first
client to be seen should be the client who needs the attention of the
nurse initially. A client with hepatitis A does experience diarrhea,
but diarrhea for the last 24 hours could cause the client to have a
problem with dehydration and experience a state of fluid volume
Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
,Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
deficit.
Cognitive Level: Application
Client Needs: Safe, Effective Care
Environment Nursing Process:
Planning
• The nurse is preparing to administer influenza vaccines to a mass
drive-through clinic. Which statement by a client would indicate
further questioning prior to giving the client the influenza vaccine?
1. “I am allergic to horse hair.”
2. “I try to get my vaccine every year.”
3. “I am not allergic to anything except eggs.”
4. “My husband had a severe allergic reaction after he
received his influenza vaccine.”
Answer: 3
Rationale: Influenza vaccines are recommended for person at high risk
for serious sequelae of influenza. The nurse should be aware that
client with a sensitivity to eggs should not receive the vaccine.
Vaccines prepared from chicken or duck embryos are
contraindicated in clients who are allergic to eggs.
Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
,Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
Cognitive Level: Application
Client Needs: Safe, Effective Care
Environment Nursing Process:
Assessment
• The nurse is caring for four clients on a medical–surgical unit. The
secretary gives the nurse the morning labs. Which of the following labs
would require that the nurse call the physician and inform the
healthcare provider about the client’s abnormalities?
1. WBC 14,600 mm3
2. Serum protein 6.9 g/dL
3. I & D (incision and drainage) showing no growth for the last
24 hours
4. Albumin 4.2 g/dL
Answer: 1
Rationale: When the nurse is caring for several clients, all of the labs
should be checked frequently throughout the shift to assess for any
abnormalities. The WBC in option 1 is abnormal. (Normal WBC 4,000–
10,000 mm3.) All of the other lab results are within acceptable range;
Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
, Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+
therefore, the results should not be called in to the physician.
Cognitive Level:
Application Client Needs:
Physiologic Integrity
Nursing Process:
Assessment
• The nurse is orienting a new graduate. The nurse is reinforcing the
importance of standard precautions. Which of the following
observations by the nurse would require further education regarding
standard precautions?
• The graduate nurse understands to wash hands when
entering and exiting the client’s room.
• The graduate nurse wears gloves when serving breakfast
trays to various clients.
• The graduate nurse wears a gown, gloves, and goggles
when suctioning a client.
• The graduate nurse leaves all supplies in the room of a
client who is in contact isolation.
Answer: 2
Test Bank for Medical-Surgical Nursing Critical Thinking
in Client Care, 4th Edition Priscilla LeMon Q&A
LATEST UPDATE 2022/2023 GRADED A+