NUR 224 EXAM 1 REVIEW QUESTIONS
A wound is full thickness with visible bone and serous drainage. What stage is this
wound? - Answers - Stage IV
A wound has eschar, is dry, hardened, and closed. What stage is this wound? -
Answers - Unstageable
A wound is closed with non-blanchable redness plus and intact blister. What stage is
this wound? - Answers - Stage I
A wound is shallow with serous drainage and no visible fat. What stage is this wound? -
Answers - Stage II
A wound has visible fat with partial thickness tissue loss. What stage is this wound? -
Answers - Stage III
A client's telemetry monitor displays ventricular tachycardia. Upon reaching the client's
bedside, which action should the nurse take first? - Answers - Check the client's pulse
The nurse teaches a client with hypertension to recognize the signs/symptoms that may
occur during periods of elevated blood pressure. The nurse determines that the client
needs additional teaching if the client states that which sign/symptom is associated with
this condition? - Answers - Nausea
A client has implemented dietary and other lifestyle changes to manage hypertension.
The nurse determines that the client has been most successful when the client has
which follow-up blood pressure reading? - Answers - 125/85
The nurse notes that an older client's current apical pulse is 82 beats per minute, strong
but irregular. The nurse notes that prior baseline data indicated that the client's apical
pulse ranged from 60 to 90 beats per minute and was strong and regular. On further
assessment, the client reports "feeling tired lately." Based on this data, what
intervention should the nurse implement? - Answers - Call the client's healthcare
provider
A clinic nurse is performing an assessment on a client diagnosed with primary
hypertension. Which should the nurse do to best assess the client's blood pressure
accurately? - Answers - Seat the client with the arm bared, supported and at heart
level
A client diagnosed with chronic obstructive pulmonary disease (COPD) is on home
oxygen at 2 L per minute. The nurse assesses the client's respiratory rate at 22 breaths
per minute. When the client reports an increase in the dyspnea, what should the nurse
do initially? - Answers - Conduct further assessment of the client's respiratory status.
A wound is full thickness with visible bone and serous drainage. What stage is this
wound? - Answers - Stage IV
A wound has eschar, is dry, hardened, and closed. What stage is this wound? -
Answers - Unstageable
A wound is closed with non-blanchable redness plus and intact blister. What stage is
this wound? - Answers - Stage I
A wound is shallow with serous drainage and no visible fat. What stage is this wound? -
Answers - Stage II
A wound has visible fat with partial thickness tissue loss. What stage is this wound? -
Answers - Stage III
A client's telemetry monitor displays ventricular tachycardia. Upon reaching the client's
bedside, which action should the nurse take first? - Answers - Check the client's pulse
The nurse teaches a client with hypertension to recognize the signs/symptoms that may
occur during periods of elevated blood pressure. The nurse determines that the client
needs additional teaching if the client states that which sign/symptom is associated with
this condition? - Answers - Nausea
A client has implemented dietary and other lifestyle changes to manage hypertension.
The nurse determines that the client has been most successful when the client has
which follow-up blood pressure reading? - Answers - 125/85
The nurse notes that an older client's current apical pulse is 82 beats per minute, strong
but irregular. The nurse notes that prior baseline data indicated that the client's apical
pulse ranged from 60 to 90 beats per minute and was strong and regular. On further
assessment, the client reports "feeling tired lately." Based on this data, what
intervention should the nurse implement? - Answers - Call the client's healthcare
provider
A clinic nurse is performing an assessment on a client diagnosed with primary
hypertension. Which should the nurse do to best assess the client's blood pressure
accurately? - Answers - Seat the client with the arm bared, supported and at heart
level
A client diagnosed with chronic obstructive pulmonary disease (COPD) is on home
oxygen at 2 L per minute. The nurse assesses the client's respiratory rate at 22 breaths
per minute. When the client reports an increase in the dyspnea, what should the nurse
do initially? - Answers - Conduct further assessment of the client's respiratory status.
