• NUR 445 EXAM 09/20/2026
NUR 445 EXAM 2025 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+/ARIZONA COLLEGE
OF NURSING
A nurse is caring for a client who has full-thickness burns covering 63% of her body and smoke inhalation. Which
of the following nursing actions is the top priority?
A. Monitor intake and output.
B. Administer antibiotics.
P 1
, • NUR 445 EXAM 09/20/2026
C. Monitor respiratory status.
D. Encourage fluid and food intake. - Correct Answer :ANS: C. Monitor respiratory status.
Rationale: The priority action for the nurse when using the airway, breathing, and circulation (ABC) approach to
client care is to monitor the client's respiratory status closely. Smoke inhalation most likely includes a thermal
injury to the tracheobronchial tree. Edema from the inflammatory response to heat can obstruct the airway.
Endotracheal intubation may become necessary to maintain a patent airway. (pg. 464)
A nurse is assessing a client who sustained superficial partial-thickness and deep partial-thickness burns 72 hr
ago. Which of the following findings should the nurse report to the provider?
A. Edema in the burned extremities
B. Severe pain at the burn sites
C. Urine output of 30 mL/hr
D. Temperature of 39.1°C (102.4°F) - Correct Answer :ANS: D. Temperature of 39.1°C (102.4°F)
Rationale: An elevated temperature is an indication of infection, and the nurse should report this finding to the
provider. Sepsis is a critical finding following a major burn injury. Initially, burn wounds are relatively pathogen-
free. On approximately the third day following the injury, early colonization of the wound surface by gram-
negative organisms changes to predominantly gram-positive opportunistic organisms.
A nurse in an emergency department is assessing a client who has extensive burns, including on her face. Which
of the following assessments should the nurse perform first?
A. Estimation of burn injury
B. Characteristics of the cough and sputum
C. Extent of peripheral edema
D. Amount of urine output - Correct Answer :ANS: B. Characteristics of the cough and sputum
Rationale: The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of
human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and
circulating oxygen to the body's organs via the blood. An alteration in any of these areas can indicate a threat to
life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the
P 2
, • NUR 445 EXAM 09/20/2026
highest priority because the airway must be clear for oxygen exchange to occur. Breathing is the second-highest
priority because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the
third-highest priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels
are capable of efficiently carrying oxygen to them. Therefore, the nurse's priority assessment is the client's
cough characteristics. A client who has burns to the face is at risk for pulmonary injury, and the development of a
brassy cough can indicate an impending loss of airway.
A nurse is teaching a client who has extensive deep partial- and full-thickness burns and requires a topical
antimicrobial medication. The goal of this medication therapy is to reduce which of the following outcomes?
A. Bacterial growth
B. Scarring
C. Skin graft size
D. Pain - Correct Answer :ANS: A. Bacterial growth
Rationale: Topical antimicrobial medications (particularly broad-spectrum antimicrobials) help prevent bacteria
from entering the body when a client has an impairment of the protective covering of the skin, as with burns. It
and the dressing create a protective barrier between bacteria and the exposed body tissues. This therapy helps
prevent infection.
A nurse is teaching a client about how to use her new hearing aids. Which of the following statements should
the nurse identify as an indication that the client needs further instruction?
A. "I will clean the hearing aids with alcohol wipes."
B. "I will not use hairspray if I am wearing the hearing aids."
C. "I will change the batteries once a week."
D. "I will expect the hearing aids to whistle when I cup my hand over them. - Correct Answer :ANS: A. "I will
clean the hearing aids with alcohol wipes."
Rationale: Alcohol use can break down the mechanism of the hearing aids. The client should follow the
manufacturer's instructions, which usually include using a soft cloth to remove cerumen and other debris and
never immersing them in water.
P 3
, • NUR 445 EXAM 09/20/2026
A nurse is admitting a client who has a partial hearing loss. Which of the following is the priority action by the
nurse?
A. Speak using his usual tone of voice.
B. Stand directly in front of the client.
C. Rephrase statements the client does not hear.
D. Determine if the client uses hearing aids. - Correct Answer :ANS: D. Determine if the client uses hearing aids.
Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse
should find out if the client has hearing aids and whether they are in place and functioning.
A nurse is teaching a class of older adults about the expected physiologic changes of aging. Which of the
following changes should the nurse include in the discussion? (Select all that apply.)
A. More difficulty seeing due to a greater sensitivity to glare
B. Decreased cough reflex
C. Decreased bladder capacity
D. Decreased systolic blood pressure
E. Dehydration of intervertebral disc - Correct Answer :ANS: A, B, C, E
Rationale: Expected physiologic changes of aging include more difficulty seeing due to greater sensitivity to
glare, decreased cough reflex, decreased bladder capacity, dehydration of intervertebral disc.
A nurse is caring for a client who has urinary incontinence. Which of the following actions should the nurse
implement to prevent the development of skin breakdown?
A. Apply a moisture barrier ointment to the client's skin.
B. Clean the client's skin and perineum with hot water after each episode of incontinence.
C. Check the client's skin every 8 hr for signs of breakdown.
D. Request a prescription for the insertion of an indwelling urinary catheter. - Correct Answer :ANS: A. Apply a
moisture barrier ointment to the client's skin.
P 4
NUR 445 EXAM 2025 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+/ARIZONA COLLEGE
OF NURSING
A nurse is caring for a client who has full-thickness burns covering 63% of her body and smoke inhalation. Which
of the following nursing actions is the top priority?
A. Monitor intake and output.
B. Administer antibiotics.
P 1
, • NUR 445 EXAM 09/20/2026
C. Monitor respiratory status.
D. Encourage fluid and food intake. - Correct Answer :ANS: C. Monitor respiratory status.
Rationale: The priority action for the nurse when using the airway, breathing, and circulation (ABC) approach to
client care is to monitor the client's respiratory status closely. Smoke inhalation most likely includes a thermal
injury to the tracheobronchial tree. Edema from the inflammatory response to heat can obstruct the airway.
Endotracheal intubation may become necessary to maintain a patent airway. (pg. 464)
A nurse is assessing a client who sustained superficial partial-thickness and deep partial-thickness burns 72 hr
ago. Which of the following findings should the nurse report to the provider?
A. Edema in the burned extremities
B. Severe pain at the burn sites
C. Urine output of 30 mL/hr
D. Temperature of 39.1°C (102.4°F) - Correct Answer :ANS: D. Temperature of 39.1°C (102.4°F)
Rationale: An elevated temperature is an indication of infection, and the nurse should report this finding to the
provider. Sepsis is a critical finding following a major burn injury. Initially, burn wounds are relatively pathogen-
free. On approximately the third day following the injury, early colonization of the wound surface by gram-
negative organisms changes to predominantly gram-positive opportunistic organisms.
A nurse in an emergency department is assessing a client who has extensive burns, including on her face. Which
of the following assessments should the nurse perform first?
A. Estimation of burn injury
B. Characteristics of the cough and sputum
C. Extent of peripheral edema
D. Amount of urine output - Correct Answer :ANS: B. Characteristics of the cough and sputum
Rationale: The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of
human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and
circulating oxygen to the body's organs via the blood. An alteration in any of these areas can indicate a threat to
life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the
P 2
, • NUR 445 EXAM 09/20/2026
highest priority because the airway must be clear for oxygen exchange to occur. Breathing is the second-highest
priority because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the
third-highest priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels
are capable of efficiently carrying oxygen to them. Therefore, the nurse's priority assessment is the client's
cough characteristics. A client who has burns to the face is at risk for pulmonary injury, and the development of a
brassy cough can indicate an impending loss of airway.
A nurse is teaching a client who has extensive deep partial- and full-thickness burns and requires a topical
antimicrobial medication. The goal of this medication therapy is to reduce which of the following outcomes?
A. Bacterial growth
B. Scarring
C. Skin graft size
D. Pain - Correct Answer :ANS: A. Bacterial growth
Rationale: Topical antimicrobial medications (particularly broad-spectrum antimicrobials) help prevent bacteria
from entering the body when a client has an impairment of the protective covering of the skin, as with burns. It
and the dressing create a protective barrier between bacteria and the exposed body tissues. This therapy helps
prevent infection.
A nurse is teaching a client about how to use her new hearing aids. Which of the following statements should
the nurse identify as an indication that the client needs further instruction?
A. "I will clean the hearing aids with alcohol wipes."
B. "I will not use hairspray if I am wearing the hearing aids."
C. "I will change the batteries once a week."
D. "I will expect the hearing aids to whistle when I cup my hand over them. - Correct Answer :ANS: A. "I will
clean the hearing aids with alcohol wipes."
Rationale: Alcohol use can break down the mechanism of the hearing aids. The client should follow the
manufacturer's instructions, which usually include using a soft cloth to remove cerumen and other debris and
never immersing them in water.
P 3
, • NUR 445 EXAM 09/20/2026
A nurse is admitting a client who has a partial hearing loss. Which of the following is the priority action by the
nurse?
A. Speak using his usual tone of voice.
B. Stand directly in front of the client.
C. Rephrase statements the client does not hear.
D. Determine if the client uses hearing aids. - Correct Answer :ANS: D. Determine if the client uses hearing aids.
Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse
should find out if the client has hearing aids and whether they are in place and functioning.
A nurse is teaching a class of older adults about the expected physiologic changes of aging. Which of the
following changes should the nurse include in the discussion? (Select all that apply.)
A. More difficulty seeing due to a greater sensitivity to glare
B. Decreased cough reflex
C. Decreased bladder capacity
D. Decreased systolic blood pressure
E. Dehydration of intervertebral disc - Correct Answer :ANS: A, B, C, E
Rationale: Expected physiologic changes of aging include more difficulty seeing due to greater sensitivity to
glare, decreased cough reflex, decreased bladder capacity, dehydration of intervertebral disc.
A nurse is caring for a client who has urinary incontinence. Which of the following actions should the nurse
implement to prevent the development of skin breakdown?
A. Apply a moisture barrier ointment to the client's skin.
B. Clean the client's skin and perineum with hot water after each episode of incontinence.
C. Check the client's skin every 8 hr for signs of breakdown.
D. Request a prescription for the insertion of an indwelling urinary catheter. - Correct Answer :ANS: A. Apply a
moisture barrier ointment to the client's skin.
P 4
