nursing-3165-predictor-version

1. The nurse cares for a client diagnosed with superficial partial thickness burn. The nurse should assign the client to a room with which client? A. A client diagnosed with Cushing’s Syndrome. B. A client Diagnosed with cellulitis of the left leg. C. A Client diagnosed with acute peritonsillar abscess. D. A client diagnosed with acute pelvic inflammatory disease. Answer: A 2. The nurse observes client care on a geriatric unit. The nurse should intervene in which situation? a. A student nurse assist the client out of bed toward the clients strong side. b. A student nurse assist the client to sit on the side of the bed by lifting the client’s shoulders and swinging the client’s legs over the edge of the bed. c. A student nurse assists the client to stand from a sitting position by grasping the client’s elbows. d. Two student nurses use a draw sheet to turn a client in the bed. Answer: C 3. The nurse evaluates the results of the client’s purified protein derivative (PPD) 2 ½ days after the injection. The nurse noted the induration is 4 mm. which action by the nurse is most appropriate? a. Inform the client the results are negative b. Obtain the names of the client’s closest contacts. c. Determine the HIV status of the client. d. Wait and additional 24 hours to read the results. Answer: A 4. The nurse cores for the client with a history of schizophrenia. The nurse expects to note which speech pattern? a. Repetition of the words used by the nurse. b. Rapid, coherent conversation about unrelated topics. c. Immediately answering questions appropriately. d. Slow, purposeful answers to the nurses questions. Answer: A 5. The nurse cares for a 6-month-old infant. The parents report that the infant had severe diarrhea for twelve hours. The nurse anticipates which finding? a. Normal skin elasticity. b. Depresses anterior fontanel. c. Pale yellow urine. d. Absent bowel sounds. Answer: B 6. The nurse cares for a client receiving hydrocodone every 6 hours prn for pain. The client reports pain at 1600. The nurse notes that the hydrocodone was last administered at 1200, and the nurse proceeds to administer hydromorphone at 1615. After discovering the error, how should the nurse record the occurrence? a. “Wrong pain tablet given early. Client will be monitored closely. Asleep now.” b. “Hydromorphone given instead of hydrocodone. Nursing supervisor aware of error.” c. Hydrocodone tablet ordered every 6 hours; pain medication given after 4 hours. Health care provider notified.” d. “Hydromorphone given at 1615; health care provider notified. B/P 122/80, RR 16.” Answer: D