Comprehensive - Predictor review

Comprehensive - Predictor review 1. A nurse is assessing a client who has left-sided heart failure. Which of the following symptoms should the nurse identify as the highest priority? Jugular distention Frothy pink sputum Hepatomegaly Weight gain 2. A nurse in the emergency department is assisting with the suturing of a laceration to the client’s face. Which of the following actions should the nurse take? Pour the sterile cleansing solution holding the bottle 10 cm (4 in.) above the sterile field Pull the top flap of the suture tray towards the body when opening. Place the bottle of local anesthetic 5 cm (2 in) inside the sterile field border. Drop the suture package on to the sterile field from a distance of 30 cm (12 in). 3. A nurse is assessing a client 1 hr following delivery and notes that her uterus is boggy and….to the umbilicus. Which of the following actions should the nurse take first? Massage the fundus. Assess lochia Take vital signs Give oxytocin (Pitocin) IV bolus. 4. (missing) 5.. A nurse is caring for a client who is 1 day postoperative following a hypophysectomy for removal of a pituitary tumor. Which of the following findings requires further assessment by the nurse? Urinary output greater than fluid intake Report of dry mouth Glasgow Coma Scale score of 15 Bloody drainage on the nasal dressing measuring 3 cm 6. A nurse in an emergency department is caring for a client who has multiple wounds due to a crash. Which of the following interventions are appropriate? (Select all that apply). Apply direct pressure to bleeding wounds. Clean lacerations and abrasions with hydrogen peroxide. Administer 650 mg aspirin PO as needed for pain. Cover wounds with a sterile dressing Determine date of last tetanus toxoid vaccination. 7. A nurse is planning care for four clients. Which of the following clients is the highest priority?