COMPLETE QUESTIONS WITH
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1. Which of the following is an unexpected value that the nurse, in reviewing
the results of the client's blood work, should report to the physician?
Select one:
a. Calcium, 1.9 mmol/L
b. Sodium, 140 mmol/L
c. Potassium, 3.5 mmol/L
d. Magnesium, 1.8 mmol/L - ANSWER ✓ Calcium, 1.9 mmol/L
2. When a client's serum sodium level is 120 mmol/L, the priority nursing
assessment is to monitor the status of which of the following body systems?
Select one:
a. Neurological
b. Gastrointestinal
c. Pulmonary
d. Hepatic - ANSWER ✓ Neurological
3. Correct pattern of lochia:
a. Lochia rubra; dark red; 3-4 days
b. Lochia serosa; dark red; 4-10 days
c. Lochia alba; whitish yellow; 3-4 days
, d. Lochia mucosa; brown; 5-10 days - ANSWER ✓ Lochia rubra; dark
red; 3-4 days
4. Correct pattern of lochia progression:
a. Alba, Serosa, Rubra
b. Serosa, Rubra, Alba
c. Rubra, Serosa, Alba
d. Rubra, Alba, Serosa - ANSWER ✓ Rubra, Serosa, Alba
5. What might you find postpartum with bladder distention?
a. Constipation
b. Boggy uterus deviated to the right
c. Poor bladder tone
d. Uterine atony and constipation - ANSWER ✓ Boggy uterus deviated
to the right
6. True or False: Bladder distention is a potential cause of postpartum
hemorrhage - ANSWER ✓ True
7. The most common communicable diseases impact which body system?
a. cardiovascular and integumentary
b. digestive and integumentary
c. endocrine and integumentary
d. respiratory and integumentary - ANSWER ✓ respiratory and
integumentary
8. The nurse is assessing a pediatric client with acute myeloid leukemia. Which
assessment data supports this diagnosis?
a. fever and infections
b. nausea and vomiting
c. excessive energy and high platelet count
d. cervical lymph node enlargement and positive acid-fast bacillus -
ANSWER ✓ fever and infections
,9. What assessment questions need to be asked to a child with possible
rheumatic fever?
a. Any sore throat or unexplained fever in last 2 months?
b. Any nausea or vomiting?
c. Any complaints of headaches?
d. Any complaints of back pain? - ANSWER ✓ Any sore throat or
unexplained fever in last 2 months?
10.Child who is post-op from an abdominal surgery has an elevated heart and
respiratory rate. What assessments might the nurse make?
a. Child is playing too hard
b. Child is having a temper tantrum
c. Child is tired
d. Child is having pain - ANSWER ✓ Child is having pain
11.Child assessment orders determine whether the child
a. is suffering/ likely to suffer significant harm
b. can be taken into immediate local authority care - ANSWER ✓ is
suffering/ likely to suffer significant harm
12.5 Factors that affect wound healing - ANSWER ✓ age, poor circulation,
poor nutrition, type of tissue affected, rest
13.4 Phases of wound healing - ANSWER ✓ phase 1: homeostsis/bleeding
stops, phase 2 inflammation, phase 3: proliferation/granulation, phase 4:
remodeling/maturation
14.Types of dressings - ANSWER ✓ non adherent(silicone), hydrogel,
hydrocolloid, alginate, foams hydrofibre, antimicrobial, charcoal
15.Non adherent silicone - ANSWER ✓ removal without causing damage to
wound, requires a cover
16.Hydrogel - ANSWER ✓ water in polymer; used in dry wounds to hydrate;
soothing; does not adhere; not to be used on draining or infected wounds
, 17.Hydrocolloid - ANSWER ✓ pectin base; forms a gel as fluid is absorbed;
absorbs min-moderate exudate; q5-7 days
18.Calcium alginate - ANSWER ✓ highly absorbent; use for high drainage
wounds
19.Foam dressings - ANSWER ✓ absorbs moderate-lrg exudate; q7 days;
adhesive or non-adhesive
20.Hydrofibre - ANSWER ✓ similar to alginate but more absorbent
21.Honey - ANSWER ✓ antimicrobial properties
22.When to flush a saline lock - ANSWER ✓ 1)before and after fluids/meds 2)
q12 hrs
23.Steps to flushing a saline lock - ANSWER ✓ hand hygiene, assess site, clean
ppc with alcohol 15 sec, NS 3 - 5mls turbulent flush, remove syringe, clamp
tubing
24.Phlebitis - ANSWER ✓ complication of IV therapy; inflammation of vein;
increased skin temp
25.Irrigating simple wound steps - ANSWER ✓ -check order
-hand hygiene
-gloves
-patient id and consent
-supplies: wound kit, 60ml syringe, tip, sterile gloves, pad, tape, culture
swab?, saline, measuring tape, gauze/dressing
-set up area
-assess and measure wound
-fill syringe as ordered
-wash hands, sterile gloves
-irrigate clean to dirty
-dry
-swab?
-dress