DETAILED ANSWERS WELL VERIFIED .GRADED
A+
A pt with multiple injuries is being treated in the burn trauma unit just
hours after the injuries occurred. The healthcare provider instructs the
nurse to avoid auto contamination when performing dressing changes.
Which intervention is most important for the nurse to implement? -
ANSWER -use gown, mask, and gloves with dressing changes
A pt is recovering in the critical care unit following a cardiac cath. IV
nitro and heparin are infusing. The pt is sedated but responds to
instructions. After changing positions, the pt complains of pain at the
,right groin insertion site. What action should the nurse implement? -
ANSWER -Stimulate the pt to take deep breaths
Prior to obtaining a trapeze bar for a pt with limited mobility, which pt
assessment is most important for the nurse to obtain? - ANSWER -
upper body muscle strength
While the nurse is assessing an older pt fall risk, the pt reports living at
home alone and never falling. Which action should the nurse take? -
ANSWER -Continue to obtain pt data needed to complete the fall risk
survey
The nurse is feeding an older adult who was admitted with aspiration
pneumonia. The pt is weak and begins coughing while attempting to
drink through a straw. Which intervention should the nurse implement?
- ANSWER -Teach coughing and deep breathing exercises
The nurse is teaching the pt about home care after surgery for an ileal
conduit placement. When reviewing the information, which statement
should the nurse recognize as needing additional education? - ANSWER
-Empty the pouch when it is half full.
, A 12 week gestation is admitted to the antepartum unit with a dx of
hyperemesis gravidarum. Which action is most important for the nurse
to implement? - ANSWER -initiate prescribed IV fluids
A pt with dyspnea is being admitted to the medical unit. To best prepare
for the pt arrival, the nurse should ensure that the pt bed is in which
position? - ANSWER -Picture with the bed sitting up
A pt who is scheduled for a bronchoscopy in the morning is anxious and
asking the nurse numerous questions about the procedure. In preparing
the pt for the procedure, which intervention has the highest priority? -
ANSWER -Instruct pt to write down questions
While caring for a pt post operative dressing, the nurse observes
purulent drainage at the wound. Before reporting this finding to the
provider, the nurse should review which of the pt lab values? -
ANSWER -culture for sensitive organisms
A pt with a lower respiratory tract infection receives a prescription for
ciprofloxacin 500mg PO every 12hrs. When the client requests an
afternoon snack, which dietary choice should the nurse provide? -
ANSWER -Cinnamon apple sauce