Download NUR 242 Exam 1 Questions and Answers: Nursing Fundamentals and more Quizzes Nursing in PDF only on Docsity!
NUR 242 EXAM 1 QUESTIONS WITH 100% CORRECT
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"An 85 year old woman is admitted to the hospital. When doing the initial assessment, what are some
factors that you know put her at risk for pressure injuries? - CORRECT ANSWER=> -if the pt is immobile
-if the pt is incontinent -if the pt has comorbidities such as diabetes or PVD -if the pt is malnourished or dehydrated -if the pt suffers from decreased sensory perception" "The nurse notices a localized red area that is nonblanchable on the the patient's coccyx. What stage
pressure injury is this recognized as? - CORRECT ANSWER=> Stage 1
Stage 1 pressure injury means the skin is intact with a localized area of nonblanchable erythema (fancy word for redness)."
"Why is it important for a pt to ambulate and wear SCDs or TED stockings after a procedure? - CORRECT
ANSWER=> To reduce the risk of DVT"
"A pt's health history states that they are on corticosteroids. The PACU nurse that this increases the risk
of what? - CORRECT ANSWER=> wound dehiscence"
"After a procedure, what should the nurse assess immediately? - CORRECT ANSWER=> ABC's
Make sure airway is clear, note respiration depth, listen to lung sounds" "After a procedure, a pt's vitals signs are the following: BP: 90/ RR: 26 HR: 110 O2: 88% What is this a potential sign of? A.Infection B. Heavy blood loss
C. These vitals are to be expected after a procedure - CORRECT ANSWER=> B"
"Normal RBC Lab Values - CORRECT ANSWER=> Women: 4.2 to 5.4 million/uL
Men: 4.7 to 6.1 million/uL Children: 4.6 to 4.8 million/uL"
"A pt presents with muscle weakness, trouble walking, and a beefy red tongue. Based on these
symptoms, what might we conclude the patient will be diagnosed with? - CORRECT ANSWER=> B-
Deficiency" "A pt asks you why what he eats has anything to do with wound healing. What is your response? -
CORRECT ANSWER=> Successful healing of pressure injuries depends on adequate intake of calories
protein, vitamins, minerals and water." "After receiving shift report, the night nurse looks at the lab values for a patient with cellulitis. What
abnormal lab values might you see? - CORRECT ANSWER=> -WBC - elevated
-Creatinine- elevated -Bicarbonate- low -Albumin- low -Calcium- low"
"What pain rating scale might you use for a child or a nonverbal patient? - CORRECT ANSWER=> Wong
Baker-Faces Scale" "When assessing a pt's pain. He tells you that the pain comes and goes. What part of the pain assessment is he describing? A. Quality B. Intensity C. Onset and Duration
D. Location - CORRECT ANSWER=> C. Onset and Duration"
"When explaining to a pt what an intraspinal analgesic the pt states "So the medication will be given to
me through the IV in my arm." How would you correct him? - CORRECT ANSWER=> instraspinal
analgesics are delivered into the epidural space of the spine, also known as the subarachnoid space." "When adjusting a TENs machine on a patient, how do you know the conduction of electricity has
reached a therapeutic level? - CORRECT ANSWER=> The patient will verbalize feeling a sensation of
pins and needles." "Your pt verbalizes a pain of 2/10 and requests their dose of morphine. How would you educate your pt?
- CORRECT ANSWER=> Morphine is an opioid analgesic used for moderate to severe pain."
"What is the most common side effect of analgesic use and how can we prevent it? - CORRECT
ANSWER=> Constipation.
A high fiber diet, plenty of fluids, and stool softeners are prophylactic measures."
A. Standard B. Droplet C. Airborne
- __ MRSA. 5. __ Measles
- __ TB 6. __ Varicella
- __ Influenza 7. __ Pneumonia
4. __ Pediculosis 8 .__ Meningitis - CORRECT ANSWER=> A, C, B, A, C, C, B, B"
"A pt is receiving a blood transfusion and breaks out in hives. What is the nurses first step? - CORRECT
ANSWER=> Immediately stop the the transfusion and start normal saline"
"How often should the nurse monitor patient's vital signs when they are receive a blood transfusion? -
CORRECT ANSWER=> Vital sings must be checked after 15 minutes, 30 minutes, and one hour followed
by every hour after." “Patricia is an RN working at a rehabilitation center and witnesses a nurse aid struggling to lift and reposition an elderly, bed ridden patient. She explains to the nurse aide that there is a No Lift Policy in
place in the establishment. What does this policy entail? - CORRECT ANSWER=> The concept of a no-lift
policy is a pledge from administrators that proper equipment, adequately maintained and in sufficient numbers, will be available to care providers to reduce the risks associated with manual patient handling" "Immobility effects multiple body systems. What are some interventions that you can implement to decrease these effects? Select all that apply. A. Utilizing waffle mattress to reduce the need for repositioning B. Teds/SCDs C. Rubbing reddened areas D. Limiting fluid intake
E. ROM exercises - CORRECT ANSWER=> Answer: B and E
Rational: -A is incorrect because regardless of implemented mattress, positioning should be every 2 hours -C is incorrect. You should not rub at reddened areas. This increases the risk for skin break. -D is incorrect. You should encourage proper hydration to promote well hydrated and healthy skin."
"True or False: Nurses should do skin assessments once a week. - CORRECT ANSWER=> False
Rational: Nurses should do full skin assessments a minimum of once per shift." "A pt goes to the ER for swelling and pain in her right calf. The PT states that it occurred after she accidentally cut herself. Based on her symptoms, what skin condition might the nurse suspect the patient
has? - CORRECT ANSWER=> Cellulitis.
Cellulitis is inflammation of the skin and sub tissue." "Pt A is admitted from a nursing home with a stage 3 pressure ulcer. When creating his plan of care, who
else would be involved besides the primary care physician? - CORRECT ANSWER=> Wound care nurse,
Dietician, Physical therapist. OT can also be included, however they deal more with fine motor skills."
