RNUR 126 Exam #4 PrepU Questions

A nurse has administered 1 unit of glucose to the client as per order. What is the correct documentation of this information? A. 1U of glucose B. One U of glucose C. 1 bottle of glucose D. 1 Unit of glucose

D. 1 Unit of glucose

What type of dressing is occlusive or semi-occlusive, limits exchange of oxygen between wound and environment, provides minimal to moderate absorption of drainage, maintains a moist wound environment, and may be left in place for three to seven days, thus resulting in less interference with healing? A. hydrogel B. alginate C. hydrocolloid D. transparent film

C. hydrocolloid

A nurse is documenting care for an older adult client who is recovering from a mild stroke. Which documentation entry(ies) follows the recommended guidelines for communicating and documenting client information? Select all that apply. -The client appears anxious about having another stroke. -The client drank an average amount of fluids. -The client seems comfortable today. -The client rates pain as 2 compared to a 7 yesterday. -Radial pulse 72 beats/min, strong and regular. -Vital signs returned to normal.

-The client rates pain as 2 compared to a 7 yesterday -Radial pulse 72 beats/min, strong and regular.

The nurse is teaching a client who is preparing for a left mastectomy due to breast cancer. Which teaching about a Jackson-Pratt drain will the nurse include? A. "It provides a way to remove drainage and blood from the surgical wound." B. "The bulb-like system will stay in place permanently after your mastectomy." C. "You will receive medication through this device." D. "Drainage will occur by gravity and capillary action."

A. "It provides a way to remove drainage and blood from the surgical wound."

Which abbreviation is correct for use in documentation? A. BT B. Per os C. Sub q D. PO

D. PO

The nurse is caring for a client who requests to see a copy of the client's own health care records. What action by the nurse is most appropriate? A. Access the health care record at the bedside and show the client how to navigate the electronic health record. B. Discuss how the hospital can be fined for allowing clients to view their health care records. C. Explain that only a paper copy of the health care record can be viewed by the client. D. Review the hospital's process for allowing clients to view their health care records.

D. Review the hospital's process for allowing clients to view their health care records.

The nurse is preparing to measure the depth of a client's tunneled wound. Which implement should the nurse use to measure the depth accurately? A. an otic curette B. a small plastic ruler C. a sterile tongue blade lubricated with water soluble gel D. a sterile, flexible applicator moistened with saline

D. a sterile, flexible applicator moistened with saline

A pediatric nurse is familiar with specific characteristics of skin across the life span. Which statement accurately describes skin characteristics? A. An infant's skin and mucous membranes are easily injured and at risk for infection. B. An individual's skin changes little over the life span. C. In children younger than 2 years, the skin is thicker and stronger than in adults. D. A child's skin becomes less resistant to injury and infection as the child grows.

A. An infant's skin and mucous membranes are easily injured and at risk for infection.

A nurse is preparing to document client care in the electronic medical record using the SOAP format. The client had abdominal surgery 2 days ago. How would the nurse document the "S" information? A. Client states, "I have more pain in my belly today than I did yesterday. My pain is about a 7 out of 10." B. Client states expecting some pain, but it is more severe than anticipated. C. Abdomen soft, slightly tender on palpation. Incision clean, dry and intact. Positive bowel sounds all four quadrants. D. Client is requesting pain medications, is grimacing, and is diaphoretic.

A. Client states, "I have more pain in my belly today than I did yesterday. My pain is about a 7 out of 10."

Besides being an instrument of continuous client care, the client's health care record also serves as a(an): A. legal document. B. Kardex. C. incident report. D. assessment tool.

A. legal document.

A child is brought to the clinic by a parent. The parent states that the child has been at camp. The child has a rash on the face, arms, and legs. The child states it itches severely. How will the nurse describe the assessment findings? A. Superficial abscess accompanied by pruritus B. Diffuse dermatitis accompanied by pruritus C. Diffuse fungal infection accompanied by pruritus D. Superficial contusion accompanied by pruritus

B. Diffuse dermatitis accompanied by pruritus

The nurse is teaching a client about healing of a minor surgical wound by first intention. What teaching will the nurse include? A. "The surgeon will leave your wound open intentionally for a period of time." B. "The margins of your wound are not in direct contact." C. "Very little scar tissue will form." D. "This is a complex reparative process."

C. "Very little scar tissue will form."

The nursing student is reading the plan of care established by the RN in the clinical facility. The students ask the nursing instructor why rationales are not written on the hospital care plan. The nursing instructor states: A. Rationales are only important while the nurse is in training. B. Some facilities do not require them on their plans of care. C. Although not written, the nurse must know or question the rationale before performing an action. D. The rationale is deleted to provide additional charting space in the computer system. E. The use of rationales is not commonly practiced in the clinical setting.

C. Although not written, the nurse must know or question the rationale before performing an action.