eaqs

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The registered nurse (RN) is caring for a client who is on isolation precautions. Which task can be safely assigned to the nursing assistive personnel? Select all that apply. One, some or all responses may be correct.

Bringing equipment and transporting

Which manifestation indicates tertiary syphilis ?

Gummas

A client shows an increase in respiratory rate that is abnormally deep and regular. Which condition would the nurse expect ?

Kussmauls - deep regular breathing

When a client expresses anxiety about an upcoming surgical procedure, which action wo the nurse take first to help decrease anxiety?

Take vitals and ask about anxiety

Which term describes the practice of placing clients with the same infection in a semi private room ?

Cohorting

Stridor

A stained high pitched sound (wheeze like) generated from partially obstructed air flow in the upper airway.

Which action would the nurse take for a client whose right radial pulse is weak and thready? Select all that apply. One, some, or all responses may be correct.

ALL answers

The spouse of a client with pulmonary tuberculosis (TB) received a tuberculin skin test. nurse examined the skin test and identified an area of induration greater than 10 mm. Which response to this finding would the nurse implement?

Additional tests are necessary to determine infection status

Which product would the nurse instruct intravenous drug users rs(1DUs) to use for cleaning of needles and syringes between uses?

Bleach

Which sexually transmitted infection (STI) is most commonly reported?

Chlamydia

The nurse is changing the soiled bed linens of a client with a wound that is draining seropurulent exudate. Which personal protective equipment (PPE) would the nurse wear?

Clean gloves

Wheezing

High pitched sound heard in the lungs from narrowing

Which sexually transmitted infection causes condylomata acuminate?

Human papillomavirus (HPV)

Which antibody forms first, after exposure to an antigen?

IgM

The nurse is preparing to change a client's dressing. For which reason would the nurse use surgical asepsis?

Keeps area free of organisms

Which action would the nurse take to decrease the risk of transmission of vancomycin resistant enterococci (VRE)?

Move the client to a private room

Abduction

Movement away from the midline of the body

Adduction

Movement toward the midline of the body

A 50-year-old client is diagnosed with chronic obstructive pulmonary disease (COPD) . The clinical data on admission are as follows : a heart rate of 100 10beats / m * in , a blood pressure of 138/82 * mmHs , a respiratory rate of 32 2breaths / m * in , a tympanic temperature 98.2 0.2 degrees * F; (36.8 degrees * C) and an oxygen saturation of 80%. Which vital signs obtained by the nurse indicates a positive outcome? Select all that apply. One, some, or all responses may be

RR, BP, Oxy

Which should the nurse include when teaching a client with Clostridium difficile about decreasing the risk of transmission to family members?

Soap and water for hand washing

extension

Straightening of a joint

Why are the faucet handles on the sink in a client's room considered contaminated?

They are touched by dirty hands when turning water on

Which reaction is an example of a type hypersensitivity reaction?

anaphylaxis

Flexion

bending a joint

rotation

circular movement around an axis such as the shoulder joint

While caring for four different clients, the nurse assesses their breathing pattern. Which client's assessment findings indicate Cheyne-Stokes respiration?

client 3

Kussamaul Breathing

deep and rapid respirations

What is the significance of the procedure in the figure (ULNAR PULSE)

evaluating arterial insufficiency

rales (crackles)

fine crackling sounds heard on auscultation (inhalation) when there is fluid in the alveoli

PPE removal

gloves, goggles, gown, mask

The nurse is providing colostomy care to a client with methicillin-resistant Staphylococcus aureus (MRSA) infection. Which personal protective equipment (PPE) would the nurse use Select all that apply. One , some, or all responses may be correct .

gloves. gown. goggles

PPE on

gown, mask, goggles, gloves

Abdomen Assessment

inspection, auscultation, percussion, palpation

Body assessment

inspection, palpation, percussion and auscultation

Biot breathing

irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken

Rhonci

loud rumbling sounds (snoring) heard on auscultation of bronchi obstructed by sputum

circumduction movement

moving a part so that its end follows a circular path (moving the finger in a circular motion without moving the hand)

The nurse is obtaining a health history from the newly admitted client who has chronic pain in the right knee. Which would the nurse include in the pain assessment? Select all that apply. One, some, or all responses may be correct .

pain history & pain pattern

5 P's of neurovascular assessment

pain, pallor, pulselessness, paresthesia, paralysis

Cheyene-Stokes breathing

quick and deep respirations followed by a period of apnea

Which action should the nurse take to maintain sterility when performing a dressing change?

remove sterile drape from package by lifting corners

Which definition is correct to explain the nursing process?

sequence of steps used to meet the clients needs

Which stage of the human immunodeficiency virus (HIV) would a client with a CD4+T count of 325cells / m * m ^ 3 be classified?

stage 2

The registered nurse (RN) is teaching the student nurse about various sites for assessing body temperature. Which statement(s) made by the student nurse is/are correct? Select al that apply. One, some , or all responses may be correct.

the axilla, the tympanic membrane, the temporal artery

normal lung sounds

tracheal(bronchial) , bronchovesicular, vesicular

Romberg test

used to ear function and balance


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