final exam pn 1006 UPDATED ACTUAL Questions and CORRECT Answers
The nurse is caring for a patient with a small chronic reposition the patient at least eveey 2 hours
pressure ulcer on the ankle what can be assigned to the
health care assistant
which of the following patients would be at most risk to an elderly patient with mobility issues
develop a pressure ulcer?
an elderly patient with mobility issues , a diabetic patient
with properly controlled blood sugars, a patient
receiving physiotherapy following knee replacement,
middle aged woman with lupus who is having back
surgery but is ambulatory
what assessment data would a nurse see to support the full thickness skin loss from the surface down to the fascia
ID of a stage 3 pressure ulcer
The nurse is caring for four patients at risk for impaired malnourished homeless patient with nasogastric tube who is bedridden
skin integrity which patient need most frequent
assessment and possible intervention?
a malnourished, homeless patient with nasogastric tube
who is bed ridden, a college football player with bilateral
long leg casts after motorcycle accident, an elderly
female ambulating after hip replacement surgery, a
school age child recovering from a tonsillectomy and
adenoidectomy
an older adult who lives alone takes three different white place a piece of different coloured tape on each pill bottle to differentiate the
flat unscored medication every day. He has trouble medication
remembering if he has taken the correct pill at the
correct time. What Strategy would be best help this
patient maintain independence and safety in taking his
medications?
place a piece of different colored tape on each pill
bottle to differentiate the medication, take th medications
out of the bottles and place them in a pill holder, have a
neighbor give the patient his pills once a day , ask the
patient how he wants to identify the medications
which schedule would the nurse select to achieve a 8 am, 2pm, 8pm, and 2am
therapeutic level if the medication if the medication is
prescribed for administration 4 times a day?
8am, 10 am , 2pm, 8pm; 10am,2pm, 6pm, 8pm;10 am,noon,
4pm, 6pm; 8am 2pm 8pm and 2am
the nurse is having difficulty reading a medication order clarify the order with the physician who wrote it.
what action should they take
a prescription reads " aspirin 325 mg 2 tablets orally for clarify the administration frequency whether the medication should be PRN or
pain " what action should the nurse take when the patient standing
has pain ?
, The nurse needs to document a PRN medication that has record the time administered and the nurses name immediately after
just been administered what technique does the nurse administration
use
The nurse needs to administer a rectal suppository to a informing the nurse of the BM
patient to treat constipation which action may the nurse
assign to the health care assistant ?
confirming the medication on the medication
administration record, notifying the patients physician of
the suppository results, documenting the admin of a
suppository after insertion, informing the nurse of the BM
the nurse prepares a medication for a patient 1 hour after the allergy history
admission. What information about the patient is the
nurses priority assessment before the initial administration
of medication?
the diet history, any drug tolerance, any allergy history ,
the surgical history
The nurse teaches the patient progressive self relaxation establish the patients ability to participate and cooperate
techniques. Which should the nurse implement first?
direct the patient to envision sailing on a sailboat, instruct
the patient to increase respiratory rate and depth,
establish the patients ability to participate and cooperate,
darken the patients room significantly and close the door
the nurse massages the patient to promote relaxation. assess for pain anxiety and discomfort
Which is suitable intervention for the patient to
implement during the massage?
use the friction technique over the spine, assess for pain,
anxiety and discomfort, instruct the patient to sit upright
and forward , knead the patients scalp with warm lotion
a patient is receiving as much opioid analgesia as the encourage controlled breathing
prescription allows and continues to have difficulty
sleeping at night because of pain. Which should the nurse
implement to relieve pain and improve sleep? encourage
controlled breathing, provide a glass of wine at bedtime,
administer more analgesia and inform the physician in the
morning, increase fluids and reposition the patient
the patient complains of a slight burning- like pain and remove the compress and assess the affected area
numbness on the skin under a cold compress. Which
action should the nurse take immediately? reassure the
patient that some numbness is expected, assess the
entire patient before continuing the treatment, remove
the compress and assess the affected area, provide a
warm blanket for the patients treatment
A braden scale of 8 would indicate the patient is at low False
risk for skin breakdown: True or False
The nurse is caring for a patient with a small chronic reposition the patient at least eveey 2 hours
pressure ulcer on the ankle what can be assigned to the
health care assistant
which of the following patients would be at most risk to an elderly patient with mobility issues
develop a pressure ulcer?
an elderly patient with mobility issues , a diabetic patient
with properly controlled blood sugars, a patient
receiving physiotherapy following knee replacement,
middle aged woman with lupus who is having back
surgery but is ambulatory
what assessment data would a nurse see to support the full thickness skin loss from the surface down to the fascia
ID of a stage 3 pressure ulcer
The nurse is caring for four patients at risk for impaired malnourished homeless patient with nasogastric tube who is bedridden
skin integrity which patient need most frequent
assessment and possible intervention?
a malnourished, homeless patient with nasogastric tube
who is bed ridden, a college football player with bilateral
long leg casts after motorcycle accident, an elderly
female ambulating after hip replacement surgery, a
school age child recovering from a tonsillectomy and
adenoidectomy
an older adult who lives alone takes three different white place a piece of different coloured tape on each pill bottle to differentiate the
flat unscored medication every day. He has trouble medication
remembering if he has taken the correct pill at the
correct time. What Strategy would be best help this
patient maintain independence and safety in taking his
medications?
place a piece of different colored tape on each pill
bottle to differentiate the medication, take th medications
out of the bottles and place them in a pill holder, have a
neighbor give the patient his pills once a day , ask the
patient how he wants to identify the medications
which schedule would the nurse select to achieve a 8 am, 2pm, 8pm, and 2am
therapeutic level if the medication if the medication is
prescribed for administration 4 times a day?
8am, 10 am , 2pm, 8pm; 10am,2pm, 6pm, 8pm;10 am,noon,
4pm, 6pm; 8am 2pm 8pm and 2am
the nurse is having difficulty reading a medication order clarify the order with the physician who wrote it.
what action should they take
a prescription reads " aspirin 325 mg 2 tablets orally for clarify the administration frequency whether the medication should be PRN or
pain " what action should the nurse take when the patient standing
has pain ?
, The nurse needs to document a PRN medication that has record the time administered and the nurses name immediately after
just been administered what technique does the nurse administration
use
The nurse needs to administer a rectal suppository to a informing the nurse of the BM
patient to treat constipation which action may the nurse
assign to the health care assistant ?
confirming the medication on the medication
administration record, notifying the patients physician of
the suppository results, documenting the admin of a
suppository after insertion, informing the nurse of the BM
the nurse prepares a medication for a patient 1 hour after the allergy history
admission. What information about the patient is the
nurses priority assessment before the initial administration
of medication?
the diet history, any drug tolerance, any allergy history ,
the surgical history
The nurse teaches the patient progressive self relaxation establish the patients ability to participate and cooperate
techniques. Which should the nurse implement first?
direct the patient to envision sailing on a sailboat, instruct
the patient to increase respiratory rate and depth,
establish the patients ability to participate and cooperate,
darken the patients room significantly and close the door
the nurse massages the patient to promote relaxation. assess for pain anxiety and discomfort
Which is suitable intervention for the patient to
implement during the massage?
use the friction technique over the spine, assess for pain,
anxiety and discomfort, instruct the patient to sit upright
and forward , knead the patients scalp with warm lotion
a patient is receiving as much opioid analgesia as the encourage controlled breathing
prescription allows and continues to have difficulty
sleeping at night because of pain. Which should the nurse
implement to relieve pain and improve sleep? encourage
controlled breathing, provide a glass of wine at bedtime,
administer more analgesia and inform the physician in the
morning, increase fluids and reposition the patient
the patient complains of a slight burning- like pain and remove the compress and assess the affected area
numbness on the skin under a cold compress. Which
action should the nurse take immediately? reassure the
patient that some numbness is expected, assess the
entire patient before continuing the treatment, remove
the compress and assess the affected area, provide a
warm blanket for the patients treatment
A braden scale of 8 would indicate the patient is at low False
risk for skin breakdown: True or False
