Questions & answers
infection?
A streptococcal microorganism
coli
albicans
, B
A
A
During the initial assessment of a burn victim, the nurse must look for evidence of
inhalation injury. Once oxygen saturation and respirations are determined, pain
intensity is evaluated. The assessment of damage to the tissues and prevention of
infection are secondary to airway issues.
D
Don't know?
2 of 222
Term
The nurse is caring for an older adult client who has been admitted to
the unit with anemia. What would the nurse expect the client to
possibly exhibit?
A. Excessive consumption of coffee or tea
B. Elimination of iron by the body
C. Decrease in the total body iron stores with age
D. Blood loss from the gastrointestinal or genitourinary tract
, D
If an older adult is anemic, blood loss from the gastrointestinal or
genitourinary tract is suspected. This is because iron-deficiency anemia is
unusual in older adults as the body does not eliminate excessive iron, causing
total body iron stores to increase with age. Excessive consumption of coffee
or tea is not a causative factor for anemia in older adults.
D
Normally, total bilirubin concentration ranges from 0.2 to 1.3 mg/dL. If the serum
bilirubin level exceeds 2.5 mg/dL, jaundice is visible, notably on the skin, oral
mucous membranes, and, especially, sclera.
D
Clients may complain of sharp, stabbing discomfort that resembles a myocardial
infarction; however, sitting up relieves the pain
A
Upon receiving the client in the PACU, the client is drowsy and not fully conscious. A
standard of care to prevent aspiration is to place the client lying on either side with
an emesis basin to catch drainage. Laying the client is a supine position, semi-
Fowler's position, or high-Fowler's position does not provide an easy exit for
secretions as the client is recovering from the anesthesia.
Don't know?
3 of 222
Term
The nurse receives a client following a serious thermal burn. Which
complication will the nurse take action to prevent first?
, A. Tissue hypoxia
B. Infection
C. Renal failure
D. Hypovolemia
B
Sickle cell disease is a common genetic disorder found primarily in clients of African
descent but also in people from Mediterranean and Middle Eastern countries. It is
unlikely that a Caucasian male, Native American/First Nations female, or eastern
European female will be affected by this disease.
D
D
Pacemaker insertion is the treatment for complete heart block. Treatments for
supraventricular tachycardia are: Valsalva maneuver, unilateral carotid massage,
immersion of face in ice water, administration of IV adenosine, cardioversion, and
radiofrequency ablation. Cardioversion and drug therapy are used for the treatment
of atrial flutter. Treatment for ventricular fibrillation is defibrillation preceded by or
followed with epinephrine.
D
After a burn, fluid from the body moves toward the burned area, which leads
to intravascular fluid deficit. Steps must be taken to prevent irreversible
hypovolemic shock in the initial stages of treatment.
Don't know?
infection?
A streptococcal microorganism
coli
albicans
, B
A
A
During the initial assessment of a burn victim, the nurse must look for evidence of
inhalation injury. Once oxygen saturation and respirations are determined, pain
intensity is evaluated. The assessment of damage to the tissues and prevention of
infection are secondary to airway issues.
D
Don't know?
2 of 222
Term
The nurse is caring for an older adult client who has been admitted to
the unit with anemia. What would the nurse expect the client to
possibly exhibit?
A. Excessive consumption of coffee or tea
B. Elimination of iron by the body
C. Decrease in the total body iron stores with age
D. Blood loss from the gastrointestinal or genitourinary tract
, D
If an older adult is anemic, blood loss from the gastrointestinal or
genitourinary tract is suspected. This is because iron-deficiency anemia is
unusual in older adults as the body does not eliminate excessive iron, causing
total body iron stores to increase with age. Excessive consumption of coffee
or tea is not a causative factor for anemia in older adults.
D
Normally, total bilirubin concentration ranges from 0.2 to 1.3 mg/dL. If the serum
bilirubin level exceeds 2.5 mg/dL, jaundice is visible, notably on the skin, oral
mucous membranes, and, especially, sclera.
D
Clients may complain of sharp, stabbing discomfort that resembles a myocardial
infarction; however, sitting up relieves the pain
A
Upon receiving the client in the PACU, the client is drowsy and not fully conscious. A
standard of care to prevent aspiration is to place the client lying on either side with
an emesis basin to catch drainage. Laying the client is a supine position, semi-
Fowler's position, or high-Fowler's position does not provide an easy exit for
secretions as the client is recovering from the anesthesia.
Don't know?
3 of 222
Term
The nurse receives a client following a serious thermal burn. Which
complication will the nurse take action to prevent first?
, A. Tissue hypoxia
B. Infection
C. Renal failure
D. Hypovolemia
B
Sickle cell disease is a common genetic disorder found primarily in clients of African
descent but also in people from Mediterranean and Middle Eastern countries. It is
unlikely that a Caucasian male, Native American/First Nations female, or eastern
European female will be affected by this disease.
D
D
Pacemaker insertion is the treatment for complete heart block. Treatments for
supraventricular tachycardia are: Valsalva maneuver, unilateral carotid massage,
immersion of face in ice water, administration of IV adenosine, cardioversion, and
radiofrequency ablation. Cardioversion and drug therapy are used for the treatment
of atrial flutter. Treatment for ventricular fibrillation is defibrillation preceded by or
followed with epinephrine.
D
After a burn, fluid from the body moves toward the burned area, which leads
to intravascular fluid deficit. Steps must be taken to prevent irreversible
hypovolemic shock in the initial stages of treatment.
Don't know?
