Xx MDC4 Final Exam
1.Which of the following describes the process of initial surveillance of victims injury
severity when administering first aid in an emergency situation?
A. The Good Samaritan law
B. an emergency interview
C. Triage
D. taking vital signs
2.The nurse reminds a group of certified nursing assistants (CNA) that for a client with an
elevated temperature, the quickest and simplest technique to reduce a temperature is Which of
the following?
A. Apply cool wash cloth to forehead
B. bathe in tepid water
C. remove clothing and bed linen
D. give chilled drinks- don't want to give them drinks cuz they could aspirate
3. Which time of the day should the nurse encourage a client with Parkinson's disease
to schedule the most demanding physical activities to minimize the effects of hypokinesia?
A. early in the morning when the clients energy level is high
B. to coincide with the peak action of drug therapy
C. immediately after a rest period
D. When family members will be available
4. A client with multiple sclerosis(MS) is receiving baclofen. The nurse determines
that the drug is effective with which of the following outcomes
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A. Induces sleep
B. stimulates the client's appetite
C. relieve muscular spasticity
D. reduces the urine bacterial count
5.The nurse is caring for several clients on the Burn Unit who have sustained extensive
tissue damage. The nurse should monitor for which electrolyte imbalance that is typical
associated with the initial third spacing fluid shift?
A. Hypercalcemia
B. Hypernatremia
C. Hyperkalemia
D. Hypokalemia
6. When taking a client's vital signs on the first postoperative day, the unlicensed assistive
Personnel reports to the nurse that the oral temperature is 100 degrees. After
encouraging the clients use the incentive spirometer, the nurse should delegate which
activity to the UAP?
A. Apply a ice caps the clients forehead
B. bathe the client with cool water
C. place a hyperthermia blanket on the client's bed
D. continue to monitor the client's temperature
7. The nurse is assessing a client with multiple traumas who is at risk for developing acute
respiratory distress syndrome(ARDS). the nurse assesses for which earliest sign of
acute respiratory distress syndrome?
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A. Bilateral wheezing
B. inspiratory crackles
C. intercostal retractions
D. increased respiratory rate
8. What drain is removed through gravity?
wound vac, jp drain, penrose Penrose- I put penrose.
9. An emergency department charge nurse notes an increase in sick calls and bickering
among the staff after a week with multiple trauma incidents. What action would the
nurse take?
A. Organize a pizza party for each shift
B. Remind the staff of the facilities sick leave policy
C. Arrange for critical incident stress debriefing
D. Talk individually with staff members
10. The nurse is assessing a client for decorticate posturing. What should the nurse assess
the client for?
A. Internal rotation and adduction of arms with flexion of elbows, wrists, and
fingers
B. Back hunched over and rigid flexion of all four extremities with supination
of arms and plantar flexion of feet
C. Supination of arms and dorsiflexion of the feet
D. Back arched and rigid extension of all four extremities
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11. A client with a serious head injury with increased intracranial pressure is to be
discharged to a rehabilitation facility. Which outcome of rehab would be appropriate for
the client? The client will:
A. Exhibit no further episodes of short-term memory loss
B. Be able to return to his construction job in 3 weeks
C. Actively participate in the rehabilitation process as appropriate
D. Be emotionally stable and display preinjury personality traits
12. Which findings will the nurse observe in the client in the ictal phase of generalized
tonic-clonic seizure?
A. Jerking in one extremity that spreads gradually to adjacent areas
B. Vacant staring and abruptly ceasing all activity
C. Facial grimaces, patting motions, and lip-smacking
D. Loss of consciousness, body stiffening, and violent muscle contractions
13. The nurse is aware that the treatment for frostbite includes the following: (SATA)
A.Vigorously rubbing the hands in fingers to reestablish circulation
B. Immersion of hands and feet in warm water
C. Tightly wrapping hands in mitten-like dressings to retain warmth
D. Administering opioids to reduce pain
E. Elevating the affected limbs
14. A nurse is caring for several clients at risk for shock. Which laboratory values requires
the nurse to communicate with the healthcare provider?
A. Creatinine: 0.9 mg/dL
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