NURS 255 Exam Questions and Answers with Explanations

Question 1 2 / 2 pts A 42-year-old patient is admitted to the ED after an assault. The patient received blunt trauma to the face and has a suspected nasal fracture. Which of the following interventions should the nurse perform? Administer nasal spray and apply an occlusive dressing to the patient's face. Position the patient's head in a dependent position. Irrigate the patient's nose with warm tap water. Apply ice and keep the patient's head elevated. Immediately after the fracture, the nurse applies ice and encourages the patient to keep the head elevated. The nurse instructs the patient to apply ice packs to the nose to decrease swelling. Dependent positioning would exacerbate bleeding and the nose is not irrigated. Occlusive dressings are not used. Question 2 2 / 2 pts A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP? Administration of prophylactic antibiotics Administration of pneumococcal vaccine to vulnerable individuals Pneumococcal vaccination reduces the incidence of pneumonia, hospitalizations for cardiac conditions, and deaths in the general older adult population. A onetime vaccination of pneumococcal polysaccharide vaccine (PPSV) is recommended for all patients 65 years of age or older and those with chronic diseases. Antibiotics are not given on a preventative basis and antiretroviral medications do not affect the most common causative microorganisms. Culture and sensitivity testing by swabbing is not performed for pneumonia since the microorganisms are found in sputum. Obtaining culture and sensitivity swabs from all newly admitted patients Administration of antiretroviral medications to patients over age 65 Question 3 2 / 2 pts A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to notify the health care provider immediately. give atropine per agency dysrhythmia protocol. prepare the patient for temporary pacemaker insertion.