MED SURG FINAL EXAM S.G. BOLD ONES I GOT WRONG EXAM 1

MED SURG FINAL EXAM S.G. BOLD ONES I GOT WRONG EXAM 1 1. A nurse performs a skin screening for a client who has numerous skin lesions. Which lesion does the nurse evaluate first? 2. The nurse is caring for a client with an acute burn injury. Which action should the nurse take to prevent infection by autocontamination? 3. A client has a leg wound that is in the second stage of the inflammatory response. For what manifestation does the nurse assess? 4. A nurse is caring for a client with systemic sclerosis. The client’s facial skin is very taut, limiting the client’s ability to open the mouth. After consulting with a registered dietitian for appropriate nutrition, what other consultation should the nurse facilitate? 5. A student nurse asks the nursing instructor what “apoptosis” means. What response by the instructor is best? 6. A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team? 7. Which statement about carcinogenesis is accurate? 8. A nurse is caring for a client who is receiving an epidural infusion for pain management. Which assessment finding requires immediate intervention from the nurse? 9. The nurse caring for oncology clients knows that which form of metastasis is the most common? 10. A nurse prepares to administer intravenous cimetidine (Tagamet) to a client who has a new burn injury. The client asks, “Why am I taking this medication?” How should the nurse respond? "I 11. A nurse is orienting a new client and family to the inpatient unit. What information does the nurse provide to help the client promote his or her own safety? 12. A nurse assesses a client who has burn injuries and notes crackles in bilateral lung bases, a respiratory rate of 40 breaths/min, and a productive cough with blood-tinged sputum. Which action should the nurse take next? 13. A nurse is caring for a client who has a spinal cord injury at level T3. Which intervention should the nurse implement to assist with bladder dysfunction? 14. A nurse plans care for a client who is immobile. Which interventions should the nurse include in this client’s plan of care to prevent pressure sores? (Select all that apply.) 15. A nurse assesses an older adult’s skin. Which findings require immediate referral? (Select all that apply. 16. A nurse reads on a hospitalized client’s chart that the client is receiving teletherapy. What action by the nurse is best? ..............................................................continued......................................................