VSIM JOSEPHINE MORROW PRE-SIM & POST-SIM ANSWERS

The nurse is reviewing the patient's laboratory results. Which lab test most accurately represents current nutritional status? CORRECT ANSWER Prealbumin The nurse is completing an admission assessment on a patient admitted for impaired skin integrity. Which questions would be appropriate for the nurse to ask the patient? CORRECT ANSWER -Have you noticed any swelling on your feet, ankles, or fingers? -Do some areas of your skin seem warmer or colder than others? -Have you used pads or special pants because you can't control your urine? -Do you have any sores on your body? The nurse is caring for a patient admitted with bilateral lower extremity edema. What questions should the nurse ask when completing a health history? CORRECT ANSWER -When did the edema start? -Can you describe the edema? -Do you have any recent history of surgery or illness? The nurse is conducting a skin assessment using the Braden scale. How would the nurse interpret a score of 12? CORRECT ANSWER High Risk The nurse is assessing a patient admitted with a venous stasis ulcer on the right lower extremity. What would the nurse expect to find when assessing the leg? CORRECT ANSWER Dark discoloration of the skin surrounding the wound site The nurse is preparing to irrigate a wound. Which statement, if made by the nurse, indicates an understanding of the procedure? CORRECT ANSWER I will gently direct a stream of fluid into the wound, keeping the syringe tip at least one inch from the upper tip of the wound. The nurse removes a dressing and assesses yellow, foul smelling drainage. How would the nurse document this finding? CORRECT ANSWER Purulent