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Question 1

Question 1. Which client should the nurse assess first? The client with hyperthyroidism who is complaining of being hot. The client with Type 1 diabetes who is complaining of being jittery and nervous. The client with a full thickness burn who is complaining of pain.

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Question 1

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  1. Question 1 Which client should the nurse assess first? • The client with hyperthyroidism who is complaining of being hot. • The client with Type 1 diabetes who is complaining of being jittery and nervous. • The client with a full thickness burn who is complaining of pain. • The client with hypoparathyroidism who is complaining of being tired all the time.

  2. Question 2 The client has a Stage 1 pressure ulcer on the coccyx. Which priority intervention should the nurse implement? • Notify the client’s HCP. • Request an air flow mattress. • Place the client on the side. • Keep the linens wrinkle free.

  3. Question 3 Which task is most appropriate to delegate to the UAP? • Take vital signs on the client in myxedema coma. • Check the blood glucose level on the client who is hyperglycemic. • Obtain the weight on the client who has prednisone toxicity. • Change the wound dressing on the client with full thickness burns.

  4. Question 4 Which assignment/delegation is most appropriate for the charge nurse to make on the medical unit? • The UAP takes vital signs on the clients. • The LVN provides AM to the clients. • The RN administers the routine medications. • The LVN completes the shift assessments.

  5. Question 5 Which client should the nurse assess first? • The client with Cushing’s disease who has a buffalo hump. • The client with Type 2 DM who has a glycoslated hemoglobin of 9%. • The client with Grave’s disease who has exopthalmus. • The client 2 days postop thyroidectomy who has a positive Chvostek’s sign.

  6. Question 6 The UAP tells the nurse the client has a reddened area on the right heel. Which intervention should the nurse implement first? • Tell the UAP to place the right foot on a pillow. • Notify the client’s HCP. • Assess the client’s right heel. • Request the wound care nurse to evaluate the client.

  7. Question 7 The client with adrenal hypofunction is admitted to the ER with AP 113 and B/P 88/60. Which intervention should the nurse implement first? • Administer solumedrol IVP. • Prepare to transfer the client to ICU. • Insert a 20 gauge angiocath. • Place the client on telemetry.

  8. Question 8 Which client should the charge nurse assign the new graduate nurse? a. The client with Cushing’s disease who is scheduled for left knee replacement. b. The client with Type 1 DM who is in diabetic ketoacidosis. c. The client who sustained 20% full thickness burns 12 hours ago. d. The client who is 3 hours postop thyroidectomy who is having difficulty swallowing.

  9. Question 9 Which medication should the nurse question administering? • The prednisone to the client with Cushing’s disease. • The oral hypoglycemic to the client with Type 2 DM. • The synthroid to the client with hypothyroidism. • The IV antibiotic to the client with a Stage 4 pressure ulcer.

  10. Question 10 Which intervention should the nurse implement first for the client with full thickness burns scheduled for a dressing change? • Obtain informed consent. • Premedicate the client. • Assess the client’s wound. • Gather the needed supplies.

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