Nursing Elites

1. What nursing interventions increase the risk the pressure injuries?

• A. Padding hard surfaces
• B. Have client sit in wheelchair as much as possible
• C. Place pillows between bony surfaces
• D. Keep head of bed (HOB) at or less than 3

Correct answer: B

Rationale:

2. Convert 30 ml to ounces. (Type the answer as numeric only)

• A. 1
• B. 2
• C. 3
• D. 4

Correct answer: A

Rationale: 30 ml is equivalent to 1 ounce.

3. A client is in skeletal traction. With the nurse's assessment, it is noted that the pairs appear red, swollen and there is purulent drainage. What action does the nurse take first?

• A. Collect a culture of the purulent fluid
• B. Cleanse the skin around the pins
• C. Administer an antibiotic
• D. Instruct the client to complete exercise of the affected extremity

Correct answer: A

Rationale:

4. A nurse is caring for an immobile client. What is the priority assessment in this client?

• A. Auscultation of lung sounds
• B. Assessment of skin turgor
• C. Auscultation of bowel sounds
• D. Assessment for the presence of peripheral edema

Correct answer: A

Rationale:

5. The client is at risk for impaired skin integrity related to the need for several weeks of bedrest. The nurse evaluates the client after 1 week and finds skin integrity is not impaired. In evaluating the plan of care, what is the nurse's best action?

• A. Remove the nursing diagnosis in the plan of care since it has not occurred
• B. Change the nursing diagnosis in plan of care to impaired mobility
• C. Modify the nursing diagnosis in plan of care to impaired skin integrity
• D. Keep the nursing diagnosis in the plan of care the same since the risk factors are still present

Correct answer: D

Rationale:

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