Exam (elaborations)
Adult Health Final Exam/200 Questions and Answers
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- Adult Health
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- Adult Health
Adult Health Final Exam/200 Questions and Answers
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Adult Health Final Exam/200Questions and Answers
During assessment of the patient's skin, the nurse observes a similar pattern
of small, raised lesions on the left and right upper back areas. Which term
should the nurse use to document these lesions? - -Symmetric
-The nurse prepares to obtain a culture from a patient who has a possible
fungal infection on the foot. Which items should the nurse gather for this
procedure? - -Cotton-tipped applicators
-A dark-skinned patient has been admitted to the hospital with chronic heart
failure. How would the nurse best assess this patient for cyanosis? - -check
the lips and oral mucous membranes
-When examining an older patient in the home, the home health nurse
notices irregular patterns of bruising at different stages of healing on the
patient's body. Which action should the nurse take first? - -talk with the
patient alone and ask about what caused the bruising
-The nurse assess a circular, flat, reddened lesion about 5 cm in diameter on
a middle-aged patient's ankle. How should the nurse determine if the lesion
is related to intradermal bleeding - -Press firmly on the lesion
-Which integumentary assessment data from an older patient admitted with
bacterial pneumonia is of most concern for the nurse? - -Reports a history of
allergic rashes
-When taking the health history of an older adult, the nurse discovers that
the patient has worked in the landscaping business for 40 years. The nurse
will plan to teach the patient about how to self-assess for which clinical
manifestations? - -actinic keratosis and erythema
-A patient who is scheduled for a right breast biopsy asks the nurse the
difference between a benign tumor and a malignant tumor. Which answer by
the nurse is correct? - -"Malignant tumors may spread to other tissues or
organs"
-A nurse is caring for a patient who smokes 2 packs/day. To reduce the
patient's risk of lung cancer, which action by the nurse is the best? - -
Discuss the risks associated with cigarettes during every patient encounter
, -The nurse should include which food choice when providing dietary
teaching for a patient scheduled to receive external beam radiation for
abdominal cancer? - -Roasted chicken
-A patient who is diagnosed with cervical cancer that is classified as Tis, N0,
M0 asks the nurse what the letters and numbers mean. Which response by
the nurse is most appropriate? - -"the cancer involves only the cervix"
-During the teaching session for a patient who has a new diagnosis of acute
leukemia the patient is restless and is looking away, never making eye
contact. After teaching about the complications associated with
chemotherapy, the patient asks the nurse to repeat all of the information.
Based on this assessment, which nursing diagnosis is most appropriate for
the patient? - -Risk for ineffective health maintenance related to anxiety
about new leukemia
-A hospitalized patient who has received chemotherapy for leukemia
develops neutropenia. Which observation by the nurse would indicate a need
for further teaching - -The patients visitors bring in some fresh peaches from
home
-The nurse receives change-of-shift report on the oncology unit. Which
patient should the nurse assess first? - -24-year-old patient who received
neck radiation and has blood oozing from the neck
-An older adult patient who has colorectal cancer is receiving IV fluids at
175mL/hour in conjunction with the prescribed chemotherapy. Which finding
by the nurse is most important to report to the health care provider? - -
Patient has audible crackles in the midline posterior chest
-A patient with an open leg wound has a white blood cell (WBC) count of
13,500/uL and a band count of 11%. Which action should the nurse take
first? - -Obtain wound cultures
-A patient has an open surgical wound on the abdomen that contains deep
pink granulation tissue. How would the nurse document this wound? - -Red
wound
-A patient from a long-term care facility is admitted to the hospital with a
sacral pressure ulcer. The base of the wound is yellow and involves
subcutaneous tissue. How should the nurse classify this pressure ulcer? - -
Stage III
-A young male patient who is a paraplegic has a stage II sacral pressure
ulcer and is being cared for at home by his mother. To prevent further tissue
, damage, what instructions are most important for the nurse to teach the
mother? - -Change the patient's position at least every 2 hours
-A new nurse performs a dressing change on a stage II left heel pressure
ulcer. Which action by the new nurse indicates a need for further teaching
about pressure ulcer care? - -the new nurse cleans the ulcer with a sterile
dressing soaked in half-strength peroxide
-Which finding is most important for the nurse to communicate to the health
care provider when caring for a patient who is receiving negative pressure
wound therapy? - -Low serum albumin level
-The nurse is caring for a patient with diabetes who had abdominal surgery
3 days ago. Which finding is most important for the nurse to report to the
health care provider? - -Separation of the proximal wound edges by 1 cm
-After receiving a change-of-shift report, which patient should the nurse
assess first? - -The patient who has been receiving chemotherapy and has a
temperature of 102 F
-A patient scheduled for an elective hysterectomy tells the nurse, "I am
afraid that i will die in surgery like my mother did." Which response by the
nurse is most appropriate? - -"Tell me more about what happened to your
mother"
-A 38-year-old female is admitted for an elective surgical procedure. Which
information obtained by the nurse during the preoperative assessment is
most important to report to the anesthesiologist before surgery? - -The
patient's statement that her last menstrual period was 8 weeks previously
-The nurse is preparing to witness the patient signing the operative consent
form when the patient says, "I do not really understand what the doctor
said," which action is best for the nurse to take? - -Notify the surgeon that
the informed consent process is not complete
-The outpatient surgery nurse reviews the complete blood cell count (CBC)
results from a patient who is scheduled for surgery in a few days. The results
are white blood cell count (WBC)10.2 x 108/uL; hemoglobin 15g/dL;
hematocrit 45%; platelets 150 x 103/uL. Which action should the nurse take?
- -Send the patient to the holding area when the operating room calls.
-When caring for a preoperative patient on the day of surgery, which actions
included in the plan of care can the nurse delegate to unlicensed assistive
personnel (UAP)? (select all that apply) - -Remove nail polish and apply
pulse oximeter
Transport the patient by stretcher to the operating room
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