Nightingale College BSN 205 Hallmark Final Exam Wound Care ISB Questions With Complete Solutions
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Course
NU1426
Institution
NU1426
Nightingale College BSN 205 Hallmark Final Exam| Wound Care ISB| Questions With Complete Solutions
Which of the following patients would require follow- up?
An adolescent with a respiratory rate of 16 breaths per minute.
A child with a respiratory rate of 20 breaths per minute.
A newborn wit...
Nightingale College BSN 205 Hallmark Final
Exam| Wound Care ISB| Questions With
Complete Solutions
1). Which of the following patients would require follow- up?
an adolescent with a respiratory rate of 16 breaths per minute.
a child with a respiratory rate of 20 breaths per minute.
a newborn with a respiratory rate of 40 breaths per minute.
an adult with a respiratory rate of 10 breaths per minute.
Ans: An adult with a respiratory rate of 10 breaths per minute.
2). Which of the following vital signs recorded for an older adult would be considered
acceptable (within normal limits)?
temp 98.6 °f (37 °c), p-56, r-20, bp 120/80, o2 sat 91%.
temp 97.0° f (36.1 °c), p-60, r-16, bp 116/78, o2 sat 95%.
temp 96.8° f (36 °c), p-60, r-18, bp 160/90, o2 sat 93%.
temp 98.0 °f (36.7 °c), p-76, r-22, bp 110/70, o2 sat 88%.
Ans: Temp 97.0° F (36.1 °C), P-60, R-16, BP 116/78, O2 sat 95%.
3). The nurse has delegated the task of temperature assessment to the nap. which information
should be provided to the nap? (select all that apply.) the patient's diagnosis. the frequency
for taking or monitoring the temperature. the patient's age. the type of temperature required.
what changes to report immediately to the nurse.
Ans: The frequency for taking or monitoring the temperature.
The type of temperature required.
What changes to report immediately to the nurse.
4). Which of the following situations may affect a patient's vital signs? (select all that apply.) o
isolation precautions. time of day. o occupation. pain rated as a 7 on 0-10 pain scale.
moving from lying to standing position.
Ans: Time of day.
Pain rated as a 7 on 0-10 pain scale.
Moving from lying to standing position.
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, 5). The nurse will take the patient's vital signs preoperatively and record them as part of the
patient's preparation for surgery. why is it necessary to take vital signs preoperatively?
(select all that apply.)
to provide a set of vital signs to use for comparison during and after surgery.
to determine whether the patient is "feeling funny" or "different".
to verify the patient is not experiencing any complications that may contraindicate surgery
or require intervention.
to ensure the equipment is appropriately calibrated and functional.
to provide the patient with reassurance that he or she is being cared for by a competent
staff.
Ans: To provide a set of vital signs to use for comparison during and after surgery.
To verify the patient is not experiencing any complications that may contraindicate
surgery or require intervention.
6). The nap reports to the nurse a 65-year-old patient s blood pressure is 160/98. what is the
appropriate initial response of the nurse?
document this as a normal finding in an elderly adult.
assess the patient s blood pressure.
ask the nap if the patient is nauseous. instruct the nap to obtain a full set of vital signs.
Ans: Assess the patient s blood pressure.
7). Which patient would it be appropriate for the nurse to delegate vital signs?
patient with recent complaint of headache.
new admission to the hospital.
elderly nursing home resident.
patient transferred from 1cu.
Ans: Elderly nursing home resident.
8). Which person would be expected to have the lowest body temperature?
a toddler who is febrile
a child playing softball
a 16 year old who ran 1 mile
an 80 year old who walked half a mile
Ans: An 80 year old who walked half a mile
9). The nap is preparing to measure a patient's vital signs. the patient reports having eaten a
bowl of warm soup. the nap asks the rn what he should do. what is the best response?
ask the patient not to eat, drink, or smoke for 20 minutes and then assess the patient's oral
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