Nursing Elites

1. A client is bedridden and appears to be frail and malnourished. Which nursing interventions will increase the risk of pressure injury?

• A. Applying moisturizer to dry areas of the skin
• B. Massaging the client's reddened shoulders and heels
• C. Cleansing the skin routinely after soiling occurs
• D. Using a Hoyer lift for all transfers

Correct answer: B

Rationale:

2. A client has a new diagnosis of human immunodeficiency virus HIV. The client is distraught and does not know what to do. What intervention by the nurse is the best?

• A. Offer to tell the family for the client
• B. Call the hospital clergy to speak with the client
• C. Assess the client's support system
• D. Explain the legal requirements to tell sex partners

Correct answer: C

Rationale:

3. Which of the following assessments is found in neurovascular compromise?

• A. Tingling
• B. Strong pulses
• C. Warm skin
• D. Full range motion

Correct answer: A

Rationale: Tingling is a common sign of neurovascular compromise.

4. What client is a susceptible host most at risk for infection?

• A. A client with leukemia
• B. A hospitalized 35-year-old-client
• C. A child who is immunized
• D. A 60-year-old client

Correct answer: A

Rationale:

5. What is the priority nursing diagnosis after surgery to repair a fracture?

• A. Disturbed body image
• B. Risk for infection
• C. Risk for impaired skin integrity
• D. Acute pain

Correct answer: B

Rationale: The correct answer is B: Risk for infection. After surgery to repair a fracture, the priority nursing diagnosis is to monitor for the risk of infection to promote proper healing. Infections can significantly delay the healing process and lead to further complications. Choices A, C, and D are not the priority immediately post-surgery. Disturbed body image, risk for impaired skin integrity, and acute pain may be concerns but are not the priority in the immediate post-operative period following fracture repair.

Similar Questions