Week 1: JC Garcia

1. To check for wound hemorrhage after a client has had a surgery for the removal of a tumor in the
neck, nurse grace should:
• A. Loosen an edge of the dressing and lift it to see the wound
• B. Observe the dressing at the back of the neck for the presence of blood
• C. Outline the blood as it appears on the dressing to observe any progression
• D. Press gently around the incision to express accumulated blood from the wound
2. As part of the diagnostic workup for pulmonic stenosis, a child has cardiac catheterization. Nurse
Julius is aware that children with pulmonic stenosis have increased pressure:
• A. In the pulmonary vein
• B. In the pulmonary artery

• C. On the left side of the heart

• D. On the right side of the heart

3. A patient has partial-thickness burns to both legs and portions of his trunk. Which of the following
I.V. fluids is given first?
• A. Albumin
• B. D5W
• C. Lactated Ringer’s solution
• D. 0.9% sodium chloride solution with 2 mEq of potassium per 100 ml
4. During the first 48 hours after a severe burn of 40% of the clients body surface, the nurse’s
assessment should include observations for water intoxication. Associated adaptations include:
• A. Sooty-colored sputum
• B. Frothy pink-tinged sputum
• C. Twitching and disorientation
• D. Urine output below 30ml per hour
5. Before a client whose left hand has been amputated can be fitted for a prosthesis, nurse Joy is aware
that:
• A. Arm and shoulder muscles must be developed
• B. Shrinkage of the residual limb must be completed
• C. Dexterity in the other extremity must be achieved
• D. Full adjustment to the altered body image must have occurred
6. After a lateral crushing chest injury, client experiences DOB , obvious right-sided paradoxic motion
of the client’s chest demonstrates multiple rib fractures, resulting in a flail chest. The complication the
nurse should carefully observe for would be:
• A. Mediastinal shift
• B. Tracheal laceration
 • C. Open pneumothorax
• D. Pericardial tamponade
7. To assess orientation to place in a client suspected of having dementia of the alzheimers type,
nurse Chris should ask:
• A. “Where are you?”
• B. “Who brought you here?”
• C. “Do you know where you are?”
• D. “How long have you been there?”
8. While a client is on intravenous magnesium sulfate therapy for preeclampsia, it is essential for
nurse Amy to monitor the client’s deep tendon reflexes to:
• Asses level of consciousness
• Evaluate the mobility of the extremities and response to medication
• Determine her response to painful stimuli
• Prevent development of respiratory distress
9. Realizing that the hypokalemia is a side effect of steroid therapy, nurse Monette should
monitor a client taking steroid medication for:
• Hyperactive reflexes
• An increased pulse rate
• Nausea, vomiting, and diarrhea
• Leg weakness with muscle cramps
10. When planning care with a client during the postoperative recovery period following an
abdominal hysterectomy and bilateral salpingo-oophorectomy, nurse Frida should include the
explanation that:
• Surgical menopause will occur
• Urinary retention is a common problem
• Weight gain is expected, and dietary plan are needed
• Depression is normal and should be expected