Question: A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse’s priority when assessing the severity of the client’s burns?

Answer Options:
Age of the client
Cause of the burn
Location of the burn
Associated medical history

Answer: Location of the burn

 

Question: A nurse is caring for a client who has a fractured tibia as a result of a fall. The client’s x-ray shows that the bone is splintered into several pieces around the shaft. The nurse should identify that the client has which of the following types of fractures?

Answer Options:
Impacted
Transverse
Comminuted
Oblique

Answer: Comminuted

 

Question: A nurse is developing a plan of care to prevent skin breakdown for a client with a spinal cord injury and paralysis. Which of the following nursing actions are appropriate? (Select all that apply.)

Answer Options:
Minimize skin exposure to moisture
Use pillows to keep heels off the bed surface
Massage over erythematous bony prominences
Implement turning schedule every 4 hours
Keep the client’s skin dry with powder

Answer: Minimize skin exposure to moisture
Use pillows to keep heels off the bed surface

 

Question: The client is at risk for developing _____ and _____ (for a client with systemic lupus erythematosus).

Answer Options:
Hypoglycemia
Chronic fatigue
Weight loss
Photosensitivity

Answer: Chronic fatigue and Photosensitivity