RN Fundamentals Online Practice 2020A
- A nurse is performing a skin assessment for a client who expresses
concern about skin cancer. Which of the following findings should the
nurse identify as a potential indication of a skin malignancy?
a. A lesion with uniform pigmentation
Variations in pigmentation are a possible indication of a skin
malignancy. A lesion with uniform pigmentation is not an expected
indication of a skin malignancy.
b. New appearance of petechiae
Petechiae are capillaries that have burst under the skin and appear as
small spots on the skin. Although they can be indications of other
conditions, petechiae are not an expected indication of a skin
malignancy.
c. A mole with asymmetrical appearance
An uneven or asymmetrical shape is a potential indication of a skin
malignancy. This is manifested when part of a lesion or mole looks
different from the other part
d. The presence of a papule
Papules are solid elevations that are palpable in the skin and are less
than 1 cm (0.39 in) in size. They are not an expected indication of a skin
malignancy.
1 | Page - A nurse is assessing a client who reports pain following physical therapy.
Which of the following questions should the nurse as when assessing the
quality of the client’s pain?
a. “Is your pain constant or intermittent?”
Asking the client whether the pain is constant or intermittent
determines the onset, duration, and pattern of the pain.
b. “What would you rate your pain on a scale of 0 to 10?”
Asking the client to rate the pain using the pain scale determines the
intensity of the pain.
c. “Does the pain radiate?”
Asking the client whether the pain radiates determines the
pain’s location.
d. “Is your pain sharp or dull?”
Asking the client whether the pain is sharp or dull, crushing, throbbing,
aching, burning, electric- like, or shooting helps determine the quality of
the pain. - A nurse is admitting a new client. Which of the following actions should
the nurse take while performing medication reconciliation?
a. Verify the client’s name on their identification bracelet with the
medication administration record.
The nurse should verify the client’s name on their identification bracelet
when administering medication; however, this action is not a part of
performing medication reconciliation.
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b. Call the pharmacy to determine whether the client’s medications are
available. The nurse should call the pharmacy if the client’s
medications are not available to administer at the appropriate time;
however this action is not a part of performing medication
reconciliation
c. Compare the client’s home medications with the provider’s
prescriptions. The nurse should compare the client’s home
medications with the provider’s prescriptions when performing
medication reconciliation.
d. Place the client’s home medication bottles in a secure location.
The nurse should place the client’s home medications in a secure
location to ensure safe handling of prescribed medications; however,
this action is not a part of performing medication reconciliation.
- A nurse is auscultating the anterior chest of a client who was admitted to
a medicalsurgical unit. Listen to the audio clip of what the nurse
auscultates through the stethoscope and identify the type of breath
sounds. (Click on the audio button to listen to the clip.)
a. Crackles
Unlike these breath sounds, crackles (also called rales) are
discontinuous sounds heard primarily during inhalation and resulting
from air bubbling through fluid or mucus in the airways.
b. Rhonchi
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Rhonchi are dry, low-pitched, snore-like noises produced in the throat
or bronchial tube due to a partial obstruction, such as by secretions.
c. Friction rub
Friction rub is a scratching sound that persists throughout the
respiratory cycle.
d. Normal breath sounds
These are normal bronchovesicular breath sounds, characteristically of
moderate intensity and sounding like blowing as air moves through the
larger airways on inspiration and expiration.
- A nurse is preparing to administer enoxaparin subcutaneously to a
client. Which of the following actions should the nurse take?
a. Administer the medication with the needle at 45o
angle.
The nurse should insert the needle at 45o to 90omangle for a
subcutaneous injection.
b. Administer the medication into the client’s nondominant arm.
The nurse should administer enoxaparin into the abdomen, at least 5cm
(2 inches) from the umbilicus.
c. Pull the client’s skin laterally or downward prior to administration.
The Z-track technique involves displacing the skin laterally or downward
prior to administration of an IM injection.
d. Massage the injection site after the administration.
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