Nurs 123 final exam review Latest Update -

Nurs 123 final exam review Latest Update - Questions and 100% Verified Correct Answers Guaranteed A+

.On admission a patient is noted to have an alteration in skin integrity on the right heel.The nurse uses the Braden Scale. Which areas will the nurse assess when using this scale? (Select all that apply.)

• Mobility
• Nutrition
• Infection
• Friction and shear

e. Sensory perception - CORRECT ANSWER: a. Mobility

• Nutrition
• Friction and shear
• Sensory perception

• A patient comes to the emergency department and tells the triage nurse that he is

having a heart attack. What is the nurses top priority at this time?

• Determine the patients personal data and insurance coverage.
• Ask the patient to take a seat in the waiting room until his name is called.
• Request that a nurse collect data for a comprehensive history.
• Ask a nurse to start a focused assessment of this patient now. - CORRECT

ANSWER: d. Ask a nurse to start a focused assessment of this patient now.

• Which findings are expected from a musculoskeletal assessment of a left-handed

healthy adult? Select all that apply.

• Cervical concave, thoracic convex, and lumbar concave contours of the spine
• Muscle strength of 3/5 bilaterally
• Circumference of left upper arm larger than right upper arm
• Lumbar and thoracic spine flexion of 75 degrees
• External rotation and abduction of left arm of 90 degrees

f. Flexion of right and left knees of 90 degrees - CORRECT ANSWER: a. Cervical

concave, thoracic convex, and lumbar concave contours of the spine

• Circumference of left upper arm larger than right upper arm
• Lumbar and thoracic spine flexion of 75 degrees
• External rotation and abduction of left arm of 90 degrees

CORRECT ANSWER: A, C, D, E

• Which technique should the nurse use to obtain more data about a patients vague

or ambiguous statement?

• Laughing and smiling during conversation
• Using phrases such as Go on, and Then? 1 / 2

• Repeating what the patient has said, but using different words
• Asking the patient to explain a point - CORRECT ANSWER: d. Asking the patient to

explain a point

• A nurse is auscultating the lungs of a healthy male patient and hears crackles on

inspiration. What action can the nurse take to ensure this is an accurate finding?

• Make sure the bell of the stethoscope is used, rather than the diaphragm.
• Hold stethoscope firmly to prevent movement when placed over chest hair.
• Ask the patient not to talk while the nurse is listening to the lungs.

d. Change the patients position to ensure accurate sounds. - CORRECT ANSWER: b.

Hold stethoscope firmly to prevent movement when placed over chest hair.

• How does a nurse accurately palpate carotid pulses?
• Two fingers of each hand are placed firmly over the right and left temples at the same

time.

• One finger is placed gently in the space between the biceps and triceps muscles.
• Two fingers are placed at the thumb side of the forearm at the wrist.
• One finger is placed along the right and then the left medial sternocleidomastoid

muscle. - CORRECT ANSWER: d. One finger is placed along the right and then the left medial sternocleidomastoid muscle.

• What does the nurse say to obtain more data about a patients vague statement

about diet such as, My diets okay?

• Eating a variety of meats, fruits, and vegetables each day is important.
• Give me an example of the foods you eat in a typical day.
• Go on.
• Does your diet meet your needs or does it need improvement? - CORRECT

ANSWER: b. Give me an example of the foods you eat in a typical day

• A nurse is teaching a patient how to manage chronic obstructive pulmonary disease

(COPD). This intervention is an example of which level of health promotion?

• Primary prevention
• Secondary prevention
• Tertiary prevention

d. Risk factor prevention - CORRECT ANSWER: c. Tertiary prevention

• A patient is admitted to the emergency department with a tracheal obstruction. What

sound does the nurse expect to hear as this patient breathes?

• Dull sounds on percussion
• Soft, muffled rhonchi heard over the trachea
• Bubbling or rasping sounds heard over the trachea

d. High-pitched sounds on inspiration and exhalation - CORRECT ANSWER: d. High-

pitched sounds on inspiration and exhalation

• To document the palpation of a pulse, the nurse is correct in making which notation

about the rhythm?

• / 2