Tiêu đề WORKBOOK - FUNDA (KEY) ✅

A. Call the family so they can expect the patient at home B. Allow the patient to leave because no one can be held against his or her will C. Call security because there must be a physician’s order before a patient may leave D. Explain the risk of leaving and request that the patient sign a paper accepting responsibility for problems that may occur 12. Which among the following is the most appropriate action of the nurse during the client’s discharge? A. Tell the patient everything will be all right B. Encourage the patient not to worry C. Wish the patient well D. Introduce the patient to the office staff Situation: Hygiene is the science of health and its preservation. Hygiene is personal matter established by individual’s values and practices. The nurse must be knowledgeable in the proper ways of rendering hygienic care to clients. 13. A nurse is bathing a 10year old client with a cast on the left leg. Which of the following actions is appropriate for the nurse do when providing eye care? A. To wash from the outer canthus to inner canthus B. To cleanse dried exudate with hot water C. To avoid drying circumorbital area after washing D. To use a different section of washcloth for each eye 14. A nurse is to render perineal care to an 80 year old male client 1 day post TURP. Which among the following is most appropriate action of the nurse? A. Retract the foreskin, cleanse the penis, and allow the foreskin to return to former position B. Sprinkle powder under the foreskin to facilitate retraction of the foreskin C. Leave the foreskin slightly damp to allow retraction to its former state D. Retract the foreskin, cleanse the penis, and return the foreskin with a gentle forward motion 15. Which among the following clients has the highest risk for complication of the feet? A. A young man in a career that requires standing B. A disoriented, elderly man C. A 60-year-old person with diabetes mellitus D. A 62-year-old patient with total hip replacement Situation: Pressure ulcer is any lesions brought by unrelieved pressure leading to the damage of the underlying tissue. It is most common among clients who are confined in bed. 16. When the nurse is placing the client on a 30 degrees lateral position, she is preventing the client to develop pressure ulcer over which of the following areas? A. Spinous processes B. Ischial tuberosities C. Greater tronchanters D. Temporal area 17. Which among the following pertains to stage III pressure ulcers? A. Nonblanchable reddened areas where the skin is intact B. Full-thickness skin loss extending to but not through the fascia C. Extensive destruction of skin and muscle with possible sinus tracts D. Areas of full-thickness skin loss with possible extension to the bone Situation: Conduction of surgical procedures may vary in every health care institution but providing quality care and ensuring client’s safety is a mutual aim among every health care facilities. 18. A nurse is caring for a female client with Penrose drain in the left lower quadrant, who has been returned to the medical-surgical unit from the post anesthesia care unit. The nurse knows that the Penrose drain was placed to A. instill solution for wound irrigation B. prevent blockage of a passageway C. drain the wound area by suction D. drain the wound area by gravity 19. While doing an assessment to the client, the nurse noticed that the client’s abdominal wound eviscerated, the nurse should; A. Place her in high Fowler’s position B. Give her fluids to prevent shock C. Replace dressings with sterile fluffy pads D. Apply warm, moist sterile dressings 20. A client was prescribed to wear an antiembolic stocking. The nurse should initially; A. Measure the legs before applying stockings to assure proper fit B. Apply the stockings while the client is sitting in a chair C. Massage the legs when removing the stockings D. Leave the stockings in place for one week intervals 21. The OR nurse must be aware of the surgical environment and the proper attire in each area. Which of the following constitute a break in infection control which may cause contamination in the OR? A. The spouse of the client enters the unrestricted area in street clothes. B. The OR nurse wear surgical attire when going to the storage areas. C. The OR nurse is wearing scrub attire in the restricted area. D. The OR nurse wear surgical scrubs alone in the OR room when preparing for the instruments. Situation: Infection control is one of the most important parts of health care. It is concerned on preventing nosocomial or health care related infection 22. To be able to protect the client’s first line of defense against infection, the nurse should do which of the following? A. Turn the client who is immobilized every 2 hours so the skin does not break down. TOP RANK REVIEW ACADEMY, INC. Page 2 | 9