NUR 2755 Multidimensional Care IV
MDC4 Exam 2
Which assessment is important for the nurse to evaluate whether the treatment of a client with anaphylactic shock has been effective?
- Pulse rate
- Orientation
- Blood pressure
- Oxygen saturation
Correct Answer:
- Oxygen saturation
Burn client is brought into the emergency department with the following burns: half of the front torso, entire left arm, front of the left leg. The nurse should record the total body surface area burn as?
A. 27%
B. 35%
C. 20%
D. 40%
Correct Answer:
A. 27%
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Nurse is planning care for an adult client who sustained severe burn injuries.Which interventions should the nurse include in the plan of care? SATA
- limit visitors in the clients room when immunosuppressed
- encourage raw foods to improve exposure to natural flora
- offer high calorie, high protein foods or supplemental feeding
- ambulate 2 or 3 times a day and progress in length each time
- apply compression dressings before the graft heals to prevent scar
formation
Correct Answer:
- limit visitors in the clients room when immunosuppressed
- offer high calorie, high protein foods or supplemental feeding
Nurse is caring for a client in shock. The nurse understands the client sympathetic nervous system is still correctly attempting to compensate when the following is assessed?
- Client has decreased peripheral pulses
- Client has an increase thirst
- Client has decreased heart rate
- Client has an increased respiratory rate
- Client has widening pulse pressure
Correct Answer:
- Client has an increased respiratory rate
- Client has widening pulse pressure
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Client is treated in the emergency department for shock of unknown etiology. The first action by the nurse is which of the following?
- Administer oxygen
- Attach a cardiac monitor
- Obtain a blood pressure
- Check level of consciousness
Correct Answer:
- Administer oxygen
Client has been diagnosed with pulmonary embolism. Which diagnostics and treatments does the nurse anticipate will be ordered? SATA
- D dimer
- Thrombolytics
- Atropine
- Nitroglycerin
- CT angiogram
Correct Answer:
- D dimer
- Thrombolytics
- CT angiogram
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