A nurse is caring for a client who is scheduled to have his alanine aminotransferase (ALT) level checked. The client asks the nurse to explain the laboratory test. Which of the following is an appropriate response by the nurse?

This test will determine if your heart is performing properly."

This test will indicate if you are at risk for developing blood clots."

This test will provide information about the function of your liver."

This test is used to check how your kidneys are working."

Answer and Explanation

The Correct Answer is C

A tracheostomy is a surgical opening in the neck that allows air to enter the lungs through a tube called a tracheostomy tube. The tube has two parts: an outer cannula that stays in place and an inner cannula that can be removed for cleaning. The tracheostomy ties are used to secure the tube to the neck and prevent it from falling out. They should be adjusted to allow one finger to fit snugly underneath so that they are not too tight or too loose.

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Correct Answer is A

Explanation

The nurse should use a separate, sterile swab for each stroke when cleaning the wound to prevent cross-contamination and infection. The nurse should also clean from the least contaminated area (the incision) to the most contaminated area (the drain site). Cutting a 4x4 piece of gauze to place around the drain site may cause loose fibers to enter the wound and increase the risk of infection. The nurse should wear sterile gloves when cleaning the wound, not just clean gloves.

A. "The client's age is part of the measurement." B. The scale measures six elements." C. "Each element has a range from one to five points. D. "The higher the score, the higher the pressure injury risk."

Correct Answer is B

Explanation

This response shows that the newly licensed nurse knows the components of the Braden scale, which are sensory perception, moisture, activity, mobility, nutrition, and friction and shear.

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A nurse is caring for a client who is scheduled to have his alanine aminotransferase (ALT) level checked. The client asks the nurse to explain the laboratory test. Which of the following is an appropriate response by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is completing a dressing change on a client who has a surgical wound drain. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is teaching a group of newly licensed nurses about the Braden scale. Which of the following responses by a newly licensed nurse indicates an understanding of the teaching?

Correct Answer is B

Explanation

A nurse is providing teaching about preventing back strain to the caregiver of a client who is immobile and requires assistance to reposition in bed. Which of the following statements by the caregiver indicates an understanding of the teaching?

A nurse is providing care for a client who is to undergo a total laryngectomy. Which of the following interventions is the nurse's priority?

A nurse is planning care for a client who has a prescription for extremity restraints to both wrists. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)

A nurse is caring for a client who is scheduled to have his alanine aminotransferase (ALT) level checked. The client asks the nurse to explain the laboratory test. Which of the following is an appropriate response by the nurse?

A nurse is providing instruction to a client who has diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching?

A visitor reports to a nurse that she slipped and fell in a client's room. The visitor denies any injury, but is walking with a slight limp. Which of the following actions should the nurse take?

A nurse receives a new prescription over the telephone from a client's provider. Which of the following actions should the nurse take first?

A nurse is monitoring a client who is receiving continuous IV fluid therapy via a peripheral vein in the left forearm. Which of the following findings indicates that the client has developed phlebitis at the IV site?