immediate follow-up.)

Decreased lung sounds

Heart rate 110/min and regular

Oxygen saturation of 95%

Subcutaneous emphysema

Answer and Explanation

Correct Answer : A,B,D

A.   This may indicate a pneumothorax, which is a potential complication of thoracentesis.
B.   A heart rate of 110/min may indicate tachycardia, which can be a sign of hypoxia or other complications.
C.   While oxygen saturation of 95% is within the normal range, it is slightly lower than expected for a patient with respiratory distress.
D.   This may indicate air leakage into the subcutaneous tissue, which can be a sign of a pneumothorax or other complications.

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Correct Answer is B

Explanation

A. Using a dosimeter to measure radiation levels may be necessary in certain situations, but it is not the first step in determining what type of PPE to use.
B. Choosing the highest level of protection equipment available is important in minimizing the chances of the provider contacting the disease.
C. Waiting before delivering care might lead to loss of valuable time.
D. Decontaminating victims before intervening is not the nurse's responsibility. The focus should be on protecting oneself and providing care to those who need it.

A. Weakened gag reflex B. Hyperthermia C. Absence of bowel sounds D. Polyuria E. Hypotension

Correct Answer is ["A","B","C","E"]

Explanation

A. A weakened gag reflex is a common complication of cervical spinal cord injuries and can lead to difficulty swallowing and increased risk of aspiration.
B. Hyperthermia can occur due to autonomic dysreflexia, a common complication of cervical spinal cord injuries.
C. Absence of bowel sounds can indicate a paralytic ileus, a common complication of cervical spinal cord injuries.
D. Polyuria is not a common complication of cervical spinal cord injuries. It may occur due to other factors, such as diabetes insipidus, but it is not directly related to the injury itself.
E. Hypotension can occur due to autonomic dysreflexia, a common complication of cervical spinal cord injuries.

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immediate follow-up.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is among the first responders to a mass-casualty incident and does not know what type of personal protective equipment (PPE) is needed. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? (Select all that apply.)

Correct Answer is ["A","B","C","E"]

Explanation

A nurse is educating a group of clients about addiction. The nurse should include that which of the following factors increases the potential for addiction?

A nurse is caring for a 73-year-old client in the emergency department (ED). Exhibits It has been identified that the client is in sepsis. Select the 4 actions that the nurse should complete in the first hour to manage sepsis and prevent further complications.

A nurse is caring for a client who has a mental disorder. Which of the following statements by the client suggests the inability to process new information?

A school nurse is partnering with the local hospital system's tobacco cessation program to give a presentation focused on discouraging tobacco use in high school students. According to the Health Belief Model, which of the following might be included in the presentation?

A nurse is reviewing information about the Health Insurance Portability and Accountability Act (HIPAA) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?

A nurse is teaching a client who has been newly diagnosed with schizophrenia. Which of the following information should the nurse include?

Whenever a nurse is caring for clients who are receiving warfarin (Coumadin), which of the following medications should the nurse have on hand in the event of an overdose?

A school nurse is helping a special needs student with tube feeding during the lunch hour. Which of the following levels of prevention does this fall under?