The critical care nurse is giving end-of-shift report on a client.
The nurse uses the Glasgow Coma Scale (GCS) to assess the level of consciousness (LOC) of a female client and reports to the oncoming nurse that the client has an LOC of 6. What does an LOC score of 6 in a client indicate?

Stupor.

Somnolence.

Normal.

Deep coma.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Stupor refers to a state of near-unconsciousness or insensibility, where the patient can be briefly aroused by vigorous or repeated stimuli.

Choice B rationale

Somnolence refers to a state of strong desire for sleep or sleeping for unusually long periods (drowsiness), but it is not as severe as stupor or coma.

Choice C rationale

Normal consciousness means the patient is awake, alert, and responsive to their environment with no neurological deficits.

Choice D rationale

A score of 6 on the Glasgow Coma Scale indicates deep coma, where the patient has minimal to no response to stimuli, indicating severe brain injury.

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Correct Answer is C

Explanation

Choice A rationale

Furuncles, also known as boils, are deep folliculitis caused by bacterial infection, not sebum blockage.

Choice B rationale

Carbuncles are clusters of furuncles connected under the skin and are also caused by bacterial infection, not sebum blockage.

Choice C rationale

Comedones are primary lesions of acne caused by the blockage of hair follicles by sebum and keratin. They can be open (blackheads) or closed (whiteheads).

Choice D rationale

Striae, also known as stretch marks, are caused by the tearing of the dermis due to rapid stretching of the skin and are not related to sebum blockage in hair follicles.

A. Keep the dressing very wet at all times. B. Do not use a dressing 6 hours/day. C. Cleanse the wound with Dakin's solution. D. The wound may have a foul odor.

Correct Answer is D

Explanation

Choice A rationale

Keeping the dressing very wet at all times is not advisable with autolytic debriding agents. Excess moisture can cause maceration of the surrounding skin and increase the risk of infection. The dressing should maintain an optimal level of moisture to promote autolysis without causing harm.

Choice B rationale

Not using a dressing for 6 hours/day is incorrect advice. Continuous application of the dressing is essential for the autolytic process. Removing the dressing for extended periods disrupts the environment needed for autolysis, delaying wound healing.

Choice C rationale

Cleansing the wound with Dakin's solution is not recommended with autolytic debridement. Dakin's solution is a chemical debriding agent, and its use can interfere with the natural autolytic process. It is better to use saline or appropriate cleansers as directed.

Choice D rationale

The wound may have a foul odor due to the autolytic debridement process. As dead tissue is broken down, it can produce a distinct odor. Educating the client about this expected outcome helps them understand that it is a normal part of the healing process and not necessarily a sign of infection.

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The critical care nurse is giving end-of-shift report on a client. The nurse uses the Glasgow Coma Scale (GCS) to assess the level of consciousness (LOC) of a female client and reports to the oncoming nurse that the client has an LOC of 6. What does an LOC score of 6 in a client indicate?

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Naxlex Comprehensive Predictor Exams

Which primary lesions are associated with acne caused by sebum blockage in hair follicles?

Correct Answer is C

Explanation

A client's orders include a wound dressing using an autolytic debriding agent. The nurse providing discharge instructions to the client should include which statement?

Correct Answer is D

Explanation

A client is scheduled for a myelogram, and the nurse explains to the client that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests?

When learning about the nervous system, students learn that which nervous system regulates the expenditure of energy?

A nurse practitioner prescribes a therapeutic bath for a client with an exacerbation of psoriasis. The nurse tells the client to make sure the bath area is well ventilated. Which of the following is the therapeutic bath solution prescribed by the nurse?

A nurse's assessment of a teenage client reveals that their shoulders are not level and that they have one prominent scapula that is accentuated by bending forward. The nurse should expect to read about what health problem in the client's electronic health record?

A client receives treatment for a dermatophyte infection of the toenail. How would the nurse document this condition in the chart?

During the skin assessment of a client, the nurse observes a skin lesion that is elevated, round, and filled with serum. Identify the type of lesion.

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The critical care nurse is giving end-of-shift report on a client.
The nurse uses the Glasgow Coma Scale (GCS) to assess the level of consciousness (LOC) of a female client and reports to the oncoming nurse that the client has an LOC of 6. What does an LOC score of 6 in a client indicate?