Which of the following would the nurse understand is correct when implementing a primary assessment for clients suffering major trauma? The primary assessment:

includes the head-to-toe anterior and posterior assessment.

priorities are continuing and ongoing but treatment will be deferred if the clients unstables

is focused on airway maintenance and ventilation effectiveness.

focuses on the ABCDs of the client to identify life threatening problems

Answer and Explanation

The Correct Answer is D

A. includes the head-to-toe anterior and posterior assessment.
This describes a secondary assessment, not a primary one. The primary assessment focuses on the immediate life-threatening issues rather than a full head-to-toe examination.

B. priorities are continuing and ongoing but treatment will be deferred if the client is unstable.
In primary assessment, treatment should not be deferred in unstable clients. Immediate treatment and stabilization take priority.

C. is focused on airway maintenance and ventilation effectiveness.
As airway and ventilation are key aspects of the primary assessment (known as the "ABC" of trauma: Airway, Breathing, Circulation). However, it does not cover all of the primary assessment areas.

D. focuses on the ABCDs of the client to identify life-threatening problems.
The primary assessment is focused on identifying life-threatening problems using the ABCDs (Airway, Breathing, Circulation, Disability).

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is ["31"]

Explanation

Flow rate=(Total volume×Drop factor)÷ Time in minutes

= (250×15)÷120

= 31.25

A. Laterally on the left side with a pillow under the head and the right arm and hand hyperextended B. Supine with a pillow under the head, and elevate the right hand and arm on a pillow C. Semi-Fowler's position without a pillow under the head, and the right arm and hand elevated on a pillow D. Prone without a pillow, and with the right arm and hand flexed in a position of comfort and elevated on a pillow

Correct Answer is C

Explanation

A. Laterally on the left side

Lateral positioning may not fully prevent contractures.

B. Supine with a pillow under the head

A pillow under the head can cause neck contractures.

C. Semi-Fowler’s without a pillow, right arm & hand elevated

Prevents contractures and promotes drainage of edema.

D. Prone without a pillow

Prone position increases discomfort and risk of respiratory complications.

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Which of the following would the nurse understand is correct when implementing a primary assessment for clients suffering major trauma? The primary assessment:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is ordered 1 unit of packed red blood cells (250mL) to be transfused over 120 minutes. The drop factor on the tubing is 15 gtt/mL. At what rate should the nurse regulate the IV (gtt/min)? (round to the nearest whole number)

Correct Answer is ["31"]

Explanation

How would the nurse position the client with burns of the head, neck, chest, right arm and hand to prevent contractures?

Correct Answer is C

Explanation

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