NUR392-910 Fundamentals Final Summer - Adelphi University
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A nurse has measured and assessed the pressure injury on a client. The wound is crater-like and extends into the subcutaneous tissue. The nurse would document this as which of the following?
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Stage 2
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Stage 3
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Stage 4
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Stage 1
Explanation
A Stage 3 pressure injury is characterized by full-thickness skin loss with a crater-like appearance, extending into the subcutaneous tissue, but without exposure of muscle, tendon, or bone. This matches the description of the wound assessed by the nurse.
Why the other options are incorrect:
A. Stage 2 involves partial-thickness skin loss with exposed dermis, presenting as a shallow open wound, not a deep crater extending into subcutaneous tissue.
C. Stage 4 involves full-thickness tissue loss with exposed or palpable muscle, tendon, or bone, which is more extensive than the subcutaneous involvement described here.
D. Stage 1 presents as intact skin with non-blanchable redness, with no open wound or tissue loss at all.
Condition the client is most likely experiencing A. Hyperkalemia B. Hyponatremia C. Hypocalcemia D. Hypermagnesemia
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Initiate IV calcium supplementation
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Allow the client to ambulate to the bathroom
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Start a fluid restricted diet
Explanation
Correct Answer: (1) C — Hypocalcemia — Mrs. Black's recent parathyroidectomy places her at high risk for hypocalcemia, since the parathyroid glands regulate calcium levels. Her presentation—perioral numbness and tingling, fingertip paresthesia, positive Chvostek's sign (facial twitching), positive Trousseau's sign (carpal pedal spasm), and muscle tightening/cramping in the extremities—is classic for hypocalcemia following parathyroid removal. (2) A — Initiate IV calcium supplementation — IV calcium replacement is the priority treatment to correct symptomatic hypocalcemia and prevent progression to more severe complications such as tetany, laryngospasm, or seizures. (3) B — Initiate seizure and fall precautions — Severe hypocalcemia can progress to neuromuscular irritability, tetany, and seizures, so the nurse must implement safety precautions to protect the client from injury. (4) B — Musculoskeletal status — Ongoing monitoring of muscle cramping, spasms, and neuromuscular irritability (Chvostek's/Trousseau's signs) allows the nurse to track the progression or resolution of hypocalcemia symptoms. (5) A — Serum electrolyte levels every 4 hours as ordered — Frequent monitoring of serum calcium and other electrolytes is essential to evaluate the effectiveness of calcium replacement therapy and detect any further imbalance.
Why the other options are incorrect:
Hyperkalemia, hyponatremia, and hypermagnesemia do not correlate with the classic signs presented (Chvostek's, Trousseau's, perioral numbness); these are hallmark findings specifically associated with hypocalcemia.
Allowing the client to ambulate to the bathroom is unsafe given her risk for tetany/seizure, and starting a fluid-restricted diet does not address the underlying calcium deficiency.
Administering Dextrose 50% IV with insulin is a treatment for hyperkalemia, not hypocalcemia, and initiating 3% NS IV is used for severe hyponatremia, neither of which fits this client's presentation.
Urine output and pain scale are not the most specific or relevant parameters for tracking hypocalcemia progression compared to musculoskeletal status; ability to perform ADLs and blood pressure are not the priority monitoring parameters for this acute electrolyte imbalance compared to serum electrolyte levels.
The nurse is caring for a client who is at risk for skin breakdown. Which of the following interventions should the nurse use to prevent skin breakdown? Select all that apply.
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Provide the client a high protein diet
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Turn and position the client every 2 hours
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Place the client on a pressure reducing mattress
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Apply cornstarch to the skin
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Massage bony prominences
Explanation
Adequate protein intake supports skin integrity and wound healing, while turning and repositioning every 2 hours relieves sustained pressure on vulnerable areas. Pressure-reducing mattresses further redistribute pressure across the body surface, all of which are evidence-based interventions to prevent skin breakdown.
Why the other options are incorrect:
D. Applying cornstarch to the skin is not recommended as it can promote fungal growth in moist areas and does not provide evidence-based protection against skin breakdown.
E. Massaging bony prominences is contraindicated, as it can cause further tissue damage and increase the risk of skin breakdown in areas already vulnerable to pressure injury.
Nurses provide care to meet needs in all the human dimensions. Which of the following nursing interventions can be implemented to meet spiritual needs?
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Remind clients that nurses are not ministers.
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Offer a compassionate presence.
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Avoid any discussion of religion or spirituality.
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Refer all questions to a spiritual advisor.
Explanation
Offering a compassionate presence — actively listening, showing empathy, and being emotionally available — is a fundamental, universally appropriate nursing intervention for addressing spiritual needs, regardless of the client's specific beliefs or religious affiliation. This holistic approach supports the client's spiritual well-being within the nurse's scope of practice.
Why Other Options are Incorrect:
A. While nurses are not ministers, stating this to a client is dismissive and unhelpful; it does not meet the client's spiritual needs and may create emotional distance.
C. Avoiding all discussion of religion or spirituality neglects an important dimension of holistic client care and fails to acknowledge the client's spiritual needs.
D. While referral to a chaplain or spiritual advisor may sometimes be appropriate, deflecting all spiritual questions rather than engaging with the client fails to provide immediate, basic supportive care that is within the nurse's role.
A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The health care provider prescribes an enteral tube feeding of a standard formula to run at 40 mL/hour. A nursing student is assigned to care for the client, and the nursing instructor asks the student to describe the nursing considerations related to a tube feeding. Which statement, if made by the student, indicates an understanding of this dietary treatment?
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"Enteral feeding formula should not be diluted."
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"Enteral feedings should be refrigerated until just before use."
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"The patient's oral medications should be crushed and mixed with the formula."
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"Enteral tube feeding frequently cause sepsis."
Explanation
Correct Answer: (A) "Enteral feeding formula should not be diluted." Standard enteral formulas are specifically calibrated to deliver precise caloric, protein, and nutrient content per volume. Diluting the formula would reduce the nutritional value the client receives per hour and is not recommended practice, so recognizing that formula should not be diluted indicates correct understanding of enteral feeding principles.
Why the other options are incorrect:
B. Enteral formula should be at room temperature when administered, not cold from refrigeration, as cold formula can cause GI discomfort such as cramping; formula should not sit out unrefrigerated for extended periods either, but this statement about refrigeration timing is not the key correct consideration being tested here.
C. Medications should generally be administered separately, not mixed directly into the formula, as mixing can cause clogging of the tube, drug-formula interactions, or altered medication absorption; each medication should be given individually with water flushes.
D. While enteral feedings do carry some risk of complications like aspiration, sepsis is not described as a frequent or expected complication, making this an inaccurate and overly alarming statement.
Nurse's Notes
1200: Mrs. Thomas lives in an aged care facility. She has been experiencing headaches for three days and cannot perform ADLs. She also refused to eat or drink over the last two days. Today, Mrs. Thomas had an episode of confusion early in the morning and kept asking for her husband who died 5 years ago. Mrs. Thomas was transferred to emergency room for further investigation.
Assessment findings: Neuro: Alert & Oriented X 4, constant headache to the frontal lobe 6/10, onset 3 days ago, denies visual changes or trauma; Cardiovascular: S1 & S2 noted, regular rhythm, peripheral pulses weak but palpable, no edema, denied chest pain; Respiratory: Lung sounds clear, rhythm regular, no cough; Gastrointestinal: Abdomen soft, non-distended, nontender, bowel sounds active X 4 quadrants, last bowel movement 2 days ago, stating "no appetite"; Genitourinary: No urine output in the last 12 hours. Integumentary: Skin dry with tenting, capillary refill < 2 seconds. Fingerprint bruises were noted on right upper arm, red, moist rash under breasts and skin folds. Psychosocial: The client states "I've been feeling sad lately." She is unmotivated to get out of bed. When asked how she got the fingerprint bruises to the arm, Mrs. Thomas states "The girls at the nursing home are a little rough sometimes." Vital signs: BP 98/58 mmHg (supine), 80/50 mmHg (standing), Pulse 110 bpm, RR 18 breaths/min, Pulse oximetry reading is 95% on room air, Temp 98.9 F (37 C)
Past medical history: Coronary Artery Disease; Depression; Gastroesophageal Reflux Disease
1300: Lab results on admission show: Na+ 149 mEq/L (normal 135-145 mEq/L), K+ 3.7 mEq/L (normal 3.5-5.0 mEq/L), Cl- 107 mEq/L (normal 97-107 mEq/L), BUN 38 mg/dL (normal 10-20 mg/dL), Creatinine 1.1 mg/dL (normal 0.7-1.2 mg/dL), Glucose 81 mg/dL (normal 70-100 mg/dL)
1400: Upon reviewing the client, the healthcare provider writes the following prescriptions:
- Insert peripheral IV
- Infuse NaCl 0.9 % @ 125 mL/h
- Obtain urinalysis via straight catheter
- Orthostatic vital signs daily
- Monitor intake and output
- Encourage oral intake
- Activity: out of bed for meals if tolerated
- Diet: low sodium
- Acetaminophen 650 mg by mouth q6h PRN for headache >= 5/10 on pain scale
The nurse has reviewed the healthcare provider's (HCP) orders. Determine 3 HCP orders that the nurse should perform first, and drag them to the box on the right.
HCP Orders A. Infuse NaCl 0.9% @ 125 mL/h B. Encourage oral intake C. Activity: out of bed for meals if tolerated D. Obtain urinalysis via straight catheter E. Orthostatic vital signs daily F. Acetaminophen 650 mg by mouth q6h PRN for headache >= 5/10 on pain scale G. Monitor intake and output H. Diet: low sodium I. Insert peripheral IV
Orders to be Performed First:
- Insert peripheral IV
- Infuse NaCl 0.9% @ 125 mL/h
- Obtain urinalysis via straight catheter
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Request an order for Furosemide — Contraindicated
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Keep I & O record — Indicated
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IV fluids — Indicated
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Urinalysis — Indicated
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Dietitian consultation — Indicated
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Establish peripheral IV access — Indicated
Explanation
Correct Answer: Contraindicated — Request an order for Furosemide. Indicated — Keep I & O record; IV fluids; Urinalysis; Dietitian consultation; Establish peripheral IV access.
Mrs. Thomas is presenting with clear signs of dehydration/hypovolemia: orthostatic hypotension, tachycardia, hypernatremia, dry skin with tenting, elevated BUN, and no urine output in 12 hours. Furosemide is a loop diuretic that promotes fluid loss and would worsen her already significant fluid volume deficit, making it contraindicated in this situation. Establishing peripheral IV access and administering IV fluids are indicated to correct her dehydration and hypernatremia. Keeping an accurate intake and output record is essential to monitor her fluid status and response to treatment. A urinalysis helps evaluate renal function and concentration (consistent with dehydration) and can rule out infection as a contributing factor to her confusion. A dietitian consultation is appropriate to address her poor oral intake, "no appetite" complaints, and nutritional needs going forward.
Why Other Options Are Incorrect:
Furosemide would exacerbate her volume depletion and electrolyte imbalance, worsening her clinical condition rather than resolving it — this intervention should not be taken.
0800: Mrs. Black is a 57 year old female who presents to the Emergency Department complaining of numbness and tingling around her mouth and at her fingertips that started 2 days ago. She tells the nurse that since her parathyroid glands were removed 3 weeks ago, and has been home since. She has been able to complete all of her ADLs without assistance. She tells the nurse that since the surgery her constipation has been worse than usual, so she's been taking two additional doses of her Miralax/Polyethylene glycol 3350 (laxative) each day. When the nurse is assessing Chvostek's sign, the nurse taps the client's cheek and notes facial twitching. The nurse takes Mrs. Black's vital signs, and they are as follows: HR 80, BP 110/70, RR 18, SpO2 100% on room air, temp 98.6 degrees F/37 degrees C. As the nurse is assessing Trousseau's sign, the nurse notes a carpal pedal spasm elicited on the client's right hand.
While Mrs. Black is laying on the stretcher, she continues to complain of pain in her arms and legs, and she states "my arms and leg muscles feel like they're tightening and contracting!" She has drawn blood work and it is in the lab pending.
Past Medical History: Parathyroid removal surgery (3 weeks ago), chronic constipation Medications: Miralax/Polyethylene glycol 3350 (laxative) twice daily
Complete the diagram by selecting the corresponding number from the dropdown menu:
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Hyperkalemia
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Hyponatremia
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Hypocalcemia
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Hypermagnesemia
Explanation
Correct Answer: (1) C — Hypocalcemia — Mrs. Black's recent parathyroidectomy places her at high risk for hypocalcemia, since the parathyroid glands regulate calcium levels. Her presentation—perioral numbness and tingling, fingertip paresthesia, positive Chvostek's sign (facial twitching), positive Trousseau's sign (carpal pedal spasm), and muscle tightening/cramping in the extremities—is classic for hypocalcemia following parathyroid removal. (2) A — Initiate IV calcium supplementation — IV calcium replacement is the priority treatment to correct symptomatic hypocalcemia and prevent progression to more severe complications such as tetany, laryngospasm, or seizures. (3) B — Initiate seizure and fall precautions — Severe hypocalcemia can progress to neuromuscular irritability, tetany, and seizures, so the nurse must implement safety precautions to protect the client from injury. (4) B — Musculoskeletal status — Ongoing monitoring of muscle cramping, spasms, and neuromuscular irritability (Chvostek's/Trousseau's signs) allows the nurse to track the progression or resolution of hypocalcemia symptoms. (5) A — Serum electrolyte levels every 4 hours as ordered — Frequent monitoring of serum calcium and other electrolytes is essential to evaluate the effectiveness of calcium replacement therapy and detect any further imbalance.
Why the other options are incorrect:
Hyperkalemia, hyponatremia, and hypermagnesemia do not correlate with the classic signs presented (Chvostek's, Trousseau's, perioral numbness); these are hallmark findings specifically associated with hypocalcemia.
Allowing the client to ambulate to the bathroom is unsafe given her risk for tetany/seizure, and starting a fluid-restricted diet does not address the underlying calcium deficiency.
Administering Dextrose 50% IV with insulin is a treatment for hyperkalemia, not hypocalcemia, and initiating 3% NS IV is used for severe hyponatremia, neither of which fits this client's presentation.
Urine output and pain scale are not the most specific or relevant parameters for tracking hypocalcemia progression compared to musculoskeletal status; ability to perform ADLs and blood pressure are not the priority monitoring parameters for this acute electrolyte imbalance compared to serum electrolyte levels.
The nurse administers a prescribed medication to a client and does not document doing so in the MAR (Medication Administration Record). The nurse who comes on during the next shift assumes that the medication has not been administered, and administers the same medication to the client again. Shortly after, the nurse from the previous shift calls to report that she gave the medication to the client but forgot to document the medication in the MAR. What should the nurse on duty do first upon receiving this information?
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Check the client's condition
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Report this information to the HCP (Health Care Provider)
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Fill out an incident report
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Report this information to Nurse Manager
Explanation
The priority action following any medication error, including a duplicate dose, is to first assess the client's current condition to identify any adverse effects or complications resulting from the error. Ensuring client safety takes precedence over documentation or reporting steps.
Why the other options are incorrect:
B. Reporting to the HCP is an important subsequent step to obtain further orders, but it should occur only after the nurse has first assessed the client's immediate physical status.
C. Completing an incident report is a necessary follow-up action for quality and safety tracking, but it is not the first priority when client safety needs immediate assessment.
D. Notifying the nurse manager is part of appropriate follow-up communication, but it does not take precedence over first checking on the client's clinical condition.
The nurse is providing education by demonstrating purse-lip breathing to a client with a chronic respiratory illness. Which of the following actions should the nurse include in the demonstration?
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Inhale slowly and evenly through his nose and exhale slowly through puckered (pursed) lips
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Hold his breath for at least 20 seconds before exhaling
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Inhale while counting to 4 and exhale while counting to 2
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Place his hands on the side of his rib cage
Explanation
Pursed-lip breathing involves inhaling slowly and evenly through the nose, then exhaling slowly through lips held in a pursed (puckered) position, similar to blowing out a candle. This technique prolongs exhalation, helps keep airways open longer, and reduces air trapping, which improves gas exchange in clients with chronic respiratory illnesses such as COPD.
Why the other options are incorrect:
B. Holding the breath for 20 seconds is not part of pursed-lip breathing technique and does not offer the therapeutic benefit of prolonged, controlled exhalation.
C. The proper technique emphasizes a longer exhalation than inhalation (typically inhale for 2 counts, exhale for 4), which is the reverse of what is described here.
D. Placing hands on the rib cage is associated with diaphragmatic breathing technique, not pursed-lip breathing.
A nurse is teaching a community group of parents of school-aged children about risk factors influencing patient safety. The nurse should prioritize education on the proper use of which of the following items?
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Soccer shin guards
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Swimming goggles
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Baseball sliding shorts
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A bicycle helmet
Explanation
Correct Answer Is:
D
Why the other options are incorrect:
A. Shin guards protect against relatively minor lower-extremity injuries during soccer and do not carry the same risk of life-threatening injury as inadequate helmet use.
B. Swimming goggles primarily protect eye comfort and vision in water and are not associated with major safety risks warranting priority education.
C. Sliding shorts provide minor protective padding during baseball but do not address a high-risk, potentially fatal injury category like head trauma.
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