The nursing instructor is having a group discussion about the functions of the skin prior to reviewing common skin disorders. The instructor is pleased when the students answer (SATA).

Metabolism.

Temperature regulation.

Protection.

Sensory processing.

Chemical synthesis.

Answer and Explanation

Correct Answer : B,C,D,E

"Temperature regulation," "Protection," "Sensory processing," and "Chemical synthesis." These are all functions of the skin that the nurse should expect students to identify during a group discussion about the skin's functions. Choice A, "Metabolism," is not a primary function of the skin, although the skin does play a role in the synthesis of vitamin D, which can impact metabolism.

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Correct Answer is A

Explanation

Giving non-prescription laxatives to a client with cirrhosis can cause severe dehydration and electrolyte imbalances, which can be life-threatening. The nurse should report this intervention immediately to the physician.

Choice B is incorrect because measuring abdominal girth is a standard nursing intervention for clients with cirrhosis to assess for ascites.

Choice C is incorrect because asking the client about food intake is a standard nursing intervention for assessing nutritional status.

Choice D is incorrect because checking for signs of hepatic encephalopathy is a standard nursing intervention for clients with cirrhosis.

A. The client's vital signs are temperature, 101.9 F; heart rate, 88 beats/minute; respiratory rate, 18 breaths/minute, and blood pressure, 138/80 mm Hg. B. The client has periorbital edema and ecchymosis. C. The client prefers to rest in the semi-Fowler's position. D. The client's level of consciousness has improved.

Correct Answer is A

Explanation

The client's vital signs are temperature, 101.9 F; heart rate, 88 beats/minute; respiratory rate, 18 breaths/minute, and blood pressure, 138/80 mm Hg. An elevated temperature is a significant finding that may indicate the presence of an infection, which can cause further neurological damage in a client with an intracranial injury. The physician should be notified promptly, as the client may require antibiotic therapy to prevent the spread of infection.

B. Periorbital edema and ecchymosis are normal findings following head injury and should be monitored but do not require immediate intervention.

C. Resting in semi-Fowler's position is an appropriate position to maintain after intracranial pressure-reducing surgery.

D. Improved level of consciousness is a positive finding and indicates that the client is responding well to treatment.

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The nursing instructor is having a group discussion about the functions of the skin prior to reviewing common skin disorders. The instructor is pleased when the students answer (SATA).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While performing a physical examination on a client with cirrhosis, which of the following interventions should the nurse report immediately to the physician?

Correct Answer is A

Explanation

The nurse is caring for a postoperative client who had surgery to decrease intracranial pressure after suffering a head injury. Which assessment finding is promptly reported to the physician?

Correct Answer is A

Explanation

A suspicious breast lump is noted on a mammogram. The client asks the nurse which diagnostic test confirms if the lump is cancerous or benign. Which response by the nurse is most correct?

A client has a history of dislocations of the same joint. The nurse understands that this is most likely due to an insufficient deposit of collagen during the healing process leading to which of the following?

During a pharmacology class, the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?

The nurse is assessing the abdomen of the client with an undiagnosed disorder. In which sequence would the nurse conduct the abdominal assessment? (Use all options.)

The nursing student is taking an anatomy and physiology class. What anatomical structure equalizes air pressure in the middle ear?

A client, who is recovering from bariatric surgery, is eating from a po [portable commode]. Nursing assessment is of greatest concern in the immediate postoperative period for which of the following?

The nurse is caring for a client with a neurological deficit. In assessing the client, the nurse will utilize the standard Glasgow Coma Scale. What will the nurse be assessing on this patient? Select all that apply.

The nurse is performing an assessment of the thyroid gland. In order to decrease the risk that the nurse will stimulate the release of large amounts of thyroid hormone, what should the nurse be sure to do?