Question

1. A nurse is preparing to administer IV fluids to a client. The nurse notes sparks when plugging in the IV pump. Which of the following actions should the nurse take first?
   1. Label the pump with a defective equipment sticker.
   2. Unplug the pump.
   3. Obtain a replacement pump.
   4. Notify the biomedical department to fix the pump.
2. A nurse is caring for a client who has a surgical wound. Which of the following laboratory values places the client at risk for poor wound healing?
   1. Serum albumin 3 g/dL
   2. Total lymphocyte count 2,400 mm3
   3. Hct 42%
   4. Hgb 16 g/dL
3. A nurse is preparing to check a client’s blood pressure. Which of the following actions should the nurse take?
   1. Apply the cuff above the client’s antecubital fossa
   2. Use a cuff with a width that is about 60% of the client’s arm circumference.
   3. Have the client sit with his arm resting above the level of his heart.
   4. Release the pressure on the client’s arm 5 to 6 mm per second.
4. A nurse is preparing to perform nasotracheal suctioning for a client. Which of the following is an appropriate action for the nurse to take?
   1. Hold the suction catheter with the clean, nondominant hand.
   2. Apply intermittent suction for 20-30 seconds.
   3. Place the catheter in a location that is clean and dry for later use.
   4. Use surgical asepsis when performing the procedure.
5. A nurse is collecting a blood pressure (BP) reading from a client who is sitting in a chair. The nurse determines that the client's BP is 158/96 mm Hg. Which of the following actions should the nurse take?
   1. Ensure that the width of the BP cuff is 50% of the client’s upper arm circumference
   2. Reposition the client supine and recheck her BP.
   3. Recheck the client’s BP in her other arm for comparison.
   4. Request that another nurse check the client’s BP in 30 min.

Answer 1

Answer 2 :- B (total lymphocytes count is low cause poor wound healing. )

Answer 3 :-A ( BP cup apply at the heart level)

Answer 4 :- D (During nasotracheal suction use for aseptic technique to prevent infection. )

Answer 5:- B ( Recheck the BP change position, supine after 5 minutes. )