1. A nurse is assessment pressure ulcers on four clients to evaluate the effectiveness of a change in the wound

care procedure. Which of the following findings indicate wound healing.

a. erythema on the skin surrounding a client's wound

b. deep red color on the center of the client's wound

c. inflammation noted on the tissue edges of a client's wound

d. increase in serosanguinous exudate from the client's wound

2. A nurse receiving change of shift report at 0700 for four clients. which of the following actions should the

nurse perform first?

a. obtain a breakfast tray for a client who receiving a morning dose of insulin as part

b. administer pain medication to a client who has rheumatoid arthritis and received the last dose at

0400

c. restart an infiltrated IV for a client whose antibiotic is scheduled for 0900

d. Replace a client's enteral nutrition feeding solution that has been hanging for 24 hours

3. A nurse is orienting a newly license nurse on the neurological unit. Which of the following clients should

the nurse assign to the newly licensed nurse?

a. a client who has multiple sclerosis and ataxia

b. a client who has a brain tumor and is admitted for chemotherapy

c. a client who has Guillain-Barre syndrome and a tracheostomy

d. a client who sustained a concussion and is being monitored for complications.

4. A nurse is providing teaching to a client about advance directives. Which of the following client statements

by the client indicates an understanding of the teaching?

a. "Once I sign my living will, a family member must co-sign it."

b. "I will wait until I have a serious health problem to sign my advance directive"

c. "My doctor will need to provide approval for the decisions outlined in my living will"

d. My durable power of attorney for health care is part of my advance directive"

5. A nurse is chairing a committee about preventing infant abduction in a new birth care center. Which of the

following quality control tasks should the nurse assign to be completed first?

a. identify the industry standards for infant safety

b. evaluate the selected infant safety system

c. choose an infant safety system

d. establish measurement criteria for infant safety systems