NCLEX-PN Exam Dumps | A patient has suffered a left CVA and has developed severe hemiparesis resulting in a loss of mobility.

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Question 366/700

A patient has suffered a left CVA and has developed severe hemiparesis resulting in a loss of mobility. The nurse notices on assessment that an area over the patient's left elbow appears as non-blanchable erythema and the skin is intact. The nurse should score the patient as having which of the following?

A. Stage I pressure ulcer

B. Stage II pressure ulcer

C. Stage III pressure ulcer

D. Stage IV pressure ulcer

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She stated the...; Question 446: A thirty-seven year-old female in room 307 has a diagnosis o...; Question 447: People-related supervisory tasks include all of the followin...; Question 448: A contraindication for topical corticosteroid use in a clien...; Question 449: Which of the following should be included in a diet rich in ...; Question 450: Health promotion activities are designed to help clients:...; Question 451: During a routine health screening, the nurse should talk to ...; Question 452: Spirituality affects a client's life in all of the following...; Question 453: Pulling is easier than pushing. So pulling a client rather t...; Question 454: A nurse is screening patients for various vaccines. Which of...; Question 455: Medication bound to protein can have which of the following ...; Question 456: The nurse is preparing to administer IV Vancomycin to a clie...; Question 457: A nurse observes a client sitting alone and talking. When as...; Question 458: When a woman is receiving postpartum epidural morphine, the ...; Question 459: A client with sickle cell disease is worried about passing t...; Question 460: The death of a beloved spouse places the surviving partner i...; Question 461: A patient has a history of cardiac arrhythmia. A nurse has b...; Question 462: During the health screening of an adolescent, which finding ...; Question 463: A couple from the Philippines living in the United States is...; Question 464: A 12-year-old male is brought to his primary care provider t...; Question 465: The method of splinting is always dictated by:...; Question 466: Which of the following foods is a complete protein?...; Question 467: The nurse provides a postoperative client with an analgesic ...; Question 468: Which is an appropriate outcome for the nursing diagnosis of...; Question 469: A client is taking the fluoroquinolone Ciprofloxin for acute...; Question 470: How does the ANA define the psychiatric nursing role?...; Question 471: When questioning an elder about suspected abuse, the nurse s...; Question 472: People who live in poverty are most likely to obtain health ...; Question 473: The nurse should utilize data about which of the following t...; Question 474: Some drugs are excreted into bile and delivered to the intes...; Question 475: A patient has just been prescribed Minipress to control hype...; Question 476: When a client with a major burn experiences body image distu...; Question 477: Metformin (Glucophage) is administered to clients with type ...; Question 478: Which of the following is not considered one of the five rig...; Question 479: Following a classic cholecystectomy resection for multiple s...; Question 480: Which of the following is one of the main goals for Healthy ...; Question 481: The nurse who was not promoted tells another friend, "I knew...; Question 482: A teenage client is admitted to the hospital because of acet...; Question 483: A patient has recently been prescribed Albuterol. Which of t...; Question 484: When suctioning a client, what is the usual amount of time t...; Question 485: The kind of man who beats a woman is:...; Question 486: Which of the following nursing diagnoses might be appropriat...; Question 487: Which statement best describes electrolytes in intracellular...; Question 488: Which of the following statements by an adult child of a cli...; Question 489: A corporate executive works 60-80 hours a week. The client i...; Question 490: A man expresses surprise that his wife has become very withd...; Question 491: An example of an extended care facility is a:...; Question 492: Which of the following procedures describes an opening betwe...; Question 493: A client describes her cervical mucus as clear, thin, and el...; Question 494: A nurse is returning phone calls in a pediatric clinic. Whic...; Question 495: The best definition of communication is:...; Question 496: After securing the client's safety from a faulty electric be...; Question 497: After breast reconstruction secondary to breast cancer, the ...; Question 498: Kleinman's Explanatory Model of Health and Illness is signif...; Question 499: Which type of exercises might be prescribed to strengthen th...; Question 500: A client with an ileus is placed on intestinal tube suction....; Question 501: Which of the following motions is identified with the corres...; Question 502: Which medication might the physician order if the client exp...; Question 503: A client is taking hydrocodone (Vicodin) for chronic back pa...; Question 504: An appropriate question when assessing a client's self-expec...; Question 505: A nurse observes a client sitting alone and talking. When as...; Question 506: In a disaster, triage situation, the nurse should be least c...; Question 507: The parents of a 2-year-old child ask the nurse how they can...; Question 508: A nurse is instructing a person who had a left CVA and right...; Question 509: One day postoperative, the client complains of dyspnea, and ...; Question 510: When making an occupied bed, it is important for the nurse t...; Question 511: Nursing care for a client undergoing chemotherapy includes a...; Question 512: A 4-year-old client is unable to go to sleep at night in the...; Question 513: A client with asthma develops respiratory acidosis. Based on...; Question 514: A nursing care plan for a client with sleep problems has bee...; Question 515: One of the major functions of the kidneys in maintaining nor...; Question 516: When the nurse is determining the appropriate size of an oro...; Question 517: American families are having difficulty adequately performin...; Question 518: Signs of impaired breathing in infants and children include ...; Question 519: A nurse suspects a patient is developing Bell's Palsy. The n...; Question 520: A legal right to confidentiality of client information is wa...; Question 521: An Rh-negative woman with previous sensitization has deliver...; Question 522: The nurse is teaching a client about communicable diseases a...; Question 523: A hospitalized adult client who routinely works from midnigh...; Question 524: When choosing a needle gauge for an intramuscular injection ...; Question 525: A client has experienced a CVA with right hemiparesis and is...; Question 526: A client with massive chest and head injuries is admitted to...; Question 527: When giving an intramuscular injection to an infant. Which o...; Question 528: To remove a client's gown when she has an intravenous line, ...; Question 529: A 20-year-old male client had a diving accident with subsequ...; Question 530: A client is having problems with her ankles. To assess her a...; Question 531: A patient that has TB can be taken off restrictions after wh...; Question 532: A client has been diagnosed with Disseminated Intravascular ...; Question 533: A health care worker is concerned about a new mother being o...; Question 534: A nurse is teaching a group of clients with a diagnosis of S...; Question 535: A client is told that his test is positive, but in fact, the...; Question 536: An advance directive is written and notarized according to l...; Question 537: A client is diagnosed with HIV. Which of the following are a...; Question 538: A fifty-five year-old man suffered a left frontal lobe CVA. ...; Question 539: A 2-year-old child diagnosed with HIV comes to a clinic for ...; Question 540: When working with multicultural populations, the nurse shoul...; Question 541: For a client requiring total oral care, it is important for ...; Question 542: To manage time most effectively, the nurse responds to which...; Question 543: Safety measures for using crutches must be taught to clients...; Question 544: A 10-month-old child is brought to the Emergency Department ...; Question 545: A client receiving drug therapy with furosemide and digitali...; Question 546: A client who is experiencing infertility says to the nurse, ...; Question 547: In managing nausea related to Morphine epidural analgesia, t...; Question 548: A female having her first child is experiencing which type o...; Question 549: Quality is defined as a combination of all of the following ...; Question 550: A client turns her ankle. She is diagnosed as having a Pulle...; Question 551: Which of the following microorganisms are considered normal ...; Question 552: The highest incident of child abuse occurs in children in wh...; Question 553: Padding on a restraint helps:; Question 554: The tendency of a drug to combine with its receptor is calle...; Question 555: The nurse is caring for a dying client who has persistently ...; Question 556: Which of the following is responsible for laws mandating the...; Question 557: A client with a diagnosis of Schizophrenia has been released...; Question 558: If a client is suffering from thyroid storm, the PN can expe...; Question 559: The PN is caring for a client with diabetes insipidus. The n...; Question 560: Which of the following syndromes associated with incomplete ...; Question 561: Referral for client education in the community can be accomp...; Question 562: Which of the following developmental milestones for a 6-mont...; Question 563: Using clichés in therapeutic communication leads the client ...; Question 564: The physician wants to know if a client is tolerating his to...; Question 565: A nurse working in a pediatric clinic and observes the follo...; Question 566: The nurse has completed client teaching about introducing so...; Question 567: When a client who is having trouble conceiving says to the n...; Question 568: A case management clinical pathway for congestive heart fail...; Question 569: Which of the following represents a normal serum potassium l...; Question 570: A 32 year-old male with a complaint of dizziness has an orde...; Question 571: A nurse is instructing a patient about the warning signs of ...; Question 572: Clients who take iron preparations should be warned of the p...; Question 573: Which of the following vaccines are not part of the regular ...; Question 574: The primary organ for drug elimination is the:...; Question 575: When a client has a chest drainage system in place, where sh...; Question 576: For which of the following conditions might blood be drawn f...; Question 577: All of the following are causes of vaginal bleeding in late ...; Question 578: Which of the following is likely to increase the risk of sex...; Question 579: Which of the following statements by a client indicates adeq...; Question 580: Light therapy can be effective for:...; Question 581: A client and his family facing the end stage of a terminal i...; Question 582: Which of the following conditions is mammography used to det...; Question 583: Which of the following blood pressure parameters indicates P...; Question 584: Which of the following values should the nurse monitor close...; Question 585: A female client complains to the nurse at the health departm...; Question 586: Which of the following medications should be held 24-48 hour...; Question 587: The nurse teaching an obese client about nutritional needs a...; Question 588: The ICU nurse caring for a client who has just been declared...; Question 589: A 13 year old girl is admitted to the ER with lower right ab...; Question 590: A nurse teaching a patient with COPD pulmonary exercises sho...; Question 591: A client taking isotretinoin (Accutane) tells the nurse that...; Question 592: A nurse runs into the significant other of a patient with en...; Question 593: The major electrolytes in the extracellular fluid are:...; Question 594: The Token Economy is a type of therapy that focuses on:...; Question 595: Which of the following arterial blood gas values indicates a...; Question 596: When discussing the patterns of use of alcohol and other dru...; Question 597: A person using over-the-counter nasal decongestant drops who...; Question 598: A client who has a known history of cardiac problems and is ...; Question 599: A nurse is assessing a patient in the rehab unit at shift ch...; Question 600: In teaching clients with Buck's Traction, the major areas of...; Question 601: The greatest time savers when planning client care include a...; Question 602: A client with a nasogastric (NG) tube begins vomiting. What ...; Question 603: The nurse supporting a family who has just experienced a sud...; Question 604: An appraisal of self-care practices involves an assessment o...; Question 605: Two staff nurses were considered for promotion to head nurse...; Question 606: A serious complication of a total hip replacement is displac...; Question 607: Which of the following coping mechanisms protects an individ...; Question 608: Which of the following vaccines is a live virus?...; Question 609: While admitting a client to an acute-care psychiatric unit, ...; Question 610: The nurse observes bilateral bruises on the arms of an elder...; Question 611: Which of the following actions should a nurse take first for...; Question 612: Mr. H is upset regarding being in the hospital for another d...; Question 613: Nurses caring for clients who have cancer and are taking opi...; Question 614: If Ms. Barrett's distance vision is 20/30, which of the foll...; Question 615: The nurse is assessing an elder who the nurse suspects is be...; Question 616: When medications have an additive, synergistic, or antagonis...; Question 617: Which of the following terms refers to soft-tissue injury ca...; Question 618: The nurse teaching a client about hepatitis and its transmis...; Question 619: If a client has chronic renal failure, which of the followin...; Question 620: Support systems during the grieving process include all of t...; Question 621: Which direction given to the nursing assistant is most likel...; Question 622: Ten-year-old Jackie is admitted to the hospital with a medic...; Question 623: Which of the following tests is commonly performed on newbor...; Question 624: The nurse should teach a client in the Emergency Department,...; Question 625: Which of the following observations is most important when a...; Question 626: A client diagnosed with Borderline Personality Disorder freq...; Question 627: A client recently lost a child due to poisoning. The client ...; Question 628: Acyclovir (Zovirax) is the agent of choice for which of the ...; Question 629: A client begins a regimen of chemotherapy. Her platelet coun...; Question 630: A nurse at outpatient clinic is returning phone calls that h...; Question 631: The goals of palliative care include all of the following ex...; Question 632: A client was involved in a motor vehicle accident in which t...; Question 633: Distraction therapy is:; Question 634: Rehabilitation services begin:; Question 635: A nurse has been ordered to administer Morphine to a patient...; Question 636: A concern regarding maternal and infant mortality and morbid...; Question 637: In a disaster situation, the nurse assessing a diabetic clie...; Question 638: A nurse has been ordered to set-up Buck's traction on a pati...; Question 639: A client with stress incontinence should be advised:...; Question 640: A 60-year-old widower is hospitalized after complaining of d...; Question 641: Attaching a restraint to a side rail or other movable part o...; Question 642: A nurse is screening patients for immunizations. Which of fo...; Question 643: When a couple experiencing infertility presents for a fertil...; Question 644: A nurse is assigned to do pre-operative teaching on a blind ...; Question 645: Two staff nurses were considered for promotion to head nurse...; Question 646: Which type of dressing is recommended to place over a site w...; Question 647: When assessing a client in the Emergency Department whose me...; Question 648: Which of the following individuals may legally give informed...; Question 649: Which of the following home-care strategies is most likely t...; Question 650: A client is 36 hours post-op a TKR surgery. 270 cc's of sero...; Question 651: After 12 months of cessation of menses, which of the followi...; Question 652: While repositioning a comatose client, the nurse senses a ti...; Question 653: A 24 year-old man has been admitted to the hospital due to w...; Question 654: Which of the following foods present a problem for a client ...; Question 655: According to the ANA Code of Ethics for Nurses, professional...; Question 656: Broccoli, oranges, dark greens, and dark yellow vegetables c...; Question 657: A hospitalized client has just been informed that he has ter...; Question 658: A client with a pleural drainage system to suction has gentl...; Question 659: When caring for a Native-American family, the nurse needs to...; Question 660: Which of the following microorganisms is easily transmitted ...; Question 661: A client begins bleeding from the site of a previous arteria...; Question 662: A child comes to the clinic with a skin rash. The maculopapu...; Question 663: A 28 year-old male has a diagnosis of AIDS. The patient has ...; Question 664: A patient is scheduled for electro-convulsive therapy treatm...; Question 665: On first meeting, a new nurse manager makes eye contact, smi...; Question 666: The nurse notices that a family is waiting at the nursing st...; Question 667: Ethical and moral issues concerning restraints include all o...; Question 668: Which of the following strategies should the nurse include w...; Question 669: Erythropoietin used to treat anemia in clients with renal fa...; Question 670: Acute hyphema is associated with what type of injury?...; Question 671: A client with major head trauma is receiving bolus enteral f...; Question 672: A visitor accidentally knocks over a plastic pleural drainag...; Question 673: A patient that has delivered a 8.2 lb. baby boy 3 days ago v...; Question 674: Mr. Lee comes to the clinic with thick green drainage around...; Question 675: The 24-hour day-night cycle is known as:...; Question 676: A complication of total parenteral nutrition (TPN) is the de...; Question 677: In administering NSAID adjunctive therapy to an elderly clie...; Question 678: During the work phase of the nurse-client relationship, the ...; Question 679: A patient has experienced a severe third degree burn to the ...; Question 680: Why is it often necessary to draw a complete blood count and...; Question 681: When a client who is 25 years of age asks the nurse when she...; Question 682: Chemotherapeutic agents often produce a degree of myelosuppr...; Question 683: Which of the following solutions is routinely used to flush ...; Question 684: When a client informs the nurse that he is experiencing hypo...; Question 685: The nurse who was not promoted then went to the utility room...; Question 686: A nurse is assessing a 18 year-old female who has recently s...; Question 687: Teaching the client with gonorrhea how to prevent reinfectio...; Question 688: A client is admitted with a diagnosis of Multiple Drug Use. ...; Question 689: A nurse is setting up a vision-screening program for a new s...; Question 690: Which of the following medications is a serotonin antagonist...; Question 691: Which type of diet should the nurse provide to help a client...; Question 692: As part of the teaching plan for a client with type I diabet...; Question 693: A client has been taking a drug (Drug A) that is highly meta...; Question 694: A 20-year-old obese female client is preparing to have gastr...; Question 695: The acts enacted by states to provide immunity from liabilit...; Question 696: In an obstetrical emergency, which of the following actions ...; Question 697: Which of the following physical findings indicates that an 1...; Question 698: When a client needs oxygen therapy, what is the highest flow...; Question 699: A successful resolution of the nursing diagnosis Negative Se...; Question 700: A pregnant client has congenital heart disease. The nurse sh...

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