NGN Style Question the Client Is a 38 - Year Old Female Who Was Brought to the Hospital Following a Workplace Accident. She Has a Deep Laceration to Her Cleft

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Sample questions from NGN Style Question the Client Is a 38 - Year Old Female Who Was Brought to the Hospital Following a Workplace Accident. She Has a Deep Laceration to Her Cleft

This material has 150 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 38-year-old warehouse worker has a deep laceration through the gluteal cleft after falling onto exposed metal. The wound is packed with gauze, and the client is pale and diaphoretic. HR is 124/min, RR 24/min, BP 88/54 mm Hg, and SpO2 97% on room air. Which action should the nurse take first?

   • A.Prepare the client for wound irrigation and primary closure.
   • B.Remove the packing to inspect the full depth of the wound and identify the bleeding vessel.
   • C.Obtain a detailed account of the accident and document the client's tetanus immunization history.
   • D.Apply firm direct pressure over the wound while another team member activates the emergency response and obtains large-bore IV access.

   Rationale: The hypotension, tachycardia, pallor, and diaphoresis indicate possible hemorrhagic shock, so controlling external bleeding and mobilizing resuscitation are immediate priorities. Removing packing may disrupt clot formation and worsen bleeding. History-taking and definitive wound care are important but must wait until circulation and hemorrhage are addressed.

2. 2.At change of shift on a surgical unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 72-year-old client with chronic heart failure who has bilateral ankle edema unchanged from yesterday and an SpO2 of 94% on room air.
   • B.A 67-year-old client 1 day after colectomy who reports incisional pain of 7/10 and has a BP of 146/84 mm Hg.
   • C.A 24-year-old client with a repaired hand laceration who has new numbness and increasing tightness beneath the dressing.
   • D.A 51-year-old client awaiting discharge who needs review of wound-care instructions.

   Rationale: New numbness and increasing tightness under a dressing may signal impaired perfusion or evolving compartment syndrome, which requires prompt assessment and intervention. The postoperative client's pain needs treatment, but the reported vital signs do not suggest immediate instability. Unchanged chronic edema and discharge teaching can be addressed after the threatened limb is assessed.

3. 3.Refer to the client's chart. Which actions should the nurse take now for this 38-year-old client with a deep gluteal-cleft laceration? Select all that apply.

   • A.Reassess vital signs and mental status frequently while preparing for transfer to a higher level of care.
   • B.Prioritize obtaining a complete occupational history before intervening on the wound.
   • C.Maintain firm direct pressure over the wound and reinforce the existing packing without removing it.
   • D.Establish large-bore IV access and anticipate isotonic fluid resuscitation and blood products as prescribed.
   • E.Activate the rapid response or trauma response and notify the provider of the deteriorating perfusion findings.
   • F.Ask the client to stand so the nurse can assess whether dizziness worsens with position change.

   Rationale: The chart shows worsening tachycardia and hypotension from 0900 to 1000, with new pallor and diaphoresis, so escalation, hemorrhage control, resuscitation preparation, and frequent reassessment are indicated. Removing or disturbing packing can worsen bleeding, and direct pressure should be maintained. Standing a client with suspected shock risks collapse, while a complete occupational history is secondary to stabilization.

4. 4.A provider prescribes IV heparin for a 56-year-old client with a new pulmonary embolism. The client also has a deep laceration that was repaired earlier today. The aPTT is 118 seconds (therapeutic range 60-80 seconds), and the dressing has a new area of sanguineous drainage. Which action should the nurse take first?

   • A.Hold the heparin infusion and promptly notify the provider of the supratherapeutic aPTT and bleeding.
   • B.Remove the dressing and apply an antiseptic solution to the incision.
   • C.Administer the next scheduled dose of an oral anticoagulant to maintain therapeutic coverage.
   • D.Continue the infusion because pulmonary embolism treatment takes priority over wound drainage.

   Answer and rationale are in the full material.

5. 5.During a home visit, a 79-year-old client with a healing lower-leg wound says, 'I cannot see the label on my warfarin bottle, so I take one tablet whenever my leg looks more swollen.' The client has new bruising, an INR of 5.6 (target range 2.0-3.0), and no active bleeding. Which nursing action is the priority?

   • A.Ask the client to stop all fluids until the bruising resolves.
   • B.Hold further warfarin doses and contact the prescribing clinician promptly for management instructions.
   • C.Instruct the client to take the usual dose tonight and recheck the INR next week.
   • D.Have the client double the next dose if the leg swelling continues.

   Answer and rationale are in the full material.