Clinical Nursing Skills
Pre-Test Questions
Course Introduction
Clinical Nursing Skills is a comprehensive course designed to equip students with the foundational competencies required in nursing practice. Through a combination of theoretical instruction and hands-on laboratory experiences, students develop proficiency in essential clinical techniques such as patient assessment, infection control, medication administration, wound care, vital sign monitoring, and basic life support. The course emphasizes the application of evidence-based practices, critical thinking, and effective communication within diverse healthcare settings to ensure safe and compassionate patient care. Students also learn to integrate ethical and legal principles in clinical decision-making, preparing them for professional roles in various clinical environments.
Recommended Textbook
Fundamentals of Nursing 8th Edition by Taylor
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45 Chapters
1562 Verified Questions
1562 Flashcards
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Page 2
Chapter 1: Introduction to Nursing
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Sample Questions
Q1) A nurse is caring for a young victim of a terrorist attack. During the rehabilitative process, the nurse assists the client in bathing and dressing. What role the nurse is engaged in?
A) Advocate
B) Caregiver
C) Counselor
D) Educator
Answer: B
Q2) A nurse receives an x-ray report on a newly admitted patient suspected of having a fractured tibia. The nurse contacts the physician to report the findings. What role is the nurse engaged in?
A) Communicator
B) Advocate
C) Caregiver
D) Researcher
Answer: A
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Chapter 2: Theory, Research, and Evidence-Based Practice
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Sample Questions
Q1) The nurse working in research correctly identifies which of the following to be mandatory for the ethical conduction of research in a hospital setting?
A) Clients must grant informed consent if they are to participate.
B) All interventions must benefit all clients.
C) The client must directly and personally benefit from the research.
D) Descriptive studies are more ethical than experimental studies.
Answer: A
Q2) Which of the following are characteristics of nursing theories? Select all that apply.
A) They provide rational reasons for nursing interventions.
B) They are based on descriptions of what nursing should be.
C) They provide a knowledge base for appropriate nursing responses.
D) They provide a base for discussion of nursing issues.
E) They help resolve current nursing issues and establish trends.
Answer: A, C, D, E
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4
Chapter 3: Health, Illness, and Disparities
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Sample Questions
Q1) The nurse is performing a routine assessment of a male client who has an artificial arm as a result of a small plane crash many years earlier. How should the nurse best understand this client's health?
A) Despite the loss of his limb, the client may consider himself to be healthy.
B) The client may be well, but his loss of limb means that he is unhealthy.
C) The loss of his limb prevents the client from achieving wellness, though he may be healthy.
D) Because the client's injury is far in the past, it does not have a bearing on his health or wellness.
Answer: A
Q2) An woman 80 years of age has had a cerebrovascular accident. She has flaccidity of her right side with aphasia. For this client, which of the following activities constitutes tertiary prevention?
A) Assessment of her blood pressure
B) Daily bleeding and clotting times
C) Gait training and speech therapy
D) Education on the symptoms of a CVA
Answer: C
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Chapter 4: Health of the Individual, Family, and Community
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Sample Questions
Q1) A couple recently married. Both the husband and the wife have previously been married and had two children. What name is given to this type of family?
A) Extended family
B) Nuclear family
C) Blended family
D) Cohabiting family
Q2) Five functions have been identified as being essential to the growth of individuals and families. One of these functions is education and support. How is support manifested in the context of coping with crisis and illness situations?
A) Making clear distinctions between the generations
B) Actions that tell family members they are cared about and loved
C) The promotion of exercise in the lifestyle
D) Transmitting culture and acceptable behaviors
Q3) What is one method by which a nurse can be a role model to promote health in the community?
A) Demonstrating a healthy lifestyle
B) Becoming a member of a family
C) Meeting own basic needs
D) Exhibiting self-actualization
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Page 6
Chapter 5: Cultural Diversity
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Sample Questions
Q1) When providing care on an Indian reservation, the nurse has prioritized assessments for diabetes and fetal alcohol syndrome when working with residents of the reservation. How should this nurse's practice be best understood?
A) The nurse is correct in assessing for health problems that have a higher incidence and prevalence among this population.
B) The nurse is stereotyping American Indians as leading unhealthy lifestyles and abusing alcohol.
C) The nurse is performing cultural imposition of the majority American culture, and the accompanying beliefs around diabetes and alcohol use.
D) The nurse should seek specific permission from each client before proceeding with these assessments.
Q2) When providing nursing care to an African American individual, which of the following cultural factors should the nurse consider?
A) Values and beliefs are often present oriented.
B) Families are usually patriarchal.
C) They possess weak religious affiliations.
D) Families are highly competitive.
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Chapter 6: Values, Ethics, and Advocacy
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Sample Questions
Q1) Which of the following are examples of a nurse demonstrating the professional value of altruism? Select all that apply.
A) The nurse arranges for an interpreter for a client whose primary language is Spanish.
B) The nurse calls the physician of a client whose pain medication is not strong enough.
C) The nurse provides information for a client so he is capable of participating in planning his care.
D) The nurse reviews a client chart to determine who may be informed of the patient's condition.
E) The nurse documents client care accurately and honestly and reviews the entry to ensure there are no errors.
Q2) A woman age 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. This is an example of what ethical principle?
A) Nonmaleficence
B) Veracity
C) Autonomy
D) Justice
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8
Chapter 7: Legal Dimensions of Nursing Practice
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Sample Questions
Q1) A client refuses to have a pain medication administered by injection. A nurse says, "If you don't let me give you the shot, I will get help to hold you down and give it." With what crime might the nurse be charged?
A) Assault
B) Battery
C) Negligence
D) Defamation
Q2) Which of the following is the nurse's best legal safeguard?
A) Collective bargaining
B) Written or implied contracts
C) Competent practice
D) Patient education
Q3) A nurse has taken a telephone order from a physician for an emergency medication. The dose of the medication is abnormally high. What should the nurse do next?
A) Administer the medication based on the order
B) Question the order for the medication
C) Refuse to administer the medication
D) Document concerns about the order
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9
Chapter 8: The Health Care Delivery System
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Sample Questions
Q1) A nurse has been hired to work as an occupational health nurse. In this position as a registered nurse, what will this nurse provide?
A) Occupational therapy to schoolchildren.
B) Education and safety programs in industrial settings.
C) Assessment and motivation services to the unemployed.
D) Activities to assist patients with ADLs in homeless shelters.
Q2) The Public Health Service (PHS) is a federal agency of the U.S. Department of Health and Human Services. The professional nurse is aware that the services provided by the PHS include which of the following? Select all that apply.
A) Care to migrant workers
B) Care in federal prisons
C) Veterans Administration (VA) hospitals
D) Indian Health Services
Q3) Which of the following is true of long-term care facilities?
A) They provide care only to older adults.
B) They provide care for homeless adults.
C) They provide care to people of any age.
D) They provide care only for people with dementia.
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Chapter 9: Care Coordination and Continuity
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Sample Questions
Q1) Which one of the following roles of the home health care nurse illustrates the role of coordinator of services?
A) Providing certification for home care
B) Providing direct physical care to the client
C) Providing information about community resources
D) Educating the client and caregiver about wound care
Q2) Which of the following roles of the nurse is most important in providing continuity of care to clients? Select all that apply.
A) Educator
B) Collaborator
C) Mentor
D) Advocate
E) Role model
Q3) What technique should the nurse use to implement infection control in the home?
A) Avoid touching any object in the home, including door knobs.
B) Practice hand hygiene when beginning and ending the home visit.
C) Wear gloves at all times when in the home or traveling in the car.
D) Take prescribed antibiotics on a regular basis on working days.
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Chapter 10: Blended Competencies
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Sample Questions
Q1) A nurse interviews a pregnant teenager and documents her answers on the client record. At the same time, the nurse responds to the client's concerns and makes a referral for counseling and maternity care. This scenario is an example of which of the descriptors of the nursing process?
A) Systematic
B) Dynamic
C) Outcome oriented
D) Universally applicable
Q2) A home health nurse reviews the nursing care with the client and family and then mutually discusses the expected outcomes of the nursing care to be provided. Which step of the nursing process is the nurse illustrating?
A) Diagnosing
B) Planning
C) Implementing
D) Evaluating
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Chapter 11: Assessing
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Sample Questions
Q1) Which of the following examples of client data needs to be validated? Select all that apply.
A) A client has trouble reading an informed consent, but states he does not need glasses.
B) An elderly client explains that the black and blue marks on his arms and legs are due to a fall.
C) A nurse examining a client with a respiratory infection documents fever and chills.
D) A client in a nursing home states that she is unable to eat the food being served.
E) A pregnant client is experiencing contractions that are two minutes apart.
Q2) The nurse is using a systematic approach to the collection of assessment data. The nurse uses an assessment guide that uses a hierarchy of five life requirements universal to all persons. What model for organizing the assessment data is the nurse using?
A) Human Needs (Maslow) model
B) Functional Health Patterns model
C) Human Response Patterns model
D) Body System model
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Chapter 12: Diagnosing
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Sample Questions
Q1) A nurse who is caring for an unresponsive client formulates the nursing diagnosis, "Risk for Aspiration related to reduced level of consciousness." The nurse documents this nursing diagnosis as correct based on the understanding that which of the following is a characteristic of this type of diagnosis?
A) Is written as a two-part statement
B) Describes human response to a health problem
C) Describes potential for enhancement to a higher state
D) Made when not enough evidence supports the problem
Q2) A nurse develops a plan of care to meet the needs of a client who has had a large loss of blood after a snowmobile crash. Intravenous fluids and blood are administered and the nurse monitors the client's physiologic response. This action is known as a:
A) medical diagnosis.
B) nursing diagnosis.
C) collaborative problem.
D) goal for care.
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14
Chapter 13: Outcome Identification and Planning
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Sample Questions
Q1) The nurse is caring for a client who has been newly diagnosed with diabetes. One of the outcomes the nurse read on the client's plan of care this morning was: "Client will demonstrate correct technique for self-injecting insulin." The client required insulin prior to his lunch and successfully drew up and administered his insulin while the nurse observed. How should the nurse follow up this observation?
A) Record an evaluative statement in the client's plan of care.
B) Remove the outcome from the client's care plan.
C) Ask the nurse who wrote the plan of care to document this development.
D) Reassess the client's psychomotor skills at dinner time.
Q2) Critical thinking is an essential component in all phases of the nursing process. What question might be used to facilitate critical thinking during outcome identification and planning?
A) "How do I best cluster these data and cues to identify problems?"
B) "What problems require my immediate attention or that of the team?"
C) "What major defining characteristics are present for a nursing diagnosis?"
D) "How do I document care accurately and legally?"
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Page 15
Chapter 14: Implementing
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Sample Questions
Q1) Which is a responsibility of the nurse in the nurse-client-family team relationship?
A) Provide creative leadership to make the nursing unit a satisfying and challenging place to work.
B) Support the nursing care given by other nursing and non-nursing personnel.
C) Educate the family to be informed and assertive consumers of health care.
D) Coordinate the inputs of the multidisciplinary team into a comprehensive plan of care.
Q2) Educating clients on their diabetic regimen of administering insulin is the implementation of which skill?
A) Intrinsic
B) Technical
C) Interpersonal
D) Visual
Q3) A nurse delegates a specific intervention to a UAP. What implications does this have for the nurse?
A) The UAP is responsible and accountable for his or her own actions.
B) Nurses do not have authority to delegate interventions.
C) The nurse transfers responsibility but is accountable for the outcome.
D) The UAP can function in an independent role for all interventions.
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Page 16
Chapter 15: Evaluating
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Sample Questions
Q1) An expected client outcome is, The client will remain free of infection by discharge. When evaluating the client's progress, the nurse notes the client's vital signs are within normal limits, the white blood cell count is 12,000, and the client's abdominal wound has a half-inch gap at the lower end with yellow-green discharge. Which statement would be an appropriate evaluation statement?
A) Goal partially met; client identified fever and presence of wound discharge.
B) Client understands the signs and symptoms of infection.
C) Goal partially met; client able to perform activities of daily living.
D) Goal not met; white blood cell count elevated, presence of yellow-green discharge from wound.
Q2) A nurse is educating a client on how to administer insulin, with the expected outcome that the client will be able to self-administer the insulin injection. How would this outcome be evaluated?
A) Asking the client to verbally repeat the steps of the injection
B) Asking the client to demonstrate self-injection of insulin
C) Asking family members how much trouble the client is having with injections
D) Asking the client how comfortable he or she is with injections
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Page 17
Chapter 16: Documenting, Reporting, Conferring, and Using Informatics
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Sample Questions
Q1) The nurse managers of a home health care office wish to maximize nurses' freedom to characterize and record client conditions and situations in the nurses' own terms. Which of the following documentation formats is most likely to promote this goal?
A) Narrative notes
B) SOAP notes
C) Focus charting
D) Charting by exception
Q2) In which of the following cases should a progress note be written? Select all that apply.
A) For any nurse-client interaction
B) When admitting a client
C) When receiving a client postoperatively
D) When assisting a client with ADLs
E) When a procedure is performed
Q3) What is the nurse's best defense if a client alleges nursing negligence?
A) Testimony of other nurses
B) Testimony of expert witnesses
C) Client's record
D) Client's family
18
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Chapter 17: Developmental Concepts
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Sample Questions
Q1) A boy age 4 years is constantly seeking out and exploring new experiences, and repeatedly asking his parents why-type questions. The boy's behavior suggests that he is successfully navigating an important developmental task within the developmental theory of:
A) Erikson
B) Freud
C) Kohlberg
D) Fowler
Q2) According to Erikson, normal adolescent behavior includes trying on new roles and possibly even rebelling. What is the purpose of this behavior in adolescents?
A) To establish a sense of security
B) To establish a sense of identity
C) To gain autonomy
D) To avoid inferiority
Q3) A child gains weight and becomes taller each year. What is this process called?
A) Development
B) Orderly change
C) Progression
D) Growth
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Page 19
Chapter 18: Conception Through Young Adult
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Q1) A nurse documents the following data upon assessment of a neonate: heart rate 89 BPM, slow respiratory effort, flaccid muscle tone, weak cry, and pale skin tone. What would be the Apgar score for this neonate?
A) 2
B) 3
C) 4
D) 5
Q2) The nurse is educating a Young Childcare class and one of the parents asks what kinds of actions on his part may increase safety for his 14-month-old daughter during the next 2 years. Which of the following responses would be appropriate? Choose all that apply.
A) Keep medications locked away
B) Keep plastic bags out of reach
C) Use approved car seats
D) Teach to chew small food well
E) Do not swing by arms or legs
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Chapter 19: The Aging Adult
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Sample Questions
Q1) Which of the following are physical changes that occur in middle adulthood? Select all that apply.
A) Body fat is redistributed.
B) The skin is more elastic.
C) Cardiac output begins to increase.
D) Muscle mass gradually decreases.
E) There is a loss of calcium from bones.
Q2) According to Erikson, the middle adult is in a period of generativity versus stagnation. What happens if developmental tasks are not achieved?
A) Physical changes are denied
B) Health needs become a major concern
C) Motivation to learn is decreased
D) Awareness of own mortality increases
Q3) A nurse is providing care to an older adult at home after major abdominal surgery. Which of the following nursing diagnoses would most likely be appropriate?
A) Adult Failure to Thrive
B) Anticipatory Grieving
C) Impaired Memory
D) Risk for Infection
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Page 21
Chapter 20: Communicator
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Sample Questions
Q1) A nurse pays a house visit to a client who is on total parenteral nutrition. The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse?
A) Tell me more about how it feels to eat with your family.
B) You can sit with your family at meal times, even though you don't eat.
C) In a few weeks you may be allowed to eat a little; you may enjoy then.
D) I know that you must be missing your favorite foods.
Q2) A nurse uses the SBAR method to hand off the communication to the health care team. Which of the following might be listed under the "B" of the acronym?
A) Vital signs
B) Mental status
C) Client request
D) Further testing
Q3) Which of the nursing roles is primarily performed during the working phase of the helping relationship?
A) Educator and counselor
B) Provider of care
C) Leader and manager
D) Researcher
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Page 22
Chapter 21: Teacher and Counselor
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Sample Questions
Q1) A nurse notices that a toddler is constantly snatching toys from the hands of other preschool children at the health care facility, placing the toddler and other children at risk for injury. Which of the following would be a most effective method for teaching the toddler not to snatch toys?
A) Ask the children to play another game.
B) Tell the toddler that God punishes children who snatch.
C) Give the toddler another toy with which to play.
D) Enlist the aid of the toddler's parents in education.
Q2) A nurse instructs a client to tell her about the side effects of a medication. What learning domain is the nurse evaluating?
A) Affective
B) Cognitive
C) Psychomotor
D) Emotional
Q3) What is the most critical element of documentation of education?
A) A summary of the education plan
B) The implementation of the education plan
C) the client's need for learning
D) Evidence that learning has occurred
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Page 23
Chapter 22: Nurse Leader, Manager, and Care Coordinator
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Q1) The nurse is having an exceptionally busy shift on an obstetrical unit. Which of the following tasks is the nurse justified in delegating to an unlicensed care provider?
A) Emptying a client's Foley catheter bag and reporting the volume to the nurse
B) Helping a first-time mother achieve a good latch when breast-feeding her infant
C) Assessing the size and quantity of clots that are in a client's bedpan and informing the nurse
D) Giving an anti-inflammatory to a client who is eight hours postdelivery
Q2) A nurse is considering the delegation of administering medications to an unskilled assistant. What is the first question the nurse must ask herself before doing so?
A) Has the assistant been trained to perform the task?
B) Have I evaluated the client's response to this task?
C) Is the delegated task permitted by law?
D) Is appropriate supervision available?
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Chapter 23: Asepsis and Infection Control
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Q1) A nurse is performing a sterile dressing change. If new sterile items or supplies are needed, how can they be added to the sterile field?
A) With sterile forceps or hands wearing sterile gloves
B) By carefully handling them with clean hands
C) With clean forceps that touch only the outermost part of the item
D) By clean hands wearing clean latex gloves
Q2) A nurse is caring for a client with a serious bacterial infection. The client is dehydrated. Knowledge of the physical effects of the infection would support which of the following nursing diagnoses?
A) High Risk for Infection
B) Excess Fluid Volume
C) Risk for Imbalanced Body Temperature
D) Risk for Latex Allergy Response
Q3) The nurse is aware that an antiviral medication is most effective when given during which phase of the infectious process?
A) Prodromal stage
B) Incubation period
C) Full stage of illness
D) Convalescent period
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Page 25
Chapter 24: Vital Signs
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Q1) A nurse is assessing a client who has a fever, has an infection of a flank incision, and is in severe pain. What type of pulse rate would be likely?
A) Bradycardia
B) Tachycardia
C) Dysrhythmia
D) Bigeminal
Q2) Various sounds are heard when assessing a blood pressure. What does the first sound heard through the stethoscope represent?
A) Systolic pressure
B) Diastolic pressure
C) Auscultatory gap
D) Pulse pressure
Q3) What site for taking body temperature with a glass thermometer is contraindicated in clients who are unconscious?
A) Rectal
B) Tympanic
C) Oral
D) Axillary
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26
Chapter 25: Health Assessment
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Q1) An African American client with jaundice has been admitted to the health care facility. Which of the following body areas is the best place to assess jaundice?
A) Sclera
B) Nailbeds
C) Lips
D) Palm
Q2) A nurse is preparing to examine the breasts of a client. In what position should the nurse place the client?
A) Prone
B) Standing
C) Dorsal recumbent
D) Lithotomy
Q3) A nurse is conducting a health assessment. How will the information collected from the client be used?
A) As a basis for the nursing process
B) To illustrate nursing competence
C) To facilitate nurse-client caring
D) As one component of medical care
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Chapter 26: Safety, Security, and Emergency Preparedness
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Q1) A nurse specializes in caring for victims of domestic violence. Which of the following statements accurately describes domestic violence in the United States? (Select all that apply.)
A) Studies indicate that each year, more than 12 million adults in the United States are victims of intimate partner violence.
B) Intimate partner violence is domestic violence or battering between two people in a close relationship.
C) Many men who batter their spouses also batter their children.
D) There is no evidence linking childhood sexual abuse to adult physical symptoms or substance abuse.
E) Domestic violence is not seen in a cycle.
Q2) What age group is most vulnerable to toxic fumes or asphyxiation?
A) Young children
B) Adolescents
C) Toung adults
D) Middle adults
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Chapter 27: Complementary and Alternative Therapies
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Q1) Which of the following would be the least consistent as a reason for the use of complementary and alternative medicine (CAM)?
A) Increasing numbers of acute conditions
B) Dissatisfaction with conventional medicine
C) Difficulty meeting rising health care costs
D) Growth of culturally diverse groups
Q2) A client interested in acupuncture asks a nurse, "Just exactly what does it do?" What would the nurse explain?
A) "Acupuncture is based on a philosophy of laying on of hands."
B) "I don't think it does anything, so I don't know anything about it."
C) "It uses a manual process of adjusting the spine."
D) "It changes the flow of energy and helps healing."
Q3) The nurse caring for a Native American client plans care understanding that one belief of Native American healing practices is which of the following?
A) Modern life facilitates healing agents.
B) Healing takes time.
C) Balancing yin and yang is important.
D) Energy flows through meridians throughout the body.
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29
Chapter 28: Medications
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Q1) The nurse is preparing to administer a medication via a nasogastric tube. What guideline is appropriate for the nurse to follow when administering a drug via this route?
A) Flush the tube with water between each drug administered.
B) Position the client supine prior to administering the drug.
C) Administer the medication at a cold temperature.
D) If connected to suction, do not reconnect to suction for five minutes after drug administration.
Q2) A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets?
A) To prevent absorption in the mouth
B) To prevent absorption in the esophagus
C) To facilitate absorption in the stomach
D) To prevent gastric irritation
Q3) Which medication system allows for client independence?
A) Unit dose system
B) Self-administered medication system
C) Automated medication-dispensing system
D) Bar Code Medication Administration
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Chapter 29: Perioperative Nursing
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Q1) A nurse is assisting a physician during a cesarean section for a client. The client is administered epidural anesthesia. Which of the following is an advantage of epidural anesthesia?
A) It counteracts the effects of conscious sedation.
B) It decreases the risk of gastrointestinal complications.
C) It prevents clients from remembering the initial recovery period.
D) It acts on the central nervous system to produce loss of sensation.
Q2) A preoperative assessment finds a client to be 75 pounds overweight. The client is to have abdominal surgery. What nursing diagnosis would be appropriate based on the client's weight?
A) Risk for Aspiration
B) Risk for Imbalanced Body Temperature
C) Risk for Infection
D) Risk for Falls
Q3) Which of the following nursing interventions occurs in the postoperative phase of the surgical experience?
A) Airway/oxygen therapy/pulse oximetry
B) Teaching deep breathing exercises
C) Reviewing the meaning of p.r.n. orders for pain medications
D) Putting in IV lines and administering fluids
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Chapter 30: Hygiene
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Sample Questions
Q1) The nurse assists the client to the bathroom sink to perform morning care. The nurse observes the client wash his face, arms, abdomen, and legs. The nurse washes the client's back and rectal area and applies soap to the back. The client brushes his teeth and ambulates to a chair in his room with assistance. How will the nurse describe the morning care on the client's chart?
A) Partial care
B) As-needed care
C) Self-care
D) Complete care
Q2) What care should the nurse take when providing foot care for a client with peripheral vascular disease? Select all that apply.
A) Use an emery board to file toe nail edges
B) Cut the toenails short
C) Cut the nail in one piece
D) Avoid cutting into calluses
E) Cut the nails straight across
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Chapter 31: Skin Integrity and Wound Care
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Sample Questions
Q1) A nurse is caring for a client who is two days postoperative after abdominal surgery. What nursing intervention would be important to promote wound healing at this time?
A) Administer pain medications on a p.r.n. and regular basis.
B) Assist in moving to prevent strain on the suture line.
C) Tell the client that a mild fever is a normal response.
D) If a scar forms over a joint, it may limit movement.
Q2) Which of the following is a recommended guideline nurses follow when using an electric heating pad on a client?
A) Secure the heating pad to the client's clothing with safety pins.
B) Place a heavy towel or blanket over the heating pad to maximize heat effects.
C) Use a heating pad with a selector switch that can be turned up by the client if needed.
D) Place a heating pad anteriorly or laterally to, not under, the body part.
Q3) Which is an example of a closed wound?
A) Abrasion
B) Ecchymosis
C) Incision
D) Puncture wound
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Chapter 32: Activity
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Sample Questions
Q1) Which of the following clients would be an appropriate candidate to move by using a powered stand-assist device?
A) A comatose client who is being taken for x-rays
B) An alert client after knee replacement surgery who is being assisted to ambulate
C) An obese client who has Alzheimer's disease and is being escorted to the shower room
D) A car accident victim with fractures in both legs who is being moved to another room
Q2) While being measured for anti-embolism stockings, the client asks the nurse why they are necessary. What would be the nurses's best response?
A) They promote venous blood return to the heart.
B) They eliminate peripheral edema.
C) They provide a nonslip foot surface to help prevent falls.
D) They reduce the risk for impaired skin integrity.
Q3) Once applied, antiembolism stockings should not be removed until the primary care provider writes an order to discontinue them.
A)True
B)False
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Chapter 33: Rest and Sleep
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Q1) Which of the following is the most common sleep disorder?
A) Hypersomnia
B) Parasomnia
C) Insomnia
D) Dyssomnia
Q2) Which individual is likely to require more hours of sleep?
A) a person 75 years of age
B) a person 43 years of age
C) a person 25 years of age
D) a person 15 years of age
Q3) A nurse is caring for a client who is sleeping for abnormally long periods of time. This condition may be caused by injury to which of the following body structures?
A) Spinal cord
B) Pancreas
C) Hypothalamus
D) Thyroid
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Chapter 34: Comfort and Pain Management
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Q1) The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which of the following responses is most appropriate?
A) "The mild electrical impulses block the pain signal before it can reach the brain."
B) "The electrode patches generate heat and decrease muscle tension."
C) "The machine tricks the mind into believing the pain does not exist."
D) "The electricity produces numbness and alters tissue sensitivity."
Q2) A mother calls the nurse practitioner to say, "I don't know what is wrong with my baby. He cried all night and kept pulling at his ear." How would the nurse respond?
A) "Oh, he probably was just hungry and wet. Did you feed him?"
B) "Babies at that age cry at night. Think nothing of it."
C) "That means his ear hurt. Bring him in to be checked."
D) "That probably means he had a tummy ache. How is he now?"
Q3) Which of the following clients would be classified as having chronic pain?
A) A client with rheumatoid arthritis
B) A client with pneumonia
C) A client with controlled hypertension
D) A client with the flu
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Chapter 35: Nutrition
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Q1) While reviewing an adult client's chart, a nurse notes average daily intake of fluids as 2,000 mL/day. What will the nurse do based on this information?
A) Change the plan of care to include forcing fluids.
B) Ask the client to drink more water during the day.
C) Post a sign limiting fluids to 1,000 mL every 24 hours.
D) Continue with care; this is a normal fluid intake.
Q2) In planning to meet the nutritional needs of a critically ill client in the intensive care unit, which factor will increase the client's basal metabolic rate?
A) Infection
B) Advanced age
C) Prolonged fasting
D) Long periods of sleep
Q3) What is the route of administration for TPN?
A) Oral
B) Subcutaneous
C) Intramuscular
D) Intravenous
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Chapter 36: Urinary Elimination
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Sample Questions
Q1) A nurse is preparing to catheterize a female client. What will the nurse consider when comparing the anatomy of the female urethra with that of the male urethra?
A) Has different innervation
B) No connection with bladder
C) Shorter in length
D) Longer in length
Q2) A nurse is using a bladder scanner to assess the bladder volume of a client with urinary frequency. In which of the following positions would the nurse place the client?
A) Supine
B) Sims'
C) High Fowler's
D) Dorsal recumbent
Q3) A client has been taught how to do Kegel exercises. What statement by the client indicates a need for further information?
A) "I understand these will help me control stress incontinence."
B) "I know this is also called pelvic floor muscle training."
C) "I will do these 30 to 80 times a day for two months."
D) "I will contract the muscles in my abdomen and thighs."
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Chapter 37: Bowel Elimination
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Q1) A client tells the nurse that he takes laxatives every day but is still constipated. The nurse's response is based on:
A) Habitual laxative use is the most common cause of chronic constipation.
B) If laxatives are not effective, the client should begin to use enemas.
C) A laxative that works by a different method should be used.
D) Chronic constipation is nothing to be concerned about.
Q2) A client tells the nurse, "I increased my fiber, but I am very constipated." What further information does the nurse need to tell the client?
A) "Just give it a few more days and you should be fine."
B) "Well, that shouldn't happen. Let me recommend a good laxative for you."
C) "When you increase fiber in your diet, you also need to increase liquids."
D) "I will tell the doctor you are having problems; maybe he can help."
Q3) A nurse is conducting an abdominal assessment. What is the rationale for palpating the abdomen last in the sequence when conducting an abdominal assessment?
A) It is the most painful assessment method
B) It is the most embarrassing assessment method
C) To allow time for the examiner's hands to warm
D) It disturbs normal peristalsis and bowel motility
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Chapter 38: Oxygenation and Perfusion
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Q1) What prevents air from re-entering the pleural space when chest tubes are inserted?
A) The location of the tube insertion
B) The sutures that hold in the tube
C) A closed water-seal drainage system
D) Respiratory inspiration and expiration
Q2) The nurse is developing a plan of care for a client admitted with pneumonia. The nurse has determined that a priority nursing diagnosis for this client is "Ineffective Airway Clearance related to copious and tenacious secretions." Based upon this nursing diagnosis, what is an appropriate nursing intervention to include in the client's care plan?
A) Encouraging the client to consume two to three quarts of clear fluids daily
B) Creating an environment that is likely to reduce anxiety
C) Positioning the client supine
D) Encouraging the client to decrease the number of cigarettes smoked daily
Q3) What does pulse oximetry measure?
A) Cardiac output
B) Peripheral blood flow
C) Arterial oxygen saturation
D) Venous oxygen saturation
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Page 40
Chapter 39: Fluid, Electrolyte, and Acid-Base Balance
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Q1) Which body fluid is the fluid within the cells, constituting about 70% of the total body water?
A) Extracellular fluid (ECF)
B) Intracellular fluid (ICF)
C) Intravascular fluid
D) Interstitial fluid
Q2) A nurse is caring for a client with dehydration. Which of the following signs is observed in a client with dehydration? Select all that apply.
A) Decreased skin turgor over sternum
B) Decreased blood pressure
C) Low urine output
D) Increased pulse rate
E) Increased respiratory rate
Q3) A physician writes an order to "force fluids." What will be the first action the nurse will take in implementing this order?
A) Explain to the client why this is needed.
B) Tell the client and family to increase oral intake.
C) Decide how much fluid to increase each eight hours.
D) Divide the intake so the largest amount is at night.
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Chapter 40: Self-Concept
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Q1) A nurse always addresses clients by the preferred name when entering a client's home or room. What is the nurse facilitating by this action?
A) A sense of self and worth
B) Reorientation to who they are
C) Personal strengths
D) Negative self-concept
Q2) Which term best describes an individual's self-concept?
A) Self-esteem
B) Self-actualization
C) Self-realization
D) Self-image
Q3) The nurse promotes the self-concept of the parents of an infant age 6 months admitted to the hospital with a fever and dehydration by doing what?
A) Telling the parents that the infant's condition was not their fault
B) Allowing the parents to participate in the infant's care
C) Encouraging the parents to visit the infant every other day
D) Educating the parents on health-maintenance behaviors
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42
Chapter 41: Stress and Adaptation
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Sample Questions
Q1) Which of the following best describes stress?
A) A response to changes in the normal balanced state
B) A perception that something is threatening
C) A response to internal environment for homeostasis
D) A localized response of a tissue or organ to a stressor
Q2) A client with an inflamed appendix is feeling pain in the stomach area. What is the term for this body response to stress?
A) Local adaptation syndrome
B) General adaptation syndrome
C) Physiological homeostasis
D) Fight-or-flight response
Q3) What is the term for the change that takes place in response to a stressor?
A) Rehabilitation
B) Adaptation
C) Positive movement
D) Negative movement
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Chapter 42: Loss, Grief, and Dying
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Q1) Palliative care is a structured system for care delivery that has what as its aim?
A) To give traditional medical care
B) To prevent and relieve suffering
C) To bridge between curative care and hospice care
D) To provide care while there is still hope
Q2) Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse tell the family?
A) "Please leave the room now. It is time to let go."
B) "Only one family member at a time can stay in the room."
C) "Please stay with your loved one and talk to him."
D) "I will have to get an order for you to stay now."
Q3) A nurse is developing a plan of care for a dying client. Which of the following physiologic basic human needs should be addressed?
A) Personal hygiene
B) Rsk for infection
C) Family support
D) Spirituality
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44
Chapter 43: Sensory Functioning
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Q1) A nurse is caring for a person who is delusional. What is important for the nurse to do while communicating with the client?
A) Touch the client gently while talking.
B) Avoid arguing about erroneous statements.
C) Reinforce reality for delusional statements.
D) Maintain eye contact at all times.
Q2) What intervention is recommended to reduce sensory stimulation for infants in the neonatal ICU?
A) Use bright lights
B) Use limited light
C) Play loud music
D) Avoid touch
Q3) When a new mother asks the nurse whether her newborn infant can see her, the best response by the nurse is to tell the mother that her infant ...
A) cannot see for 2 weeks of age
B) can differentiate objects only
C) can differentiate colors only
D) can see light and dark patterns
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Chapter 44: Sexuality
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Q1) A nurse is responding to sexual harassment from a client at work. Which of the following is a recommended guideline for dealing with this behavior?
A) If confronted by management, deny any feelings about being harassed.
B) Do not confront the person harassing you in person.
C) Set and enforce limits to the behavior and maintain boundaries.
D) Document the incident but do not report it to the supervisor unless harassment continues.
Q2) Which of the following questions or statements would be most useful for the nurse to make when eliciting information about a client's sexual history?
A) "We need to talk about this."
B) Why did you have unprotected sex?
C) "How would you describe the problem?
D) I need to know sex partners' numbers."
Q3) What term is used to describe painful intercourse?
A) Dyspareunia
B) Dysmenorrhea
C) Impotence
D) Vulvodynia
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Chapter 45: Spirituality
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Q1) A client expresses confidence in his traditional healer to relieve symptoms of an illness. What is the client demonstrating?
A) Hope
B) Spirituality
C) Faith
D) Charity
Q2) Which of the following group of terms best defines spiritual distress?
A) Spirituality, religion
B) Alienation, despair
C) Faith, prayer
D) Forgiveness, purpose
Q3) Some religious beliefs may conflict with prevalent health care practices. For example, what type of treatment is prohibited by the doctrine of Jehovah's Witnesses?
A) Using narcotics to treat pain
B) Administering blood transfusions
C) Minor surgical procedures
D) Diagnostic x-ray examinations
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