Fundamentals of Nursing Textbook Exam
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Course Introduction
Fundamentals of Nursing introduces students to the essential concepts, skills, and values foundational to the nursing profession. The course covers the principles of patient-centered care, basic clinical procedures, health assessment, safety, infection control, and effective communication within healthcare teams. Through a combination of theoretical knowledge and hands-on practice, students learn to apply the nursing process, demonstrate empathy, and uphold ethical standards in various clinical settings. This course prepares students to provide safe, compassionate, and evidence-based care to individuals across the lifespan.
Recommended Textbook Essentials for Nursing Practice 9th Edition by Potter FAAN
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Page 2
Chapter 1: Professional Nursing
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Q1) Which program is appropriate for a nurse who wishes to become an expert in ostomy and wound care?
A) Specialty certification
B) Master of Science program
C) Doctoral degree program
D) Continuing education program
Answer: A
Q2) The nurse is mandated by the state to complete 25 contact hours of nursing education before the nursing license may be renewed.Which term best describes this requirement?
A) In-service education
B) Advanced education
C) Continuing education
D) Certification education
Answer: C
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Page 3
Chapter 2: Health and Wellness
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Q1) Using the Health Promotion Model while rendering care enables a nurse to do which of the following:
A) Help the patient attain better health
B) Detect the presence of illness
C) Promote health behaviors in a patient
D) Assess a family's response to illness
E) Stimulate relational transcendence
Answer: A,C
Q2) Which patient action demonstrates the concept of health promotion?
A) The patient receives the influenza vaccination every year.
B) The patient participates in cardiac rehabilitation after a heart attack.
C) The patient has yearly mammograms to screen for breast cancer.
D) The patient follows a macrobiotic,vegetarian diet with organic foods.
Answer: D
Q3) Which is an example of an environmental risk factor?
A) The patient's drinking water contains high levels of lead.
B) The patient has a strong family history of autoimmune diseases.
C) The patient carefully follows a lactose-free,gluten-free diet.
D) The patient drinks one glass of red wine every night before bed.
Answer: A
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Chapter 3: The Health Care Delivery System
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Q1) Which is an example of health care disparity?
A) The physician treats cardiac patients with insurance more aggressively than noninsured patients.
B) The patient takes longer to recover from surgery due to a history of aggressive rheumatoid arthritis.
C) The nurse prioritizes care so that additional time is spent with patients who require more intensive interventions.
D) The registered nurse is able perform more advanced interventions than the licensed practical nurse.
Answer: A
Q2) Which type of patient is an appropriate candidate for restorative care services?
A) A patient who uses supplemental oxygen for emphysema
B) A patient who is actively dying of metastatic cancer
C) A patient with right-sided hemiplegia after a recent stroke
D) A patient with depression who tried to commit suicide
Answer: C
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Chapter 4: Community-Based Nursing Practice
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Q1) Which problem is the highest priority for a family who has just moved to the United States and does not speak any English?
A) Risk for acute confusion
B) Disturbed energy field balance
C) Impaired verbal communication
D) Readiness for enhanced decision making
Q2) Which is the priority goal for a patient who is being abused by the spouse?
A) The patient's dignity will remain intact.
B) The patient will remain free from injury.
C) The patient will develop a sense of trust with the nurse.
D) The patient will be able to verbalize fears to the nurse.
Q3) Which patients are considered to belong to vulnerable populations?
A) An HIV-positive young adult working as a finance expert
B) A college graduate living in his parents' basement
C) A registered nurse who works at two different clinics
D) An unemployed single mother with four small children
E) A family that just moved to Florida and speaks no English
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Chapter 5: Legal Principles in Nursing
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Q1) What is the primary difference between negligence and malpractice?
A) Malpractice is intentional while negligence is unintended.
B) Malpractice is a felony while negligence is a misdemeanor.
C) Malpractice leads to more serious patient injury than negligence.
D) Malpractice is committed by a licensed professional while negligence is not.
Q2) Which situation will enable a nurse to use restraints?
A) To punish a patient
B) To ensure staff convenience
C) To ensure the patient's safety
D) To retaliate against poor behavior
Q3) Which situation gives the patient cause to sue for malpractice due to injury or harm?
A) The patient developed an itchy rash after receiving a prescribed antibiotic.
B) The patient died after being struck in the head by an oxygen tank during an MRI.
C) The patient developed a sore throat after being intubated for emergency surgery.
D) The patient developed permanent joint deformity due to severe rheumatoid arthritis.
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Chapter 6: Ethics
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Q1) The nurse administers the wrong dose of medication and then blames the mistake on a co-worker.Which ethical principle is violated by the nurse?
A) Fidelity
B) Accountability
C) Confidentiality
D) Social networking
Q2) Which ethical principle is upheld when the nurse refuses to administer a placebo pill to the patient?
A) Justice
B) Culture
C) Veracity
D) Competency
Q3) Which ethical area is involved when the clinic releases genetic test results to the patient's employer without the patient's consent?
A) Veracity
B) Bioethics
C) Justice
D) Beneficence
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8
Chapter 7: Evidence-Based Practice
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Q1) Which type of research study is most appropriate to determine if premedication with diphenhydramine is more effective than acetaminophen to reduce the incidence of aseptic meningitis after intravenous globulin infusion?
A) Randomized trial
B) Qualitative study
C) Historical review
D) Descriptive report
Q2) Which is an example of a sentinel event?
A) The patient suffers a fatal air embolism after a central line is removed incorrectly.
B) The nurse identifies a patient's urinary tract infection before symptoms develop.
C) The unit's urinary tract infection rate is 5% lower than the national average.
D) The pilot study indicates potential effectiveness of a new oral care protocol.
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9
Chapter 8: Critical Thinking
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Sample Questions
Q1) The nurse is caring for a patient who is having severe pain despite regular doses of narcotic pain medication.The nurse suspects that the patient may be experiencing neuropathy and obtains an order for gabapentin which relieves the patient's pain.Which term most accurately describes the action of the nurse?
A) Intuition
B) Reflection
C) Perseverance
D) Critical thinking
Q2) The nurse becomes very skilled at feeding patients with dysphagia after working on a rehabilitation unit for many years.Which component of critical thinking allows the nurse to function at this high level of practice?
A) Integrity
B) Experience
C) Risk taking
D) Responsibility
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Chapter 9: Nursing Process
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Q1) The nurse is caring for a nonverbal patient who just had surgery.The nurse notes that the patient moans with position changes,the hands are clenched,and the skin is very sweaty.The nurse decides that the patient is in pain and decides to administer an analgesic.What is the correct term for this nursing action?
A) Setting priorities
B) Recognizing inconsistencies
C) Using empathy
D) Making inferences
Q2) The nurse is preparing to insert an indwelling urinary catheter into the patient.Where will the nurse check to ensure that the packaging is sterile,intact,and not past the expiration date?
A) In the clean utility room immediately after removing the package from the shelf
B) At the patient's bedside after verifying the patient's name and birthdate
C) At the nurses' station after verifying the physician's order for the procedure
D) At the patient's bedside after performing careful perineal care for the patient
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Chapter 10: Informatics and Documentation
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Q1) The patient requests that her chart be destroyed as soon as she is discharged.What is the best response of the nurse?
A) "The hospital can give you the chart after you are discharged."
B) "Your chart will be kept secure and confidential."
C) "The information must be reported to the health department first."
D) "Your chart can be shredded if you give consent."
Q2) The nurse realizes that the wrong patient's name was written on several important paperwork forms that were already signed by the attending physician.How will the nurse correct this error?
A) Black out the error with a thick marker and enter the correct information.
B) Use correction tape to write over the incorrect information.
C) Draw one line through the error,make the correction and initial it.
D) Shred the forms with the incorrect information and write on new ones.
Q3) Which statement by the nurse accurately reflects a benefit of installing a new electronic medical record system?
A) "I am thankful that I won't have to keep changing my passwords all the time."
B) "I'll be able to see my son's medical record using my password and user ID."
C) "I won't have to worry about reading the doctor's messy handwriting anymore."
D) "It will take me so much less time than writing everything out on paper."
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Page 12
Chapter 11: Communication
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Sample Questions
Q1) Which technique by the nurse will facilitate communication with an older adult?
A) Allow reminiscing.
B) Use long sentences.
C) Ask several questions in a row.
D) Play soft music in the background.
Q2) Which assessment findings will the nurse communicate to the physician using the SBAR tool?
A) The patient is having difficulty breathing and the pulse oximetry is 75%.
B) The patient has not had a bowel movement since surgery eight hours ago.
C) The patient's family member initially refused to learn how to perform the dressing changes.
D) The patient sent the breakfast tray back to the kitchen because the food was cold.
Q3) Which technique is the best way for the nurse to obtain information from the patient?
A) Ask personal questions so as to show interest.
B) Use medical vocabulary to appear competent.
C) Ask why the patient waited so long to get treatment.
D) Use silence while the patient collects his or her thoughts.
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Chapter 12: Patient Education
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Q1) Which patient learning goal is measurable?
A) The patient will understand the importance of daily iron supplements.
B) The patient will be able to learn sufficient information to be discharged.
C) The patient will feel comforted by the nurses' presence during anxious periods.
D) The patient will verbalize responsibility for obtaining daily weights each morning.
Q2) Which teaching approach is demonstrated when the nurse provides guidance while the patient performs the sterile dressing change?
A) Telling
B) Entrusting
C) Reinforcing
D) Participating
Q3) The nurse educator uses manikins to teach patients how to correctly perform CPR on a victim of cardiac arrest.Which teaching technique is used by the nurse?
A) Analogy
B) Role play
C) Simulation
D) Enunciation
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Chapter 13: Managing Patient Care
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Q1) A nurse is using SBAR.Which information will the nurse report for the "B"?
A) The patient has a fractured right leg with a cast that was applied 2 days ago.
B) The patient's toes are cool and pale and the patient reports that the foot feels numb.
C) The patient is reporting severe pain 1 hour after pain medication was given.
D) The nurse requests that the primary health care provider examines the patient.
Q2) Which approaches will the nurse use in order to effectively participate in interprofessional collaboration?
A) Utilize a top-down communication strategy.
B) Work to maintain a climate of mutual respect.
C) Support a team approach to the maintenance of health.
D) Use role-specific knowledge to address health care needs.
E) Apply relationship-building values and principles of team dynamics.
Q3) Which preoperative task may be delegated to the nursing assistant?
A) Apply the patient's thromboembolism deterrent (TED)stockings.
B) Teach the patient how to perform incentive spirometry exercises.
C) Witness the patient's signature on the informed consent document.
D) Make sure that the patient swallowed the prescribed preoperative medication.
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Chapter 14: Infection Prevention and Control
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Q1) Which action of the nurse is appropriate after leaving the room of the patient with Clostridium difficile?
A) Wash hands thoroughly for 20 seconds with antibacterial soap and water.
B) Vigorously rub a quarter-sized dollop of hand sanitizer into both hands.
C) Perform a sterile scrub procedure using chlorhexidine soap solution.
D) Scrub the hands for 2 minutes keeping hands above the level of the elbows.
Q2) Which item of protective apparel is removed first when the nurse leaves the room of the patient with Clostridium difficile?
A) Gown
B) Mask
C) Gloves
D) Eyewear
Q3) Which precautions are appropriate for a patient with a methicillin-resistant Staphylococcus aureus (MRSA)wound infection?
A) Contact
B) Airborne
C) Droplet
D) Standard
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Chapter 15: Vital Signs
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Q1) The nurse is caring for an adult patient with a temperature of 101.2° F.Which statement will the nurse make to the patient's family member who verbalizes concern over the patient's fever?
A) "Fevers this high can cause permanent neurological damage."
B) "Fevers under 102° F help the body's immune system fight infections."
C) "The fever may cause the patient to have a febrile seizure."
D) "I will call the physician now to obtain an order for antibiotics."
Q2) Which site will the nurse use to measure the patient's pulse rate before administering the cardiac medication digoxin?
A) Apical
B) Radial
C) Brachial
D) Carotid
Q3) The nurse notes that the patient's radial pulse is irregular.What is the most appropriate first action of the nurse?
A) Document the finding in the patient's medical record.
B) Count the patient's apical pulse for 1 full minute.
C) Assess the brachial pulse for a pulse deficit.
D) Notify the health care provider immediately.
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Page 17
Chapter 16: Health Assessment and Physical Examination
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Q1) The nurse hears a blowing sound when auscultating the patient's carotid artery.What is the appropriate action of the nurse?
A) Notify the health care provider immediately as the patient may be having a stroke.
B) Gently feel over the patient's carotid artery to check for a faint vibration.
C) Massage the patient's carotid artery to determine if the blowing sound subsides.
D) Palpate the patient's carotid pulse while the patient's neck is hyperextended.
Q2) Which technique will the nurse use to facilitate the history and physical examination of a small child?
A) Examine the child's hands and feet before listening to breath sounds.
B) Direct assessment questions to the child to avoid unwanted parental influence.
C) Gently palpate the child's abdomen before auscultating for bowel sounds.
D) Call the parents by their first names to establish a more trusting bond.
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Chapter 17: Administering Medications
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Q1) The patient crushes extended-release pain medication tablets in order to obtain relief immediately.Which term describes the action of this patient?
A) Medication dependence
B) Medication abuse
C) Medication misuse
D) Medication underuse
Q2) Order: Potassium chloride solution 9 mL PO daily
Potassium chloride
Oral solution
USP 10%
20 mEq per 15 mL
How many mEq of medication will be administered? _____ mEq
Q3) Which of the following orders are for topical medications?
A) Methotrexate 20 mg subcutaneously once weekly on Wednesdays
B) Latanoprost 0.005% one drop in left eye daily at bedtime
C) Acetaminophen 650 mg suppository Q 4 hours prn mild pain
D) Ofloxacin otic solution 0.3% instill drops into right ear daily
E) Calcitonin nasal spray one spray daily into alternating nostrils
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Chapter 18: Fluid, Electrolyte, and Acid-Base Balances
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Q1) The nurse is caring for a diabetic patient with a blood sugar of 879 mg/dL,and notes the patient has fruity breath,and Kussmaul respirations.Which acid-base imbalance should the nurse expect?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Q2) The nurse is to administer 40 mEq of IV KCl to the patient with severe hypokalemia.Why did the pharmacy send up four 100 mL IV bags with 10 mEq of KCl in each bag?
A) To prevent the patient from receiving too much IV fluid.
B) The four smaller bags are less expensive than one large one.
C) To prevent accidentally infusing the 40 mEq of KCl too quickly.
D) The doctor may change his mind and lower the prescribed KCl dose.
Q3) Which is the appropriate action of the nurse when selecting a vein for IV placement?
A) Select a vein that appears to be well dilated.
B) Elevate the extremity to visualize the vein.
C) Tap and rub the vein vigorously with friction.
D) Stroke from proximal to distal above the site.
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Page 20
Chapter 19: Complementary and Alternative Therapies
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Q1) The nurse is caring for a patient who is taking garlic for high cholesterol.Which assessment finding puts the patient at high risk for an adverse reaction?
A) The patient is training for a marathon.
B) The patient is severely allergic to beestings.
C) The patient takes enoxaparin daily.
D) The patient has a history of hypothyroid disease.
Q2) Which is an example of allopathic treatment?
A) Prescription of antibiotic medication for a bacterial infection
B) Use of tai chi exercises to relieve chronic back pain
C) Manipulation of the spine to relieve migraine headaches
D) Burning dried herbs to relieve chronic abdominal pain and diarrhea
Q3) Which assessment finding indicates that the patient is not a candidate for acupuncture therapy?
A) The patient has several herniated lumbar disks.
B) The patient follows a lactose-free diet.
C) The patient is allergic to latex and strawberries.
D) The patient has a history of thrombocytopenia.
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21
Chapter 20: Caring in Nursing Practice
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Q1) The hospice nurse is caring for a terminally ill patient who is preparing for a peaceful death at home after spending quality time with loved ones.Which nursing diagnosis is most appropriate for this patient?
A) Situational low self-esteem related to negative perception of self-worth
B) Ineffective therapeutic regimen management related to decisional conflicts
C) Impaired religiosity related to inability to participate in faith-based services
D) Readiness for enhanced comfort related to desire for peace and companionship
Q2) Which nursing goal is consistent with Watson's Transpersonal Theory of Caring?
A) The nurse will develop a therapeutic relationship with the patient.
B) The nurse will tell the patient what needs to be done to resolve health problems.
C) The nurse will be viewed as the authority when it comes to health care issues.
D) The nurse will exclude the family from health discussions to protect privacy.
Q3) Which statement is part of Leininger's Transcultural View of Caring?
A) Caring and curing are basically synonymous.
B) Caring acts are independent of patient values.
C) Care uses a standardized approach for all patients.
D) Care is tailored to meet the needs of the individual patient.
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Chapter 21: Cultural Awareness
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Q1) Which action of the nurse demonstrates culturally competent care?
A) Helping a Hindu patient to eat meatloaf and gravy for dinner
B) Cutting up ham and vegetables for an orthodox Jewish patient
C) Bringing a grieving Mormon family a tray of coffee and snacks
D) Adding fruit to a Buddhist patient's bowl of oatmeal for breakfast
Q2) Which technique is most appropriate when performing a physical assessment for a male Muslim patient?
A) Use short,simple sentences and complete the physical assessment as quickly as possible.
B) Have a male nurse perform the assessment and expose only the body part being examined.
C) Stand close to the patient,speak clearly,and be careful not to exaggerate lip movements or facial expressions.
D) Use therapeutic touch to reassure the patient and convey the nurse's sense of concern.
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23
Chapter 22: Spiritual Health
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Q1) The nurse feels a deep sense of altruism and wonderment after successfully resuscitating a young athlete who suddenly collapsed in cardiac arrest.Which term best describes the sensation experienced by the nurse?
A) Holy conviction
B) Spiritual distress
C) Divine expectation
D) Self-transcendence
Q2) Which assessment finding leads the nurse to include hopelessness as a nursing diagnosis in the patient's plan of care?
A) The patient does not wish to attend any type of religious services.
B) The patient does not believe in a higher power,spirit guide,or God.
C) The patient has a source of structure and guidance for difficult times.
D) The patient has no motivation or resources to achieve any life goals.
Q3) A patient refuses to remove a religious headscarf when being bathed.Which is appropriate action of the nurse?
A) Remove the headscarf because its presence hinders hygiene.
B) Respect the patient's wishes and work around the headscarf.
C) Explain to the patient that the headscarf has no real spiritual value.
D) Identify the refusal to remove the headscarf as a sign of spiritual distress.
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Page 24
Chapter 23: Growth and Development
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Q1) Which is the most appropriate goal for an elderly adult with the nursing diagnosis of sedentary lifestyle related to deconditioning and lack of physical exercise?
A) The patient will participate in social activities with others.
B) The patient will increase walking to at least 5000 steps per day.
C) The patient will identify ways to conserve energy and prevent fatigue.
D) The patient will develop meaningful relationships with the nursing staff.
Q2) Which assessment finding indicates that the patient is at risk for developing polypharmacy?
A) The patient stores medications in the kitchen cabinet.
B) The patient takes four different medications for congestive heart failure.
C) The patient requires financial assistance to pay for prescriptions.
D) The patient obtains all prescription medications from a mail-order pharmacy.
Q3) Loud wails erupt whenever the nurse tries to pick up the infant from the mother.Which developmental stage is the infant experiencing?
A) Affiliation and love
B) Production and care
C) Trust versus mistrust
D) Autonomy versus doubt
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Chapter 24: Self-Concept and Sexuality
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Q1) Which is the priority intervention for an elderly patient with the nursing diagnosis ineffective sexuality pattern related to vaginal dryness?
A) Help the patient to communicate the need for privacy for sexual activity.
B) Encourage the patient to utilize a water-based vaginal lubricant for comfort.
C) Let the patient know that vaginal dryness is a normal finding in older women.
D) Instruct the patient to void immediately after intercourse to prevent irritation.
Q2) Which is the priority nursing diagnosis for an adolescent who is being bullied by peers?
A) Powerlessness related to inability to stop bullying from peers
B) Social isolation related to dysfunctional relationships with peers
C) Risk for self-directed violence related to feelings of worthlessness
D) Risk for loneliness related to inability to make supportive friendships
Q3) The nurse is caring for an adolescent patient who dips snuff because all of his friends do it.Which self-concept need led the patient to do this?
A) Body image
B) Sexual identity
C) Cultural identity
D) Role performance
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Chapter 25: Family Dynamics
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Q1) Which outcome is most important for the family with the nursing diagnosis interrupted family processes related to terminally ill father?
A) Family members will verbalize their feelings when sharing the evening meal.
B) Family members will feel fulfilled when meeting the dying wishes of the father.
C) Family members will cooperate to support the father's needs during his last days.
D) Family members will find spiritual meaning and peace through the dying process.
Q2) Which interventions are appropriate for the nursing diagnosis risk for caregiver role strain related to inadequate support for caregiver?
A) Monitor the caregiver for signs of physical and/or emotional fatigue.
B) Observe both the patient and caregiver for any signs of neglect or abuse.
C) Encourage placement of the patient in a residential skilled nursing facility.
D) Help the caregiver to schedule time to meet needs for rest and personal care.
E) Identify resources for the caregiver in the family,church,and local community.
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Chapter 26: Stress and Coping
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Q1) The patient develops an inability to swallow after many years of emotional abuse.The physicians can find no medical reason for the patient's dysphagia.Which ego-defense mechanism is used by the patient?
A) Displacement
B) Dissociation
C) Compensation
D) Conversion
Q2) Which interventions are appropriate to assist the patient who is exhausted and depressed from providing care to the spouse with advanced dementia?
A) Assist the patient to identify and utilize support systems.
B) Teach the patient how to maintain a sleep and activity log.
C) Arrange for intervals of respite care for the patient's spouse.
D) Help the patient to find personal time to rest and recuperate.
E) Educate the patient about advanced directive and living will options.
Q3) Which intervention is appropriate for the nurse to reduce compassion fatigue?
A) Increase nursing responsibilities at work.
B) Hang out with co-workers when not at work.
C) Strengthen relationships outside of the hospital.
D) Take control over new areas at work to reduce stress.
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Page 28
Chapter 27: Loss and Grief
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Q1) The chart lists the patient's daughter as having medical durable power of attorney for the patient.How does this impact the patient's care?
A) The daughter is an attorney and plans to sue to the nursing staff and hospital for malpractice after the patient's death.
B) The daughter can provide consent for medical procedures if the patient becomes unresponsive or disoriented.
C) The patient's daughter must be consulted before asking the patient to consent to medical procedures.
D) The patient's daughter will translate medical terminology used by health care providers when communicating with the patient.
Q2) Which treatment would be refused by a patient who has requested palliative care?
A) Therapeutic touch
B) Supplemental oxygen
C) Narcotic pain medications
D) Knee-replacement surgery
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Chapter 28: Exercise and Activity
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Q1) Which instruction directs the patient to perform an isometric exercise?
A) "Use the trapeze to lift your upper body off the bed."
B) "Tighten and hold your stomach muscles for 15 seconds."
C) "Close your fists and squeeze them tightly,release and repeat."
D) "Lift your buttocks off the bed by pushing against the mattress."
Q2) Which action demonstrates correct use of crutches by a patient following a left leg injury?
A) The handgrips are set so that the axillae fully support the patient's body weight.
B) The patient looks down at the floor when taking each step with the crutches.
C) The patient moves the crutches approximately 12 inches forward with each step.
D) The patient's elbows are flexed at a 45-degree angle when holding the handgrips.
Q3) How does the nurse maintain a low center of gravity while transferring the patient from the bed to the chair?
A) The nurse ties the gait belt loosely around the patient's waist.
B) The nurse stands with the knees slightly bent and legs spread apart.
C) The nurse bends at the waist when setting the patient's feet on the floor.
D) The nurse leans backward slightly when helping the patient to stand.
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Chapter 29: Immobility
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Q1) Which is an appropriate outcome for an elderly patient with the nursing diagnosis adult failure to thrive related to placement in extended care agency after right hip fracture?
A) The patient will participate in social activities and maintain usual weight.
B) The patient will exercise both legs to minimize effects of unilateral neglect.
C) The patient will verbalize need for extended nursing care during rehabilitation.
D) The patient will not demonstrate symptoms of deep vein thrombus development.
Q2) Which patient would benefit from the use of a hand roll?
A) A patient with paralysis of the right hand after a left-sided stroke
B) A paraplegic patient who requires assistance moving up in the bed
C) A confused patient who is attempting to pull out the urinary catheter
D) A patient with lymphedema of the right arm and hand after mastectomy
Q3) Which assessment finding indicates that the patient developed osteoporosis after a long period of immobility?
A) The patient fractured three ribs after coughing on spicy food.
B) The patient is unable to dorsiflex the foot,leading to an unsteady gait.
C) The patient has a steppage gait with exaggerated flexion of the hip and knee.
D) The patient's knees curve inward and bump against each other with ambulation.
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31
Chapter 30: Safety
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Q1) Which assessment finding indicates that the patient is at risk for developing hypothermia?
A) The patient is disoriented due to senile dementia.
B) The patient is 5-foot 6-inch tall with a BMI of 35.
C) The patient has a history of congestive heart failure.
D) The patient takes three different antihypertensive medications.
Q2) The wrong type of medication was administered to the patient.Which type of error is this?
A) Exposure-related accident
B) Procedure-related accident
C) Equipment-related accident
D) Organization-related accident
Q3) Which is the appropriate disposal method for used insulin syringes at home?
A) Engage the safety cap over the needle and place it in the recycle bin.
B) Remove the needle from the syringe and then flush it down the toilet.
C) Place the used syringes in a sharps container that is mailed back for destruction.
D) Place the used needles in a plastic can that is placed in the center of the trash bin.
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Chapter 31: Hygiene
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Q1) Which interventions are appropriate when providing oral care to an intubated patient receiving mechanical ventilation?
A) Floss the gums gently after brushing the teeth each morning.
B) Rinse the mouth with a solution of peroxide and baking soda.
C) Suction the patient's mouth throughout the cleaning procedure.
D) Keep the head of the patient's bed elevated at least 30 degrees.
E) Clean the oral mucosa using a chlorhexidine-based mouthwash.
Q2) How can the nurse best respect the patient's cultural preferences for hygiene?
A) Shave the patient's facial hair every morning after the bath.
B) Add scented bath oils to the water before bathing the patient.
C) Ensure that a staff member of the same sex bathes the patient.
D) Accommodate the patient's wish to wash before morning prayers.
Q3) Which is the priority nursing intervention for a patient with confusion and the diagnosis impaired dentition related to inability to perform oral care?
A) Assess the patient's preferred methods for oral hygiene.
B) Brush the patient's teeth twice daily with a soft toothbrush.
C) Use foam swab sticks to clean the oral cavity every morning.
D) Encourage the patient to chew sugarless gum during the day.
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33
Chapter 32: Oxygenation
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Q1) Which respiratory problem is experienced by premature infants due to lack of surfactant in their lungs?
A) The alveoli shrivel and are unable to exchange oxygen for carbon dioxide.
B) Weakness of the respiratory muscles limits airflow in and out of the lungs.
C) Swelling of abdominal organs limits expansion and contraction of the diaphragm.
D) Insufficient hemoglobin impairs delivery of oxygen to tissues throughout the body.
Q2) Which patient would benefit from BiPAP therapy?
A) Surgical patient under general anesthesia
B) Confused,agitated patient with no gag reflex
C) Patient with pulmonary edema due to CHF exacerbation
D) Stroke patient who frequently aspirates fluids and saliva
Q3) Which laboratory finding indicates that the body is attempting to compensate for the patient's end-stage chronic obstructive pulmonary disease (COPD)?
A) Hemoglobin 22.1 g/dL
B) Serum sodium 130 mEq/L
C) Serum cholesterol 236 mg/dL
D) Serum albumin level 4.8 g/dL
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Chapter 33: Sleep
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Q1) Which assessment findings lead the nurse to suspect that the patient has obstructive sleep apnea?
A) Daytime sleepiness,snoring,and obesity
B) Insomnia,inability to concentrate,and anemia
C) Early morning awakening,shift work,and attention deficit disorder (ADD)
D) Latex allergy,stressful career,and recent divorce
Q2) A nurse is caring for a patient who suffers from a sleep pattern disturbance.To promote adequate sleep,what are the most appropriate nursing interventions?
A) Provide personal hygiene before bedtime.
B) Straighten and change any soiled bed linens.
C) Assist the patient to use the toilet before bed.
D) Administer sleep aids every night at the same time.
E) Synchronize the schedule for medications and vital signs.
Q3) How can the nurse best assist a hospitalized young child to fall asleep?
A) Eliminate a daytime nap.
B) Offer the child warm chocolate milk.
C) Maintain the child's home bedtime routine.
D) Allow the child to sleep longer in the morning.
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35
Chapter 34: Pain Management
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Q1) The patient expresses frustration about not being able to function as the family breadwinner any longer due to chronic severe pain.Which psychosocial nursing diagnosis is most appropriate for this patient's concern?
A) Risk for loneliness related to need for prescription pain medications
B) Interrupted family processes related to changes in assigned roles
C) Disturbed sensory perception related to insufficient environmental stimuli
D) Moral distress related to time constraints for ethical decision making
Q2) The nurse is caring for a patient who just underwent knee-replacement surgery.The patient complains of pain at the operative site but it is too soon for the nurse to administer the next dose of pain medication.What is the appropriate action of the nurse?
A) Give the next dose of prescribed pain medication early.
B) Contact the surgeon immediately to assess the patient's knee.
C) Caution the patient about the risk of addiction to pain medications.
D) Apply an ice pack to the knee and elevate the patient's knee on pillows.
Q3) Which is an example of an adjuvant medication for pain management?
A) Naloxone
B) Gabapentin
C) Morphine sulfate liquid
D) Fentanyl transdermal patch
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Page 36
Chapter 35: Nutrition
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Q1) The nurse is caring for a pediatric patient with the nursing diagnosis constipation related to side effects of medications.Which menu option will the nurse recommend to the patient?
A) Baked chicken nuggets and canned peaches
B) Pancakes with sausage,butter,and maple syrup
C) Peanut butter and jelly sandwich on white bread
D) Snack mix with dried apricots,raisins,and almonds
Q2) Which is the best reason why a gastrostomy tube is ordered rather than parenteral nutrition for a patient with dysphagia?
A) Parenteral nutrition can only be administered to the patient in the hospital.
B) The gastrostomy tube provides more nutrition and protects intestinal function.
C) Parenteral nutrition is significantly more expensive than gastrostomy feedings.
D) The gastrostomy tube allows for administration of medications as well as nutrition.
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Chapter 36: Urinary Elimination
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Q1) The patient's urinalysis indicates small amounts of protein in the urine.Which diagnosis does the nurse anticipate to see in the patient's electronic health record?
A) Diabetes mellitus
B) Diabetes insipidus
C) Hypothyroid disease
D) Hyperparathyroid disease
Q2) Which teaching will the nurse provide to the patient before having an intravenous pyelogram (IVP)?
A) Drink water and do not void so the bladder will be full during the test.
B) An urge to void may be felt as the endoscope passes through the urethra.
C) The urine may have an orange or pink for a day or two following the test.
D) Drink plenty of water afterward to prevent kidney damage from the contrast dye.
Q3) Which assessment finding needs to be communicated promptly to the patient's health care provider?
A) Postvoid residual of 15 mL of urine.
B) Leakage of small amounts of urine when coughing.
C) Urine output of 160 mL over the last 8 hours.
D) Patient's report of an urge to void during palpation of the bladder.
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Chapter 37: Bowel Elimination
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Q1) Which patient would benefit from a sitz bath?
A) A patient who has not had a bowel movement for the last 4 days
B) A patient with painful,swollen hemorrhoids after vaginal childbirth
C) A patient with perineal skin breakdown due to continuous oozing of stool
D) A patient who is having difficulty adhering the ostomy appliance to the skin
Q2) Which patient does the nurse identify that would benefit from a nasogastric tube to low intermittent suction?
A) A patient who is vomiting due to a complete large bowel obstruction
B) A patient with constipation who has not had a bowel movement in 6 days
C) A patient with constant diarrhea due to side effects of antibiotic therapy
D) A patient with extensive skin irritation due to a leaking colostomy appliance
Q3) The nurse is caring for a patient who relies on laxatives to ensure daily bowel movements.Which is the appropriate nursing diagnosis for this patient?
A) Risk for constipation related to irregular bowel elimination patterns
B) Perceived constipation related to expectation of daily bowel movements
C) Toileting self-care deficit related to inability to set regular defecation regimen
D) Powerlessness related to inability to have daily bowel movements without laxatives
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Chapter 38: Skin Integrity and Wound Care
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Q1) The nurse notes a reddened area on the right heel that does not turn lighter in color when pressed with a finger.Which term will the nurse use to describe this area?
A) Reactive hyperemia
B) Secondary erythema
C) Blanchable hyperemia
D) Nonblanchable erythema
Q2) A postoperative abdominal surgery patient has been admitted to the surgical floor.The nurse is aware that wound healing is delayed due to complications.Which conditions would prevent normal wound healing at the surgical site?
A) Dehiscence
B) Evisceration
C) Debridement
D) Hemostasis
E) Hemorrhage
Q3) Which intervention will the nurse use for an abscessed leg wound?
A) Warm water sitz baths
B) Cold moist compresses
C) Warm moist compresses
D) Epsom salt solution soaks
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Chapter 39: Sensory Alterations
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Q1) The parent is concerned because the child has been referred to an optometrist after a routine eye screening at school.What is the nurse's most appropriate response to the parent?
A) "Most children have a mild form of color blindness as their eyes mature."
B) "You should wash the child's eyelids every morning with a damp washcloth."
C) "It is normal for children to squint to see but it should be checked out anyway."
D) "Most likely your child will need glasses to see the teacher and board at school."
Q2) Which nursing diagnosis is most appropriate for a patient with xerostomia?
A) Total urinary incontinence related to inability to feel urge to urinate
B) Bathing self-care deficit related to inability to perceive left-sided body parts
C) Impaired oral mucus membranes related to decreased salivation and dry mouth
D) Disturbed sensory perception related to feeling of electric pain in feet and hands
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Chapter 40: Surgical Patient
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Q1) Which is the most appropriate outcome for the postoperative patient with the nursing diagnosis ineffective breathing pattern related to side effects of pain medication?
A) The patient will correctly demonstrate how to use pursed-lip breathing.
B) The patient will report the ability to breathe comfortably without anxiety.
C) The patient's pulse oximetry will stay greater than 94% with at least 12 breaths/minute.
D) The patient will rest comfortably and rate pain no higher than 4 on 0-to-10 scale.
Q2) Which assessment finding leads the nurse to include risk for ineffective airway clearance to the surgical patient's care plan?
A) The patient is extremely anxious about the upcoming surgery.
B) The patient will be receiving a local anesthetic for the procedure.
C) The patient sleeps poorly and wakes up every morning with a headache.
D) The patient speaks no English and requires the services of an interpreter.
Q3) Which surgical procedure may be performed using conscious sedation?
A) Knee-replacement surgery
B) Coronary artery bypass surgery
C) Cataract removal with lens implant
D) Modified radical mastectomy surgery
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