Introduction to Nursing Practice Review
Questions
Course Introduction
Introduction to Nursing Practice provides students with foundational knowledge and skills essential for beginning a career in nursing. The course explores the core principles of professional nursing, including patient-centered care, ethical and legal responsibilities, communication techniques, and basic clinical procedures. Through a combination of lectures, simulations, and hands-on practice, students learn to apply the nursing process, promote safety, and collaborate within healthcare teams. Emphasis is placed on developing critical thinking, cultural sensitivity, and compassionate care to meet the diverse needs of patients across various healthcare settings.
Recommended Textbook
Essentials for Nursing Practice 9th Edition by Potter FAAN
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40 Chapters
977 Verified Questions
977 Flashcards
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Page 2
Chapter 1: Professional Nursing
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12 Verified Questions
12 Flashcards
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Sample Questions
Q1) The nurse is caring for a patient who suddenly becomes acutely short of breath.The nurse elevates the head of the patient's bed,checks the patient's pulse oximetry,and administers 2 L of oxygen before notifying the patient's physician.Which term best describes the actions of the nurse?
A) Accountability
B) Autonomy
C) Licensure
D) Certification
Answer: B
Q2) 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
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Chapter 2: Health and Wellness
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21 Flashcards
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Sample Questions
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 action of the nurse addresses Maslow's need for love and belongingness?
A) The nurse uses a gait belt and assists the patient to use a walker for ambulation.
B) The nurse encourages a widowed patient to join a bereavement support group.
C) The nurse plans daily care to allow for rest periods for the patient as needed.
D) The nurse reorients the patient to time and place during periods of acute confusion. Answer: B
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Chapter 3: The Health Care Delivery System
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28 Flashcards
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Sample Questions
Q1) Which is a responsibility of the Centers for Medicare and Medicaid (CMS)?
A) Create teaching materials to educate health care professionals.
B) Research evidenced-based practices to improve health care for patients.
C) Accredit and certify hospitals in order to ensure safe health care for patients.
D) Manage health insurance coverage for elderly,disabled,and low-income patients.
Answer: D
Q2) Which is an example of a diagnosis-related group (DRG)?
A) Patients recovering from orthopedic surgery are placed on the same nursing unit.
B) Specialty hospitals are utilized to treat patients with life-threatening illnesses.
C) The speech therapist is consulted to see every patient admitted with dysphagia.
D) Hospitals will be paid $4500 to care for patients with uncomplicated pneumonia
Answer: D
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5
Chapter 4: Community-Based Nursing Practice
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Sample Questions
Q1) Which is an appropriate goal for the public health nurse working in the community?
A) At least 95% of children in the elementary schools will be up to date on immunizations.
B) The family will learn how to transfer the patient to the toilet and assist the patient to dress each morning.
C) The patient's white blood cell count will return to normal by the time the antibiotic treatment has been completed.
D) Nursing assistants will be allowed to administer routine medications to residents of assisted care facilities.
Q2) 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
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Chapter 5: Legal Principles in Nursing
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Sample Questions
Q1) The nurse is frustrated with an agitated patient and tells him "Now stay in that bed or I will make you stay there!" Which tort has the nurse just committed?
A) Assault
B) Battery
C) Incursion
D) Onslaught
Q2) Which example demonstrates a breach of confidentiality and a violation of the Health Insurance Portability and Accountability Act (HIPAA)of 1996?
A) Giving a report to the oncoming nurse in a conference room
B) Discussing a patient's diagnosis with the patient's health care provider
C) Providing patient information to the nursing assistant caring for the patient
D) Sharing a patient's diagnosis and prognosis with other nurses in the cafeteria
Q3) 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.
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Chapter 6: Ethics
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19 Flashcards
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Sample Questions
Q1) Which ethical area is challenged when the nurse feels bound to refuse to assist with an abortion procedure?
A) Values
B) Culture
C) Confidentiality
D) Social networking
Q2) 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
Q3) Which ethical principle is upheld when the surgeon refuses to operate on the patient because potential benefit is minimal compared to the pain that the patient will endure?
A) Autonomy
B) Justice
C) Fidelity
D) Nonmaleficence
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Chapter 7: Evidence-Based Practice
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Sample Questions
Q1) Which statements are examples of hypotheses?
A) Hospitals staffed with primarily bachelor-prepared nurses will have lower mortality rates than hospitals staffed with primarily associates-prepared nurses.
B) More than 80% of the patients with catheter-associated urinary tract infections did not have any signs or symptoms of infection.
C) Patients who receive ondansetron preoperatively will experience lower rates of nausea and vomiting than patients who do are not premedicated.
D) The greatest risk factor for developing ventilator-associated pneumonia was the length of time that the patient was intubated.
E) Ultraviolet light disinfection of equipment is a nontoxic,effective method for prevention of Clostridium difficile infection.
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9
Chapter 8: Critical Thinking
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Sample Questions
Q1) The new nurse keeps a diary to record experiences,patient encounters,and feelings when beginning work in the nursing profession.Which critical thinking action is used by the nurse?
A) Professional standards
B) Nursing process
C) Concept mapping
D) Purposeful reflection
Q2) 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
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Chapter 9: Nursing Process
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Sample Questions
Q1) Which question is the most appropriate for the nurse to use to start the health history assessment?
A) "Does your family doctor know that you are here?"
B) "Did you drive yourself to the hospital?"
C) "What brings you to the hospital today?"
D) "Did you give your insurance card to the receptionist?"
Q2) The extended care agency administers the flu vaccination to all of the patients who do not have contraindications to the injection.What is the reason that the nurses do not have to obtain orders from each patient's physician for vaccination each year?
A) The agency's medical director placed a standing order for patients to receive the flu vaccination yearly unless contraindicated.
B) The Centers for Disease Control and Prevention highly recommend yearly flu vaccinations for all individuals over the age of 65.
C) The State Licensing Board for extended care facilities requires annual flu vaccinations for all residents and staff.
D) The administrator of the agency has the authority to order annual flu vaccinations for all residents and staff.
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Chapter 10: Informatics and Documentation
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) The nurse has just completed teaching the patient how to self-administer insulin injections.Which entry in the patient's chart demonstrates that the teaching was successful?
A) The patient correctly self-administered his next scheduled dose of insulin.
B) The patient denied having any questions or concerns about the procedure.
C) Additional written instructions about how to perform the injection was provided.
D) The patient identified the steps and equipment used for the injection.
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 chart entry reflects appropriate documentation of patient data?
A) The patient voided a moderate amount of urine.
B) The patient voided 220 mL of clear yellow urine.
C) The patient was incontinent.
D) The patient voided an adequate amount of urine for the shift.
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Page 12
Chapter 11: Communication
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Sample Questions
Q1) The emergency room nurse obtains report from the paramedics as the patient is on the way to the hospital.The nurse is in which phase of the therapeutic relationship?
A) Working
B) Orientation
C) Termination
D) Preinteraction
Q2) Which behavior best demonstrates active listening by the nurse?
A) Keeping arms crossed
B) Sitting facing the patient
C) Standing facing the patient
D) Leaning away from the patient
Q3) The nurse informs the patient that a code pink is paged overhead when an infant is abducted from the hospital.What is the best description of the use of the term code pink in this situation?
A) Denotative meaning
B) Perceptual stereotype
C) Emotional inflection
D) Sender territoriality
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13
Chapter 12: Patient Education
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Sample Questions
Q1) The nurse is caring for a patient who had a stroke because of lack of understanding about how to take the prescribed blood pressure medication.Which is the priority nursing diagnosis for this patient?
A) Noncompliance related to patient's refusal to follow the prescribed treatment regimen
B) Ineffective therapeutic regimen management related to lack of understanding about prescribed medications
C) Ineffective health maintenance related to lack of expressed interest in taking prescribed medications correctly
D) Readiness for enhanced decision making related to desire to choose the course of action that best meets health needs
Q2) Which is the best method to begin teaching the adult patient how to self-administer tube feeding through a new gastrostomy tube?
A) Analogies
B) Detachment
C) Role play
D) Demonstration
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14
Chapter 13: Managing Patient Care
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Sample Questions
Q1) 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.
Q2) Which nursing leadership approach demonstrates decentralized management?
A) The nurse manager sets unit policies,conducts annual reviews,and disciplines the staff as needed.
B) The staff nurses work with the manager to review care options to prevent surgical site infections.
C) The nurse manager conducts regular staff meetings to provide updates about new equipment and agency policies.
D) The nurse manager makes rounds on the unit every day to monitor for problems with patient care.
Q3) Which action by the nurse demonstrates the concept of nurse autonomy?
A) The nurse braids the patient's long hair to prevent tangles.
B) The nurse directs the nursing assistant to obtain the patient's weight.
C) The nurse counts the patient's pulse before administering digoxin.
D) The nurse checks the policy manual before changing the central line dressing.
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Page 15
Chapter 14: Infection Prevention and Control
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Sample Questions
Q1) Which is an example of suprainfection?
A) The patient develops Clostridium difficile diarrhea after taking broad-spectrum antibiotics.
B) The immunocompromised patient develops an upper respiratory despite protective isolation precautions.
C) The bacteria in the patient's wound are resistant to cephalosporin and penicillin antibiotics.
D) The patient's upper respiratory infection progresses to pneumonia with right-sided pleural effusion.
Q2) The patient's urine cultures tested positive for Escherichia coli (E.coli)following urinary catheterization.Which term describes this type of infection?
A) Protozoan
B) Endogenous
C) Diagnostic
D) Bactericidal
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16
Chapter 15: Vital Signs
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Sample Questions
Q1) The nurse is unable to hear the blood pressure for a patient who is in septic shock.What is the best option of the nurse?
A) Determine the diastolic blood pressure by palpation and notify the health care provider immediately.
B) Elevate the head of the patient's bed and obtain the patient's blood pressure with an electronic vital sign machine.
C) Assess the patient's blood pressure using a lower extremity and a thigh-sized blood pressure cuff.
D) Raise the patient's arm above the level of the heart and apply the stethoscope more firmly against the antecubital fossa.
Q2) The nurse applies a warmed blanket to a chilled patient.Which term is used to describe the process by which the blanket increases the patient's temperature?
A) Convection
B) Radiation
C) Conduction
D) Emission
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Chapter 16: Health Assessment and Physical Examination
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Sample Questions
Q1) The nurse is caring for a patient who develops slurred speech with right-sided facial drooping.The patient is also unable to make a fist with the right hand.What is the priority action of the nurse?
A) Place a cool washcloth on the patient's forehead and turn down the lights.
B) Obtain an order from the provider for a consultation with a speech therapist.
C) Feed the patient by placing the food on the unaffected side of the mouth.
D) Immediately obtain vital signs and notify the hospital's acute stroke team.
Q2) Which assessment finding will the nurse expect to note during physical examination of the patient with a history of uncontrolled hyperthyroid disease?
A) Exophthalmos
B) Strabismus
C) Entropion
D) Diplopia
Q3) Which technique will the nurse use to assess the patient's olfactory nerve?
A) Ask to shrug the shoulders and turn the head against the nurse's hand.
B) Ask the patient to identify the smell of peppermint oil and orange peel.
C) Ask the patient to read the smallest set of letters on a Snellen eye chart.
D) Ask the patient to stick out the tongue and move it side to side from midline.
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Chapter 17: Administering Medications
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Sample Questions
Q1) The nurse notes that the patient is to receive diprivan to treat the patient's vaginal yeast infection.What is the appropriate action of the nurse?
A) Immediately contact the prescriber to clarify the order.
B) Check with the pharmacy to confirm that the order was received.
C) Ensure that the order appears on the patient's medication sheet.
D) Confirm that the dosage is appropriate for the patient's body weight.
Q2) Which of the following patients is most at risk for liver damage after taking acetaminophen regularly for arthritis pain?
A) Patient with a history of alcohol abuse and hepatitis C
B) Patient with type 2 diabetes and end-stage renal disease
C) Patient with prostate enlargement and urinary frequency
D) Patient with COPD and a 20 pack-year history of smoking
Q3) The patient's rheumatoid arthritis symptoms were not adequately controlled with methotrexate so adalimumab was prescribed as well.What is the rationale for prescribing both medications?
A) To obtain a synergistic effect
B) To prevent an anaphylactic reaction
C) To reduce medication interactions
D) To avoid an iosyncratic reaction
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Page 19
Chapter 18: Fluid, Electrolyte, and Acid-Base Balances
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Sample Questions
Q1) 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.
Q2) Order: IV 1000 mL 0.9% NS to infuse over 5 hours
IV tubing: 10 drops/mL
No infusion pump is used.What is the flow rate in drops/minute? _____
Q3) Which is the highest priority of the nurse immediately after withdrawing the needle from the IV catheter after venipuncture?
A) Engage the safety device to cover the needle.
B) Check for blood return in the flashback chamber.
C) Stabilize the catheter with the nondominant hand.
D) Align the catheter on the top of vein at a 15-degree angle.
Q4) Order: 500 mL D W to infuse at 50 mL/hour
IV tubing: 10 drops/mL
How many mL will infuse over the nurse's 12 hour shift? _____
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20
Chapter 19: Complementary and Alternative Therapies
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Sample Questions
Q1) The patient reports taking valerian root capsules regularly.What is the patient's rationale for taking the supplement?
A) Relief of constipation
B) Relief of nausea and vomiting
C) Relief of arthritis pain
D) Inability to fall asleep at night
Q2) Which patient would be a candidate for biofeedback therapy?
A) A patient with a history of heart failure and hypotension
B) A diabetic patient with difficulty managing blood sugar levels
C) A patient with an anxiety disorder after a traumatic experience
D) A forgetful,anxious patient with a history of senile dementia
Q3) The patient reports using chaparral to ease breathing.Which assessment finding leads the nurse to advise stopping the supplement immediately?
A) The patient has a history of hepatitis C.
B) The patient is morbidly obese.
C) The patient requires supplemental oxygen.
D) The patient has frequent sinus infections.
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Chapter 20: Caring in Nursing Practice
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Sample Questions
Q1) 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.
Q2) The nurse ensures that the patient's room is cool,quiet,and dark so that the patient can rest and sleep.Which caring behavior is demonstrated by the nurse?
A) Fulfilling affiliation needs
B) Providing a sense of presence
C) Creating a healing environment
D) Demonstrating an encouraging manner
Q3) What is the goal of the nurse when listening to the patient's story about the meaning of the illness?
A) Provide the patient with hope for full recovery.
B) Maintain the patient's sense of confidentiality.
C) Determine the extent of the patient's recuperation.
D) Allow the patient to express frustrations about the illness.
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Chapter 21: Cultural Awareness
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Sample Questions
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 assessment findings are social determinants of health?
A) Living in a house containing lead paint
B) Genetic predisposition to spinal osteoarthritis
C) Growing up in a neighborhood without grocery stores
D) Annual income 125% above the federal poverty level
E) Completed high school and 1 year of community college
Q3) The patients with health insurance receive higher dosages of pain medications than patients who are uninsured.Which term best describes this problem?
A) Health disparity
B) Intersectionality
C) Cultural dissonance
D) Linguistic incompetence
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23
Chapter 22: Spiritual Health
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Sample Questions
Q1) The patient is distressed because hospitalization has prevented participation in church services and adherence to important prayer rituals.Which nursing diagnosis is most appropriate for this patient?
A) Impaired religiosity related to inability to participate in religious services
B) Noncompliance related to failure to adhere to prescribed treatment regimens
C) Disturbed thought processes related to delirium and altered level of consciousness
D) Ineffective role performance related to discrimination and inadequate coping
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.
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Chapter 23: Growth and Development
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Sample Questions
Q1) Which are expected physical assessments finding for a middle-aged adult?
A) Difficulty hearing female voices
B) Diminished breath sounds bilaterally
C) Gradual loss of senses of taste and smell
D) Need for reading glasses to see small print
E) Decreased ability to solve practical problems
Q2) The nurse is caring for an elderly patient who has become withdrawn and refuses to eat after being admitted to a long-term nursing facility.Which is the highest priority goal for the patient?
A) The patient will participate in social activities with other residents.
B) The patient will ask questions about the prescribed care and treatment.
C) The patient will develop meaningful relationships with the nursing staff.
D) The patient will maintain usual weight and show no signs of dehydration.
Q3) Which abilities are required for moral development of the child?
A) Accept social responsibility.
B) Perform repetitive motion responses.
C) Respect the integrity and rights of others.
D) Integrate principles of justice and fairness.
E) Use symbols and objects for abstract thinking.
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Page 25
Chapter 24: Self-Concept and Sexuality
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Sample Questions
Q1) The patient tells the nurse that the spouse is only interested in sexual activity when inflicting physical pain on the patient.Which is the priority nursing diagnosis for the patient?
A) Activity intolerance related to inability to fulfill spouse's sexual needs
B) Ineffective sexuality pattern related to differing sexual activity expectations
C) Risk for injury related to physical abuse from spouse during sexual activity
D) Risk for compromised human dignity related to spouse's demeaning actions
Q2) An elderly patient with Alzheimer's disease tells the nurse that she will be baking cookies with her mommy when she gets home from school later that afternoon.Which nursing diagnosis is most appropriate for this patient?
A) Disturbed personal identity related to delusional description of self
B) Readiness for enhanced power related to desire for freedom of choices
C) Risk for loneliness related to hospitalization and separation from family
D) Chronic low self-esteem related to negative feelings about self-capabilities
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Chapter 25: Family Dynamics
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Sample Questions
Q1) Which is the priority nursing diagnosis for a homeless family?
A) Risk for trauma related to lack of protection from crime and weather
B) Caregiver role strain related to meeting needs of children without a home
C) Unilateral neglect related to failure to maintain a safe home for the family
D) Powerlessness related to dependence on charitable organizations for shelter
Q2) Which is the appropriate action of the nurse when the patient's daughter offers to assist with the morning bath?
A) Accept the daughter's offer if the patient agrees.
B) Accept the daughter's offer and encourage her to assist.
C) Politely decline the daughter's offer of assistance.
D) Decline the daughter's offer as it will not be needed.
Q3) Which family members are considered to be part of the nuclear family?
A) Mother and father
B) Grandparents
C) Adopted children
D) Aunts and uncles
E) Nieces and nephews
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Chapter 26: Stress and Coping
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Sample Questions
Q1) 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.
Q2) Which position is best suited for a nurse who preferred to study until the early hours of the morning during nursing school?
A) Full-time 8-hour day/evening rotation
B) Part-time 12-hour day/night rotation position
C) Full-time 12-hour night position
D) Full-time 8-hour day position
Q3) Which assessment finding is expected for a patient who was just chased by an attacker?
A) Blood sugar 45 mg/dL
B) Blood pressure 180/94
C) Pulse rate 55 beats/minute
D) Hyperactive bowel sounds
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Page 28
Chapter 27: Loss and Grief
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Sample Questions
Q1) The patient is on a ventilator and has a heartbeat,but is brain dead.What should the nurse do?
A) Explain that as long as the heart is beating,the patient is still alive.
B) Provide a private area for the family to discuss organ donation options.
C) Inform the family that the organs will be harvested when he is off the ventilator.
D) Stress the importance of leaving the patient on the ventilator to harvest the corneas.
Q2) Which behavior supports inclusion of the nursing diagnosis complicated grieving related to sudden death of a sibling in the patient's care plan?
A) The patient donates the sibling's clothes to a local charity.
B) The patient withdraws from relationships with friends and family.
C) The patient adopts the sibling's dog and arranges for veterinary care.
D) The patient arranges for the gravestone to be placed at the sibling's burial site.
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Chapter 28: Exercise and Activity
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Sample Questions
Q1) 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.
Q2) The nurse is caring for a patient with a traumatic injury to the cerebellum.Which assessment finding will be expected as a result?
A) The patient sways from side to side when walking.
B) The patient's ligaments are weak and easily ruptured.
C) The patient has fine tremors with purposeful movement.
D) The patient's joints are reddened,swollen,and warm to touch.
Q3) 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."
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Chapter 29: Immobility
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Sample Questions
Q1) Which action of the nurse will help to reduce the effects of orthostatic hypotension?
A) Perform isometric and range-of-motion exercises.
B) Encourage the patient to move from a sitting position to standing position slowly.
C) Place trochanter rolls on either side of the patient's hips.
D) Participate in chest physiotherapy and incentive spirometry.
Q2) Which intervention will help prevent the development of footdrop for a comatose patient?
A) Place high-top tennis shoes on the patient's feet.
B) Place pillows under the legs to keep the heels off the mattress.
C) Apply sequential compression devices to the patient's feet.
D) Assist the patient to a lateral position whenever possible.
Q3) The nurse is caring for a patient who must lay flat in bed for several days after spinal surgery.Which is the priority nursing diagnosis for this patient?
A) Impaired social interaction related to prolonged bed rest
B) Toileting self-care deficit related to inability to use the restroom
C) Ineffective breathing pattern related to prolonged supine position
D) Ineffective thermoregulation related to lengthy period of immobility
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Chapter 30: Safety
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Sample Questions
Q1) A patient has just undergone an abdominal aortic aneurysm repair.The patient is pulling at the Foley catheter,nasogastric tube,central line,and abdominal dressing,and a wrist restraint is applied after an order is received.Later,the patient reports tingling and numbness in the fingers and hand.Which actions should the nurse take?
A) Stay with the patient.
B) Medicate the patient for pain.
C) Notify the health care provider.
D) Remove the restraint immediately.
E) Tell the patient to relax and it will feel better shortly.
Q2) Which is an example of a procedure-inherent accident?
A) The patient suffered a burn due to a malfunctioning heating pad.
B) The patient suffered a tongue laceration during a grand mal seizure.
C) The nurse suffered a back injury when repositioning a heavy patient in bed.
D) The physician suffered a broken wrist after it was caught in the elevator door.
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Chapter 31: Hygiene
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Q1) 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.
Q2) Which interventions are appropriate for a patient with the nursing diagnosis impaired oral mucus membranes related to immunosuppression,thrush,and ulceration?
A) Rinse the mouth with warm saline solution every few hours.
B) Rinse the mouth with half strength hydrogen peroxide twice daily.
C) Use cotton swabs soaked in lemon-glycerin solution to clean the oral mucosa.
D) Use a tongue scraper to remove the thick coating from the oral mucosa.
E) Encourage the patient to have soft foods such as yogurt,ice cream,and pudding.
Q3) Which patient would benefit from the use of lubricant eye ointment?
A) A patient with chronic viral conjunctivitis
B) A stroke patient whose right eye does not close fully
C) A patient who has extended-wear contact lenses in place
D) A patient with an eye infection after swimming in a pond
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Chapter 32: Oxygenation
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Sample Questions
Q1) Which assessment findings indicate that the patient is at risk for developing ventricular fibrillation?
A) Serum potassium level 7.6 mEq/L
B) Long history of coronary artery disease
C) Impaired conduction through the SA node
D) Recent incidents of ventricular tachycardia
E) Vagal stimulation from removal of fecal impaction
Q2) The nurse has orders to titrate the patient's oxygen to maintain a pulse oximetry level greater than 94%.The patient's pulse oximetry will not rise above 90% despite use of a nonrebreather mask.Which is the appropriate action of the nurse?
A) Insert an oral airway and apply a full face oxygen mask.
B) Call respiratory therapy to consider BiPAP support for the patient.
C) Remove the nonrebreather mask and replace it with a Venturi mask.
D) Place an oxygen nasal cannula underneath the patient's nonrebreather mask.
Q3) 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
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Page 34
Chapter 33: Sleep
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Q1) Which outcome is most appropriate for the patient with the nursing diagnosis insomnia related to night shift work?
A) The patient will rotate day/night work shifts frequently.
B) The patient will obtain at least 48 hours of sleep per week.
C) The patient will use caffeine sparingly to wake up before shifts.
D) The patient will use bright lights to stay awake through the night.
Q2) Which nursing intervention can cause an unsafe sleeping environment for the hospitalized patient?
A) A small night-light left on in the bedroom.
B) The patient's bed is in high position with side rails up.
C) All clutter is removed between the bed and the bathroom.
D) Call bell at the bedside for the patient to contact the nurse.
Q3) What is the best intervention to help a school-age child fall asleep at night?
A) Encourage exercise in the evening to promote fatigue.
B) Provide the child with a high-protein snack before bed.
C) Have the parent read a quiet bedtime story to the child.
D) Have the child complete homework before going to bed.
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Page 35
Chapter 34: Pain Management
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Q1) Which is an appropriate goal for a patient's preoperative teaching?
A) The nurse will provide written materials about nonpharmacological pain-management techniques.
B) The patient will verbalize understanding of the pain-management techniques to be used after surgery.
C) The nurse will demonstrate correct use of the patient-controlled anesthesia (PCA)pump.
D) The patient will rate current pain of less than 3 out of 10 on the descriptive pain intensity scale.
Q2) The nurse is caring for a patient who continues to have severe pain at the site of a fracture long after it healed.The patient's physicians can find no rationale for the pain.What is the most likely cause of the patient's discomfort?
A) The patient is trying to obtain unneeded pain medications.
B) The patient has developed a complex regional pain syndrome.
C) The patient is in denial that the fracture has healed completely.
D) The patient is experiencing referred pain from a fracture elsewhere.
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Chapter 35: Nutrition
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Q1) Which food item contains the most calories?
A) 1 g of cane sugar
B) 1 g of lean meat
C) 1 g of butter
D) 1 g of banana
Q2) Which action of the nurse is best to reduce abdominal discomfort when administering intermittent gravity feedings through a gastrostomy tube?
A) Chill the formula.
B) Dilute the formula.
C) Infuse the formula slowly.
D) Lower the head of the bed.
Q3) Which is the appropriate intervention for a patient with the nursing diagnosis feeding self-care deficit related to neuromuscular hand and arm weakness?
A) Provide meticulous oral hygiene before and after meals.
B) Consult a speech-language pathologist for swallow precautions.
C) Provide the patient with a pleasant,quiet environment for meals.
D) Teach the patient how to use adaptive utensils to facilitate independence.
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Chapter 36: Urinary Elimination
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Q1) 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.
Q2) The patient's urinalysis indicates increased specific gravity of the urine.Which finding does the nurse anticipate will be found upon assessment?
A) The patient uses supplemental oxygen due to COPD.
B) The patient is thirsty with dry oral mucus membranes.
C) The patient has a history of benign prostatic enlargement.
D) The patient just completed antibiotics for a bladder infection.
Q3) Which assessment finding supports the nursing diagnosis overflow urinary incontinence related to urethral obstruction?
A) Advanced dementia prevents the patient from indicating need to urinate
B) Postvoid residual of 900 mL after incontinence of small amounts of urine
C) Leakage of urine around the urostomy appliance leading to skin irritation
D) Incontinence of large amounts of urine every time the patient coughs or sneezes
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Chapter 37: Bowel Elimination
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Q1) The nurse is caring for a patient who has just undergone knee-replacement surgery.The patient has incontinent of continuous oozing stool for the last few days.Which is the appropriate action of the nurse?
A) Administer loperamide 8 mg PO BID.
B) Check the patient's rectum for presence of impacted stool.
C) Liberally apply skin barrier cream to prevent perineal irritation.
D) Encourage the patient to drink at least 2 L of fluid each day.
Q2) Which actions of the nurse demonstrate correct administration of a soapsuds enema?
A) The enema is administered while the patient is in the right Sims' position.
B) Liquid antibacterial soap is added to the enema bag before administration.
C) The tip of the enema tube is lubricated with petroleum jelly before insertion.
D) The enema bag is lowered when the patient reports abdominal cramping.
E) The nurse removes the patient's fecal impaction before administering the enema.
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Chapter 38: Skin Integrity and Wound Care
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Q1) Which is the first intervention of the nurse for changing the dressing to a painful burn?
A) Administer pain medication 30 minutes beforehand.
B) Gently irrigate the wound using sterile normal saline.
C) Loosen the tape gently by pressing the skin away from it.
D) Observe the wound bed for presence of granulation tissue.
Q2) The patient's sacral pressure injury is open with exposed bone.Which pressure injury stage will be recorded in the patient's chart?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Q3) Which assessment finding indicates to the nurse that the patient is at high risk for developing a pressure injury?
A) Serum total protein level of 4.6 g/dL
B) Braden Scale score of 22
C) Cetirizine 5 mg PO daily
D) Fasting serum glucose level 84 mg/dL
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Chapter 39: Sensory Alterations
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Sample Questions
Q1) Which assessment finding indicates to the nurse that the patient is experiencing difficulty with proprioception?
A) The patient must hold on to the railing when ambulating in the hallway.
B) The patient must add extra seasoning to food in order for it to have any flavor.
C) The patient did not smell smoke even though the smoke detector was alarming.
D) The patient suffered a first-degree burn when a heating pad was left on too long.
Q2) Which medications can lead to development of tinnitus?
A) Furosemide
B) Vancomycin
C) Insulin glulisine
D) Docusate sodium
E) Naproxen sodium
Q3) Which complication may develop as a result of frequent middle ear infections as a child?
A) Meniere's disease
B) Serous otitis media
C) Hearing impairment
D) Impaction of cerumen
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Chapter 40: Surgical Patient
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Sample Questions
Q1) Which is the highest priority nursing diagnosis for the patient undergoing a lengthy surgery in the operating room?
A) Powerlessness related to unconscious state from general anesthesia
B) Hypothermia related to cool ambient temperature in the operating room
C) Risk for impaired oral mucus membranes related to prolonged NPO status
D) Risk for caregiver role strain related to lengthy waiting period for family members
Q2) The nurse is teaching the patient about postoperative exercises including incentive spirometry.How can the nurse best determine that the teaching was effective?
A) The patient states that the preoperative anxiety has decreased significantly.
B) The patient correctly demonstrates the exercises and how to use the spirometer.
C) The patient senses a caring presence of the nurse in the therapeutic relationship.
D) The patient explains to the nurse why the exercises and spirometer are important.
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