Fundamentals Nursing Review Quiz

fundamentals nursing review quiz

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Question #1: Nurse is using the computer when a client calls for pain medication. Which action by the nurse is the best?

A nurse should meet a client’s request for pain medication as quickly as possible after she logs out of the computer. A nurse shouldn't ask a client to wait for as long as 15 minutes for requested pain medication. If the nurse leaves the terminal without logging out, others may view confidential information or use her password. Asking a coworker to log her out isn't safe computer practice. 

Question #2: Elizabeth Kubler-Ross identified five stages of death and dying. Loss, grief, and intense sadness are symptoms of which stage?

According to Kübhler-Ross, the five stages of death and dying are denial and isolation, anger, bargaining, depression, and acceptance. In denial, the client denies aspects of the illness and death. Loss, grief, and intense sadness indicate depression. In anger, the client has hostility that may be directed to family members, God, heath care workers, and others. In bargaining, the client asks God for more time, and in return promises to do something good.  

Question #3: To help minimize calcium loss from a hospitalized client’s bones, the nurse should

Calcium absorption diminishes with reduced physical activity because of decreased bone stimulation. Therefore, encouraging the client to increase physical activity such as by walking the hall, helps minimize calcium loss. Turning or repositioning the client every 2 hours wouldn’t increase activity sufficiently to minimize bone loss, Providing dairy products and supplemental feedings wouldn't lessen calcium loss - even if the dairy products and feedings contained extra calcium — because the additional calcium doesn’t increase bone stimulation or osteoblast activity. 

Question #4: Which statement regarding heart sounds is correct?

The S1 sound — the “lub” sound — is loudest at the apex of the heart. It sounds longer, lower, and louder there than the S2 — the “dub” sound — is loudest at the base. It sounds shorter, sharper, higher, and louder there than the S1. 

Question #5: A client has a nursing diagnosis of ineffective airway clearance related to poor coughing. When planning this client’s care the nurse should include which intervention?

Interventions should address the etiology of the client's problem — poor coughing. Teaching deep breathing and coughing addresses this etiology. Increasing fluids may improve the client’s condition, but this intervention doesn't address poor coughing. Improving airway clearance is too vague to be considered an appropriate intervention. Suctioning isn't indicated unless other measures fail to clear the airway

Question #6: What is the most appropriate nursing diagnosis for the client with acute pancreatitis

Clients with acute pancreatitis often experience deficient fluid volume, which can lead to hypovolemic shock. Vomiting, hemorrhage (in hemorrhagic pancreatitis), and plasma leaking into the peritoneal cavity may cause the volume deficit. Hypovolemic shock will cause a decrease in cardiac output. Gastrointestinal tissue perfusion will be ineffective if hypovolemic shock occurs, but this wouldn't be the primary nursing diagnosis.

Question #7: One aspect of implementation related to drug therapy is:

Athough documentation isn't a step in the nursing process, the nurse is legally required to document activities related to drug therapy, including the time of administration, the quantity, and the client's reaction. Developing a plan of care, establishing outcome criteria, and setting realistic client goals are parts of planning rather than implementation.

Question #8: A nurse notes that a client’s I.V. insertion site is red, swollen, and warm to the touch. which action should the nurse take first?

Because redness, swelling, and warmth at an I.V. site are signs of infection, the nurse should discontinue the infusion immediately and restart at another site. After doing this, the nurse should apply warmth to the original site. Checking infusion patency isn't warranted because assessment findings suggest infection and inflammation, not infiltration. Heat, not cold is the appropriate treatment for inflammation.

Question #9: A nurse is caring for a client with a history of falls. The nurse’s first priority when caring for a client at risk for falls is:

Keeping the bed at the lowest possible position the first priority for clients at risk for falling. Keeping the call light easy accessible is important but isn’t a top priority. Instructing the client not to get out of bed may not effectively prevent falls — for example, if the client is confused. Even when the client needs assistance to get out of bed, the nurse should place the bed in the lowest position. The client may not require a bedpan.

Question #10: A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). which statement describes priorities the nurse should establish while performing the physical assessment?

The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and his family should be kept informed at every step of the recovery process, this action isn’t the priority when treating a client with a suspected MI. 

Question #11: A nurse is monitoring a client for adverse reactions during barbiturate therapy. What is the major disadvantage of barbiturate use?

Clients can become dependent on barbiturates, especially with prolonged use. Because of the rapid distribution of some barbiturates, no correlation exists between duration of action and half-life. Barbiturates are absorbed well and don't cause hepatotoxicity, but because barbiturates are metabolized in the liver, existing hepatic damage does require cautious use of these drugs. 

Question #12: A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse anticipates that the client will require:

Chest x-ray confirms diagnosis by revealing air or fluid in the pleural space. SaO2 values may initially decrease with a pneumothorax but typically return to normal within 24 hours. ABG studies may show hypoxemia, possibly with respiratory acidosis and hypercapnia not related to a pneumothorax. Chest auscultation will determine overall lung status, but it's difficult to determine if the chest has reexpanded sufficiently.

Question #13: During her morning assessment, a nurse notes that a client has severe dyspnea, his respirations are 34 breaths/minute and labored. Oxygen saturation is 79% on 3L of oxygen. The nurse remembers that the client’s chart includes his living will, When considering best practice, the nurse should

A living will doesn't go into effect unless the client is unable to make his own decisions. A nurse shouldn't withhold care for an alert client unless he specifically refuses care. The nurse should give all appropriate care while also maintaining the client's right to refuse treatment. Increasing the oxygen flow rate might be an appropriate response, but isn't the best action at this time. The family isn't responsible for determining care at this time. 

Question #14: A client is to receive a glycerin suppository. Which nursing action is appropriate when administering a suppository?

A suppository must be lubricated before insertion. Because suppositories melt at body temperature, they usually require refrigeration until administration. It isn’t appropriate to dissolve a suppository in warm water. It should remain in a solid state. Instructing the client to bear down would cause the anal sphincter to contract, making insertion difficult. 

Question #15: A physician orders regular insulin 10 units LV. along with 50 ml of dextrose 50% for a client with acute renal failure. What problem is this client most likely experiencing

Administering regular IV concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't he reverse the effects of hypercalcemia, hypenatremia, or hyperglycemia.

 

 

Question #16: . A nurse identifies a client’s responses to actual or potential health problems during which step of the nursing process?

The nurse identifies human responses to actual or potential health problems during the diagnosis step of the nursing process, which encompasses the nurse’s ability to formulate a nursing diagnosis. During the assessment step, the nurse systematically collects data about the client or his family. During the planning step, she develops strategies to resolve or decrease the client’s problem. During the evaluation step, the nurse determines the effectiveness of the care plan. 

Question #17: In a client with a urine specific gravity of 1.040, a subnormal serum osmolality, and a serum sodium level of 128 mEq/L, the nurse should question an order for which I.V. fluid?

An elevated urine specific gravity, a subnormal serum osmolality, and a subnormal serum sodium level indicate that the client is excreting too many solutes. Because the client is in a hypotonic state, the nurse shouldn't give him a hypotonic I.V. solution. D5W, also referred to as free water, is  hypotonic when given I.V. and can further hemodilute the clent. Dextrose 5% half-normal saline solution is hypertonic, normal saline solution is isotonic, and lactated Ringer's solution is isotonic. For this client, each of these three choices are more acceptable than D5w. 

Question #18: A 10-year-old child with rheumatic fever must have his heart rate measured while he’s awake and while he’s sleeping. Why are two readings necessary?

Tachycardia may be a sign of heart failure. The nurse can detect mild tachycardia more easily when the child is asleep than when he's awake because activity can increase his heart rate. Medications given for rheumatic fever and rheumatic heart disease, such as digoxin (Lanoxin), exert their influence both day and night. Chorea, a symptom of rheumatic fever, is the loss of voluntary muscle control. It doesn't affect pulse because the child would be sitting quietly while the nurse measured his heart rate and wouldn't be involved in purposeful movement. A 10-year-old child probably doesn't know how to consciously raise or lower his heart rate. 

Question #19: A nurse preparing to administer a sustained-release capsule to a client. Which is an appropriate nursing intervention:

Question #20: After receiving an I.M. injection, a client complains of burning pain at the injection site. which nursing action would be most appropriate at this time

Applying heat increases blood flow to the area, which, in turn, increases medication absorption. Cold decreases pain but allows the medication to remain in the muscle longer. Massage is a good intervention, but applying a warm compress is better. Tightening the gluteal muscles may cause additional burning if the drug irritates muscular tissues

Question #21: A client undergoes a total abdominal hysterectomy. When assessing the client 10 hours later, the nurse identifies which finding as an early sign of shock?

Early in shock, inadequate perfusion leads to anaerobic metabolism, which causes metabolic acidosis. As the respiratory rate increases to compensate, the client’s carbon dioxide level decreases, causing alkalosis and subsequent confusion and combativeness. Inadequate tissue perfusion causes pale, cool, clammy skin (not pale, warm, dry skin). An above-normal heart rate is a late sign of shock. A urine output of 30 ml/hour is within normal limits.

Question #22: Cross-tolerance to a drug is defined as:

Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug. A drug that can prevent withdrawal symptoms from another drug describes cross-dependence. Cross-tolerance isn't an allergic reaction to a class of drugs. A drug's ability to increase the potency of another drug describes potentiating effects.

Question #23: A nurse caring for a client wth a fecal impaction should watch for:

Passage of liquid or semiliquid stools results from seepage of unformed bowel contents around the impacted stool in the rectum. Clients with fecal impaction don’t pass hard, brown, formed stools because the feces can't move past the impaction. These clients  typically report the urge to defecate (although they can't pass stool) and decreased appetite.

Question #24: A physician orders an intestinal tube to decompress a client’s GI tract. when gathering equipment for this procedure, a nurse should obtain a:

A Miller-Abbott tube is an intestinal tube. A Sengstaken-8lakemore tube is an esophageal tube. Levin tubes and Salem sump tubes are nasogastric tubes.

REFERENCE: Smeltzer, S.C., and Bare, B. Brunner & Suddarth’s Textbook of Medical Surgica Nursing, 2008, p. 1175

Question #25: . A client has a blood pressure of 152/86 mm Hg. The nurse should document the client’s pulse pressure as:

Pulse pressure is the difference between the systolic and diastolic pressures — in this case, 66 mm Hg. 

Question #26: A client has a nursing diagnosis of Risk for Injury related to adverse effects of potassium-wasting diuretics. What is a correctly written client outcome for this nursing diagnosis?

The client understands all complications of the disease process." RATIONALE: A client outcome must be measurable, objective, concise, realistic for the client, and attainable through nursing management. For each client outcome, the nurse should include only one client behaviour. She should express that behaviour in terms of client expectations and should indicate a time frame in which to accomplish. Knowing the importance of consuming potassium-rich foods and knowing which foods are high in potassium aren't measurable outcomes. Understanding all complications of a disease process isn't measurable or specific to the nursing diagnosis listed. 

Question #27: When caring for a client with a 3-cm stage I pressure ulcer on the coccyx, which action may the nurse institute independently?

Question #28: A client with burns on his groin has developed blisters. As the client is bathing, a few blisters break. The best action tor the nurse to take is to:

The nurse should clean the area with a mild solution such as normal saline, and then cover it with a protective dressing. Soap and water and alcohol are too harsh. The body's first line of defense broke when the blisters opened: removing the skin exposes a larger area to the risk of  infection

Question #29: A nurse is assisting with a subclavian vein central be insertion when the client’s oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the chent has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade. 

Question #30: A nurse determines that a client has 20/40 vision. Which statement about this client’svision is true?

The numerator, which is always 20, is the distance in feet between the vision chart and the client. The denominator indicates from what distance a person with normal vision can read the chart. 

Question #31: For the past few days, a client has been having calf pain and notices that the painful calf is larger than the other one. The right calf is red, warm, achy, and tender to touch. Which question about the pain should a nurse include in the assessment?

The client's symptoms indicate deep vein thrombosis (DVT). Pointing toes toward the knee will cause discomfort in a client with DVT. Time of the day doesn’t influence the pain associated with DVT. A client with intermittent claudication experiences pain that increases during activity and decreases with rest. A dependent position, not a position change, will increase venous stasis and the pain associated with DVT. 

Question #32: A physician orders the following preoperative medications to be administered to a client by the I.M. route: meperidine (Demerol), 50 mg: hydroxyzine pamoate (Vistaril), 25 mg; and glycopyrrolate (Robinul), 0.3 mg. The medications are dispensed as follows: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer?

Computation: 0.5 ml + 0.5 ml + 1.5 ml = 2.5 ml

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Question #33: What is a common source of airway obstruction in an unconscious client:

In an unconscious client, the muscles controlling the tongue commonly relax, causing the tongue to obstruct the airway. When this situation occurs, the nurse should use the head-tilt, chin-lift maneuver to cause the tongue to fall back into place. If she suspects the client has a neck injury she must perform the jaw-thrust maneuver.

Question #34: After undergoing small-bowel resection, a client is ordered Metronidazole (Flagyl) 500 mg IV The mixed IV solution contains 100 ml. The nurse is to run the drug over 30 minutes. The drip factor of the available IV tubing is 15 gtts/ml. What is the drip rate? Round your answer to the nearest whole number.

Use the following equation: 100 ml/30 minutes x 15 gtt/1 ml = 49.9 gtt/minute (50 gtt/minute) 

Question #35: An elderly client who experiences several adverse drug reactions may benefit from:

In older clients, diminished hepatic and renal function commonly reduces drug metabolism and excretion. Because adverse reactions are frequently related to drug blood level, the client may benefit from reduced drug dosages. Adverse drug reactions don’t represent a reason for nursing home placement. Increased drug doses at longer intervals may increase adverse reactions rather than decrease them. Although frequent visits to the physician may benefit the client, the visits themselves won't alter how the client's body reacts to the drug

Question #36: When examining a client who has abdominal pain, a nurse should assess:

The nurse should systematically assess all areas of the abdomen, if time and the client's condition permit, concluding with the symptomatic area. Otherwise, the nurse may elicit pain in the symptomatic area, causing the muscles in other areas to tighten. This tightening would interfere with further assessment.

Question #37: A nurse is teaching a group of nursing assistants about infection-control measures. The nurse tells the group that the first line of intervention for preventing the spread of infection

Hand washing is the first line of intervention for preventing the spread of infection. Wearing gloves and assigning private rooms for clients can also decrease the spread of infection and should be implemented according to standard precautions. Antibiotics should be initiated when a causative organism is identified.

Question #38: A nurse caring for a client who has suffered a severe stroke. During routine assessment, the nurse notices Cheyne-Stokes respirations. Cheyne-Stokes respirations are

Cheyne-Stokes respirations are breaths that become progressively deeper followed by shallower respirations with apneic periods. Biot’s respirations are rapid, deep breaths with abrupt pauses between each breath, and equal depth between each breath. Kussmaul’s respirations are rapid, deep breaths without pauses. Tachypnea is abnormally rapid respirations.

Question #39: When positioned properly, the top of a central venous catheter should lie in the:

When positioned correctly, the top of a central venous catheter lies in the superior vena cava, inferior vena cava, or right atrium — that is, in the central venous circulation. Blood flows unimpeded around the tip, allowing the rapid infusion of large amounts of fluid directly into circulation. The basilic, jugular, and subclavian veins are common insertion sites for central venous catheters.

Question #40: A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51, PaCO2, 28 mm Hg; PaO2, 70 mm Hg: and HCO3, 24 mEq/L. What do these values indicate

A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (Co2) loss, which causes alkalosis — indicated by this client's elevated pH value. with respiratory alkalosis, the kidneys’ bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

Question #41: The ear canal of an infant or young child:

 The ear canal slants up in a younger child and down in an older child or adult.

Question #42: When a central venous catheter dressing becomes moist or loose, what should a nurse do first?

A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning  solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. She should notify the physician if she observes any catheter-related complications. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn’t a reason to remove the catheter.

 

References: Smeltzer, S.C., and Bare, B. Brunner&Suddarth’s Texthook of MedicalSurgical Nursing, 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1005

 

 

Question #43: A nurse is assigned to care for a client with a tracheostomv tube. How can the nurse communicate with this client?

The nurse should use a nonverbal communication method, such as a magic slate, note pad and picture boards (if the client can’t write or speak English). The physician orders a tracheostomy plug when a client is being weaned off a tracheostomy; it doesn’t enable the client to communicate. The call button, which should be within reach at al times for all clients, can summon attention but doesn't communicate additional information. Suctioning clears the airway but doesn't enable the client to communicate

Question #44: A home care nurse is assessing a geriatric client. What is the most common cause of medication errors in noninstitutionalized geriatric clients?

Knowledge deficit is the most common cause of medication errors among noninstitutionalized geriatric clients. Poor vision, dementia, and confusion can contribute to medication errors in this group, but they occur less frequently.

Question #45: Which drug delivery system relieves the nurse of the responsibility for transcribing the medication order

An automated drug delivery system relieves the nurse of the responsibility for transcribing the medication order. The floor stock and unit-dose drug delivery systems require a transcription of the medication order. An individual prescription isn't dispensed by the nurse in a hospital setting.

 

 

Question #46: Before administering the evening dose of a prescribed medication, the nurse on the evening shift finds an unlabeled, filled syringe in the client’s medication drawer. What should the nurse do?

As a safety precaution, the nurse should discard an unlabeled syringe that contains medication. The other options are considered unsafe because they promote error

Question #47: The nurse is assisting with a subclavian vein central line insertion when the client’s oxygen saturation rapidly drops. He complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include

In the case of a pneumothorax, auscultating the breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in pericardial tamponade.

Question #48: When monitoring a client’s central venous pressure (CVP), the nurse knows that a normal CVP measurement is:

Normally, CVP ranges from 4 to 10 cm water, or 3 to 7 mm Hg. The other options are outside this range.

 

 

Question #49: During an admission assessment, the nurse asks a client why he’s being admitted to the facility. The client responds, “The physician found a lump in my prostate gland. I guess I have cancer.” Which response by the nurse would be most therapeutic

This response acknowledges the client's concern and shows a willingness to listen. Although a biopsy is needed to confirm cancer, telling the client this wouldn't permit him to discuss his concerns. Urging the client not to worry or advising him to maintain a positive attitude is a clichéd response. Offering advice about how he should handle the problem also wouldn't be therapeutic.

Question #50: Which action would be contraindicated for a client who develops a temperature of 102° F (38.9° C).

A client with a fever has an increased basal metabolism rate. Therefore, he needs additional calories in his diet. All the other responses — monitoring the client's temperature, increasing his fluid intake, and covering him with a light blanket — are therapeutic interventions for a fever.

Question #51: A client hospitalized with pneumonia has thick, tenacious secretions. To help liquefy these secretions, the nurse should

Increasing the client's intake of oral or I.V. fluids helps liquefy thick, tenacious secretions and ensures adequate hydration. Turning the client every 2 hours would decrease pooling of secretions but wouldn't liquefy them. Elevating the head of the bed would reduce pressure on the diaphragm and ease breathing but wouldn't liquefy secretions. Maintaining a cool room temperature would increase the client's comfort but wouldn't liquefy secretions.

Question #52: The nurse is giving nutritional counseling to the mother of a child with celiac disease. Which statement by the mother would indicate understanding?

A child with celiac disease must eat a gluten-free diet. If foods containing gluten are eaten, changes occur in the intestinal mucosa that prevent the absorption of foods, especially fats. Therefore, all foods containing wheat, rye, oats, and barley must be eliminated from the diet. Such foods as potatoes, rice, flour, and cornstarch are allowed in a gluten-free diet. Frozen and packaged foods may contain gluten fillers; therefore, they should be avoided.

 

 

Question #53: After intentionally taking an overdose of hydrocodone (Vicodin), a client is admitted to the emergency department. Activated charcoal is prescribed. Before administering the drug, the nurse should ensure that the client:

Activated charcoal binds to the ingested drug and is eliminated in the stool. Therefore, the client should have audible bowel sounds before the drug is given. Being able to follow commands isn't required; in some instances, the client may not be fully responsive. Ideally, a NG tube should be in place; however, a NG tube isn't necessary because the client can drink the activated charcoal. Advance directives aren't required for treatment.

Question #54: A facility has a system for transcribing medication orders to a Kardex as well as a computerized medication administration record (MAR). A physician writes the following order for a client: “Prednisone 5 mg P.O. daily for 3 days.” The order is correctly transcribed on the Kardex. However, the nurse who transcribes the order onto the MAR neglects to place the limitation of 3 days on the prescription. On the 4th day after the order was instituted, a nurse administers prednisone 5 mg P.O. During an audit of the chart, the error is identified. The person most responsible for the error is the

The nurse administering the dose should have compared the MAR with the Kardex and noted the discrepancy. The transcribing nurse and pharmacist aren't void of responsibility; however, the nurse administering the dose is most responsible. The facility's policy does provide for a system of checks and balances. Therefore, the facility isn't responsible for the error.

Question #55: To evaluate a client’s chief complaint, the nurse performs deep palpation. The purpose of deep palpation is to assess which of the following

The purpose of deep palpation, in which the nurse indents the client's skin approximately 1½" (3.8 cm), is to assess underlying organs and structures, such as the kidneys and spleen. Skin turgor, hydration, and temperature can be assessed by using light touch or light palpation.

Question #56: When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of

When giving an I.M. injection, the nurse inserts the needle into the muscle at a 90-degree angle, using a quick, dartlike motion. A 15-degree angle is appropriate when administering an intradermal injection. A 30-degree angle isn't used for any type of injection. A 45- or 90-degree angle can be used when giving a subcutaneous injection.

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