Fundamentals of Nursing Set II

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A client is admitted to the hospital with abrupt symptoms of in-
creasing shortness of breath, fever, and a productive cough with
green sputum. Upon further exam, the client is diagnosed with
chronic obstructive pulmonary disease (COPD) exacerbation. The
nurse identifies this as which type of illness?
A. Chronis
A. Chronic
B. Acute
C. Contagious
D. Terminal
When caring for your 52 year old client you note that he is having
difficulty breathing. He is lying in bed and is already receiving oxy-
gen therapy via nasal cannula. Which of the following interventions
would the nurse do first?
C. Assist the patient to Fowler's position
A. Promote removal of pulmonary secretions
B. Obtain a specimen for atrial blood gases
C. Assist the patient to Fowler's position
D. Increase the oxygen flow
Which are correctly written as client goals? Select all that apply.

A. The client will rate pain as a 3 or less on a 10-point scale by A. The client will rate pain as a 3 or less on a 10-point scale by
1700 today. 1700 today.
B. The client will eat at least 75% of all meals by May 5. B. The client will eat at least 75% of all meals by May 5.
C. The client will understand the side effects of digoxin. D. The client will identify five low-sodium foods by October 9.
D. The client will identify five low-sodium foods by October 9.
E. The client will know the signs and symptoms of infection.
How will you know if your client teaching about using the incentive
spirometer was effective?

A. The patient will verbalize that the spirometer will help prevent
blood clots in his/her lungs.
D. The patient will demonstrate the correct use of inspiration into
B. The patient will change the settings on the spirometer to a lower
the spirometer and correctly answer questions about how and why
number each day.
to use a spirometer.
C. The patient will blow forcefully into the spirometer 10 times each
hour.
D. The patient will demonstrate the correct use of inspiration into
the spirometer and correctly answer questions about how and why
to use a spirometer.
The client is a minor child who was involved in an accident. The
child is now on a pediatric unit. The health care provider has
prescribed the client to receive 2 units of packed red blood cells
due to a low hemoglobin and hematocrit.The nurse needs to
obtain consent from a parent to initiate the blood therapy. The
client's religion is Jehovah's Witnesses. What is the nurse's first
action?
D. Ask the parent to consent for administration of the blood.
A. Contact the ethics board at the clinical agency about this
situation.
B. Administer the blood without obtaining consent.
C. Notify the health care provider that the client is a member of
Jehovah's Witnesses.
D. Ask the parent to consent for administration of the blood.
The nurse is assessing the smoking history of a 62 year old man.
The man states that he smoked a pack of cigarettes for 32 years.
How many pack years does the nurse document for this client?
D. 32 pack years
A. 42 pack years
B. 50 pack years
C. 30 pack years
D. 32 pack years
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The client reports taking an OTC laxative daily for several weeks
and remains constipated. What are appropriate actions of the
nurse? Select all that apply.

A. Assess the client's diet and fluid intake. A. Assess the client's diet and fluid intake.
B. Instruct the client to continue taking bisacodyl until the medica- C. Ask the client about abdominal pain.
tion produces a bowel movement. E. Question the client about the color, consistency, pattern, and
C. Ask the client about abdominal pain. shape of stools.
D. Tell the client to increase fiber intake and keep fluid intake the F. Auscultate the abdomen for bowel sounds.
same.
E. Question the client about the color, consistency, pattern, and
shape of stools.
F. Auscultate the abdomen for bowel sounds.
The nurse is assessing a client's respiratory status. The client's
breathing is rapid and shallow at a rate of 28 breaths per minute.
What is the appropriate term for this client's respiratory status?

A. Orthopnea D. Tachypnea
B. Tachycardia
C. Bradypnea
D. Tachypnea
E. Apnea
A client verbalizes to a mental health counselor that his life is
meaningless since his wife divorced him and that he no longer
wants to live. What nursing diagnosis, resulting from his spiritual
distress, would be appropriate?
B. Risk for Self-Directed Violence
A. Powerlessness
B. Risk for Self-Directed Violence
C. Fear
D. Sexual Dysfunction
The post-abdominal-surgical client is noted by the nurse to have
shallow respirations of 8 per minute and tachycardia. The nurse
obtains an order for oxygen administration as the client is at risk
for:
B. Hypoventilation
A. Orthopnea
B. Hypoventilation
C. Hyperventilation
D. Airway Obstruction
In planning to meet the nutritional needs of a critically ill client in
the intensive care unit, which factor will increase the client's basal
metabolic rate?
B. Infection
A. Advanced age
B. Infection
C. Prolonged fasting
D. Long periods of sleep

A client is receiving oxygen therapy by venturi-mask to deliver a

FiO2 of 65%. The client is distressed by having the mask in place
and asks if he can have the little nose things he had once before.
The best nursing response would be:
B. "The prongs that provide oxygen below your nose cannot pro-
A. "i'll call the doctor and get an order to change. It should not vide this amount of oxygen. What can I do to make you more
make a difference." comfortable with the mask?"
B. "The prongs that provide oxygen below your nose cannot
provide this amount of oxygen. What can I do to make you more
comfortable with the mask?"
C. "We can change to them if you prefer."

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D. " Try to tough it out. If you really cannot stand it, maybe the
doctor will do something else when he comes in."
The client has an order to have oxygen administered by nasal
cannula to keep the O2 saturation at 90% or greater. The oxygen
is currently at 1 L per minute with a saturation of 85%. The nurse
should:

A. Leave the flow rate set as is because 85% is close enough for B. Increase the flow rate to 2 liters per minute.
this test.
B. Increase the flow rate to 2 liters per minute.
C. Notify the physician because any higher level of oxygen is
dangerous.
D. Decrease the flow rate.
The nurse is assessing factors related to a client's complaint of
constipation. Which of the following factors are associated with
constipation? Select all that apply.
B. Insufficient activity of immobility
C. Change in diet
A. Increased intake of coffee
D. Insufficient fluid intake
B. Insufficient activity of immobility
C. Change in diet
D. Insufficient fluid intake
A nurse developing a plan of care for a client newly admitted
with prolonged diarrhea establishes which of the following as the
priority diagnosis for the client?
D. Risk of fluid volume deficit related to prolonged diarrhea
A.Risk for impaired skin integrity related to prolonged diarrhea
B. Anxiety related to lack of control of fecal elimination
C. Knowledge deficit related to lack of previous experience
D. Risk of fluid volume deficit related to prolonged diarrhea
A nurse is assessing a client the first day after colon surgery.
Based on knowledge of the effects of anesthesia and manipulation
of of the bowel during surgery, which focused assessment will be
included?
C. Bowel sounds
A. Urinary output
B. Pulse amplitude
C. Bowel sounds
D. Skin turgor
You are administering an enema to a female client who is con-
stipated. You notice the client's skin is pale and a little moist. You
take the pulse and obtain a rate of 44 bpm. What do you suspect
is occuring?
D. She is having a vagal response.
A. She is hemorrhaging internally.
B. This is a normal reaction to an enema when one is so full of
feces.
C. She has a fecal impaction.
D. She is having a vagal response.
Factors that are known to cause diarrhea include: Select all that
apply.
A. Stress
A. Stress
D. Recent change in diet
B. Depression
C. The natural again process
D. Recent change in diet
You are caring for a 78 year old female client who lives alone. She
was admitted to the hospital with malnutrition and anemia. You are
suspicious that she has a fecal impaction based on the fact that:

A. She tells you that she only has a bowel movement every other
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day.
B. She has been incontinent of continuous small amounts of liquid
stool all times today. B. She has been incontinent of continuous small amounts of liquid
C. Her last bowel movement was yesterday. stool all times today.
D. Her bowel sounds are hyperactive in all four quadrants of her
abdomen.
A man is diagnosed with terminal kidney failure. His wife demon-
strates loss and grief behaviors. What type of loss is the wife
experiencing?

A. Toast B. Anticipatory loss

B. Anticipatory loss
C. Bereavement
D. Maturational loss
E. Dysfunctional grieving
Kübler-Ross defines five stages of psychosocial responses to dy-
ing and death. Which statement is characteristic of the bargaining
stage?
A. "Just let me live to see my grandson born."
A. "Just let me live to see my grandson born."
B. "I've had a good life and I can die in peace."
C. "The doctors must have made a mistake."
D. "Why did this happen to me? I always exercised."
How much fluid should the average adult take in each day?

A. 500 to 1,500 mL
B. 500 to 1,000 mL C. 2,000 to 3,000 mL
C. 2,000 to 3,000 mL
D. 3,000 to 4,000 mL
E. 500 mL or less
Diets modified by consistency include all of the following except:

A. Clear liquid diet

C. Low-sodium diet
B. Mechanical soft diet
C. Low-sodium diet
D. Pureed diet
You are caring for a client who is hospitalized with congestive
heart failure and is retaining fluids. Which of the following ther-
apeutic diets is most likely to be ordered for this client?
A. Low-sodium diet
A. Low-sodium diet
B. Calorie-restricted diet
C. High-protein diet
D. Clear liquid diet
Mr. Brown has a severe large pressure ulcer that the hospital staff
is working to heal. What type of diet would best meet the needs
of the client?

A. Diabetic diet D. High-calorie, high-protein diet

B. Renal diet
C. Protein-restricted diet
D. High-calorie, high-protein diet
E. Full liquid diet
You are delegating a task for monitoring the output of an elderly
male client at risk for oliguria. He has an indwelling catheter in
place. Which is the most appropriate direction for you to give an
C. "Check his output after 2 hours. If it is not above 60 mL let me
unlicensed assistant?
know immediately."
A. "Tell me is his urine output decreases."
B. "Check his output half-way through the shift and let me know
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the total."
C. "Check his output after 2 hours. If it is not above 60 mL let me
know immediately."
D. "Keep an eye on his output for me."
A client visits the health care facility for a scheduled physical
assessment. What should the nurse do when physically assessing
the quality of the client's oxygenation? Select all that apply.
A. Check the symmetry of the client's chest.
B. Observe the breathing pattern and effort.
A. Check the symmetry of the client's chest.
C. Monitor the client's respiratory rate.
B. Observe the breathing pattern and effort.
C. Monitor the client's respiratory rate.
D. Note the amount of urine output in a 24 hour period.
Which two blood tests are most important in assessing kidney
function?

A. CBC and hematocrit D. BUN and creatinine

B. BUN and hematocrit
C. CBC and creatinine
D. BUN and creatinine
You are instructing your patient on collecting all urine passed in
a 24-hour period. One of the most important steps in obtaining a
24-hour urine sample is to:
A. Have the patient void, discard this urine, note the time, and then
A. Have the patient void, discard this urine, note the time, and then
begin collecting.
begin collecting.
B. Keep the sample of room temperature.
C. Begin the collection time as soon as the doctor orders the test.
D. Make sure there is a preservative in the collection bottle.
A dyig client is undergoing terminal weaning. What is the purpose
of this intervention?

A. To manage the symptoms of the illness. D. To gradually withdraw mechanical ventilation.

B. To initiate life-sustaining measures for the client.
C. To prepare for resuscitation of the client.
D. To gradually withdraw mechanical ventilation.
A client has been recently diagnosed with diabetes. He is seen in
the emergency room every day with high blood sugar. The client
apologizes to the nurses for bothering them every day but he
cannot give himself insulin injections. What should the nurse's
response be?
A. "Has someone taught you how to take them?"
A. "Has someone taught you how to take them?"
B. "You could ask the doctor to change the medication."
C. "You should learn to take injections yourself."
D. "I myself cannot take insulin injections."
A nurse is teaching a home care client and the family about using
prescribed oxygen. What is a critical factor that must be included
in teaching?
C. The safety measures necessary to prevent a fire
A. The cost and source of supply for the oxygen
B. The importance of communication with the client
C. The safety measures necessary to prevent a fire
D. The need to provide good skin care
What type of order would a physician most likely write to treat a
client whose pain levels vary widely throughout the day?

A. One-time C. PRN
B. Stat
C. PRN
D. Standing
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A nurse is preparing a client for a physical assessment. The client
appears anxious about the assessment. Which statement by the
nurse would be most appropriate?
C. "Let me tell you what I will be doing. It should not be painful."
A. "Some of the examination may be painful but I will be gentle."
B. "I have to do this, so just relax and it won't last long."
C. "Let me tell you what I will be doing. It should not be painful."
D. "This is nothing to worry about. None of this will hurt you."
A client says to the nurse, "That night nurse need to go back to
school. She gave me a shot in the wrong arm, she forgot to fill my
water pitcher, and she wouldn't answer my light!" What would be
a therapeutic response by the nurse?

A. "Sounds like you had a bad night. Tell me more about it, and
A. "Sounds like you had a bad night. Tell me more about it, and
let's see if there is anything I can do to help you now."
let's see if there is anything I can do to help you now."
B. "Well the least competent nurses do sort of drift to the night
shift. I don't blame you for being upset."
C. "You seem fine this morning. I guess it couldn't have been that
bad."
D. "We are always understaffed on nights. I'm sure the nurse did
the best she could."
Which one of the following is the cause of ascites?

A. Flatus
D. Fluid
B. Feces
C. Fibroid tumor
D. Fluid
The nurse works on a med-surg unit and is beginning assess-
ments for clients. Which client would the nurse assess first, based
on recent vital sign readings?
C. The client whose respiratory rate is 9 breaths/minute
A. The client whose axillary temperature is 98.5* F
B. The client whose blood pressure is 102/62 mmHg
C. The client whose respiratory rate is 9 breaths/minute
D. The client whose radial pulse is 100 beats/minute
When a client with a repair of a fractured hip has gained stability
and is ready to progress to the use of a cane, following use of a
walker, you would teach the client to:

A. Hold the cane on the affected side

C. Hold the cane on the unaffected side.
B. Hold the cane in front of the patient so that this provides support
for both extremities.
C. Hold the cane on the unaffected side.
D. Hold the cane in the dominate hand regardless of the side that
was injured.
A female client is on isolation because she acquired a me-
thicillin-resistant Staphylococcus aureus (MRSA) infection after
hospitalization for hip replacement surgery. What name is given
to this type of infection?
C. Healthcare-associated (HAI)
A. Antimicrobial
B. Viral
C. Healthcare-associated (HAI)
D. Iatrogenic
A nurse is ambulation a client who has had a stroke. The client
has weakness on the right side of the upper body. Where would
the nurse stand to walk the client?
D. On the weak side
A. In back of the patient
B. In front of the patient
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C. On the strong side
D. On the weak side
The elevation of the WBC count noted on your client with a
diagnosis of urinary tract infection is called:

A. Neutrophils B. Leukocytosis
B. Leukocytosis
C. Polycythemia
D. Differential
The nurse is educating a client on the proper procedure for a stool
test for occult blood. The nurse should caution the client to omit
which food from her diet?
B. Red meat
A. Eggs
B. Red meat
C. Dairy products
D. Green vegetables
A client with dehydration is being administered IV fluids. During
rounds, the nurse noticed that the skin immediately surrounding
the IV site was reddish in color and showing signs of inflammation.
The nurse recognizes that what phenomenon is likely responsi-
ble?
D. Phlebitis
A. Infiltration
B. Thrombus formation
C. Pulmonary embolus
D. Phlebitis
A nurse is teaching a home care client how to do pursed-lip
breathing. What is the therapeutic effect of this procedure?

A. Replacing the use of incentive spirometry D. Prolonging expiration to reduce airway resistance
B. Using upper chest muscles more effectively
C. Reducing the need to PRN pain medications
D. Prolonging expiration to reduce airway resistance
What nursing diagnosis has the highest priority?

A. Ineffective airway clearance related to incisional pain

A. Ineffective airway clearance related to incisional pain
B. Social isolation related to impaired mobility
C. Impaired skin integrity related to leakage of ileostomy drainage
D. Anxiety related to outcome of diagnostic bronchoscopy
The client's expected outcome is "The client will maintain skin
integrity by discharge." Which measure is best in evaluating the
outcome?
C. Condition of skin over bony prominence
A. The client's ability to reposition self in bed
B. Pressure-relieving mattress on the bed
C. Condition of skin over bony prominence
D. Percent intake of a diet high in protein
Changes seen in the pulmonary system as a result of immobility
include increased pooling of secretions and mucus in the lungs
which can cause:
C. Hypostatic pneumonia
A. Orthostatic hypotension
B. Venous stasis
C. Hypostatic pneumonia
D. Disuse tuberculosis

The nurse is caring for a client with a diagnosis of end-stage

renal disease. The client has expressed the desire to be "kept
comfortable" and to not continue further treatment. The daughter

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arrives from out of town and is demanding to have further testing
done to determine the best treatment option for the client. What is
the best action for the nurse to take at this time?

A. Persuade the client to agree to the daughter's request B. Explain to the daughter the wishes of the client.
B. Explain to the daughter the wishes of the client.
C. Arrange a meeting between the physician and daughter to
change code status.
D. Contact the imaging center to schedule the testing.
A nurse need to administer an intradermal tuberculin skin test
injection to a client. What is the most suitable angle when admin-
istering an intradermal injection?
B. 10 degree angle
A. 45 degree angle
B. 10 degree angle
C. 180 degree angle
D. 90 degree angle
According to Maslow, which of the following needs is the most
important to fulfill?

A. The need for acceptance

C. The need for rest because it is on the 1st level of hierarchy and
B. The need for love because this is the most important need a
is therefore most basic.
human being ever experienced.
C. The need for rest because it is on the 1st level of hierarchy and
is therefore most basic.
D. The need for self-actualization because it is the highest need.
Which of the following links in the infection chain is the basis for
the type of isolation implemented?

A. Strict isolation D. Means/mode of transmission

B. Infectious agent
C. Respiratory link
D. Means/mode of transmission
The client is actively dying and has a prescription for Do Not
Resuscitate. The nonresponsive client is mouth breathing and has
noisy respirations. The client is incontinent of uring and feces.
Family is at the bedside. What interventions would be appropriate
for the nurse to perform to meet the needs of the client and family?
B. Cleanse the client's mouth every shift and PRN.
Select all that apply.
C. Elevate the head of the bed to a semi-Fowler's position.
E. Encourage the family to reminisce about positive, enjoyable
A. Provide ice chips for the family to administer to the client
events that the client and family shared together
B. Cleanse the client's mouth every shift and PRN.
C. Elevate the head of the bed to a semi-Fowler's position.
D. Insert a catheter for the client's urinary incontinence.
E. Encourage the family to reminisce about positive, enjoyable
events that the client and family shared together
A client taking insulin has his levels adjusted to ensure that the
concentration of drug in the blood serum produces the desired
effect without causing toxicity. What is the term for this desired
effect?
B. Therapeutic range
A. Peak level
B. Therapeutic range
C. Trough level
D. Half-life

A client has a black, hard, leathery scab on his left heel. The stage
of this ulcer is:
A. Unstageable
A. Unstageable
B. Stage II
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C. Deep tissue injury
D. Stage III
A client is diagnosed with a terminal illness. Who is usually re-
sponsible for deciding what, when, and how the client should be
told?
C. Physician
A. Family
B. Chaplain
C. Physician
D. Nurse
The nurse realizes that the patient with a shoulder incision needs
more teaching when the client says:

A. "I know how to change the dressing on my incision and have

done it three times." C. "I will take the antibiotics until the doctor removes the staples."
B. "If my fever goes about 101 degrees, I will notify my doctor."
C. "I will take the antibiotics until the doctor removes the staples."
D. I know the signs of infection and will report them to the physician
if they occur."
If a client had a stage III pressure ulcer, you would expect to see
which of the following assessment?

A. An open area that reveals damage to the epidermis, dermis,

subcutaneous tissue, muscle, fascia, tendon, capsule, and bone.
C. An open area that extends through the epidermis, dermis, and
B. Erythema that remains 15-30 minutes after the pressure is
subcutaneous tissue with possible undermining and tunneling
relieved and does not blanch.
C. An open area that extends through the epidermis, dermis, and
subcutaneous tissue with possible undermining and tunneling
D. Intact serum-filled blisters and broke blisters with shallow, pink
or red shiny ulcerations
While assessing the skin of a client on bedrest, you notice an
undocumented area of non-blanchable erythema over the left hip
with a small blister in the center. What action will you take?
C. Notify the physician that a possible pressure ulcer has devel-
A. Massage the are vigorously with lotion to promote circulation oped
B. Order a special gel-filled mattress for the patient
C. Notify the physician that a possible pressure ulcer has devel-
oped
Pulse pressure is:

A. The radial pulse minus the apical pulse

B. The difference between the systolic pressure and the diastolic
B. The difference between the systolic pressure and the diastolic
pressure
pressure
C. The pressure of blood as it circulates in the arteries
D. The blood pressure minus the pulse
Your client with a diagnosis of paraplegia has a fecal impaction.
Which of the following types of enemas should be given, initially,
to soften stool before an attempted digital removal?
B. Oil retention
A. High-cleansing
B. Oil retention
C. Soap suds
D. Low-cleansing
When a blood pressure cuff is too narrow for an individual's arm,
the blood pressure is:

A. Not affected D. Falsely high

B. Normal
C. Falsely low
D. Falsely high
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Discharge planning should begin:

A. When the client is well

B. Upon admission
B. Upon admission
C. The day before discharge
D. 24 hours after admission
When taking an initial blood pressure, the cuff should be inflated
to ___ mmHg above the client's highest systolic pressure.

A. 10 C. 30
B. 80
C. 30
D. 100
The nurse is a new graduate and is starting her first job. The
nurse wants to project an image of a healing presence to the
clients. Which actions would the nurse employ to project a healing
presence? Select all that apply.
A. Maintain privacy for clients when providing nursing care.
B. Seek ways to set appropriate boundaries with clients and with
A. Maintain privacy for clients when providing nursing care.
others in the workplace.
B. Seek ways to set appropriate boundaries with clients and with
D. Develop a group of friends that can provide the nurse with
others in the workplace.
support
C. Encourage client to adhere to the health care provider's rec-
E. Remain calm even in situations that are stressful.
ommendations even when the client wants something different.
D. Develop a group of friends that can provide the nurse with
support
E. Remain calm even in situations that are stressful.
The largest amount of cooling of the body occurs through the
movement of heart from a warmer source to a cooler source
throughout the air around us. An example of this would be a client
who is uncovered in a room that has a low temperature. This
mechanism of cooling is called:
A. Radiation
A. Radiation
B. Conduction
C. Evaporation
D. Convection
Critical thinking is an essential component in all phases of the
nursing process. What question might be used to facilitate critical
thinking during outcome identification and planning?

A. "What problems require my immediate attention or that of the

A. "What problems require my immediate attention or that of the
team?"
team?"
B. "How do I document care accurately and legally?"
C. "What major defining characteristics are present for a nursing
diagnosis?"
D. "How do I best cluster these data and cues to identify prob-
lems?"
When a person has a fever or diaphoresis, the urine output will be:
A. Decrease
A. Decrease
B. Increase
A camp nurse is educating a group of adolescent girls on the
importance of regular physical exercise. Which level of preventive
care does this activity represent?
C. Primary
A. Restorative
B. Tertiary
C. Primary
D. Secondary

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Your client has just returned to his room after undergoing ex-
ploratory abdominal surgery. You note red drainage saturated on
his dressing. You will describe the drainage as which one of the
following:
B. Sanguineous
A. Serous-sanguineous
B. Sanguineous
C. Purulent
D. Serous
You and an unlicensed assistive personnel are preparing to turn
an immobile client from her back to her right side. Which of the
following actions will you take first?
D. Move the patient to the left side of the bed
A. Place a pillow between her knees and ankles
B. Cross the patient's left leg over her right leg
C. Externally rotate the patient's right shoulder
D. Move the patient to the left side of the bed
Your client's temperature has been recorded as 100.2* F. The
policy requires all temperatures to be recorded in Celsius. What 37.9* C
is your client's temperature converted to in Celsius?
Your client's weight is 22 pounds. To record your client's weight in
10 kg
kg, you would record your client's weight as:
Order: Procrit 9,750 units subcutaneous every 8 hours
Available: Procrit 4,000 U/mL
2.4 mL
Administer: ______________
Order: Levothyroxine 500 mcg p.o. tid
Available: Levothyroxine 0.5 mg per tablet
1 tab
Per dose- Administer ____________________
You are working the 11:00 pm to 7:00 am shift. Your client is a new
post-op admission following cranial surgery. He is nauseated and
vomits 375 mL of yellow liquid at 1:00 am. At 2:00 am he vomits
Intake: 800 mL
another 125 mL of liquid. You give him some medication and he
Output: 1950 mL
falls asleep and rests well . He has continuous IV fluids infusing at
100 mL/hr. You empty his catheter bag and note 1450 mL of clear
yellow urine. Calculate the intake and output for your shift.

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