Fundamentals of Nursing Week 3 Practice Questions

A nurse is teaching a group of older adults about expected age related changes. Which of the following statements by a group member indicates that the teaching has been effective? A. "I should expect my heart rate to take longer to return to normal after exercise as I get older." B. "Urinary incontinence is something I will have to live with as I grow older." C. "I can expect to have less ear wax as I get older." D. "My stomach will empty more quickly after meals as I grow older."

A. "I should expect my heart rate to take longer to return to normal after exercise as I get older." Older adults experience decrease cardiac output, which causes an increased pulse rate during exercise.

A community health nurse is conducting a class about body mechanics for county office workers. Which of the following instructions should the nurse include? (Select all that apply) A. "Sit with your back supported" B. "Keep your knees at hip level." C. "Use an ergonomically designed computer keyboard." D. "Keep your elbows away from your body." E. "Adjust the monitor screen so that you have to tilt your head slightly to look at it."

A. "Sit with your back supported" B. "Keep your knees at hip level." C. "Use an ergonomically designed Using a lumbar support in a straight-back chair helps maintain good posture and prevent back pain. Keeping knees at the level of the hip or higher helps reduce the risk of lordosis, which is an exaggeration of the curve of the lumbar spine. Using a keyboard that maintains ergonomic positioning of the wrists can help prevent carpal tunnel syndrome.

A nurse is assessing a client for conductive hearing loss. When using the Rinne test, which of the following results should the nurse identify as an indication that the client has conductive hearing loss of the left ear? A. Air conduction is less than bone conduction in the left ear B. Air conduction is greater than bone conduction in the left ear C. Sound is lateralizing to the right ear D. Sound is lateralizing to the left ear

A. Air conduction is less than bone conduction in the left ear

A nurse is caring for a client who reports not sleeping at night, which interferes with her ability to function during the day. Which of the following interventions should the nurse suggest to this client? A. Avoid beverages that contain caffeine B. Take a sleep medication regularly at bedtime C. Watch television for 30 minutes in bed to relax prior to falling asleep D. Advise the client to take several naps during the day

A. Avoid beverages that contain caffeine Caffeine is a stimulant. The nurse should suggest that the client avoid caffeinated beverages

A nurse is planning to perform passive range-of-motion exercises for a client. Which of the following actions should the nurse take? A. Repeat each joint motion 5 times during each session B. Move the joint to the point of considerable resistance C. Six approximately 2ft from the side of the bed closest to the joint being exercised D. Exercise the smaller joints first

A. Repeat each joint motion 5 times during each session To maintain the client's joint mobility, the nurse should repeat each motion 3-5 times

A nurse on a medical unit is caring for a client who has been coughing intermittently during meals, attempting to clear her throat repeatedly, and eating only a small portion of each meal. The nurse should recommend a referral to which of the following members of the inter professional team to evaluate the client for dysphasia? A. Speech language pathologist B. Social worker C. Physical therapist D. Occupational therapist

A. Speech language pathologist A speech language pathologist can perform a thorough evaluation of the client for dysphasia and help the client learn ti eat safely.

A nurse is teaching a client about the use of a straight legged cane. Which of the following client actions indicates an understanding of the teaching? A. The client holds the cane on the unaffected side B. The client walks by stepping with the unaffected leg before the affected leg. C. The client holds the cane directly next to the foot D. The client holds the cane with a straight elbow

A. The client holds the cane on the unaffected side The nurse should instruct the client to hold the cane on the unaffected side to provide a wide base of support and stability

A nurse is teaching range of motion exercises to a client who has osteoarthritis. Which of the following client positions demonstrates an understanding of supination of the hand? A. The client holds the hand with the palm up B. The client holds the hand with the palm down C. The client points the fingers towards the floor D. The client points the fingers towards the ceiling

A. The client holds the hand with the palm up

A nurse is teaching a client who is postoperative about the importance of turning, coughing and breathing deeply. Which of the following statements should the nurse identify as an indication that the client understands the instruction? A. "If I do this often, I won't experience muscle wasting." B. "If I do this often, I won't get pneumonia." C. "If I do this often, I won't get constipation." D. "If I do this often, I won't have a fast heartbeat."

B. "If I do this often, I won't get pneumonia." Turning, coughing and breathing deeply help prevent respiratory complications such as pneumonia by promoting lung expansion and secretion removal

A nurse is providing teaching about crutches to a client who has a fracture on the right foot. Which of the following instructions should the nurse include? A. "When you go up a flight of stairs, place your right foot on the first step." B. "Keep the rubber crutch tips securely in place." C. "When standing, keep the crutches 12 inches in front of you and 12 inches to the side." D. "Place your weight on the crutch pads at your armpits."

B. "Keep the rubber crutch tips securely in place." The client should never use crutches without the rubber crutch tips. The client should inspect tips regularly, replace them when they show signs of wear and remove and dry them thoroughly with paper towels if the become wet.

A nurse is responding to a parent's question about his infant's expected physical development during the first year of life. Which of the following pieces of information should the nurse include? A. A 2-month-old infant can turn from his abdomen to his back B. A 10-month-old infant can pull up to a standing position C. A 4-month-old infant can sit up without support D. A 6-month-old infant can crawl on his hands and knees

B. A 10-month-old infant can pull up to a standing position

A nurse on a medical unit is caring for a client who has difficulty sleeping. Which of the following actions should the nurse take to promote the client's ability to fall asleep? A. Encourage the client to ambulate in the hallway just before bedtime B. Allow the client to maintain the same bedtime routine as at home C. Keep the room temperature warm D. Offer the client a cup of hot chocolate before bedtime

B. Allow the client to maintain the same bedtime routine as at home For many clients in an acute care facility, disrupting the usual sleep routine is the primary reason for a clients inability to sleep. Maintaining the home bedtime routine promotes sleep in ways that are effective for the client.

A nurse is teaching a client who is postoperative following a knee arthroplasty about the muscles he will need to strengthen in physical therapy. Which of the following muscle groups is responsible for movement at the knee joint? A. Antigravity B. Antagonistic C. Synergistic D. Skeletal

B. Antagonistic The nurse should teach the client that the antagonistic muscle group is responsible for movement of the knee joint by contracting while other muscle relax

A nurse is caring for an older adult client who has in the canal hearing aid. The client sates that the hearing aid is making a whistling sound. The nurse should identify which of the following factors for this sound? A. Low battery power B. Excessive wax in the ear canal C. A volume setting is too low D. A crack in the ear tube

B. Excessive wax in the ear canal Factors that can make a hearing aid whistle include a poor seal with the ear mold, an ear infection, excessive wax in the ear canal, an improper fit or a malfunction

A nurse is teaching a client who is recovering form gallbladder surgery how to use an incentive spirometer. Which of the following pieces of information should the nurse include in the teaching? A. Exhale slowly to reach the goal volume B. Hold the breath for 5 sec after goal volume is reached C. Continue to breathe deeply between each cycle D. Limit the repeat pattern of breathing to 5 breaths

B. Hold the breath for 5 sec after goal volume is reached The nurse should instruct the client to hold the breath for 3-5 seconds after reaching maximal inspiratory volume. This decreases the collapse of alveoli which helps prevent the risk of atelectasis (complete or partial collapse of a lung or a section of lung)

A nurse is admitting a client who has a hearing aid. Which of the following actions should the nurse take before beginning the interview process? A. Sit beside the client during the interview B. Make sure the device is functioning C. Make sure lighting in the room is soft D. Provide a lengthy interview process to allow adequate time to answer questions

B. Make sure the device is functioning The nurse should ensure that all of the client's assistive devices are working before beginning the interview process

A nurse is demonstrating postoperative deep breathing and coughing exercises to a client who is scheduled for emergency surgery for appendicitis. Which of the following statements indicates a lack of readiness to learn by the client? A. The client asks the nurse to repeat the instructions before attempting the exercises. B. The client reports severe pain. C. The client asks the nurse how often deep breathing should be done after surgery. D. The client tells the nurse that this exercise will probably be painful after surgery.

B. The client reports severe pain. A client who is experiencing severe pain is not able to concentrate and is not ready to lean a new activity.

A nurse is teaching a client with lower extremity weakness how to use a 4-point crutch gait. Which of the following instructions should the nurse include in the reaching? A. "support the majority of your weight on the axillae." B. "Keep your elbows extended." C. "Bear weight on both of your legs." D. "Move both crutches forward at the same time."

C. "Bear weight on both of your legs." The client should keep 3 points on the ground at all time. Therefore, he mist be able to bear weight on both legs.

A nurse is preparing to assess the function of the clients trigeminal nerve (cranial nerve V) Which of the following should the nurse gather for the test? A. Sugar B. Coffee C. Cotton wisps D. Snellen chart

C. Cotton wisps

A nurse is caring for a client who states that she does not want to get out of bed due to pain from arthritis. Which of the following actions should the nurse take? A. Tell the client that the provider does not want her to remain in bed B. Allow the client to remain in bed until her pain subsides C. Instruct the family to perform ADLs for the client D. Advise the client to perform range-of-motion exercises while in bed

D. Advise the client to perform range-of-motion exercises while in bed Performing range-of-motion exercises will help the client maintain mobility until her pain is under control and she is able to ambulate without excessive discomfort

A nurse is caring for a client who has a hearing impairment. Which of the following interventions should the nurse use when speaking with a client? A. Speak directly into the client's impaired ear. B. Exaggerate lip movements C. Speak loudly D. Face the client when speaking

D. Face the client when speaking The nurse should directly face the client who has a hearing impairment and stand or sit at the same level to maximize communication. Many clients who are hearing impaired combine lip reading with their residual hearing when communicating

A nurse in an acute care facility is planning care for a client who is alert but temporarily immobile due to a total hip arthroplasty. Which of the following interventions should the nurse plan to take to prevent complications of immobility? A. Move the client from supine to a low Fowler's position ever 2-3 hours to prevent orthostatic hypotension B. Limit fluid intake to 1 L (33.8 oz) in 24 hr to help prevent dependent edema C. Encourage the client to turn from side to side every 3-4 hr to help prevent respiratory complications D. Instruct the client to preform foot and leg exercises every 1-2 hr while awake to help prevent thrombophlebitis

D. Instruct the client to preform foot and leg exercises every 1-2 hr while awake to help prevent thrombophlebitis Antiembolic exercises (ex: flexion of the knees and rolls and pumps of the feet and ankles) every 1-2 hr helps prevent thrombophlebitis

A nurse is evaluating a client's use of crutches. The nurse should identify that which of the following actions by the client indicates safe usage of this equipment? A. The client places a crutch on each side when assuming a sitting position B. The client moves the unaffected leg onto a step first when descending stairs C. The client places weight on the axillae when walking D. The client has slightly flexed elbows when ambulating with crutches

D. The client has slightly flexed elbows when ambulating with crutches The client should have slightly flexed elbows when ambulating with crutches. This allows the client to bear weight on the hands and not on the axillae.

A nurse is assisting a client who has right sided weakness while ambulating using a cane. Which of the following client actions should indicate to the nurse that the client understand the procedure of cane walking? A. The client holds the can on the affected side. B. The client advances the unaffected leg followed by the cane C. The client supports his weight on the unaffected leg when moving the cane forward D. The client keeps 2 points of support on the ground.

D. The client keeps 2 points of support on the ground. When ambulating with a cane the client should keep 2 points of support on the ground at all times, which can be either both feet or a foot and the cane.

A nurse is applying antiembolitic stockings for a client who has a history of deep vein thrombosis. Which of the following actions should the nurse take when applying stockings? A. Roll the stocking partially down if too long B. Remove the stocking once per day C. Bunch and pull the stocking halfway up the calf D. Turn the stocking inside out up to the heel before applying

D. Turn the stocking inside out up to the heel before applying The nurse should turn the stocking inside out up to the client's heel to make the application of the stocking easier and cause fewer constrictive wrinkles

A nurse is reviewing measures to prevent back injuries with assistive personnel (AP). Which of the following instructions should the nurse include? A. Stand 3 feet from the client when assisting with lifting B. Lock your knees when standing for long periods C. Lift up to 22.6 kg (50 ib) without the use of assistive devices. D. When lifting an object, spread your feet apart to provide a wide base of support.

D. When lifting an object, spread your feet apart to provide a wide base of support. The AP should spread the feet apart because a wide base of support increases stability