NCLEX Practice Questions FUNDS Exam 1

Which factor would the nurse assess in a client reporting constipation?

Diet, fluid intake, use of laxatives, date of last bowel movement, use of opioid pain medication

When discussing with a graduate nurse the delegation of client tasks such as assistance with daily living activities, which statement about accountability would the nurse leader include?

'Remaining answerable for one's choices to oneself and others characterizes accountability.'

Within how many hours after a surgical procedure requiring general anesthesia would the expect a client to void?

8 hours

Which would be placed in the medical record before implementing the use of restrains?

A prescription from a health care provider

The nurse is administering medication via gastronomy tube in an older client in the long-term care setting. Which finding would necessitate holding the feedings and medications and notifying the healthcare provider immediately?

Absence of bowel sounds, presence of abdominal distension, residual capacity exceeding 300 ml, positive guaiac test of abdominal contents, seepage of feeding around the tracheostomy

Which data would the nurse use to determine a client's score on the Braden Scale to predict a client's risk for developing pressure injuries?

Anorexia, hemiplegia, history of diabetes, urinary incontinence

The nurse gives the child a vaccination injection against the wishes of the mother. Which legal charges may be brought against the nurse?

Battery

After abdominal surgery, a client's postoperative prescriptions include a nasogastric (NG) tube to lower intermittent wall suction and an antiemetic every 6 hours as needed for nausea. When the client reports feeling nauseated, which action would the nurse take first?

Check for correct placement of the NG tube.

The nurse is preparing the administer a nasogastric tube feeding to a client via infusion pump. Which is an important assessment the nurse needs to perform before beginning the pump?

Checking for residual stomach contents

Which client response during the insertion of a nasogastric tube indicates to the nurse that the client is experiencing serious difficulty with the insertion?

Cyanosis

Which combination of client responses would the nurse determine represents the highest risk for the development of pressure injuries?

Incontinence; inability to move independently

The registered nurse advises a nursing student to value learning for learning's sake. Which concept of critical-think behavior is the nurse referring to?

Inquisitiveness

Which legal charge may be brought against the nurse for showing the family the client results of a human immunodeficiency virus (HIV) test without the consent of the client?

Invasion of privacy

A client who recently experienced a brain attack (CVA) and has limited mobility reports constipation. Which is most important for the nurse to determine when collecting information about constipation?

Length of time this problem has existed

An older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. IN addition to sodium, which electrolyte would the nurse be most concerned about?

Potassium

Five days after a client has abdominal surgery the nurse assesses the client's incision site for signs of dehiscence. Which clinical finding supports that the client is experiencing wound dehiscence?

Serosanguineous drainage

Which findings occur with orthostatic hypotension?

The feeling of faintness, decrease systolic pressure

Which application in practice would best suit the critical thinking attitude of integrity?

To be able to recognize personal opinions that may conflict with a client's opinions

At which site would the nurse obtain a sterile urinalysis from a client with an indwelling catheter?

Tubing injection port

A client has a stage III pressure injury. Which nursing intervention can prevent further injury by eliminating shearing force?

Use of draw sheets to pull up, transfer, and position the client

Which information would the nurse provide an older adult and caregivers regarding medication safety?

Use of pill organizer, read all medication labels, review medications with a pharmacist

Which action by the nurse would prevent aspiration when administering medication through a nasogastric tube?

Verifying placement of the nasogastric tube

which task would the nurse delegate to unlicensed assistive personnel for a client with a NG tube in place for feedings?

oral care for the patient

Which priority action would the nurse perform when discharging a client with limited English proficiency?

Assess the need for a medical interpreter for client teaching

Which action would the nurse take first when an excessive amount of serosanguinous drainage is noted on the mastectomy dressing of a client who has just had a mastectomy and has a portable wound drainage system to the axillary area in place?

Checking the function of the drainage system

Which category of isolation would the nurse implement for a client who is positive for Clostridium difficile?

Contact precautions

Which complication would the nurse monitor for in a client on strict bed rest for 3 days?

Atelectasis, hypotension, constipation, pressure injuries, urinary tract infections