FUNDAMENTALS CMS FINAL EXAM
Questions and Answers
1. A nurse is assessing the heart sounds of a client who has
developed chest pain that becomes worse with inspiration. The nurse
auscultates a high-pitched scratching sound during both systole
and diastole with the diaphragm of the stethoscope positioned at
the left sternal border. Which of the following heart sounds should
the nurse document?
A. Audible Click
B. Murmur
C. Third heart sound
D. Pericardial friction rub
Answer D
2. A nurse is obtaining the blood pressure in a client's lower
extremity. Which of the following action should the nurse take?
A. Auscultate for the blood presure at the dorsalis pedis artery.
B. Measure the blood pressure with the client sitting on the side of the
bed.
C. Place the cuff 7.6cm (3in) above the popliteal artery.
D. Place the bladder of the cuff over the posterior aspect of the thigh.
Answer D
,3. A charge nurse is teaching adult cardiopulmonary resusciation
(CPR) to a group of newly licensed nurses. Which of the
following actions should the charge nurse teach as the first
response in CPR?
A. Call for assisstance
B. Begin Chest compressions
C. Confirm unresponsiveness.
D. Give rescue breaths.
Answer C
4. A nurse is caring for a client who requires a chest x-ray. Prior
to the client being transported for the procedure, which of the
following actions should the nurse take first?
A. Explain the x-ray procedure to the client.
B. Help the client into a wheelchair before the transporter arrives.
C. Ask if the client has any questions.
D. Identify the client using two identifiers.
Answer D
5. A nurse is caring for a child who is postoperative following a
tonsillectomy. Which of the following actions should the nurse
take?
A. Encourage the child to cough frequently to clear congestion from
, anesthe-
sia.
B. Place a heating pad at the child's neck for comfort.
C. Administer analgesics to the child on a routine schedule throughout
the day and night.
D. Provide the child with ice cream when oral intake is initiated.
Answer C
6. A nurse is providing taching to a client who has heart failure about
how to reduce his daily intake of sodium. Which of the following
factors is the most important in determining the client's ability to
learn new dietary habits?
A. The involvement of the client in planning the change.
B. The emphasis the provider places on the dietary changes.
C. The learning theory the nurse uses to teach the dietary changes.
D. The extent of the dietary changes planned for the client.
Answer A
7. A charge nurse is observing a newly licensed nurse perform
tracheostomy care for a client. Which of the following actions by
the newly licensed nurse requires intervention?
A. Obtaining hydrogen peroxide for the trachesotomy care.
B. Obtainging cotton balls for the tracheostomy care.
C. Obtaining sterile gloves for the tracheostomy care.
Questions and Answers
1. A nurse is assessing the heart sounds of a client who has
developed chest pain that becomes worse with inspiration. The nurse
auscultates a high-pitched scratching sound during both systole
and diastole with the diaphragm of the stethoscope positioned at
the left sternal border. Which of the following heart sounds should
the nurse document?
A. Audible Click
B. Murmur
C. Third heart sound
D. Pericardial friction rub
Answer D
2. A nurse is obtaining the blood pressure in a client's lower
extremity. Which of the following action should the nurse take?
A. Auscultate for the blood presure at the dorsalis pedis artery.
B. Measure the blood pressure with the client sitting on the side of the
bed.
C. Place the cuff 7.6cm (3in) above the popliteal artery.
D. Place the bladder of the cuff over the posterior aspect of the thigh.
Answer D
,3. A charge nurse is teaching adult cardiopulmonary resusciation
(CPR) to a group of newly licensed nurses. Which of the
following actions should the charge nurse teach as the first
response in CPR?
A. Call for assisstance
B. Begin Chest compressions
C. Confirm unresponsiveness.
D. Give rescue breaths.
Answer C
4. A nurse is caring for a client who requires a chest x-ray. Prior
to the client being transported for the procedure, which of the
following actions should the nurse take first?
A. Explain the x-ray procedure to the client.
B. Help the client into a wheelchair before the transporter arrives.
C. Ask if the client has any questions.
D. Identify the client using two identifiers.
Answer D
5. A nurse is caring for a child who is postoperative following a
tonsillectomy. Which of the following actions should the nurse
take?
A. Encourage the child to cough frequently to clear congestion from
, anesthe-
sia.
B. Place a heating pad at the child's neck for comfort.
C. Administer analgesics to the child on a routine schedule throughout
the day and night.
D. Provide the child with ice cream when oral intake is initiated.
Answer C
6. A nurse is providing taching to a client who has heart failure about
how to reduce his daily intake of sodium. Which of the following
factors is the most important in determining the client's ability to
learn new dietary habits?
A. The involvement of the client in planning the change.
B. The emphasis the provider places on the dietary changes.
C. The learning theory the nurse uses to teach the dietary changes.
D. The extent of the dietary changes planned for the client.
Answer A
7. A charge nurse is observing a newly licensed nurse perform
tracheostomy care for a client. Which of the following actions by
the newly licensed nurse requires intervention?
A. Obtaining hydrogen peroxide for the trachesotomy care.
B. Obtainging cotton balls for the tracheostomy care.
C. Obtaining sterile gloves for the tracheostomy care.
