FUNDAMENTALS OF NURSING
12TH EDITION
• AUTHOR(S)PATRICIA A. POTTER;
ANNE G. PERRY; PATRICIA A.
STOCKERT; AMY HALL; WENDY
R. OSTENDORF
TEST BANK
,Question 1 The nurse is exiting the room of a patient who is on
airborne and contact precautions for varicella. In which order
should the nurse remove the personal protective equipment
(PPE)? A. Gloves, gown, goggles, respirator, wash hands B.
Respirator, gown, gloves, goggles, wash hands C. Gown,
goggles, gloves, respirator, wash hands D. Goggles, gloves,
respirator, gown, wash hands Correct Answer: A Rationale: To
minimize self-contamination, the correct order for removing
PPE is from most contaminated to least contaminated: gloves
first, followed by the gown, and then goggles or face shield. The
nurse should remove the respirator or mask after exiting the
patient's room and closing the door to avoid inhaling airborne
particles remaining in the room. Hand hygiene must be
performed immediately after removing all PPE.
Question 2 The nurse prepares to assess a patient for
orthostatic hypotension. Which action should the nurse take
first? A. Help the patient stand up and immediately measure
the blood pressure. B. Assist the patient to a supine position
and allow them to rest for 3 to 5 minutes. C. Measure the
patient's heart rate while they are sitting on the edge of the
bed. D. Ask the patient if they are experiencing any dizziness or
lightheadedness. Correct Answer: B Rationale: The standard
procedure for measuring orthostatic vital signs requires
obtaining baseline measurements after the patient has been in
a flat, supine position for at least 3 to 5 minutes. Afterward, the
,nurse measures blood pressure and pulse with the patient
sitting, and finally with the patient standing, waiting 1 to 3
minutes between position changes to assess the body's
compensatory response.
Question 3 The nurse is teaching a patient with left-sided
weakness how to walk using a standard cane. Which instruction
should the nurse include? A. "Hold the cane in your left hand
and move it forward with your right foot." B. "Hold the cane in
your right hand and move it forward with your left foot." C.
"Hold the cane in your left hand and advance the cane before
moving either foot." D. "Hold the cane in your right hand and
advance your right foot first." Correct Answer: B Rationale: A
cane should always be held on the patient's unaffected
(stronger) side, which is the right side in this scenario. This
provides a wider base of support and mimics natural gait. The
cane should be advanced together with, or just before, the
affected (left) leg so that the patient's weight is shifted away
from the weak extremity onto the cane and the strong leg.
Question 4 The nurse is preparing to administer eardrops to a
45-year-old patient. Which technique should the nurse use to
straighten the ear canal? A. Pull the auricle down and back. B.
Pull the auricle straight back. C. Pull the auricle up and out. D.
Pull the auricle down and out. Correct Answer: C Rationale: For
adults and children older than 3 years of age, the auricle (pinna)
, should be pulled upward and outward to straighten the external
auditory canal, allowing the medication to reach the eardrum.
For infants and children younger than 3 years of age, the auricle
is pulled downward and backward.
Question 5 The nurse is providing foot care education to a
patient newly diagnosed with type 2 diabetes mellitus. Which
statement by the patient indicates a need for further
instruction? A. "I will dry thoroughly between my toes after
washing my feet." B. "I should apply a thin layer of moisturizing
lotion between my toes every day." C. "I will inspect the
bottoms of my feet daily using a hand mirror." D. "I should avoid
walking barefoot, even when I am inside my house." Correct
Answer: B Rationale: Patients with diabetes should apply
moisturizer to dry areas of their feet to prevent cracking, but
they must avoid putting lotion between the toes. Moisture
trapped between the toes creates a warm, dark environment
that promotes fungal growth and skin breakdown. The other
options reflect appropriate diabetic foot care.
Question 6 The nurse is positioning a patient who is at high risk
for developing pressure injuries. To minimize skin shear and
friction, what is the maximum elevation the nurse should
maintain for the head of the bed? A. 30 degrees B. 45 degrees
C. 60 degrees D. 90 degrees Correct Answer: A Rationale:
Elevating the head of the bed to 30 degrees or less prevents the
12TH EDITION
• AUTHOR(S)PATRICIA A. POTTER;
ANNE G. PERRY; PATRICIA A.
STOCKERT; AMY HALL; WENDY
R. OSTENDORF
TEST BANK
,Question 1 The nurse is exiting the room of a patient who is on
airborne and contact precautions for varicella. In which order
should the nurse remove the personal protective equipment
(PPE)? A. Gloves, gown, goggles, respirator, wash hands B.
Respirator, gown, gloves, goggles, wash hands C. Gown,
goggles, gloves, respirator, wash hands D. Goggles, gloves,
respirator, gown, wash hands Correct Answer: A Rationale: To
minimize self-contamination, the correct order for removing
PPE is from most contaminated to least contaminated: gloves
first, followed by the gown, and then goggles or face shield. The
nurse should remove the respirator or mask after exiting the
patient's room and closing the door to avoid inhaling airborne
particles remaining in the room. Hand hygiene must be
performed immediately after removing all PPE.
Question 2 The nurse prepares to assess a patient for
orthostatic hypotension. Which action should the nurse take
first? A. Help the patient stand up and immediately measure
the blood pressure. B. Assist the patient to a supine position
and allow them to rest for 3 to 5 minutes. C. Measure the
patient's heart rate while they are sitting on the edge of the
bed. D. Ask the patient if they are experiencing any dizziness or
lightheadedness. Correct Answer: B Rationale: The standard
procedure for measuring orthostatic vital signs requires
obtaining baseline measurements after the patient has been in
a flat, supine position for at least 3 to 5 minutes. Afterward, the
,nurse measures blood pressure and pulse with the patient
sitting, and finally with the patient standing, waiting 1 to 3
minutes between position changes to assess the body's
compensatory response.
Question 3 The nurse is teaching a patient with left-sided
weakness how to walk using a standard cane. Which instruction
should the nurse include? A. "Hold the cane in your left hand
and move it forward with your right foot." B. "Hold the cane in
your right hand and move it forward with your left foot." C.
"Hold the cane in your left hand and advance the cane before
moving either foot." D. "Hold the cane in your right hand and
advance your right foot first." Correct Answer: B Rationale: A
cane should always be held on the patient's unaffected
(stronger) side, which is the right side in this scenario. This
provides a wider base of support and mimics natural gait. The
cane should be advanced together with, or just before, the
affected (left) leg so that the patient's weight is shifted away
from the weak extremity onto the cane and the strong leg.
Question 4 The nurse is preparing to administer eardrops to a
45-year-old patient. Which technique should the nurse use to
straighten the ear canal? A. Pull the auricle down and back. B.
Pull the auricle straight back. C. Pull the auricle up and out. D.
Pull the auricle down and out. Correct Answer: C Rationale: For
adults and children older than 3 years of age, the auricle (pinna)
, should be pulled upward and outward to straighten the external
auditory canal, allowing the medication to reach the eardrum.
For infants and children younger than 3 years of age, the auricle
is pulled downward and backward.
Question 5 The nurse is providing foot care education to a
patient newly diagnosed with type 2 diabetes mellitus. Which
statement by the patient indicates a need for further
instruction? A. "I will dry thoroughly between my toes after
washing my feet." B. "I should apply a thin layer of moisturizing
lotion between my toes every day." C. "I will inspect the
bottoms of my feet daily using a hand mirror." D. "I should avoid
walking barefoot, even when I am inside my house." Correct
Answer: B Rationale: Patients with diabetes should apply
moisturizer to dry areas of their feet to prevent cracking, but
they must avoid putting lotion between the toes. Moisture
trapped between the toes creates a warm, dark environment
that promotes fungal growth and skin breakdown. The other
options reflect appropriate diabetic foot care.
Question 6 The nurse is positioning a patient who is at high risk
for developing pressure injuries. To minimize skin shear and
friction, what is the maximum elevation the nurse should
maintain for the head of the bed? A. 30 degrees B. 45 degrees
C. 60 degrees D. 90 degrees Correct Answer: A Rationale:
Elevating the head of the bed to 30 degrees or less prevents the
