Testing and Remediation Advanced Test |
Comprehensive Questions with Answers &
Rationales
1. A nurse is caring for a client who has borderline
personality disorder. Which of the following is a
manifestation of the disorder?
A) Stable interpersonal relationships
B) Unstable interpersonal relationships
C) Consistent self-image
D) Predictable emotional responses
Correct Answer: B
Rationale: Borderline personality disorder is characterized
by unstable interpersonal relationships, intense emotions,
impulsivity, and a distorted self-image. Clients often have
difficulty maintaining stable relationships and may
experience rapid mood swings.
2. A nurse in a long-term care facility is assisting with an
educational program regarding common sites of healthcare-
associated infections for a group of newly hired assistive
personnel. Which of the following sites should be included in
the teaching? (Select all that apply.)
A) Bloodstream
B) Urinary tract
,C) Surgical wound
D) Respiratory tract
Correct Answer: A, B, C, D
Rationale: Common sites of healthcare-associated
infections include the bloodstream (bacteremia), urinary
tract (catheter-associated UTIs), surgical wounds (surgical
site infections), and respiratory tract (ventilator-associated
pneumonia). These are the most frequent sites of infection
in healthcare settings.
3. A nurse is assessing a client who is postoperative
following a gastric bypass. Which of the following findings
indicates the client could be experiencing an anastomotic
leak?
A) Hypertension
B) Oliguria
C) Tachycardia
D) Polyuria
Correct Answer: B
Rationale: Oliguria (decreased urine output) can indicate
hypovolemia from an anastomotic leak. Other signs include
fever, tachycardia, abdominal pain, and peritoneal signs. An
anastomotic leak is a serious postoperative complication
requiring immediate intervention.
4. A nurse is working with administration to enhance the
quality of care provided to clients during the prenatal
,period. In which of the following roles is the nurse
functioning?
A) Educator
B) Advocate
C) Manager
D) Researcher
Correct Answer: B
Rationale: The nurse is functioning as an advocate by
working to enhance the quality of care for clients. Advocacy
involves speaking up for clients' needs, promoting their
rights, and working to improve healthcare services.
5. A nurse is reviewing the laboratory results of four clients.
Which of the following should be immediately reported to
the provider?
A) A client with a hemoglobin of 12 g/dL
B) A client with a potassium of 3.1 mEq/L who is prescribed
digoxin and furosemide
C) A client with a sodium of 138 mEq/L
D) A client with a glucose of 110 mg/dL
Correct Answer: B
Rationale: A potassium level of 3.1 mEq/L indicates
hypokalemia, which increases the risk of digoxin toxicity.
This should be reported immediately. The combination of
digoxin and furosemide can cause potassium depletion,
leading to cardiac arrhythmias.
, 6. A nurse is caring for a client who is from a culture
different than his own. Which of the following actions by the
nurse is most important in the provision of culturally
competent care?
A) Learn the client's language
B) Identify one's own beliefs and values
C) Follow facility policies
D) Ask the client to adapt to the nurse's culture
Correct Answer: B
Rationale: The most important action in providing culturally
competent care is identifying one's own beliefs and values.
This self-awareness helps prevent bias and promotes
respect for the client's cultural perspective.
7. A nurse is reinforcing teaching regarding foods
containing complete protein to a client. Which of the
following should be included in the teaching?
A) Rice
B) Soybeans
C) Pasta
D) Vegetables
Correct Answer: B
Rationale: Soybeans are a complete protein, containing all
essential amino acids. Complete proteins are found in
Comprehensive Questions with Answers &
Rationales
1. A nurse is caring for a client who has borderline
personality disorder. Which of the following is a
manifestation of the disorder?
A) Stable interpersonal relationships
B) Unstable interpersonal relationships
C) Consistent self-image
D) Predictable emotional responses
Correct Answer: B
Rationale: Borderline personality disorder is characterized
by unstable interpersonal relationships, intense emotions,
impulsivity, and a distorted self-image. Clients often have
difficulty maintaining stable relationships and may
experience rapid mood swings.
2. A nurse in a long-term care facility is assisting with an
educational program regarding common sites of healthcare-
associated infections for a group of newly hired assistive
personnel. Which of the following sites should be included in
the teaching? (Select all that apply.)
A) Bloodstream
B) Urinary tract
,C) Surgical wound
D) Respiratory tract
Correct Answer: A, B, C, D
Rationale: Common sites of healthcare-associated
infections include the bloodstream (bacteremia), urinary
tract (catheter-associated UTIs), surgical wounds (surgical
site infections), and respiratory tract (ventilator-associated
pneumonia). These are the most frequent sites of infection
in healthcare settings.
3. A nurse is assessing a client who is postoperative
following a gastric bypass. Which of the following findings
indicates the client could be experiencing an anastomotic
leak?
A) Hypertension
B) Oliguria
C) Tachycardia
D) Polyuria
Correct Answer: B
Rationale: Oliguria (decreased urine output) can indicate
hypovolemia from an anastomotic leak. Other signs include
fever, tachycardia, abdominal pain, and peritoneal signs. An
anastomotic leak is a serious postoperative complication
requiring immediate intervention.
4. A nurse is working with administration to enhance the
quality of care provided to clients during the prenatal
,period. In which of the following roles is the nurse
functioning?
A) Educator
B) Advocate
C) Manager
D) Researcher
Correct Answer: B
Rationale: The nurse is functioning as an advocate by
working to enhance the quality of care for clients. Advocacy
involves speaking up for clients' needs, promoting their
rights, and working to improve healthcare services.
5. A nurse is reviewing the laboratory results of four clients.
Which of the following should be immediately reported to
the provider?
A) A client with a hemoglobin of 12 g/dL
B) A client with a potassium of 3.1 mEq/L who is prescribed
digoxin and furosemide
C) A client with a sodium of 138 mEq/L
D) A client with a glucose of 110 mg/dL
Correct Answer: B
Rationale: A potassium level of 3.1 mEq/L indicates
hypokalemia, which increases the risk of digoxin toxicity.
This should be reported immediately. The combination of
digoxin and furosemide can cause potassium depletion,
leading to cardiac arrhythmias.
, 6. A nurse is caring for a client who is from a culture
different than his own. Which of the following actions by the
nurse is most important in the provision of culturally
competent care?
A) Learn the client's language
B) Identify one's own beliefs and values
C) Follow facility policies
D) Ask the client to adapt to the nurse's culture
Correct Answer: B
Rationale: The most important action in providing culturally
competent care is identifying one's own beliefs and values.
This self-awareness helps prevent bias and promotes
respect for the client's cultural perspective.
7. A nurse is reinforcing teaching regarding foods
containing complete protein to a client. Which of the
following should be included in the teaching?
A) Rice
B) Soybeans
C) Pasta
D) Vegetables
Correct Answer: B
Rationale: Soybeans are a complete protein, containing all
essential amino acids. Complete proteins are found in
