PN Fundamentals 2023
A nurse at a rehabilitation facility is assisting with the admission of a client who has left
hemiplegia following a stroke. Which of the following actions should the nurse take first?
- answersDetermine the client's mental status
A nurse is planning care for a client who practices Judaism. Which of the following
questions should the nurse ask the client to better understand how he practices
Judaism? - answers"Do you observe the Sabbath?"
Rationale: Some clients who practice Judaism might avoid a number of activities on the
Sabbath, including medical procedures and business transactions
A nurse is caring for a client who has a visual impairment. When setting up the client's
meal tray, the nurse should take which of the following actions? - answersDescribe food
placement using the numbers on the face of a clock
By using the numbers of a clock to describe the placement of food on the client's plate,
the nurse is providing the client an opportunity to eat independently.
A nurse is reinforcing teaching with a male client about clean intermittent self-
catheterization. Which of the following instructions should the nurse include? -
answersWash the catheter with soap and water after use
Rationale: Medical aseptic technique is used for clean intermittent self-catheterization.
Therefore, the client should wash the catheter with soap and water and store it in a
clean place. The client should replace the catheter before it becomes dry and brittle.
A nurse is caring for a client who has a terminal illness. Which of the following is an
expected response by a family member during the anger stage of grieving? -
answersThe family member criticizes care provided by the nurse
, A nurse is assisting with the plan of care for a client who is dying. Which of the following
interventions should the nurse include in the plan of care? - answersAllow family to
assist the client with personal hygiene
A nurse is preparing to collect blood samples from an older adult client. Which of the
following actions should the nurse take when performing venipuncture? - answersApply
the tourniquet over the client's sleeve
A nurse is collecting data from a client who is receiving a continuous IV infusion of
lactated Ringer's for dehydration. Which of the following findings indicates infiltration of
the solution into the subcutaneous area? - answersThe area around the infusion site is
cool to the touch
Rationale: Swelling, coolness, paleness, and discomfort at the infusion site indicate
infiltration. The nurse should stop the infusion and discontinue the IV line
A nurse is reinforcing teaching about home safety with a client who is at risk for falls.
Which of the following client statements indicates an understanding of the teaching? -
answersI will secure all of my electrical cords to the baseboard
A nurse is reinforcing teaching about sleep promotion with a client who reports having
difficulty sleeping. Which of the following client statements indicates an understanding
of the teaching? - answersI should play music that relaxes me before I go to bed
Rationale: The client should establish a relaxing routine such as taking a warm bath,
reading, or listening to soothing sounds, such as soft music. The client should avoid
playing music while sleeping because this can be a distraction and interrupt sleep.
A nurse is reinforcing teaching with the partner of a client who has left-sided weakness
about how to safely move the client from a bed to a chair at home. which of the
following statements by the partner indicates an understanding of the teaching? -
answersI'll bend at the knees when lifting to get better leverage
A nurse is reinforcing teaching about health promotion with an older adult client. Which
of the following instructions to the client is an example of secondary prevention? -
answersParticipate in screenings for tuberculosis
A nurse is monitoring an assistive personnel (AP) who is measuring a client's oxygen
saturation using a pulse oximeter. Which of the following observations by the nurse
indicates that the AP is correctly performing the task? - answersThe AP chooses a site
with a capillary refill of less than 2 seconds.
Rationale: The nurse should evaluate that the AP is performing the task correctly by
choosing a site with a capillary refill of less than 2 seconds. The oximeter probe
calculates the percentage of oxygen in hemoglobin. Decreased peripheral circulation
will result in an inaccurate reading.
A nurse at a rehabilitation facility is assisting with the admission of a client who has left
hemiplegia following a stroke. Which of the following actions should the nurse take first?
- answersDetermine the client's mental status
A nurse is planning care for a client who practices Judaism. Which of the following
questions should the nurse ask the client to better understand how he practices
Judaism? - answers"Do you observe the Sabbath?"
Rationale: Some clients who practice Judaism might avoid a number of activities on the
Sabbath, including medical procedures and business transactions
A nurse is caring for a client who has a visual impairment. When setting up the client's
meal tray, the nurse should take which of the following actions? - answersDescribe food
placement using the numbers on the face of a clock
By using the numbers of a clock to describe the placement of food on the client's plate,
the nurse is providing the client an opportunity to eat independently.
A nurse is reinforcing teaching with a male client about clean intermittent self-
catheterization. Which of the following instructions should the nurse include? -
answersWash the catheter with soap and water after use
Rationale: Medical aseptic technique is used for clean intermittent self-catheterization.
Therefore, the client should wash the catheter with soap and water and store it in a
clean place. The client should replace the catheter before it becomes dry and brittle.
A nurse is caring for a client who has a terminal illness. Which of the following is an
expected response by a family member during the anger stage of grieving? -
answersThe family member criticizes care provided by the nurse
, A nurse is assisting with the plan of care for a client who is dying. Which of the following
interventions should the nurse include in the plan of care? - answersAllow family to
assist the client with personal hygiene
A nurse is preparing to collect blood samples from an older adult client. Which of the
following actions should the nurse take when performing venipuncture? - answersApply
the tourniquet over the client's sleeve
A nurse is collecting data from a client who is receiving a continuous IV infusion of
lactated Ringer's for dehydration. Which of the following findings indicates infiltration of
the solution into the subcutaneous area? - answersThe area around the infusion site is
cool to the touch
Rationale: Swelling, coolness, paleness, and discomfort at the infusion site indicate
infiltration. The nurse should stop the infusion and discontinue the IV line
A nurse is reinforcing teaching about home safety with a client who is at risk for falls.
Which of the following client statements indicates an understanding of the teaching? -
answersI will secure all of my electrical cords to the baseboard
A nurse is reinforcing teaching about sleep promotion with a client who reports having
difficulty sleeping. Which of the following client statements indicates an understanding
of the teaching? - answersI should play music that relaxes me before I go to bed
Rationale: The client should establish a relaxing routine such as taking a warm bath,
reading, or listening to soothing sounds, such as soft music. The client should avoid
playing music while sleeping because this can be a distraction and interrupt sleep.
A nurse is reinforcing teaching with the partner of a client who has left-sided weakness
about how to safely move the client from a bed to a chair at home. which of the
following statements by the partner indicates an understanding of the teaching? -
answersI'll bend at the knees when lifting to get better leverage
A nurse is reinforcing teaching about health promotion with an older adult client. Which
of the following instructions to the client is an example of secondary prevention? -
answersParticipate in screenings for tuberculosis
A nurse is monitoring an assistive personnel (AP) who is measuring a client's oxygen
saturation using a pulse oximeter. Which of the following observations by the nurse
indicates that the AP is correctly performing the task? - answersThe AP chooses a site
with a capillary refill of less than 2 seconds.
Rationale: The nurse should evaluate that the AP is performing the task correctly by
choosing a site with a capillary refill of less than 2 seconds. The oximeter probe
calculates the percentage of oxygen in hemoglobin. Decreased peripheral circulation
will result in an inaccurate reading.
