Challenge Exam (NACE) I PN-
RN Foundations of Nursing
Practice Test LATEST
UPDATE 2025
A bed-bound patient has a 1.5-inch foam overlay over her mattress. The nurse
places her hand under the overlay and finds that the foam overlay has compressed
to 0.75 inch. What does this indicate?
Excess wear
Adequate support
Bottoming out
, Moisture retention - ✔✔✔ANSWER-Bottoming out
Support surface material should provide at least one inch of support under areas to
be protected when in use to prevent "bottoming out." (Check by placing a hand
palm-side up under the overlay and below the pressure point.) Static support
surfaces are appropriate for patients who can change position without increasing
pressure to an ulcer. Dynamic support surfaces are needed for those who need
assistance to move or when static pressure devices provide less than one inch of
support.
A burn patient is upset and argues loudly with the nurse, refuses wound care, and
states that the treatment is too painful. Which response is an example of therapeutic
communication?
"You should be happy that the burns are healing so well"
"You should stop arguing with the nurses"
"Everyone gets upset at times"
"Let's talk about this and see if we can figure out a way to make the treatment more
comfortable for you" - ✔✔✔ANSWER-"Let's talk about this and see if we can
figure out a way to make the treatment more comfortable for you"
Collaborating with the patient to find a solution to a problem is an example of
therapeutic communication. The other responses are nontherapeutic and can block
effective communication. Saying "Everyone gets upset at times" devalues the
patient's feelings. "You should stop arguing with the nurses" is a negative judgment
that may anger the patient more and does not deal with the real issue. Saying "You
should be happy the wound is healing" provides unwanted advice and ignores the
patient's concerns.
A patient who is a Jehovah's Witness needs a transfusion of packed red blood cells
because of blood loss, but his religion prohibits blood transfusions. Which of the
following is the correct action?
Tell the patient that he may die without the transfusion
Provide full information and the reasons for the transfusion