NR 224 Fundamentals Final Review
Questions with complete solution 2025
updated
What is the most effective method to prevent the transfer of clostridium difficile
(C. Difficile) ? - correct answer ✔HAND HYGIENE with soap and water is
effective to physically remove C. difficile spores from the hands. (Potter 1092)
What is the term for the [abnormal] method used to assist in stool passage by
exerting pressure to expel fecal matter through voluntary contraction of the
abdominal muscles while maintaining a forced expiration against a closed
airway? - correct answer ✔Valsalva Manuever
*Normal passage of bowels should be painless, passing soft formed stool*
Which patients are at greatest risk for cardiac dysrhythmia and high blood
pressure with the Valsalva manuever and MUST avoid straining to pass stool?
- correct answer ✔Patients with cardiovascular disease, glaucoma,
increased intracranial pressure, or a new surgical wound
(Potter 1089)
What is the term for a collection of hardened feces in the rectum that cannot
be expelled due to unrelieved constipation? - correct answer ✔Fecal
Impaction
Where does fecal impaction occur in the colon? - correct answer ✔Rectum
,Least formed stool is present in which portion of the digestive tract? - correct
answer ✔Ascending Colon
Most formed stool is present in which portion of the digestive tract? - correct
answer ✔Descending Colon
Which position should the patient be in while administering an enema? -
correct answer ✔Left Side-Lying or Sim's Position
Which factors would contribute to stopping enema administration? - correct
answer ✔If bleeding occurs, abdomen becomes rigid and distended, pain
occurs, or resistance is felt
Which enema solution is the safest for administration because it does NOT
create a danger for excess fluid absorption? - correct answer ✔Normal
Saline [Isotonic Solution]
Which enema solution is contraindicated in patients who are dehydrated or
young infants because of risk for fluid imbalance? - correct answer
✔Hypertonic Solution
Which enema solution is considered to be hypotonic and should NOT be
repeated because of the risk of water toxicity or circulatory overload if and
because the body absorbs excessive amounts of water? - correct answer
✔Tap Water [Hypotonic Solution]
Which enema solution lubricates the rectum and allows the feces to absorb
the oil making them soft and easier to pass? - correct answer ✔Oil Retention
,Which enema solution creates intestinal irritation to stimulate peristalsis by
using castile soap? - correct answer ✔Soapsuds
Which enema solution should used in caution in pregnant women and elderly
because it may cause an electrolyte imbalance or damage to intestinal
mucosa? - correct answer ✔Soapsuds
Which laboratory test is used to measure microscopic amounts of blood in the
feces (blood that cannot be seen) - correct answer ✔Guaiac Fecal Occult
Blood Test
Repeat the test at least three times while the patient refrains from ingesting
foods (e.g., some raw vegetables, red meat, poultry, fish) and medications
(e.g., vitamin C, aspirin, non steroidal anti-inflammatory drugs) that cause
false-positive results
(Potter 1100)
When analyzing a fecal specimens for ova and parasites, what is required of
the stool? - correct answer ✔The stool MUST be warm.
If the stool specimen remains at room temperature, bacteriological changes
can alter the test results
Which cathartic form is most effective because of its stimulant effect on the
rectal mucosa
(Example: Dulcolax)? - correct answer ✔Cathartic Suppositories
Which foods induce a constipating effect? - correct answer ✔cheese, lean
meats, eggs, and pasta
, Which food induce a laxative effect? - correct answer ✔fruits, vegetables,
bran, chocolate, alcohol, and coffee
What are the assessment findings of a normal stoma? - correct answer
✔bright pink or brick red
Notify HCP of stoma is blue, purple, brown, or black which indicates
circulation problem to the stoma
How does the nurse measure the length of the NG tube for insertion? - correct
answer ✔Tip of the nose --> earlobe --> xiphoid process
What is the most reliable method of verification for placement of the NG tube?
- correct answer ✔X-ray
Other methods include: pH test (aspirate and inspect color)
What are the ranges for body mass index? - correct answer ✔Normal = 19-
24
Overweight = 25-29
Obese = 30-39
Extremely Obese = > 40
When energy requirements are completely met or EQUALS kcal intake in food
what occurs? - correct answer ✔Weight does not change
When kcal intake in food is LESS THAN energy requirements what occurs? -
correct answer ✔Loose weight
Questions with complete solution 2025
updated
What is the most effective method to prevent the transfer of clostridium difficile
(C. Difficile) ? - correct answer ✔HAND HYGIENE with soap and water is
effective to physically remove C. difficile spores from the hands. (Potter 1092)
What is the term for the [abnormal] method used to assist in stool passage by
exerting pressure to expel fecal matter through voluntary contraction of the
abdominal muscles while maintaining a forced expiration against a closed
airway? - correct answer ✔Valsalva Manuever
*Normal passage of bowels should be painless, passing soft formed stool*
Which patients are at greatest risk for cardiac dysrhythmia and high blood
pressure with the Valsalva manuever and MUST avoid straining to pass stool?
- correct answer ✔Patients with cardiovascular disease, glaucoma,
increased intracranial pressure, or a new surgical wound
(Potter 1089)
What is the term for a collection of hardened feces in the rectum that cannot
be expelled due to unrelieved constipation? - correct answer ✔Fecal
Impaction
Where does fecal impaction occur in the colon? - correct answer ✔Rectum
,Least formed stool is present in which portion of the digestive tract? - correct
answer ✔Ascending Colon
Most formed stool is present in which portion of the digestive tract? - correct
answer ✔Descending Colon
Which position should the patient be in while administering an enema? -
correct answer ✔Left Side-Lying or Sim's Position
Which factors would contribute to stopping enema administration? - correct
answer ✔If bleeding occurs, abdomen becomes rigid and distended, pain
occurs, or resistance is felt
Which enema solution is the safest for administration because it does NOT
create a danger for excess fluid absorption? - correct answer ✔Normal
Saline [Isotonic Solution]
Which enema solution is contraindicated in patients who are dehydrated or
young infants because of risk for fluid imbalance? - correct answer
✔Hypertonic Solution
Which enema solution is considered to be hypotonic and should NOT be
repeated because of the risk of water toxicity or circulatory overload if and
because the body absorbs excessive amounts of water? - correct answer
✔Tap Water [Hypotonic Solution]
Which enema solution lubricates the rectum and allows the feces to absorb
the oil making them soft and easier to pass? - correct answer ✔Oil Retention
,Which enema solution creates intestinal irritation to stimulate peristalsis by
using castile soap? - correct answer ✔Soapsuds
Which enema solution should used in caution in pregnant women and elderly
because it may cause an electrolyte imbalance or damage to intestinal
mucosa? - correct answer ✔Soapsuds
Which laboratory test is used to measure microscopic amounts of blood in the
feces (blood that cannot be seen) - correct answer ✔Guaiac Fecal Occult
Blood Test
Repeat the test at least three times while the patient refrains from ingesting
foods (e.g., some raw vegetables, red meat, poultry, fish) and medications
(e.g., vitamin C, aspirin, non steroidal anti-inflammatory drugs) that cause
false-positive results
(Potter 1100)
When analyzing a fecal specimens for ova and parasites, what is required of
the stool? - correct answer ✔The stool MUST be warm.
If the stool specimen remains at room temperature, bacteriological changes
can alter the test results
Which cathartic form is most effective because of its stimulant effect on the
rectal mucosa
(Example: Dulcolax)? - correct answer ✔Cathartic Suppositories
Which foods induce a constipating effect? - correct answer ✔cheese, lean
meats, eggs, and pasta
, Which food induce a laxative effect? - correct answer ✔fruits, vegetables,
bran, chocolate, alcohol, and coffee
What are the assessment findings of a normal stoma? - correct answer
✔bright pink or brick red
Notify HCP of stoma is blue, purple, brown, or black which indicates
circulation problem to the stoma
How does the nurse measure the length of the NG tube for insertion? - correct
answer ✔Tip of the nose --> earlobe --> xiphoid process
What is the most reliable method of verification for placement of the NG tube?
- correct answer ✔X-ray
Other methods include: pH test (aspirate and inspect color)
What are the ranges for body mass index? - correct answer ✔Normal = 19-
24
Overweight = 25-29
Obese = 30-39
Extremely Obese = > 40
When energy requirements are completely met or EQUALS kcal intake in food
what occurs? - correct answer ✔Weight does not change
When kcal intake in food is LESS THAN energy requirements what occurs? -
correct answer ✔Loose weight
