TEST QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES | INSTANT
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1. A nurse assists a client who is weak after surgery to ambulate for the first time. What should
the nurse do first?
A. Encourage the client to walk independently
B. Place a gait belt around the client's waist
C. Walk slightly behind the client
D. Ask the client to use a walker
Answer: B. Place a gait belt around the client's waist
Rationale: A gait belt provides support and prevents falls during initial ambulation after surgery.
2. A client on bed rest complains of constipation. Which nursing action is most appropriate?
A. Increase fluid intake
B. Decrease dietary fiber
C. Limit activity
D. Administer a sedative
Answer: A. Increase fluid intake
Rationale: Adequate hydration softens stool and promotes bowel movement in immobile
patients.
3. The nurse provides oral care to an unconscious client. What should the nurse do?
A. Place the client in a supine position
B. Use a large amount of water
C. Place the client in a side-lying position
D. Insert a nasogastric tube
,Answer: C. Place the client in a side-lying position
Rationale: This position prevents aspiration during oral care in unconscious patients.
4. A nurse provides perineal care for a female client with an indwelling catheter. What action is
correct?
A. Clean from anus to urethra
B. Clean from urethra to anus
C. Use alcohol-based wipes
D. Avoid touching the catheter
Answer: B. Clean from urethra to anus
Rationale: Cleaning from front to back prevents introduction of bacteria into the urinary tract.
5. When transferring a client from the bed to a wheelchair, the nurse should:
A. Lock the wheelchair brakes
B. Lower the bed below the wheelchair
C. Stand behind the client
D. Keep feet close together
Answer: A. Lock the wheelchair brakes
Rationale: Locking the brakes prevents movement and ensures safety during transfer.
6. A client with limited mobility is at risk for pressure ulcers. The nurse should:
A. Massage reddened areas
B. Reposition every 2 hours
C. Use plastic sheets
D. Encourage fluid restriction
Answer: B. Reposition every 2 hours
Rationale: rrequent repositioning promotes circulation and prevents skin breakdown.
7. Which meal is most appropriate for a client on a low-sodium diet?
A. Ham sandwich and chips
B. Grilled chicken with steamed vegetables
C. Hotdog and fries
D. Canned soup and crackers
, Answer: B. Grilled chicken with steamed vegetables
Rationale: rresh, unprocessed foods are naturally low in sodium.
8. A nurse is providing foot care for a diabetic client. What should the nurse avoid?
A. Drying between the toes
B. Soaking the feet in warm water
C. Checking for cuts daily
D. Wearing cotton socks
Answer: B. Soaking the feet in warm water
Rationale: Prolonged soaking can cause skin breakdown and increase infection risk in diabetics.
9. A client complains of difficulty sleeping in the hospital. What is the best nursing intervention?
A. Offer a warm drink before bedtime
B. Turn on bright lights
C. Encourage daytime naps
D. Increase nighttime noise
Answer: A. Offer a warm drink before bedtime
Rationale: A warm, caffeine-free drink promotes relaxation and better sleep.
10. The nurse observes a client with dysphagia (difficulty swallowing) during meals. What is the
best action?
A. Encourage large bites
B. Feed the client quickly
C. Keep the client upright during meals
D. Offer thin liquids
Answer: C. Keep the client upright during meals
Rationale: Upright positioning reduces the risk of aspiration.
11. A nurse applies anti-embolism stockings. The most important step is:
A. Roll the stockings down
B. Apply while the legs are dependent
C. Apply in the morning before ambulation
D. Leave wrinkles in the fabric