Rosdahl's Textbook of Basic Nursing 12th Edition
Advanced Prep: Master Nursing Foundations &
Clinical Practice Chapters 1-103 Practice Questions &
Detailed Explanations
Subject: Core Nursing Foundations, Clinical Pathophysiology, and Holistic
Patient Care (Chapters 1-103)
Question 1: A nurse is caring for a patient who adheres to a philosophy of Christian Science. The
patient requires emergency surgery for a ruptured appendix. Based on the fundamental tenets of
Christian Science, how should the nurse approach the request for informed consent and surgical
intervention?
A) Insist on the surgery, citing that the state’s interest in preserving life overrides religious
objection.
B) Facilitate communication between the patient, the family, and the hospital’s spiritual advisor
or Church representative to address potential conflicts between medical intervention and the
patient’s belief system.
C) Document the patient’s refusal as a psychological deficit and proceed with court-ordered
emergency intervention.
D) Administer sedation immediately to minimize the patient's anxiety, then proceed with the
surgery without further discussion.
Correct Answer: B) Facilitate communication between the patient, the family, and the
hospital’s spiritual advisor or Church representative to address potential conflicts between
medical intervention and the patient’s belief system.
Explanation: Christian Scientists generally rely on prayer for healing, but they are not strictly
prohibited from seeking medical care, especially in emergencies. The nurse must honor the
patient's autonomy and support their spiritual decision-making process, ensuring they are
informed of the risks of refusal without imposing personal or institutional bias.
Question 2: In the context of Maslow’s Hierarchy of Needs, a nurse identifies that a patient with
severe chronic obstructive pulmonary disease (COPD) is prioritizing the need to arrange for their
funeral expenses over the immediate need for supplemental oxygen. How should the nurse
interpret this behavior?
A) The patient is exhibiting a lack of cognitive insight due to hypoxia.
B) The patient has progressed to the self-actualization level and is focusing on legacy.
,C) The patient’s perception of "safety and security" has shifted to include existential peace,
necessitating a nursing intervention that addresses both physiological and psychosocial stressors.
D) The patient is demonstrating "denial" as a defense mechanism against their terminal
diagnosis.
Correct Answer: C) The patient’s perception of "safety and security" has shifted to include
existential peace, necessitating a nursing intervention that addresses both psychosocial and
physiological stressors.
Explanation: Maslow’s hierarchy is not always linear. For a terminally ill patient, "safety and
security" often include the completion of tasks that alleviate anxiety for family members or
personal closure. The nurse must address the immediate physiological need (oxygen) while
validating the patient's psychological focus.
Question 3: A nurse is preparing to perform a sterile dressing change. Which of the following
actions best maintains the integrity of the sterile field?
A) Placing a sterile package on the bedside table and reaching across it to open the outer
wrapper.
B) Ensuring that the sterile field is established at waist level or higher, as any object below waist
level is considered contaminated.
C) Utilizing a clean glove to adjust the sterile drape once it has been placed on the patient’s skin.
D) Removing the sterile field's outer wrappings and leaving the setup unattended for 5 minutes
while retrieving additional supplies.
Correct Answer: B) Ensuring that the sterile field is established at waist level or higher, as
any object below waist level is considered contaminated.
Explanation: The waist is the standard demarcation for sterility; objects below this level are
outside the field of vision and are automatically considered contaminated. Reaching across a
field (A), touching with clean gloves (C), or leaving a field unattended (D) are all fundamental
breaches of sterile technique.
Question 4: A nurse is assessing an older adult patient who presents with "sundowning"
syndrome. Which intervention is most clinically indicated to manage this phenomenon?
A) Administering a sedative at 1700 hours to ensure the patient sleeps through the night.
B) Keeping the environment brightly lit and quiet throughout the entire 24-hour period.
C) Increasing natural light exposure during the day and providing a consistent, low-stimulus
routine during the evening.
,D) Frequently reorienting the patient to date, time, and location throughout the evening hours to
correct their confusion.
Correct Answer: C) Increasing natural light exposure during the day and providing a
consistent, low-stimulus routine during the evening.
Explanation: Sundowning is often linked to circadian rhythm disruptions. Increasing natural
light exposure during the day helps regulate the sleep-wake cycle, while reducing evening stimuli
prevents the agitation that characterizes this syndrome. Reorientation (D) often increases
frustration and agitation in patients with cognitive decline.
Question 5: A nurse is caring for a patient experiencing hypovolemic shock. Which
physiological mechanism will the body primarily engage first to maintain mean arterial pressure
(MAP)?
A) Activation of the Renin-Angiotensin-Aldosterone System (RAAS).
B) Stimulation of the baroreceptor reflex, resulting in sympathetic nervous system activation.
C) Release of Antidiuretic Hormone (ADH) from the posterior pituitary.
D) Increased production of erythropoietin by the kidneys.
Correct Answer: B) Stimulation of the baroreceptor reflex, resulting in sympathetic nervous
system activation.
Explanation: The baroreceptor reflex provides the most immediate response to a drop in blood
pressure. It acts within seconds to increase heart rate and systemic vascular resistance. RAAS
and ADH (A, C) are vital but serve as intermediate and long-term compensatory mechanisms.
Question 6: When administering an enteric-coated medication, the nurse understands that the
primary rationale for this formulation is:
A) To increase the speed of absorption in the stomach.
B) To protect the stomach mucosa from irritation or to prevent the drug from being inactivated
by gastric acid.
C) To allow the patient to chew the medication for easier swallowing.
D) To make the medication more palatable for pediatric patients.
Correct Answer: B) To protect the stomach mucosa from irritation or to prevent the drug
from being inactivated by gastric acid.
, Explanation: Enteric coatings are designed to resist dissolution in the acidic environment of the
stomach, ensuring that the medication is released in the alkaline environment of the small
intestine. Crushing or chewing these tablets (C) destroys this protection.
Question 7: A nurse is assessing a patient for "pitting edema" in the lower extremities. The nurse
notes that the depression remains for 30 seconds and appears deep (approximately 6mm). Which
grade of edema should the nurse document?
A) 1+
B) 2+
C) 3+
D) 4+
Correct Answer: C) 3+
Explanation: Edema grading is standardized: 1+ is a slight indentation; 2+ is a deeper pit that
rebounds in seconds; 3+ is a deep pit (about 6mm) that lasts for a prolonged period (often 30+
seconds); 4+ is a very deep pit that can last minutes.
Question 8: In the implementation of a bladder training program for a patient with urge
incontinence, which strategy is most appropriate?
A) Limiting fluid intake to 500ml per day to reduce the frequency of urination.
B) Encouraging the patient to void immediately upon feeling the "urge" to prevent leakage.
C) Implementing a schedule of timed voiding and gradually increasing the intervals between
bathroom visits.
D) Applying an external catheter to keep the patient dry at all times.
Correct Answer: C) Implementing a schedule of timed voiding and gradually increasing the
intervals between bathroom visits.
Explanation: Bladder training aims to restore control by teaching the bladder to hold larger
volumes of urine. Urge incontinence is characterized by overactive detrusor muscles; timed
voiding helps retrain the bladder, whereas limiting fluids (A) can lead to concentrated urine and
increased irritation.
Question 9: A patient with diabetes mellitus is exhibiting signs of "Kussmaul respirations." The
nurse recognizes this as a compensatory mechanism for which acid-base imbalance?
A) Respiratory alkalosis.
Advanced Prep: Master Nursing Foundations &
Clinical Practice Chapters 1-103 Practice Questions &
Detailed Explanations
Subject: Core Nursing Foundations, Clinical Pathophysiology, and Holistic
Patient Care (Chapters 1-103)
Question 1: A nurse is caring for a patient who adheres to a philosophy of Christian Science. The
patient requires emergency surgery for a ruptured appendix. Based on the fundamental tenets of
Christian Science, how should the nurse approach the request for informed consent and surgical
intervention?
A) Insist on the surgery, citing that the state’s interest in preserving life overrides religious
objection.
B) Facilitate communication between the patient, the family, and the hospital’s spiritual advisor
or Church representative to address potential conflicts between medical intervention and the
patient’s belief system.
C) Document the patient’s refusal as a psychological deficit and proceed with court-ordered
emergency intervention.
D) Administer sedation immediately to minimize the patient's anxiety, then proceed with the
surgery without further discussion.
Correct Answer: B) Facilitate communication between the patient, the family, and the
hospital’s spiritual advisor or Church representative to address potential conflicts between
medical intervention and the patient’s belief system.
Explanation: Christian Scientists generally rely on prayer for healing, but they are not strictly
prohibited from seeking medical care, especially in emergencies. The nurse must honor the
patient's autonomy and support their spiritual decision-making process, ensuring they are
informed of the risks of refusal without imposing personal or institutional bias.
Question 2: In the context of Maslow’s Hierarchy of Needs, a nurse identifies that a patient with
severe chronic obstructive pulmonary disease (COPD) is prioritizing the need to arrange for their
funeral expenses over the immediate need for supplemental oxygen. How should the nurse
interpret this behavior?
A) The patient is exhibiting a lack of cognitive insight due to hypoxia.
B) The patient has progressed to the self-actualization level and is focusing on legacy.
,C) The patient’s perception of "safety and security" has shifted to include existential peace,
necessitating a nursing intervention that addresses both physiological and psychosocial stressors.
D) The patient is demonstrating "denial" as a defense mechanism against their terminal
diagnosis.
Correct Answer: C) The patient’s perception of "safety and security" has shifted to include
existential peace, necessitating a nursing intervention that addresses both psychosocial and
physiological stressors.
Explanation: Maslow’s hierarchy is not always linear. For a terminally ill patient, "safety and
security" often include the completion of tasks that alleviate anxiety for family members or
personal closure. The nurse must address the immediate physiological need (oxygen) while
validating the patient's psychological focus.
Question 3: A nurse is preparing to perform a sterile dressing change. Which of the following
actions best maintains the integrity of the sterile field?
A) Placing a sterile package on the bedside table and reaching across it to open the outer
wrapper.
B) Ensuring that the sterile field is established at waist level or higher, as any object below waist
level is considered contaminated.
C) Utilizing a clean glove to adjust the sterile drape once it has been placed on the patient’s skin.
D) Removing the sterile field's outer wrappings and leaving the setup unattended for 5 minutes
while retrieving additional supplies.
Correct Answer: B) Ensuring that the sterile field is established at waist level or higher, as
any object below waist level is considered contaminated.
Explanation: The waist is the standard demarcation for sterility; objects below this level are
outside the field of vision and are automatically considered contaminated. Reaching across a
field (A), touching with clean gloves (C), or leaving a field unattended (D) are all fundamental
breaches of sterile technique.
Question 4: A nurse is assessing an older adult patient who presents with "sundowning"
syndrome. Which intervention is most clinically indicated to manage this phenomenon?
A) Administering a sedative at 1700 hours to ensure the patient sleeps through the night.
B) Keeping the environment brightly lit and quiet throughout the entire 24-hour period.
C) Increasing natural light exposure during the day and providing a consistent, low-stimulus
routine during the evening.
,D) Frequently reorienting the patient to date, time, and location throughout the evening hours to
correct their confusion.
Correct Answer: C) Increasing natural light exposure during the day and providing a
consistent, low-stimulus routine during the evening.
Explanation: Sundowning is often linked to circadian rhythm disruptions. Increasing natural
light exposure during the day helps regulate the sleep-wake cycle, while reducing evening stimuli
prevents the agitation that characterizes this syndrome. Reorientation (D) often increases
frustration and agitation in patients with cognitive decline.
Question 5: A nurse is caring for a patient experiencing hypovolemic shock. Which
physiological mechanism will the body primarily engage first to maintain mean arterial pressure
(MAP)?
A) Activation of the Renin-Angiotensin-Aldosterone System (RAAS).
B) Stimulation of the baroreceptor reflex, resulting in sympathetic nervous system activation.
C) Release of Antidiuretic Hormone (ADH) from the posterior pituitary.
D) Increased production of erythropoietin by the kidneys.
Correct Answer: B) Stimulation of the baroreceptor reflex, resulting in sympathetic nervous
system activation.
Explanation: The baroreceptor reflex provides the most immediate response to a drop in blood
pressure. It acts within seconds to increase heart rate and systemic vascular resistance. RAAS
and ADH (A, C) are vital but serve as intermediate and long-term compensatory mechanisms.
Question 6: When administering an enteric-coated medication, the nurse understands that the
primary rationale for this formulation is:
A) To increase the speed of absorption in the stomach.
B) To protect the stomach mucosa from irritation or to prevent the drug from being inactivated
by gastric acid.
C) To allow the patient to chew the medication for easier swallowing.
D) To make the medication more palatable for pediatric patients.
Correct Answer: B) To protect the stomach mucosa from irritation or to prevent the drug
from being inactivated by gastric acid.
, Explanation: Enteric coatings are designed to resist dissolution in the acidic environment of the
stomach, ensuring that the medication is released in the alkaline environment of the small
intestine. Crushing or chewing these tablets (C) destroys this protection.
Question 7: A nurse is assessing a patient for "pitting edema" in the lower extremities. The nurse
notes that the depression remains for 30 seconds and appears deep (approximately 6mm). Which
grade of edema should the nurse document?
A) 1+
B) 2+
C) 3+
D) 4+
Correct Answer: C) 3+
Explanation: Edema grading is standardized: 1+ is a slight indentation; 2+ is a deeper pit that
rebounds in seconds; 3+ is a deep pit (about 6mm) that lasts for a prolonged period (often 30+
seconds); 4+ is a very deep pit that can last minutes.
Question 8: In the implementation of a bladder training program for a patient with urge
incontinence, which strategy is most appropriate?
A) Limiting fluid intake to 500ml per day to reduce the frequency of urination.
B) Encouraging the patient to void immediately upon feeling the "urge" to prevent leakage.
C) Implementing a schedule of timed voiding and gradually increasing the intervals between
bathroom visits.
D) Applying an external catheter to keep the patient dry at all times.
Correct Answer: C) Implementing a schedule of timed voiding and gradually increasing the
intervals between bathroom visits.
Explanation: Bladder training aims to restore control by teaching the bladder to hold larger
volumes of urine. Urge incontinence is characterized by overactive detrusor muscles; timed
voiding helps retrain the bladder, whereas limiting fluids (A) can lead to concentrated urine and
increased irritation.
Question 9: A patient with diabetes mellitus is exhibiting signs of "Kussmaul respirations." The
nurse recognizes this as a compensatory mechanism for which acid-base imbalance?
A) Respiratory alkalosis.
