Fundamentals Practice Test A
1.A nurse is evaluating a client’s use of a cane. Which of the following actions should the nurse identify as an indication of correct use?
a.The top of the cane is parallel to the client’s waist
b.When walking, the client moves the cane 46 cm (18 in) forward
c.The client holds the cane on the stronger side of her body
d.The client moves her stronger limb forward with the cane
2.A nurse receives report about a client who has 0.9% sodium chloride infusing IV at 125 mL/hr. When the nurse performs the initial assessment, he notes that the client has received only 80 mL over the last 2 hr. Which of the following actions should the nurse take first?
a.Reposition the client
b.Document the client’s IV intake in the medical record
c.Request a new IV fluid prescription
d.Check the IV tubing for obstruction
3.A nurse is caring for a client who requires an NG tube for stomach decompression. Which of the following actions should the nurse take when inserting the NG tube?
a.Position the client with the head of the bed elevated to 30* prior to insertion of the NG tube
b.Remove the NG tube if the client begins to gag or choke
c.Apply suction to the NG tube prior to insertion
d.Have the client take sips of water to promote insertion of the NG tube into the esophagus
4.A nurse is reviewing a client’s fluid and electrolyte status. Which of the following findings should the nurse report to the provider?
a.BUN 15/mg/dL
i.Normal range 10 to 20 mg/dL
b.Creatinine 0.8 mg/dL
i.Normal range 0.5 to 1.1 mg/dL for women 41 to 60 years of age
ii.0.6 to 1.3 mg/dL for me 41 to 60 years of age
c.Sodium 143 mEq/L
i.Normal range 136 to 145 mEq/L
d.Potassium 5.4 mEq/L
i.Normal range 3.5 to 5 mEq/L
ii.Client is at risk for dysrhythmias
5.A nurse is providing discharge instructions to a client who will be using a walker. Which of the following client statements indicates an understanding of the teaching?
a.“I can place an extension cord across my living room to plug in my television.”
b.“I will hire someone to trim the tree that hangs low over the stairs of my front porch.”Fundamentals Practice Test A & B 120 Questions and Answers
60 Q & As c.“I will place my alarm clock on my bedroom dresser across the room.”
d.I will replace the old throw rug in my kitchen with a new one.”
6.A nurse is planning care for a client who has had a stroke, resulting in aphasia & dysphagia. Which of the following tasks should the nurse assign to an assistive personnel (AP)? Select all that apply.
a.Assist the client with a partial bed bath
b.Measure the client’s BP after the nurse administers an antihypertensive medication
c.Test the client’s swallowing ability by providing thickened liquids
d.Use a communication board to ask what the client wants for lunch
e.Irrigate the client’s indwelling urinary catheter
7.A nurse is caring for a client who is expressing anger about his diagnosis of colorectal cancer. Which of the following actions should the nurse take?
a.Discuss the risk factors for the colon cancer
b.Focus teaching on what the client will need to do in the future to manage his illness
c.Provide the client with written information about the phases of loss and grief
d.Reassure the client that this is an expected response to grief
8.A nurse is preparing to apply a dressing for a client who has a stage 2 pressure injury. Which of the following types of dressing should the nurse use?
a.Alginate
i.Used to treat stage 3 & 4 pressure injuries to absorb drainage
ii.Alginate forms a soft gel when it comes in contact with drainage
b.Gauze
i.Moistened gauze promotes healing in stage 4 or unstageable pressure injuries by causing debridement & allowing granulation of the wound bed
c.Transparent
i.Promote healing in stage 1 pressure injuries by preventing further friction & shearing
d.Hydrocolloid
i.Promote healing in stage 2 pressure injuries by creating a moist wound bed
9.A nurse is administering an otic medication to an older adult client. Which of the following actions should the nurse take to ensure that the medication reaches the inner ear?
a.Press gently on the tragus of the client’s ear
b.Pack a small piece of cotton deep into the client’s ear canal
c.Move the client’s auricle down & back toward her head
d.Tilt the client’s head backward for 5 min
10.A nurse is using an open irrigation technique to irrigate a client’s indwelling urinary catheter. Which of the following actions should the nurse take? a.Place the client in a side-lying position
b.Instill 15 mL of irrigation fluid into the catheter with each flush
c.Subtract the amount of irrigant used from the client’s urine output
d.Perform the irrigation using a 20-mL syringe
11.A nurse is initiating a protective environment for a client who has had an allogeneic stem
cell transplant. Which of the following precautions should the nurse plan for this client?
a.Make sure the client’s room has at least 6 air exchanges per hour
b.Make sure the client wears a mask when outside her room if there is construction in the area
c.Place the client in a private room with negative-pressure airflow
d.Wear an N95 respirator when giving the client direct care
12.A nurse is auscultating the anterior chest of a client who was newly admitted to a medical-surgical unit. Listen to the audio clip of what the nurse auscultates through the stethoscope and identify the type of breath sounds.
a.Crackles
b.Rhonchi
c.Friction rub
d.Normal breath sounds
13.A nurse is planning strategies to manage time effectively for client care. Which of the following strategies should the nurse implement?
a.Combine client care tasks when caring for multiple clients
b.Wait until the end of shift to document client care
c.Use the planning step of the nursing process to prioritize client care delivery
d.Allow for interruptions in tasks to discuss client care issues with colleagues
14.A nurse is caring for a client who is postoperative following a knee arthroplasty & requires the use of thigh-length sequential compression sleeves. Which of the following actions should the nurse take?
a.Assist the client into a prone position
b.Place a sleeve over the top of each leg with the opening at the knee
c.Make sure 2 fingers can fit under the sleeves
d.Set the ankle pressure at 65 mm Hg
15.A nurse is caring for a client who has a respiratory infection. Which of the following techniques should the nurse use when performing nasotracheal suctioning for the client?
a.Insert the suction catheter while the client is swallowing
b.Apply intermittent suction when withdrawing the catheter
c.Place the catheter in a location that is clean and dry for later use
d.Hold the suction catheter with her clean, nondominant hand
16.A nurse is assessing a client who reports increased pain following physical therapy. Which of the following questions should the nurse ask when assessing the quality of the client’s pain?
1.A nurse is evaluating a client’s use of a cane. Which of the following actions should the nurse identify as an indication of correct use?
a.The top of the cane is parallel to the client’s waist
b.When walking, the client moves the cane 46 cm (18 in) forward
c.The client holds the cane on the stronger side of her body
d.The client moves her stronger limb forward with the cane
2.A nurse receives report about a client who has 0.9% sodium chloride infusing IV at 125 mL/hr. When the nurse performs the initial assessment, he notes that the client has received only 80 mL over the last 2 hr. Which of the following actions should the nurse take first?
a.Reposition the client
b.Document the client’s IV intake in the medical record
c.Request a new IV fluid prescription
d.Check the IV tubing for obstruction
3.A nurse is caring for a client who requires an NG tube for stomach decompression. Which of the following actions should the nurse take when inserting the NG tube?
a.Position the client with the head of the bed elevated to 30* prior to insertion of the NG tube
b.Remove the NG tube if the client begins to gag or choke
c.Apply suction to the NG tube prior to insertion
d.Have the client take sips of water to promote insertion of the NG tube into the esophagus
4.A nurse is reviewing a client’s fluid and electrolyte status. Which of the following findings should the nurse report to the provider?
a.BUN 15/mg/dL
i.Normal range 10 to 20 mg/dL
b.Creatinine 0.8 mg/dL
i.Normal range 0.5 to 1.1 mg/dL for women 41 to 60 years of age
ii.0.6 to 1.3 mg/dL for me 41 to 60 years of age
c.Sodium 143 mEq/L
i.Normal range 136 to 145 mEq/L
d.Potassium 5.4 mEq/L
i.Normal range 3.5 to 5 mEq/L
ii.Client is at risk for dysrhythmias
5.A nurse is providing discharge instructions to a client who will be using a walker. Which of the following client statements indicates an understanding of the teaching?
a.“I can place an extension cord across my living room to plug in my television.”
b.“I will hire someone to trim the tree that hangs low over the stairs of my front porch.”Fundamentals Practice Test A & B 120 Questions and Answers
60 Q & As c.“I will place my alarm clock on my bedroom dresser across the room.”
d.I will replace the old throw rug in my kitchen with a new one.”
6.A nurse is planning care for a client who has had a stroke, resulting in aphasia & dysphagia. Which of the following tasks should the nurse assign to an assistive personnel (AP)? Select all that apply.
a.Assist the client with a partial bed bath
b.Measure the client’s BP after the nurse administers an antihypertensive medication
c.Test the client’s swallowing ability by providing thickened liquids
d.Use a communication board to ask what the client wants for lunch
e.Irrigate the client’s indwelling urinary catheter
7.A nurse is caring for a client who is expressing anger about his diagnosis of colorectal cancer. Which of the following actions should the nurse take?
a.Discuss the risk factors for the colon cancer
b.Focus teaching on what the client will need to do in the future to manage his illness
c.Provide the client with written information about the phases of loss and grief
d.Reassure the client that this is an expected response to grief
8.A nurse is preparing to apply a dressing for a client who has a stage 2 pressure injury. Which of the following types of dressing should the nurse use?
a.Alginate
i.Used to treat stage 3 & 4 pressure injuries to absorb drainage
ii.Alginate forms a soft gel when it comes in contact with drainage
b.Gauze
i.Moistened gauze promotes healing in stage 4 or unstageable pressure injuries by causing debridement & allowing granulation of the wound bed
c.Transparent
i.Promote healing in stage 1 pressure injuries by preventing further friction & shearing
d.Hydrocolloid
i.Promote healing in stage 2 pressure injuries by creating a moist wound bed
9.A nurse is administering an otic medication to an older adult client. Which of the following actions should the nurse take to ensure that the medication reaches the inner ear?
a.Press gently on the tragus of the client’s ear
b.Pack a small piece of cotton deep into the client’s ear canal
c.Move the client’s auricle down & back toward her head
d.Tilt the client’s head backward for 5 min
10.A nurse is using an open irrigation technique to irrigate a client’s indwelling urinary catheter. Which of the following actions should the nurse take? a.Place the client in a side-lying position
b.Instill 15 mL of irrigation fluid into the catheter with each flush
c.Subtract the amount of irrigant used from the client’s urine output
d.Perform the irrigation using a 20-mL syringe
11.A nurse is initiating a protective environment for a client who has had an allogeneic stem
cell transplant. Which of the following precautions should the nurse plan for this client?
a.Make sure the client’s room has at least 6 air exchanges per hour
b.Make sure the client wears a mask when outside her room if there is construction in the area
c.Place the client in a private room with negative-pressure airflow
d.Wear an N95 respirator when giving the client direct care
12.A nurse is auscultating the anterior chest of a client who was newly admitted to a medical-surgical unit. Listen to the audio clip of what the nurse auscultates through the stethoscope and identify the type of breath sounds.
a.Crackles
b.Rhonchi
c.Friction rub
d.Normal breath sounds
13.A nurse is planning strategies to manage time effectively for client care. Which of the following strategies should the nurse implement?
a.Combine client care tasks when caring for multiple clients
b.Wait until the end of shift to document client care
c.Use the planning step of the nursing process to prioritize client care delivery
d.Allow for interruptions in tasks to discuss client care issues with colleagues
14.A nurse is caring for a client who is postoperative following a knee arthroplasty & requires the use of thigh-length sequential compression sleeves. Which of the following actions should the nurse take?
a.Assist the client into a prone position
b.Place a sleeve over the top of each leg with the opening at the knee
c.Make sure 2 fingers can fit under the sleeves
d.Set the ankle pressure at 65 mm Hg
15.A nurse is caring for a client who has a respiratory infection. Which of the following techniques should the nurse use when performing nasotracheal suctioning for the client?
a.Insert the suction catheter while the client is swallowing
b.Apply intermittent suction when withdrawing the catheter
c.Place the catheter in a location that is clean and dry for later use
d.Hold the suction catheter with her clean, nondominant hand
16.A nurse is assessing a client who reports increased pain following physical therapy. Which of the following questions should the nurse ask when assessing the quality of the client’s pain?
