CURRENTLY TESTING SOLUTIONS OF NACE FINAL EXAM AND
PRACTICE EXAM QUESTIONS WITH ACTUAL CORRECT
DETAILED ANSWERS
A client who has been on nothing by mouth may now have fluids. Which of these beverages should be
offered first?
a. Skim milk.
b. Eggnog.
c. Cream of chicken soup.
d. Apple juice.
d. Apple juice.
Following NPO, the client should be offered clear liquids. Among these options, apple juice should be
offered first. Skim milk, eggnog, and cream of chicken soup are considered full liquids and can be offered
after the client has demonstrated tolerance of a clear liquid diet.
A client who has chronic obstructive pulmonary disease (COPD) uses oxygen. A nurse should recognize
that which of these measures would be a safety hazard to the client?
a. Having plants or cut flowers in the room.
b. Wearing clothing made of 100 percent cotton.
c. Using humidified oxygen.
d. Using oxygen at six liters per minute
d. Using oxygen at six liters per minute
Clients who have COPD should maintain low-flow oxygen rates. These clients have hypoxia and
hypercarbia. Increasing their oxygen levels can cause a loss of the respiratory drive and lead to
respiratory arrest. Having plants in the room, wearing clothing made of 100% cotton, or using humidified
oxygen would not be safety hazards to a client who has COPD.
A client who is on bed rest with an indwelling urinary catheter has had no urinary drainage for the past
four hours. Which of these actions should a nurse take first?
,a. Force fluids.
b. Elevate the client's legs.
c. Palpate the client's suprapubic area.
d. Ensure the drainage bag is below the level of the bed.
d. Ensure the drainage bag is below the level of the bed.
Urine from a Foley catheter drains by gravity, and thus the drainage bag needs to be below the level of
the bed. Forcing fluids, elevating the client's legs, and palpating the client's suprapubic area are not the
first actions a nurse should take for this client.
A nurse should recognize that an elderly client who has a history of osteoporosis is at greatest risk for
developing which of these complications?
a. Bone cancer.
b. Impotence.
c. Sciatica.
d. Stress fractures.
d. Stress fractures.
Elderly clients with osteoporosis often develop stress fractures. An elderly client with a history of
osteoporosis is not at an increased risk for bone cancer, impotence or sciatica.
When a client is hospitalized for pneumonia, a nurse should plan to increase fluid intake for which of
these primary purposes?
a. Maintain renal function.
b. Improve cardiac output.
c. Promote bowel function.
d. Improve airway clearance.
d. Improve airway clearance.
The primary purpose of increasing fluid intake for a client hospitalized for pneumonia is to improve
airway clearance by liquefying secretions so the client can cough and expectorate. A client's renal
function, cardiac output, and bowel function are not affected by pneumonia.
A nursing home client has been confined to a geriatric chair for two hours. Which of these measures
should a nurse take at this time?
a. Give the client a bed bath.
b. Sit and talk with the client for ten minutes.
c. Walk with the client around the unit.
d. Encourage the client to socialize with the roommate.
,c. Walk with the client around the unit.
After being confined to a geriatric chair for two hours, the nurse should walk around the unit with the
client. This will reduce pressure on the client's skin and promote circulation and lung expansion. Giving
the client a bed bath, sitting and talking with the client or encouraging the client to socialize with the
roommate would not promote the client's circulation. It is more important to move the client.
A client in a long-term care facility is learning to use a walker. Which of these instructions should a nurse
reinforce to the client?
a. "Use the walker as needed for balance."
b. "Step and move the walker simultaneously."
c. "Move the walker and then step into it."
d. "Glide the walker along the floor with each step."
c. "Move the walker and then step into it."
The client should be instructed to move the walker and step into it for safety and balance. The walker
should be used each time the client ambulates. Stepping and moving the walker simultaneously, or
gliding the walker along the floor with each step, may lead to falls.
For which of these reasons should a nurse administer a diuretic to a client early in the morning?
a. Any toxic effects of the drug will be readily recognized.
b. The peak action of the drug will occur while the client is awake.
c. Mobility during the day will increase the volume of urine produced.
d. The client will require additional fluid intake at night.
b. The peak action of the drug will occur while the client is awake.
A diuretic should be administered to a client in the morning so the peak action of the drug (diuresis and
increased urine output) will occur while the client is awake. Toxic effects, the client's mobility, and
required fluid intake are not affected by what time the drug is taken.
A nurse is caring for a client with a self-care deficit related to toileting. Which of these nursing orders
would serve as the best guide when providing care to this client?
a. Reposition the client frequently to improve renal perfusion.
b. Ambulate client to toilet every four hours while the client is awake.
c. Teach coping strategies for dealing with incontinence based on client readiness.
d. Provide emotional support and reassurance for voiding accidents.
b. Ambulate client to toilet every four hours while the client is awake.
Offering a bedpan every four hours while the client is awake is the best intervention for self-care deficit
related to toileting, as it provides a regular schedule for bladder retraining. Repositioning the client
, frequently, teaching coping strategies based on client readiness, and providing emotional support are
not the best guides when providing care for self-care deficit related to toileting.
Which of these nursing measures is appropriate during an asthmatic attack?
a. Minimizing environmental stress.
b. Teaching the client to deep breathe and cough.
c. Having the client use a pillow to splint the chest.
d. Maintaining the client in a semi-Fowler's position.
a. Minimizing environmental stress.
During an asthmatic attack, a nurse should minimize environmental stress. Environmental stress will
increase dyspnea. Teaching the client to deep breathe and cough, or using a pillow to splint the client's
chest are not effective nursing methods during an asthmatic attack. Allow client to assume position of
comfort & don't insist on semi-Fowler's position.
An elderly client fell and sustained head trauma. A nurse is monitoring this client for signs of increased
intracranial pressure. Which of these signs would provide the earliest indication that the client's
intracranial pressure has increased?
a. Change in the level of consciousness.
b. Drop in blood pressure.
c. Decrease in temperature.
d. Difficulty breathing.
a. Change in the level of consciousness.
One of the earliest signs of increased intracranial pressure following head trauma is a change in the level
of consciousness. Clients with increasing intracranial pressure will experience an increase in blood
pressure. A decrease in temperature and difficulty breathing are not early signs of increased intracranial
pressure.
A client who is suspected of having a hiatal hernia is admitted to the hospital. It is important for a nurse
to ask the client which of these questions?
a. "Do you experience heartburn after a large meal?"
b. "Do you experience loose stools after eating?"
c. "Do you have gastric pain before meals?"
d. "Do you have difficulty swallowing when eating?"
a. "Do you experience heartburn after a large meal?"
Clients with hiatal hernia often experience heartburn after large meals. They need to eat small, frequent
meals. Clients with hiatal hernia do not experience loose stools after eating, gastric pain before meals, or
difficulty swallowing.
PRACTICE EXAM QUESTIONS WITH ACTUAL CORRECT
DETAILED ANSWERS
A client who has been on nothing by mouth may now have fluids. Which of these beverages should be
offered first?
a. Skim milk.
b. Eggnog.
c. Cream of chicken soup.
d. Apple juice.
d. Apple juice.
Following NPO, the client should be offered clear liquids. Among these options, apple juice should be
offered first. Skim milk, eggnog, and cream of chicken soup are considered full liquids and can be offered
after the client has demonstrated tolerance of a clear liquid diet.
A client who has chronic obstructive pulmonary disease (COPD) uses oxygen. A nurse should recognize
that which of these measures would be a safety hazard to the client?
a. Having plants or cut flowers in the room.
b. Wearing clothing made of 100 percent cotton.
c. Using humidified oxygen.
d. Using oxygen at six liters per minute
d. Using oxygen at six liters per minute
Clients who have COPD should maintain low-flow oxygen rates. These clients have hypoxia and
hypercarbia. Increasing their oxygen levels can cause a loss of the respiratory drive and lead to
respiratory arrest. Having plants in the room, wearing clothing made of 100% cotton, or using humidified
oxygen would not be safety hazards to a client who has COPD.
A client who is on bed rest with an indwelling urinary catheter has had no urinary drainage for the past
four hours. Which of these actions should a nurse take first?
,a. Force fluids.
b. Elevate the client's legs.
c. Palpate the client's suprapubic area.
d. Ensure the drainage bag is below the level of the bed.
d. Ensure the drainage bag is below the level of the bed.
Urine from a Foley catheter drains by gravity, and thus the drainage bag needs to be below the level of
the bed. Forcing fluids, elevating the client's legs, and palpating the client's suprapubic area are not the
first actions a nurse should take for this client.
A nurse should recognize that an elderly client who has a history of osteoporosis is at greatest risk for
developing which of these complications?
a. Bone cancer.
b. Impotence.
c. Sciatica.
d. Stress fractures.
d. Stress fractures.
Elderly clients with osteoporosis often develop stress fractures. An elderly client with a history of
osteoporosis is not at an increased risk for bone cancer, impotence or sciatica.
When a client is hospitalized for pneumonia, a nurse should plan to increase fluid intake for which of
these primary purposes?
a. Maintain renal function.
b. Improve cardiac output.
c. Promote bowel function.
d. Improve airway clearance.
d. Improve airway clearance.
The primary purpose of increasing fluid intake for a client hospitalized for pneumonia is to improve
airway clearance by liquefying secretions so the client can cough and expectorate. A client's renal
function, cardiac output, and bowel function are not affected by pneumonia.
A nursing home client has been confined to a geriatric chair for two hours. Which of these measures
should a nurse take at this time?
a. Give the client a bed bath.
b. Sit and talk with the client for ten minutes.
c. Walk with the client around the unit.
d. Encourage the client to socialize with the roommate.
,c. Walk with the client around the unit.
After being confined to a geriatric chair for two hours, the nurse should walk around the unit with the
client. This will reduce pressure on the client's skin and promote circulation and lung expansion. Giving
the client a bed bath, sitting and talking with the client or encouraging the client to socialize with the
roommate would not promote the client's circulation. It is more important to move the client.
A client in a long-term care facility is learning to use a walker. Which of these instructions should a nurse
reinforce to the client?
a. "Use the walker as needed for balance."
b. "Step and move the walker simultaneously."
c. "Move the walker and then step into it."
d. "Glide the walker along the floor with each step."
c. "Move the walker and then step into it."
The client should be instructed to move the walker and step into it for safety and balance. The walker
should be used each time the client ambulates. Stepping and moving the walker simultaneously, or
gliding the walker along the floor with each step, may lead to falls.
For which of these reasons should a nurse administer a diuretic to a client early in the morning?
a. Any toxic effects of the drug will be readily recognized.
b. The peak action of the drug will occur while the client is awake.
c. Mobility during the day will increase the volume of urine produced.
d. The client will require additional fluid intake at night.
b. The peak action of the drug will occur while the client is awake.
A diuretic should be administered to a client in the morning so the peak action of the drug (diuresis and
increased urine output) will occur while the client is awake. Toxic effects, the client's mobility, and
required fluid intake are not affected by what time the drug is taken.
A nurse is caring for a client with a self-care deficit related to toileting. Which of these nursing orders
would serve as the best guide when providing care to this client?
a. Reposition the client frequently to improve renal perfusion.
b. Ambulate client to toilet every four hours while the client is awake.
c. Teach coping strategies for dealing with incontinence based on client readiness.
d. Provide emotional support and reassurance for voiding accidents.
b. Ambulate client to toilet every four hours while the client is awake.
Offering a bedpan every four hours while the client is awake is the best intervention for self-care deficit
related to toileting, as it provides a regular schedule for bladder retraining. Repositioning the client
, frequently, teaching coping strategies based on client readiness, and providing emotional support are
not the best guides when providing care for self-care deficit related to toileting.
Which of these nursing measures is appropriate during an asthmatic attack?
a. Minimizing environmental stress.
b. Teaching the client to deep breathe and cough.
c. Having the client use a pillow to splint the chest.
d. Maintaining the client in a semi-Fowler's position.
a. Minimizing environmental stress.
During an asthmatic attack, a nurse should minimize environmental stress. Environmental stress will
increase dyspnea. Teaching the client to deep breathe and cough, or using a pillow to splint the client's
chest are not effective nursing methods during an asthmatic attack. Allow client to assume position of
comfort & don't insist on semi-Fowler's position.
An elderly client fell and sustained head trauma. A nurse is monitoring this client for signs of increased
intracranial pressure. Which of these signs would provide the earliest indication that the client's
intracranial pressure has increased?
a. Change in the level of consciousness.
b. Drop in blood pressure.
c. Decrease in temperature.
d. Difficulty breathing.
a. Change in the level of consciousness.
One of the earliest signs of increased intracranial pressure following head trauma is a change in the level
of consciousness. Clients with increasing intracranial pressure will experience an increase in blood
pressure. A decrease in temperature and difficulty breathing are not early signs of increased intracranial
pressure.
A client who is suspected of having a hiatal hernia is admitted to the hospital. It is important for a nurse
to ask the client which of these questions?
a. "Do you experience heartburn after a large meal?"
b. "Do you experience loose stools after eating?"
c. "Do you have gastric pain before meals?"
d. "Do you have difficulty swallowing when eating?"
a. "Do you experience heartburn after a large meal?"
Clients with hiatal hernia often experience heartburn after large meals. They need to eat small, frequent
meals. Clients with hiatal hernia do not experience loose stools after eating, gastric pain before meals, or
difficulty swallowing.
