fundamentals test bank questions with complete solutions
. A nurse is teaching the staff about alterations in breathing
patterns. Which information will the nurse include in the
teaching session? (Select all that apply.)
a. Apnea—no respirations
b. Tachypnea—regular, rapid respirations
c. Kussmaul's—abnormally deep, regular, fast respirations
d. Hyperventilation—labored, increased in depth and rate
respirations
e. Cheyne-Stokes—abnormally slow and depressed ventilation
respirations
f. Biot's—irregular with alternating periods of apnea and
hyperventilation respirations Correct Answer a. Apnea—no
respirations
b. Tachypnea—regular, rapid respirations
c. Kussmaul's—abnormally deep, regular, fast respirations
. The nurse is caring for a patient who needs a protective
environment. The nurse has provided the care needed and is now
leaving the room. In which order will the nurse remove the
personal protective equipment, beginning with the first step? 1.
Remove eyewear/face shield and goggles. 2. Perform hand
hygiene, leave room, and close door. 3. Remove gloves. 4. Untie
gown, allow gown to fall from shoulders, and do not touch
outside of gown; dispose of properly. 5. Remove mask by
strings; do not touch outside of mask. 6. Dispose of all
contaminated supplies and equipment in designated receptacles.
a. 3, 1, 4, 5, 6, 2
b. 1, 4, 5, 3, 6, 2
c. 1, 4, 5, 3, 2, 6
,d. 3, 1, 4, 5, 2, 6 Correct Answer d. 3, 1, 4, 5, 2, 6
. The nurse is providing perineal care to an uncircumcised male
patient. Which action will the nurse take?
a. Leave the foreskin alone because there is little chance of
infection.
b. Retract the foreskin for cleansing and allow it to return on its
own.
c. Retract the foreskin and return it to its natural position when
done.
d. Leave the foreskin retracted after cleansing the penis Correct
Answer c. Retract the foreskin and return it to its natural
position when done.
A 55-year-old patient is preparing to start an exercise program.
The health care provider wants 60% of maximum target heart
rate. Calculate the heart rate that the nurse will add to the care
plan as the target heart rate. Record answer as a whole number.
_________ maximum heart rate Correct Answer 99
A diabetic patient presents to the clinic for a dressing change.
The wound is located on the right foot and has purulent yellow
drainage. Which action will the nurse take to prevent the spread
of infection?
a. Position the patient comfortably on the stretcher.
b. Explain the procedure for dressing change to the patient. c.
Review the medication list that the patient brought from home.
d. Don gloves and other appropriate personal protective
equipment Correct Answer d. Don gloves and other appropriate
personal protective equipment
,A female adult patient presents to the clinic with reports of a
white discharge and itching in the vaginal area. A nurse is taking
a health history. Which question is the priority?
a. "When was the last time you visited your primary health care
provider?"
b. "Has this condition affected your eating habits in any way?"
c. "What medications are you currently taking?"
d. "Are you able to sleep at night? Correct Answer c. "What
medications are you currently taking?"
A nurse delegates a position change to a nursing assistive
personnel. The nurse instructs the assistive personnel (AP) to
place the patient in the lateral position. Which finding by the
nurse indicates a correct outcome?
a. Patient is lying on side.
b. Patient is lying on back.
c. Patient is lying semiprone.
d. Patient is lying on abdomen Correct Answer a. Patient is
lying on side.
A nurse is assessing a patient who began experiencing severe
pain 3 days ago. When the nurse asks the patient to describe the
pain, the patient states, "The pain feels like it is in my stomach.
It is a burning pain, and it spreads out in a circle around the spot
where it hurts the most." Which type of pain does the nurse
document the patient is having at this time?
a. Superficial pain
b. Idiopathic pain
c. Chronic pain
d. Visceral pain Correct Answer d. Visceral pain
, A nurse is assessing a patient with activity intolerance for
possible orthostatic hypotension. Which finding will help
confirm orthostatic hypotension?
a. Blood pressure sitting 120/64; blood pressure 140/70 standing
b. Blood pressure sitting 126/64; blood pressure 120/58 standing
c. Blood pressure sitting 130/60; blood pressure 110/60 standing
d. Blood pressure sitting 140/60; blood pressure 130/54 standing
Correct Answer c. Blood pressure sitting 130/60; blood pressure
110/60 standing
A nurse is assessing a patient's skin. Which patient is most at
risk for impaired skin integrity?
a. A patient who is afebrile
b. A patient who is diaphoretic
c. A patient with strong pedal pulses
d. A patient with adequate skin turgor Correct Answer b. A
patient who is diaphoretic
A nurse is assessing activity tolerance of a patient. Which areas
will the nurse assess? (Select all that apply.)
a. Skeletal abnormalities
b. Emotional factors
c. Pregnancy status
d. Race
e. Age Correct Answer a. Skeletal abnormalities
b. Emotional factors
c. Pregnancy status
e. Age
A nurse is assessing body alignment. What is the nurse
monitoring?
. A nurse is teaching the staff about alterations in breathing
patterns. Which information will the nurse include in the
teaching session? (Select all that apply.)
a. Apnea—no respirations
b. Tachypnea—regular, rapid respirations
c. Kussmaul's—abnormally deep, regular, fast respirations
d. Hyperventilation—labored, increased in depth and rate
respirations
e. Cheyne-Stokes—abnormally slow and depressed ventilation
respirations
f. Biot's—irregular with alternating periods of apnea and
hyperventilation respirations Correct Answer a. Apnea—no
respirations
b. Tachypnea—regular, rapid respirations
c. Kussmaul's—abnormally deep, regular, fast respirations
. The nurse is caring for a patient who needs a protective
environment. The nurse has provided the care needed and is now
leaving the room. In which order will the nurse remove the
personal protective equipment, beginning with the first step? 1.
Remove eyewear/face shield and goggles. 2. Perform hand
hygiene, leave room, and close door. 3. Remove gloves. 4. Untie
gown, allow gown to fall from shoulders, and do not touch
outside of gown; dispose of properly. 5. Remove mask by
strings; do not touch outside of mask. 6. Dispose of all
contaminated supplies and equipment in designated receptacles.
a. 3, 1, 4, 5, 6, 2
b. 1, 4, 5, 3, 6, 2
c. 1, 4, 5, 3, 2, 6
,d. 3, 1, 4, 5, 2, 6 Correct Answer d. 3, 1, 4, 5, 2, 6
. The nurse is providing perineal care to an uncircumcised male
patient. Which action will the nurse take?
a. Leave the foreskin alone because there is little chance of
infection.
b. Retract the foreskin for cleansing and allow it to return on its
own.
c. Retract the foreskin and return it to its natural position when
done.
d. Leave the foreskin retracted after cleansing the penis Correct
Answer c. Retract the foreskin and return it to its natural
position when done.
A 55-year-old patient is preparing to start an exercise program.
The health care provider wants 60% of maximum target heart
rate. Calculate the heart rate that the nurse will add to the care
plan as the target heart rate. Record answer as a whole number.
_________ maximum heart rate Correct Answer 99
A diabetic patient presents to the clinic for a dressing change.
The wound is located on the right foot and has purulent yellow
drainage. Which action will the nurse take to prevent the spread
of infection?
a. Position the patient comfortably on the stretcher.
b. Explain the procedure for dressing change to the patient. c.
Review the medication list that the patient brought from home.
d. Don gloves and other appropriate personal protective
equipment Correct Answer d. Don gloves and other appropriate
personal protective equipment
,A female adult patient presents to the clinic with reports of a
white discharge and itching in the vaginal area. A nurse is taking
a health history. Which question is the priority?
a. "When was the last time you visited your primary health care
provider?"
b. "Has this condition affected your eating habits in any way?"
c. "What medications are you currently taking?"
d. "Are you able to sleep at night? Correct Answer c. "What
medications are you currently taking?"
A nurse delegates a position change to a nursing assistive
personnel. The nurse instructs the assistive personnel (AP) to
place the patient in the lateral position. Which finding by the
nurse indicates a correct outcome?
a. Patient is lying on side.
b. Patient is lying on back.
c. Patient is lying semiprone.
d. Patient is lying on abdomen Correct Answer a. Patient is
lying on side.
A nurse is assessing a patient who began experiencing severe
pain 3 days ago. When the nurse asks the patient to describe the
pain, the patient states, "The pain feels like it is in my stomach.
It is a burning pain, and it spreads out in a circle around the spot
where it hurts the most." Which type of pain does the nurse
document the patient is having at this time?
a. Superficial pain
b. Idiopathic pain
c. Chronic pain
d. Visceral pain Correct Answer d. Visceral pain
, A nurse is assessing a patient with activity intolerance for
possible orthostatic hypotension. Which finding will help
confirm orthostatic hypotension?
a. Blood pressure sitting 120/64; blood pressure 140/70 standing
b. Blood pressure sitting 126/64; blood pressure 120/58 standing
c. Blood pressure sitting 130/60; blood pressure 110/60 standing
d. Blood pressure sitting 140/60; blood pressure 130/54 standing
Correct Answer c. Blood pressure sitting 130/60; blood pressure
110/60 standing
A nurse is assessing a patient's skin. Which patient is most at
risk for impaired skin integrity?
a. A patient who is afebrile
b. A patient who is diaphoretic
c. A patient with strong pedal pulses
d. A patient with adequate skin turgor Correct Answer b. A
patient who is diaphoretic
A nurse is assessing activity tolerance of a patient. Which areas
will the nurse assess? (Select all that apply.)
a. Skeletal abnormalities
b. Emotional factors
c. Pregnancy status
d. Race
e. Age Correct Answer a. Skeletal abnormalities
b. Emotional factors
c. Pregnancy status
e. Age
A nurse is assessing body alignment. What is the nurse
monitoring?
