N153: Fundamentals Quiz Final Exam With
Complete Solutions
A nurse is assessing a client who is postoperative following thoracic surgery. Which of
the following manifestations should alert the nurse to the possibility of early
hypovolemic shock? - ANSWER Irritability
Which nursing action demonstrates safe principles of administering a routine
immunization to an infant? - ANSWER Inject the vaccine into the vastus lateralis muscle.
A nurse is caring for a female client who has an indwelling urinary catheter. The nurse
determines that the assistive personnel (AP) performing hygiene care for the client
requires further education about the care of indwelling catheters when she observes
the AP - ANSWER hanging the collection bag at the level of the bladder.
A nurse caring for a client who is immobilized knows that, without interventions to
prevent constipation and fecal impaction, this client is at risk for - ANSWER intestinal
obstruction.
A nurse has organized a discussion session for assistive personnel (AP) at an extended
care facility about cultural and religious traditions and rituals at the time of death. The
nurse determines that one of the participants has a misconception when the AP states
that - ANSWER organ donation is strictly forbidden by the Baptist Church.
A nurse is caring for a client on strict bed rest. When entering the client's room, the
nurse notices flames in the waste basket. The nurse's priority action is to - ANSWER pull
the client out into the hall in the bed.
While preparing a client for discharge, the nurse teaches the proper position for
postural drainage. The nurse knows that to achieve success in this teaching program,
the information about the client that is most important is the - ANSWER client's goal
concerning his ability to be self-sufficient.
, A right handed client is admitted with a fractured right arm and contusions of the left
wrist following a motor vehicle crash. Which intervention should the nurse use when
assisting the client with feeding? - ANSWER Offer small bites of food.
When transcribing the orders for a client admitted with an exacerbation of systemic
lupus erythematosus (SLE), a newly licensed nurse notes that the provider has
prescribed a medication with which the nurse is unfamiliar. The nurse should - ANSWER
consult the medication reference book available on the unit.
A client is 2 days postoperative following an appendectomy. While changing the linens
on the client's bed, the nurse notes drainage from an infected wound has soiled the bed
sheet. The appropriate nursing action is to - ANSWER carefully place the soiled sheet in
a moisture-resistant plastic laundry bag.
Following an accidental fall while playing volleyball, a client is sent home in a lower leg
cast due to a hairline fracture of the tibia and must use crutches. When teaching the
client the four-point gait, the nurse explains that the client should - ANSWER be able to
bear weight on both legs.
A client is prescribed a hypothermia blanket. When caring for the client, the nurse -
ANSWER places a layer of cloth between the client and the blanket.
A client is ambulating in the hallway in bare feet. What is the priority nursing action at
this time? - ANSWER Get the client's slippers and have him put them on.
A client is about to have a nasogastric tube (NG) inserted. The nurse explains the
procedure and is ready to begin the insertion when the client says, "No way! You are not
putting that hose down my throat. Get away from me." Which of the following statements
is an appropriate nursing response? - ANSWER "I can see that this is upsetting you."
A nurse is teaching a client recovering from a cerebrovascular accident how to dress.
The client has residual hemiplegia, so the nurse instructs the client to do which of the
following when putting on a shirt? - ANSWER "Slide your weaker arm through its sleeve
first."
Complete Solutions
A nurse is assessing a client who is postoperative following thoracic surgery. Which of
the following manifestations should alert the nurse to the possibility of early
hypovolemic shock? - ANSWER Irritability
Which nursing action demonstrates safe principles of administering a routine
immunization to an infant? - ANSWER Inject the vaccine into the vastus lateralis muscle.
A nurse is caring for a female client who has an indwelling urinary catheter. The nurse
determines that the assistive personnel (AP) performing hygiene care for the client
requires further education about the care of indwelling catheters when she observes
the AP - ANSWER hanging the collection bag at the level of the bladder.
A nurse caring for a client who is immobilized knows that, without interventions to
prevent constipation and fecal impaction, this client is at risk for - ANSWER intestinal
obstruction.
A nurse has organized a discussion session for assistive personnel (AP) at an extended
care facility about cultural and religious traditions and rituals at the time of death. The
nurse determines that one of the participants has a misconception when the AP states
that - ANSWER organ donation is strictly forbidden by the Baptist Church.
A nurse is caring for a client on strict bed rest. When entering the client's room, the
nurse notices flames in the waste basket. The nurse's priority action is to - ANSWER pull
the client out into the hall in the bed.
While preparing a client for discharge, the nurse teaches the proper position for
postural drainage. The nurse knows that to achieve success in this teaching program,
the information about the client that is most important is the - ANSWER client's goal
concerning his ability to be self-sufficient.
, A right handed client is admitted with a fractured right arm and contusions of the left
wrist following a motor vehicle crash. Which intervention should the nurse use when
assisting the client with feeding? - ANSWER Offer small bites of food.
When transcribing the orders for a client admitted with an exacerbation of systemic
lupus erythematosus (SLE), a newly licensed nurse notes that the provider has
prescribed a medication with which the nurse is unfamiliar. The nurse should - ANSWER
consult the medication reference book available on the unit.
A client is 2 days postoperative following an appendectomy. While changing the linens
on the client's bed, the nurse notes drainage from an infected wound has soiled the bed
sheet. The appropriate nursing action is to - ANSWER carefully place the soiled sheet in
a moisture-resistant plastic laundry bag.
Following an accidental fall while playing volleyball, a client is sent home in a lower leg
cast due to a hairline fracture of the tibia and must use crutches. When teaching the
client the four-point gait, the nurse explains that the client should - ANSWER be able to
bear weight on both legs.
A client is prescribed a hypothermia blanket. When caring for the client, the nurse -
ANSWER places a layer of cloth between the client and the blanket.
A client is ambulating in the hallway in bare feet. What is the priority nursing action at
this time? - ANSWER Get the client's slippers and have him put them on.
A client is about to have a nasogastric tube (NG) inserted. The nurse explains the
procedure and is ready to begin the insertion when the client says, "No way! You are not
putting that hose down my throat. Get away from me." Which of the following statements
is an appropriate nursing response? - ANSWER "I can see that this is upsetting you."
A nurse is teaching a client recovering from a cerebrovascular accident how to dress.
The client has residual hemiplegia, so the nurse instructs the client to do which of the
following when putting on a shirt? - ANSWER "Slide your weaker arm through its sleeve
first."
