Fundamentals OF Nursing Nclex
FUNDAMENTALS OF NURSING NCLEX
1. The most important nursing intervention to correct skin dryness is:
A. Consult the dietitian about increasing the patient’s fat intake, and take necessary
measures to prevent infection.
B. Ask the physician to refer the patient to a dermatologist, and suggest that the patient
wear home-laundered sleepwear.
C. Encourage the patient to increase his fluid intake, use non-irritating soap when
bathing the patient, and apply lotion to the involved areas.
D. Avoid bathing the patient until the condition is remedied, and notify the physician.
Correct Answer: C. Encourage the patient to increase his fluid intake, use non-irritating
soap when bathing the patient, and apply lotion to the involved areas.
Dry skin will eventually crack, ranking the patient more prone to infection. To prevent
this, the nurse should provide adequate hydration through fluid intake, use non irritating
soaps or no soap when bathing the patient, and lubricate the patient’s skin with lotion. In
most cases, dry skin responds well to lifestyle measures, such as using moisturizers
and avoiding long, hot showers and baths. Moisturizers provide a seal over the skin to
keep water from escaping. Apply moisturizer several times a day and after bathing.
● Option B: The attending physician and dietitian may be consulted for treatment,
but home-laundered items usually are not necessary. Natural fibers, such as
1|Page
,Fundamentals OF Nursing Nclex
cotton and silk, allow the skin to breathe. But wool, although natural, can irritate
even normal skin. Wash clothes with detergents without dyes or perfumes, both
of which can irritate the skin.
● Option C: Increasing fat intake is unnecessary. Hot, dry, indoor air can parch
sensitive skin and worsen itching and flaking. A portable home humidifier or one
attached to the furnace adds moisture to the air inside the home. Be sure to keep
the humidifier clean. It’s best to use cleansing creams or gentle skin cleansers
and bath or shower gels with added moisturizers. Choose mild soaps that have
added oils and fats. Avoid deodorant and antibacterial detergents, fragrance, and
alcohol.
● Option D: Bathing may be limited but need not be avoided entirely. Long showers
or baths and hot water remove oils from the skin. Limit baths or showers to five
to 10 minutes and use warm, not hot, water.
2. When bathing a patient’s extremities, the nurse should use long, firm strokes from the
distal to the proximal areas. This technique:
A. Provides an opportunity for skin assessment.
B. Avoids undue strain on the nurse.
C. Increases venous blood return.
D. Causes vasoconstriction and increases circulation.
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,Fundamentals OF Nursing Nclex
Correct Answer: C. Increases venous blood return.
Washing from distal to proximal areas stimulates venous blood flow, thereby preventing
venous stasis. Good personal hygiene is essential for skin health but it also has an
important role in maintaining self-esteem and quality of life. Supporting patients to
maintain personal hygiene is a fundamental aspect of nursing care.
● Option A: The nurse can assess the patient’s condition throughout the bath.
Helping patients to wash and dress is frequently delegated to junior staff, but
time spent attending to a patient’s hygiene needs is a valuable opportunity for
nurses to carry out a holistic assessment (Dougherty and Lister, 2015; Burns and
Day, 2012). It also allows time to address any concerns patients have and
provides a valuable opportunity to assess the condition of their skin.
● Option B: The nurse should feel no strain while bathing the patient. Nurses
should also discuss with patients any religious and cultural issues relating to
personal care (Dougherty and Lister, 2015). For example, ideally, Muslim patients
should be cared for by a nurse of the same gender (Rassool, 2015), and Hindus
may wish to wash before prayer (Dougherty and Lister, 2015).
● Option D: It improves circulation but does not result in vasoconstriction. Bed
bathing is not as effective as showering or bathing and should only be
undertaken when there is no alternative (Dougherty and Lister, 2015). If a bed
3|Page
, Fundamentals OF Nursing Nclex
bath is required, it is important to offer patients the opportunity to participate in
their own care, which helps to maintain their independence, self-esteem and
dignity.
3. Vivid dreaming occurs in which stage of sleep?
A. Stage I non-REM
B. Rapid eye movement (REM) stage
C. Stage II non-REM
D. Delta stage
Correct Answer: B. Rapid eye movement (REM) stage
Other characteristics of rapid eye movement (REM) sleep are deep sleep (the patient
cannot be awakened easily), depressed muscle tone, and possibly irregular heart and
respiratory rates. This is the stage associated with dreaming. Interestingly, the EEG is
similar to an awake individual, but the skeletal muscles are atonic and without
movement. The exception is the eye and diaphragmatic breathing muscles, which
remain active. The breathing rate is altered though, being more erratic and irregular.
This stage usually starts 90 minutes after falling asleep, and each of the REM cycles
gets longer throughout the night. The first period typically lasts 10 minutes, and the final
one can last up to an hour.
● Option A: Non-REM sleep is a deep, restful sleep without dreaming. This is the
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FUNDAMENTALS OF NURSING NCLEX
1. The most important nursing intervention to correct skin dryness is:
A. Consult the dietitian about increasing the patient’s fat intake, and take necessary
measures to prevent infection.
B. Ask the physician to refer the patient to a dermatologist, and suggest that the patient
wear home-laundered sleepwear.
C. Encourage the patient to increase his fluid intake, use non-irritating soap when
bathing the patient, and apply lotion to the involved areas.
D. Avoid bathing the patient until the condition is remedied, and notify the physician.
Correct Answer: C. Encourage the patient to increase his fluid intake, use non-irritating
soap when bathing the patient, and apply lotion to the involved areas.
Dry skin will eventually crack, ranking the patient more prone to infection. To prevent
this, the nurse should provide adequate hydration through fluid intake, use non irritating
soaps or no soap when bathing the patient, and lubricate the patient’s skin with lotion. In
most cases, dry skin responds well to lifestyle measures, such as using moisturizers
and avoiding long, hot showers and baths. Moisturizers provide a seal over the skin to
keep water from escaping. Apply moisturizer several times a day and after bathing.
● Option B: The attending physician and dietitian may be consulted for treatment,
but home-laundered items usually are not necessary. Natural fibers, such as
1|Page
,Fundamentals OF Nursing Nclex
cotton and silk, allow the skin to breathe. But wool, although natural, can irritate
even normal skin. Wash clothes with detergents without dyes or perfumes, both
of which can irritate the skin.
● Option C: Increasing fat intake is unnecessary. Hot, dry, indoor air can parch
sensitive skin and worsen itching and flaking. A portable home humidifier or one
attached to the furnace adds moisture to the air inside the home. Be sure to keep
the humidifier clean. It’s best to use cleansing creams or gentle skin cleansers
and bath or shower gels with added moisturizers. Choose mild soaps that have
added oils and fats. Avoid deodorant and antibacterial detergents, fragrance, and
alcohol.
● Option D: Bathing may be limited but need not be avoided entirely. Long showers
or baths and hot water remove oils from the skin. Limit baths or showers to five
to 10 minutes and use warm, not hot, water.
2. When bathing a patient’s extremities, the nurse should use long, firm strokes from the
distal to the proximal areas. This technique:
A. Provides an opportunity for skin assessment.
B. Avoids undue strain on the nurse.
C. Increases venous blood return.
D. Causes vasoconstriction and increases circulation.
2|Page
,Fundamentals OF Nursing Nclex
Correct Answer: C. Increases venous blood return.
Washing from distal to proximal areas stimulates venous blood flow, thereby preventing
venous stasis. Good personal hygiene is essential for skin health but it also has an
important role in maintaining self-esteem and quality of life. Supporting patients to
maintain personal hygiene is a fundamental aspect of nursing care.
● Option A: The nurse can assess the patient’s condition throughout the bath.
Helping patients to wash and dress is frequently delegated to junior staff, but
time spent attending to a patient’s hygiene needs is a valuable opportunity for
nurses to carry out a holistic assessment (Dougherty and Lister, 2015; Burns and
Day, 2012). It also allows time to address any concerns patients have and
provides a valuable opportunity to assess the condition of their skin.
● Option B: The nurse should feel no strain while bathing the patient. Nurses
should also discuss with patients any religious and cultural issues relating to
personal care (Dougherty and Lister, 2015). For example, ideally, Muslim patients
should be cared for by a nurse of the same gender (Rassool, 2015), and Hindus
may wish to wash before prayer (Dougherty and Lister, 2015).
● Option D: It improves circulation but does not result in vasoconstriction. Bed
bathing is not as effective as showering or bathing and should only be
undertaken when there is no alternative (Dougherty and Lister, 2015). If a bed
3|Page
, Fundamentals OF Nursing Nclex
bath is required, it is important to offer patients the opportunity to participate in
their own care, which helps to maintain their independence, self-esteem and
dignity.
3. Vivid dreaming occurs in which stage of sleep?
A. Stage I non-REM
B. Rapid eye movement (REM) stage
C. Stage II non-REM
D. Delta stage
Correct Answer: B. Rapid eye movement (REM) stage
Other characteristics of rapid eye movement (REM) sleep are deep sleep (the patient
cannot be awakened easily), depressed muscle tone, and possibly irregular heart and
respiratory rates. This is the stage associated with dreaming. Interestingly, the EEG is
similar to an awake individual, but the skeletal muscles are atonic and without
movement. The exception is the eye and diaphragmatic breathing muscles, which
remain active. The breathing rate is altered though, being more erratic and irregular.
This stage usually starts 90 minutes after falling asleep, and each of the REM cycles
gets longer throughout the night. The first period typically lasts 10 minutes, and the final
one can last up to an hour.
● Option A: Non-REM sleep is a deep, restful sleep without dreaming. This is the
4|Page
