NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND
ANSWERS
1. A nurse is performing a straight urinary catheterization for a female client who has urinary retention.
Which of the following actions indicates the nurse is maintaining sterile technique?
Wiping the labia minora in an anteroposterior direction
1. A nurse in a rehabilitation facility is observing an assistive personnel (AP) help a client transfer from a
bed to a wheelchair. Which of the following actions indicates to the nurse that the AP understands
how to perform this task?
Locking the brakes on the bed and the wheelchair before moving the client
2. A nurse is preparing to administer a tuberculin skin test to a client. After performing hand hygiene,
which of the following actions should the nurse take?
Circle the injection area with a pen
3. A nurse is caring for a client who has major fecal incontinence and reports irritation in the perianal
area. Which of the following actions should the nurse take first?
Check the client's perineum
4. A nurse is caring for a client who is postoperative following a vaginal hysterectomy and asks for a
drink. Her postoperative diet prescription states “clear liquids; advance diet as tolerated.” Which of
the following responses should the nurse make?
I am going to listen to your abdomen.
5. A nurse is changing the dressings for a client recovering from an appendectomy following a ruptured
appendix. The client's surgical wound is healing by secondary intention. Which of the following
observations should the nurse report to the provider?
Halo of erythema on the surrounding skin
6. A nurse is caring for a client who just received a diagnosis of cancer. The client states, "I just don't
,NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
know what I'm going to do now. Which of the following responses should the nurse make?
Can you explain the concerns you're having right now?
7. A nurse is caring for a client who has a stage III pressure ulcer on the heel. When preparing to
irrigate the wound, which of the following actions should the nurse take first?
Check the client's pain level
8. A nurse is calculating a client's intake for a 12-hr shift. The client had dextrose 5% in 0.45% sodium
chloride infusing at 125 ml/hr, gentamicin 150 mg in 100 mL at 1400, famotidine 20 mg in 50 mL at
1000 and 1600, 250 mL of blood over 2 hr, and a nasogastric flush of 30 ml every 2 hr. What is the
total intake in milliliters that the nurse should document for this client for this 12-hr period?
2130
,NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
9. A nurse is caring for a client who is receiving a blood transfusion. The client reports flank pain, and
the nurse notes reddish-brown urine in the client's urinary catheter bag. The nurse recognizes these
manifestations as which of the following types of transfusion reactions?
Hemolytic
10. A nurse is caring for a client who has a terminal illness. The client asks several questions about the
nurse's religious beliefs related to death and dying. Which of the following actions should the nurse
take?
Encourage the client to express thoughts about death and dying
11. A nurse is caring for a client who reports feeling a pop after coughing without properly splinting an
abdominal incision. On assessment, the nurse notes that the client's wound has eviscerated. Which
of the following actions should the nurse take? (SATA)
Place the client in a supine position with the hips and knees flexed
Cover the wound and intestine with a sterile, moistened dressing
Monitor the client for manifestations of shock
12. A nurse is providing teaching to a client regarding protein intake. Which of the following foods
should the nurse include as an example of an incomplete protein?
Lentils
13. A nurse is providing discharge teaching for a client who has type 2 diabetes mellitus and will be
caring for herself at home. The client expresses concerns about preparing an appropriate diet for her
diabetes due to her cultural beliefs and preferences. Which of the following responses should the
nurse offer?
The dietitian will help you choose foods you are used to that also meet your health needs.
14. A nurse is caring for a client who has emphysema. The client has not stopped smoking cigarettes and
states, "it's too late for me to quit." Which of the following actions should the nurse take?
Assist the client in finding local smoking cessation assistance programs
15. A nurse is collecting a specimen for culture from a clients infected wound. Which of the following
actions should the nurse perform?
Cleanse the wound with 0.9% sodium chloride irrigation
16. A nurse is providing teaching about proper care to a client who has a new colostomy. Which of the
following pieces of information should the nurse include in the teaching?
Cleanse the skin around the stoma with warm water
, NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
17. A nurse is preparing to administer an afternoon dose of ampicillin to a client. The client appears
upset and refuses to take the medication before throwing the pill on the floor. Which of the
following entries should the nurse enter into the client's medical record?
The client threw the medication on the floor.
18. A nurse is caring for a client who is 48 hr postoperative following a small bowel resection. The client
reports gas pains in the periumbilical area. The nurse should plan care based on which of the
following factors contributing to this postoperative complication?
Impaired peristalsis of the intestines
19. A nurse is explaining Piaget's theory of cognitive development to a group of daycare providers for
employees' children at an acute care facility. Which of the following activities should the nurse
include as an example of concrete operational thinking?
Collecting and trading game cards
20. A nurse is planning care for a group of clients receiving oxygen therapy. Which of the following
clients should the nurse plan to see first?
A client who has heart failure and is receiving 100% oxygen via partial rebreather mask
21. A nurse is caring for a group of clients. Which of the following tasks should the nurse assign to an
assistive personnel (AP)?
Provide oral care to a client who cannot take oral fluids
22. A nurse is assessing a client who reports nausea and vomiting for 2 days. Which of the following
findings should indicate to the nurse that the client is experiencing fluid volume deficit?
Increased heart rate
23. A nurse is caring for a client who has a BMI of 29 and expresses a desire to lose weight. Which of the
following actions should the nurse take first?
Determine the client's intention to change current eating habits
24. A nurse is beginning a therapeutic relationship with a client. Which of the following actions should
the nurse take to convey empathy when using the therapeutic communication technique of active
listening?
Assume an open position
25. A nurse is caring for a client who has the head of his bed elevated to a 45° angle with his knees
slightly flexed. Which of the following positions should the nurse document for the client?
Fowler's
NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND
ANSWERS
1. A nurse is performing a straight urinary catheterization for a female client who has urinary retention.
Which of the following actions indicates the nurse is maintaining sterile technique?
Wiping the labia minora in an anteroposterior direction
1. A nurse in a rehabilitation facility is observing an assistive personnel (AP) help a client transfer from a
bed to a wheelchair. Which of the following actions indicates to the nurse that the AP understands
how to perform this task?
Locking the brakes on the bed and the wheelchair before moving the client
2. A nurse is preparing to administer a tuberculin skin test to a client. After performing hand hygiene,
which of the following actions should the nurse take?
Circle the injection area with a pen
3. A nurse is caring for a client who has major fecal incontinence and reports irritation in the perianal
area. Which of the following actions should the nurse take first?
Check the client's perineum
4. A nurse is caring for a client who is postoperative following a vaginal hysterectomy and asks for a
drink. Her postoperative diet prescription states “clear liquids; advance diet as tolerated.” Which of
the following responses should the nurse make?
I am going to listen to your abdomen.
5. A nurse is changing the dressings for a client recovering from an appendectomy following a ruptured
appendix. The client's surgical wound is healing by secondary intention. Which of the following
observations should the nurse report to the provider?
Halo of erythema on the surrounding skin
6. A nurse is caring for a client who just received a diagnosis of cancer. The client states, "I just don't
,NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
know what I'm going to do now. Which of the following responses should the nurse make?
Can you explain the concerns you're having right now?
7. A nurse is caring for a client who has a stage III pressure ulcer on the heel. When preparing to
irrigate the wound, which of the following actions should the nurse take first?
Check the client's pain level
8. A nurse is calculating a client's intake for a 12-hr shift. The client had dextrose 5% in 0.45% sodium
chloride infusing at 125 ml/hr, gentamicin 150 mg in 100 mL at 1400, famotidine 20 mg in 50 mL at
1000 and 1600, 250 mL of blood over 2 hr, and a nasogastric flush of 30 ml every 2 hr. What is the
total intake in milliliters that the nurse should document for this client for this 12-hr period?
2130
,NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
9. A nurse is caring for a client who is receiving a blood transfusion. The client reports flank pain, and
the nurse notes reddish-brown urine in the client's urinary catheter bag. The nurse recognizes these
manifestations as which of the following types of transfusion reactions?
Hemolytic
10. A nurse is caring for a client who has a terminal illness. The client asks several questions about the
nurse's religious beliefs related to death and dying. Which of the following actions should the nurse
take?
Encourage the client to express thoughts about death and dying
11. A nurse is caring for a client who reports feeling a pop after coughing without properly splinting an
abdominal incision. On assessment, the nurse notes that the client's wound has eviscerated. Which
of the following actions should the nurse take? (SATA)
Place the client in a supine position with the hips and knees flexed
Cover the wound and intestine with a sterile, moistened dressing
Monitor the client for manifestations of shock
12. A nurse is providing teaching to a client regarding protein intake. Which of the following foods
should the nurse include as an example of an incomplete protein?
Lentils
13. A nurse is providing discharge teaching for a client who has type 2 diabetes mellitus and will be
caring for herself at home. The client expresses concerns about preparing an appropriate diet for her
diabetes due to her cultural beliefs and preferences. Which of the following responses should the
nurse offer?
The dietitian will help you choose foods you are used to that also meet your health needs.
14. A nurse is caring for a client who has emphysema. The client has not stopped smoking cigarettes and
states, "it's too late for me to quit." Which of the following actions should the nurse take?
Assist the client in finding local smoking cessation assistance programs
15. A nurse is collecting a specimen for culture from a clients infected wound. Which of the following
actions should the nurse perform?
Cleanse the wound with 0.9% sodium chloride irrigation
16. A nurse is providing teaching about proper care to a client who has a new colostomy. Which of the
following pieces of information should the nurse include in the teaching?
Cleanse the skin around the stoma with warm water
, NUR 707 FUNDAMENTALS- DYNAMIC QUESTIONS AND ANSWERS
17. A nurse is preparing to administer an afternoon dose of ampicillin to a client. The client appears
upset and refuses to take the medication before throwing the pill on the floor. Which of the
following entries should the nurse enter into the client's medical record?
The client threw the medication on the floor.
18. A nurse is caring for a client who is 48 hr postoperative following a small bowel resection. The client
reports gas pains in the periumbilical area. The nurse should plan care based on which of the
following factors contributing to this postoperative complication?
Impaired peristalsis of the intestines
19. A nurse is explaining Piaget's theory of cognitive development to a group of daycare providers for
employees' children at an acute care facility. Which of the following activities should the nurse
include as an example of concrete operational thinking?
Collecting and trading game cards
20. A nurse is planning care for a group of clients receiving oxygen therapy. Which of the following
clients should the nurse plan to see first?
A client who has heart failure and is receiving 100% oxygen via partial rebreather mask
21. A nurse is caring for a group of clients. Which of the following tasks should the nurse assign to an
assistive personnel (AP)?
Provide oral care to a client who cannot take oral fluids
22. A nurse is assessing a client who reports nausea and vomiting for 2 days. Which of the following
findings should indicate to the nurse that the client is experiencing fluid volume deficit?
Increased heart rate
23. A nurse is caring for a client who has a BMI of 29 and expresses a desire to lose weight. Which of the
following actions should the nurse take first?
Determine the client's intention to change current eating habits
24. A nurse is beginning a therapeutic relationship with a client. Which of the following actions should
the nurse take to convey empathy when using the therapeutic communication technique of active
listening?
Assume an open position
25. A nurse is caring for a client who has the head of his bed elevated to a 45° angle with his knees
slightly flexed. Which of the following positions should the nurse document for the client?
Fowler's
