Fundamentals pre assessment quiz
A nurse is caring for a client with a stage 2 pressure ulcer. Define the characteristics of
the ulcer. - answersPartial-thickness skin loss involving the epidermis and the dermis.
The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow
crater. Edema persists, and the ulcer may become infected, possibly with pain and
scant drainage.
A nurse is caring for a client receiving chemotherapy that is experiencing neutropenia.
Which of the following should the nurse include in this client's education? -
answersAvoid crowded events
Clients with neutropenia do not have enough circulating neutrophils to fight off
infections. This client should avoid crowds to prevent exposure to colds/viruses.
A nurse is caring for a client who is admitted for observation and has full range of
motion. Which is the best manner to encourage this client to void? - answersclient
bathroom
The goal is to encourage clients to maintain independence and privacy if the client has
full function and is able to safely complete ADLs.
A client with hearing loss has been fitted for a hearing aid. Which of the following
teaching points are important for the nurse to discuss with the client? - answersUse a
mild soap and water to clean the ear mold.
A nurse is caring for an older adult client with delirium. Which intervention will most
effectively reduce the client's risk for falls? - answershourly rounding by the nurse
, In the health care environment, hourly rounding by nurses significantly reduces the
occurrence of client falls, as well as reducing call light usage and increasing client
satisfaction.
A nurse is providing teaching about the Mediterranean diet to a client who has a new
diagnosis of hypertension. Which of the following statements by the client indicates a
need for further teaching? - answers"I will limit my intake of red meat to twice weekly"
This statement by the client indicates a need for further teaching. Following the
Mediterranean diet, red meat should be limited to two times monthly.
A nurse is admitting a client who has tuberculosis and a productive cough. Which of the
following types of isolation precautions should the nurse initiate for the client? -
answersAirborne
The nurse should initiate airborne precautions when a client has an infection that
spreads through small droplets that remain airborne for longer periods, such as
tuberculosis and measles. The client requires a negative-pressure airflow room, and
staff should wear an N95 respirator when in contact with the client.
A nurse is assessing a client who has Parkinson's disease. Which of the following
manifestations should the nurse expect? - answersBradykinesia
The nurse should expect to find bradykinesia or difficulty moving in a client who has
Parkinson's disease
A nurse is caring for a client with celiac disease. Which foods should be removed from
the meal tray? - answerstortillas
A nurse is caring for a client with a closed head injury. When pressure is applied to the
client's nail beds, the client's eyes open and adduction of the arms with flexion of the
elbows and wrists is noted. The client also moans with stimulation. What is the client's
Glasgow Coma Score? - answers7
The GCS is calculated by using appropriate stimuli (a painful stimulus may be
necessary such as pressure to the nail beds) and then assessing the client's response
in three areas.
Eye opening (E)- the best eye response, with responses ranging from 4 to 1
4= Eye opening occurs spontaneously
3= Eye opening occurs secondary to voice
2= Eye opening occurs secondary to pain
1= Eye opening does not occur
Verbal (V)- The best verbal response, with responses ranging from 5 to 1
A nurse is caring for a client with a stage 2 pressure ulcer. Define the characteristics of
the ulcer. - answersPartial-thickness skin loss involving the epidermis and the dermis.
The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow
crater. Edema persists, and the ulcer may become infected, possibly with pain and
scant drainage.
A nurse is caring for a client receiving chemotherapy that is experiencing neutropenia.
Which of the following should the nurse include in this client's education? -
answersAvoid crowded events
Clients with neutropenia do not have enough circulating neutrophils to fight off
infections. This client should avoid crowds to prevent exposure to colds/viruses.
A nurse is caring for a client who is admitted for observation and has full range of
motion. Which is the best manner to encourage this client to void? - answersclient
bathroom
The goal is to encourage clients to maintain independence and privacy if the client has
full function and is able to safely complete ADLs.
A client with hearing loss has been fitted for a hearing aid. Which of the following
teaching points are important for the nurse to discuss with the client? - answersUse a
mild soap and water to clean the ear mold.
A nurse is caring for an older adult client with delirium. Which intervention will most
effectively reduce the client's risk for falls? - answershourly rounding by the nurse
, In the health care environment, hourly rounding by nurses significantly reduces the
occurrence of client falls, as well as reducing call light usage and increasing client
satisfaction.
A nurse is providing teaching about the Mediterranean diet to a client who has a new
diagnosis of hypertension. Which of the following statements by the client indicates a
need for further teaching? - answers"I will limit my intake of red meat to twice weekly"
This statement by the client indicates a need for further teaching. Following the
Mediterranean diet, red meat should be limited to two times monthly.
A nurse is admitting a client who has tuberculosis and a productive cough. Which of the
following types of isolation precautions should the nurse initiate for the client? -
answersAirborne
The nurse should initiate airborne precautions when a client has an infection that
spreads through small droplets that remain airborne for longer periods, such as
tuberculosis and measles. The client requires a negative-pressure airflow room, and
staff should wear an N95 respirator when in contact with the client.
A nurse is assessing a client who has Parkinson's disease. Which of the following
manifestations should the nurse expect? - answersBradykinesia
The nurse should expect to find bradykinesia or difficulty moving in a client who has
Parkinson's disease
A nurse is caring for a client with celiac disease. Which foods should be removed from
the meal tray? - answerstortillas
A nurse is caring for a client with a closed head injury. When pressure is applied to the
client's nail beds, the client's eyes open and adduction of the arms with flexion of the
elbows and wrists is noted. The client also moans with stimulation. What is the client's
Glasgow Coma Score? - answers7
The GCS is calculated by using appropriate stimuli (a painful stimulus may be
necessary such as pressure to the nail beds) and then assessing the client's response
in three areas.
Eye opening (E)- the best eye response, with responses ranging from 4 to 1
4= Eye opening occurs spontaneously
3= Eye opening occurs secondary to voice
2= Eye opening occurs secondary to pain
1= Eye opening does not occur
Verbal (V)- The best verbal response, with responses ranging from 5 to 1
