FUNDAMENTALS SKILLS NR-224 QUESTIONS AND
ANSWERS/ A+ GRADE
Which statement is related to the concept that is central to the nursing process?
A. It is dynamic rather than static.
Which action reflects the assessment step of the nursing process?
C. Examining a patient for injury after a patient falls in the bathroom.
Which information supports the appropriateness of a nursing diagnosis?
A. Defining characteristics
Which most directly influences the planning step of the nursing process?
A. Related factors
A nurse collects information about a patient. What should the nurse do next? -D.
Determine significance of the data.
When two nursing diagnoses appear closely related, which should the nurse
do first to determine which diagnosis most accurately reflects the needs of the
patient?
D. Review the defining characteristics.
Which human responses identified by the nurse are examples of objective data?
Select all that apply
A. Irregular radial pulse of 50 beats per minute B. Wheezing on expiration. C.
Temperature of 99°F
The nurse assesses a patient and collects a variety of data. Identify the human
responses that are subjective data. Select all that apply
A. Nausea C. Dizziness
A nurse is caring for a patient who is blind in the left eye and visually impaired in
the right eye. Which actions should the nurse employ to promote communication
with this patient?
D. Knock on the door and request permission to enter before approaching the patient.
Which nursing actions should the nurse implement when speaking with an older
adult whose hearing is impaired? Select all that apply
A. Limit background noise. C. Lower the pitch of your voice. D. Stand directly in front of
the patient when speaking.
A risk manager is conducting a retrospective audit of a patient's clinical record to
identify the use of unacceptable abbreviations. Which abbreviations did the risk
manager identify that are on The Joint Commission's official Do Not Use List?
Select all that apply
A. U D. MS E. QOD
A nurse is teaching an older adult how to perform a dressing change. Which
nursing action is most important to address a developmental stress of older
adults?
D. Allow more time for the patient to process information.
A culturally competent nurse is planning to teach a patient about a new regimen
of self
, care. Which must the nurse assess first about the patient before implementing the
teaching plan? -D. Health beliefs
Which condition places a patient at the greatest risk for developing an infection?
B. Burns over more than 20% of the body.
A patient has a wound that is healing by secondary intention. Which solution to
cleanse the wound and dressing should the nurse expect will be ordered to
support wound healing?
B. Normal saline and a wet-to-damp dressing.
A patient's stool specimen is positive for Clostridium difficile. Which isolation
precautions should the nurse institute for this patient?
B. Contact
Which should the nurse do to interrupt the transmission link in the chain of
infection?
A. Wash the hands before providing care to a patient.
A nurse is caring for patients with a variety of wounds. Which wounds will likely heal by
primary intention? Select all that apply -A. Cut in the skin from a kitchen knife. D.
Surgical incision
Which type of isolation precaution is a N95 respirator mask designed to protect
the nurse?
B. Airborne
Which nursing actions protect patients from infection at the portal of entry
portion of the chain of infection? Select all that apply
A. Positioning an indwelling urine collection bag below the level of the patient's pelvis.
B. Using sterile technique when administering an intramuscular injection. F. Maintaining
a dressing over a surgical incision.
A nurse is preparing to reconstitute a medication in a multiple
dose vial. Which is the most essential step in the preparation of this medication? -A.
Instilling an accurate amount of diluent into the vial.
Which information about a parenteral medication indicates that the nurse should
use a filtered needle when preparing the medication?
B. Is supplied in an ampule.
Which should the nurse use when administering a subcutaneous injection?
B. 25-gauge needle
Which abbreviation indicates that the primary health
care provider wants a medication administered before meals? -D. ac
A nurse plans to administer a bolus dose of a medication via a currently running
intravenous infusion. Which should the nurse do first?
B. Ensure that it is compatible with the IV solution being infused.
A nurse is administering an intradermal injection. At which angle should the
nurse insert the needle?
D. 15-degree angle
A nurse plans to administer a 3
mL intramuscular injection. Which muscle is the least desirable to use for the
administration of this medication? -A. Deltoid
ANSWERS/ A+ GRADE
Which statement is related to the concept that is central to the nursing process?
A. It is dynamic rather than static.
Which action reflects the assessment step of the nursing process?
C. Examining a patient for injury after a patient falls in the bathroom.
Which information supports the appropriateness of a nursing diagnosis?
A. Defining characteristics
Which most directly influences the planning step of the nursing process?
A. Related factors
A nurse collects information about a patient. What should the nurse do next? -D.
Determine significance of the data.
When two nursing diagnoses appear closely related, which should the nurse
do first to determine which diagnosis most accurately reflects the needs of the
patient?
D. Review the defining characteristics.
Which human responses identified by the nurse are examples of objective data?
Select all that apply
A. Irregular radial pulse of 50 beats per minute B. Wheezing on expiration. C.
Temperature of 99°F
The nurse assesses a patient and collects a variety of data. Identify the human
responses that are subjective data. Select all that apply
A. Nausea C. Dizziness
A nurse is caring for a patient who is blind in the left eye and visually impaired in
the right eye. Which actions should the nurse employ to promote communication
with this patient?
D. Knock on the door and request permission to enter before approaching the patient.
Which nursing actions should the nurse implement when speaking with an older
adult whose hearing is impaired? Select all that apply
A. Limit background noise. C. Lower the pitch of your voice. D. Stand directly in front of
the patient when speaking.
A risk manager is conducting a retrospective audit of a patient's clinical record to
identify the use of unacceptable abbreviations. Which abbreviations did the risk
manager identify that are on The Joint Commission's official Do Not Use List?
Select all that apply
A. U D. MS E. QOD
A nurse is teaching an older adult how to perform a dressing change. Which
nursing action is most important to address a developmental stress of older
adults?
D. Allow more time for the patient to process information.
A culturally competent nurse is planning to teach a patient about a new regimen
of self
, care. Which must the nurse assess first about the patient before implementing the
teaching plan? -D. Health beliefs
Which condition places a patient at the greatest risk for developing an infection?
B. Burns over more than 20% of the body.
A patient has a wound that is healing by secondary intention. Which solution to
cleanse the wound and dressing should the nurse expect will be ordered to
support wound healing?
B. Normal saline and a wet-to-damp dressing.
A patient's stool specimen is positive for Clostridium difficile. Which isolation
precautions should the nurse institute for this patient?
B. Contact
Which should the nurse do to interrupt the transmission link in the chain of
infection?
A. Wash the hands before providing care to a patient.
A nurse is caring for patients with a variety of wounds. Which wounds will likely heal by
primary intention? Select all that apply -A. Cut in the skin from a kitchen knife. D.
Surgical incision
Which type of isolation precaution is a N95 respirator mask designed to protect
the nurse?
B. Airborne
Which nursing actions protect patients from infection at the portal of entry
portion of the chain of infection? Select all that apply
A. Positioning an indwelling urine collection bag below the level of the patient's pelvis.
B. Using sterile technique when administering an intramuscular injection. F. Maintaining
a dressing over a surgical incision.
A nurse is preparing to reconstitute a medication in a multiple
dose vial. Which is the most essential step in the preparation of this medication? -A.
Instilling an accurate amount of diluent into the vial.
Which information about a parenteral medication indicates that the nurse should
use a filtered needle when preparing the medication?
B. Is supplied in an ampule.
Which should the nurse use when administering a subcutaneous injection?
B. 25-gauge needle
Which abbreviation indicates that the primary health
care provider wants a medication administered before meals? -D. ac
A nurse plans to administer a bolus dose of a medication via a currently running
intravenous infusion. Which should the nurse do first?
B. Ensure that it is compatible with the IV solution being infused.
A nurse is administering an intradermal injection. At which angle should the
nurse insert the needle?
D. 15-degree angle
A nurse plans to administer a 3
mL intramuscular injection. Which muscle is the least desirable to use for the
administration of this medication? -A. Deltoid
