NUR 211 EXAM 2 REVIEW QUESTIONS WITH COMPLETE
SOLUTIONS
1) The nurse is performing a fall risk assessment on a newly admitted patient. Which
finding is a known risk factor for falls?
a) medications
b) urinary incontinence
c) multiple comorbidities
d) malnutrition -- Correct Answer ✔✔ b
2) A patient is ordered to have a urine culture to rule out methicillin-resistant
Staphylococcus aureus (MRSA). When obtaining this specimen, which personal
protective equipment (PPE) should the nurse don?
a) gloves, mask, eye shield
b) gloves, gown, shoe covers
c) gloves, mask, hat
d) gloves, gown, eye shield -- Correct Answer ✔✔ d
3) An elderly client residing in the community with cardiopulmonary compromise and
impaired ability to perform activities of daily living (ADLs) presents safety concerns
to the nurse. Which is the greatest concern?
a) ability to obtain and take medications correctly
b) ability to safely get on and off a toilet
c) ability to safely procure food and prepare meals
d) ability to safely eat without choking -- Correct Answer ✔✔ b
4) What other health care professional should the nurse consult when a patient has
difficulty with ADLs and why?
a) occupational therapist to evaluate the ability to perform ADLs
b) physical therapist to evaluate the patient's need for assistive devices
c) social worker to arrange for needed assistive devices
, d) area agency on aging to arrange for Meals on Wheels -- Correct Answer ✔✔
a
5) A 56 YO man who has been staying at a cabin while hunting arrives at the emergency
department with complaints of dizziness, light-headedness, and nausea. What does
the nurse initially suspect?
a) carbon monoxide poisoning
b) lead poisoning
c) radon exposure
d) food poisoning -- Correct Answer ✔✔ a
6) Which activity would be most for the registered nurse (RN) to delegate to
unlicensed assistive personnel (UAP)?
a) assessing the patient for fall risk and complications of restraint use
b) evaluating the patient's ability to perform ADLs
c) Assisting with or performing the patient's ADL
d) Teaching the patient use of assistive devices -- Correct Answer ✔✔ c
7) When working with radiation diagnostics or treatments, which preventive measure
should be followed to avoid exposure? (select all that apply)
a) using lead shielding of patients and staff
b) keeping staff at the farthest distance possible from the radiation source
c) limiting the length of exposure
d) wearing a badge to monitor the length of exposure
e) following procedures and safety checks -- Correct Answer ✔✔ All of the
above
8) An uncooperative 70 YO male with right-sided paralysis from a recent
cerebrovascular event (CVA) has to be transferred from the bed to a wheelchair.
Which action indicates the best method to transfer this patient?
a) a two-person lift is performed, with one person on each side of the patient.
b) the patient is steadied under the arms and pivoted on his left leg
c) a full-body sling lift is used with the help of unlicensed assistive personel
(UAP)
d) a stand assist lift is used with the help of another nurse -- Correct Answer
✔✔ c
, According to safe patient handling algorithms, a full-body sling with the assistance
of the nurse and UAP is indicated because the patient is uncooperative and able
to bear only partial weight. Lifting a patient manually has the potential to injure
the patient and the care providers. The stand and pivot technique is not indicated
because the patient is uncooperative. The stand assist lift is not indicated because
the patient is uncooperative.
9) What bony prominences are greatest risk for skin breakdown on a patient who is
restricted to bed rest and placed in the side-lying position? (select all that apply)
a) sternum
b) ear
c) elbows
d) hips
e) coccyx -- Correct Answer ✔✔ b, c, d
The patient's ears, elbows, and hips are in contact with the bed surface in the
side-lying position. Breakdown on the sternum would be a potential risk if the
patient were in prone position. The coccyx experiences the most pressure when
a patient is sitting or in the supine position.
10) Which area of the central nervous system has most likely sustained damage if a
patient exhibits a lack of coordination and an unsteady gait after a traumatic head
injury?
a) medulla oblongata
b) articular disk
c) brainstem
d) cerebellum -- Correct Answer ✔✔ d
Injury to the cerebellum directly affects a patient's ability to ambulate and control
movement. The medulla oblongata regulates heart rate, breathing, blood
pressure, and reflexive actions such as vomiting. The articular disk is fibrous
connective tissue in the temporomandibular joint, which facilitates jaw
movement. The brainstem connects the spinal cord to the hemispheres of the
brain.
SOLUTIONS
1) The nurse is performing a fall risk assessment on a newly admitted patient. Which
finding is a known risk factor for falls?
a) medications
b) urinary incontinence
c) multiple comorbidities
d) malnutrition -- Correct Answer ✔✔ b
2) A patient is ordered to have a urine culture to rule out methicillin-resistant
Staphylococcus aureus (MRSA). When obtaining this specimen, which personal
protective equipment (PPE) should the nurse don?
a) gloves, mask, eye shield
b) gloves, gown, shoe covers
c) gloves, mask, hat
d) gloves, gown, eye shield -- Correct Answer ✔✔ d
3) An elderly client residing in the community with cardiopulmonary compromise and
impaired ability to perform activities of daily living (ADLs) presents safety concerns
to the nurse. Which is the greatest concern?
a) ability to obtain and take medications correctly
b) ability to safely get on and off a toilet
c) ability to safely procure food and prepare meals
d) ability to safely eat without choking -- Correct Answer ✔✔ b
4) What other health care professional should the nurse consult when a patient has
difficulty with ADLs and why?
a) occupational therapist to evaluate the ability to perform ADLs
b) physical therapist to evaluate the patient's need for assistive devices
c) social worker to arrange for needed assistive devices
, d) area agency on aging to arrange for Meals on Wheels -- Correct Answer ✔✔
a
5) A 56 YO man who has been staying at a cabin while hunting arrives at the emergency
department with complaints of dizziness, light-headedness, and nausea. What does
the nurse initially suspect?
a) carbon monoxide poisoning
b) lead poisoning
c) radon exposure
d) food poisoning -- Correct Answer ✔✔ a
6) Which activity would be most for the registered nurse (RN) to delegate to
unlicensed assistive personnel (UAP)?
a) assessing the patient for fall risk and complications of restraint use
b) evaluating the patient's ability to perform ADLs
c) Assisting with or performing the patient's ADL
d) Teaching the patient use of assistive devices -- Correct Answer ✔✔ c
7) When working with radiation diagnostics or treatments, which preventive measure
should be followed to avoid exposure? (select all that apply)
a) using lead shielding of patients and staff
b) keeping staff at the farthest distance possible from the radiation source
c) limiting the length of exposure
d) wearing a badge to monitor the length of exposure
e) following procedures and safety checks -- Correct Answer ✔✔ All of the
above
8) An uncooperative 70 YO male with right-sided paralysis from a recent
cerebrovascular event (CVA) has to be transferred from the bed to a wheelchair.
Which action indicates the best method to transfer this patient?
a) a two-person lift is performed, with one person on each side of the patient.
b) the patient is steadied under the arms and pivoted on his left leg
c) a full-body sling lift is used with the help of unlicensed assistive personel
(UAP)
d) a stand assist lift is used with the help of another nurse -- Correct Answer
✔✔ c
, According to safe patient handling algorithms, a full-body sling with the assistance
of the nurse and UAP is indicated because the patient is uncooperative and able
to bear only partial weight. Lifting a patient manually has the potential to injure
the patient and the care providers. The stand and pivot technique is not indicated
because the patient is uncooperative. The stand assist lift is not indicated because
the patient is uncooperative.
9) What bony prominences are greatest risk for skin breakdown on a patient who is
restricted to bed rest and placed in the side-lying position? (select all that apply)
a) sternum
b) ear
c) elbows
d) hips
e) coccyx -- Correct Answer ✔✔ b, c, d
The patient's ears, elbows, and hips are in contact with the bed surface in the
side-lying position. Breakdown on the sternum would be a potential risk if the
patient were in prone position. The coccyx experiences the most pressure when
a patient is sitting or in the supine position.
10) Which area of the central nervous system has most likely sustained damage if a
patient exhibits a lack of coordination and an unsteady gait after a traumatic head
injury?
a) medulla oblongata
b) articular disk
c) brainstem
d) cerebellum -- Correct Answer ✔✔ d
Injury to the cerebellum directly affects a patient's ability to ambulate and control
movement. The medulla oblongata regulates heart rate, breathing, blood
pressure, and reflexive actions such as vomiting. The articular disk is fibrous
connective tissue in the temporomandibular joint, which facilitates jaw
movement. The brainstem connects the spinal cord to the hemispheres of the
brain.
