FUNDAMENTALS OF NURSING SKILLS AND CONCEPTS
,Table of Contents
Chapter 1: Nursing Foundations............................ 3
Chapter 2: Nursing Process..................................15
Chapter 3: Laws and Ethics ..................................28
Chapter 4: Health and Illness...............................47
Chapter 5: Homeostasis, Adaptation, and Stress
. ........................................................................ 62
Chapter 6: Culture and Ethnicity .........................82
Chapter 7: The Nurse–Client Relationship ..........98
Chapter 8: Client Teaching .................................114
Chapter 9: Recording and Reporting .................134
Chapter 10: Asepsis ...........................................153
Chapter 11: Admission, Discharge, Transfer, and
Referrals ............................................................170
Chapter 12: Vital Signs .......................................187
Chapter 13: Physical Assessment............................................................................................ 204
Chapter 14: Special Examinations and Tests .......................................................................... 221
Chapter 15: Nutrition ............................................................................................................. 239
Chapter 16: Fluid and Chemical Balance ................................................................................ 257
Chapter 17: Hygiene ............................................................................................................... 275
Chapter 18: Comfort, Rest, and Sleep .................................................................................... 293
Chapter 19: Safety .................................................................................................................. 310
Chapter 20: Pain Management ............................................................................................... 332
Chapter 21: Oxygenation........................................................................................................ 349
Chapter 22: Infection Control ................................................................................................. 370
,Chapter 23: Body Mechanics, Posi oning, and Moving ......................................................... 390
Chapter 24: Fitness and Therapeu c Exercise ........................................................................ 411
Chapter 25: Mechanical Immobiliza on ................................................................................. 432
Chapter 26: Ambulatory Aids.................................................................................................. 453
Chapter 27: Periopera ve Care............................................................................................... 471
Chapter 28: Wound Care ........................................................................................................ 493
Chapter 29: Gastrointes nal Intuba on ................................................................................. 510
Chapter 30: Urinary Elimina on ............................................................................................. 527
Chapter 31: Bowel Elimina on ............................................................................................... 545
Chapter 32: Oral Medica ons................................................................................................. 563
Chapter 33: Topical and Inhalant Medica ons ....................................................................... 582
Chapter 34: Parenteral Medica ons ....................................................................................... 600
Chapter 35: Intravenous Medica ons .................................................................................... 620
Chapter 36: Airway Management ........................................................................................... 638
Chapter 37: Resuscita on ....................................................................................................... 656
Chapter 38: End-of-Life Care................................................................................................... 675
,Chapter 1: Nursing Foundations
1. A client reports to the emergency department with ankle pain due to a minor road
accident. By asking the client to describe the accident, which type of nursing skill is the nurse
using?
A. assessment skills
B. comforting skills
C. counseling skills
D. caring skills
Answer: A
Rationale: By asking the client to describe the accident, the nurse is using
assessment skills to collect more information about the client's condition. The nurse
is interviewing the client to collect related data. The nurse is not using comforting
skills, as the nurse is not providing any emotional support. The counseling skills of
the nurse are also not used, as no health education is provided. Caring skills include
assistance provided with the activities of daily living, which is not applicable in
this scenario.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Understand
Client Needs: Safe, Effective Care Environment: Management of Care Integrated
Process: Nursing Process
Reference: p. 15
2. One of the nursing achievements in the Crimean War was that the death rate of soldiers
dropped from 60% to 1%. What is the most appropriate reason for the fall in the death rate?
A. increased motivation among the soldiers
B. decreased rate of infection and gangrene
C. increased funds courtesy of donations from families
D. college-based education and training of nurses
Answer: B
, Rationale: During the Crimean War, the death rate of British soldiers was 60%,
which dropped to 1% due to the nursing care provided. The nurses improved the
ventilation, nutritional, and sanitary conditions of the soldiers, leading to decreased
rates of infection and gangrene. As a result, the death rate dropped. The families and
the soldiers donated funds after the war, not during the war, through which an
organized education and training facility for nurses was started.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Remember
Client Needs: Safe, Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process
Reference: p. 3
3. A nurse at a health care facility provides information, assistance, and encouragement to
clients during the various phases of nursing care. In which activity does the nurse use counseling
skills?
A. educating a group of young girls about AIDS
B. telling a client to localize the pain in his abdomen
C. encouraging a client to walk without support
D. assisting a lactating mother in feeding her child
Answer: A
Rationale: The activity of educating a group of young girls about AIDS is based on
the nurse using counseling skills. Telling a client to localize his pain is an assessment
skill.
Encouraging a client to walk without support can be both a comforting skill and a
caring skill. Assisting a lactating mother in feeding her baby is an example of a
caring skill.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Understand
Client Needs Pn: Safe, Effective Care Environment: Coordinated Care Client Needs:
Safe, Effective Care Environment: Management of Care Client Needs: Health
Promotion and Maintenance
Client Needs Pn: Health Promotion and Maintenance Integrated Process:
Teaching/Learning
Reference: p. 15
,4. A nurse is conducting an interview of a 40-year-old client who is admitted with chest
pain. Which action by the nurse indicates active listening?
A. listening to the client silently
B. interrupting after each sentence
C. asking for clarifications and repetitions
D. talking about the nurse's own experience
Answer: C
Rationale: Active listening is an important component of counseling skills. It
encourages the client to open up and express their concerns. The nurse may ask the
client to repeat and clarify statements. Interrupting after every sentence may annoy
the client. When the nurse listens to the client silently, the client may feel that the
nurse is not interested. On the other hand, if the nurse talks about the nurse's own
experience, the focus of the session shifts to the nurse rather than to the client.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Apply Client Needs: Psychosocial Integrity Integrated Process: Caring Reference: p.
15
5. A student wants to attend a nursing program that prepares its graduates for both staff and
managerial positions. Which type of nursing program should the nurse suggest for this student?
A. hospital-based diploma
B. baccalaureate nursing program
C. associate degree program
D. continuing nursing program
Answer: B
Rationale: Baccalaureate-prepared nurses have the greatest potential for qualifying
for nursing positions at both staff and managerial levels. Hospital-based diploma
programs are 3- year courses and provide maximum exposure to clinical nursing.
Students
becoming nurses through the associate degree program would not be expected to
work in a management position. Continuing nursing programs are on-the-job
educational programs.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Remember
, Client Needs Pn: Safe, Effective Care Environment: Coordinated Care Client Needs:
Safe, Effective Care Environment: Management of Care Integrated Process:
Teaching/Learning
Reference: p. 11
6. A client is brought to the emergency department with a head injury following an all-
terrain vehicle (ATV) accident. The nurse asks the family members to describe how the accident
occurred. The nurse is implementing which type of skill?
A. assessment skills
B. caring skills
C. counseling skills
D. comforting skills
Answer: A
Rationale: The immediate requirement when a client is brought to the
emergency department with a head injury is to assess the injury and the system
affected, as well as a description of how the accident occurred. This requires
implementation of assessment skills. Subsequently, the nurse can implement caring
skills, counseling skills, and comforting skills; however, assessment should be the
priority.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Understand
Client Needs: Safe, Effective Care Environment: Management of Care Integrated
Process: Nursing Process
Reference: p. 15
7. Training schools for nurses were established in the United States after the Civil War.
The standards of U.S. schools deviated from those of the Nightingale paradigm. Which
statement is true about U.S. training schools?
A. Training schools were affiliated with a few select hospitals.
B. Training of nurses provided no financial advantages to the hospital.
C. Training was formal, based on nursing care.
D. Training schools eliminated the need to pay employees.
Answer: D
, Rationale: Training schools in the United States profited by eliminating the need
to pay employees because students worked without pay in return for training, which
usually consisted of chores. U.S. training schools were established by any hospital;
there was no formal training. Training was an outcome of work, which eliminated
the need to pay employees. Nightingale training schools were affiliated with a few
select hospitals, training
of nurses provided no financial advantages to the hospital, and the training was
formal, based on nursing care.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Remember
Client Needs Pn: Safe, Effective Care Environment: Coordinated Care Client Needs:
Safe, Effective Care Environment: Management of Care Integrated Process:
Teaching/Learning
Reference: p. 5
8. In a nursing unit, the RN delegates nursing tasks to the LPN. Keeping in mind the
delegation guidelines, which statement denotes the right task for the LPN?
A. Make beds with the help of unlicensed assistive personnel.
B. Assist clients with nasogastric tube feeds.
C. Take orders from an in-house physician.
D. Assess the client's needs and start an intravenous line.
Answer: B
Rationale: Assisting clients with nasogastric tube feeding is an appropriate task
for an LPN, as it does not require independent decisions and sophisticated techniques.
According to the delegation guidelines, "right task" means that the task should be
assigned according to the competency of the caregiver. LPNs may not be authorized
to make independent decisions, like starting an IV line, for the client. Bed making is
a very basic task and may not be appropriate for an LPN if the UAP is already
present. When the RN and LPN are present, the RN takes the physician's orders.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level: Apply
Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process:
Nursing Process
Reference: p. 8
,9. A 50-year-old client reports to a primary care unit with an open wound due to a fall in the
bathroom. Which nursing actions represent caring skills?
A. The nurse cleans the wound and applies a dressing to it.
B. The nurse inspects and examines the wound for swelling.
C. The nurse tells the client to take care while on slippery surfaces.
D. The nurse informs the client that the wound is small and will heal easily.
Answer: A
Rationale: The nursing action of cleaning the wound and applying a dressing
indicates caring skills. Caring skills involve nursing interventions that restore or
maintain a person's health.
The nurse implements assessment skills while inspecting and examining the wound.
The nurse counsels the client to take care when walking on slippery surfaces. By
informing the client about the wound's condition, the nurse uses comforting skills.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Understand
Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process:
Caring Reference: p. 15
10. The scope and character of nursing practice underwent significant changes in the years
following the Civil War. Which activity exemplifies nursing practice in the early years of the 20th
century?
A. providing basic health care to recent immigrants to the United States
B. contributing to the scientific knowledge base of nursing by conducting research
C. participating in collaborative practice with physicians
D. establishing school nursing as a recognized specialty in urban settings
Answer: A
Rationale: In the early 20th century, some nurses moved into communities and
established "settlement houses" where they lived and worked among poor
immigrants. This period of history was not characterized by collaboration between
physicians and
, nurses due to the subservient view of nursing that prevailed. Research and school
nursing were not major focuses at this time.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Understand
Client Needs: Safe, Effective Care Environment: Management of Care Integrated
Process: Teaching/Learning
Reference: p. 4
11. A nursing student has begun a clinical placement at a large hospital that serves a diverse
population. The student has consequently acquired a new appreciation for the fact that nursing
combines art with science. What is the clearest manifestation of the scientific basis for nursing?
A. mentoring students and junior nurses
B. providing evidence-based nursing care
C. maintaining an attitude of curiosity
D. participating in continuing educational activities
Answer: B
Rationale: By developing an accumulating body of unique scientific knowledge,
it is now possible to predict which nursing interventions are most likely to produce
desired outcomes, a process referred to as evidence-based practice (EBP). EBP is
possible because of the scientific basis that underlies nursing. Mentoring,
maintaining curiosity, and participating in continuing education are beneficial, but
these are not direct manifestations of the scientific basis for nursing.
Question format: Multiple Choice Chapter 1: Nursing Foundations Cognitive Level:
Understand
Client Needs: Safe, Effective Care Environment: Management of Care Integrated
Process: Teaching/Learning
Reference: p. 6
12. Beginning with Florence Nightingale, many definitions of nursing have been put forth
by individual nurses and by nursing organizations. Which statement best describes an aspect of
the changes in these definitions over time?
A. drawing a clear distinction between the art of nursing and science of nursing