UNIT 1 FOUNDATIONS OF NURSING PRACTICE STUDY
QUESTIONS WITH CORRECT VERIFIED ANSWERS 100%
GUARANTEED PASS | RATED A+
While instructing a male client's wife in the performance of passive range-of-motion exercises to
his contracted shoulder, the nurse observes that she is holding his arm above and below the
elbow. What nursing action should the nurse implement?
A. Acknowledge that she is supporting the arm correctly.
B. Encourage her to keep the joint covered to maintain warmth.
C. Reinforce the need to grip directly under the joint for better support.
D. Instruct her to grip directly over the joint for better motion. - Answer>>> The wife is
performing the passive ROM correctly, therefore the nurse should acknowledge this fact (A).
The joint that is being exercised should be uncovered (B) while the rest of the body should
remain covered for warmth and privacy. (C and D) do not provide adequate support to the joint
while still allowing for joint movement.
Correct Answer: A
While undergoing a soapsuds enema, the client reports abdominal cramping. What action should
the nurse take?
1 Immediately stop the infusion.
2 Lower the height of the enema bag.
3 Advance the enema tubing 2 to 3 inches.
4 Clamp the tube for 2 minutes, then restart the infusion. - Answer>>> 2
Abdominal cramping during a soapsuds enema may be due to too rapid administration of the
enema solution. Lowering the height of the enema bag slows the flow and allows the bowel time
to adapt to the distention without causing excessive discomfort. Stopping the infusion is not
,necessary. Advancing the enema tubing is not appropriate. Clamping the tube for several minutes
then restarting the infusion may be attempted if slowing the infusion does not relieve the cramps.
Examination of a client complaining of itching on his right arm reveals a rash made up of
multiple flat areas of redness ranging from pinpoint to 0.5 cm in diameter. How should the nurse
record this finding?
A) Multiple vesicular areas surrounded by redness, ranging in size from 1 mm to 0.5 cm.
B) Localized red rash comprised of flat areas, pinpoint to 0.5 cm in diameter.
C) Several areas of red, papular lesions from pinpoint to 0.5 cm in size.
D) Localized petechial areas, ranging in size from pinpoint to 0.5 cm in diameter. - Answer>>>
B) Localized red rash comprised of flat areas, pinpoint to 0.5 cm in diameter
Macules are localized flat skin discolorations less than 1 cm in diameter. However, when
recording such a finding the nurse should describe the appearance (B) rather than simply naming
the condition. (A) identifies vesicles -- fluid filled blisters -- an incorrect description given the
symptoms listed. (C) identifies papules -- solid elevated lesions, again not correctly identifying
the symptoms. (D) identifies petechiae -- pinpoint red to purple skin discolorations that do not
itch, again an incorrect identification
A client who is in hospice care complains of increasing amounts of pain. The healthcare provider
prescribes an analgesic every four hours as needed. Which action should the nurse implement?
A. Give an around-the-clock schedule for administration of analgesics.
B. Administer analgesic medication as needed when the pain is severe.
C. Provide medication to keep the client sedated and unaware of stimuli.
D. Offer a medication-free period so that the client can do daily activities. - Answer>>> The
most effective management of pain is achieved using an around-the-clock schedule that provides
analgesic medications on a regular basis (A) and in a timely manner. Analgesics are less
,effective if pain persists until it is severe, so an analgesic medication should be administered
before the client's pain peaks (B). Providing comfort is a priority for the client who is dying, but
sedation that impairs the client's ability to interact and experience the time before life ends
should be minimized (C). Offering a medication-free period allows the serum drug level to fall,
which is not an effective method to manage chronic pain (D).
Correct Answer: A
A client who is 5' 5" tall and weighs 200 pounds is scheduled for surgery the next day. What
question is most important for the nurse to include during the preoperative assessment?
A) What is your daily calorie consumption?
B) What vitamin and mineral supplements do you take?
C) Do you feel that you are overweight?
D) Will a clear liquid diet be okay after surgery? - Answer>>> A) What is your daily calorie
consumption?
Vitamin and mineral supplements (B) may impact medications used during the operative period.
(A and C) are appropriate questions for long-term dietary counseling. The nature of the surgery
and anesthesia will determine the need for a clear liquid diet (D), rather than the client's
preference
An elderly male client who suffered a cerebral vascular accident is receiving tube feedings via a
gastrostomy tube. The nurse knows that the best position for this client during administration of
the feedings is
A. prone.
B. Fowler's.
C. Sims'.
, D. supine. - Answer>>> The client should be positioned in a semi-sitting or Fowler's (B)
position during feeding, in order to decrease the chance of aspiration. A gastrostomy tube, often
referred to as a PEG tube, is inserted directly into the stomach through an incision in the
abdomen and is used when long-term tube feedings are needed. In (A and/or C) positions, the
client would be lying on his abdomen and on the tubing. In (D), the client would be lying flat on
his back which would increase the chance of aspiration.
Correct Answer: B
The nurse notices that the mother a 9-year-old Vietnamese child always looks at the floor when
she talks to the nurse. What action should the nurse take?
A. Talk directly to the child instead of the mother.
B. Continue asking the mother questions about the child.
C. Ask another nurse to interview the mother now.
D. Tell the mother politely to look at you when answering. - Answer>>> Eye contact is a
culturally-influenced form of non-verbal communication. In some non-Western cultures, such as
the Vietnamese culture, a client or family member may avoid eye contact as a form of respect, so
the nurse should continue to ask the mother questions about the child (B). (A, C, and D) are not
indicated.
Correct Answer: B
When conducting an admission assessment, the nurse should ask the client about the use of
complimentary healing practices. Which statement is accurate regarding the use of these
practices?
A. Complimentary healing practices interfere with the efficacy of the medical model of
treatment.
B. Conventional medications are likely to interact with folk remedies and cause adverse effects.
C. Many complimentary healing practices can be used in conjunction with conventional
practices.