This is a 30 point Pre-Board Exam Drill on Fundamentals of Nursing SET C.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. When a client responds to a crisis situation or an acute injury, the sympathetic nervous system will respond in which of the following ways?
a. it will increase blood flow to the abdominal organs
b. it will decrease blood flow to the vital organs
c. it will stimulate the adrenals to release epinephrine
2. During the clonic phase of a generalized seizure, you may expect to see:
a. pupil dilatation, tachycardia and muscle spasms
b. bladder incontinence, elevated blood pressure and diaphoresis
c. loss of consciousness, cessation of breathing and cyanosis
d. contracted throat muscles, hyperventilation and salivation
3. The physician orders ice for the scrotum of a client diagnosed with epididymitis. The nurse correctly assumes that:
a. ice slows circulation and decreases peripheral edema
b. ice should be applied in intervals, not continuously
c. ice is placed on the scrotum continuously until the physician orders otherwise
d. ice will not stop the pain, and it has a placebo effect
4. The best time for menstruating women to perform a breast self-examination is:
a. right before the menstrual period
b. during the menstrual period
c. a few days after the menstrual period
d. 14 days after the menstrual period
5. Which of the following procedures is most effective for preventing hemolytic blood transfusion reactions?
a. administer the blood through 5% dextrose in water (D5W)
b. administration of a steroid prior to the transfusion
c. careful identification of the client and the blood product
d. using a leukocyte-poor filter during the transfusion
6. A superficial partial-thickness burn should heal in:
a. one week c. six weeks
b. three weeks d. two months
Answer A: Healing of superficial partial-thickness burns usually occurs within a week.
7. The setting that is most suitable for the treatment of a client with a full thickness burn is:
a. admission to a burn unit
b. admission to a medical unit
c. treatment in an emergency room or ambulatory care setting
d. home health care
Answer A: Full-thickness burns usually require hospitalization in a burn unit with comprehensive care by a burn team. The age of a client and the body area involved determine the need for emergency attention.
8. A full thickness burn would appear:
a. red, as if client were sunburned
b. bright red and weeping fluid
c. mottled without weeping fluid
d. brown and leather-like
9. In a patient with full thickness burn of the face, the nurse must immediately address:
a. airway management and hypovolemic shock
b. moderate discomfort and minor fluid loss
c. pain management with intravenous morphine
d. wound care
10. A full thickness burn of the face should heal in:
a. one week c. six weeks
b. three weeks d. months
11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing
12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place
13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream
14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication
15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy
b. communication
c. empathy
d. encouragement
16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain
17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application
18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body
19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form
20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.
21. The primary purpose of client education is to:
a. collect client data
b. determine readiness to learn
c. assess degree of compliance
d. increase client’s knowledge that will affect health status
22. Your initial instruction to a client on the use of crutches to move upstairs should be to:
a. start with crutches and the unaffected leg on the same level
b. start with crutches and the affected leg on the same level
c. place crutches on the step after the affected leg is moved up the stair
d. place crutches on the stair and then move the affected leg to the stair
23. When a client experiences a severe anaphylactic reaction to a medication, your initial action is to:
a. start an IV
b. assess vital signs
c. place the client in a supine position
d. prepare equipment for intubation
24. If a blood transfusion reaction occurs, the first intervention is to:
a. place the client in high-fowler’s position
b. call the physician
c. slow the rate of transfusion to “keep open” rate
d. shut off the transfusion
25. The correct action for instilling eye drops is to instill the drops:
a. at the outer canthus of the eye
b. over the conjunctiva
c. directly on the cornea
d. into the center of conjunctival sac
26. Assessing a client for hypovolemic shock, the sign that you would expect to note if this complication occurs is:
a. hypertension
b. cyanosis
c. oliguria
d. tachypnea
27. When evaluating the client’s understanding of a low potassium diet, you will know he understands if he tells you that he will avoid:
a. pasta
b. raw apples
c. dry cereal
d. french bread
28. Irrigating a nasogastric tube should be carried out using which one of the following protocols?
a. gently instill 20 cc normal saline and then withdraw solution
b. instill 30 cc sterile water and then withdraw solution
c. instill 30 cc sterile saline, forcefully if necessary, and allow fluid to flow into basin for return
d. gently instill 20 cc sterile water and then allow fluid to flow into basin for return
29. The morning of the second postoperative day, a female patient is to be ambulated. Your first intervention is to:
a. get her up in a chair
b. use a walker when getting her up
c. have her put minimal weight on the affected side
d. practice getting her out of bed by slightly flexing her lips
30. You are assigned a client who has just had a nasogastric tube inserted postoperatively. During your evaluation of his status, you will check for:
a. electrolyte imbalance
b. gastric distention
c. ulcerative colitis
d. infection
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