Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A nurse is caring for a patient who has been on prolonged bedrest and is now experiencing shortening and
tightening of the muscles due to disuse. The nurse identifies this condition as
1. Footdrop.
2. Contractures.
3. Osteoporosis.
4. Thromboembolism.
2. When proper flexion of the ankle is lost and permanent plantar flexion of the foot develops, the condition is
known as
1. Footdrop.
2. Contractures.
3. Osteoporosis.
4. Thromboembolism.
3. A nurse recognizes that a condition that occurs because of a loss of bone minerals, which leads to an increased
risk for skeletal fractures, is known as
1. Footdrop.
2. Contractures.
3. Osteoporosis.
4. Thromboembolism.
4. When caring for a patient who is confined to bed, a nurse recognizes that the patient is at increased risk for
the formation of a blood clot, which is known as
1. Footdrop.
2. Contractures.
3. Osteoporosis.
4. Thromboembolism.
5. A nurse educates a patient about how to avoid developing osteoporosis. The nurse recognizes that additional
teaching is needed when the patient states:
1. “I will consume dairy products.”
2. “I will remain in bed when I have a cold.”
3. “I will exercise several times a week.”
4. “I will take a daily calcium supplement.”
6. A nurse recognizes that the most preventable cause of death during hospitalization is
1. An embolism.
2. Hospital-acquired pneumonia.
3. Skin breakdown because of not turning patients.
4. A urinary tract infection leading to urosepsis.
7. While a nurse assists a patient from a lying position to a sitting position, the patient suddenly becomes
dizzy, pale, clammy, and nauseated. The nurse recognizes these symptoms are most likely related to
1. Thromboembolism.
2. Orthostatic hypotension.
3. Orthostatic hypertension.
4. Symptomatic bradycardia.
, 8. A nurse educator teaches a student nurse that prevention of venous thrombosis includes
1. Limiting movement of the extremities.
2. Applying bilateral ankle restraints.
3. Performing passive range-of-motion exercises.
4. Discouraging the patient from wearing sequential compression devices.
9. A nursing instructor is educating a student nurse about methods to prevent orthostatic hypotension.
The nursing instructor recognizes that further teaching is needed when the student states:
1. “I will encourage the patient to remain flat in bed.”
2. “I will change the patient’s position in bed frequently.”
3. “I will encourage dorsal and plantar flexion of the feet.”
4. “I will perform passive range-of-motion exercises if the patient can’t move.”
10. A nurse encourages a patient to take full, deep breaths to keep the alveoli open. The nurse teaches the patient
that this is done to prevent
1. Shearing.
2. Peristalsis.
3. Atelectasis.
4. Deep vein thrombosis (DVT).
11. A nurse knows that the major effect of immobility on the gastrointestinal system is the lack of
natural movement of the intestines, which is known as
1. Shearing.
2. Peristalsis.
3. Atelectasis.
4. Deep vein thrombosis (DVT).
12. A nurse knows that when skin slides over another surface in the opposite direction, it can cause abrasions and
open skin areas, which is known as
1. Shearing.
2. Peristalsis.
3. Atelectasis.
4. Deep vein thrombosis (DVT).
13. While supervising a student nurse who is caring for a patient on bedrest, a nurse intervenes when observing
the student
1. Using mild soaps for cleansing the skin.
2. Repositioning in bed at 2-hour intervals.
3. Offering the patient high-protein snacks.
4. Massaging directly on reddened bony prominences.
14. While supervising a certified nursing student who is positioning a patient in bed, a nurse intervenes when
observing the student
1. Locking the wheels on the bed.
2. Elevating the bed to a comfortable working height.
3. Changing a patient’s position at least every 2 hours.
4. Allowing a patient’s arm to dangle over the side of the bed.
15. When educating a student nurse about how to correctly logroll a patient, a nursing instructor recognizes that
additional teaching is necessary when the student nurse states:
1. “I will count to three before the move occurs.”
2. “I will ask two people to help me logroll a patient.”
, 3. “I will stand at the patient’s feet and control the turn.”
4. “I will ensure that staff members turn the patient as one unit.”
16. While caring for a patient who has a spinal cord injury, a nurse obtains assistance to logroll the patient. The
nurse intervenes when observing the assistant prepare for the logroll by standing at the patient’s
1. Feet.
2. Head.
3. Waist.
4. Thighs.
17. While supervising a student who is manually transferring a patient from a bed to a chair, a nurse intervenes
when the student transfers the patient while
1. Twisting at the torso.
2. Standing close to the patient.
3. Using proper body mechanics.
4. Maintaining a wide base of support.
18. A nurse delegates the task of assisting patients with ambulation to a student nurse. The nurse intervenes when
observing the student
1. Instructing the patient to move from supine to standing positions in stages.
2. Assisting the patient to a dangling position with his or her feet firmly on the floor.
3. Holding the transfer belt loosely near the patient’s body while ambulating.
4. Raising the head of the bed and assisting the patient with sitting on the side of the bed.
19. A patient begins to fall during ambulation. The nurse should
1. Hold the patient upright.
2. Keep his or her back bent while lowering the patient.
3. Keep his or her knees straight while lowering the patient.
4. Allow the patient to slide down his or her leg to the floor.
20. While lying in bed, a patient has a blood pressure of 142/86 mm Hg and a heart rate of 76 beats/min. When
anurse helps the patient to sit up and dangle at the side of the bed, the patient becomes dizzy. The nurse
rechecks the patient’s vital signs and finds that the patient’s blood pressure is now 112/54 mm Hg, and the
patient’s heart rate is now 98 beats/min. The next action to take would be to
1. Recheck the patient’s vital signs.
2. Assist the patient to a Fowler position.
3. Assist the patient to a standing position.
4. Assist the patient to a lithotomy position.
21. A nurse is preparing a patient for an enema. The correct body position for this type of procedure would be
1. Dorsal recumbent.
2. Semi-Fowler.
3. Lithotomy.
4. Left Sims.
22. A nurse needs to position a patient in severe respiratory distress in a manner that allows the chest to expand to
maximum capacity for moving air in and out of the lungs. The correct body position for this patient would be
1. Right Sims.
2. Orthopneic.
3. Trendelenburg.
4. Supine.
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