PN FUNDAMENTALS ONLINE PRACTISE TEST A 2023 / QUESTIONS AND VERIFIED ANSWERS

A nurse is caring for a client who is receiving continuous NG tube feedings.The nurse listens to the client's bowel sounds.Which of the following actionsshould the nurse take? (Click on the audio button to listen to the clip.): Decrease the rate of the feeding - Rationality:The nurse should expect to hear bowel sounds every 5 to 35 seconds.This audio clip indicates hypermotility because there are greater than 40 bowel sounds/min.Hypermotility leadsto diarrhea and is an indication of intolerance to theenteral feeding.Therefore, the nurse should slow the rate of the feeding to promotethe client's tolerance of the feeding. The nurse should maintain a client who is receiving continuous NG tube feedings ina position with the head of the bed elevated 30° to 45° to prevent aspiration of the formula. 2. A nurse is preparing to administer oxygen to a client who has heart failureand is having severe difficulty breathing.Which of the following oxygen deliv-ery equipment should the nurse select to provide the highest concentration of oxygen to the client?: Nonrebreather mask Rationality: A nonrebreather mask provides the highest percentage of oxygen concentrationwithout intubation and mechanical ventilation. AVenturi mask can be adjusted to provide a consistent lower oxygen concentration. A simple face mask can be adjusted forshort-term delivery oflow to medium oxygenconcentration. A nasal cannula provides a low oxygen concentration. 3. A charge nurse smells smoke, enters the visitor restroom, and sees flamesin the trash can. What is the sequence of actions that the nurse should take?(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.): Evacuate clients from the area is the first step. Rationality:The first action the nurse should take when using the RACE protocol isto "rescue" or evacuate the clients from the area to prevent harm. Pull the lever on the fire alarm box is the second step. 3 / 22 Rationality: For the next step, "alarm," the nurse should activate the facility fire alarm and call to report the fire to the facility emergency extension. Close the fire doors on the unit is the third step. Rationality: Close the fire doors on the unit is the third step. For the third step, "confine," the nurse should close the unit fire doorsto prevent the fire fromspreading. Use a fire extinguisher to put out the fire is the fourth step. Rationality: For the final step, "extinguish," the nurse should use a fire extinguisher to put out the fire by aiming the nozzle at the base of the fire and using a sweepingmotion. 4. A nurse is caring for a client who has metastatic cancer and practices Catholicism. The client asks the nurse to discuss the afterlife with them. Which of the following statements by the nurse assists in meeting the client's spiritual needs?: "Tell me what the afterlife means to you." Rationale: This statement respects the client's spiritual needs by using open-endedtherapeutic communication to assist the client to talk about their concerns. 5. A nurse is reinforcing teaching with a client about the prevention of stress injuries. Which of the following instructions should the nurse include?: "Whenlifting a heavy object, keep it close to your body." Rationality: The nurse should instruct the client to keep the object as close to their body as possible to increase stability and decrease back strain when lifting a heavyobject. 6. A nurse is reinforcing teaching with a client about the use of crutches. Which of the following actions by the client indicates an understanding of theteaching?: The client advances the unaffected leg first while climbing stairs. Rationality:When ascending stairs, the client should first advance the unaffectedleg. The nurse should reinforce with the client that their axilla should not bear any weightwhile in the tripod position because this can cause pressure injury formation. The client should bear their weight with their arms and hands. 7. A client who has advanced cancer tells the nurse that they have a difficult time talking to anyone about the illness.Which of the following actionsshould 4 / 22 the nurse take to encourage therapeutic communication?: Let the client knowthat, as their nurse, they are available and willing to listen. - Rationality: Active listening conveys the nurse's respect and acceptance for theclient's feelings and gives the client an opportunity to express their thoughts andneeds. 8. A nurse is preparing to remove a client's peripheral IV catheter. After performing hand hygiene and applying clean gloves, which of the followingactions should the nurse take first?: Clamp the infusion tubing. Rationality: Evidence-based practice indicates that the nurse should first clamp the infusion tubing after applying clean gloves. This action stops the flow of the IV fluidand prevents it from leaking out during the IV removal. 9. A nurse is contributing to the plan of care for a client who has a positive throat culture for streptococci. Which of the following interventions should the nurse recommend to be included in the plan of care?: Ensure that the client wears a surgical mask during transportation throughout the facility. rationality: Streptococcal pharyngitis requires droplet precautions. The nurse should instruct the client to wear a surgical mask when outside of the room to prevent the spreadof infection. Staff should make every attempt to limit the client's movement outsideof the room. The nurse should provide a room with negative-pressure airflow for clients whorequire airborne precautions. 10. A nurse is caring for a client who has just died and practiced the Islamic faith.Which of the following cultural practices should the nurse expect?: Theclient's face should be turned toward Mecca. Rationality: Following death, it can be a practice of the Islamic faith to turn the face of a deceasedperson toward Mecca. It can be a Hispanic and Latino cultural practice to adorn the body of a deceasedperson with amulets or rosary beads. It can be a Chinese cultural practice for the oldest child to bathe the body of a 5 / 22 deceased person under the direction of an older relative or priest. It can be a practice of the Hindu faith to place the body of a deceased person on thefloor. 11. A nurse is preparing to transfer a client from an acute care facility to a long-term care facility.Which of the following information should the nurseplan to include in the transfer report?: Resolved health conditions rationality:The nurse should report both unresolved and resolved health conditionsto promote continuity of care. The nurse should report ongoing interventions, rather than completed interventions. 12. A nurse is contributing to the plan of care for a client who has a pre- scription for elastic bandages to the lower extremities.Which of the followingactionsshould the nurse recommend for the plan of care?: Compare the client'spedal pulses bilaterally every 4 hr. Rationality: The nurse should compare the pedal pulses bilaterally every 4 hr to check for adequate circulation for a client who has elastic bandages on their lowerextremities. The nurse should remove the elastic bandages daily to inspect for skin breakdown. The nurse should check capillary refill distally every 4