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 N101 FUNDAMENTALS OF NURSINGFINAL EXAM12/10/07 NAME: _________________________________________________________ 
1.A nursing intervention that reduces a reservoir of infection for a patient is;a.covering the mouth and nose when sneezing and coughing, b.wearing disposable gloves,c.isolating the patient’s belongings,
d.
changing the patient’s soiled dressings.2.Which of the following patients will have an increased metabolic rate and require nutritionalinterventions?a.A healthy young adult who works in an office b.A retired person living in a temperate climatec.A person with a serious infection and fever d.An older, sedentary adult with painful joints3.The most effective way to prevent nosocomial infections is toa.isolate patients who have infections b.wash all contaminated equipment with detergentsc.cover the mouth and nose with tissues when coughing or sneezingd.practice conscientious handwashing4.
A patient comes to the emergency department with major burns over 40% of his body.Although all of the following are true, which one would provide the rationale for a nursingdiagnosis of Risk for Infection?
a.
stress may adversely affect normal defense mechanismsb. stress may adversely affect normal defense mechanismsc. intact skin and mucous membranes protect against microbial invasiond. age, race, sex, and hereditary factors influence susceptibility to infection
5. The nurse should include which of these procedures when implementing standard precautions?a Having visitors wear cap, mask and gown b Washing hands after removing glovesc Recapping needles before placing them in containersd Cleaning areas contaminated with body fluids with hydrogen peroxide6 Which of these patients is at highest risk for developing a fluid imbalance?a. a 2-month-old infant who has diarrhea b. a 15-year-old boy who is mowing the lawn on a hot dayc a 45-year-old woman who is vomitingd. a 64-year-old man who has hypertension7. Which of these patients is most susceptible to developing a nosocomial infection?a. A 28-year-old athlete who had abdominal surgery yesterdayb. A 39-year-old patient who is anemicc. A 62-year-old patient who has hypothermiad. A 76-year-old who uses a walker to ambulate
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4.
Which nursing action would be most effective for monitoring a patient’s fluid balance?a.auscultate the patient’s lungs for rales every 2 hours b.assess the patient’s temperaturec.inspect the patient for periorbital edema every 4 hour d.weigh the patient at the same time every day5.All of the following are normal findings. Which set of patient data would allow the nurse toconclude that the nursing actions taken to prevent postoperative pneumonia have been effective?a.Temperature 98.6F, no cough, no dyspnea, no chest pain. b.No nausea or vomiting, appetite good, slept well last night.c.Intake = output, voiding normal amounts, no discomfort in incision except when moving in bed, Temp. 98.6F.d.Pulse regular @ 80/min., respirations clear bilaterally @ 20/min., lips pink, skin warm anddry.6.Which of these statements, if made by a patient during the nursing history, would indicate the needto assess for a possible fluid and electrolyte imbalance?a.“I take a multivitamin everyday.” b.“I take a laxative every night at bedtime.”c.“I take acetaminophen occasionally for a headache.”d.“I take aspirin every day for arthritis.”7.Which of these is the preferred method for a nurse to obtain an accurate pulse on a 2- year-oldchild?a.Count the radial pulse. b.Auscultate the apical pulsec.Palpate the femoral pulsed.Assess the carotid pulse8.A patient’s PaCO2 is abnormal on an ABG report. Which of the following would most likely be themedical diagnosis?a.rheumatoid arthritis b.sexually transmitted infectionc.chronic obstructive pulmonary diseased.infection of the bladder and ureters9.A nurse should recognize that which of these sets of vital signs would be considered normal for a42-year-old patient?
a.
Blood pressure, 92/56 mm Hg; pulse, 52/min: respirations, 28/min.
 b.
Blood pressure, 118/80 mm Hg: pulse, 72/min: respirations, 6/min.c.Blood pressure, 128/74 mm Hg: pulse, 70/min: respirations, 18/min.
d.
Blood pressure, 152/98 mm Hg: pulse, 74/min: respirations, 20/min.10.A patient has a decreased potassium level. What high-potassium foods would the nurse teach the patient to eat?a.lunch meat, salted nuts, whole milk  b.buttermilk, hard candy, spinachc.carbonated beverages, beer, olivesd.oranges, bananas, broccoli
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15. A nurse who is working at a community health fair identifies that a 48-year-oldwoman has a blood pressure of 148/88 mm Hg. Which of these actions should the nurse include inher discussion with the woman?a. Tell the woman go the ER immediately. b. Advise the woman make an appointment with her doctor to follow-up on her  blood pressure.c. Review life style modifications with the woman since she has hypertension based onthis one reading.d. Recognize that this reading is within normal limits.16. A student is learning how to administer intravenous fluids, including accessing a vein.Although all of the following may occur, which is the most potentially harmful risk posed for the patient when accessing the vein?
a.
discomfort
 b.
pain
c.
minor bleeding
d.
infection17. A nurse assesses an area of pale white skin over a patient's coccyx. After turning the patient on her side, the skin becomes red and feels warm. What should the nurse do aboutthese assessments?a. immediately report to the physician that the patient has a pressure ulcer b. recognize that this is ischemia, followed by reactive hyperemia and take measures toavoid the patient developing any further skin problemsc. implement nursing interventions for Altered Skin Integrityd. document the presence of a pressure ulcer and develop a care plan18. A specially trained nurse has inserted a PICC line. What would be done next?a.start administration of prescribed fluids b.explain the procedure to the patient and familyc.place the patient on restricted oral fluidsd.send the patient to the radiology department 19. Which of these approaches should a nurse take when assisting a 90-year-old patientwho is blind to eat?a. Feed the patient the entire meal.b. Encourage the patient to experiment with foods.c.Orient the patient to the location of the foods on the plate.d.Teach the patient’s family how to feed the patient.20. What is the legal source of rules of conduct for nurses?a. Constitution of the United States b. agency policies and protocolsc. American Nurses Association
d.
Nurse Practice Acts 
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