Fundamentals Proctored Exam

The nurse is taking vital signs on a patient with a fractured femur. The blood pressure reading is 150/96. The patient does not have a history of hypertension. What action should the nurse take next?

Which laboratory result indicates the presence of malnutrition?

Upon auscultation of a client's heart rate, the nurse notes the rate to have an irregular pattern of 72 bpm. The nurse notifies the health care provider because the client is exhibiting signs of:

The nurse is evaluating outcomes for a patient with insomnia. Which key principle will the nurse consider during this process?

Precise wound documentation contributes to which of the below elements? (Select all that apply)

A nurse is caring for a patient who is experiencing fluid volume deficit. Which signs should the nurse document as part of the assessment which correlates with a fluid volume deficit? (Select all that

Before administering a cleansing enema to an 80-year-old patient, the patient says, “I don’t think I will be able to hold the enema.” Which is the next priority nursing action?

While reading a physician’s note, a student learns the patient is having hypoxia. Which abnormal patient assessments would a student expect to find with hypoxia?

The nurse is assessing a client with dark skin for the presence of a Stage I pressure ulcer. Which is the best approach to making this assessment?

Before administering a medication to a client, the nurse must identify the client. Which of the following methods of identification should the nurse use?

A patient has a hemoglobin of 7.1 g/dL. The nurse understands that anemia is likely to result in which of the following?

Which is an example of nonmaleficence?

In providing diet education for a patient on a low-fat diet, which information is important for the nurse to share?

The client's plan of care is created by the nurse using which guideline for nursing practice?

While caring for a client near end of life, a nurse talks to the client. An unlicensed assistive personnel asks why the nurse is talking to someone who is dying. Which response is accurate?

Based on an established plan of care, a nurse turns a client every 2 hours. Which part of the nursing process is the nurse using?

The patient complains of abdominal pain. Before palpating the abdomen, which action should the nurse perform?

A nurse is assessing a client who has a fever, has an infection of a flank incision, and is in severe pain. What type of pulse rate would the client most likely exhibit?

A registered nurse assigns the task of tracheostomy suctioning of a client to the Licensed Practical Nurse (LPN). The LPN informs the nurse that the LPN has never performed this procedure on a client.

The nurse is caring for a patient diagnosed with tuberculosis in a hospital setting and must initiate airborne precautions. Which of the following is true related to airborne precautions?

A nurse is educating a postoperative client on how to use an incentive spirometer. What is an accurate statement that should be included in the education plan?

The nurse is providing preoperative teaching to a patient to have an operation on their colon for cancer. The nurse should take which of the following actions regarding informed consent?

The nurse is assessing the patient’s respirations. Which action by the nurse is most appropriate?

A nurse is going to teach a patient about hypertension. Which action should the nurse implement first?

During an assessment of the cranial nerves, the nurse asks the client to smile, frown, wrinkle the forehead, and puff out the cheeks. Which nerve is affected? being tested?