Fundamentals of Nursing NCLEX Practice Questions Quiz #4 | 75 Questions

FNDNRS-04-001

All of the following can cause tachycardia except:

A. Fever
B. Exercise
C. Sympathetic nervous system stimulation
D. Parasympathetic nervous system stimulation

Correct Answer: D. Parasympathetic nervous system stimulation

Parasympathetic nervous system stimulation of the heart decreases the heart rate as well as the force of contraction, rate of impulse conduction and blood flow through the coronary vessels. Fever, exercise, and sympathetic stimulation all increase the heart rate. The parasympathetic nervous system (PNS) releases the hormone acetylcholine to slow the heart rate. Such factors as stress, caffeine, and excitement may temporarily accelerate your heart rate, while meditating or taking slow, deep breaths may help to slow your heart rate.

Option A: Tachypnea and tachycardia develop, and the patient becomes dehydrated because of sweating and vapor losses from the increased respiratory rate. Many manifestations of fever are related to the increased metabolic rate, increased need for oxygen, and use of body proteins as an energy source.
Option B: Often, ventricular tachycardia will occur during the recovery period post exercise due to increased levels of adrenaline. In a study conducted in 1991, it was found that 70% of patients tested experienced idiopathic ventricular tachycardia as a result of exercise. Exercising for any duration will increase your heart rate and will remain elevated for as long as the exercise is continued. At the beginning of exercise, your body removes the parasympathetic stimulation, which enables the heart rate to gradually increase. As you exercise more strenuously, the sympathetic system “kicks in” to accelerate your heart rate even more.
Option C: Heart rate is controlled by the two branches of the autonomic (involuntary) nervous system. The sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The sympathetic nervous system (SNS) releases the hormones (catecholamines – epinephrine and norepinephrine) to accelerate the heart rate.

FNDNRS-04-002

Palpating the midclavicular line is the correct technique for assessing:

A. Baseline vital signs
B. Systolic blood pressure
C. Respiratory rate
D. Apical pulse

Correct Answer: D. Apical pulse

The apical pulse (the pulse at the apex of the heart) is located on the midclavicular line at the fourth, fifth, or sixth intercostal space. Assessing whether the rhythm of the pulse is regular or irregular is essential. The pulse could be regular, irregular, or irregularly irregular. Changes in the rate of the pulse, along with changes in respiration is called sinus arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and slows down during expiration. Irregularly irregular pattern is more commonly indicative of processes like atrial flutter or atrial fibrillation.

Option A: Baseline vital signs include pulse rate, temperature, respiratory rate, and blood pressure. Vital signs are an objective measurement for the essential physiological functions of a living organism. They have the name “vital” as their measurement and assessment is the critical first step for any clinic evaluation. The first set of clinical examinations is an evaluation of the vital signs of the patient.
Option B: Blood pressure is typically assessed at the antecubital fossa. The arm should be supported at the heart level. Unsupported arm leads to 10 mmHg to the pressure readings. The patient’s blood pressure should get checked in each arm, and in younger patients, it should be tested in an upper and lower extremity to rule out the coarctation of the aorta.
Option C: Respiratory rate is assessed best by observing chest movement with each inspiration and expiration. The respiratory rate is the number of breaths per minute. The normal breathing rate is about 12 to 20 beats per minute in an average adult. In the pediatric age group, it is defined by the particular age group. Parameters important here again include its rate, depth of breathing, and its pattern rate of breathing is a crucial parameter.

FNDNRS-04-003

The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?

A. Apical
B. Radial
C. Pedal
D. Femoral

Correct Answer: C. Pedal

Because the pedal pulse cannot be detected in 10% to 20% of the population, its absence is not necessarily a significant finding. However, the presence or absence of the pedal pulse should be documented upon admission so that changes can be identified during the hospital stay. Absent peripheral pulses may be indicative of peripheral vascular disease (PVD). PVD may be caused by atherosclerosis, which can be complicated by an occluding thrombus or embolus. This may be life-threatening and may cause the loss of a limb.

Option A: Apical pulse rate is indicated during some assessments, such as when conducting a cardiovascular assessment and when a client is taking certain cardiac medications (e.g., digoxin). Sometimes the apical pulse is auscultated pre and post medication administration. It is also a best practice to assess apical pulse in infants and children up to five years of age because radial pulses are difficult to palpate and count in this population.
Option B: Examiners frequently evaluate the radial artery during a routine examination of adults, due to the unobtrusive position required to palpate it and it’s easy accessibility in various types of clothing. Like other distal peripheral pulses (such as those in the feet) it also may be quicker to show signs of pathology. Palpation is at the anterior wrist just proximal to the base of the thumb.
Option D: The femoral pulse may be the most sensitive in assessing for septic shock and is routinely checked during resuscitation. It is palpated distally to the inguinal ligament at a point less than halfway from the pubis to the anterior superior iliac spine.

FNDNRS-04-004

Which of the following patients is at greatest risk for developing pressure ulcers?

A. An alert, chronic arthritic patient treated with steroids and aspirin.
B. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home.
C. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula.
D. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed.

Correct Answer: B. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home.

Pressure ulcers are most likely to develop in patients with impaired mental status, mobility, activity level, nutrition, circulation and bladder or bowel control. Age is also a factor. Thus, the 88-year old incontinent patient who has impaired nutrition (from gastric cancer) and is confined to bed is at greater risk. Pressure injuries are defined as localized damage to the skin as well as underlying soft tissue, usually occurring over a bony prominence or related to medical devices. They are the result of prolonged or severe pressure with contributions from shear and friction forces.

Option A: Risk factors for developing pressure injuries, in general, include immobility, reduced perfusion, malnutrition, and sensory loss. Other patients at increased risk for pressure injury development include those with cerebrovascular or cardiovascular disease, recent fracture of a lower extremity, diabetes, and incontinence. Older patients are also at increased risk for the formation of pressure injuries due to skin changes associated with aging, including thinning of the dermis and epidermis, resulting in decreased resistance to shear forces.
Option C: The pressure of an individual’s body weight or pressure from a medical device above a certain threshold for a prolonged period is thought to be the cause of pressure injuries. In patients with sensory deficits, an absent pressure feedback response may result in sustained pressure for a prolonged period, leading to tissue injury. Many factors are identified in contributing to pressure ulcer and injury formation, such as increased arteriole pressure, shearing forces, friction, moisture, and nutrition status.
Option D: Pressure injuries of the skin and soft tissues affect an estimated 1 to 3 million people in the United States each year. The incidence differs based on the clinical setting. For example, the prevalence of pressure injuries among hospitalized patients is 5% to 15%, with the percentage considerably higher in some long-term care environments and intensive care units.

FNDNRS-04-005

The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler’s position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation?

A. Encourage the patient to increase her fluid intake to 200 ml every 2 hours.
B. Place a humidifier in the patient’s room.
C. Continue administering oxygen by a high humidity face mask.
D. Perform chest physiotherapy on a regular schedule.

Correct Answer: A. Encourage the patient to increase her fluid intake to 200 ml every 2 hours

Adequate hydration thins and loosens pulmonary secretions and also helps to replace fluids lost from elevated temperature, diaphoresis, dehydration, and dyspnea. Encourage patients to increase fluid intake to 3 liters per day within the limits of cardiac reserve and renal function. Fluids help minimize mucosal drying and maximize ciliary action to move secretions.

Option B: Consider the need of humidifiers in home care settings. This facilitates liquefaction of secretions. Teach the patient the proper ways of coughing and breathing. (e.g., take a deep breath, hold for 2 seconds, and cough two or three times in succession). The most convenient way to remove most secretions is coughing. So it is necessary to assist the patient during this activity. Deep breathing, on the other hand, promotes oxygenation before controlled coughing.
Option C: Maintain humidified oxygen as prescribed. Increasing humidity of inspired air will reduce thickness of secretions and aid their removal. Provide supplemental oxygen if the patient experiences bradycardia, an increase in ventricular ectopy, and/or significant desaturation. Oxygen therapy is recommended to improve oxygen saturation and reduce possible complications.
Option D: Coordinate with a respiratory therapist for chest physiotherapy and nebulizer management as indicated. Chest physiotherapy includes the techniques of postural drainage and chest percussion to mobilize secretions from smaller airways that cannot be eliminated by means of coughing or suctioning.

FNDNRS-04-006

The most common deficiency seen in alcoholics is:

A. Thiamine
B. Riboflavin
C. Pyridoxine
D. Pantothenic acid

Correct Answer: A. Thiamine

Chronic alcoholism commonly results in thiamine deficiency and other symptoms of malnutrition. Chronic alcohol consumption can cause thiamine deficiency and thus reduced enzyme activity through several mechanisms, including inadequate dietary intake, malabsorption of thiamine from the gastrointestinal tract, and impaired utilization of thiamine in the cells.

Option B: Riboflavin, vitamin B2, is a water-soluble and heat-stable vitamin that the body uses to metabolize fats, protein, and carbohydrates into glucose for energy. In addition to boosting energy, riboflavin functions as an antioxidant for the proper function of the immune system, healthy skin, and hair. Riboflavin deficiency can result from inadequate dietary intake or by endocrine abnormalities. Riboflavin deficiency also correlates with other vitamin B complexes.
Option C: Vitamin B6 deficiency is usually caused by pyridoxine-inactivating drugs (eg, isoniazid), protein-energy undernutrition, malabsorption, alcoholism, or excessive loss. Deficiency can cause peripheral neuropathy, seborrheic dermatitis, glossitis, and cheilosis, and, in adults, depression, confusion, and seizures.
Option D: Pantothenic acid deficiency is very rare in the United States. Severe deficiency can cause numbness and burning of the hands and feet, headache, extreme tiredness, irritability, restlessness, sleeping problems, stomach pain, heartburn, diarrhea, nausea, vomiting, and loss of appetite.

FNDNRS-04-007

Which of the following statements is incorrect about a patient with dysphagia?

A. The patient will find pureed or soft foods, such as custards, easier to swallow than water.
B. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing.
C. The patient should always feed himself.
D. The nurse should perform oral hygiene before assisting with feeding.

Correct Answer: C. The patient should always feed himself.

A patient with dysphagia (difficulty swallowing) requires assistance with feeding. Feeding himself is a long-range expected outcome. Dysphagia is defined as objective impairment or difficulty in swallowing, resulting in an abnormal delay in the transit of a liquid or solid bolus. The delay may be during the oropharyngeal or esophageal phase of swallowing.

Option A: The Academy of Nutrition and Dietetics has created a diet plan for people with dysphagia. The plan is called the National Dysphagia Diet. The dysphagia diet has 4 levels of foods. Level 1 foods are foods that are pureed or smooth, like pudding. They need no chewing. This includes foods such as yogurt, mashed potatoes with gravy to moisten it, smooth soups, and pureed vegetables and meats.
Option B: While eating or drinking, it may help to sit upright, with the back straight. The client may need support pillows to get into the best position. It may also help to have few distractions while eating or drinking. Changing between solid food and liquids may also help the swallowing. Stay upright for at least 30 minutes after eating. This can help reduce the risk for aspiration.
Option D: After meals, it’s important to do proper oral care. The SLP (speech language pathologist) can give the client instructions for the teeth or dentures. Make sure to not swallow any water during the oral care routine. While on a dysphagia diet, the client may have trouble taking in enough fluid. This can cause dehydration, which can lead to serious health problems. Talk with the healthcare team about how it can be prevented. In some cases drinking thicker liquids may make some of the medicines work less well. Because of this, the client may need some of the medicines changed for a while.

FNDNRS-04-008

To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. She should notify the physician if the urine output is:

A. Less than 30 ml/hour
B. 64 ml in 2 hours
C. 90 ml in 3 hours
D. 125 ml in 4 hours

Correct Answer: A. Less than 30 ml/hour

A urine output of less than 30ml/hour indicates hypovolemia or oliguria, which is related to kidney function and inadequate fluid intake. Urine output is a noninvasive method to measure fluid balance once intravascular volume has been restored. Normal urine output is defined as 1.5 to 2 mL/kg per hour

Option B: Micturition process entails contraction of the detrusor muscle and relaxation of the internal and external urethral sphincter. The process is slightly different based on age. Children younger than three years old have the micturition process coordinated by the spinal reflex.
Option C: It starts with urine accumulation in the bladder that stretches the detrusor muscle causing activation of stretch receptors. The stretch sensation is carried by the visceral afferent to the sacral region of the spinal cord where it synapses with the interneuron that excites the parasympathetic neurons and inhibits the sympathetic neurons. The visceral afferent impulse concurrently decreases the firing of the somatic efferent that normally keeps the external urethral sphincter closed allowing reflexive urine output.
Option D: Low bladder volume activates the pontine storage center which activates the sympathetic nervous system and inhibits the parasympathetic nervous system cumulatively allowing the accumulation of urine in the bladder. High bladder volume activates the pontine micturition center which activates the parasympathetic nervous system and inhibits the sympathetic nervous system as well as triggers awareness of a full bladder; consequently leading to relaxation of the internal sphincter and a choice to relax the external urethral sphincter once ready to void.

FNDNRS-04-009

Certain substances increase the amount of urine produced. These include:

A. Caffeine-containing drinks, such as coffee and cola
B. Beets
C. Urinary analgesics
D. Kaolin with pectin (Kaopectate)

Correct Answer: A. Caffeine-containing drinks, such as coffee and cola.

Fluids containing caffeine have a diuretic effect. Drinking caffeine-containing beverages as part of a normal lifestyle doesn’t cause fluid loss in excess of the volume ingested. While caffeinated drinks may have a mild diuretic effect — meaning that they may cause the need to urinate — they don’t appear to increase the risk of dehydration.

Option B: In some people, eating beets turns urine pink or red—which can be alarming because it looks like blood in the urine. These odor and color changes are harmless. But if urine smells sweet, that’s a cause for concern because it could mean diabetes.
Option C: Pyridium will most likely darken the color of urine to an orange or red color. This is a normal effect and is not cause for alarm unless there are other symptoms such as pale or yellowed skin, fever, stomach pain, nausea, and vomiting.
Option D: Kaopectate is an antidiarrheal medication. This medication is used to treat occasional upset stomach, heartburn, and nausea. It is also used to treat diarrhea and help prevent travelers’ diarrhea. It works by helping to slow the growth of bacteria that might be causing the diarrhea. This product should not be used to self-treat diarrhea if there is also fever or blood/mucus in the stools. These could be signs of a serious health condition.

FNDNRS-04-010

A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?

A. Encourage the patient to walk in the hall alone.
B. Discourage the patient from walking in the hall for a few more days.
C. Accompany the patient for his walk.
D. Consult a physical therapist before allowing the patient to ambulate.

Correct Answer: C. Accompany the patient for his walk.

Accompanying him will offer moral support, enabling him to face the rest of the world. Ambulation stimulates circulation which can help stop the development of stroke-causing blood clots. Walking improves blood flow which aids in quicker wound healing. The gastrointestinal, genitourinary, pulmonary and urinary tract functions are all improved by walking.

Option A: A hospitalized surgical patient leaving his room for the first time fears rejection and others staring at him, so he should not walk alone. Refusal to ambulate correlated with those that eventually developed a complication. Those that eventually developed a postoperative complication were more likely to be in the higher refusal group. Thorn et al. suggested that patient compliance may be a marker of underlying complications. If patients are not engaged in their recovery, there may be a physiologic reason for refusal (i.e., a developing abscess).
Option B: Patients should begin ambulation as soon as possible after surgery to decrease complications and to regain strength and confidence. The multiple physiological benefits of patient ambulation have been documented including the prevention of muscular and cardiovascular deconditioning, reducing the risk of pulmonary and thromboembolic events, and stimulating gastrointestinal recovery through prokinetic effects
Option D: Waiting to consult a physical therapist is unnecessary. Daily ambulation requires collaboration between hospital resources, patient education and available personnel. Second, aggressive non-opioid pain medication regimens are critical to maintain a low mLOS. The increasing use of narcotics especially with a PCA prolonged the LOS. Third, refusal of ambulation often predicted the development of a postoperative complication.

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FNDNRS-04-011

A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. An appropriate nursing diagnosis would be:

A. Ineffective airway clearance related to thick, tenacious secretions
B. Ineffective airway clearance related to dry, hacking cough
C. Ineffective individual coping to COPD
D. Pain related to immobilization of affected leg

Correct Answer: A. Ineffective airway clearance related to thick, tenacious secretions.

Thick, tenacious secretions, a dry, hacking cough, orthopnea, and shortness of breath are signs of ineffective airway clearance. Chronic obstructive pulmonary disease (COPD) is a common and treatable disease characterized by progressive airflow limitation and tissue destruction. It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases most commonly cigarette smoke. Chronic inflammation causes airway narrowing and decreased lung recoil. The disease often presents with symptoms of cough, dyspnea, and sputum production.

Option B: Ineffective airway clearance related to dry, hacking cough is incorrect because the cough is not the reason for the ineffective airway clearance. COPD is an inflammatory condition involving the airways, lung parenchyma, and pulmonary vasculature. The process is thought to involve oxidative stress and protease-antiprotease imbalances. Emphysema describes one of the structural changes seen in COPD where there is destruction of the alveolar air sacs (gas-exchanging surfaces of the lungs) leading to obstructive physiology.
Option C: Ineffective individual coping related to COPD is wrong because the etiology for a nursing diagnosis should not be a medical diagnosis (COPD) and because no data indicate that the patient is coping ineffectively. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation.
Option D: Pain related to immobilization of affected legs would be an appropriate nursing diagnosis for a patient with a leg fracture. COPD will typically present in adulthood and often during the winter months. Patients usually present with complaints of chronic and progressive dyspnea, cough, and sputum production. Patients may also have wheezing and chest tightness. While a smoking history is present in most cases, there are many without such history.

FNDNRS-04-012

Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be:

A. “Don’t worry. It’s only temporary”
B. “Why are you crying? I didn’t get to the bad news yet”
C. “Your hair is really pretty”
D. “I know this will be difficult for you, but your hair will grow back after the completion of chemotherapy”

Correct Answer: D. “I know this will be difficult for you, but your hair will grow back after the completion of chemotherapy”

“I know this will be difficult” acknowledges the problem and suggests a resolution to it. The term alopecia means hair loss regardless of the cause. It is not exclusive to the scalp; it can be anywhere on the body. As an individual grows older, they will lose hair. The difference between male hair loss and female hair loss is the pattern. Men generally lose hair in the front and the temporal region, while women tend to lose hair from the central area of the scalp. Also, female hair loss will not end up with complete baldness, whereas male hair loss can end up with complete baldness.

Option A: “Don’t worry..” offers some relief but doesn’t recognize the patient’s feelings. The epidemiology is variable depending on the cause of alopecia and the type. In alopecia areata, the prevalence is 0.2% with no racial or sexual predilection, and it may affect any age group. Androgenetic alopecia is a common disorder affecting 50% of men and 15% of women, especially postmenopausal women.
Option B: “..I didn’t get to the bad news yet” would be inappropriate at any time. Pathophysiology is dependent on the type of alopecia. In alopecia areata, it is unknown, but the most common hypothesis involves autoimmunity in the form of a T-cell–mediated pathway. In androgenetic alopecia, both genetic and hormonal androgens play a role in pathogenesis. In telogen effluvium, the shedding of hair is under the influence of hormone or stress, but sometimes the trigger is not very clear.
Option C: “Your hair is really pretty” offers no consolation or alternatives to the patient. During the physical examination, it is essential to notice the pattern of hair loss. In a patient with androgenetic alopecia, patients tend to lose hair from the frontal and temporal area (male type) and the central scalp area (female type). In alopecia areata, the patient may lose hair from a single area (alopecia areata classical type), the whole scalp and eyebrows (alopecia totalis), or from the entire body (alopecia universalis). In tinea capitis, the classic presentation is black dots associated with broken hair, while the inflammatory type (favus) correlates with the scarring type of alopecia.

FNDNRS-04-013

An additional Vitamin C is required during all of the following periods except:

A. Infancy
B. Young adulthood
C. Childhood
D. Pregnancy

Correct Answer: B. Young adulthood

Additional Vitamin C is needed in growth periods, such as infancy and childhood, and during pregnancy to supply demands for fetal growth and maternal tissues. Other conditions requiring extra vitamin C include wound healing, fever, infection and stress. Vitamin C is a water-soluble vitamin, antioxidant, and essential cofactor for collagen biosynthesis, carnitine and catecholamine metabolism, and dietary iron absorption. Humans are unable to synthesize vitamin C, so they can only obtain it through dietary intake of fruits and vegetables.

Option A: An infant requires Vitamin C. Although most vitamin C is completely absorbed in the small intestine, the percentage of absorbed vitamin C decreases as intraluminal concentrations increase. Proline residues on procollagen require vitamin C for the hydroxylation, making it necessary for the triple-helix formation of mature collagen. The lack of a stable triple-helical structure compromises the integrity of the skin, mucous membranes, blood vessels, and bone.
Option C: Children need lots of Vitamin C. Usual dietary doses of up to 100 mg/day are almost completely absorbed. The highest concentrations of ascorbic acid are in the pituitary gland, the adrenal gland, the brain, leukocytes, and eyes. Ascorbic acid functions as a cofactor, enzyme complement, co-substrate, and a powerful antioxidant in a variety of reactions and metabolic processes. It also stabilizes vitamin E and folic acid and enhances iron absorption. It neutralizes free radicals and toxins as well as attenuates inflammatory response, including sepsis syndrome.
Option D: A pregnant woman requires an abundant amount of Vitamin C. The average protective adult dose of vitamin C is 70 to 150 mg daily. Increase the dose to 300 mg to 1 g daily when scurvy is present. Daily need increases in patients with conditions like gingivitis, asthma, glaucoma, collagen disorders, heatstroke, arthritis, infections (pneumonia, sinusitis, rheumatic fever), and chronic illnesses. Hemovascular disorders, burns, and delayed wound healing are causes for an increase in daily intake.

FNDNRS-04-014

A prescribed amount of oxygen is needed for a patient with COPD to prevent:

A. Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2).
B. Circulatory overload due to hypervolemia.
C. Respiratory excitement.
D. Inhibition of the respiratory hypoxic stimulus.

Correct Answer: D. Inhibition of the respiratory hypoxic stimulus.

Delivery of more than 2 liters of oxygen per minute to a patient with chronic obstructive pulmonary disease (COPD), who is usually in a state of compensated respiratory acidosis (retaining carbon dioxide (CO2)), can inhibit the hypoxic stimulus for respiration. Long-term oxygen therapy is used for COPD if the client has low levels of oxygen in the blood (hypoxia). It is used mostly to slow or prevent right-sided heart failure. It can help the client live longer.

Option A: An increased partial pressure of carbon dioxide in arterial blood (PACO2) would not initially result in cardiac arrest. Long-term oxygen therapy should be used for at least 15 hours a day with as few interruptions as possible. Regular use can reduce the risk of death from low oxygen levels.. To get the most benefit from oxygen, the client should use it 24 hours a day. Supplemental oxygen is a well-established therapy with clear evidence for benefit in patients with COPD and severe resting hypoxemia, which is defined as a room air Pao2 ≤ 55 mm Hg or ≤ 59 mm Hg with signs of right-sided heart strain or polycythemia.
Option B: Long-term use of supplemental oxygen improves survival in patients with COPD and severe resting hypoxemia. However, the role of oxygen in symptomatic patients with COPD and more moderate hypoxemia at rest and desaturation with activity is unclear. The few long-term reports of supplemental oxygen in this group have been of small size and insufficient to demonstrate a survival benefit.
Option C: Circulatory overload and respiratory excitement have no relevance to the question. Short-term trials have suggested beneficial effects other than survival in patients with COPD and moderate hypoxemia at rest. In addition, supplemental oxygen appeared to improve exercise performance in small short-term investigations of patients with COPD and moderate hypoxemia at rest and desaturation with exercise, but long-term trials evaluating patient-reported outcomes are lacking.

FNDNRS-04-015

After 1 week of hospitalization, Mr. Gray develops hypokalemia. Which of the following is the most significant symptom of his disorder?

A. Lethargy
B. Increased pulse rate and blood pressure
C. Muscle weakness
D. Muscle irritability

Correct Answer: C. Muscle weakness

Presenting symptoms of hypokalemia ( a serum potassium level below 3.5 mEq/liter) include muscle weakness, chronic fatigue, and cardiac dysrhythmias. The combined effects of inadequate food intake and prolonged diarrhea can deplete the potassium stores of a patient with GI problems. Significant muscle weakness occurs at serum potassium levels below 2.5 mmol/L but can occur at higher levels if the onset is acute. Similar to the weakness associated with hyperkalemia, the pattern is ascending in nature affecting the lower extremities, progressing to involve the trunk and upper extremities and potentially advancing to paralysis.

Option A: Periodic paralysis is a rare neuromuscular disorder, which is inherited or acquired, that is caused by an acute transcellular shift of potassium into the cells. It is characterized by potentially fatal episodes of muscle weakness or paralysis that can affect the respiratory muscles. Clinical manifestations mainly involve the musculoskeletal and cardiovascular systems. Hence, the physical exam should focus on identifying neurologic manifestations and cardiac dysrhythmias.
Option B: Clinical symptoms of hypokalemia do not become evident until the serum potassium level is less than 3 mmol/L unless there is a precipitous fall or the patient has a process that is potentiated by hypokalemia. The severity of symptoms also tends to be proportional to the degree and duration of hypokalemia. Symptoms resolve with correction of the hypokalemia.
Option D: Affected muscles can include the muscles of respiration which can lead to respiratory failure and death. Involvement of GI muscles can cause an ileus with associated symptoms of nausea, vomiting, and abdominal distension. Severe hypokalemia can also lead to muscle cramps, rhabdomyolysis, and resultant myoglobinuria.

FNDNRS-04-016

Which of the following nursing interventions promotes patient safety?

A. Assess the patient’s ability to ambulate and transfer from a bed to a chair.
B. Demonstrate the signal system to the patient.
C. Check to see that the patient is wearing his identification band.
D. All of the above.

Correct Answer: D. All of the above

Patient Safety is a healthcare discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors, and harm that occur to patients during the provision of health care. A cornerstone of the discipline is a continuous improvement based on learning from errors and adverse events.

Option A: Assisting a patient with ambulation and transfer from a bed to a chair allows the nurse to evaluate the patient’s ability to carry out these functions safely. Patient safety is fundamental to delivering quality essential health services. Indeed, there is a clear consensus that quality health services across the world should be effective, safe, and people-centered. In addition, to realize the benefits of quality health care, health services must be timely, equitable, integrated, and efficient.
Option B: Demonstrating the signal system and providing an opportunity for a return demonstration ensures that the patient knows how to operate the equipment and encourages him to call for assistance when needed. To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals, and effective involvement of patients in their care, are all needed.
Option C: Checking the patient’s identification band verifies the patient’s identity and prevents identification mistakes in drug administration. Safety of patients during the provision of health services that are safe and of high quality is a prerequisite for strengthening health care systems and making progress towards effective universal health coverage (UHC) under Sustainable Development Goal 3 (Ensure healthy lives and promote health and well-being for all at all ages).

FNDNRS-04-017

Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions?

A. Side rails are ineffective.
B. Side rails should not be used.
C. Side rails are a deterrent that prevent a patient from falling out of bed.
D. Side rails are a reminder to a patient not to get out of bed.

Correct Answer: D. Side rails are a reminder to a patient not to get out of bed.

Since about 40% of patients fall out of bed despite the use of side rails, side rails cannot be said to prevent falls; however, they do serve as a reminder that the patient should not get out of bed. A process that requires ongoing patient evaluation and monitoring will result in optimizing bed safety. Many patients go through a period of adjustment to become comfortable with new options. Patients and their families should talk to their health care planning team to find out which options are best for them.

Option A: Patients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who get out of bed and walk unsafely without assistance, must be carefully assessed for the best ways to keep them from harm, such as falling. Assessment by the patient’s health care team will help to determine how best to keep the patient safe.
Option B: Historically, physical restraints (such as vests, ankle or wrist restraints) were used to try to keep patients safe in health care facilities. In recent years, the health care community has recognized that physically restraining patients can be dangerous. Although not indicated for this use, bed rails are sometimes used as restraints. Regulatory agencies, health care organizations, product manufacturers and advocacy groups encourage hospitals, nursing homes and home care providers to assess patients’ needs and to provide safe care without restraints.
Option C: Anticipate the reasons patients get out of bed such as hunger, thirst, going to the bathroom, restlessness and pain; meet these needs by offering food and fluids, scheduling ample toileting, and providing calming interventions and pain relief. When bed rails are used, perform an on-going assessment of the patient’s physical and mental status; closely monitor high-risk patients.

FNDNRS-04-018

Examples of patients suffering from impaired awareness include all of the following except:

A. A semiconscious or over fatigued patient.
B. A disoriented or confused patient.
C. A patient who cannot care for himself at home.
D. A patient demonstrating symptoms of drugs or alcohol withdrawal.

Correct Answer: C. A patient who cannot care for himself at home

A patient who cannot care for himself at home does not necessarily have impaired awareness; he may simply have some degree of immobility.

Option A: Fatigue is the feeling of tiredness and decreased energy that results from inadequate sleep time or poor quality of sleep. Fatigue can also result from increased work intensity or long work hours. Sleep deprivation has long been known to impair various cognitive functions, including mood, motivation, response time, and initiative. In a classic review of sleep deprivation and decision-making, investigators argued that effective performance in health care environments requires naturalistic decision-making and situation awareness.
Option B: Impaired self-awareness of deficits is a common finding in patients who have suffered traumatic brain injury. Impaired awareness can limit motivation for treatment and contribute to poor outcome. Consequently, it is important for brain injury rehabilitation professionals to understand this phenomenon and utilize treatment approaches that may improve patient awareness.
Option D: Most alcoholics exhibit mild-to-moderate deficiencies in intellectual functioning, along with diminished brain size and regional changes in brain-cell activity. The most prevalent alcohol-associated brain impairments affect visuospatial abilities and higher cognitive functioning. Visuospatial abilities include perceiving and remembering the relative locations of objects in 2- and 3-dimensional space. Examples include driving a car or assembling a piece of furniture based on instructions contained in a line drawing. Higher cognitive functioning includes the abstract-thinking capabilities needed to organize a plan, set it in motion, and change it as needed.

FNDNRS-04-019

The most common injury among elderly persons is:

A. Atherosclerotic changes in the blood vessels

B. Increased incidence of gallbladder disease

C. Urinary Tract Infection

D. Hip fracture

Correct Answer: D. Hip fracture

Hip fracture, the most common injury among elderly persons, usually results from osteoporosis. Hip fractures from falls are one of the leading causes of injuries for seniors and result in the largest number of hospitalizations. Family members and hourly caregivers can take steps to prevent falls, such as removing area rugs, improving lighting throughout the home, and offering mobility support when needed.

Option A: Some changes in the heart and blood vessels normally occur with age. However, many other changes that are common with aging are due to modifiable factors. If not treated, these can lead to heart disease. Arteriosclerosis (hardening of the arteries) is very common. Fatty plaque deposits inside the blood vessels cause them to narrow and totally block blood vessels. The capillary walls thicken slightly. This may cause a slightly slower rate of exchange of nutrients and wastes.
Option B: Increasing age is a major risk factor for their formation, with the prevalence of gallstones being greatest at advanced age. While the majority of gallstones remain asymptomatic, seniors have a high risk for acute cholecystitis with atypical presentation, even when gangrene or perforation has occurred.
Option C: The main cause of UTIs, at any age, is usually bacteria. Escherichia coli is the primary cause, but other organisms can also cause a UTI. In older adults who use catheters or live in a nursing home or other full-time care facility, bacteria such as Enterococci and Staphylococci are more common causes.

FNDNRS-04-020

The most common psychogenic disorder among elderly person is:

A. Depression
B. Sleep disturbances (such as bizarre dreams)
C. Inability to concentrate
D. Decreased appetite

Correct Answer: A. Depression

Depression typically begins before the onset of old age and usually is caused by psychosocial, genetic, or biochemical factors. Depression is a common problem among older adults, but it is NOT a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems. However, important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness. Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders.

Option B: Primary sleep disorders are more common in the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. Sleep apnea can lead to excessive daytime sleepiness.
Option C: A study finds that seniors’ attention shortfall is associated with the locus coeruleus, a tiny region of the brainstem that connects to many other parts of the brain. The locus coeruleus helps focus brain activity during periods of stress or excitement. Increased distractibility is a sign of cognitive aging.
Option D: Sleep disturbances, inability to concentrate and decreased appetite are symptoms of depression, the most common psychogenic disorder among elderly persons. Other symptoms include diminished memory, apathy, disinterest in appearance, withdrawal, and irritability.

FNDNRS-04-021

Which of the following vascular systems changes results from aging?

A. Increased peripheral resistance of the blood vessels
B. Decreased blood flow
C. Increased workload of the left ventricle
D. All of the above

Correct Answer: D. All of the above.

Aging decreases the elasticity of the blood vessels, which leads to increased peripheral resistance and decreased blood flow. These changes, in turn, increase the workload of the left ventricle. Some changes in the heart and blood vessels normally occur with age. However, many other changes that are common with aging are due to modifiable factors. If not treated, these can lead to heart disease.

Option A: Receptors called baroreceptors monitor the blood pressure and make changes to help maintain a fairly constant blood pressure when a person changes positions or is doing other activities. The baroreceptors become less sensitive with aging. This may explain why many older people have orthostatic hypotension, a condition in which the blood pressure falls when a person goes from lying or sitting to standing. This causes dizziness because there is less blood flow to the brain.
Option B: The main artery from the heart (aorta) becomes thicker, stiffer, and less flexible. This is probably related to changes in the connective tissue of the blood vessel wall. This makes the blood pressure higher and makes the heart work harder, which may lead to thickening of the heart muscle (hypertrophy). The other arteries also thicken and stiffen. In general, most older people have a moderate increase in blood pressure.
Option C: The heart has a natural pacemaker system that controls the heartbeat. Some of the pathways of this system may develop fibrous tissue and fat deposits. The natural pacemaker (the SA node) loses some of its cells. These changes may result in a slightly slower heart rate. A slight increase in the size of the heart, especially the left ventricle occurs in some people. The heart wall thickens, so the amount of blood that the chamber can hold may actually decrease despite the increased overall heart size. The heart may fill more slowly.

FNDNRS-04-022

Which of the following is the most common cause of dementia among elderly persons?

A. Parkinson’s disease
B. Multiple sclerosis
C. Amyotrophic lateral sclerosis (Lou Gehrig’s disease)
D. Alzheimer’s disease

Correct Answer: D. Alzheimer’s disease

Alzheimer’s disease, sometimes known as senile dementia of the Alzheimer’s type or primary degenerative dementia, is an insidious; progressive, irreversible, and degenerative disease of the brain whose etiology is still unknown. Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.

Option A: Parkinson’s disease is a neurologic disorder caused by lesions in the extrapyramidal system and manifested by tremors, muscle rigidity, hypokinesia, dysphagia, and dysphonia. Parkinson disease is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder).
Option B: Multiple sclerosis, a progressive, degenerative disease involving demyelination of the nerve fibers, usually begins in young adulthood and is marked by periods of remission and exacerbation. Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation, demyelination, gliosis, and neuronal loss. Pathologically, perivascular lymphocytic infiltrates, and macrophages produce degradation of myelin sheaths that surround neurons.
Option C: Amyotrophic lateral sclerosis, a disease marked by progressive degeneration of the neurons, eventually results in atrophy of all the muscles; including those necessary for respiration. Amyotrophic lateral sclerosis (ALS), also known as “Lou Gehrig’s disease,” is a neurodegenerative disease of the motor neurons. No single etiology has been proven; rather, multiple pathways (both heritable and sporadic) have been shown to result in unmistakably similar disease entities. ALS necessarily affects both upper and lower motor neurons with variable patterns of onset, most commonly beginning with signs of lower motor neuron degeneration within proximal limbs.

FNDNRS-04-023

The nurse’s most important legal responsibility after a patient’s death in a hospital is:

A. Obtaining a consent of an autopsy.
B. Notifying the coroner or medical examiner.
C. Labeling the corpse appropriately.
D. Ensuring that the attending physician issues the death certification.

Correct Answer: C. Labeling the corpse appropriately.

The nurse is legally responsible for labeling the corpse when death occurs in the hospital. After a person dies it is important to give the family the time that they need with the body. Some family members might like to lie in bed with their loved one who has died, while others might like to be involved with washing the body. Others may not want to be there at all. Washing the body is particularly important in paediatric palliative care, as often parents feel it is a special ritual to have washed their baby after they are born, and it is the same after they die. It is important to discuss rigor mortis with families as people are often unaware of this.

Option A: She may be involved in obtaining consent for an autopsy. There are considerations regarding care and preparation of the body after someone dies. Traditionally this task was performed by families, but nowadays much of the preparation of a body is done by nursing staff or undertakers. The required procedures are often included in an organizations’ procedures manual or there may be local requirements regarding the preparation of a body.
Option B: The nurse may be responsible for notifying the coroner or medical examiner of a patient’s death; however, she is not legally responsible for performing these functions. Depending on the location of the death, the nurse would contact the medical examiner to notify them of the death, as well as the physician and other clinicians who were involved with the patient. The nurse can also contact the funeral home for the family as requested.
Option D: The attending physician may need information from the nurse to complete the death certificate, but he is responsible for issuing it. A doctor must certify the death. This involves completing a medical certificate of the cause of death and stating what the cause of death was. This should happen as soon as possible. If there are any unexpected or suspicious circumstances, or if the cause of death is not known, the doctor may not be able to issue a death certificate without talking to the coroner (England, Wales, and Northern Ireland) or procurator fiscal (Scotland). The doctor completing the certificate may wish to talk to you as part of their standard checks.

FNDNRS-04-024

Before rigor mortis occurs, the nurse is responsible for:

A. Providing a complete bath and dressing change.
B. Placing one pillow under the body’s head and shoulders.
C. Removing the body’s clothing and wrapping the body in a shroud.
D. Allowing the body to relax normally.

Correct Answer: B. Placing one pillow under the body’s head and shoulders.

The nurse must place a pillow under the deceased person’s head and shoulders to prevent blood from settling in the face and discoloring it. A body undergoes complex and intricate changes after death. These post mortem changes depend on a diverse range of variables. Factors such as the ambient temperature, season, and geographical location at which the body is found, the fat content of the body, sepsis/injuries, intoxication, presence of clothes/insulation over the body, etc. determine the rate at which post-mortem changes occur in a cadaver.

Option A: She is required to bathe only soiled areas of the body since the mortician will wash the entire body. Changes that occur to a body after death are a result of complex physicochemical and environmental processes. They are affected by factors within the cadaver and outside it. These factors affect the onset and either increase the rate of post-mortem changes or retard it. Factors that hasten the rate of post mortem changes include hot and humid climate, presence of body fat, open injuries on the body, sepsis or infection, and the location of the cadaver in the open.
Option C: Before wrapping the body in a shroud, the nurse places a clean gown on the body and closes the eyes and mouth. igor mortis appears in 1 to 2 hours after death, is completely formed 12 hours after death, is sustained for the next 12 hours, and vanishes over the next 12 hours, sometimes referred to as the ‘march of rigor.’
Option D: Rigor mortis appears rapidly in children and the old aged individuals, in cases of persons dying of diseases or conditions involving great exhaustion such as cholera, or due to convulsions as in cases of strychnine poisoning. In such cases, the rigor disappears early as well. The effect of rigor on individual muscles can be of additional significance. The rigor of erector pilae muscles may cause elevation of hair leading to the pimpled appearance of the skin.

FNDNRS-04-025

When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:

A. Protect the patient from injury.
B. Insert an airway.
C. Elevate the head of the bed.
D. Withdraw all pain medications.

Correct Answer: A. Protect the patient from injury

Ensuring the patient’s safety is the most essential action at this time. This phase is different for each patient, and the needs may differ for each patient and family, but it is vital for healthcare providers to provide care and support in a way that respects the patient’s dignity and autonomous wishes.

Option B: The vast majority of patients who experience a natural death, meaning no medical, life-saving interventions to counter the process, follow a stereotypical pattern of signs and symptoms in the time leading up to death. This time frame is often referred to as “actively dying” or “imminent death.” It is important for healthcare providers to be familiar with this process, not only so they know what to expect when providing direct care to patients during this time, but also so they can guide the family in understanding what to expect during this process and providing support as needed.
Option C: The self-determination of the patient with capacity must be respected. When the patient can make their own choices, their autonomy must be upheld. It is not the role of the provider to impart their values and beliefs onto patients. Patients’ families may experience anticipatory grief and have a hard time fully handling the current situation, and they may want to push their personal choices for the situation instead of respecting their loved one’s wishes and choices.
Option D: The primary goal in treatment for patients is alleviating suffering. Hospice care and palliative care are often confused. Hospice care is the term given to the care provided when a patient is given a prognosis of death within 6 months, and they do not pursue curative treatments. They focus on improving the quality of life which can mean many things. Palliative care can be incorporated into the plan of care at any time for any patient who is experiencing suffering and wants to ease that suffering without directly treating the cause of that suffering.

FNDNRS-04-026

Which element in the circular chain of infection can be eliminated by preserving skin integrity?

A. Host
B. Reservoir
C. Mode of transmission
D. Portal of entry

Correct Answer: D. Portal of entry

In the circular chain of infection, pathogens must be able to leave their reservoir and be transmitted to a susceptible host through a portal of entry, such as broken skin. The portal of entry refers to the manner in which a pathogen enters a susceptible host. The portal of entry must provide access to tissues in which the pathogen can multiply or a toxin can act. Often, infectious agents use the same portal to enter a new host that they used to exit the source host.

Option A: The final link in the chain of infection is a susceptible host. Susceptibility of a host depends on genetic or constitutional factors, specific immunity, and nonspecific factors that affect an individual’s ability to resist infection or to limit pathogenicity. An individual’s genetic makeup may either increase or decrease susceptibility.
Option B: The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may not be the source from which an agent is transferred to a host.
Option C: An infectious agent may be transmitted from its natural reservoir to a susceptible host in different ways. There are different classifications for modes of transmission. In direct transmission, an infectious agent is transferred from a reservoir to a susceptible host by direct contact or droplet spread. Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).

FNDNRS-04-027

Which of the following will probably result in a break in sterile technique for respiratory isolation?

A. Opening the patient’s window to the outside environment.
B. Turning on the patient’s room ventilator.
C. Opening the door of the patient’s room leading into the hospital corridor.
D. Failing to wear gloves when administering a bed bath.

Correct Answer: C. Opening the door of the patient’s room leading into the hospital corridor.

Respiratory isolation, like strict isolation, requires that the door to the door patient’s room remain closed. Appropriate patient placement is a significant component of isolation precautions. A private room is important to prevent direct- or indirect-contact transmission when the source patient has poor hygienic habits, contaminates the environment, or cannot be expected to assist in maintaining infection control precautions to limit transmission of microorganisms (ie, infants, children, and patients with altered mental status).

Option A: Opening the patient’s window is acceptable because the room needs to be well-ventilated. A private room with appropriate air handling and ventilation is particularly important for reducing the risk of transmission of microorganisms from a source patient to susceptible patients and other persons in hospitals when the microorganism is spread by airborne transmission. Some hospitals use an isolation room with an anteroom as an extra measure of precaution to prevent airborne transmission.
Option B: The patient’s room should be well ventilated, so turning on the ventilator is desirable.
Option D: The nurse does not need to wear gloves for respiratory isolation, but good hand washing is important for all types of isolation. Wearing gloves does not replace the need for handwashing, because gloves may have small, apparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard.

FNDNRS-04-028

Which of the following patients is at greater risk for contracting an infection?

A. A postoperative patient who has undergone orthopedic surgery.
B. A patient receiving broad-spectrum antibiotics.
C. A patient with leukopenia.
D. A newly diagnosed diabetic patient.

Correct Answer: C. A patient with leukopenia.

Leukopenia is a decreased number of leukocytes (white blood cells), which are important in resisting infection. Leukopenia is a condition where a person has a reduced number of white blood cells. This increases their risk of infections. A person’s blood is made up of many different types of blood cells. White blood cells, also known as leukocytes, help to fight off infection. Leukocytes are a vital part of the immune system.

Option A: Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk.
Option B: Antibiotic-mediated cell death, however, is a complex process that begins with the physical interaction between a drug molecule and its bacterial-specific target, and involves alterations to the affected bacterium at the biochemical, molecular and ultrastructural levels. Antibiotic-induced cell death has been associated with the formation of double-stranded DNA breaks following treatment with DNA gyrase inhibitors, with the arrest of DNA-dependent RNA synthesis following treatment with rifamycins, with cell envelope damage and loss of structural integrity following treatment with cell-wall synthesis inhibitors, and with cellular energetics, ribosome binding and protein mistranslation following treatment with protein synthesis inhibitors.
Option D: People who have had diabetes for a long time may have peripheral nerve damage and reduced blood flow to their extremities, which increases the chance for infection. The high sugar levels in your blood and tissues allow bacteria to grow and allow infections to develop more quickly.

FNDNRS-04-029

Effective hand washing requires the use of:

A. Soap or detergent to promote emulsification.
B. Hot water to destroy bacteria.
C. A disinfectant to increase surface tension.
D. All of the above.

Correct Answer: A. Soap or detergent to promote emulsification.

Soaps and detergents are used to help remove bacteria because of their ability to lower the surface tension of water and act as emulsifying agents. Handwashing is the act of washing hands with soap, either antimicrobial or non antimicrobial, and water for at least 15 to 20 seconds with a vigorous motion to cause friction making sure to include all surfaces of the hands and fingers.

Option B: Hot water may lead to skin irritation or burns. Warm water would be enough for handwashing. Healthcare professionals caring for high-risk patients that are immunocompromised must take great care in performing proper hand hygiene as this patient population is at high risk for opportunistic infections
Option C: Handwashing with soap and water will remove nearly all transient gram-negative bacilli in 10 seconds while chlorhexidine may be more appropriate than soap and water for the removal of transient gram-positive bacteria. According to the CDC, established guidelines recommend that agents used for surgical hand scrubs should reduce microorganisms on intact skin in a substantial manner, contain a nonirritating antimicrobial preparation, have broad-spectrum activity, and be fast-acting and persistent.
Option D: Hand hygiene practices are paramount in reducing cross-transmission of microorganisms, hospital-acquired infections and the risk of occupational exposure to infectious diseases. According to the CDC, understanding the importance of hand hygiene and its impact on the pathogenic spread of microorganisms is best understood when one understands the anatomy of the skin. The skin serves as a protective barrier against water loss, heat loss, microorganisms, and other environmental hazards.

FNDNRS-04-030

After routine patient contact, hand washing should last at least:

A. 30 seconds
B. 1 minute
C. 2 minutes
D. 3 minutes

Correct Answer: A. 30 seconds

Depending on the degree of exposure to pathogens, hand washing may last from 10 seconds to 4 minutes. After routine patient contact, hand washing for 30 seconds effectively minimizes the risk of pathogen transmission. According to the Centers for Disease Control and Prevention (CDC), hand hygiene is the single most important practice in the reduction of the transmission of infection in the healthcare setting.

Option B: According to the CDC, hand hygiene encompasses the cleansing of your hands with soap and water, antiseptic hand washes, antiseptic hand rubs such as alcohol-based hand sanitizers, foams or gels, or surgical hand antisepsis. Indications for handwashing include when hands are visibly soiled, contaminated with blood or other bodily fluids, before eating, and after restroom use.
Option C: Handwashing is the act of washing hands with soap, either antimicrobial or non antimicrobial, and water for at least 15 to 20 seconds with a vigorous motion to cause friction making sure to include all surfaces of the hands and fingers. Hand rubbing with an alcohol-based rub should not be performed when the hands are visibly soiled. In this case, the CDC and WHO guidelines recommend that handwashing with soap and water
Option D: Alcohol-based hand sanitizers are the recommended product for hand hygiene when hands are not visibly soiled. Apply alcohol-based products per manufacturer guidelines on dispensing of the product. Typically, 3 mL to 5 mL in the palm, rubbing vigorously, ensuring all surfaces on both hands get covered, about 20 seconds is required for all surfaces to dry completely.

FNDNRS-04-031

Which of the following procedures always requires surgical asepsis?

A. Vaginal instillation of conjugated estrogen
B. Urinary catheterization
C. Nasogastric tube insertion
D. Colostomy irrigation

Correct Answer: B. Urinary catheterization

The urinary system is normally free of microorganisms except at the urinary meatus. Any procedure that involves entering this system must use surgically aseptic measures to maintain a bacteria-free state. Guidelines from The Centers for Disease Control and Prevention (CDC) and The European Association of Urology Nurses (EAUN) recommend ‘sterile technique’ when inserting an indwelling urinary catheter. Insertion of indwelling urinary catheters should be performed in a way that minimizes the risk of introducing bacteria to the urinary bladder.

Option A: Conjugated estrogens is a medicine that contains a mixture of estrogen hormones. Conjugated estrogen vaginal cream is used to treat changes in and around the vagina (such as vaginal dryness, itching, and burning) caused by low estrogen levels or menopause. It is also used to treat vaginal pain during sexual intercourse. This medicine is to be used only in the vagina. Use at bedtime unless your doctor tells otherwise.
Option C: Nasogastric (NG) intubation is a procedure in which a thin, plastic tube is inserted into the nostril, toward the esophagus, and down into the stomach. Once an NG tube is properly placed and secured, healthcare providers such as the nurses can deliver food and medicine directly to the stomach or obtain substances from it. Clean, not sterile, technique is necessary because the gastrointestinal (GI) tract is not sterile.
Option D: Sterile supplies are used in acute care with a fresh post-surgical urostomy. A patient in the community may not use sterile supplies, but strict adherence to proper hand hygiene is required to prevent infections of the bladder, kidney, or urinary tract. Never place anything inside the stoma.

FNDNRS-04-032

Sterile technique is used whenever:

A. Strict isolation is required
B. Terminal disinfection is performed
C. Invasive procedures are performed
D. Protective isolation is necessary

Correct Answer: C. Invasive procedures are performed

All invasive procedures, including surgery, catheter insertion, and administration of parenteral therapy, require a sterile technique to maintain a sterile environment. All equipment must be sterile, and the nurse and the physician must wear sterile gloves and maintain surgical asepsis. In the operating room, the nurse and physician are required to wear sterile gowns, gloves, masks, hair covers, and shoe covers for all invasive procedures.

Option A: Strict isolation requires the use of clean gloves, masks, gowns, and equipment to prevent the transmission of highly communicable diseases by contact or by airborne routes. Strict isolation is used for diseases spread through the air and in some cases by contact. Patients must be placed in isolation to prevent the spread of infectious diseases. Those who are kept in strict isolation are often kept in a special room at the facility designed for that purpose.
Option B: Terminal disinfection is the disinfection of all contaminated supplies and equipment after a patient has been discharged to prepare them for reuse by another patient. Terminal disinfection has the objective of preparing complete rooms or areas for subsequent patients or residents for them to be treated or cared for without the risk of acquiring an infection. This disinfection measure is applied in rooms and areas where an infected or colonized patient/resident has been cared for or treated. Depending on the existing disease or type of pathogen all near-patient surfaces/objects or all accessible surfaces (e.g. also floors or walls) are to be disinfected.
Option D: The purpose of protective (reverse)isolation is to prevent a person with seriously impaired resistance from coming into contact with potentially pathogenic organisms. Protective Isolation aims to protect an immunocompromised patient who is at high risk of acquiring micro-organisms from either the environment or from other patients, staff, or visitors.

FNDNRS-04-033

Which of the following constitutes a break in sterile technique while preparing a sterile field for a dressing change?

A. Using sterile forceps, rather than sterile gloves, to handle a sterile item.
B. Touching the outside wrapper of sterilized material without sterile gloves.
C. Placing a sterile object on the edge of the sterile field.
D. Pouring out a small amount of solution (15 to 30 ml) before pouring the solution into a sterile container.

Correct Answer: C. Placing a sterile object on the edge of the sterile field.

The edges of a sterile field are considered contaminated. When sterile items are allowed to come in contact with the edges of the field, the sterile items also become contaminated. The sterile field should be prepared as close as possible to the time of use.2 The sterility of supplies used during a surgical procedure can be affected by the events taking place within the operating room, and the length of time the items have been exposed to the environment.

Option A: Under no circumstances should sterile and nonsterile items/areas be mixed since one contaminates the other.4 Sterilization provides the highest level of assurance that all instruments, sutures, fluids, supplies, and drapes are void of microorganisms.2 The sterility of a package is determined by events, not by time. To ensure sterility, all sterile items need to be inspected for package integrity and sterilization process indicators, such as indicator tape and internal chemical indicators, prior to introduction onto the sterile field. If a package has been compromised, it should be considered contaminated and not be used.
Option B: When opening wrapped supplies, the nonsterile person should open the top wrapper flap away from them first, then open the flaps to each side. The last wrapper flap is pulled toward the nonsterile person opening the package. This technique of opening a wrapped package ensures that the nonsterile person does not reach over the sterile item inside. All wrapper edges should be secured to prevent flipping the wrapper and contaminating the contents of the sterile package or field.
Option D: Only the top rim of the bottle top and bottle contents are considered sterile once the cap has been removed from the bottle. Therefore, when sterile fluids are dispensed, the entire contents of the bottle must be poured or the fluid remaining in the bottle discarded. When solutions are poured onto the sterile field, they should be poured slowly to prevent contamination and fluid strikethrough from splashing.

FNDNRS-04-034

A natural body defense that plays an active role in preventing infection is:

A. Yawning
B. Body hair
C. Hiccupping
D. Rapid eye movements

Correct Answer: B. Body hair

Hair on or within body areas, such as the nose, traps and holds particles that contain microorganisms. One of the body’s most important physical barriers is the skin barrier, which is composed of three layers of closely packed cells. The thin upper layer is called the epidermis. A second, thicker layer, called the dermis, contains hair follicles, sweat glands, nerves, and blood vessels. A layer of fatty tissue called the hypodermis lies beneath the dermis and contains blood and lymph vessels

Option A: Evidence suggests that drowsiness is the most common stimulus of yawn. Boredom occurs when the main source of stimulation in a person’s environment is no longer able to sustain their attention. This induces drowsiness by stimulating the sleep generating system. At this moment, the mind has to make an effort to maintain contact with the external environment.
Option C: Hiccupping does not prevent microorganisms from entering or leaving the body. As they breathe out, the diaphragm pushes up to expel the air. When a person has hiccups, the diaphragm contracts and pulls down, drawing in air between breaths. Immediately after this, the windpipe closes for a moment to prevent more air from entering the lungs. Hiccups often come after eating or drinking too much or too quickly.
Option D: Rapid eye movement marks the stage of sleep during which dreaming occurs. Rapid eye movement (REM) is the stage of sleep characterized by rapid saccadic movements of the eyes. During this stage, the activity of the brain’s neurons is quite similar to that during waking hours. Most of the vividly recalled dreams occur during REM sleep.

FNDNRS-04-035

All of the following statement are true about donning sterile gloves except:

A. The first glove should be picked up by grasping the inside of the cuff.
B. The second glove should be picked up by inserting the gloved fingers under the cuff outside the glove.
C. The gloves should be adjusted by sliding the gloved fingers under the sterile cuff and pulling the glove over the wrist.
D. The inside of the glove is considered sterile.

Correct Answer: D. The inside of the glove is considered sterile.

The inside of the glove is always considered to be clean, but not sterile. Sterile gloves are gloves that are free from all microorganisms. They are required for any invasive procedure and when contact with any sterile site, tissue, or body cavity is expected (PIDAC, 2012).

Option A: Pick up the glove for the dominant hand by touching the inside cuff of the glove. Do not touch the outside of the glove. Pull the glove completely over the dominant hand. Sterile gloves help prevent surgical site infections and reduce the risk of exposure to blood and body fluid pathogens for the health care worker. Studies have shown that 18% to 35% of all sterile gloves have tiny holes after surgery, and up to 80% of the tiny puncture sites go unnoticed by the surgeon (Kennedy, 2013).
Option B: Insert gloved hand into the cuff of the remaining glove. Pull the remaining glove on a non-dominant hand and insert fingers. Adjust gloves if necessary. Double gloving is known to reduce the risk of exposure and has become common practice, but does not reduce the risk of cross-contamination after surgery (Kennedy, 2013).
Option C: Once gloves are on, interlock gloved hands and keep at least six inches away from clothing, keeping hands above waist level and below the shoulders. To remove gloves, grasp the outside of the cuff or palm of the glove and gently pull the glove off, turning it inside out and placing it into a gloved hand.

FNDNRS-04-036

When removing a contaminated gown, the nurse should be careful that the first thing she touches is the:

A. Waist tie and necktie at the back of the gown
B. Waist tie in front of the gown
C. Cuffs of the gown
D. Inside of the gown

Correct Answer: A. Waist tie and necktie at the back of the gown

The back of the gown is considered clean, the front is contaminated. So, after removing gloves and washing hands, the nurse should untie the back of the gown; slowly move backward away from the gown, holding the inside of the gown and keeping the edges off the floor; turn and fold the gown inside out; discard it in a contaminated linen container; then wash her hands again.

Option B: First, release the tie, then grasp the gown at the hip area, and pull the gown down and away from the sides of the body. Once the gown is off the shoulders, pull one arm at a time from the sleeves of the gown so that the gown arms are bunched at the wrists. Then, roll the exposed side of the gown inward until it’s a tight ball. Dispose of it.
Option C: Following the doffing protocol will minimize the risk for disease transmission, so it’s very important that you understand all the steps. A Trained Observer will help you with the process. Gown front and sleeves are contaminated!
Option D: Grasp the gown in the front and pull away from your body so that the ties break, touching the outside of the gown only with gloved hands. While removing the gown, fold or roll the gown inside-out into a bundle

FNDNRS-04-037

Which of the following nursing interventions is considered the most effective form for universal precautions?

A. Cap all used needles before removing them from their syringes.
B. Discard all used uncapped needles and syringes in an impenetrable protective container.
C. Wear gloves when administering IM injections.
D. Follow enteric precautions.

Correct Answer: B. Discard all used uncapped needles and syringes in an impenetrable protective container.

According to the Centers for Disease Control (CDC), blood-to-blood contact occurs most commonly when a health care worker attempts to cap a used needle. Universal precautions are a standard set of guidelines aimed at preventing the transmission of bloodborne pathogens from exposure to blood and other potentially infectious materials (OPIM).

Option A: Therefore, used needles should never be recapped; instead they should be inserted in a specially designed puncture resistant, labeled container. In 1987, the CDC introduced another set of guidelines termed Body Substance Isolation. These guidelines advocated the avoidance of direct physical contact with “all moist and potentially infectious body substances,” even if blood is not visible. A limitation of this guideline was that it emphasized handwashing after removal of gloves only if the hands were visibly soiled.
Option C: Wearing gloves is not always necessary when administering an I.M. injection. Must be worn when touching blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin. Change when there is contact with potentially infected material in the same patient to avoid cross-contamination. Remove before touching surfaces and clean items. Wearing gloves does not mitigate the need for proper hand hygiene.
Option D: Enteric precautions prevent the transfer of pathogens via feces. Universal precautions do not apply to sputum, feces, sweat, vomit, tears, urine, or nasal secretions unless they are visibly contaminated with blood because their transmission of Hepatitis B or HIV is extremely low or non-existent.

FNDNRS-04-038

All of the following measures are recommended to prevent pressure ulcers except:

A. Massaging the reddened area with lotion.
B. Using a water or air mattress.
C. Adhering to a schedule for positioning and turning.
D. Providing meticulous skin care.

Correct Answer: A. Massaging the reddened area with lotion

Nurses and other healthcare professionals previously believed that massaging a reddened area with lotion would promote venous return and reduce edema to the area. However, research has shown that massage only increases the likelihood of cellular ischemia and necrosis to the area.

Option B: In patients with a high risk of developing pressure injuries, support surfaces to alleviate pressure can be used. This can include higher-speciation foam mattresses, medical-grade sheepskins, continuous low-pressure supports, alternating-pressure devices, low air loss therapy; however, the effectiveness of these devices compared to other surfaces in the treatment of existing pressure injuries has not been conclusively established.
Option C: General care for pressure injuries can include redistribution of pressure with the use of support surfaces and changes in positioning. Redistribution of pressure and appropriate patient positioning is required to prevent the development and worsening of pressure injuries, as these methods can reduce force from friction and shear.
Option D: Wound care, including maintaining a clean environment, debridement, application of dressings, monitoring, and various adjunctive therapies, is generally advised to facilitate the healing of pressure injuries. Options for treatment can be guided by the stage of the pressure injury. Stage 1 pressure injuries can be covered with transparent film dressings as needed.

FNDNRS-04-039

Which of the following blood tests should be performed before a blood transfusion?

A. Prothrombin and coagulation time
B. Blood typing and cross-matching
C. Bleeding and clotting time
D. Complete blood count (CBC) and electrolyte levels

Correct Answer: B. Blood typing and cross-matching

Before a blood transfusion is performed, the blood of the donor and recipient must be checked for compatibility. This is done by blood typing (a test that determines a person’s blood type) and cross-matching (a procedure that determines the compatibility of the donor’s and recipient’s blood after the blood types have been matched). If the blood specimens are incompatible, hemolysis and antigen-antibody reactions will occur. If the donor is eligible to donate, the donated blood is tested for blood type (ABO group) and Rh type (positive or negative). This is to make sure that patients receive blood that matches their blood type. Before transfusion, the donor and blood unit are also tested for certain proteins (antibodies) that may cause adverse reactions in a person receiving a blood transfusion.

Option A: A prothrombin time (PT) is a test used to help detect and diagnose a bleeding disorder or excessive clotting disorder. A PT measures the number of seconds it takes for a clot to form in your sample of blood after substances (reagents) are added. The PT is often performed along with a partial thromboplastin time (PTT) and together they assess the amount and function of proteins called coagulation factors that are an important part of proper blood clot formation. The coagulation time is a measurement of the intrinsic power of the blood to convert fibrinogen to fibrin. It is an empirical test no matter how performed, and therefore in order to be reliable requires that the test be done on venous blood under strictly controlled conditions.
Option C: Bleeding time is a laboratory test to assess platelet function and the body’s ability to form a clot. The test involves making a puncture wound in a superficial area of the skin and monitoring the time needed for bleeding to stop (ie, bleeding site turns “glassy”). The expected range for clotting time is 4-10 mins. This test measures the time taken for blood vessel constriction and platelet plug formation to occur. No clot is allowed to form, so that the arrest of bleeding depends exclusively on blood vessel constriction and platelet action.
Option D: The complete blood count (CBC) is a group of tests that evaluate the cells that circulate in blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect a variety of diseases and conditions, such as infections, anemia and leukemia.

FNDNRS-04-040

The primary purpose of a platelet count is to evaluate the:

A. Potential for clot formation
B. Potential for bleeding
C. Presence of an antigen-antibody response
D. Presence of cardiac enzymes

Correct Answer: A. Potential for clot formation

Platelets are disk-shaped cells that are essential for blood coagulation. A platelet count determines the number of thrombocytes in blood available for promoting hemostasis and assisting with blood coagulation after injury. Platelets, also called thrombocytes, are tiny fragments of cells that are essential for normal blood clotting. They are formed from very large cells called megakaryocytes in the bone marrow and are released into the blood to circulate. The platelet count is a test that determines the number of platelets in your sample of blood.

Option B: It also is used to evaluate the patient’s potential for bleeding; however, this is not its primary purpose. The normal count ranges from 150,000 to 350,000/mm3. A count of 100,000/mm3 or less indicates a potential for bleeding; count of less than 20,000/mm3 is associated with spontaneous bleeding.
Option C: Platelets, the smallest of our blood cells, can only be seen under a microscope. They’re literally shaped like small plates in their inactive form. A blood vessel will send out a signal when it becomes damaged. When platelets receive that signal, they’ll respond by traveling to the area and transforming into their “active” formation. To make contact with the broken blood vessel, platelets grow long tentacles and then resemble a spider or an octopus.
Option D: If you have too many platelets, it can increase your risk for clotting. But often your cardiovascular risk has more to do with platelet function than platelet number. For example, you could have a healthy number of platelets, but if they’re sticking together too much it can increase your chance of having a heart attack or stroke.

FNDNRS-04-041

Which of the following white blood cell (WBC) counts clearly indicates leukocytosis?

A. 4,500/mm³
B. 7,000/mm³
C. 10,000/mm³
D. 25,000/mm³

Correct Answer: D. 25,000/mm³

Leukocytosis is any transient increase in the number of white blood cells (leukocytes) in the blood. The normal number of WBCs in the blood is 4,500 to 11,000 WBCs per microliter (4.5 to 11.0 × 10⁹/L). Normal value ranges may vary slightly among different labs. Thus, a count of 25,000/mm3 indicates leukocytosis.

Option A: A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. WBCs are also called leukocytes. They help fight infections. A higher than normal WBC count is called leukocytosis. Leukocytosis is the broad term for an elevated white blood cell (WBC) count, typically above 11.0×10^9/L, on a peripheral blood smear collection. The exact value of WBC elevation can vary slightly between laboratories depending on their ‘upper limits of normal’ as identified by their reference ranges.
Option B: The WBC value represents the sum-total of white blood cell subtypes, including neutrophils, eosinophils, lymphocytes, monocytes, atypical leukocytes that are not normally present on a peripheral blood smear (e.g., lymphoblasts), or any combination of these. The clinician should properly characterize the leukocytosis and determine if further evaluation and workup are indicated.
Option C: Leukocytosis can occur acutely and often transiently or chronically, either in response to an inflammatory stressor/cytokine cascade or as part of an autonomous myeloproliferative neoplasm. Neutrophilia is the most common presentation, but clinicians should be aware of the other cell lines that can be involved in acute and chronic presentations. A detailed history, physical examination, medication reconciliation, full evaluation of a CBC with differential, and comparison to prior CBCs can help clinicians elucidate the underlying cause of leukocytosis and guide appropriate treatment.

FNDNRS-04-042

After 5 days of diuretic therapy with 20mg of furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping and muscle weakness. These symptoms probably indicate that the patient is experiencing:

A. Hypokalemia
B. Hyperkalemia
C. Anorexia
D. Dysphagia

Correct Answer: A. Hypokalemia

Fatigue, muscle cramping, and muscle weaknesses are symptoms of hypokalemia (an inadequate potassium level), which is a potential side effect of diuretic therapy. The physician usually orders supplemental potassium to prevent hypokalemia in patients receiving diuretics.Hypokalemia is more prevalent than hyperkalemia; however, most cases are mild. Although there is a slight variation, an acceptable lower limit for normal serum potassium is 3.5 mmol/L. Severity is categorized as mild when the serum potassium level is 3 to 3.4 mmol/L, moderate when the serum potassium level is 2.5 to 3 mmol/L, and severe when the serum potassium level is less than 2.5 mmol/L.

Option B: Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L. While mild hyperkalemia is usually asymptomatic, high levels of potassium may cause life-threatening cardiac arrhythmias, muscle weakness or paralysis. Symptoms usually develop at levels higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important than the numerical value.
Option C: Anorexia is another symptom of hypokalemia. The most frequent electrolyte imbalances seen in anorexia are hyponatremia (a low concentration of sodium ions in the bloodstream) and hypokalemia (a low concentration of potassium ions). A low potassium level has many causes but usually results from vomiting, diarrhea, adrenal gland disorders, or use of diuretics. A low potassium level can make muscles feel weak, cramp, twitch, or even become paralyzed, and abnormal heart rhythms may develop.
Option D: Dysphagia means difficulty swallowing. Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking. bringing food back up, sometimes through the nose.

FNDNRS-04-043

Which of the following statements about chest X-ray is not true?

A. No contradictions exist for this test.
B. Before the procedure, the patient should remove all jewelry, metallic objects, and buttons above the waist.
C. A signed consent is not required.
D. Eating, drinking, and medications are allowed before this test.

Correct Answer: A. No contradictions exist for this test

Pregnancy or suspected pregnancy is the only contraindication for a chest X-ray. However, if a chest X-ray is necessary, the patient can wear a lead apron to protect the pelvic region from radiation. X-rays during pregnancy don’t increase the risk of miscarriage or cause problems in the unborn baby, such as birth defects and physical or mental development problems. However, if a pregnant woman has an X-ray and is exposed to radiation there is a very small increased risk that the baby may go on to develop cancer in childhood. This is why the dose of radiation used in an X-ray is always as low as possible.

Option B: Jewelry, metallic objects, and buttons would interfere with the X-ray and thus should not be worn above the waist. Metal appears as a bright area on an X-ray, blocking visibility of underlying structures. The reason you’re asked to remove metal is to give the radiologist an unobstructed view of the area of interest. Basically, you remove metal because it blocks anatomy.
Option C: A signed consent is not required because a chest X-ray is not an invasive examination. Consent is ensuring the patient is aware of the purpose and nature of any procedure to be carried out. The radiographer must ensure that the patient is fully aware of his/her options, including alternatives, the right to refuse and the consequences of refusal.
Option D: Eating, drinking and medications are allowed because the X-ray is of the chest, not the abdominal region. To create a radiograph, a patient is positioned so that the part of the body being imaged is located between an x-ray source and an x-ray detector. When the machine is turned on, x-rays travel through the body and are absorbed in different amounts by different tissues, depending on the radiological density of the tissues they pass through.

FNDNRS-04-044

The most appropriate time for the nurse to obtain a sputum specimen for culture is:

A. Early in the morning
B. After the patient eats a light breakfast
C. After aerosol therapy
D. After chest physiotherapy

Correct Answer: A. Early in the morning

Obtaining a sputum specimen early in this morning ensures an adequate supply of bacteria for culturing and decreases the risk of contamination from food or medication. A sputum culture is a test to detect and identify bacteria or fungi that infect the lungs or breathing passages. Sputum is a thick fluid produced in the lungs and in the adjacent airways. Normally, a fresh morning sample is preferred for the bacteriological examination of sputum.

Option B: A sputum culture is a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs. Sputum, also known as phlegm, is a thick type of mucus made in your lungs. If you have an infection or chronic illness affecting the lungs or airways, it can make you cough up sputum.
Option C: Sputum is not the same as spit or saliva. Sputum contains cells from the immune system that help fight the bacteria, fungi, or other foreign substances in your lungs or airways. The thickness of sputum helps trap the foreign material. This allows cilia (tiny hairs) in the airways to push it through the mouth and be coughed out.
Option D: A sputum culture is often done with another test called a Gram stain. A Gram stain is a test that checks for bacteria at the site of a suspected infection or in body fluids such as blood or urine. It can help identify the specific type of infection you may have.

FNDNRS-04-045

A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:

A. Withhold the moderation and notify the physician.
B. Administer the medication and notify the physician.
C. Administer the medication with an antihistamine.
D. Apply cornstarch soaks to the rash.

Correct Answer: A. Withhold the moderation and notify the physician

Initial sensitivity to penicillin is commonly manifested by a skin rash, even in individuals who have not been allergic to it previously. Because of the danger of anaphylactic shock, the nurse should withhold the drug and notify the physician, who may choose to substitute another drug.

Option B: To determine if a patient has an IgE mediated penicillin allergy, the only validated test currently available in the united states is penicillin skin testing. A board-certified allergist should perform the test. It involves a skin-prick with the application of the major and minor determinants as well as a control. The area of skin is examined 15 minutes later. If a wheel of at least 3 mm and concomitant erythema develop, the test is positive. The test should not be performed if the reaction to penicillin was a severe non-IgE mediated reaction.
Option C: Administering an antihistamine is a dependent nursing intervention that requires a written physician’s order. Treatment for acute IgE mediated reaction to penicillin depends on severity. Patients presenting in acute anaphylaxis need to have immediate treatment with IM epinephrine (1 mg/ml) 0.3 mg to 0.5 mg every 5 to 15 minutes until resolution of symptoms. Adjunctive therapies include H1 and H2 antihistamines including diphenhydramine 25 mg to 50 mg intravenously (IV) and ranitidine 50 mg IV, respectively.
Option D: Although applying cornstarch to the rash may relieve discomfort, it is not the nurse’s top priority in such a potentially life-threatening situation. Cutaneous symptoms are often the first and most common finding of an allergic reaction, however, are absent in 10% to 20% of patients experiencing an allergic reaction. Common cutaneous symptoms are generalized urticaria, flushing, pruritus, and angioedema.

FNDNRS-04-046

All of the following nursing interventions are correct when using the Z-track method of drug injection except:

A. Prepare the injection site with alcohol.
B. Use a needle that’s at least 1” long.
C. Aspirate for blood before injection.
D. Rub the site vigorously after the injection to promote absorption.

Correct Answer: D. Rub the site vigorously after the injection to promote absorption

The Z-track method is an I.M. injection technique in which the patient’s skin is pulled in such a way that the needle track is sealed off after the injection. This procedure seals medication deep into the muscle, thereby minimizing skin staining and irritation. Rubbing the injection site is contraindicated because it may cause the medication to extravasate into the skin.

Option A: Clean the injection site with an alcohol pad to minimize the possibility of infection. Allow the area to air dry for a few minutes. The Z-track method is not often recommended, but can be particularly useful with medication that must be absorbed by muscle to work. It also helps to prevent medication from seeping into the subcutaneous tissue and ensures a full dosage.
Option B: In an adult, the most commonly used needles are one inch or one and a half inches long, and 22 to 25 gauge thick. Smaller needles are typically used when injecting a child. Some medications are dark colored and can cause staining of the skin. If this is a side effect of the medication you will be taking, the doctor may recommend using this technique to prevent injection site discoloration or lesions.
Option C: Use one hand to pull downward on your skin and fatty tissue. Hold it firmly about an inch away (2.54 cm) from the muscle. On the other hand, hold the needle at a 90-degree angle and insert it quickly and deeply enough to penetrate your muscle. If there is no blood in the syringe, push on the plunger to inject the medication slowly into the muscle.

FNDNRS-04-047

The correct method for determining the vastus lateralis site for I.M. injection is to:

A. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest.
B. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm.
C. Palpate a 1” circular area anterior to the umbilicus.
D. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh.

Correct Answer: D. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh

The vastus lateralis, a long, thick muscle that extends the full length of the thigh, is viewed by many clinicians as the site of choice for I.M. injections because it has relatively few major nerves and blood vessels. The middle third of the muscle is recommended as the injection site. The patient can be in a supine or sitting position for an injection into this site.

Option A: There are specific landmarks to be taken into consideration while giving IM injections so as to avoid any neurovascular complications. The heel of the opposing hand is placed in the greater trochanter, the index finger in the anterior superior iliac spine and the middle finger below the iliac crest. The drug is injected in the triangle formed by the index, middle finger, and the iliac crest
Option B: The deltoid area is 2.5 to 5 cm below the acromion process. Intramuscular injection is the method of installing medications into the depth of the bulk of specifically selected muscles. The basis of this process is that the bulky muscles have good vascularity, and therefore the injected drug quickly reaches the systemic circulation and thereafter into the specific region of action, bypassing the first-pass metabolism.
Option C: The vastus lateralis is a common site for IM injection. The middle third of the line joining the greater trochanter of the femur and the lateral femoral condyle of the knee. It is one of the most common medical procedures to be performed on an annual basis. However, there is still a lack of uniform guidelines and an algorithm in giving IM among health professionals across the world.

FNDNRS-04-048

The mid-deltoid injection site is seldom used for I.M. injections because it:

A. Can accommodate only 1 ml or less of medication.
B. Bruises too easily.
C. Can be used only when the patient is lying down.
D. Does not readily absorb parenteral medication.

Correct Answer: A. Can accommodate only 1 ml or less of medication

The mid-deltoid injection site can accommodate only 1 ml or less of medication because of its size and location (on the deltoid muscle of the arm, close to the brachial artery and radial nerve). It is becoming increasingly important for clinicians to identify a safer intramuscular (IM) injection site in the deltoid muscle because of possible complications following the vaccine administration of IM injections.

Option B: However, Cook reported that these 4 injection sites have the potential to cause injury to the subdeltoid/subacromial bursa and/or anterior branch of the axillary nerve with the arm in the anatomical position. Additionally, we showed that the axillary nerve often runs near the site 5 cm below the mid-acromion lateral border, and concluded that this site is unsuitable for IM injection in terms of the high risk for the complications related to this nerve.
Option C: The deltoid muscle has been used in clinical settings because it is easy for clinicians to administer injections at this site and for patients to expose it, and it is the most commonly used site for vaccines worldwide. Four injection sites have been recommended as safer and appropriate IM injection sites in the deltoid muscle: the first site is 1 to 3 finger breadths (5 cm) below the mid-acromion, the second is a triangular injection site, the third is the middle third of the deltoid muscle, and the fourth is a mid-deltoid site.
Option D: The following complications have been reported after the administration of IM injections: injection site reactions such as pain, erythema, and swelling due to over- or under penetration by the needle, axillary or radial nerve palsies, musculoskeletal injuries, local sepsis, and vascular complications. Therefore, it is becoming increasingly important to establish a safer site for IM injections.

FNDNRS-04-049

The appropriate needle size for insulin injection is:

A. 18G, 1 ½” long
B. 22G, 1” long
C. 22G, 1 ½” long
D. 25G, 5/8” long

Correct Answer: D. 25G, 5/8” long

A 25G, 5/8” needle is the recommended size for insulin injection because insulin is administered by the subcutaneous route. The board recommends 4-, 5-, and 6-mm needles for all adult patients regardless of their BMI. It is also recommended to insert 4-, 5-, and 6-mm needles at a 90-degree angle and that, if needed, longer needles should be injected with either a skinfold or a 45-degree angle to avoid intramuscular injection of insulin.

Option A: An 18G, 1 ½” needle is usually used for I.M. injections in children, typically in the vastus lateralis. Ensuring the correct delivery of insulin is essential in the treatment of diabetes. Both proper injection technique and needle length are important considerations for adequate insulin delivery. There have been several studies demonstrating that BMI does not affect efficacy or insulin leakage with shorter pen needles (e.g., 4 or 5 mm vs. 12.7 mm).
Option B: Additionally, the International Scientific Advisory Board for the Third Injection Technique Workshop released recommendations in 2010 on best practices for injection technique for patients with diabetes, which, with regard to needle length, concluded that 4-mm pen needles were efficacious in all patients regardless of BMI.
Option C: A 22G, 1 ½” needle is usually used for adult I.M. injections, which are typically administered in the vastus lateralis or ventrogluteal site. Needle lengths for subcutaneous injections started out as long as 16 mm in 1985, and 12.7-mm needles were introduced in the early 1990s. Over time, with growing evidence of longer needles increasing risks for intramuscular injections and improved technology, shorter needles of 4, 5, 6, and 8 mm have been developed.

FNDNRS-04-050

The appropriate needle gauge for intradermal injection is:

A. 20G
B. 22G
C. 25G
D. 26G

Correct Answer: D. 26G

Because an intradermal injection does not penetrate deeply into the skin, a small-bore 26G-27G needle is recommended. This type of injection is used primarily to administer antigens to evaluate reactions for allergy or sensitivity studies. Equipment used for ID injections is a tuberculin syringe calibrated in tenths and hundredths of a millilitre, and a 1/4 to 1/2 in., 26 or 27 gauge needle. The dosage of an ID injection is usually under 0.5 ml. The angle of administration for an ID injection is 5 to 15 degrees.

Option A: A 20G needle is usually used for I.M. injections of oil-based medications. Intramuscular injections are administered at a 90-degree angle to the skin, preferably into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm, depending on the age of the patient. The needle gauge for intramuscular injection is 22-25 gauge.
Option B: A 22G-25G needle for I.M. injections. A decision on needle length and site of injection must be made for each person on the basis of the size of the muscle, the thickness of adipose tissue at the injection site, the volume of the material to be administered, injection technique, and the depth below the muscle surface into which the material is to be injected
Option C: A 25G needle, for subcutaneous insulin injections. Choosing the right size needle and syringe is necessary to get the correct dose of medicine, inject it properly, and minimize pain.To make it easier, these items are sold separately and designed to attach securely. Subcutaneous injections go into the fatty tissue just below the skin. Since these are relatively shallow shots, the needle required is small and short—typically one-half to five-eighths of an inch long with a gauge of 25 to 30.

FNDNRS-04-051

Parenteral penicillin can be administered as an:

A. IM injection or an IV solution
B. IV or an intradermal injection
C. Intradermal or subcutaneous injection
D. IM or a subcutaneous injection

Correct Answer: A. IM injection or an IV solution

Parenteral penicillin can be administered I.M. or added to a solution and given I.V. It cannot be administered subcutaneously or intradermally. Penicillin G administration can be either intravenously or intramuscularly. Penicillin G benzathine administration ensures a continuous low dose of penicillin G over 2 to 4 weeks.

Option B: Intradermal injection, often abbreviated ID, is a shallow or superficial injection of a substance into the dermis, which is located between the epidermis and the hypodermis. This route is relatively rare compared to injections into the subcutaneous tissue or muscle.
Option C: A subcutaneous injection is a method of administering medication. Subcutaneous means under the skin. In this type of injection, a short needle is used to inject a drug into the tissue layer between the skin and the muscle. Medication given this way is usually absorbed more slowly than if injected into a vein, sometimes over a period of 24 hours.
Option D: An intramuscular injection is a technique used to deliver a medication deep into the muscles. This allows the medication to be absorbed into the bloodstream quickly. Intramuscular injections are a common practice in modern medicine. They’re used to deliver drugs and vaccines. Several drugs and almost all injectable vaccines are delivered this way.

FNDNRS-04-052

The physician orders gr 10 of aspirin for a patient. The equivalent dose in milligrams is:

A. 0.6 mg
B. 10 mg
C. 60 mg
D. 600 mg

Correct Answer: D. 600 mg

gr 10 x 60 mg/gr 1 = 600 mg. There are 3 primary methods for the calculation of medication dosages, as referenced above. These include Desired Over Have Method or Formula, Dimensional Analysis and Ratio and Proportion (as cited in Boyer, 2002)[Lindow, 2004].

Option A: Desired over Have or Formula Method is a formula or equation to solve for an unknown quantity (x) much like ratio proportion. Drug calculations require the use of conversion factors, such as when converting from pounds to kilograms or liters to milliliters. Simplistic in design, this method allows us to work with various units of measurement, converting factors to find our answer. Useful in checking the accuracy of the other methods of calculation as above mentioned, thus acting as a double or triple check.
Option B: Units of measurement must match, for example, milliliters and milliliters, or one needs to convert to like units of measurement. In the example above, the ordered dose was in milligrams, and the have dose was in milligrams, both of which cancel out leaving milliliters (answer called for milliliters), so no further conversion is required.
Option C: The Ratio and Proportion Method has been around for years and is one of the oldest methods utilized in drug calculations (as cited in Boyer, 2002)[Lindow, 2004]. Addition principals is a problem-solving technique that has no bearing on this relationship, only multiplication, and division are used to navigate through a ratio and proportion problem, not adding.

FNDNRS-04-053

The physician orders an IV solution of dextrose 5% in water at 100ml/hour. What would the flow rate be if the drop factor is 15 gtt = 1 ml?

A. 5 gtt/minute
B. 13 gtt/minute
C. 25 gtt/minute
D. 50 gtt/minute

Correct Answer: C. 25 gtt/minute

100ml/60 min X 15 gtt/ 1 ml = 25 gtt/minute. When the nurse has an order for an IV infusion, it is her responsibility to make sure the fluid will infuse at the prescribed rate. IV fluids may be infused by gravity using a manual roller clamp or dial-a-flow, or infused using an infusion pump. Regardless of the method, it is important to know how to calculate the correct IV flow rate.

Option A: When calculating the flow rate, determine which IV tubing you will be using, microdrip or macrodrip, so you can use the proper drop factor in your calculations. The drop factor is the number of drops in one mL of solution, and is printed on the IV tubing package.
Option B: Macrodrip and microdrip refers to the diameter of the needle where the drop enters the drip chamber. Macrodrip tubing delivers 10 to 20 gtts/mL and is used to infuse large volumes or to infuse fluids quickly. Microdrip tubing delivers 60 gtts/mL and is used for small or very precise amounts of fluid, as with neonates or pediatric patients.
Option C: To calculate the drops per minute, the drop factor is needed. The formula for calculating the IV flow rate (drip rate).. total volume (in mL) divided by time (in min), multiplied by the drop factor (in gtts/mL), which equals the IV flow rate in gtts/min.

FNDNRS-04-054

Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion?

A. Hemoglobinuria
B. Chest pain
C. Urticaria
D. Distended neck veins

Correct Answer: A. Hemoglobinuria

Hemoglobinuria, the abnormal presence of hemoglobin in the urine, indicates a hemolytic reaction (incompatibility of the donor’s and recipient’s blood). In this reaction, antibodies in the recipient’s plasma combine rapidly with donor RBC’s; the cells are hemolyzed in either circulatory or reticuloendothelial systems. Hemolysis occurs more rapidly in ABO incompatibilities than in Rh incompatibilities.

Option B: Flank pain is a common sign of hemolytic reaction. Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion. Sometimes, they may develop after several days (delayed reaction).
Option C: Chest pain and urticaria may be symptoms of impending anaphylaxis. A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The reaction occurs when the red blood cells that were given during the transfusion are destroyed by the person’s immune system. When red blood cells are destroyed, the process is called hemolysis.
Option D: Distended neck veins are an indication of hypervolemia. Most of the time, a blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. Blood transfusions between incompatible groups (such as A+ to O-) cause an immune response. This can lead to a serious transfusion reaction. The immune system attacks the donated blood cells, causing them to burst.

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FNDNRS-04-055

Which of the following conditions may require fluid restriction?

A. Fever
B. Chronic Obstructive Pulmonary Disease
C. Renal Failure
D. Dehydration

Correct Answer: C. Renal Failure

In renal failure, the kidney loses their ability to effectively eliminate wastes and fluids. Because of this, limiting the patient’s intake of oral and I.V. fluids may be necessary. The term renal failure denotes the inability of the kidneys to perform excretory function leading to retention of nitrogenous waste products from the blood.

Option A: A fever draws moisture out of the body. Plus, you lose fluid as your body makes mucus and it drains away. And that over-the-counter cold medicine you’re taking to dry up your head can dry the rest of you out, too. So drink plenty of water, juice, or soup.
Option B: Chronic obstructive pulmonary disease (COPD) is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. Alpha-1 antitrypsin deficiency and various occupational exposures are less common causes in nonsmokers.
Option D: Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients, however, will require intravenous fluids in order to rehydrate.

FNDNRS-04-056

All of the following are common signs and symptoms of phlebitis except:

A. Pain or discomfort at the IV insertion site
B. Edema and warmth at the IV insertion site
C. A red streak exiting the IV insertion site
D. Frank bleeding at the insertion site

Correct Answer: D. Frank bleeding at the insertion site

Phlebitis, the inflammation of a vein, can be caused by chemical irritants (I.V. solutions or medications), mechanical irritants (the needle or catheter used during venipuncture or cannulation), or a localized allergic reaction to the needle or catheter. It usually affects lower limbs, particularly the great saphenous vein (60% to 80%) or the small/short saphenous vein (10% to 20%). However, it can occur at other sites (10% to 20%) and may occur bilaterally (5% to 10%).

Option A: When there is venous turbulence or stasis, vessel wall injuries, abnormal coagulability, or vessel wall injuries, microthrombi could propagate and then form macroscopic thrombi. Vascular endothelial injury reliably results in thrombus formation by triggering an inflammatory response that results in immediate platelet adhesion. Platelet aggregation is mediated by thrombin and thromboxane A2.
Option B: Patients with superficial thrombophlebitis typically present with a reddened, warm, inflamed, tender area overlying the track of a superficial vein. There is often a palpable cord. Some surrounding edema or associated pruritus may occur. Significant swelling of the limb is more commonly associated with DVT and should only be attributed to SVT after DVT has been excluded.
Option C: Signs and symptoms of phlebitis include pain or discomfort, edema and heat at the I.V. insertion site, and a red streak going up the arm or leg from the I.V. insertion site. Patients should be educated on the likelihood and significance of the propagation of disease and recurrence based on their risk factors. They should be advised of the need for further evaluation in the presence of migratory thrombophlebitis or if they are more than 40 years old at the time of their initial presentation and are without other risk factors for venous thromboembolic disease.

FNDNRS-04-057

The best way of determining whether a patient has learned to instill ear medication properly is for the nurse to:

A. Ask the patient if he/she has used ear drops before.
B. Have the patient repeat the nurse’s instructions using her own words.
C. Demonstrate the procedure to the patient and encourage to ask questions.
D. Ask the patient to demonstrate the procedure.

Correct Answer: D. Ask the patient to demonstrate the procedure

Return demonstration provides the most certain evidence for evaluating the effectiveness of patient teaching. No matter what kind of ear drops you use or why you use them, it’s important to administer them correctly. Using ear drops properly allows the medication to enter your ear canal and treat your ear problem.

Option A: Merely asking the patient does not guarantee that he knows the correct way of instilling the ear drops. Position the head so that the ear faces upward. If you’re giving the drops to yourself, it may be easiest to sit or stand upright and tilt your head to the side. If you’re giving the drops to someone else, it may be easiest if the person tilts their head or lies down on their side.
Option B: It is better to repeat actions than only repeating words. or adults, gently pull the upper ear up and back. For children, gently pull the lower ear down and back. Squeeze the correct number of drops into the ear. Your doctor’s instructions or the bottle’s label will tell you how many drops to use.
Option C: After demonstrating to the patient, allow him to demonstrate the procedure too. You should also know how long you can use the ear drops safely after opening the bottle. For prescription ear drops, ask your pharmacist or doctor about the expiration date. For over-the-counter drops, check the expiration date on the label. If the drops have expired, throw them away. Don’t use expired ear drops.

FNDNRS-04-058

Which of the following types of medications can be administered via gastrostomy tube?

A. Any oral medications.
B. Capsules’ whole contents are dissolved in water.
C. Enteric-coated tablets that are thoroughly dissolved in water.
D. Most tablets designed for oral use, except for extended-duration compounds.

Correct Answer: D. Most tablets designed for oral use, except for extended-duration compounds

Most tablets designed for oral use, except for extended-duration compounds can be administered via gastrostomy tube. Drug therapy can be complicated in hospitalized patients requiring an enteral feeding tube (EFT). Some medications may be given via an EFT while others are unsuitable for this form of administration.

Option A: Inappropriate drug selection for EFT administration can cause potential toxicity, reduced efficacy, and tube obstruction. Therefore, it is important to know which drugs may be altered for EFT administration as well as appropriate therapeutic alternatives that can temporarily be substituted for those that may not be given via that route.
Option B: It is preferable to utilize a liquid dosage form whenever possible for EFT administration especially if the patient has a small-bore feeding tube. If an appropriate liquid preparation is not available, the dilution of crushed tablets or the contents of capsules may be necessary prior to EFT administration.
Option C: Capsules, enteric-coated tablets, and most extended duration or sustained release products should not be dissolved for use in a gastrostomy tube. They are pharmaceutically manufactured in these forms for valid reasons, and altering them destroys their purpose. The nurse should seek an alternate physician’s order when an ordered medication is inappropriate for delivery by tube.

FNDNRS-04-059

A patient who develops hives after receiving an antibiotic is exhibiting drug:

A. Tolerance
B. Idiosyncrasy
C. Synergism
D. Allergy

Correct Answer: D. Allergy

A drug-allergy is an adverse reaction resulting from an immunologic response following a previous sensitizing exposure to the drug. The reaction can range from a rash or hives to anaphylactic shock.

Option A: Tolerance to a drug means that the patient experiences a decreasing physiologic response to repeated administration of the drug in the same dosage.
Option B: Idiosyncrasy is an individual’s unique hypersensitivity to a drug, food, or other substance; it appears to be genetically determined.
Option C: Synergism, is a drug interaction in which the sum of the drug’s combined effects is greater than that of their separate effects.

FNDNRS-04-060

A patient has returned to his room after femoral arteriography. All of the following are appropriate nursing interventions except:

A. Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours.
B. Check the pressure dressing for sanguineous drainage.
C. Assess vital signs every 15 minutes for 2 hours.
D. Order a hemoglobin and hematocrit count 1 hour after the arteriography.

Correct Answer: D. Order a hemoglobin and hematocrit count 1 hour after the arteriography

A hemoglobin and hematocrit count would be ordered by the physician if bleeding were suspected. Arterial puncture occurs at the start of angiography and interventional radiology, and is a very important factor determining the success or failure of successive procedures. Recently, this procedure has been performed by a range of approaches depending on the type of surgery, e.g, through the radial artery.

Option A: The methods of hemostasis for the femoral artery include manual compression, which is the removal of the sheath and compression with the hands, and methods that apply compression devices1). Of these, manual compression requires absolute bed rest for a few hours. On the other hand, the level of patient discomfort is increased due to lengthy bed rest and the restriction of walking.
Option B: Moreover, hematoma in the punctured area of blood vessels, formation of a pseudoaneurysm, and vascular occlusions develop in approximately 1–5% cases). A variety of hemostasis devices have been developed to treat these complications that allow for rapid recovery of patients from bed rest. These include Angio-seal device (collagen sponge and copolymer anchor) and percutaneous placement of a device (Prostar) that utilizes two nonabsorbable sutures (Perclose, Redwood City, CA, USA).
Option C: The other answers are appropriate nursing interventions for a patient who has undergone femoral arteriography. The Angio-seal device uses a method of adsorption with a collagen sponge placed within the blood vessels. The Prostar device uses a method in which the blood vessels are sutured. These hemostasis devices can reduce the discomfort and the time to hemostasis (clotting time) in the puncture area when used in patients, who cannot lie down in bed for a long time or in patients with low platelet values who have received anticoagulation treatments.

FNDNRS-04-061

The nurse explains to a patient that a cough:

A. Is a protective response to clear the respiratory tract of irritants.
B. Is primarily a voluntary action.
C. Is induced by the administration of an antitussive drug.
D. Can be inhibited by “splinting” the abdomen.

Correct Answer: A. Is a protective response to clear the respiratory tract of irritants

Coughing, a protective response that clears the respiratory tract of irritants, usually is involuntary. A cough is an innate primitive reflex and acts as part of the body’s immune system to protect against foreign materials. This reflex is characterized with the closing of the glottis apparatus with subsequent increases in the intrathoracic pressure which often exceeds 300 mm Hg. This is followed by the forceful expulsion of the airway contents through the glottis into the pharyngeal space and out of the body.

Option B: However, it can be voluntary as when a patient is taught to perform coughing exercises. Coughing is associated with a wide assortment of clinical associations and etiologies. Furthermore, there are no objective tools to measure or clinically quantify a cough. As such, evaluation of a cough is initially a subjective and highly variable assessment.
Option C: An antitussive drug inhibits coughing. Cough suppressants may be used to lessen the cough by blunting the cough reflex, and expectorants may be used when excessive mucous secretions are determined to be the primary issue to increase mucus clearance. The most commonly used suppressant is dextromethorphan, and the most common suppressant is guaifenesin.
Option D: Splinting the abdomen supports the abdominal muscles when a patient coughs. The reflex of coughing is initiated with a chemical irritation at peripheral nerve receptors within the trachea, main carina, branching points of large airways, and more distal smaller airways. They are also present in the pharynx. Laryngeal and tracheobronchial receptors respond to mechanical and chemical stimuli.

FNDNRS-04-062

An infected patient has chills and begins shivering. The best nursing intervention is to:

A. Apply iced alcohol sponges
B. Provide increased cool liquids
C. Provide additional bedclothes
D. Provide increased ventilation

Correct Answer: C. Provide additional bedclothes

In an infected patient, shivering results from the body’s attempt to increase heat production and the production of neutrophils and phagocytic action through increased skeletal muscle tension and contractions. Initial vasoconstriction may cause skin to feel cold to the touch. Applying additional bed clothes helps to equalize the body temperature and stop the chills. Attempts to cool the body result in further shivering, increased metabolism, and thus increased heat production.

Option A: This intervention would further increase shivering. Therapeutic temperature modulation, which incorporates mild hypothermia and maintenance of normothermia, is being used to manage patients resuscitated after cardiac arrest. During this therapy, the shiver response is activated as a defense mechanism in response to an altered set-point temperature and causes metabolic and hemodynamic stress for patients.
Option B: Cool liquids may increase the shivering. Recognition of shivering according to objective and subjective assessments is vital for early detection of the condition. Once shivering is detected, treatment is imperative to avoid deleterious effects. The Bedside Shivering Assessment Scale can be used to determine the efficacy of interventions intended to blunt thermoregulatory defenses and can provide continual evaluation of patients’ responses to the interventions.
Option D: Increased ventilation may be done, but it could still increase shivering. Nurses’ knowledge and understanding of the harmful effects of shivering are important to affect care and prevent injury associated with uncontrolled shivering. Chills may also be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting, such as hypothermia, which is an abnormally low body temperature.

FNDNRS-04-063

A clinical nurse specialist is a nurse who has:

A. Been certified by the National League for Nursing.
B. Received credentials from the American Nurses’ Association.
C. Graduated from an associate degree program and is a registered professional nurse.
D. Completed a master’s degree in the prescribed clinical area and is a registered professional nurse.

Correct Answer: D. Completed a master’s degree in the prescribed clinical area and is a registered professional nurse.

A clinical nurse specialist must have completed a master’s degree in a clinical specialty and be a registered professional nurse. A clinical nurse specialist (CNS) is a graduate-level registered nurse who is certified in a specialty of choice. Obtaining specialty certification demonstrates an advanced level of knowledge as well as advanced clinical skills in a niche area of nursing. There are differences between a nurse practitioner (NP) and CNS.

Option A: The National League of Nursing accredits educational programs in nursing and provides a testing service to evaluate student nursing competence but it does not certify nurses.
Option B: The American Nurses Association identifies requirements for certification and offers examinations for certification in many areas of nursing, such as medical-surgical nursing. This certification (credentialing) demonstrates that the nurse has the knowledge and the ability to provide high-quality nursing care in the area of her certification.
Option C: A graduate of an associate degree program is not a clinical nurse specialist: however, she is prepared to provide bedside nursing with a high degree of knowledge and skill. She must successfully complete the licensing examination to become a registered professional nurse.

FNDNRS-04-064

The purpose of increasing urine acidity through dietary means is to:

A. Decrease burning sensations
B. Change the urine’s color
C. Change the urine’s concentration
D. Inhibit the growth of microorganisms

Correct Answer: D. Inhibit the growth of microorganisms

Microorganisms usually do not grow in an acidic environment. A diet high in citrus fruits, vegetables, or dairy products can increase the urine pH. A diet high in meat products or cranberries can decrease the urine pH. The acidity of urine — as well as the presence of small molecules related to diet — may influence how well bacteria can grow in the urinary tract, a new study shows. The research, at Washington University School of Medicine in St. Louis, may have implications for treating urinary tract infections, which are among the most common bacterial infections worldwide.

Option A: Henderson and his team, including first author Robin R. Shields-Cutler, a graduate student in Henderson’s lab, were interested in studying how the body naturally fights bacterial infections. They cultured E. coli in urine samples from healthy volunteers and noted major differences in how well individual urine samples could harness a key immune protein to limit bacterial growth. The urine samples that prevented bacterial growth supported more activity of this key protein, which the body makes naturally in response to infection, than the samples that permitted bacteria to grow easily. The protein is called siderocalin, and past research has suggested that it helps the body fight infection by depriving bacteria of iron, a mineral necessary for bacterial growth.
Option B: Importantly, the researchers also showed that they could encourage or discourage bacterial growth in urine simply by adjusting the pH, a finding that could have implications for how patients with UTIs are treated.
Option C: Indeed, their results implicate cranberries among other possible dietary interventions. Shield-Cutler noted that many studies already have investigated extracts or juices from cranberries as UTI treatments but the results of such investigations have not been consistent. “It’s possible that cranberries may be more effective when paired with a treatment to make the urine less acidic,” Henderson said. “And even then, maybe cranberries only work in people who have the right gut microbes.”

FNDNRS-04-065

Clay-colored stools indicate:

A. Upper GI bleeding
B. Impending constipation
C. An effect of medication
D. Bile obstruction

Correct Answer: D. Bile obstruction

Bile colors the stool brown. Any inflammation or obstruction that impairs bile flow will affect the stool pigment, yielding light, clay-colored stool. The liver releases bile salts into the stool, giving it a normal brown color. One may have clay-colored stools if they have a liver infection that reduces bile production, or if the flow of bile out of the liver is blocked. Yellow skin (jaundice) often occurs with clay-colored stools.

Option A: Upper GI bleeding results in black or tarry stool. Melena is a black, tarry stool that is caused by GI bleeding. The black color is due to the oxidation of blood hemoglobin during the bleeding in the ileum and colon. Melena also refers to stools or vomit stained black by blood pigment or dark blood products and may indicate upper GI bleeding.
Option B: Constipation is characterized by small, hard masses. The problem may arise in the colon or rectum or it may be due to an external cause. In most people, slow colonic motility that occurs after years of laxative abuse is the problem. In a few patients, the cause may be related to an outlet obstruction like rectal prolapse or a rectocele. External causes of constipation may include poor dietary habits, lack of fluid intake, overuse of certain medications, an endocrine problem like hypothyroidism or some type of an emotional issue.
Option C: Many medications and foods will discolor stool – for example, drugs containing iron turn stool black; beets turn stool red. Blue feces may be caused by boric acid, chloramphenicol, or methylene blue. Causative diseases for clay feces may include alcoholic hepatitis, biliary cirrhosis, gallstones, sclerosing cholangitis, biliary strictures, or viral hepatitis. Causative medications for gray feces may include cocoa or colchicines. Potential causes for green stools may include spinach, Indomethacin, iron, or medroxyprogesterone.

FNDNRS-04-066

In which step of the nursing process would the nurse ask a patient if the medication she administered relieved his pain?

A. Assessment
B. Analysis
C. Planning
D. Evaluation

Correct Answer: D. Evaluation

In the evaluation step of the nursing process, the nurse must decide whether the patient has achieved the expected outcome that was identified in the planning phase. This final step of the nursing process is vital to a positive patient outcome. Whenever a healthcare provider intervenes or implements care, they must reassess or evaluate to ensure the desired outcome has been met. Reassessment may frequently be needed depending upon overall patient condition. The plan of care may be adapted based on new assessment data.

Option A: Assessment is the first step and involves critical thinking skills and data collection; subjective and objective. Subjective data involves verbal statements from the patient or caregiver. Objective data is measurable, tangible data such as vital signs, intake and output, and height and weight.
Option B: Analysis can be a part of diagnosing. The formulation of a nursing diagnosis by employing clinical judgment assists in the planning and implementation of patient care. The North American Nursing Diagnosis Association (NANDA) provides nurses with an up to date list of nursing diagnoses. A nursing diagnosis, according to NANDA, is defined as a clinical judgment about responses to actual or potential health problems on the part of the patient, family or community.
Option C: The planning stage is where goals and outcomes are formulated that directly impact patient care based on EDP guidelines. These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a course of direction for personalized care tailored to an individual’s unique needs. Overall condition and comorbid conditions play a role in the construction of a care plan. Care plans enhance communication, documentation, reimbursement, and continuity of care across the healthcare continuum.

FNDNRS-04-067

All of the following are good sources of vitamin A except:

A. White potatoes
B. Carrots
C. Apricots
D. Egg yolks

Correct Answer: A. White potatoes

Potatoes contain a good amount of carbs and fiber, as well as vitamin C, vitamin B6, potassium and manganese. Their nutrient contents can vary depending on the type of potato and cooking method. The main sources of vitamin A are yellow and green vegetables (such as carrots, sweet potatoes, squash, spinach, collard greens, broccoli, and cabbage) and yellow fruits (such as apricots, and cantaloupe). Animal sources include liver, kidneys, cream, butter, and egg yolks.

Option B: They’re rich in beta-carotene, a compound the body changes into vitamin A, which helps keep the eyes healthy. And beta-carotene helps protect the eyes from the sun and lowers the chances of cataracts and other eye problems. Yellow carrots have lutein, which is also good for the eyes.
Option C: Apricots are a great source of many antioxidants, including beta carotene and vitamins A, C, and E. What’s more, they’re high in a group of polyphenol antioxidants called flavonoids, which have been shown to protect against illnesses, including diabetes and heart disease.
Option D: Egg yolks contain vitamins A, D, E and K along with omega-3 fats. Compared to the whites, egg yolks are also rich in folate and vitamin B12. The yolks are also packed with tryptophan and tyrosine, and amino acids that help prevent heart diseases.

FNDNRS-04-068

Which of the following is a primary nursing intervention necessary for all patients with a Foley Catheter in place?

A. Maintain the drainage tubing and collection bag level with the patient’s bladder.
B. Irrigate the patient with 1% Neosporin solution three times a day.
C. Clamp the catheter for 1 hour every 4 hours to maintain the bladder’s elasticity.
D. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity.

Correct Answer: D. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity

To prevent obstruction, the catheter and collecting tube should be kept free from kinking, the collecting bag should be positioned below the level of the bladder at all times and never placed on the floor. The collecting bag should be emptied regularly using a clean collecting container (HICPAC, 2009). In ambulatory patients, collecting bags may be disguised in bags and pouches.

Option A: Maintaining the drainage tubing and collection bag level with the patient’s bladder could result in reflux of urine into the kidney. The indwelling catheter should be secured to the thigh or abdomen after insertion to prevent movement and the exertion of excessive force on the bladder neck or urethra (Gray, 2008). Unsecured and displaced catheters can also cause pressure ulcers on the perineum and buttock (Siegel, 2008).
Option B: Irrigating the bladder with Neosporin must be indicated and ordered by the physician. Nash (2003) conducted a recent review of the literature on self-cleaning of catheter training bags. The study showed that patients whose bags were irrigated with vinegar showed a significant reduction of bacteriuria compared with patients whose bags were irrigated with the hydrogen peroxide solutions (Washington, 2001). Authors concluded that more research is needed on the self-cleaning of Foley bags.
Option C: Clamping the catheter for 1 hour every 4 hours must be prescribed by a physician. Patients practicing intermittent catheterization should pay close attention to the catheterization schedule and avoid bladder overdistension and unnecessary catheterizations. As CAUTIs are more prevalent for intermittent catheterization in patients with high residual urine volumes at the time of catheterization, urine volume should determine the catheterization schedule.

FNDNRS-04-069

The ELISA test is used to:

A. Screen blood donors for antibodies to human immunodeficiency virus (HIV).
B. Test blood to be used for transfusion for HIV antibodies.
C. Aid in diagnosing a patient with AIDS.
D. All of the above.

Correct Answer: D. All of the above.

The ELISA test of venous blood is used to assess blood and potential blood donors to human immunodeficiency virus (HIV). A positive ELISA test combined with various signs and symptoms helps to diagnose acquired immunodeficiency syndrome (AIDS). Enzyme-linked immunosorbent assay (ELISA) is a labeled immunoassay that is considered the gold standard of immunoassays. This immunological test is very sensitive and is used to detect and quantify substances, including antibodies, antigens, proteins, glycoproteins, and hormones. The detection of these products is accomplished by the complexing of antibodies and antigens to produce a measurable result.

Option A: ELISAs are performed in polystyrene plates, typically in 96-well plates that are coated to bind protein very strongly. Depending on the ELISA type, testing requires a primary and/or secondary detection antibody, analyte/antigen, coating antibody/antigen, buffer, wash, and substrate/chromogen. The primary detection antibody is a specific antibody that only binds to the protein of interest, while a secondary detection antibody is a second enzyme-conjugated antibody that binds a primary antibody that is not enzyme-conjugated.
Option B: In HIV testing, a blood or saliva specimen is collected for testing typically by the use of indirect ELISA-based tests. The ELISA is a screening tool for HIV detection, but not diagnostic. Diagnosis requires further testing by Western blot due to potential false positives. Another virus, Molluscum contagiosum virus (MCV) that commonly infects the skin of children and young adults, can be detected by ELISA testing. ELISA testing in this setting is currently being evaluated for the assessment of global MCV seroprevalence.
Option C: ELISA testing is used in the diagnosis of HIV infection, pregnancy tests, and blood typing, among others. The first ELISA methodology involved chromogenic reporter molecules and substrates to generate observable color change that monitors the presence of antigen. Further advancement in the ELISA technique leads to the development of fluorogenic, quantitative PCR, and electrochemiluminescent reporters to generate signals. However, some of these techniques do not rely on using enzyme-linked substrates but non-enzymatic reporters that utilize the principle of ELISA.

FNDNRS-04-070

The two blood vessels most commonly used for TPN infusion are the:

A. Subclavian and jugular veins
B. Brachial and subclavian veins
C. Femoral and subclavian veins
D. Brachial and femoral veins

Correct Answer: A. Subclavian and jugular veins

Total Parenteral Nutrition (TPN) requires the use of a large vessel, such as the subclavian or jugular vein, to ensure the rapid dilution of the solution and thereby prevent complications, such as hyperglycemia. TPN is a mixture of separate components that contain lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements. TPN composition should be adjusted to fulfill individual patients’ needs. The main three macronutrients are lipids, emulsions, proteins, and dextrose.

Option B: Total parenteral nutrition is not administered through a peripheral intravenous catheter (Peripheral Parenteral Nutrition, PPN) because it has high osmolarity. PPN osmolarity needs to be less than 900 mOsm. The lower concentration necessitates larger volume feedings, and high-fat content is necessary. High osmolarity irritates peripheral veins; hence TPN is given through central venous access. PPN is used to provide additional nutrition to patients with functional gut and enteral feedings.
Option C: Historically, total parenteral nutrition (TPN) has been administered by the central venous route because of the rapid development of thrombophlebitis when TPN solutions are administered into peripheral veins. The insertion and placement of central venous catheters are, however, associated with morbidity and mortality and is the main cause of TPN-related complications.
Option D: The brachial and femoral veins usually are contraindicated because they pose an increased risk of thrombophlebitis. By avoiding central venous catheterization, TPN can be made safer. Current awareness about the pathophysiology of peripheral vein thrombophlebitis and the use of a number of techniques that prevent or delay the onset of peripheral vein thrombophlebitis means it is now possible to administer TPN via the peripheral route.

FNDNRS-04-071

Effective skin disinfection before a surgical procedure includes which of the following methods?

A. Shaving the site on the day before surgery.
B. Applying a topical antiseptic to the skin in the evening before surgery.
C. Having the patient take a tub bath on the morning of surgery.
D. Having the patient shower with an antiseptic soap on the evening before and the morning of surgery.

Correct Answer: D. Having the patient shower with an antiseptic soap on the evening before and the morning of surgery

Studies have shown that showering with an antiseptic soap before surgery is the most effective method of removing microorganisms from the skin. Procedural and surgical site infections create difficult and complex clinical scenarios. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure critical. The antiseptic used for bathing should be approved using the testing criteria from the FDA’s Tentative Final Monograph (TFM) for Antiseptic Drug Products for preoperative skin preparation. The goal for this recommendation would be to reduce the number of bacterial flora at the patient’s incision site.

Option A: Shaving the site of the intended surgery might cause breaks in the skin, thereby increasing the risk of infection; however, if indicated, shaving, should be done immediately before surgery, not the day before. The purpose of surgical skin preparation is to reduce the number of microorganisms on the skin’s surface. This is accomplished by removing dirt and oil without causing damage to the skin’s natural protective function or interfering with postoperative wound healing. The CDC’s 1999 guideline recommends that hair not be removed unless it interferes with the surgical procedure and is a Category IA recommendation.12 Also, according to AORN standards, “Whenever possible, hair should be left at the surgical site.”13 Hair-removal methods discussed are depilatory; dry clipped using an electric clipper and wet using a disposable razor.
Option B: A topical antiseptic would not remove microorganisms and would be beneficial only after proper cleaning and rinsing. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate (CHG). CHG has more sustained antimicrobial activity and is more resistant to neutralization by blood products than the iodophors. CHG is applied in a similar manner to PVP-I, but should not be used in the genital region. This agent has gained popularity as a hand-scrubbing and showering antiseptic prior to surgery, but also continues to be used as a patient skin preparation agent.
Option C: Tub bathing might transfer organisms to another body site rather than rinse them away. The CDC’s 1999 guideline states that the incision site should be clean before surgical skin preparation and has labeled this a Category IB.10 In the Standards, Recommended Practices, and Guidelines of the Association of periOperative Registered Nurses (AORN) it states, “The surgical site and surrounding areas should be clean.”

FNDNRS-04-072

When transferring a patient from a bed to a chair, the nurse should use which muscles to avoid back injury?

A. Abdominal muscles
B. Back muscles
C. Leg muscles
D. Upper arm muscles

Correct Answer: C. Leg muscles

The leg muscles are the strongest muscles in the body and should bear the greatest stress when lifting. Muscles of the abdomen, back, and upper arms may be easily injured. Place the patient’s outside leg (the one farthest from the wheelchair) between the knees for support. Bend the knees and keep the back straight. Patient safety is often the main concern when moving patients from bed. But remember not to lift at the expense of your own back. This transfer often requires the patient’s help, so clear communication is essential. If the patient can’t help much, you’ll need two people or a full body sling lift.

Option A: Allow the patient to help as much as possible. Estimate the patient’s weight and mentally practice. Make sure that the floor is free of any obstacles or liquids. Keep the feet shoulder width apart. Keep the person (or object) as close to your body as possible. Tighten your stomach muscles. Bend knees and hips, and keep your back straight throughout the movement. Lift with your legs, NOT your back.
Option B: Keep the back straight throughout the transfer to avoid bending or straining the back. Get as close to the person as possible while still allowing him/her to lean forward as needed to assist with the transfer. Do not twist your back as you lift. To turn when lifting, pivot your feet. If you have doubts, ASK FOR HELP!
Option D: To get the patient into a seated position, roll the patient onto the same side as the chair. Put one of the arms under the patient’s shoulders and one behind the knees. Bend the knees. Swing the patient’s feet off the edge of the bed and use the momentum to help the patient into a sitting position. Move the patient to the edge of the bed and lower the bed so the patient’s feet are touching the ground.

FNDNRS-04-073

Thrombophlebitis typically develops in patients with which of the following conditions?

A. Increases partial thromboplastin time
B. Acute pulsus paradoxus
C. An impaired or traumatized blood vessel wall
D. Chronic Obstructive Pulmonary Disease (COPD)

Correct Answer: C. An impaired or traumatized blood vessel wall

The factors, known as Virchow’s triad, collectively predispose a patient to thrombophlebitis; impaired venous return to the heart, blood hypercoagulability, and injury to a blood vessel wall. The three factors of Virchow’s triad include intravascular vessel wall damage, stasis of flow, and the presence of a hypercoagulable state. Understanding the factors involved in the thrombus formation and subsequent thromboembolic events enables the clinician to stratify risk, direct clinical decision making regarding treatment, and establish preventative measures.

Option A: Increased partial thromboplastin time indicates a prolonged bleeding time during fibrin clot formation, commonly the result of anticoagulant (heparin) therapy. A prolonged PTT may be due to: underlying conditions that cause low levels of clotting factors, such as: liver disease—most coagulation factors are produced by the liver, thus liver disease may cause prolonged PT and PTT. However, PT is more likely to be prolonged than PTT.
Option B: Pulsus paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg. Pulsus paradoxus results from alterations in the mechanical forces imposed on the chambers of the heart and pulmonary vasculature often due to pericardial disease, particularly cardiac tamponade and to a lesser degree constrictive pericarditis. However, it is important to understand that pulsus paradoxus may be seen in non-pericardial cardiac diseases such as right ventricular myocardial infarction and restrictive cardiomyopathy.
Option D: Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the third leading cause of death in this country.^[1]Patients typically have symptoms of chronic bronchitis and emphysema, but the classic triad also includes asthma or a combination of the above.

FNDNRS-04-074

In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:

A. Respiratory acidosis, atelectasis, and hypostatic pneumonia
B. Apneustic breathing, atypical pneumonia and respiratory alkalosis
C. Cheyne-Stokes respirations and spontaneous pneumothorax
D. Kussmaul’s respirations and hypoventilation

Correct Answer: A. Respiratory acidosis, atelectasis, and hypostatic pneumonia

Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.

Option B: Apneustic respiration (a.k.a. apneusis) is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. Pneumonia is acquired when a sufficient volume of a pathogenic organism bypasses the body’s cough and laryngeal reflexes and makes its way into the parenchyma. In almost every scenario, respiratory alkalosis is induced by a process involving hyperventilation. These include central causes, hypoxemic causes, pulmonary causes, and iatrogenic causes. Central sources are a head injury, stroke, hyperthyroidism, anxiety-hyperventilation, pain, fear, stress, drugs, medications such as salicylates, and various toxins.
Option C: Cheyne-Stokes respiration is a specific form of periodic breathing (waxing and waning amplitude of flow or tidal volume) characterized by a crescendo-decrescendo pattern of respiration between central apneas or central hypopneas. Unlike obstructive sleep apnea (OSA), which can be the cause of heart failure, Cheyne-Stokes respiration is believed to be a result of heart failure. Spontaneous pneumothorax refers to the abnormal collection of gas in the pleural space between the lungs and the chest wall. Spontaneous pneumothorax occurs without an obvious etiology such as trauma or iatrogenic causes.
Option D: Kussmaul respirations were originally observed and described by Dr. Adolf Kussmaul in 1874. He made his observation in diabetic patients who were comatose and in the late stages of diabetic ketoacidosis. As classically described, Kussmaul respirations are a deep, sighing respiratory pattern. Dr. Kussmaul actually described it as “air hunger.” Hypoventilation is breathing that is too shallow or too slow to meet the needs of the body. If a person hypoventilates, the body’s carbon dioxide level rises. This causes a buildup of acid and too little oxygen in the blood. A person with hypoventilation might feel sleepy.

FNDNRS-04-075

Immobility impairs bladder elimination, resulting in such disorders as:

A. Increased urine acidity and relaxation of the perineal muscles, causing incontinence
B. Urine retention, bladder distention, and infection
C. Diuresis, natriuresis, and decreased urine specific gravity
D. Decreased calcium and phosphate levels in the urine

Correct Answer: B. Urine retention, bladder distention, and infection

The immobilized patient commonly suffers from urine retention caused by decreased muscle tone in the perineum. This leads to bladder distention and urine stagnation, which provide an excellent medium for bacterial growth leading to infection.

Option A: Urea is the main nitrogenous waste product resulting from protein breakdown (catabolism) and is rapidly eliminated in the urine by the kidneys. During bedrest, the concentration of urea in the blood increases and the kidneys eliminate larger amounts of urea.
Option C: As food intake usually decreases during bedrest, it is speculated that these higher concentrations of urea in blood and urine can only come from the catabolic breakdown of endogenous protein sources, such as muscle and other lean tissues (Bilancio et al, 2014). This correlates with the reduction in lean tissue mass and sarcopenia that are characteristic of prolonged immobility.
Option D: Immobility is independently associated with the development of a series of complications, including pressure ulcer, deep vein thrombosis (DVT), pneumonia, and urinary tract infection (UTI) Immobility also results in more alkaline urine with excessive amounts of calcium, sodium and phosphate, a gradual decrease in urine production, and an increased specific gravity.

Fundamentals of Nursing NCLEX Practice Questions Quiz #4 | 75 Questions

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