prelim lab with key

8/13/2019 Prelim Lab With Key

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UNIVERSITY OF LA SALETTECOLLEGE OF NURSING

PRELIMINARY EXAMINATIONRLE-007 FUNDAMENTALS OF NURSING PRACTICE

1. Using the principles of standard precautions, the nurse would wear gloves in what nursinginterventions?

a. Providing a back massageb. Feeding a clientc. Providing hair cared. Providing oral hygiene

2. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydrationsecondary to vomiting and diarrhea. What is the best method used to assess the clients temperature?

a. Oralb. Axillaryc. Radiald. Heat sensitive tape

3. A nurse obtained a clients pulse and found the rate to be above normal. The nurse documents thisfinding as:

a. Tachypneab. Hyper pyrexiac. Arrhythmiad. Tachycardia

4. Which of the following actions should the nurse take to use a wide base support when assisting a

client to get up in a chair?a. Bend at the waist and place arms under the clients arms and lift b. Face the client; bend knees and place hands on clients forearm and lift c. Spread his or her feet apartd. Tighten his or her pelvic muscles

5. A client had oral surgery following a motor vehicle accident. The nurse assessing the client finds theskin flushed and warm. Which of the followi ng would be the best method to take the clients bodytemperature?

a. Oralb. Axillaryc. Arterial lined. Rectal

6. A client who is unconscious needs frequent mouth care. When performing a mouth care, the bestposition of a client is:

a. Fowlers pos itionb. Side lyingc. Supined. Trendelenburg

7. A client is hospitalized for the first time, which of the following actions ensure the safety of the client?a. Keep unnecessary furniture out of the wayb. Keep the lights on at all timec. Keep side rails up at all timed. Keep all equipment out of view

8. The ability of the body to defend itself against scientific invading agent such as bacteria, toxin, virusesand foreign body

a. Hormonesb. Secretionc. Immunityd. Glands


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9. Which of the following is the most important purpose of hand washinga. To promote hand circulationb. To prevent the transfer of microorganismc. To avoid touching the client with a dirty handd. To provide comfort

10. Which of the following technique involves the sense of sight?a. Inspectionb. Palpation

c. Percussiond. Auscultation

11. A technique in physical examination that is use to assess the movement of air through thetracheobronchial tree:

a. Palpationb. Auscultationc. Inspectiond. Percussion

12. It refers to the manner of walkinga. Gaitb. Range of motion

c. Flexion and extensiond. Hopping13. The nurse asked the client to read the Snellen chart. Which of the following is tested?

a. Opticb. Olfactoryc. Oculomotord. Troclear

14. Another name for knee-chest position is:a. Genu-dorsalb. Genu-pectoralc. Lithotomy

d. Sims15. Resonance is best described as:

a. Sounds created by air filled lungsb. Short, high pitch and thuddingc. Moderately loud with musical qualityd. Drum-like beating of the heart

16. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates thehead of the bed to the high Fowler position, which decreases his respiratory distress. The nursedocuments this breathing as:

a. Tachypneab. Eupneac. Orthopnead. Hyperventilation

17. The correct sequence for assessing the abdomen is:a. Tympanic percussion, measurement of abdominal girth, and inspectionb. Assessment for distention, tenderness, and discoloration around the umbilicus.c. Percussions, palpation, and auscultationd. Auscultation, percussion, and palpation

18. High-pitched gurgles head over the right lower quadrant are:a. A sign of increased bowel motilityb. A sign of decreased bowel motility

c. Normal bowel soundsd. A sign of abdominal cramping

19. A patient about to undergo abdominal inspection is best placed in which of the following positions?a. Proneb. Trendelenburgc. Supined. Side-lying


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20. For a rectal examination, the patient can be directed to assume which of the following positions?a. Genupectoralb. Simsc. Horizontal recumbentd. All of the above

21. During a Romberg test, the nurse asks the patient to assume which position?a. Sittingb. Standing

c. Genupectorald. Trendelenburg

22. If a patients blood pressure is 150/96, his pulse pressure is: a. 54b. 96c. 150d. 246

23. A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is99.8 F (37.7 C) this temperature reading probably indicates:

a. Infectionb. Hypothermiac. Anxietyd. Dehydration

24. Which of the following parameters should be checked when assessing respirations?a. Rateb. Rhythmc. Symmetryd. All of the above

25. A 38- year old patients vital signs at 8 a.m. are axillary temperature 99.6 F (37.6 C); pulse rate, 88;respiratory rate, 30. Which findings should be reported?

a. Respiratory rate onlyb. Temperature onlyc. Pulse rate and temperature

d. Temperature and respiratory rate26. Which element in the circular chain of infection can be eliminated by preserving skin integrity?

a. Hostb. Reservoirc. Mode of transmissiond. Portal of entry

27. Which of the following will probably result in a break in sterile technique for respiratory isolation?a. Opening the patients window to the outside environment b. Turning on the patients room ventilator c. Opening the door of the patients room leading into the hospital corridor d. Failing to wear gloves when administering a bed bath

28. Which of the following patients is at greater risk for contracting an infection?a. A patient with leukopeniab. A patient receiving broad-spectrum antibioticsc. A postoperative patient who has undergone orthopedic surgeryd. A newly diagnosed diabetic patient

29. A natural body defense that plays an active role in preventing infection is:a. Yawningb. Body hairc. Hiccuppingd. Rapid eye movements

30. All of the following statements 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 wristd. The inside of the glove is considered sterile


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42. A substance usually intended for use on inanimate objects, that destroys pathogens butnot thespores.

A. SterilizationB. Disinfectant C. AntisepticD. Autoclave

43. This is a person or animal, which is without signs of illness but harbors pathogen within his body andcan be transferred to another

A. HostB. AgentC. EnvironmentD. Carrier

44. Refers to a person or animal, known or believed to have been exposed to a disease.A. CarrierB. Contact C. AgentD. Host

45. The third period of infectious processes characterized by development of specific signs andsymptoms

A. Incubation periodB. Prodromal periodC. Illness period D. Convalescent period

46. Considered as the WEAKEST LINK in the chain of infection that nurses can manipulate to preventspread of infection and diseases

A. Etiologic/Infectious agentB. Portal of EntryC. Susceptible hostD. Mode of transmission

47. Which of the following is the exact order of the infection chain?1. Susceptible host

2. Portal of entry3. Portal of exit4. Etiologic agent5. Reservoir6. Mode of transmission

A. 1,2,3,4,5,6B. 5,4,2,3,6,1C. 4,5,3,6,2,1 D. 6,5,4,3,2,1

48. Contact transmission of infectious organism in the hospital is usually cause by:A. Urinary catheterization

B. Spread from patient to patientC. Spread by cross contamination via hands of caregiver D. Cause by unclean instruments used by doctors and nurses

49. Transmission occurs when an infected person sneezes, coughs or laugh that is usually projected at adistance of 3 feet.

A. Droplet transmission B. Airborne transmissionC. Vehicle transmissionD. Vector borne transmission

50. Considered as the first line of defense of the body against infectionA. Skin B. WBCC. LeukocytesD. Immunization

51. In hand washing by medical asepsis, Hands are held . A. Above the elbow, the hands must always be above the waistB. Above the elbow, the hands are cleaner than the elbowC. Below the elbow, Medical asepsis do not require hands to be above the waistD. Below the elbow, Hands are dirtier than the lower arms


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4. She discards contaminated suction catheter tip in a trash can found in the clients room a.) 1 and 2b.) 1 and 3c.) 1,2 and 3d.) 1,2,3, and 4

63. Which of the following is not a subjective data?a. Dizzinessb. Chest pain

c. Anxietyd. Bluish discoloration

64. The heat-regulating center is found in the:a. Medulla Oblongatab. Hypothalamus c. Ponsd. Cerebrum

65. The following statements are true about body temperature EXCEPT:a. Core body temperature measures the temperature of deep tissuesb. Highest body temperature is usually reached between 8:00 P.M. to 12:00 M.Nc. Elderly people are at risk of hypothermia due to decreased thermoregulatory controls and

decreased subcutaneous fatsd. Sympathetic response stimulation decreases body heat production

66. The following are contraindications to oral temperature taking EXCEPT:a. Dyspneab . Diarrhea c. Nasal-packingd. Nausea and vomiting

67. The following are correct nursing actions when taking the radial pulse EXCEPT:a. Put the palms downwardb. Use the thumb to palpate the artery c. Use two to three fingertips to palpate the pulse at the inner wristd. Assess the pulse rate, rhythm, volume and quality

68. The difference between the systolic pressure and the diastolic pressure is:a. Apical rateb. Cardiac ratec. Pulse deficitd. Pulse pressure

69. The characteristic manifestation of airway obstruction is:a. Bradypneab. Retractionsc. Noisy breathing d. Tachypnea

70. All of the following are purpose of inflammation except:

a. Increase heat, thereby produce abatement of phagocytosis b. Localized tissue injury by increasing capillary permeabilityc. Protect the issue from injury by producing paind. Prepare for tissue repair

71. The first manifestation of inflammation isa. Redness on the affected area b. Swelling of the affected areac. Pain, which causes guarding of the aread. Increase heat due to transient

72. An instrument used for auscultation is:a. Percussion-hammerb. Audiometerc. Stethoscope d. Sphygmomanometer

73. The best position for examining the rectum is:a. Proneb. Sims c. Knee-chest d. Lithotomy


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74. Palpating the midclavicular line is the correct technique for assessinga. Baseline vital signsb. Systolic blood pressurec .Respiratory rated. Apical pulse

75. The nurse is preparing to assess a patient's abdomen by palpation. How should the nurse proceed?a. Avoid palpation of reported "tender" areas because this may cause the patient pain.b. Quickly palpate a tender area to avoid any discomfort that the patient may experience.

c. Begin the assessment with deep palpation, encouraging the patient to relax and take deepbreaths.

d. Start with light palpation to detect surface characteristics and to accustom the patient tobeing touched.

76. When performing a physical examination, safety must be considered to protect the examiner andthe patient against the spread of infection. Which of these statements describes the most appropriateaction the nurse should take when performing a physical examination?

a. There is no need to wash one's hands after removing gloves, as long as the gloves are stillintact.

b . Wash hands before and after every physical patient encounter.c. Wash hands between the examinations of each body system to prevent the spread of bacteria

from one part of the body to another.d. Wear gloves throughout the entire examination to demonstrate to the patient concern

regarding the spread of infectious diseases.

77. During an examination, the patient states he is hearing a buzzing sound and says that it is "drivingme crazy!" The nurse recognizes that this symptom indicates:

a. vertigo.b. pruritus.c. tinnitus.d. cholesteatoma.

78. The nurse is listening to the breath sounds of a patient with severe asthma. Air passing throughnarrowed bronchioles would produce which of these adventitious sounds?

a. Wheezesb. Bronchial soundsc. Borborygmyd. Ronchi

79. Which of the following is TRUE about temperature?a. Thyroxin decreases body temperatureb. The highest temperature usually occurs later in a day, around 8 P.M to 12 Midnight c. Elderly people are risk for hyperthermia due to the absence of fats, Decreased

thermoregulatory control and sedentary lifestyle.d. The Cerebellum is the thermoregulatory center in our body.

80. In assessing the abdomen, which of the following is the correct sequence of the physicalassessment?

a. Inspection, Auscultation, Percussion, Palpationb. Palpation, Inspection, Auscultation, Percussionc. Percussion, Palpation, Inspection, Auscultationd. Auscultation, Percussion, palpation, Inspection


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prelim lab with key

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